AC4357 HAMP 53 Metropolitan Borough of Hampstead. Report on the Health of the Borough. 1952. DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.b.c.p., d.p.h., Medical Officer of Health. 67324 Metropolitan Borough of Hampstead Report on the Health of the Borough. 1 952. DENNIS H. GEFFEN, m.d., b.s., m.r.c.s., l.r.c.p., d.p.h., Medical Officer of Health. 2 Public Health Department, 33, Lancaster Grove, Hampstead, N.W.3. 16th June, 1953. To the Mayor, Aldermen and Councillors of the Metropolitan Borough of Hampstead. Mr. Mayor, Ladies and Gentlemen, I have pleasure in submitting to you my Annual Report for the year 1952. The population of Hampstead, according to the Registrar General's mid-year estimate is 97,700, which is a decrease of 50 on the figure for 1951. It differs in some aspects from that of the population at large, and I set it out according to sex and age groups in order to compare it with the country as a whole, as given in the one per cent, sample of the 1951 census. It will be seen immediately that whilst 52 per cent, of the population at large is female, in Hampstead this percentage is as high as 61 per cent. One per cent. Census, sample 195l. Hampstead (in 100's). National (in 100,000's). M. F. M. F. Total: 1921 33,3 (39%) 52,9 (61%) - - 1931 34,9 (39%) 54,0 (61%) - - 1951 37,3 (39%) 57,8 (61%) 23,4 (48%) 25,4 (52%) Single 13,4 25,9 10,4 10,5 Married 22,2 25,0 12,1 12,2 Widowed or Divorced 1,7 6,9 0,9 2,7 0—4 3,3 3,5 2,1 2,0 5—14 3,1 3,3 3,5 3,3 15—24 3,0 7,3 3,1 3,2 25—34 7,0 11,5 3,5 3,6 35—44 8,1 9,7 3,7 3,8 45—54 4,9 8,9 3,2 3,5 55—64 4,4 6,2 2,2 2,8 65 + 3,5 7,4 2,1 3,2 This higher percentage of females has been a constant feature of the Hampstead population at least since 1921. The excess would seem to consist largely of single or widowed women and is most marked in the age groups 15 to 35, and over 45. There is no apparent single reason for this difference between Hampstead and the country as a whole but it may in part be accounted for by the number of single women working in London who have rooms in Hampstead. 3 The death rate fell from 11-5 to 112. It is pleasant to record that there was no death due to child birth. 35 children died before they reached the age of 1 year, giving an Infant Mortality Rate of 24 deaths per 1,000 registered live births. This shows a diminution of 3 per 1,000 on last year and a continuation of the decline in infant mortality that started at the turn of the century. Of the 35 children who died in the first year of life, 28 succumbed before they reached the age of one month. This figure must be considered together with the number of stillbirths which amounted to 29, for it is to the care of the expectant mother that attention must be directed if these two figures are to be reduced. Stillbirth and death within the first few days of life are largely due to prematurity, toxaemias of pregnancy which may cause prematurity, and to foetal abnormalities. (5946) A 2 4 Once again I had notified to me a number of cases of poliomyelitis, 11 in all, 7 of which were paralytic. The occurrence of this distressing disease year by year has caused me great concern and I have devoted much attention to a study of its epidemiology. So far the complete aetiology of) this disease has eluded research workers although we are now aware of some factors associated with its causation. There is some hope that the use of gamma globulin (a fraction of the blood serum) can modify an attack, but its practical application has not been possible. Experiments are proceeding in the use of a vaccine and the outlook for the prevention of poliomyelitis shows at least some hopeful elements. The notifications of Tuberculosis were no less than in 1951, but the number of deaths is 19 compared with 29 last year. It is pleasant therefore to record a lower death rate, an absence of maternal mortality, an increase in the birth rate, and a decrease in the number of persons dying from tuberculosis, figures that indicate a general improvement in certain respects in the health of the residents of the Borough. In recent years it has become apparent that there are a large number of persons of retirement age resident in the Borough of Hampstead, who need care and attention over and above that provided under statutory powers. I have therefore thought it wise in the pages of this report to indicate various statutory and voluntary agencies which are combining to meet some of the needs of the aged. Whilst the total amount of help available is impressive it is unfortunate that the Public Health Department is still called in to help a number of old people who are suffering from neglect in some form or another, and I am hoping within a short period to submit a comprehensive report on this matter. During the past few years much attention has been drawn to the number of accidents, many of them fatal, which are occurring in our factories, in our streets and in our homes, for it is generally acknowledged that many of these accidents are avoidable. With this in mind, I asked Dr. M. D. Warren, the Deputy Medical Officer of Health to enquire in so far as might be possible, into the accidents which occurred or were treated in the Borough during the year, and his report will be found at the end of this annual survey. Accidents are far too readily accepted as being occurrences outside the control of man, or acts of chance or fate that cannot be avoided. At other times they are even praised as proof of the adventurous character of the individual who is involved in the accident. The study of the available information however, shows that a large proporton of accidents occurs amongst those who are infirm or unsteady either because of extreme youth or old age, when the spirit of adventure has hardly begun, or has indeed faded out. A study of Dr. Warren's research entitles us to ask what steps we should take in preventing accidents. In the first place, householders must be informed of the dangers of faulty equipment, uneven flooring, insufficient lighting and the inadequate insulation so often found in unskilled installation of electric lighting and make shift repairs in the house. Parents must be warned against exposing young children to dangers such as kettles and saucepans of boiling water, unprotected fires and sharp instruments. Medicines must be carefully labelled and kept in the 5 custody of the individual who is to use them. They must most certainly be kept out of the reach of children. It has been a sad story to read during the year of deaths resulting from children helping themselves to coloured sugar coated medicinal tablets which they have thought to be sweets. Such accidents are inexcusable. A certain number of falls are inevitable in school children and to restrain them from falling would be to interfere with their development and their spirit of adventure. These remarks however, do not apply to babies, adults or the aged. Those responsible for the planning of houses can help by eliminating differences in levels on the same floor, by avoidance of the step down into the kitchen or scullery, and designing stairs which are neither too steep nor too narrow for the aged and the infirm, and by seeing that steps and staircases are adequately lighted. Some effort has been made to reduce the number of burn accidents. Under the Fireguards Act passed during the year under review, it will become an offence to sell or let out on hire, an electric or gas fire not fitted with an adequate guard. I would like to see some step taken to avoid the use of highly inflammable material in the making of clothes for women and children. Women are particularly liable to accidents from fires. Whilst leaning forward near a fire, their dress, dressing gown, or nightdress swings forward and its voluminous folds promptly ignite. Old people are liable to upset gas and electric fires and in rooms let for old people it is safer for fires to be fixed to the wall at a reasonable height and well guarded. If they must be placed on the floor, a small asbestos or metal sheet should be placed underneath them. The essential measure in the prevention of accidents is an awareness of their causation. This can only be obtained by a study of their occurrence and the dissemination of the knowledge gained thereby. Accidents in the home, in the factory, and in the street must be treated as seriously as an epidemic of infectious disease, with the realisation of the large extent to which they can and must be prevented. Those who have a pessimistic turn of mind are inclined to say of public health efforts that as one disease disappears it is replaced by another, and to assume that this is cause and effect. It is certainly true that diphtheria has disappeared almost entirely from our midst and that rickets and scurvy are conspicuous by their complete absence in serious form. There have been no cases of smallpox, typhus, typhoid fever or cholera, and the infant mortality is at a low record. On the other hand, certain forms of cancer appear to be on the increase, as is coronary thrombosis and poliomyelitis. If cancer has increased in incidence it must be remembered that the expectation of life has increased by over 15 years and the percentage of the population in the age group most liable to cancer is increasing; that if coronary thrombosis has increased it may be due to the stress of life as we choose to live it today. Had we not prevented diphtheria, rickets, scurvy, smallpox, typhoid, typhus and cholera, and lessened infant mortality, our deaths would have been considerably higher, as would no doubt have been the percentage of those who suffered from illness. 