AC 4351 HAMP 55 Metropolitan Borough of Hampstead. Report on the Health of the Borough. 1954 DENNIS H. GEFFEN, O.B.E., M.D., B.S., M.R.C.S., L.R C.P, D.P.H., Medical Officer of Health Metropolitan Borough of Hampstead. Report on the Health of the Borough. 1954 DENNIS H. GEFFEN, O.B.E., M.D.. B.S., M.R.C.S., L.R.C.P., D.P.H., Medical Officer 0f Health 2 Public Health Department, 33 Lancaster Grove, Hampstead, N.W.3. 3rd May, 1955. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF HAMPSTEAD. Mr. Mayor, Ladies and Gentlemen, This is the fifth Annual Report which it has been my pleasure to present. During these five years 861 dwellings have been built by the Hampstead Borough Council and the London County Council. The following table shows the population, the number of rate assessments in respect of dwellings and the amount of the rateable value, retirement pensions, average working wages of men and women, and the cost of living index for each of these years. Year Borough Population Dwellings (Rate assessments ) Rateable value of dwellings £ Retirement Pensions Average Wages Cost of Living Index Men Women 1950 97,400 20,086 1,265,529 26/- 150/5 82/7 116 1951 97,750 20,344 1,275,966 30/- 166/- 90/1 130 1952 97,700 20,665 1,286,978 32/6 178/6 96/4 138 1953 97,970 21,093 1,302,413 32/6 189/2 102/5 140 1954 98,210 21,468 1,312,970 40/- 204/5 108/2 145 3 One asks oneself immediately the extent to which these improvements in the social life of the country are reflected in the health of the nation. Turning to Hampstead, we can quote the birth rate, death rate, and the infantile death rate. Birth rate Death Rate Deaths of Infants per 1,000 per 1,000 under 1 year per estimated estimated 1,000 live births population population 1950 15.5 10.0 19 1951 14.5 11.5 27 1952 14.9 11.2 24 1953 14.5 11.8 16 1954 14.7 9.1 17 The death rate has shown a satisfactory reduction, whilst the birth rate has been more or less unchanged during the past 4 years. The figure one rightly wants is that relating to sickness and this it is somewhat difficult to obtain. On the other hand it is argued that the infantile mortality rate is probably the best index of the health of a community, for it depends on family Income, housing, and knowledge of parentcraft. The figures for Hampstead indicate that the improvement in the social conditions of the community are reflected in the infantile mortality rate, for the services provided for expectant and nursing mothers and children under 5 years have remained more or less constant for the period under review. The number of deaths of children under 1 year in 1953 was 23, and in 1954 was 24. The deaths of infants under 4 weeks in 1953 was 20, in 1954 it was 16, a drop of four. When notification of birth was first adopted in 1907 its necessity was argued on the grounds that 25 per cent. of the children who died under the age of 1 year, died before they reached the age of 4 weeks. At that time the only information the Medical Officer of Health could obtain as to the births in his district was as to the registration of birth, and this could take place any time within the first 42 days of life, and was incumbent upon the parent. In that 25 per cent. of the infantile deaths occurred in the first 4 weeks of life this registration came too late to enable the Medical Officer of Health to take any practical steps in so far as 25 per cent. of such deaths were concerned. Let us look at the position today. The neo-natal death rate, that is the children dying within 4 weeks of birth 4 in Hampstead, is nearly 66 per cent. of the total infantile mortality rate. The number of children dying under 4 weeks has dropped, but it has not fallen to anything like the extent of children over 4 weeks. Looked at in another way, only 8 children died between the ages of 4 weeks and 12 months. 16 died within the first 4 weeks of life. If we are to reduce infantile mortality to an even lower figure than the 17 per 1,000 births recorded this year, then we must examine the causes of the neo-natal mortality. In 1954 6 deaths were due to prematurity and 8 to congenital malformations. In the past we have tended to look upon congenital malformation as inevitable and unpreventable. Recent experience however has shown that this is far from so. We have reason to believe that certain virus infections during the early months of pregnancy may cause foetal malformation. In the second place there is an increased liability to foetal abnormality as the age of the mother at the birth of the child advances. It is possible that earlier child bearing and the protection of the expectant mother from virus infection during the early months of pregnancy might reduce neo-natal mortality and better still reduce the number of children brought into this world with physical and even mental handicaps. There were no deaths from poliomyelitis in 1954, against 2 in the previous year. We see a distinct drop in the number of cancer deaths, which is probably due to the change in the manner of allocating deaths which occur in St. Columba's Hospital. These deaths are now transferred to the district in which the home address of the deceased is situated. In 1953 gastritis, enteritis and diarrhoea was the cause of death in six instances. Of these, one was of a child under 2 years, the other five being persons over the age of 15 years. In 1954 only 1 death was attributed to this cause and this was in a person over 75 years of age. The following figures show that this disease which once used to kill large numbers of children, especially under the age of two years, has virtually been eliminated: 1904 1914 1924 1934 1954 Deaths from gastritis, enteritis and diarrhoea under 2 years of age 22 9 10 7 Nil A welcome drop of three occurred in the deaths from 5 motor vehicle accidents, there being 6 in 1954 as against 9 in 1953. This may be due to the intensive road safety campaign. Against this there is an increase of deaths from all other accidents from 15 in 1953 to 21 in 1954. This is probably due to fatal accidents in the home. The number of deaths from suicide shows an increase of five, there being 17 in 1953 and 22 in 1954. One of the duties that has fallen upon the Department during the past few years relates to loans to persons who wish to purchase property under Section 4 of the Housing Act, 1949. Before the Council can make such a loan it must be satisfied that the house is, or will be made, in all respects fit for human habitation. It has been the policy of the Council to encourage the residents of the Borough to purchase property and to become the possessors of their own homes. It is equally important, however, that such homes should be structurally sound and healthy. In determining whether a house is unfit for human habitation, regard has to be had to its condition in respect of the following matters - (a) repair; (b) stability; (c) freedom from damp; (d) natural lighting; (e) ventilation; (f) water supply; (g) drainage and sanitary conveniences; and (h) facilities for storage, preparation and cooking of food and for the disposal of waste water. A house is deemed to be unfit if, and only if it is so far defective in one or more of the above that it is not reasonably suitable for occupation in that condition. In each case a complete survey of the premises has to be made by the officers of your Department and consideration is given not only to the house itself but to the number of families and persons who it Is proposed should occupy it, and the amenities which they will require. There has been a steady increase in the demand for loans from the Council and this is well illustrated in the following figure. 6 Loans granted under Section 4 Housing Act, 1949 I would say immediately that the Public Health Department has welcomed the opportunity of assisting the Council in this question of Section 4 of the Housing Act, 1949. It is constructive work which calls for the skill of the Sanitary Inspector in accordance with the training and experience which his profession has given him. A further duty that has fallen upon the Department is the issue of rent repairs certificates. As the Council well know a landlord may not put up his rent if his tenant can produce a certificate to the effect that the house is (a) not in good repair, (b) is not reasonably suitable for occupation. The Medical Officer of Health sees this Section of the Act neither as a means whereby a landlord can increase his profit, nor the issue of a certificate as the opportunity of a tenant to keep his rent at its pristine level. He sees it from 7 its purely public health aspect, that Is a hope that this Act will better the living conditions of the residents in the Borough by Increasing the amount of money landlords spend on maintaining their property. To what extent has this been achieved in Hampstead? The following figure shows the number of certificates which have been granted since September 1954, and those which have been revoked. In all 117 certificates have been granted, but only 16 have been revoked. Looked at optimistically there would appear to be an increasing number of revocations and It is the revocations which are of particular interest to the Public Health Department in that they signify premises which have been made suitable for occupation and are in good repair. Looked at from another point of view, however, it would appear that there are 101 houses where so far repairs have not been carried out. Certificates of Disrepair, Housing Repairs and Rents Act, 1954 It is as yet too early to judge the situation for there has not been sufficient time for landlords to carry out repairs required before they can Increase the statutory rent. I should be sorry, however, if a situation arose whereby landlords put up the statutory rent and if the tenant applies for a certificate of disrepair, they took no further action, accepting the previous situation as from their point of view being more profitable. This, of course, is not the whole story, for where the defects listed in the certificate constitute a statutory nuisance, the Council is empowered to serve a notice under the Public Health Acts and this procedure is followed where necessary. 8 SUICIDES IN HAMPSTEAD 1950 - 1953 The Registrar General commenting on the statistics of deaths for 1950 (H.M.S.O. 1954) drew attention to the fact that in that year Hampstead had the highest rate for suicides, namely 287 suicides per million of the population, followed by Holborn with 270, Burnley 259, Eastbourne 258 and Westminster 257. This observation has attracted much attention in the daily and local press and I therefore thought it would be of interest to look into this problem in Hampstead. The Registrar General's figures referred to the year 1950. Table 1 shows the crude death rates* and the number of suicides for Hampstead, Westminster, Holborn and St. Pancras for the year 1950, and for comparison the years 1951 and 1952. Table 1 Year Hampstead Westminster Holborn St. Pancras Crude Death Rate Suicides Crude Death Rate Suicides Crude Death Rate Suicides Crude Death Rate Suicides 1950 287 28 257 27 270 7 120 17 1951 242 23 202 20 203 4 224 30 1952 189 18 172 17 203 4 188 26 x Crude death rate equals number of deaths from suicide per million of population. 9 It will be noticed from the above table that there is a great variation from year to year and that Hampstead does not consistently show the highest rate. Furthermore the actual numbers of suicides are small and therefore any deductions made from the figures can only be extremely tentative. It would be unwise to make any deductions from the figures for Holborn. In the country as a whole, the figures for suicides have shown a decrease year by year since 1949. Prior to this, after a slight increase in the first years of the war there was a marked decline during the middle of the war and then a rise in the first years of peace, which reached its maximum in 1948 - 49. The Hampstead figures have more or less followed this trend. The metropolitan boroughs with the highest death rates for suicide are Hampstead, Holborn, Westminster, Paddington, St. Marylebone, Wandsworth, Kensington and Chelsea. With the exception of Wandsworth all these boroughs adjoin, forming the north-western section of the County of London. As I have already pointed out in my Annual Report for 1953, these boroughs have many other features in common, including the large percentage of their population living in lodgings, boarding houses and rooms, and it is possible that they house a large number of people who have left their own homes and familiar surroundings, attracted by stories of the wealth and opportunity awaiting them in London, the biggest city of the commonwealth. In the national figures the ratio of males to females for suicide is 1.8 males to 1 female. The figures for Hampstead vary from year to year. In 1951 the ratio was 1.3 to 1 and in 1950 it was nearer 2 to 1, whilst the provisional figures for 1953 seem to suggest a figure of 1 to 2. These figures for Hampstead demonstrate clearly the rashness of making deductions from such small figures. The national figures consistently show that the male rates increase with advancing age. This is also more or less a feature of the Hampstead figures with the exception of the marked excess in the ages 55 - 59. The women on the other hand, in the national figures, reach a maximum incidence at ages of ' 55 - 64 which then declines with increasing age. In Hampstead this rise and fall is not so clearly shown. 10 Table 2. Age Incidence and Total Rates per 10,000 Age 1950 1951 1952 1953 Total Rates per 10,000 M. F. M. F. M. F. M. F. M. F. M. F. 15- 1 — — — — — — — 1 — 7 — 20- — — — - — — — 1 — 1 — 2 25- 2 1 — 1 1 — — — 3 2 8 4 30- 1 - 1 — — — 1 — 3 — 8 — 35- 1 — — 2 3 1 — 1 4 4 10 8 40- 1 1 1 — 2 1 1 2 5 4 14 8 45- — 1 — 4 2 2 — — 2 7 6 16 50- 1 1 2 — 2 — — 1 5 2 19 5 55- 3 2 3 1 4 1 1 2 11 6 51 17 60- 1 2 1 - — 1 1 2 3 5 15 15 65- 3 — — 1 — 2 — 1 3 4 19 14 70- 2 1 — 1 1 1 — 1 3 4 27 18 75- — — 2 — 1 — — 1 3 1 43 6 80- — — — — — — 2 1 2 1 69 12 Total 16 9 10 10 16 9 6 13 48 41 15 8 11 It is interesting to calculate the number of suicides occurring in Hampstead as compared with London and the country as a whole: London: Applying the suicide death rate for London for the year 1951 to Hampstead, there should have been 12 deaths from suicide in Hampstead. In fact the Registrar General reported 23. Country as a whole: Applying the suicide rate for the country as a whole in 1952 to Hampstead, there should have been between 10 and 11 suicides in Hampstead in that year. In actual fact the Registrar General reported 18. Therefore it seems justifiable to say that Hampstead does definitely have a higher suicide rate than the average either in London or the country as a whole. To try and find the cause of this excess I have been through all the death certificate returns for Hampstead for the years 1950 - 1953 inclusive and abstracted details of deaths attributed to suicide. These total figures, shown in Table 2, do not correspond exactly to the totals published by the Registrar General as after certification of death the Registrar General makes certain adjustments for home address etc. so that his numbers tend to be slightly less than the numbers shown, which include all suicides occurring in Hampstead. The sex and age incidence is shown in Table 2, and the rates per 10,000 are shown diagrammatically in Figure 1. The month of occurrence is shown in Table 3. June and October have been the highest months, April and July the lowest, but on the whole the differences are slight. Table 3. Month of Occurrence January 9 July 5 February 8 August 8 March 7 September 6 April 3 October 11 May 6 November 9 June 11 December 6 The various ways that suicide was carried out are shown in Table 4. The taking of drugs accounts for 38 per cent. and coal gas poisoning for a further 34 per cent. The majority of deaths attributable to taking drugs are due to taking barbiturates, these accounting for about two-thirds of the total, and aspirin accounting for about one-quarter. 12 Table 4. Methods Used Drugs 34 Barbiturate Poisoning 23 Aspirin 8 Methedrine 1 Carbromal l Cyanide l Coal Gas Poisoning 30 Hanging and Strangulation 8 Drowning 2 Self Inflicted Wounds 5 Cut Neck 3 Stabbed Chest 1 Shot Head 1 Violence Injuries 9 Fall from height 5 Fall under train 3 Fall under bus 1 Electrocution l 89 Various hypotheses have been put forward to account for the excess of suicides in the Borough. It has been suggested that it may be due to the population structure, but this seems an unlikely explanation as the outstanding feature of the population of Hampstead is the excess of females and it has already been shown the females have a lower suicide rate than males. Another explanation is that suicides are commoner in students and that Hampstead with its boarding houses and hostels has an above average student population. An analysis of the occupation of those people who commit suicide (shown in Table 5) only includes two students out of a total of 89, and therefore this explanation of the excess is not tenable. Hampstead undoubtedly has a higher proportion of its population in social classes 1 and 2 and it is a feature of 13 suicides that they tend to be commoner in these social classes. Just over one-third of the population in Hampstead were classified in the 1951 census as being in the social classes 1 and 2, and from a study of the occupations of the 89 suicides shown in the Table, about the same proportion are in social classes 1 and 2. Thus it is reasonable to say that a part of the excess suicides in Hampstead is associated with the social class distribution of the population. The Registrar General in the Report already quoted points out that some of the towns with an excessive suicide rate also have a high proportion of elderly retired people. Table 2 and Figure 1 show that in Hampstead in the case of males the highest rates are indeed amongst the men over JO with the exception of the very high rates of men aged 55 - 59, but such excess in the elder women is not a feature of the Hampstead figures. It therefore seems unlikely that the excess of old people (11.9 per cent. of the population of Hampstead are over 65 as compared with 11.1 per cent. for the County of London) could have played any significant part in the excess of suicides. Table 5. Occupation. House-wife, Widow, Spinster 27 Typist, Clerk 9 Writer, Journalist 4 Painter and Decorator 4 Company Director 3 Teacher 3 Labourer and Handyman 3 Artist 3 S tudent 2 Hospital Orderly 2 Civil Servant 2 Domestic 2 Traveller, Salesman 2 Police Officer, retired 1 Greengrocer 1 Tailors Machinist 1 Ladles tailor, retired 1 Clothing manufacturer, retired 1 Chauffeur 1 Engineer 1 Insurance Manager 1 Toolmaker 1 Plumber, retired 1 Carried forward 76 14 Brought forward 76 Telephonist 1 Lengthman 1 Librarian 1 Sheet metal worker 1 Denta1 surgeon 1 Wine merchant, retired 1 Barman 1 Hosier 1 Member of Stock Exchange 1 Ironmonger's assistant 1 Motor dealer 1 Actor 1 Tractor Operator 1 Total 89 From this brief report it is impossible to put forward suggestions that might influence the suicide rate in Hampstead as a particular metropolitan unit. There are however, certain general aspects of the subject to which I would like to draw your attention. By and large there tends to be some impression amongst the public that the person who threatens to commit suicide will not do so. I do not think there is any justification for this impression. A proportion of people who eventually do commit suicide have threatened to do so, or have indicated in their conversation that their minds are turning towards the ending of their lives. In some cases it is possible that in their conversation they are throwing forward hints in the hope that their listeners will help them. In my opinion a threat of suicide should be taken seriously. I am sure in looking through the methods of committing suicide that you will come to the conclusion that some steps should be taken to prevent the ease with which the public can obtain dangerous medicines in lethal quantities. I do not think it to be a fact that the person who has made up his mind to commit suicide will sooner or later do so. It is likely that the presence of a fatal drug, or an easy means of terminating his life, may cause him to take a fatal step at a time when temporarily his mind is unbalanced. It is more than possible that if the means of death had not been available at that time, he or she might have discovered that the situation was not either so serious or permanent as had been anticipated. To some extent there are fashions in suicide and this I think is of considerable importance. It is a frequent occurrence to 15 read in the daily press of suicides and the means by which they have taken place. I can see very little justification for this publicity. Many years ago, writing on this subject, I referred to suicide as a "mentally infectious disease". When the Sidney Fridge was first opened in Australia a number of suicides followed, and I believe the same thing happened after the erection of the Eiffel Tower in Paris. The repeated readings in newspapers of deaths by coal gas poisoning or drugs, very often with the actual drug stated, may act as an inducement to the would be suicide to terminate his life rather than to seek help and advice from doctors, psychiatrists and friends. To this I would add that these reports often cause great distress to relatives. I have also seen press reports of cases of attempted suicide. These I think are of no advantage to the public and make it extremely difficult to cure and rehabilitate the would be suicide, once his friends, relatives and social contacts have become aware of the occurrence. Summary From this statistical analysis on the incidence of suicides in Hampstead it is shown that: 1. There is an excess rate of suicides in the Borough of the order of about 60 per cent. over the average for London as a whole. 