6 The pages of this report will indicate the large amount of work which falls upon your Public Health Department. This includes the routine work of the Sanitary Inspectors, upon which the health of the population largely depends—the investigation of the conditions under which people are living who wish to be rehoused either by this Council or the London County Council, the examination and the surrender of large quantities of food, the control of infection, the cleansing of individuals, rodent control, and those many branches of our work which promote environmental health. For help in preparing this Report I am much indebted to Dr. Warren, the Deputy Medical Officer of Health, Mr. Armstrong, the Chief Sanitary Inspector, and Mr. Slade, Chief Clerk of the Public Health Department. I would also like to acknowledge the help and co-operation of my colleagues in other Departments, Dr. Oldershaw, the Divisional Medical Officer, Dr. Shneerson, the Chest Physician to Hampstead, and Dr. Exton Smith who is in charge of the wards for old people in the Whittington Hospital. I am deeply indebted to the Public Health Committee for its help and enthusiasm and the co-operation it has given me throughout the whole of the year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, DENNIS GEFFEN, Medical Officer of Health. 7 PUBLIC HEALTH COMMITTEE. (as at 31st December, 1952.) His Worship the Mayor (Mr. Councillor H. G. Judd, C.B.E., J.P.), ex-officio member. Chairman: Councillor Miss D. R. Bailey. Mr. Alderman S. A. Boyd, M.S., F.R.C.S., J.P. Alderman Mrs. R. S. G. Carnegie. Mrs. F. E. Cayford, J.P., L.C.C. Mr. Councillor L. H. H. G. Baldwin. ,, A. T. Bucknell. F. J. Clark, L.C.C. ,, O. J. E. Graystone. ,, A. C. Morson, O.B.E., F.R.C.S. ,, N. Oat way. C. A. Power, A.C.V., C.T.V. Councillor Miss K. H. Smith. The Chairman of the Housing Committee. Sub-Committee: Drainage Plans. STAFF OF THE PUBLIC HEALTH DEPARTMENT. Medical Officer of Health: Dennis H. Geffen, M.D., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medical Officer: S. M. Tracy, M.R.C.S., L.R.C.P., D.P.H. (up to 30th Nov., 1952.) M. D. Warren, M.D., D.P.H., D.I.H. (from 1st Dec., 1952.) Chief Sanitary Inspector: J. F. Armstrong (a), (b). Deputy Chief Sanitary Inspector: W. Robinson (a), (b). Sanitary Inspectors: Miss C. Lambe (a), (d), (e), (f). F. V. Outlaw (a), (b). L. E. Trigg (a), (b). W. F. Newport (a), (b). D. W. Malcolm (a). T. H. Marshall (a), (b), (c). G. L. Nicklin (a). K. F. Overy (a), (b). R. Clark (a). F. E Jackson (a), (b). (a) Sanitary Inspector's Certificate. (b) Food Inspector's Certificate. (c) Smoke Inspector's Certificate. (d) Health Visitor's Certificate. (e) State Registered Nurse. (/) State Certified Midwife. 8 Chief Clerk: A. H. C. Slade. Clerical Staff: R. Johnson (Sanitary Records Clerk). G. W. Bedell (Infectious Disease Clerk). Mrs. M. C. Rabin (Senior Shorthand Typist). G. R. Young. C. F. Pidgeon. M. Adams (Temporary, from 14.11.52). Public Analyst: E. Voelcker, A.R.C.S., F.R.I.C., 1, Tudor Street, E.C.4 Mortuary Keeper: S. King. 9 STATISTICS AND SOCIAL CONDITIONS. Area (acres) 2,265 Population, Registrar General's estimate mid-1952 97,700 Rateable Value, March, 1952 £1,656,250 Sum produced by 1d. rate £6,738 BIRTHS. Live births— Total. Legitimate. Illegitimate. Males 773 705 68 Females 681 631 50 1,454 1,336 118 Birth rate per 1,000 of the estimated population 14.9 (Rate for London: 17.6) Number of Stillbirths 29 Rate of Stillbirths per 1,000 (live and still) births 19.6 DEATHS. Net deaths (males, 494; females, 603) 1,097 Death rate per 1,000 of the estimated population (Rate for London: 12.6) 11.2 Deaths from maternal causes Nil Deaths of infants under 1 year (males, 24; females, 11) 35 Infants under 1 year: Infant Mortality Rate All infants per 1,000 live births 24 Legitimate infants per 1,000 legitimate live births 20 Illegitimate infants per 1,000 illegitimate live births 68 Deaths of infants under 4 weeks (males, 21; females, 7) 28 The causes of death, arranged under the headings of the short list used by the Registrar-General, were as follows:— 1. Tuberculosis, respiratory 15 21. Other circulatory disease 48 2. Tuberculosis, other 4 22. Influenza 3 3. Syphilitic disease 8 23. Pneumonia 33 4. Diphtheria — 24. Bronchitis 67 5. Whooping cough — 25. Other diseases of respiratory system 6 6. Meningococcal infections — 7. Acute poliomyelitis 1 26. Ulcer of stomach and duodenum 14 8. Measles — 9. Other infective and parasitic diseases 6 27. Gastritis, enteritis and diarrhoea 2 10. Malignant neoplasm, stomach 18 28. Nephritis and nephrosis 13 11. Malignant neoplasm, lung, bronchus 44 29. Hyperplasia of prostate 6 30. Pregnancy, childbirth, abortion - 12. Malignant neoplasm, breast 17 13. Malignant neoplasm, uterus 9 31. Congenital malformations 11 14. Other malignant and lymphatic neoplasms 120 32. Other defined and ill-defined diseases 100 15. Leukæmia, aleukæmia 8 33. Motor vehicle accidents 6 16. Diabetes 10 34. All other accidents 28 17. Vascular lesions of nervous system 144 35. Suicide 18 36. Homicide and operations of war - 18. Coronary disease, angina 182 19. Hypertension, with heart disease 25 1,09 20. Other heart disease 131 10 PUBLIC MORTUARY, NEW END. During the year 290 bodies were brought to the mortuary; 18 by the Police, and 262 by order of the Coroner. 286 post-mortem examinations were made. INFECTIOUS DISEASE DURING 1952. Notifications Removals to Hospitals Deaths Acute Encephalitis. Post Infectious 1 1 - Diphtheria — — — Dysentery 15 3 — Erysipelas 10 3 — Food Poisoning 6 1 — Measles 561 31 — Meningococcal Infection 1 1 — Ophthalmia Neonatorum 3 3 — Paratyphoid 2 2 — Pneumonia 37 10 2 Poliomyelitis (Non-paralytic) 4 4 — Poliomyelitis (Paralytic) 7 7 1 Puerperal Pyrexia 45 45 — Scabies 17 — — Scarlet Fever 112 36 — Whooping Cough 193 20 — Total 1,014 167 3 Cancelled cases have not been included. SMALLPOX. No case of smallpox occurred in the Borough during 1952. POLIOMYELITIS. Age. Paralytic. Non-Paralytic. M. F. M. F. Under 1 year 1 1 — - 3 years old — - — 2 5 „ „ 1 — — — 6 „ „ 1 — — — 9 „ „ 1* — — — 20 „ „ — — — 1 25 „ „ - - 1 — 27 „ „ 1 1 — — * There was one death. 11 TUBERCULOSIS. NEW CASES AND MORTALITY DURING 1952. During the year 1952, 115 new cases of Tuberculosis were notified, 105 being cases of Pulmonary Tuberculosis and 10 of other forms of the disease. The following statistical table gives an analysis of the newly notified cases and deaths during 1952. Age Periods. New Cases. Deaths. Respiratory. NonRespiratory. Respiratory. NonRespiratory. M. F. M. F. M. F. M. #] Under 1 - — - - - - - - 1—4 — — — — — — 1 1 5—14 - 7 3 - - - - - 15—24 5 8 1 1 - 1 — - 25—34 19 22 1 2 2 - — - 35—44 11 10 1 - 2 1 - - 45—54 7 3 - - - - — 1 55—64 1 2 - 1 4 1 - - 65 and upwards 8 2 — — 3 1 — 1 Totals 51 54 6 4 11 4 1 3 PUBLIC HEALTH (TUBERCULOSIS) REGULATIONS. The Revocation of the Tuberculosis Regulations, 1930, has given us food of thought. Under these regulations it was the duty of the borough medical officer of health to keep a register of persons notified as suffering from tuberculosis, and he and his council were charged with the duty of investigating the source of infection, preventing the spread of infection and remedying conditions favourable to infection. In rescinding these regulations there was issued a circular from the Ministry of Health. This states that although the borough medical officer is no longer required to keep a register of notifications he might naturally be expected to do so. He is in fact urged to do so. Hospitals no longer have an obligation to inform the medical officer of health of admission to hospital and sanatorium and discharge therefrom, but nevertheless the hospital boards and committees are asked to do so. Why then rescind the regulations? This keeping of a register of tuberculous persons up-to-date and correct depends on all authorities co-operating in doing so, and this is unlikely to be achieved unless there is a statutory obligation enforcing it. I am sorry that any regulation should have been rescinded that might in any way have helped in the problem of preventing tuberculosis. It is obvious that there must be the closest co-operation between the borough medical officer and the chest physician, and it would be far 12 better if the after-care of the tuberculous person was delegated to the boroughs. Chest clinics are still mainly organized on a borough basis, as are the tuberculosis care committees. The local town hall is the first port of call in rehousing. The borough council controls requisitioned property, it is the food and drugs authority and it possesses a