2. This excess seems to be evenly distributed between the age groups and between men and women, with the exception of an excess number of suicides in the ages 55 - 59 in men. 3. The other Metropolitan Boroughs which have an excess suicide rate (with the exception of Wandsworth) adjoin, forming a large section of the north-western area of London. 4. It is not possible to attribute the excess suicides in Hampstead to the population structure, i.e. an excess of females, or to the residence in Hampstead of large numbers of students and elderly people. 5. It would appear that the cause for this excess of suicides lies more in personal factors and may be 16 associated with the type of population who leave their own home towns and come to London in search of jobs. It is my privilege to express my thanks to the members of the Council and in particular to the Public Health Committee for the courtesy and help I have received during the year. It has indeed been a pleasure to have the enthusiasm of every member of the Public Health Committee behind me, and I would assure you of the encouragement this has been, for the health problems in Hampstead are varied and in some ways unique and complex. I am indebted to the General Practitioners of Hampstead, to the staffs of the Hospitals, and in particular to the members of the Public Health Department, from all of whom I have had help, co-operation and a happy friendship. Towards the end of the year Dr. Warren ceased his duties as Deputy Medical Officer of Health and I would like to pay a tribute to the assistance he gave me in the investigation into the problem of suicides in the Borough of Hampstead. I would also like to welcome Dr. Bolz who commenced his duties as Deputy Medical Officer of Health in February, 1955 • I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, DENNIS GEFFEN, Medical Officer of Health. 17 PUBLIC HEALTH COMMITTEE (as at 31st December, 1954) His Worship the Mayor (Mr. Councillor E. Snowman, J.P.), ex-officio member. Chairman: Councillor N, Oatway. Alderman S. A . Boyd, M.S ., F.R.C.S ., J.P. " Mrs. R.S.G. Carnegie. Councillor Miss D.R. Bailey, L.C.C. " L.H.H.G. Baldwin. " Miss E, Beer. " Mrs. F.E. Cayford, J.P., L.C.C. " L.A. Curtis, A.M.H.C.I. " Mrs. R. Mactaggart. " R.M. Matheson. " Mrs. Margaret Roome, S.R.N. " Mrs, P. Unwin. The Chairman of the Housing Committee. Sub-Committee: Drainage Plans. Representatives on outside Committees and other Organisations concerned with Public Health work: Hampstead Council of Social Service: Councillors Miss D.R. Bailey, L.C.C., Miss E. Beer, Aldermen H. Brooke, M.A ., M.P., L.C.C ., Mrs. R.S.G. Carnegie, Councillors J.A. Lemkin, B.A., Mrs. Margaret Roome,S.R.N. Hampstead Old People's Housing Trust Ltd.: Alderman H. Brooke, M,A ., M.P.,L.C .C ., Councillors R.M. Brodtman, D.E. Gibbens, B.Sc., Miss A .E. Walton, M.A., Mrs. H.M. Young. Hampstead Old People's Welfare Association: Councillor Miss D.R. Bailey, L.C.C., Aldermen Mrs. R.S.G. Carnegie, R.J. Cleaver, L.C.C., Councillors Mrs. Margaret Roome, S.R.N., A.E. Skinner, Miss A.E. Walton, M.A., Mrs. B.C . Wells. 18 Hospital Management Committees: Archway Group: Councillor Mrs. M. Ormerod, B.A. Paddington Group: No.4 House Committee: Councillor Mrs. H.M.Young. London County Council Health Committee: Alderman S.A. Boyd, M.S., F .R.C.S., J.P. London County Council Divisional Health Committee, Division 2: Alderman Mrs. R.S.G. Carnegie, Councillors N. Oatway, Mrs. C.L. Sadler. National Smoke Abatement Society: Councillor N. Oatway, the Medical Officer of Health. STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: Dennis H. Geffen, O.B.E., M.D., B.S., M.R.C.S., L.R.C.P., D.P.H. Deputy Medieal Officer of Health: M.D. Warren, M.D., D.P.H., D.I.H. Chief Sanitary Inspector: J.F. Armstrong (a), (b). Deputy Chief Sanitary Inspector: F.V. Outlaw (a), (b). Sanitary Inspectors: Mrs. C. Speechley (a), (d), (e), (f). L.E. Trigg (a), (b). W.F. Newport (a), (b). D.W. Malcolm (a) . T.H. Marshall (a), (b), (c) (Up to 5.12.54). G.L. Nicklin (a). R. Clark (a). 19 Sanitary Inspectors: (Contd.) G.A. Buckingham (a). E. Ulrich (a), (b), (e). W.G. Clarkson (a), (b) (Up to 31.8.54). G.R. Watkin (a) (From 1.12.54). Chief Clerk: A.H.C . Slade. Clerical Staff: G.W. Bedell. Mrs. M.C. Rabin. G.R. Young (National Service). C.F. Pidgeon. Mrs. G. Fletcher (Temporary). J.A. Gilbody. Public Analyst: E. Voelcker, A.R.C.S., F.R.I.C., 1 Tudor Street, E.C.4. Mortuary Keeper: S. King. (a) Sanitary Inspector's Certificate. (b) Food Inspector's Certificate. (c) Smoke Inspector's Certificate. (d) Health Visitor's Certificate. (e) State Registered Nurse. (f) State Certified Midwife. 20 STATISTICS AND SOCIAL CONDITIONS Area (acres) 2,265 Population: Registrar-General's estimate mid-1954 98,210 Census, 1951 95,131 Rateable Value, March 1954 £1,684,157 Sum produced by Id. rate £6,820 No. of separate rating assessments of dwelling houses, flats and other residences 21,468 Number of structurally separate dwellings - Census 1951 23,010 Births: Total Legitimate Illegitimate Males 706 635 71 Females 738 678 60 1,444 1.313 131 Birth rate per 1,000 of the estimated population 14.7 Rate for London 15.2 Area Comparability Factor 0.75 Number of stillbirths 25 Rate of Stillbirths per 1,000 (live and still) births 17 Deaths: Net deaths (males, 434: females, 456) 890 Death rate per 1,000 of the estimated population 9.1 Rate for London 10.7 Area Comparability Factor 0.94 Deaths from maternal causes 1 Deaths of infants under 1 year (males, 12: females, 12) 24 Infants under 1 year: Infant Mortality Rate: All infants per 1,000 live births 17 Legitimate infants per 1,000 legitimate live births 17.5 Illegitimate infants per 1,000 illegitimate live births 7.6 Deaths of infants under 4 weeks (males, 7: females, 9) 16 The causes of death for 1953 and 1954, arranged under the headings of the short list used by the Registrar-General, are set out in the following list. 21 Causes of death 1953 1954 1. Tuberculosis, respiratory 11 10 2. Tuberculosis, other 1 2 3. Syphilitic disease 6 5 4. Diphtheria — — 5. Whooping Cough — — 6. Meningococcal infections 1 1 7. Acute poliomyelitis 2 — 8. Measles — — 9. Other infective and parasitic diseases 2 5 10. Malignant neoplasm, stomach 53 17 11. Malignant neoplasm, lung, bronchus 77 28 12. Malignant neoplasm, breast 61 16 13. Malignant neoplasm, uterus 29 7 l4. Other malignant and lymphatic neoplasm 190 101 15. Leukaemia, aleukaemia 9 5 16. Diabetes 6 4 17. Vascular lesions of nervous system 111 103 18. Coronary disease, angina l8l 185 19. Hypertension, with heart disease 23 24 20. Other heart disease 99 80 21. Other circulatory disease 46 49 22. Influenza 6 5 23. Pneumonia 49 35 24. Bronchitis 51 45 25. Other diseases of respiratory system 5 8 26. Ulcer of stomach and duodenum 10 10 27. Gastritis, enteritis and diarrhoea 6 1 28. Nephritis and nephrosis 9 9 29. Hyperplasia of prostate 4 8 30. Pregnancy, childbirth, abortion 2 1 31. Congenital malformations 2 8 32. Other defined and ill-defined diseases 61 68 33. Motor vehicle accidents 9 6 34. All other accidents 15 21 35. Suicide 17 22 36. Homicide and operations of war — 1 Total 1,154 890 22 INFECTIOUS DISEASE Disease NOTIFICATIONS Removed to Hosp. 1954 Deaths 1954 1950 1951 1952 1953 1954 Acute EncephalitisPost Infectious 1 2 1 l 1 1 — Diphtheria — 1 — — — — — Dysentery 16 72 15 40 73 24 — Enteric Fever — — — — 1 1 — Erysipelas 21 11 10 7 13 4 — Food Poisoning 42 23 6 21 19 9 — Malaria — — — 1 2 2 — Measles 588 1187 561 1186 36 4 — Meningococcal Infection 1 1 1 3 2 2 — Ophthalmia Neonatorum 3 3 3 5 1 — — Paratyphoid Fever 5 3 2 — — — — Pneumonia 44 74 37 53 47 19 6 Poliomyelitis Non-Paralytic 14 — 4 2 — — — Paralytic 2 7 10 2 2 — Puerperal Pyrexia 7 28 45 34 4l 41 — Scabies 24 16 17 24 23 — — Scarlet Fever 77 70 112 44 50 16 — Whooping Cough 189 289 193 215 169 14 — Total 1032 1782 1014 1646 480 139 6 No deaths occurred from any of the notifiable diseases with the exception of pneumonia, where we had six deaths. Four deaths of persons aged 70 and over and one death of a female aged were from lobar pneumonia. The sixth death was of a person aged 74 who died from acute influenzal pneumonia. The number of notifications of infectious disease was the lowest in any of the post war years. The exceptionally low figure was largely accounted for by the almost complete absence of measles from the borough. Measles epidemics tend to occur every two years, but even in a non-epidemic year there are 23 usually two or three hundred cases as the epidemic generally commences in December of one year and extends until May of the next year. Even for a non-epidemic year, 36 cases is an extremely low figure. Whooping cough was not very prevalent, except in the last quarter of the year, when 105 of the 169 cases were notified. Two cases of poliomyelitis, both paralytic, occurred. In four cases of suspected poliomyelitis the diagnosis was not confirmed. The total number of cases of dysentery was 73, the highest for several years. An outbreak of dysentery occurred in a day nursery, commencing on the 12th April, when a child was excluded with diarrhoea. Subsequently 38 cases were excluded with diarrhoea, of whom 22 were found to be excreters of sonne dysentery. Those who were positive were excluded until three negative swabs were obtained, and the remainder were excluded for two weeks after full recovery from their diarrhoea. The usual methods of scrubbing walls, floors etc. were carried out. No further cases occurred after the 10th May when new admissions recommenced. Another outbreak of dysentery occurred in a hostel for 15 working mothers and their babies. On the 26th March two babies were sent for examination and 8 babies were found to be excreting sonne dysentery. These children were sent to hospital. The 15 mothers were then swabbed and 3 symptomless excreters found, 2 of whom had babies who were also positive. All the staff, mothers and babies in the hostel had a course of antibiotic therapy. At the completion, one mother was still positive and treatment was repeated successfully. • I am grateful to the Medical Officer of Health, London County Council, and the Divisional Medical Officer, for information concerning the outbreaks of dysentery. Two cases of malaria were notified, in both instances the illness was contracted abroad. No case of smallpox was notified in the Borough during 1954. In one instance of difficult diagnosis the Medical Officer of Health was called In by a local practitioner, but the diagnosis was finally confirmed as chickenpox. 24 Information was received concerning 12 persons who had arrived in Hampstead from the Hague, Holland, where an outbreak of smallpox had occurred. These possible contacts were kept under surveillance, and where necessary arrangements were made for the contact to be vaccinated. TUBERCULOSIS. During the year 1954, 102 new cases of Tuberculosis were notified, 96 being cases of pulmonary tuberculosis and 6 of other forms of the disease» The following table gives an analysis of the newly notified cases and deaths during 1954. Age Periods New Cases Deaths Respiratory Non Respiratory. Respiratory Non Respiratory M. F. M. F. M. F. M. F. Under 1 — — 1 — — — — — 1-4 2 2 — 2 — — 1 — 5 - 14 2 3 — 1 — — — — 15 - 24 7 12 — 1 — — — — 25-34 13 10 — 1 1 — — — 35-44 11 10 — — — — — — 45-54 8 5 — — 3 1 — — 55-64 3 1 — — 2 — — — 65 and upwards 4 3 — — 3 — 1 — Totals 50 46 1 5 9 1 2 — MINIATURE MASS X-RAY. The Mass X-ray Unit visited the Council's Public Health Station, Lithos Road, from the 11th to the 19th May, 1954. Approximately 200 local firms, and all Departments of the Council were circularized and given the opportunity to use the facilities. Local Medical Practitioners were also advised of the survey so that patients could attend for a routine examination. This was the first visit of the Unit to the Public Health Station and as the following attendance figures show, the site proved very convenient and the response satisfactory. The total number X-rayed was 3154 (1613 males and 154l females). 24 were recalled for re-X-ray by large film, and 7 were finally referred to Chest Clinics. 25 FOOD POISONING. Food poisoning notifications (corrected) received during 1954: 1st Quarter 8 2nd " 1 3rd " 8 4th " 2 Total 19 Outbreaks due to Identified Agents: Total outbreaks: 1. Total cases: 2. Outbreak due to - Clostridium Welchi. Outbreaks of Undiscovered Cause: Total outbreaks: 1. Total cases: 2. Single cases: Agent Identified: 12. Unknown cause: 3. Total 15. Agent Identified: Salmonella Heidelberg 2 do. Typhimurium 8 do. Bredency 1 do. Morgani 1 BACTERIOLOGICAL EXAMINATIONS. (Infectious Diseases) The record of examinations carried out during the year by the Central Public Health Laboratory, Colindale, was as follows:- Throat/Nose Swabs: Diphtheria Bacilli found Nil Haemolytic Streptococci found 28 Vincent's Angina organisms found 2 Negative 69 Faeces: Shigella found 68 Salmonella found 15 C1. Welchii found 2 Negative 277 Pertussis: Positive 5 Negative 22 26 In all, 488 examinations were carried out on behalf of Hampstead doctors. The Department has an arrangement whereby specimens left at the offices by 2.30 p.m. are dispatched by hand to the Laboratories the same day, and 300 specimens were sent to the Laboratories by this means. CLEANSING AND DISINFECTION OF VERMINOUS PERSONS AND THEIR BELONGINGS. The following cleansing and medicinal baths were carried out at the Borough Council Cleansing Centre, during the year, where 34 adults and 20 children received treatment:- Verminous conditions; Cases Treatments. Adults 17 18 Children under 5 10 10 Children over 5 5 6 Scabies: Adults 17 50 Children under 5 5 16 Children over 5 - - 31 cases of scabies were brought to the notice of the Department during the year. Notification certificates were received in respect of 23 of these cases, the remaining 8 cases being second or subsequent cases in a family and not notifiable under the Regulations. All cases were investigated by the Sanitary Inspectors and treatment carried out at the Cleansing Station in 22 cases. The remainder received treatment either at home, or at hospital outpatient departments. 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 72 No. of treatments given 72 Scabies: No cases occurred amongst school children. London County Council (General Powers) Act, 1953. Section 43 empowers the Council to cleanse an aged person, on the application or with the consent of that person, at his home address. No case arose, however, where it was necessary for such action to be taken. 27 DISINFECTION AND DISINFESTATION. The following is a record of the work carried out by the Disinfecting Staff during 1954: No. of calls by borough van 3.058 No, of articles passed through steam chamber 6,200 No. of rooms disinfested after vermin 150 No, of rooms disinfected after infectious disease 233 Requests for the disinfection of articles of clothing for despatch abroad has increased, and during the year 249 parcels were disinfected at the request of 227 senders. STAFF MEDICAL EXAMINATIONS. 146 examinations were undertaken as follows:- 89 medical examinations were carried out of new entrants to the Superannuation Scheme. Of these 17 were classed as unfit. 10 examinations were made of persons on whom a special report was required in connection with absence through illness. 47 examinations were undertaken for other authorities. PUBLIC MORTUARY, NEW END During the year, 249 bodies were admitted to the Mortuary and 244 post-mortem examinations were carried out. The following table shows how the bodies were admitted and the cause of death:- Natural Causes 194 Suicides: Hanging 1 Railway 1 Coal gas poisoning 12 Drowning 2 Falls 1 Drugs 3 20 Accidental: Falls 5 Gas explosion 1 Burns 5 Coal gas poisoning 2 13 carried forward 227 28 brought forward 227 Post operative 6 Deaths in street 11 Bodies brought for accommodation only 5 Total 249 No. of bodies admitted by order of: Coroner 209 Police 4 Ambulance 17 Marie Curie Hospital 15 Others 4 Total 249 During recent years the Council have effected many improvements in the Public Mortuary and Chapel. The building has been renovated and equipment brought up to date. The furnishings of the Chapel have also been renewed. During 1954 the Council continued its policy of Improvement and purchased a six-body refrigerator chamber to replace the former threebody chamber. In appreciation of the co-operation received from the Council, Leverton & Sons Ltd. presented the Mortuary with a purple velvet back cloth. NATIONAL ASSISTANCE ACT, 1948. SECTION 50 During the year 16 funerals were carried out under this Section. In ten cases the full amount of the funeral expenses was recovered, either from the estate of the deceased or from liable relatives. In two cases the funeral expenses were partially recovered. The remaining four cases comprised two in which there was a liable relative who was in receipt of National Assistance and Retirement Pension as an only source of income, one case in which there was no liable relative and the value of the estate was nil, and one case of a stillborn baby found on Hampstead Heath. In these four cases the Council had to bear the whole of the cost of the funeral. The total cost of the funerals was £125.6s.5d. and an amount of £105.12s. 6d. was recovered (£9.l4s. 6d. of which was in respect of burials which occurred in the previous year). 29 NATIONAL ASSISTANCE ACT, 1948, SECTION 47 The conditions under which two old ladies were existing were first brought to ray notice in September, 1952. They were aged 80 and 70 years respectively and lived alone in their own nine roomed house. Both were senile, incontinent and completely unable, even with the assistance of a Home Help, to look after themselves or their home. Their rooms were mice and bug infested, the main roof was leaking, broken windows and door panels were stuffed with old paper and rags, internal decorations were in an appalling state of filth and disrepair, drains were frequently choked and overflowing over the yard and water and gas supplies were periodically turned off and not re-instated until interested Welfare Associations paid the outstanding accounts. Neither lady was registered with a doctor, and I was able to persuade them to register with a local medical practitioner. Despite the distressing circumstances outlined above, the Department made every conceivable effort to improve the lot of these old persons. They refused every persuasion to enter a suitable Home for Old Persons and although at our instigation they accepted the services of a Home Help, the Red Cross Meals, and assistance volunteered by several local Welfare Associations, their conditions so deteriorated that the only course left to us was to apply for their compulsory removal to a London County Council Home for Old People where both could receive proper care and attention. The Magistrate granted an Order for a period of six weeks, and it was not necessary to apply for an extension of this Order as both ladies remained voluntarily in the home. This is the first time we have had formally to invoke Section 47 compulsory powers under the 1948 Act. The last time we did so was in 1937 under Section 224 of the Public Health (London) Act, 1936. 30 ATMOSPHERIC POLLUTION As a result of the issue of the "Beaver" Report on Air Pollution and the promise of early legislation, public interest is being increasingly focused on this problem. The Metropolitan Boroughs' Standing Joint Committee considered the need, put forward by the Director of Fuel Research, Department of Scientific and Industrial Research, for further records of air pollution to be made throughout the Metropolis. A Scheme was formulated for increasing the number of daily measurements of smoke as it was felt that this will assist research in not only showing the atmospheric condition in London, but its relation to smoke in the research now going on with regard to carcinoma of the Lungs and Respiratory Passages. It was suggestedthat some 57 new stations would be necessary to provide an adequate picture of the distribution of pollution by smoke in the London Area. In Hampstead, we had already installed two deposit gauges, one in the Superintendent's garden at the Cemetery, Fortune Green, and the other at the Metropolitan Water Board Reservoir at Barrow Hill. Recordings from these actually commenced on the 1st January, 1954. The following tables give the results of the monthly analyses carried out by the Public Analyst, Mr. E. Voelcker. Month. Monthly Deposits of Impurities Tons per square mile. Barrow Hill. Cemetery. Insoluble. Soluble. Total. Insoluble. Soluble. Total. January 8.46 6.44 14.90 10.55 5.67 16.22 February — — — 9.55 11.84 21.39 March 11.15 14.09 25.24 9.97 12.54 22,51 April 22.25 5.37 27.62 22.37 5.53 27.90 May 21.99 7.38 29.37 28.84 8.47 37.31 June 23.49 7.28 30.77 21.41 12.73 34.15 July 12.12 8.73 20.84 7.27 6.74 14.01 August 10.10 7.32 17.42 6.70 5.44 12.14 September 10.20 7.0 17.20 6.87 6.14 13.01 October 7.52 6.17 13.69 6.57 3.37 9.94 November 9.46 12.32 21.78 6.70 7.67 14.37 December 7.11 8.69 15.80 5.20 7.47 12.67 31 SULPHUR The estimation of sulphur activity is carried out by the lead peroxide method and the following table gives the rate of sulphation expressed in milligrams of sulphur trioxide per 100 sq.cms. per day. Month. Sulphur Trioxide in milligrams per 100 sq. cms. per day. Barrow Hill. Cemetery. January 1.63 1.23 February 1.825 1.387 March 1.720 1.344 April 1.91 1.56 May 1.498 0.573 June 1.390 1.318 July 0.926 0.409 August 0.734 0.393 September 1.12 O.58 October 1.169 0.576 November 1.579 0.677 December 1.072 1.239 The following Figures indicate relative weights of soot, ash, etc. deposited per square mile in Hampstead as compared with the worst and the best in the London Boroughs, (Figure I), and Figure II makes the same comparison in the relative activity of sulphur compounds in the atmosphere. It will be seen that for a London Borough, Hampstead maintains a generally low level of atmospheric pollution, and as would be anticipated compares with the lowest readings in the London area. The power demands of industry remain virtually constant throughout the year so that the drop in the general level of air pollution during the summer months would appear to be accounted for largely by the non-use of domestic fireplaces and the falling off in domestic demand on power stations and gas works. 