staff of sanitary inspectors who are well versed in the prevention of infectious disease. I do not for one moment want to undervalue the work of the tuberculosis health visitor. Arrangements have been made whereby the first visit after notification is paid by her and the sanitary inspector does not visit until the patient has received the appropriate advice and explanation of his condition which can be so satisfactorily given by the skilled nurse. The tuberculosis scheme is criticisable not only because authority is divided between two bodies, but because it fails to take into consideration the valuable help which can be provided by the borough councils. I would like to express my thanks to Dr. Shneerson, the Chest Physician, for his help and advice throughout the year, and testify my appreciation of the help which the Tuberculosis Care Committee has given to many families where one of its members is suffering from this chronic long drawn out illness. During the year, with the help of the staff of the Chest Clinic, a review was made of our Tuberculosis Register. As a result it was possible to remove from the Register 400 names. At the end of the year there were 718 pulmonary and 67 non-pulmonary cases of tuberculosis known to the Department. These figures are a much more accurate estimate of the notified cases of tuberculosis in the Borough than the figures previously quoted. MASS X-RAY. No suitable accommodation was readily available in the Borough and the Mass X-ray Unit was unable to visit Hampstead. Between the 8th and 30th January however, the Unit was established at the Student Health Association, 17, Gordon Street, W.C.I, and was available for employees and residents of the Borough. Circulars were sent to over 70 of the larger employers and an announcement was made in the local press. The facilities were available to other Boroughs, and no separate summary of attendances and results in respect of Hampstead people is available in respect of this survey. Owing to the very limited time that the Unit was able to make available for Hampstead people, it was not possible to display posters, as it was felt that such a course might create a demand that the Unit would be unable to meet. FOOD POISONING. During the year we received 6 notifications of cases of food poisoning. In two cases only was it possible to trace the cause of the illness. 13 BACTERIOLOGICAL EXAMINATIONS. (Infectious Diseases.) The record of examinations carried out daring the year by the Central Public Health Laboratory, Colindale, is as follows:— Throat/Nose Swabs. Diphtheria Bacilli found Nil Hemolytic Streptococci found 23 Vincent's Angina organisms found 3 Negative 91 Faces. Shigella found 4 Salmonella found 8 Negative 111 Sputum. T.B. found 3 Other organisms found 2 Negative 17 Pertussis. Positive 8 Negative 25 DISINFECTION AND DISINFESTATION. The following is a record of the work carried out by the Disinfecting Staff during 1962:— Number of houses or parts of houses and contents disinfected 593 Number of verminous rooms disinfested 265 Number of steam chamber operations. 2,837 Number of calls by borough van 3,845 Number of rooms disinfected after I.D 328 The number of complaints of wasp nests has increased during recent years. No less than 28 instances were dealt with by the disinfectors. Requests for the disinfection of parcels of clothing prior to despatch abroad have also increased, and 100 parcels were disinfected at the request of 73 senders. 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 24 adults and 11 children received treatment: — Verminous conditions: — Adults 15 Children under 5 9 Children over 5 2 Scabies:— Adults 9 Children under 5 5 Children over 5 - 14 Daring the year, 265 verminous rooms in 148 houses were cleansed and freed from vermin. 17 cases of scabies were notified during the year. These were investigated by the Sanitary Inspectors and, where necessary, treatment arranged at the Public Health Station. During the year, the following treatments were carried out at the Centre on behalf of the London County Council:— Verminous conditions: — No. of school children treated 91 No. of treatments given 91 No. of pre-school children treated — No. of treatments given — Scabies: — No. of school children treated 2 No. of treatments given 2 No. of pre-school children treated — No. of treatments given — STAFF MEDICAL EXAMINATIONS. 76 medical examinations were carried out of new entrants to the superannuation scheme or of persons on whom a special medical report was required. 55 of these were found to be fit, and 21 unfit. NATIONAL ASSISTANCE ACT, 1948, SECTION 50. During the year 12 funerals were carried out under the National Assistance Act, 1948. In only two cases was it found impossible to recover any portion of the funeral expenses. One was a newly born child found on waste ground, where it was not possible to trace the parents, and the other was a baby of 14 days where the mother was resident in an institution but left without disclosing her address. In 8 cases the full amount was recovered. The total cost of the funerals was £99 18s. 6d., and an amount of £88 17s. 8d. was recovered from liable relatives and the estates of deceased persons, of which £8 12s. 11d. was handed over to the Treasury Solicitor. NATIONAL ASSISTANCE ACT, 1948. SECTION 47. Aged and Infirm Persons. Increasing use is being made of the Department in connection with the manifold problems of old persons. The circumstances of no less than ninety-two people were brought to the notice of the Public Health Department. Fortunately, in no case was it found necessary to apply to the Court for compulsory removal to hospital or institution in accordance with the Section. 15 The assistance rendered as a result of our investigations may be summarised as follows:— 1. Number of persons placed on Emergency Bed Service list for urgent admission to hospital, or other approach made to hospitals to expedite admissions 36 2. Number admitted to L.C.C. homes 6 3. Number admitted to other homes 5 4. Number referred to Senior Mental Welfare Officer, L.C.C. and subsequently admitted to hospital 10 5. The assistance of the appropriate organisation was enlisted as follows: — (a) Home Help Service 35 (b) District Nursing Association 26 (c) Meals Service (British Red Cross) 22 (d) National Assistance Board; Holiday Homes; Housing Department, etc. 11 A Report was presented to the Public Health Committee in December, 1952, setting out the position in Hampstead in regard to the welfare of the aged and infirm, of which the following is a summary: — There are various agencies that care for the aged in Hampstead, and these include: — Hampstead Old People's Welfare Association. Hampstead Council of Social Service. Hampstead Old People's Housing Trust, Ltd. Women's Voluntary Service. British Red Cross Society. District Nursing Association. National Assistance Board. London County Council. Hampstead Metropolitan Borough Council. In 1951-52 the Hampstead Borough Council made a grant of £49€ to the Hampstead Old People's Welfare Association for the following services: — £ Mobile Meals 150 Clubs 188 Administration 127 Christmas Party 25 £490 The following notes set out some deails of the services available:— Meals. Meals are taken to the home of house-bound old people in a van belonging to the B.R.C.S. This van is housed and maintained by the staff of the Borough Engineer's Department. Food is obtained from the L.C.C. and is delivered by volunteers provided by the B.R.C.S. and W.V.S. 16 Clubs. Darby and Joan Club, St. Stephens Hall, Pond Street Wednesdays, 2—4.30 p.m. Darby and Joan Club, All Souls, Loudoun Road Tuesdays, 2—4.0 p.m. W.V.S. Darby and Joan Club, St. Mary's, Priory Road Thursdays, 2—4.0 p.m. Brondesbury Fellowship Club, 107, Kingsgate Road Daily 2—5.0 p.m. Good Companions Club, Stan field House, Prince Hampstead Arthur Road Old Mondays, 5—8.0 p.m. People's St. Peter's Vicarage, Belsize Square Welfare Wednesdays, 3—5.0 p.m. Association Burgh House Club, Burgh House, New End Square Daily 2—7.0 p.m. Friendship Club, Congregational Church Hall, Lyndhurst Road Thursday, 3—5.0 p.m. Friendship Club, The Synagogue, Dennington Park Road Thursday, 3—5.0 p.m. Residential Accommodation. Residential accommodation is provided as follows:— 31, Eton Avenue. Hampstead Old People's Housing Trust, Ltd. 37, Elsworthy Road. 58, Elsworthy Road. Women's Voluntary Service. 15, Eton Avenue. London County Council. 9, Fitzjohn's Avenue. British Red Cross Society. The B.R.C.S., apart from manning the Mobile Meals Service three days a week, assists in the provision of the following services: — 1. Medical Loan—wheel chairs, bed rests, air rings, bed pans, etc. 2. Escort to Hospital and Convalescent Homes. 3. Bathing of invalids in their homes. 4. Visits to lonely old people. 5. Staffing of chiropody clinic. 6. Handicrafts. 7. Invalid Food on Medical recommendation. Women's Voluntary Service. The W.V.S. in addition to manning the Mobile Meals Service one day a week:— 1. Provides miscellaneous welfare visits to old people, including collection of pensions, mending and darning, shopping and escorts to Hospitals. 