32 TABLE I - Weights of soot, ash. etc., deposited per sq mile. 33 TABLE II - Activity of sulphur in the atntosphere 34 A new daily smoke and sulphur dioxide measuring station, complementary to the above, was installed on the roof of the Public Health Department at Lancaster Grove in November, 1954. Since 1st December, 1954, the mean concentration of sulphur dioxide and smoke has been ascertained daily by Mr. E. Ulrich, one of your Sanitary Inspectors. Our highest reading to date was obtained after thick fog on 20th January, 1955, when the filter paper was discoloured thus: The smoke instrument consists of an electrically operated air pump which continually aspirates a measured quantity of air through a filter paper, thus producing, with smoky air, a dark stain. At the same time, the induced air is passed through 35 hydrogen peroxide and the concentration of sulphur dioxide in the atmosphere can be determined by measuring the degree of acidity assumed by the solution. Once a day the filter paper is changed and the "shade value" of the stain assessed by comparing it visually with a set of standards. The smoke concentration is readily calculated from the shade value and the quantity of air passed. Both daily and monthly recordings are tabulated and submitted to the Fuel Research Station. SMOKE ABATEMENT. OBSERVATIONS AND INSPECTIONS Thirty-one complaints were received from residents relating to nuisances from smoke and chimneys. In the case of one large concern the trouble was of old standing (due to war damage), but it appears to have been cured by the reconstruction of the boiler house and the installation of new boilers. I was asked to make a special report to the Public Health Committee on the question of the emission of smoke, steam and grit from various of the railway tunnel ventilating shafts in the Borough, some of which terminate in most unsuitable positions. In one case the shaft which is 15' 0" wide and 50' 0" deep covers the whole of the back garden and extends to the first floor window level of premises in Belsize Crescent. Houses within 150 feet of the shafts were visited. Some residents complained bitterly of the sulphur, soot, grit, smoke and steam which emanated from the shafts and caused damage to the fabric of the building, rotting of curtains and general acute discomfort to the occupier. Others seemed to accept the position and made no complaint. Your Inspectors spent a considerable amount of time in making observations and some 220 visits were paid. Frequent representations were made to the British Transport Commission regarding these emissions. The Commission replied that "it Is not possible entirely to eliminate the emission of smoke from locomotives whilst passing through the tunnels but steps are being taken to reduce it to a minimum". The position is unsatisfactory and until the programme of electrification of the railways has been completed, I do not think we can hope for any appreciable improvement. 36 SANITARY CIRCUMSTANCES OF THE AREA STAFF I have to report the following changes in the Inspectorial Staff during the year:- W.G. Clarkson - resigned - September, 1954. T.H. Marshall - resigned - December, 1934. These vacancies were filled by the appointments of Mr. G.R. Watkin and Mr. R. Cook. Since 1952, 4 Inspectors have resigned in order to take up more remunerative positions elsewhere and 1 Inspector has died. The number of Sanitary Inspectors employed by the Council in 1939 was 10 and at the end of 1954 was 12. Delay in filling the vacancies, owing to lack of applicants and the normal procedure of advertising, has resulted in a loss to the Public Health Department of the equivalent of 1 Inspector for sixteen months. There are, however, duties devolving on the Public Health Department which the lack of staff has made it difficult to carry out. I would refer in particular to the inspections of power and non-power factories and outworkers. It has only been possible to visit 96 out of 279 power factories and 18 out of 298 non-power factories and, although the number of outworkers in the Borough is 198, it was only possible to pay l4 visits. Some difficulty has also been experienced in carrying out the additional duties which have devolved on the Department, particularly in relation to Slum Clearance, Atmospheric Pollution, Loans for House Purchase, Improvement Grants and the environmental care of Tuberculous, Aged and Infirm Persons. To meet the situation the Council increased the establishment of Sanitary Inspectors by one. Mr. G. Young, formerly a Clerk in the Department, who had just completed his military service, was promoted to Sanitary Inspector and commenced duty in 1955. An additional Clerk, Mr. D. Ring, has also been appointed with a view to training him as an Inspector and to help to meet the urgent need throughout the country for recruits to this field of the public health service. 37 At the time of writing this report, the Department is short of one Sanitary Inspector and., although advertisements have been inserted in the appropriate papers with a view to filling this vacancy, only one applicant applied. The' Council will be aware that new scales of salary are now operative for London Sanitary Inspectors. The salary award is an interim one and will be reviewed in September, 1955. I can only express the hope that the present award may attract more young people to train as Sanitary Inspectors. Lack of a sufficient Inspectorate staff is, in my opinion, very serious and must ultimately reflect on the health and comfort of the community. I would stress once again that the Sanitary Inspector is no bureaucrat serving wanton notices on reluctant owners or careless tenants. He is a friend both of the landlord and the tenant, helping the former to keep his property in repair at the least possible cost and the tenant to keep his premises in a healthy and cleanly condition and free from nuisances that are dangerous or injurious to health. Apart from this, few realise his value in preventing the spread of infection, his manifold duties in connection with the purity of food and air and the provision of those communal amenities which in summary are called, often without appreciation of the words, "environmental hygiene". Mr. J. Williams, who had completed 26 years loyal and conscientious service as a Driver/Disinfector, resigned on 31st December, 1954. STATISTICAL SUMMARY, 1954 Sanitary Inspection. Houses inspected on complaint 2l4l " " after infectious disease 469 " " under Sec.9, Housing Act, 1936 Nil. House to House inspections 116 Inspections and revisits in connection with Loans under Sec.4, Housing Act, 1949 253 Special visits and re-inspections 10,465 38 Rehousing. Visits and. revisits in connection with the investigation of 1,000 rehousing applicants 1,472 No. of reports submitted to Hampstead Housing Estates Manager 529 " " " " " L.C.C. Estates Dept. 147 " " " " " L.C.C. Divisional Medical Officer l6l " " " " " Other Boroughs 35 Notices. Intimation Notices served 959 Statutory Notices served 256 Food Premises. Inspection of Bakehouses 85 " " Dairies and Milk shops 171 " " Catering Establishments 717 " " Ice Cream premises 250 " " other food premises, stalls, markets, etc. 1,681 The Factories Act, 1937. Inspections and re-inspections made l48 Pharmacy and Poisons Act, 1933, Poisons Rules, 1952. Inspections made 23 Rag Flock, etc. Act, 1951. Inspections made 6 Shops Act, 1950 (Sec.38. Arrangements for health and comfort of shop workers. Inspections made 69 Drainage Works. Plans and applications deposited for:- (a) Voluntary additional sanitary fittings or alterations to drainage 200 39 (b) Drainage and sanitary fittings required by Sanitary Notices 22 INSPECTION AND SUPERVISION OF FOOD AND FOOD PREMISES. The Food & Drugs Amendment Act, 1954. The publication of this Act has aroused much interest but we shall not know the full impact on the work of the Department until the appointed day for Its complete operation has been fixed. The Act follows the publication of the various Governmental Working Party's deliberations and reports on Meat Products, Catering trades hygiene and Meat Inspection. It envisages new regulations concerning labelling, food hygiene and codes of practice for food premises. These will come before a body, set up under Section 13 of the Act, which is to be representative of the general public, the traders concerned and the workers in those trades. Section 13 of the principal Act, the Food & Drugs Act, 1938, regarding precautions to be taken against the contamination of food has long been inadequate for present day needs and it is hoped that the prospective Regulations will strengthen considerably our statutory powers in this direction. Inspection of Food Premises. Type of Premises. No. on Register. No. of Inspections. Milkshops and Dairies 47 171 Ice cream premises 229 250 Butchers and Prepared Meat premises 80 641 Fishmongers 25 180 Fried Fish Shops 10 65 Bakers 45 85 Restaurants and Catering Establishments 167 717 Public Houses 36 187 Delicatessen 22 608 Confectionery 99 Grocers 123 Greengrocers 85 Off Licences 32 40 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. 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 48 Greengrocers 26 Grocers 50 Butchers 2 Tobacconists 11 Fishmongers 4 Restaurants 44 Garage 1 Dairies 18 Bakers 5 Stores 5 Toy Shop 1 Clubs 5 Florist 1 Off-Licences 1 Kiosks and Stalls 6 TOTAL:- 22.9 SAUSAGES, COOKED MEATS, ETC. Types of shop registered under Section 14, Food and Drugs Act, 1938, for preparation and sale of sausages and cooked meats, etc. Grocers 8 Delicatessen 5 Provisions 4 Factory 1 Butchers 36 Cafe 1 TOTAL:- 55 41 MILK SUPPLY. The number of Licensed Distributors operating in the Borough is 77. MILK (SPECIAL DESIGNATION) REGULATIONS. 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, 24 satisfying the Methylene Blue and Phosphatase Tests which Indicate keeping quality and efficiency of heat treatment, and 33 samples being genuine chemically. The average milk fat content was 3.6 per cent, as against a legal minimum of 3 per cent. The number of Licences issued to traders is as follows:- Main Supplementary Licence. Licence. Pasteurised Milk 37 26 Tuberculin Tested Milk 33 26 Sterilised Milk 44 30 HAMPSTEAD HEATH FAIRS Catering Hygiene. Your Inspectors have again given unstintingly of their time and energy during the various Bank Holiday Fairs to ensure that foodstuffs sold to the public are produced and distributed as cleanly and safely as possible. To this end, no less than 197 samples of foodstuffs and/or catering equipment were taken, 96 for bacteriological examination and 101 for chemical analysis. This year a special Investigation was undertaken, in conjunction with the Fishmongers' Company, in connection with the bacteriological purity of shellfish. Normally, cockles and whelks are purchased direct from Billingsgate Market and transported to the Fairground by the 42 Retailer within an hour or so of being bought. Samples were taken from the same consignments., both by the Fishmongers Company's Inspector at Billingsgate and. directly the shellfish arrived at the Heath and subsequently at various periods throughout the day by the Council's Inspector, Mr. T.H. Marshall. The evidence adduced pointed to contamination occurring by reason of unsatisfactory storage and/or handling and this question will be further explored at future Fairs. 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. The following table shows the grading of Ice Cream samples taken at the fairground since the Wars:- Year No. of Samples Taken. Grading under Meth. Blue Test Percentages of Grades 1 and 2 Samples. 1 2 3 4 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 1953 42 18 10 4 10 66·6 1954 34 28 2 — 4 82·3 FOOD SAMPLING. (a) Bacteriological examination of food stuffs. 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. 43 Details of the ice cream and milk samples submitted to bacteriological examination appear under the respective headings. 158 other samples were taken for examination. Some were routine samples; others for confirmation of unsound or defective tinning, etc. and a proportion were from suspected cases of food poisoning. The following table shows the variety of the examinations made and the results thereof:- Nature of Sample. No. of Samples. Satisfactory. Unsatisfactory. Macaroon Tart 1 1 - Canned Tomatoes 1 - 1 Rollmops 1 - 1 Ox-tail Stew 1 - 1 Devonshire Cream 1 - 1 Corned Whale Meat 1 - 1 Cockles 10 5 5 Cooked Mussels 1 1 - Ham Sandwich 2 1 1 Tomato & Cheese Roll 1 1 - Whelks 8 5 3 Mussels 1 1 - Jellied Eels 3 3 — Hot Dogs 1 1 - Spam Roll l 1 - Sandwiches 3 3 - Rolls - various 5 3 2 Meat Pie 1 1 - Sausage 2 1 1 Spinach 1 1 - Ice Lollies 5 4 1 Bananas 1 - 1 Irish Cream 1 1 - Turkey l 1 - Cooked Rabbit l - 1 Haricot Beans 2 1 1 Cream Slice 1 1 - TOTALS: 58 37 21 In addition to the above, the following samples were taken for bacteriological examination - 9 swabs from feeding utensils, 75 wash-up waters, 13 wash-up waters from ice cream servers and 3 tap waters. 44 (b) Samples submitted, to Chemical Analysis. Mr. Eric Voelcker, A,R.C.S., F.R.I.C., Public Analyst to the Borough, has examined and reported upon 500 samples, of which 12 were classed as adulterated or unsatisfactory. Particulars of Adulterated Samples. Sample No. Article. Offence. How Dealt With. 33. Cheese & Macaroni. False description. Misleading use of the word "Cheese". Manufacturers warned. Labels altered. 34. ditto. ditto. ditto. 233. Foreign body in milk. Contained cold aluminium solder. Dairy proprietors cautioned. 234. Buttered Roll. Mixture of butter and margarine. Vendor cautioned. 276. Large Eggs. Not fresh. Cautionary letters sent to Retailer and Wholesaler. 320. Cheese & Macaroni. False description. Misleading use of the word "Cheese", Manufacture rs warned. Labels altered. 359. Haricot Beans. Tin content very high. Cautionary letter to Manufacturers. 365. Creamed Cottage Cheese. Prepared from separated milk. Cannot be described as cheese. Negotiations with Manufacturers in progress. 408. Rollmops in Remoulade Tins blown. Retailer cautioned. 409. ditto. ditto. ditto. 430. Milk Bottle. Containing solid matter - Calcium Salts. Dairy Proprietor cautioned. Continued. 45 Adulterated samples continued:- Sample No. Article Offence How Dealt With. 493. Blackcurrant Juice. Incorrect description. (Should be described as Blackcurrant Syrup). Letter sent to Manufacturers. The percentage of adulterated samples in 1954 was 2.4 per cent, as compared with 3.57 per cent. in 1953 and 1.97 per cent. in 1952. 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. The public and the street traders would appear to appreciate this facility judging by the number of towels which have been issued. UNSOUND FOOD SURRENDERED DURING 1954. Article. Quantity. Baby Food 64 cartons Baking Powder 54 packets Barley Crystals 92 tins Biscuits 31 lbs. Butter 4l lbs. Cake Mixture 47 packets Cereals 12 packets " 112 lbs. Cheese 87 cartons " 127 lbs. Chocolate 3 lbs. Coconut 2 lbs. Confectionery 9½ lbs. Cream 1 tin Cream of Tartar 26 packets Dates 12 lbs. ,, 6l packets Eggs (dried). 3 tins Pigs (dried) 68 packets Continued. 46 Unsound Pood continued: Article. Quantity. Fish: Tinned 152 tins Cod 1 stpne ) Haddock 1 stone ) Total - Plaice 3 stone ) Skate 3 stone ) 50 stone.Whiting 42 stone ) Flour 5 lbs. Fruit 916 tins Fruit Juice 49 tins Ham 175 lbs. Honey 2 tins Jam 114 tins Lemonade Pwder 15 packets Marmalade 43 Jars Meat: Tinned 369 tins Beef 2355 lbs. ) Calves Head 11 lbs. ) Chicken 212 lbs. ) Chicken Liver10 lbs. ) Chicken Necks 10 lbs. ) Total - Kidney11 lbs. ) Lamb125 lbs. ) Liver 30 lbs. ) 4264 lbs. Mutton 20 lbs. ) Ox Cheek 271 lbs. ) Ox Liver 436 lbs. ) Pork 311 lbs. ) Rabbit 376 lbs. ) Sausages 11 lbs. ) Sheeps Liver 30 lbs. ) Turkey 23 lbs. ) Veal 22 lbs. ) Milk 142 tins Milk Powder 71 tins Mincemeat 8 tins Mushrooms 26 lbs. Nuts 110 packets Peel 16 packets Pork Fat 38 lbs. Potatoes 256 lbs. Prunes 36 lbs. Raisins 17 lbs. Salad Cream 2 jars Continued. 47 Unsound Pood - continued Article Quantity Salt 12 packets Soup 98 tins Suet 17 lbs. Sugar 32 lbs. Tea Cakes 21 Vegetables 520 tins ,, 286 lbs. Xmas Puddings 4 Wherever possible, such food is salvaged for use either for animal feeding stuffs, soap manufacturing or other industrial purposes. Other condemned food is either destroyed at the Public Health Station or removed to the Council's Dusting Wharf for disposal with other trade refuse. LEGAL PROCEEDINGS Offences relating to food and food premises Sections 3 and 9, Pood & Drugs Act, 1938 For selling a macaroon biscuit contaminated with beetles and maggots, the Council proceeded directly against a firm of manufacturers outside the Borough. They were fined £2. with one guinea costs. For selling a loaf of bread contaminated with a cockroach, a local bakehouse proprietor was fined £20. and five guineas costs. Section 13, Food & Drugs Act, 1938 and L.C.C.By-laws for the Protection of Food Fines totalling £85 with costs of 15 guineas were imposed in respect of various contraventions of the above at two dirty bakehouse premises in the Borough. HOUSING 1. Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 2610 2. Number of dwelling-houses (included in (1) above) which were inspected and recorded under the Housing Consolidated Regs.1925 and 1932 (House—to-House Inspection) 116 48 3. Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 4. Number of dwelling-houses found not to be in all respects fit for human habitation 959 HOUSING ACT, 1936, PART II, SECTION 9 Repair of Insanitary Houses Except in very exceptional circumstances, the Council has discontinued the use of this Section. CLEARANCE AREAS AND INDIVIDUAL UNFIT HOUSES PART A - CLEARANCE AREAS (Housing Act, 1936) No. of dwelling-houses demolished during the year No. of persons displaced. Unfit Houses Other Houses Land coloured "pink" Nil - Nil Land coloured "grey" - Nil Nil PART B - HOUSES NOT INCLUDED IN CLEARANCE AREA DEMOLITION & CLOSING ORDERS Number of Houses Persons Displaced 1. Housing Act, 1936 Nil Nil (a) Houses demolished as a result of formal or informal procedure under Section 11 * (b) Houses closed in pursuance of an undertaking given by the owners under Sec.11 and still in force Nil Nil (c) Parts of buildings closed. (Section 12) ** 17 45 Continued: * One Demolition Order was made during the year. ** 10 Underground Rooms were closed, also 47 mews rooms over garages and workshops. 49 PART B continued:- DEMOLITION & CLOSING ORDERS Number of Houses Persons Displaced 2. Housing Act, 1949 Nil Nil (a) Closing Orders made under Section 3(l) (b) Demolition Orders determined and Closing Orders substituted under Section 3(2) Nil Nil 5. Local Government (Misc.Provns.) Act, 1953 Closing Orders made under Section 10(1) Nil Nil REPAIRS INFORMAL ACTION No. of Houses 4. No. of unfit or defective houses rendered fit during the period as a result of informal action by the local authority under the Public Health or Housing Acts 1109 ACTION UNDER STATUTORY POWERS 5. Public Health Acts No. of houses in which defects were remedied after service of formal notices (a) by owners 256 (b) by local authority in default of owners Nil 5. Housing Act, 1936 No. of houses made fit after service of formal notices Sees.9, 10, 11 and 16 (a) by owners Nil (b) by local authority in default of owners Nil APPLICATIONS FOR REHOUSING It is the practice now to submit to the Public Health Department applications for housing in order that we may advise as to the number of points, 0 - 20, which might be awarded on medical grounds. 50 In this respect it should be noted that cases are pointed by the Housing Estates Manager in respect of period on waiting list, overcrowding, bedroom deficiency, insanitary conditions, lack of facilities, separated families, half-way house accommodation, separate home and service in the Forces. Points awarded by the Public Health Department are made on medical grounds only. During the course of the year 529 applications were submitted by the Housing Estates Manager to the Public Health Department and we visited every case to ascertain the number of rooms occupied by the family, the sex and ages of the members of the family, the conditions under which they were living and any medical conditions which might be improved by rehousing. In addition, 308 reports on rehousing applications were submitted by us direct to the London County Council and 35 to other Boroughs. A further 128 cases were investigated for the Housing Estates Manager but were found to have obtained alternative accommodation without recourse to the Borough Council. We wish to acknowledge the help we have received from the general practitioners of Hampstead who co-operate with us freely in order that a fair estimate can be made of each case. The following table sets out the points that were awarded. No points were given in 322 cases as there were no medical grounds which would not be met by points given by the Housing Estates Manager: No. of Cases Points given 322 Nil 88 5 56 10 45 15 18 20 529 OVERCROWDING 1954 1953 1952 New cases reported during year 279 219 125 No. rehoused during year 37 53 66 No. remaining on Register 996 754 588 Of the 37 overcrowded families rehoused, 21 were by Hampstead and 16 by the London County Council. 