17 2. Helps in the provision of teas at the Elsworthy Club which is administered by the Hampstead Old People's Housing Trust, Ltd. 3. Administers three Darby and Joan Clubs with memberships of 80, 170 and 70. 4. Arranges day outings, parties and pantomime visits for club members. 5. Administers a residential club with accommodation for 21 people. The Hampstead Old People's Housing Trust, Ltd. This Trust provides two homes for elderly people in need of care and attention, but not nursing. Priority is given to Hampstead residents. The accommodation at 31, Eton Avenue is for 28 and at 37, Elsworthy Road for 24 men and women. National Assistance Board. The Area Officer is a member of the Hampstead Old People's Welfare Committee. The Board maintains close co-operation with the many voluntary organisations and in dealing with applications for noncontributory old age pensions the welfare aspect is taken into consideration. London County Council. The London County Council provides residential accommodation for old persons. As the authority responsible for mental care it provides the services of Duly Authorised Officers. As a housing authority it can provide special housing accommodation for old people. As the local health authority it provides the local Home Help Service. In this latter capacity over 250 old people are being helped. These can be grouped as follows: — (а) Old folk able to live normal lives but needing assistance to keep their independence. (б) Old folk too feeble to manage alone but not physically or mentally sick. (c) Old folk who are bedridden and for whom there are no vacancies in Homes or Hospitals. In some cases these old people have been in hospital but cannot be kept in. The Hampstead Old People's Welfare Association. This Association carries out the following functions: — 1. Advice to other bodies who are not members of the Association. 2. Administration and finance of a chiropody service. 3. Administration of the financial side of the Mobile Meals Service. 4. Administration of four clubs. 5. Organisation of entertainments, club meetings and concerts. 6. Provision of wireless sets and their maintenance. 7. Distribution of free cinema tickets to local clubs and hostels. 8. Advises on housing and living problems and liaison with other authorities regarding individual cases. (5946) B 18 9. Arrangement of holidays in suitable cases. 20 old people were sent to various holiday homes during the summer of 1952. 10. Collection and payment of private pensions. 11. Investigation of individual cases in connection with personal problems. 12. Arrangement for the tuition of students and welfare workers and for their training programmes, visits, etc. Hampstead Metropolitan Borough Council. There are certain statutory duties for which the Borough Council is responsible in connection with old people. As a housing authority its services include the making available of suitable accommodation. Section 31 of the National Assistance Act, 1948, enables the Council to '' make contributions to' the funds of any voluntary organisation whose activities consist in or include the provision of recreation or meals for old people." Section 47 places a duty on the Council to obtain the removal of an old person to an institution if he is incapable by reason of old age or infirmity of looking after himself. The Public Health Department does a considerable amount of centralisation in connection with the care of the aged. Since October, 1950, we have been called in to help no less than 150 people. These requests have come from general practitioners, neighbours, almoners of hospitals, Councillors, County Councillors, etc., and they usually refer to the deplorable condition under which the old person is living, and often include a request that we obtain or hasten admission to a hospital or an institution. Individuals referred to the Public Health Department are visited to ascertain the needs of the old person and in every case an attempt is made to keep him at home by the provision of one or other of the abovementioned services and such statutory action as may be necessary. Where admission to an institution is required, the appropriate steps are taken. It will be seen that a large number of voluntary societies and at least three statutory bodies help in the care of old people in the Borough of Hampstead, and by and large, provide a fairly comprehensive service. SANITARY CIRCUMSTANCES OF THE AREA. Statistical Summary, 1952. Sanitary Inspection. Houses inspected on complaint 1,724 „ „ after infectious diseases 623 „ „ under Sec. 9, Housing Act, 1936 10 House to House inspections 236 Inspections and revisits in connection with Loans under Sec. 4, Housing Act, 1949 58 Special visits and re-inspections 14,590 19 Rehousing. Visits and revisits in connection with the investigation of 507 rehousing applicants 968 No. of reports submitted to Hampstead Housing Estates Manager 231 ,, ,, London County Council, Estates Department 85 ,, ,, London County Council, Divisional Medical Officer 134 ,, ,, Other Boroughs 57 Notices. Intimation Notices served 1,159 Statutory Notices served 322 Food Premises. Inspection of Bakehouses 90 ,, ,, Dairies and Milk shops 197 ,, Catering establishments 782 ,, Ice Cream premises 274 ,, ,, other food premises, stalls, markets, etc. 2,075 The Factories Act, 1937. Inspections and re-inspections made 291 Pharmacy and Poisons Act, 1933. Poisons Rules, 1952. Inspections made 77 Rag Flock, etc., Act, 1951. Inspections made 61 Shops Act, 1950 (Sec. 38). (Arrangements for health and comfort of shop workers.) Inspections made 131 Drainage works. Plans and applications deposited for:— (a) Voluntary additional sanitary fittings or alterations to drainage 231 (b) Drainage and sanitary fittings required by Sanitary Notices 23 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. The new L.C.C. By-laws for the protection of food made under Section 15 of the Food and Drugs Act, 1938, came into operation on the 3rd November, 1952. Copies of the By-laws were sent to every food trader, trading association, food staff organisations, Chamber of Commerce and street trader in the Borough with an invitation to discuss the many mutual problems involved. (5946) B 2 20 In many cases, this was followed by requests for a visit from the Sanitary Inspector to clarify certain aspects of the new requirements. It is felt that this personal contact and co-operation between the shopkeeper and the staff of the Public Health Department achieves more than sporadic publicity and the service of Intimation or Statutory notices. Particular attention is drawn to By-law 5 and By-law 9, both of which require that " all steps shall be taken as may be reasonably necessary to protect food from dust, dirt, mud, filth, dirty water, dirty ice, animals, rodents, flies, insects and other sources of contamination, including contamination by other persons and, in particular, shall cause the food to be so placed as to prevent risk of contamination from such sources." Councils will have to consider whether these By-laws must be interpreted as prohibiting the old established custom of butchers covering their floors with sawdust (which is not hygienically produced). Are fishmongers to have open or closed shop fronts, refrigerated slabs or continuous " mist " sprays? What of bread, flour and confectionery —must these be covered? Should it be made impossible for customers to handle certain foods before purchase? What of the street trader? How is he to protect his stall, provide washing accommodation and the like? Time and practice (doubtless aided by Court decisions) will provide the answer to these and many other problems posed by the new legislation. In the end, it will be the public who will play the greater part in food hygiene, by reporting to the management and the Public Health Department any neglect, broken or dirty crockery, glasses and utensils or dirty food handling which they may encounter, and in refusing to accept food which is not in all respect fit for human consumption. ICE CREAM. The wholesale introduction of ice cream conservators and freezing cabinets and the vast increase in the production of wrapped ice cream have led to a considerable increase in the number of applications made to the Council for the registration of premises used for the manufacture, sale and/or storage of this commodity. Many types of business now wish to sell ice cream, in conjunction with their main business. Tobacconists, newsagents, fancy goods stores, stationers, general stores, greengrocers, fishmongers and butchers have all made application to be registered and the Council has had to give careful consideration as to whether, in its opinion, ice cream can safely be sold from such premises. In certain cases, written undertakings have been secured that the ice cream shall be prepared and stored quite separately from other goods, and that the staff serving ice cream shall not handle other produce sold in the shop. In one case, a butcher, appealed to the Magistrate's Court against the refusal of the Council to register his premises. The learned Magistrate upheld the Appeal but stipulated (1) that the applicant should provide adequate safeguards against contamination, and (2) secure that the sale of ice cream would be by a member of the staff not engaged in handling meat. 21 The following statement sets out the types of premises registered under Section 14, Food and Drugs Act, 1938, for the sale, etc., of ice cream in the Borough:— Confectioners 45 Greengrocers 19 Grocers 38 Butchers 2 Tobacconists 7 Fishmongers 2 Restaurants 35 Garage 1 Dairies 18 Bakers 4 Stores 4 Toy shop 1 Clubs 3 Kiosks and stalls 5 MILK SUPPLY. The number of Licensed Distributors operating in the Borough is 73. MILK (SPECIAL DESIGNATION) REGULATIONS. The number of Licences issued to traders is as follows:— Main Licence. Supplementary Licence. To sell Pasteurised Milk 38 26 To sell Tuberculin Tested Milk 31 27 To sell Accredited Milk 4 3 To sell Sterilised Milk 41 31 In addition to obtaining milk samples from distributors direct, it is customary to take samples for both chemical analysis and Methylene Blue Test and Phosphatase Test from the various hospitals, schools and institutions in the Borough. These have yielded excellent results, fiftyfour satisfying the Methylene Blue and Phosphatase Tests which indicate keeping quality and efficiency of heat treatment, and 38 samples being genuine chemically. The average milk fat content was 3·59 per cent. as against a legal minimum of 3 per cent. HAMPSTEAD HEATH FAIR. Members of the Inspectorial staff and their assistants were on duty throughout the Easter, Whitsun and August Bank Holidays fairs. Apart from the general hygienic supervision of the fairground catering arrangements, your Inspectors took 75 samples for bacteriological examination and 56 for chemical analysis. The following table shows the grading of Ice Cream samples taken at the fairground since the War:— Year. Number of Samples taken. Grading under Meth. Blue Test. Percentages of Grades 1 and 2 Samples. 1. 2. 3. 4. Per cent. 1948 8 Nil 3 2 3 37·5 1949 9 1 2 3 3 33·3 1950 20 10 4 3 3 70· 0 1951 38 23 6 4 5 77·8 1952 38 15 10 11 2 65·7 22 My thanks are again due to Dr. Betty Hobbs, Principal of the Food Hygiene Section of the Government Central Public Health Laboratory, Colindale, for her very valuable co-operation and assistance, even to the extent of personal visits to the Heath to see for herself the particular catering hygiene problems involved. FOOD SAMPLING. (a) Bacteriological examination oj foodstuffs. This service is undertaken by the Central Public Health Laboratory. I am greatly indebted to Colonel H. J. Benstead, the Director of the Laboratory, for unfailing co-operation and help. Details of the ice cream and milk samples submitted to bacteriological examination appear under the respective headings. Fifty-three other samples were taken for examination. Some were routine samples; others for confirmation of unsound or defective tinning, etc., and a proportion Nature of Sample. Number of Samples. Satisfactory. Unsatisfactory. Boxed dates 1 1 - Hors D'ouvres 1 1 - Liver sausage 1 — 1 Wash-up waters from ice cream servers, etc. 19 15 4 Whelks 7 5 2 Cockles 7 6 1 Jellied eels 4 3 1 Ice lollie mix 2 2 — Ox tongue 1 — 1 Pork brawn 1 1 Pressed pork 2 — 2 Plums 4 4 Herring roes 1 1 Salami sausages 1 1 Evaporated milk 1 1 — (b) Samples submitted to Chemical Analysis. Mr. Eric Voelcker, A.R.C.S., F.R.I.C., has continued to act as temporary Public Analyst to the Borough throughout the year. He has examined and reported upon 507 samples, of which ten were classed as adulterated or unsatisfactory. Particulars of A dulterated. Samples. Sample No. Article. Offence. How dealt with. 30 Dessert fruit salad (preserved). Consisted only of a mixture of dried fruits. No action. 42 Sage and onion stuffing with suet. Consisted of bread crumbs, dried onion spices and a very small amount of fat. Manufacturer cautioned. 158 Margarine Rancid Stock surrendered, and destroyed. 23 Sample No. Article. Offence. How dealt with. 159 Iced cake Unpleasant taste due to the use of rancid margarine. Stock surrendered and destroyed. 185 Cream cheese Cheese spread. Contained only 16 . 24 per cent, milk fat. Warning letter. 186 Cream cheese Cheese spread. Contained only 49.09 per cent, milk fat. Warning letter. 189 Pork brawn Unfit for human consumption. Stock surrendered and destroyed. 322 Dried thyme Contained 5 per cent, sand and silicious matter. Manufacturer cautioned. 332 Tomato ketchup Mouldy and unfit for human consumption. Manufacturer cautioned. Stock surrendered and destroyed. 348 Golden raising powder. Deficient in available carbon dioxide. Stock surrendered and destroyed. The percentage of adulterated samples in 1952 was; 1.97 per cent, as compared with 3 per cent, in 1951 and 1.6 per cent, in 1950. WRAPPING OF SWEETMEATS BY OUTWORKERS. Complaints were received of the manner in which certain confectionery was being packed and despatched by outworkers. Upon investigation, it was found that some thirty housewives were packing fruitflavoured tablets at home and delivering them to a manufacturer's agent at a garage, from whence they were transported to retailers. No lists of outworkers had been submitted to the Local Authority in accordance with the requirements of the Act. This was taken up with the manufacturer as also was the unsatisfactory condition of the hygiene of certain of the Homeworkers' premises. Lists of outworkers were then submitted with the deletion of the unsatisfactory premises. Owing to the prevalence of this type of outwork throughout the metropolis, the matter has been reported to the Metropolitan Boroughs' Standing J oint Committee with a view to the prohibition of this undesirable practice. FREE WASHING FACILITIES—PUBLIC CONVENIENCES. In connection with the clean food drive, the Council has provided free washing facilities at its four public conveniences. Liquid soap and paper hand towels are available. Increasing use is apparently being made of this facility by the general public and street traders, some 16,000 towels having been issued. 24 UNSOUND FOOD SURRENDERED DURING 1952. Article. Quantity. Apricots 108 lbs. Bacon 37 „ Barley 63 „ Biscuits 113 „ Cake Mixture 93 packets Cereals 223 lbs. Cheese 40 „ Cocoa 20 „ Coconuts 304 Confectionery 388 „ Dates 112 „ Eggs 60 Egg (frozen) 56 ,, Figs 14 „ Fish (tins) 313 Total— 94 stone. ,, Bream 2 stone ,, Cod 17 „ ,, Dogfish 3 „ ,, Haddock 6 ,, ,, Kippers 31 „ ,, Skate 29 „ ,, Whiting 6 „ Flour 79 lbs. Fruit (tins) 3,173 tins Juice (tins) 76 „ Ham 69 lbs. Jam 211 tins Marmalade 31 Marshmallow 32 lbs. Meat (tins) 1,054 ,, Beef 1,860 lbs. Total— 8,226 lbs. ,, Chicken 308 ,, ,, Duck 14 ,, ,, Lamb 3,496 ,, ,, Liver 230 ,, ,, Mutton 38 ,, ,, Pork 159 ,, ,, Preserved Meat 18 „ ,, Rabbit 41 „ ,, Salami 1,818 ,, ,, Sausages 165 ,, ,, Steak 21 ,, ,, Sweetbreads 40 ,, ,, Turkey 14 ,, Milk 103 tins Mincemeat 13 „ Nuts 58 lbs. Pickles 58 jars Prunes 300 lbs. 25 Article. Quantity. Sauerkraut 112 lbs. Sauce 17 bottles Semolina 36 lbs. Smoked Saithe 1,155 tins Soup 136 „ Suet 26 lbs. Tea 4 „ Tea Cakes 420 Tomato Puree 89 tins Vegetables 691 „ CONTRAVENTION OF SECTION 13, FOOD AND DRUGS ACT, 1938 (PRECAUTIONS AGAINST CONTAMINATION OF FOOD) AND THE L.C.C. BY-LAWS FOR THE PROTECTION OF FOOD. Fines totalling £8 8s. with £5 5s. costs were imposed in respect of dirty and insanitary conditions at a grocers and general stores. The proprietor of a baker's delivery van was fined a total of £8 with £5 5s. costs in respect of his failure to transport bread and cake confectionery under clean and hygienic conditions. Contravention of Section 3, Food and Drugs Act, 1938. Legal proceedings were taken in respect of two offences concerning contaminants in food. In both cases, the offenders were bakers, the offending foreign bodies being respectively a cigarette end and a cockroach which were found in loaves of bread. The cigarette end cost the Defendant a fine of £10 with £3 3s. costs and a fine of £1 Is. with £3 3s. costs was imposed in the second case. 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) 2,583 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 and 1932 (House to House Inspection) 236 3. Number of dwelling-houses found to be in a state so ous or injurious to health as to be unfit for human habitation 3 4. Number of dwelling-houses found not to be in all respects fit for human habitation 1,159 26 HOUSING ACT, 1936. PART II. SECTIONS 11 and 12. A Demolition Order was made affecting a four-storey dwellinghouse, the basement and ground floor of which had previously been officially closed. Closing Orders were made in respect of three underground rooms at two premises. HOUSING ACT, 1936. SECTIONS 9, 10 and 16. Action under Statutory Powers. Number of dwelling-houses in respect of which Notices were served requiring repairs 10 Number of dwelling-houses which were rendered fit after service of formal notices 10 27 SECTION 82. PUBLIC HEALTH (LONDON) ACT, 1936. Summary of Legal Proceedings Instituted during the Year. Date of Hearing. Court. Premises and Nature of Offence. Result of Proceedings. 