51 HOUSING REPAIRS AND RENTS ACT, 1954 I have dealt with the question of Disrepair Certificates in the preamble to this report. From the date of the commencement of the issue of these Certificates - 1st September, 1954 to the 31st December, 1954 - 71 Certificates of Disrepair were issued and 6 Revocations granted. SECTION 54, THE FACTORIES ACT, 1937. UNDERGROUND BAKEHOUSES It is the duty of the Council to carry out every 5 years an examination of every basement bakehouse in which a Certificate of Suitability has been issued and (a) if, as a result of the examination, the Council are not satisfied that the bakehouse is suitable for use as such as regards construction, height, light, ventilation and any hygienic respect, they must give notice in writing that the Certificate shall cease to have effect and the basement bakehouse must not again be used as a bakehouse, or (b) if the Council are satisfied that the bakehouse is suitable as regards the matters aforesaid, the Certificate shall oontinue to operate. The existing quinquennial Certificates of the 7 remaining basement bakehouses in the Borough expired on the 23rd September, 1954. Comprehensive reports on the condition of each of these bakehouses were prepared and submitted to the Public Health Committee for consideration. As a result thereof, a Sub-Committee was appointed to interview the owners of the bakehouses, together with representatives of the National Association of Master Bakers. In the meantime, the owners of 354, Kilburn High Road and 64, Belsize Lane had intimated that they did not intend to carry out any baking therein in the future. The Master Bakers concurred in the recommendations made by the Sub-Committee which were subsequently accepted by the Public Health Committee and the Council and are as follows:- Basement Bakehouses Date of Expiration of Certificate of Suitability 228 Belsize Road 31st March, 1959 7 Fairhazel Gardens 3lst March, 1959 63 Hemstal Road 30th September, 1956 98 West End Lane 30th September, 1957 279 West End Lane 31st March, 1959 354 Kilburn High Road 31st October, 1954 64 Belsize Lane 31st October, 1954 52 Two appeals against the Council's decision were subsequently made to the Magistrate. These were not heard until March, 1955, when the learned Magistrates allowed the appeals and directed that the Certificates of Suitability should each continue for the full period of 5 years. The number of underground bakehouses has steadily diminished throughout the years. For instance, prior to the Factory and Workshop Act, 1901, there were no less than 40 such premises operating in the Borough. These were reduced to 22 after the passing of the 1901 Act and after April, 1959 there will remain only 2 underground bakehouses in the Borough of Hampstead. FACTORIES ACTS, 1937 and 1948 The following tables give details of the number of inspections made, notices served and defects found under these Acts. Inspections Premises No.on Register Inspections Written Notices Occupiers Prosecuted (i) Factories in which Sec.l,2,3,4 and 6 are to be enforced by Local Authority 298 18 1 - (ii) Factories not included in (i) in which Sec.7 is enforced by the Local Authority 279 96 3 - (iii) Other premises in which Sec.7 is enforced by the Local Authority (excluding outwo rke rs' premises) 4 - - - TOTAL: 58l 114 4 - 53 Defects Found Particulars Number of cases in which defects were found Found Remedied Referred to H.M. Inspector Want of cleanliness (S.l) 6 5 - Overcrowding (S.2) - - - Unreasonable temperature (S.3) - - - Inadequate ventilation (S.4) 2 2 - Ineffective drainage of floors (S.6) - - - Sanitary conveniences (S.7) - - - (a) Insufficient — — - (b) Unsuitable or defective 3 2 — (c) Not separate for sexes - - - Other offences against the Act (not including offences relating to outworkers) 1 1 1 TOTAL: 12 10 1 During 1954 no prosecution was instituted under the Factories Acts, 1937 and 1948 with regard to factories. OUTWORKERS In accordance with the Factories Act, 1937, 21 Hampstead firms sent in lists of persons employed as home workers. Of the 198 persons so employed 48 only resided in the HampS'ead area. Information concerning 97 outworkers resident in Hampstead but employed by firms outside the Borough was received from other authorities. PHARMACY AND POISONS ACT, 1933 During the year, 113 applications for the renewal of poisons licences were granted. In 6 instances new licences were issued and 5 firms were removed from the Register. 54 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 house. There are no wells or stand pipes. RODENT AND PEST CONTROL Prevention of Damage by Pests Act, 1949 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 520 of which 115 related to rats and 405 to mice. The figures for 1953 were 467 of which 150 were rats and 317 mice infestations. 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 co-operation 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. In accordance with the Ministry's request, in respect of all infestations at business premises, charges are made at the rate of 7s.6d. per hour. 55 Sewer Maintenance Treatment against Rodent Infestation As part of the organised campaign throughout the country for the eradication of rats in sewers, etc., the whole of the sewerage system was prebaited and poison baited twice during the year. This work is undertaken by the staff of the Borough Engineer. PROVISION OF DUSTBINS - New Legislation The vexed question of who should provide the dustbin the Owner or the Occupier, has been relieved, so far as the Borough Council is concerned, by the new provisions contained in Section 12 of the London County Council (General Powers) Act, 1954. It is now the practice for the Council to ask the owner to supply the dustbin. The owner may now appeal to the Magistrates Court against the requirements of the notice within 21 days on the following grounds :– 1. (a) that the notice or any requirement thereof is not justified by the terms of the section under which notice purports to have been served; (b) that there has been some informality defect or error in or in connection with the notice; (c) that the authority have refused unreasonably to approve the carrying out of alternative proposals or that the requirements of the notice are otherwise unreasonable in charaoter or extent or are unnecessary; (d) that the time allowed by the notice for compliance with its requirements is not reasonably sufficient for that purpose; (e) that the notice might lawfully have been served upon some person other than the appellant and that it would have been equitable for it to have been so served; (f) that the notice requires the execution of works which would be for the common benefit of two or more premises and that some other person (being the owner or occupier of premises to be benefited) ought to contribute towards the expenses of executing any works required; 56 (g) that the house to which this notice relates is occupied by some other person and that any obligation to comply with the requirements of this notice ought to fall upon the occupier of the house. 2. In the case of any appeal as above, the appellant may serve a copy of his notice of appeal on any other person having an estate or interest in the premises referred to in . this notice. 3. Where the ground or one of the grounds upon which an appeal is brought is on the ground speoified in paragraph (e) or paragraph (f) above the appellant shall serve a copy of his notice of appeal on each other person referred to. 4. The owner of the premises referred to in this notice shall not be entitled to rely on the ground of appeal specified in paragraph (g) above unless the Court is satisfied that a copy of his notice of appeal has been served by him on the occupier of the premises and on the Hampstead Borough Council together with a written intimation that he proposes to rely on such ground of appeal. PLEASURE FAIR BY-LAWS In view of the lack of legal control over the persistent public health nuisances caused by the absence of sanitary conveniences at the private Vale of Health Amusement Park, the Council determined to make By-laws in pursuance of the powers contained in the London County Council (General Powers) Act, 1939. These By-laws were confirmed by the Home Office and came into operation on the 1st October, 1954. They provide as follows:- 1. Throughout these by-laws the expression "pleasure fair" means any entertainment which is run for profit and which consists of or includes any or all of the following forms of entertainment, whether or not in combination with any other forms, that is to say, any travelling circus, exhibition of human beings or performing animals, merry-go-round-about, switchback railway, cocoanut shy, hoop-la, shooting gallery or swings or anything similar to any of the foregoing. Provided that the said expression does not include any fair held by statute, charter, royal licence, letters patent or ancient custom. 57 "Premises" means the premises on which a pleasure fair is held. "Manager" means the person having the control of a pleasure fair, whether being the owner or lessee of the premises or some other person. 2. The manager of a pleasure fair shall not keep a fair open to the public other than between the following hours:– (a) on Monday, Tuesday, Wednesday, Thursday and Friday in any week the hours of 10 o'clock in the morning and 10.30 o'clock in the evening; (b) on Saturdays and Bank Holidays the hours of 10 o'clock in the morning and 11 o'clock in the evening; (c) on Sundays the hours of 2 o'clock in the afternoon and 9 o'clock in the evening; and (d) on Good Fridays the hours of 12 noon and 10 o'clock in the evening. 3. The manager of a pleasure fair shall take any necessary steps to provide adequate entrances thereto and exits therefrom. He shall while the public are on the premises keep every exit open and free from obstruction. 4. No person shall place or cause to be placed any obstruction in any exit provided in accordance with the foregoing by-law No.3, while the public are on the premises. 5. The manager of a pleasure fair not being a pleasure fair the whole of which is comprised within a building or buildings shall where adequate public sanitary accommodation is not already available within reas®nable distance of all parts of such pleasure fair take any necessary steps:- (a) to provide in suitable situations "sufficient and suitable sanitary conveniences for persons employed in or about the pleasure fair and for the public attending the pleasure fair"; (b) to label separate conveniences for men and for women respectively in such proportions as may be appropriate; and (c) to maintain the conveniences in good repair and in a reasonably clean and wholesome condition. 6. The manager shall take any necessary steps to provide:- (a) a sufficient supply of wholesome water for the use of persons employed; and 58 (b) where the circumstances so require, means for the disposal of any impure or waste liquid. 7. No person shall form or cause to be formed any refuse heap in any part of the premises. Provided that, where a fair is held in the open air, nothing in these by-laws shall prevent the collection and burning of straw, waste paper, shavings or other similar material in such a manner as not to be a nuisance or cause of danger. 8. Every person occupying any part of the premises shall, as respects that part of the premises, and the manager shall, as respects any part of the premises not occupied by some other person:- (a) so far as practicable, cause that part to be kept in a clean condition; (b) as often as is necessary and practicable, cause any refuse or litter within that part to be collected and (save as provided in the foregoing by-law) to be deposited in a suitable receptacle. 