9th April, 1952 Marylebone Magistrates' Court 74, Alexandra Road. Nuisance Work done. Summons withdrawn. 9th April, 1952 Do. 74, Alexandra Road. Nuisance. Work done. Summons withdrawn. 9th April, 1952 Do. 150, Alexandra Road. Nuisance Order to abate nuisance within 28 days. Work done. 15th May, 1952 Do. 22, Dennington Park Road. Nuisance Work in progress. Summons adjourned sine die £1 1s. costs paid. 4th June, 1952 Do. 164, Adelaide Road. Nuisance Work done. Summons withdrawn. £3 3s. costs paid. 11th June, 1952 Do. 53, Netherwood Street. Nuisance Nuisance abated. Summons withdrawn. £2 2s. costs paid. 23rd July, 1952 Do. 158, Haverstock Hill. Nuisance Work done before hearing. Summons withdrawn. 24th September, 1952 Do. 55, Priory Road. Nuisance Nuisance abated before hearing. Absolute discharge ordered and payment of £3 3s. costs. 14th October, 1952 Do. 10, Oppidans Mews. Nuisance Order to abate within 7 days. Costs £1 1s. 12th November, 1952 Do. 20, Belsize Park Gardens. Nuisance Order to abate within 42 days. 28 HOUSING ACT, 1936, PART II, SECTION 9. Repair of Insanitary Houses. Owing to the high cost of repairs, it is very difficult to operate this Section under present day circumstances. The Council does not usually undertake the work under Section 9 where the Owner in capable of doing so himself, as it may take many years to recover the cost from him. The average estimated cost per house of complying with the Section 9 notices served since 1949 amounts to no less than £535. COMMON LODGING HOUSES. There are no common lodging houses in the Borough. WATER SUPPLY. The Borough's water supply is provided entirely by the Metropolitan Water Board and has been satisfactory in quality and quantity. All the dwelling-houses in the Borough are supplied from public water mains direct to the houses. There are no wells or stand pipes. RODENT AND PEST CONTROL. PREVENTION OF DAMAGE BY PESTS ACT, 1949. The above Act came into force on the 3rd March, 1950. It repealed the Rats and Mice (Destruction) Act, 1919, and substantially strengthens the powers of the local authority in dealing with the control of pests. The Council employ two rodent operators. Complaints of other pests and vermin are dealt with by the disinfecting staff. The number of complaints of rodents received during the year was 545 of which 169 related to rats and 376 to mice. The figures for 1951 were 727, of which 308 were rats and 419 mice infestations. One summons for failure to give notice of infestation of mice at food premises resulted in the offender being fined £2 2s. Other pest infestations dealt with related to ants, bugs, cockroaches, fleas, flies, lice, pigeons, wasps, wood lice and woodworm. Charges for Rodent Extermination. The Public Health Committee resolved that, until otherwise decided, no charge be made for the destruction of rats and mice by the Council at private premises, except in cases where, as a result of the lack of cooperation on the part of the owner or occupier, it was found necessary to serve a notice under Section 4 of the Act. Besides relieving the Department of much administrative work, this decision has materially assisted the staff in dealing speedily with complaints of rodent infestation. Charges continue to be made, in accordance with the Ministry's request, in respect of all infestations at business premises. 29 SEWER MAINTENANCE. TREATMENT AGAINST RODENT INFESTATION. As part of the organised campaign throughout the country for the eradication of rats in sewers, the whole of the sewerage system was prebaited and poison baited twice during the year. I am indebted to the Borough Engineer for the following information regarding this aspect of rodent control. The first of the treatment of sewers against rodent infestation for 1952 was commenced on the 7th January and completed on the 25th January, the treatment having been carried out in conjunction with other Authorities on the No. 4 Workable Area Committee. In spite of difficulties in labour and transport, which prevented some of the No. 4 Area Authorities commencing treatment as arranged at the Committee Meeting at St. Pancras Town Hall (26th September, 1951), a start was made by the Sewers Department Staff on the pre-arranged date with the assistance of three operatives from the Ministry of Agriculture, Infestation Control Division. At the end of the first week the Ministry found it necessary, due to absence of operatives on sickness leave, courses, etc., to withdraw the assistance of one of the operatives and the treatment was continued with two operatives and their respective gangs until the 25th January, when 739 manholes had been examined and 688 of these were pre-baited. By cutting out the check visit after baiting with poison bait, it was possible to complete the programme in the time normally allocated to it. This check visit is not essential since the results and the effectiveness of the treatment are determined from pre-bait " takes." The same baiting procedure was adopted as on previous treatments. Pre-bait was put down on the first and second days, followed by poisoned bait on the third day, where a complete or partial take of pre-bait had occurred. The pre-bait consisted of sausage rusk, and poisoned bait of sausage rusk with 2½ per cent, zinc phosphide. Table I below gives the results of this treatment tabulated for comparison with those for the corresponding period in 1951: — Table I. J anuary, 1951. January, 1952. Increase (+) or decrease ( —) of 1952 over 1951. Per cent. Number of manholes pre-baited 575 688 + 19·7 Number of manholes showing complete pre-bait take 318 300 - 5·6 Number of manholes showing partial pre-bait take 140 170 + 21·4 Number of manholes showing no pre-bait take 117 218 + 86·6 The comparative decrease in the proportion of complete takes to number of manholes pre-baited is from 55·4 per cent. in 1951 to 43·6 per cent. in 1952, while the increase of the proportion of partial takes to pre-baits is from 24·4 per cent. to 24·8 per cent.—an increase of 0·4 per cent. 30 Table II. 1950. 1951. 1952. Number of manholes prebaited 654 575 688 Number of complete takes 370 318 218 Percentage of prebaits showing complete takes 56·8 55·4 43·6 In the second treatment, which was carried out in June, 1952, 652 manholes were pre-baited and the "complete takes" were still further reduced to 129 or 19·7 per cent. It may be noted that whilst the extent of the treatment has increased, the percentage of complete takes is decreasing, which indicates a progressive decrease in the rat population in sewers. FACTORIES ACTS, 1937 AND 1948. The following tables give details with regard to inspection, 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 311 47 - - (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 295 67 8 - (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 4 - - - Total 610 114 8 2. Defects found. Particulars. Number of cases in which defects were found. Found. Remedied. Referred to H.M. Inspector. Want of cleanliness (S. 1) 11 2 1 Overcrowding (S. 2) — — — Unreasonable temperature (S. 3) 1 — 1 Inadequate ventilation (S. 4) 3 — 1 Ineffective drainage of floors (S. 6) 1 — 1 Sanitary conveniences (S. 7) (a) Insufficient 1 1 — (b) Unsuitable or defective 7 7 — (c) Not separate for sexes 1 — — Other offences against the Act (not including offences relating to outworkers) 3 1 Total 28 10 5 During 1951 no prosecution was instituted under the Factories Acts, 1937 and 1948. 31 OUTWORKERS. In accordance with the Factories Act, 1937, 24 Hampstead firms sent in lists of persons employed as home workers. Of the 220 persons so employed, 44 only resided in the Hampstead area. Information cocerning 58 outworkers resident in Hampstead but employed by firms outside the Borough was received from other authorities. PHARMACY AND POISONS ACT, 1933. During the year 110 applications for the renewal of poisons licences were granted. In 2 instances new licences were issued and 2 firms ceased to sell poisons. SECTION 54. THE FACTORIES ACT, 1937. UNDERGROUND BAKEHOUSES. The Certificate of Suitability of one underground bakehouse was revoked during the year. It is interesting to note that in 1902 there were 27 underground bakehouses in use in the Borough. This number has progressively diminished and there are now only seven such premises functioning. PLEASURE FAIR BY-LAWS. Owing to the difficulty of coping adequately with sanitary nuisances arising at a private pleasure fair in the Borough, preliminary draft bylaws have been compiled mainly on the lines of the model by-laws and submitted to the Home Secretary for preliminary approval. They cover such matters as the regulation of hours when the fair shall be open; safe and adequate means of ingress and egress; the prevention and suppression of nuisances and the preservation of sanitary conditions, order and public safety at fairs. FLOODING BY STORM WATER. On the evening of the 6th August, after heavy rainfall, there was slight flooding reported in various roads in the Borough. The cause, as far as could be ascertained, was due to purely local conditions, principally blocked gullies in basement areas. There has not been any rainstorm of sufficient intensity to test whether the sewer relief works, which were completed in 1949, have completely overcome the danger of flooding and it is emphasised by the Borough Engineer that owing to the position and gradients of the areas concerned, this risk cannot be entirely eliminated. SWIMMING BATHS. Samples of water were regularly taken for chemical examination and bacteriological analysis from the Hampstead Swimming Baths. These proved to be satisfactory. 32 PET ANIMALS ACT, 1951. The administration of this Act is conducted by the Public Health Department, and the Sanitary Inspectors and I have been authorised to act as Inspection Officers. Although this is a comparatively modest additional burden, there are some somewhat complex practical difficulties arising in connection with the licensing and inspection of pet shops, which require careful investigation. Two licences were issued during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 This Act came into operation on the 1st November, 1951, and makes it obligatory for manufacturers, retailers, and other users of rag flock and other prescribed filling materials to be registered or licensed by the local authority as the case may be. Registered premises are those where filling materials of the types listed in section 33 of the Act are used in manufacturing bedding, toys, baby carriages and other articles of upholstery. Licenced premises are those where rag flock is (a) manufactured, or (b) stored for distribution to registered premises. Upholstering, etc., may only be done on registered premises. Offences in respect of the manufacture and sale of unclean filling materials are prescribed, also powers of entry, inspection and sampling. At present only one business is registered with this Authority. HEATING APPLIANCES (FIREGUARDS) ACT, 1952. This Act received the Royal Assent on 1st August, 1952. It does not come into force until 1st October, 1953. The Act prohibits the sale or letting of unguarded domestic electric fires, gas fires or oil heaters; empowers authorised officers of local authorities to inspect and list appliances kept on any premises for sale or letting and imposes penalties for contraventions. This new legislation has been referred to the Public Health Department for enforcement. THE PROVISION OF HOUSING ACCOMMODATION. The Housing Estates Manager has supplied me with the following information: — New Housing Estates. During 1952, progress was made in the provision of new housing schemes, as follows: — West End Lane. The 80 flats in Sidney Boyd Court, West End Lane, were completed and occupied during the year. The estimated cost of the land and buildings is £208,000. The housing scheme is to be opened officially on 18th April, 1953, by Mr. Alderman S. A. Boyd, M.S., F.R.C.S., J.P., after whom the estate is named in appreciation of his services as Mayor for seven years, including the whole period of World War II. 33 Lawn Road. The 25 flats in Troyes House, Lawn Road, were also completed and occupied during the year. The estimated cost of the land and buildings is £52,500. The housing estate was officially opened on 18th October, 1952, by His Worship the Mayor of Hampstead, Councillor H. G. Judd, C.B.E., J.P. Shoot-Up Hill. Building work continued during 1952 on the 112 flats in thi: scheme. Some of the flats are expected to be ready for occupatioi in August, 1953. The estimated cost of the land and buildings i: £291,000. Additional Schemes in various preparatory stages were:- No. of dwellings Broadhurst Gardens 170 Harben Road 170 Fellows Road 80 Avenue Road 54 Springfield Lane 50 Kilburn Gate (second stage) 33 Dennington Park Road 18 Abbey Road 16 Broomsleigh Street 8 Fitzjohn's Avenue 7 Kemplay Road 7 Gladys Road 4 Total 617 Other housing sites have received preliminary consideration. Requisitioned Properties. At the end of the year the total number of dwellings in requisitioned properties was 1,519. This represents a decrease of 19 dwellings during the year, due chiefly to the release of some properties from requisition at the request of the Ministry of Housing and Local Government, owing to dilapidations and structural defects, etc. An additional " halfway house," designed to give emergency accommodation for nine families, was brought into use during the year; work on a further " halfway house " for eight families was nearing completion. War Damage. Building licences were issued during the year for the repair of severely damaged and unoccupied premises and for the rebuilding of war-destroyed "Cost of Works" houses, to provide a total of 25 dwellings. (5946) c 34 Private Conversions and Buildings. During 1952, building licences were issued for the conversion of large houses by private owners to provide a total of 81 dwellings. The Council were also enabled by the Ministry of Housing and Local Government to allocate licences for the building of 72 dwellings by private enterprise. Applications for Accommodation. Accommodation was found by the Council during 1952 for the families of 176 applicants, comprising 571 persons. In October, 1952, a thorough revision of the housing waiting list took place and some 1,700 applications were cancelled. At the end of the year, 3,945 applicants were on the housing list and may be divided into groups as follows: — Group A: Applicants with very urgent housing need 1,350 (approx.) Group B: Applicants with urgent housing need 850 (approx.) Group C: Applicants with little or no housing need 1,250 (approx.) Applicants without full residential qualification, etc. 495 (approx.) During the year no less than 507 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. 35 APPENDIX. ACCIDENTS IN HAMPSTEAD, 1952. M. D. WARREN, Deputy Medical Officer of Health. (5946) C2 36 ACCIDENTS IN HAMPSTEAD, 1952. Accidents can conveniently be divided into those occurring at work, in the road, and those occurring at or around the home. Industrial accidents. In Hampstead in 1952, there were no deaths due to industrial accidents. The H.M. District Inspector of Factories has very kindly given me details of accidents which occurred in premises subject to the Factories Act during 1952, in the Borough of Hampstead. There was a total of 35 accidents, 32 in males and 3 in females. The age distribution is shown in Table I. There are 8 cases in which the age is not known. Table I. Age. 15-24 25-34 35-44 45-54 55-64 65 + U.K. Male 4 4 4 5 5 2 8 Female 3 — — — — — — In the remaining 27 there is no excess of accidents in any particular age group. The fact that all the accidents to women occurred in the youngest age group would be related to the fact that such women form the bulk of the employed female population. The older women are busy in the industry of keeping house and are indeed exposed to more hazards and strain than the industrial workers. Many of the industrial accidents are essentially preventable. Thus one man cut his hand whilst cleaning a circular saw which was in motion; another put his hand in a boring machine whilst it was in motion. Out of the 35 accidents, no less than 10 occurred in connection with building. The Building (Safety, Health and Welfare) Regulations came into force on October 1st, 1948, and it is hoped that they will diminish the number of accidents. The building trade has especial difficulties in that each building site is only a "temporary factory." In all industries, accidents cannot be avoided entirely by legislation and in the end much depends on the individual worker. Road accidents. Road accidents and measures for their prevention are under constant study by the Road Safety Committee under the Chairmanship of Miss D. R. Bailey, and the following figures are taken from their Statistical Review of 1952. In 1952 there were three fatal accidents on the road, two concerned pedestrians and one a passenger in a car. In 1951 there were four fatal accidents and in 1950 two. The number of injured in 1952 was 372, in 1951, 421 and in 1950, 417. During these three years there has been an increasing number of vehicles on the road and there is a definite improvement in safety. The age incidence is shown in Table II. 37 Table II. Age. 0- 5- 15- 20- 30- 40- 50- 60- 70- 80 + No. of accidents 11 38 28 69 77 64 48 20 16 4 To quote from the Report "Since December, 1947, no children have been killed in Hampstead road accidents. In the under 5 year age group 11 children were injured but the majority of these accidents should never have happened. For example: — 7 children were injured stepping, walking or running off the footpath. Of these 5 were unaccompanied by an older person, 2 were accompanied, but escaped from the supervision of an older person. The lowest accident totals are reported in the winter months when children are less on the streets, but the tragic fact is that during the summer months very young children are allowed to wander and play in the streets unattended." The report points out that care in crossing road junctions by drivers and care in stepping off the pavement and avoidance of crossing the road from behind a stationary vehicle by pedestrians would diminish the number of accidents. In 1952, 158 (out of the total of 375) were so caused. Home accidents. Despite the fact that industrial and road accidents are intensively studied they form only a small proportion of the total number of accidents, the majority of which occur in the home. It is very difficult to obtain precise figures about these accidents for unless they are fatal they are not reported. By the co-operation of the Superintendent of New End Hospital and the Secretary of the Hampstead General Hospital, it has been possible to search through their records and obtain details of all the cases of accidents (from all causes) admitted to Hampstead hospitals in 1952. These figures only give an indication of the number of serious accidents in the Borough in any year for they do not include the injuries treated by general practitioners or by doctors at the outpatient department of hospitals. The death certificates for 1950, 1951 and 1952 have been examined and those deaths due to accidents have been included in the analysis. Results of the Survey. Total numbers sex and age distribution. In 1952 there were 23 fatal accidents registered in Hampstead compared with 27 in 1951 and 38 in 1950. During 1952, 233 persons were admitted to New End Hospital and, 82 cases to Hampstead General Hospital. The sex and age distribution of these cases is shown in Table III, together with the sex and age distribution of the population of Hampstead at the time of the census in 1951. 38 Table III indicates that older people are more liable to sustain injury from an accident and such injury is more liable to be fatal, for 60 per Table III. Age. Fatal Accidents, 1950-1952. In-patients, New End Hospital. In-patients, Hampstead General Hospital. Population (1951), Hampstead, to the nearest 100. Male. Female. Male. Female. Male. Female. Male. Female. 0—4 4 2 8 7 5 7 3,300 3,500 5—14 1 0 25 8 20 3 3,100 3,300 15—24 0 0 11 9 6 2 3,000 7,300 25—34 4 2 11 3 6 2 7,000 11,500 35—44 0 2 19 12 7 1 8,100 9,700 45—54 4 4 16 11 2 6 4,900 8,900 55—64 6 7 9 9 0 1 4,400 6,200 65 + 12 40 23 50 3 10 3,500 7,400 Unknown 0 0 1 1 1 0 0 0 31 57 123 110 50 32 37,300 57,800 cent. of the fatal accidents occurred in people over 65 years although only 28 per cent. of the patients admitted to hospital were so aged. Whilst such a finding is to be expected, the difference in the figures nevertheless underlines the importance of taking steps to prevent accidents occurring to older people. Table IV. Month of Occurrence. Jan. Feb. Mar. Apr. May June r July Aug. Sept. Oct. Nov. Dec. 66 51 64 59 57 60 77 62 83 71 95 68 The highest incidence was in the two months of September and November. The mean incidence was 68 accidents per month. Place of Occurrence. An analysis of the place of the accident was difficult as frequently there was insufficient information on the records. However, classification into the three broad groups, industrial, road and home, is shown in Table V. The figures for industrial accidents cannot be compared with those supplied by H.M. Inspector of Factories and quoted earlier, as those figures only applied to premises coming under the Factories Act, whilst the figures in Table V apply to all accidents at work. Included in "road" accidents are those occurring in streets and other public places, such as stations, etc., and therefore are more inclusive than the accidents studied by the Road Safety Committee. 39 Table V. Place of Accident. Total Both Sexes. At Work. Road or Public Place. Home. Unknown. M. F. M. F. M. F. M. F. Deaths, 1950-52: Under 60 3 0 8 8 6 8 0 3 36 Over 60 0 0 5 2 8 35 1 1 52 Hospital cases : Under 60 23 1 47 23 31 36 42 20 223 Over 60 1 0 13 17 8 35 8 10 92 Total (both sexes) 28 123 167 85 403 Of all the accidents here considered, 32 per cent. are known to have occurred in the home. The percentage may well be higher for it is probable that the majority of the 85 "unknown" occurred in the home, as this type of accident is not reported to the same extent as industrial or road accidents where the question of compensation and court proceedings arises. Of the fatal accidents 65 per cent. occurred in the home and of these 75 per cent. were in people over the age of 60 years. The causes of these home accidents are classified in Table VI. Table VI. Table VI. Causes of Home Accidents. Deaths. Hospital Cases. Total. Falls 27 69 96 Burns 11 26 37 Swallowing tablets 6 7 13 Gassing 5 2 7 Other and unknown 8 6 14 By far the commonest cause is falls either down-stairs, over a step, or tripping on the level. Next comes burns, poisoning by swallowing an overdose or even the wrong tablets, and gassing. Falls accounted for 57 per cent. of all accidents in the home and burns for 22 per cent. (national figures for 1950—falls 58 per cent., burns 12 per cent.). Length of Stay in Hospital. To get an impression of the length of disability and the disruption to industry and home life caused by accidents, the length of time in hospital is shown in Table VII. These figures are an understatement as they do not include any time spent in hospital as a result of transfer to a burns unit or an orthopaedic hospital, nor do the figures give any indication of the time spent off-work at home whilst attending hospital as an out-patient. Once more the increased injury suffered by older 40 people is noticeable, for with one exception all those who stayed in hospital longer than 85 days were over 60 years old. Table VII. Age Days in Hospital. 1-2 3-4 5-7 8-14 15-28 29-56 57-84 85 + 0—4 2 6 3 7 7 1 1 0 5—14 8 5 14 20 3 3 2 0 15—24 3 6 4 7 6 1 1 0 25—34 7 2 3 5 5 0 0 0 35—44 4 6 11 5 8 5 2 0 45—54 0 6 8 10 4 4 2 1 55—64 2 1 3 6 3 0 1 3 65+ 5 12 5 13 18 10 11 13 Unknown 0 0 0 1 0 0 0 0 The total number of days spent in hospital by the 315 persons in this survey was 7,540. This includes the 17 cases who stayed longer than 85 days (3 months), their total being 2,776 days. The cost to the health service of all these cases would be £21,400 if it be assumed that the cost per bed per week for New End Hospital is that of the average non-teaching hospital in the N.W. Metropolitan Region and the cost in Hampstead General Hospital is that of a teaching hospital. This does not include the loss to the families and the persons involved, nor the loss to industry. 41 INDEX. page Accidents 4,35 Aged Persons 4, 14 Bacteriological Examinations: Infectious Disease 13 Food 22 Bakehouses 19,31 Births 9 British Red Cross Society 15, 16 Burials 14 Cleansing Station 13 Clubs for Old People 16 Common Lodging Houses 28 Complaints 18 Contamination of Food 22 Conveniences, Free Washing Facilities 23 Deaths: Chief Causes 9 Death Rate 9 Infant Mortality 3, 9 Maternal Mortality 9 Disinfecting and Cleansing Station 13 District Nursing Associations 15 Drainage 19 Factories Act: Inspections 19, 30 Outworkers 23, 31 Fairs, Hampstead Heath 21,31 Fairgrounds, By-laws 31 Flooding 31 Food: Adulterated Samples 22 Bacteriological Examination 22 Bakehouses, Underground 31 Chemical Analysis 22 Food and Drugs Act, 1938, Section 13 25 Food and Drugs Act, 1938, Section 3 25 Ice Cream 19, 20 Inspections 19 Restaurants 19 Street Traders 19 Sampling 22 Unsound Food 24 Food Poisoning 12 Free Washing Facilities 23 Hampstead Heath Fairs 21,31 Hampstead Council of Social Service 15 Hampstead Old People's Housing Trust 15, 17 Hampstead Old People's Welfare Association 15,17 Heating Appliances (Fireguards) Act, 1953. 32 42 Page Housing: Applications for rehousing 19, 34 Closing and Demolition Orders 26 Housing Act, 1936, Section 4 18 Housing Act, 1936, Section 9 26,28 Housing Consolidated Regulations 25 New Housing Estates 32 Rent and Mortgage Interest (Restrictions) Act 25 Statistics 25 Underground Rooms 26 Unfit Houses 25 Ice Cream 20 Infant Mortality 3 Infectious Diseases 10 Intimation Notices 19 Legal Proceedings 27 London County Council 15, 17 Mass X-ray 12 Maternal Mortality 9 Milk: Distributors 21 Special Designation, etc., Regulations 21 Supply to Schools and Hospitals 21 Mobile Meals Service 15 Mortuary 10 National Assistance Act, 1948, Section 50 14 National Assistance Act, 1948, Section 47 14 National Assistance Board 15,17 Old People—see Aged Persons. Outworkers 23, 31 Pet Animals Act, 1951 32 Pharmacy and Poisons Act 19, 31 Pleasure Fair By-laws 31 Poliomyelitis 4, 10 Population 2 Prevention of Damage by Pests Act 28 Public Conveniences 23 Public Health Committee 7 Public Mortuary 10 Rag Flock 19. 32 Rehousing 19, 34 Rent and Mortgage Interest (Restrictions) Act 25 Restaurants 19 Rodent Control 28 Sanitary Circumstances of the Area 18 Scabies 13 Sewers, Rodent Control 29 Shops Act 19 Smallpox 10 Staff of the Public Health Department 7 Staff, Medical Examinations 14 Statistics : Sanitary Circumstances 18 Vital 9 43 page Statutory Notices 19 Stillbirths 9 Sweetmeats, Wrapping of 23 Swimming Bath Water 31 Tuberculosis: Mass X-ray 12 Notifications and Deaths 4,11 Public Health (Tuberculosis) Regulations 11 Underground Bakehouses 31 Underground Rooms 26 Unsound Food 24 Verminous Persons 13 Water Supply 28 Women's Voluntary Services 15, 16 4162 P.H. 250 7/53 (5946) PRINTED By HARRISON AND SONS. LTD.. ST. MARTIN S LANE. LONDON