9. The manager shall cause all refuse and litter to be collected at suitable intervals from all such receptacles as are mentioned in the foregoing by-law and to be removed from the premises. 10. On vacation of the premises or any part thereof the manager shall remove or cause to be removed any refuse or litter remaining thereon, so as to leave the same in a clean and tidy condition. 11. Any person offending against any of the foregoing by-laws shall be liable on summary conviction to a fine not exceeding five pounds. 12. Nothing in the foregoing by-laws shall apply to any pleasure fair held on the open space administered by the London County Council and known as Hampstead Heath. SWIMMING BATHS Samples of water were regularly taken for chemical examination and bacteriological analysis from the Hampstead Swimming Baths. These proved to be satisfactory. PET ANIMALS ACT, 1951 8 licences were issued during the year. 59 HEATING APPLIANCES (FIREGUARDS) ACT, 1952 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. EMERGENCY WATER TANKS AND BOMBED SITES I am very thankful to be able to report that seven of these tank sites have now been utilised for building purposes leaving only two in the Borough. Both are in the gardens of private houses; neither holds water and there were no nuisances requiring action by the Borough Council. It will be remembered that the Council has agreed to act as Agent for the London County Council in any necessary cleaning out of such tanks. There are, unfortunately, still a number of bombed sites which inevitably give rise to recurrent nuisances, but these sites also are gradually diminishing. THE RAG FLOCK AND OTHER FILLING MATERIAL ACT, 1951 There is one firm in the Borough of Hampstead whose premises are registered for the use of filling materials used in manufacturing bedding and other articles of upholstery. Six inspections have been carried out which showed the premises to be in a satisfactory condition. LEGAL PROCEEDINGS Public Health (London) Act, 1936 Three Summonses were issued for non-compliance with Statutory Notices. Fines of £2 and costs of £4.4s.0d. were awarded and Abatement Orders made by the Magistrates. Two further Summonses were withdrawn, the necessary works having been completed prior to the hearing. London County Council Drainage By-laws A builder was prosecuted in respect of infringements of these By-laws. Fines totalling £2 were imposed and £2.2s.0d, costs awarded to the Council. 60 APPENDIX Authorities and Organisations concerned with health and welfare in the Borough of Hampstead. 6l LONDON COUNTY COUNCIL. DIVISION 2. Public Health Department. List of Clinics, Day Nurseries and School Treatment Centres situated within the Metropolitan Borough of Hampstead:- DAY NURSERIES (Normally open all day, Monday to Friday) 1. Woodchurch, 11/13 Woodchurch Road, N.W.6. MAI 2937 2. Parkhill, 2 Parkhill Road, N.W.3. GUL 4759 3. Pond Street, 27/29 Pond Street, N.W.3. HAM 1686 MATERNITY AND CHILD WELFARE CENTRES 1. 60 West End Lane, N.W.6. MAI 5381 2. 230 Haverstock Hill, N.W.3. PRI 3666 3. Hampstead Wells, Christchurch Hill, N.W.3. HAM 9534 4. 40 College Crescent, N.W.3. PRI 8033 5. Solent Road, Sumatra Road, N.W.6. HAM 5978 6. Lithos Road, N.W.3. HAM 4763 SCHOOL TREATMENT CENTRES 1. Kilburn Treatment Centre, 107 Kingsgate Road, N.W.6. MAI 3005 2. Lithos Road Centre, Finchley Road, N.W.3. HAM 4763 SPEECH THERAPY CENTRE West End Lane Welfare Centre, 60 West End Lane, N.W.6. MAI 5381 BATHING CENTRE Hampstead Bathing Centre, Lithos Road, N.W.3. HAM 7171 (This is a Borough Council establishment at which school children receive treatment under arrangements made between the London County Council and Borough Council.) DISTRICT NURSING ASSOCIATIONS Hampstead District Nursing Association, 3 Pond Street, N.W.3. HAM 6406 Kilburn & West Hampstead District Nursing Association, 20 Dennington Park Road, N.W.6. HAM 4232 62 TUBERCULOSIS CHEST CLINIC 54 Eton Avenue, N.W.3. PRI 7137 HOSPITAL Hospital Controlling No, of Authority Beds Marie Curie Hospital, Harefield & 50 HAM 3150 66 Fitzjohn's Avenue, Northwood N.W .3. Group 16 New End Hospital, Archway 236 HAM 5444 New End, N.W.3. Group 19 Queen Mary's Maternity Board of Gov- 42 HAM 6333 Home, ernors,London 124 Heath Street, N.W.3. Hospital Hampstead General & N.W. Board of Gov- 140 PRI 1151 London Hospital, ernors,Royal Haverstock Hill,N.W.3. Free Hospital Royal Free Hospital, do. 300 PRI 7671 N.W. Branch, Lawn Road,N.W.3. Garrett Anderson Maternity do. 26 PRI 2246 Home, 40 Belsize Grove,N.W.3. St.Columba's Hospital, Paddington 32 PRI 4230 98 Avenue Road,N.W.3. Group 21 ORGANISATIONS ETC. CONCERNED WITH WELFARE WORK Hampstead Council of Social Service, Burgh House, New End Square, N.W.3. HAM 0049 Hampstead Old People's Welfare Association, 107 Kingsgate Road, N.W.6. MAI 3652 Hampstead Old People's Housing Trust Ltd., Hon. Secretary - Mrs. D.M. Page, 127 Fellows Road, N.W .3. PRI 9860 British Red Cross Society, 33 Lancaster Grove, N.W.3. HAM 7171 63 Women's Voluntary Service, 249 Finchley Road, N.W.3. HAM 9552 National Assistance Board, Old Post Office, Downshire Hill, N.W.3. HAM 9027 Ministry of Pensions and National Insurance, 249 Finchley Road, N.W.3. HAM 9641 L.C.C. Home Help Organiser, 251 Finchley Road, N.W.3. HAM 4136 Mobile Meals Service, British Red Cross Society, 33 Lancaster Grove, N.W.3. HAM 7171 Dinner Club, St. Stephen's Church Hall, Pond Street, N.W.3. Chiropody Service, Hampstead Old People's Welfare Association, 107 Kingsgate Road, N.W.6. MAI 3652 Darby and Joan Club, Wednesdays 2 - 4.0 p.m. St. Stephen's Hall, Pond Street, N.W.3. Darby and Joan Club, Tuesdays 2 - 4.0 p.m. All Souls, Loudoun Road, N.W.8. Darby and Joan Club, Thursdays 2 - 4.0 p.m. St. Mary's, Priory Road, N.W.6. Brondesbury Fellowship Club, Daily 2 - 5.0 p.m. 107 Kingsgate Road, N.W.6. Good Companions Club, Mondays 5 - 8.0 p.m. Moreland Hall, Holly Bush Vale, N.W.3. St. Peter's Vicarage Club, Wednesdays 3-5.0 p.m. Belsize Square, N.W.3. Burgh House Club, Daily 2 - 7.0 p.m. Burgh House, New End Square, N.W.3. Friendship Club, Thursdays 3 - 5.0 p.m. Congregational Church Hall, Lyndhurst Road, N.W.3. Friendship Club, Thursdays 3 - 5.0 p.m. The Synagogue, Dennington Park Road, N.W.6. 64 AMBULANCE FACILITIES The London County Council, as local health authority, is responsible under Section 27 of the National Health Service Act, 1946, for the provision of ambulance facilities within the administrative county of London, free of charge. Ambulances may be summoned as follows :– (1) Accidents (wherever occurring) ) Dial "999" and ask for and sudden illness (in the ) "AMBULANCE" (or follow streets, public places or places ) the instructions given of employment) ) on telephone instrument) (2) Very urgent illness at home - ) Telephone provided a doctor certifies the ) WATerloo 6000 case is one of life or death ) NEW Cross 2645 and that arrangements have been ) RELiance 3622 made with a hospital for the ) CENtral 6301 patient's admission ) REGent 4000 (3) Maternity cases. Where an ) Follow instructions on expectant mother has booked a ) hospital admission card hospital bed, she will be in ) (Form L.A.S.23) possession of a hospital ) admission card. ) In cases of emergency, in the ) Dial "999" and ask for street or other public places, ) "AMBULANCE" (or follow if hospital bed has not been ) the instructions given booked ) on telephone instrument) In all other cases application ) Telephone - HOP 7l8l should be made by a doctor or ) midwife to the Emergency Bed ) Service ) (4) Other illness. For removal to ) Telephone - WATerloo 3311 and from hospital. Application ) or apply in writing to must be made by the hospital ) London Ambulance Service, authority, the Emergency Bed ) County Hall, S.E.1. Service or by a private doctor ) Further particulars may be had on application to the Officer-in-Charge, London Ambulance Service, County Hall, S.E.1. Telephone enquiries relating to the ordering of ambulances to WATerloo 3311; general enquiries to WATerloo 5000, Ext.6950. 65 INDEX PAGE Aged Persons: Cleansing of 26 Clubs 63 Ambulance Facilities 64 Area of Borough 20 Area Comparability Factors 20 Atmospheric Pollution 30 Average Working Wages 2 Bacteriological Examinations: Food 42 Infectious Disease 25 Bakehouses 38, 51 Bathing Centre 26, 6l Births 20 Birth Rate 3,20 British Red Cross Society 62 BuriaIs 28 Certificates of Disrepair 6,51 Certificates of Suitability 51 Chemical Analysis 44 Chiropody Service 63 Cleansing Station 26 Clearance Areas 48 Closing Orders 48 Common Lodging Houses 54 Complaints 37 Contamination of Food 44 Conveniences, Free Washing Facilities 45 Cost of Living Index 2 Darby and Joan Clubs 63 Bay Nurseries 6l Deaths: Chief Causes 4, 21 Death Rate 3, 20 Infant Mortality 3, 20 Maternal Mortality 20 Suicides 5, 8 Demolition Orders 48 Dinner Club63 Disinfecting and Cleansing Station 27 District Nursing Associations 6l Division 2, London County Council l8, 6l Dustbins, Provision of 55 66 PAGE Drainage 38 Dwellings: Structurally Separate 20 Rate Assessments 2,20 Emergency Water Tanks 59 Factories Act: Inspections 38,52 Outworkers 53 Underground Bakehouses 51 Fair, Hampstead Heath 41, 56 Food: Adulterated Samples 44 Bacteriological Examination 42 Bakehouses, Underground 51 Chemical Analysis 44 Food & Drugs Act, 1938, Sec. l4 40 Food & Drugs (Amendment) Act, 1954 39 Food Hygiene at Hampstead Heath Fair 4l Ice Cream 38, 40, 42 Inspections 38, 39 Legal Proceedings 47 Milk41 Premises 38,39 Sampling4l,42 Unsound Food 45 Food Poisoning 25 Free Washing Facilities 45 Hampstead Council of Social Service 17, 62 Hampstead Old People's Housing Trust Ltd, 17, 62 Hampstead Old People's Welfare Association 17, 62 Hampstead Heath Fair 41, 56 Heating Appliances (Fireguards) Act, 1952 59 Home Help Organiser 63 Hospitals 62 Hospital Management Committees l8 House- to -House Inspections 37 Housing: Applications for Rehousing 38, 49 Clearance Areas 48 Closing and Demolition Orders 48 Housing Act, 1949, Section 4 5,37 Housing Act, 1936, Section 9 48 Housing Repairs and Rents Act, 1954 6, 51 Statistics 47 67 PAGE Unfit Houses 48 Overcrowding 50 Ice Cream 38, 40, 42 Infant Mortality 3, 20 Infectious Disease 4, 22 Intimation Notices 38 Loans for House Purchase 5 Legal Proceedings 47, 59 Local Government (Miscellaneous Provisions) Act, 1953 49 London County Council l8, 6l London County Council (General Powers) Act, 953 S.43 26 London County Council (General Powers) Act, 1954 S.12 55 Mass X-ray 24 Maternal Mortality 20 Maternity & Child Welfare Centres 6l Medical Examinations, Staff 27 Milk: Distributors 4l Special Designations, etc. Regulations 4l Supply to Schools and Hospitals 41 Ministry of Pensions and National Insuranc 63 Mobile Meals Service 63 Mortuary 27 National Assistance Act, 1948, Section 50 28 National Assistance Act, 1948, Section 47 29 National Assistance Board 63 National Smoke Abatement Society 18 Neo-natal Mortality 3, 20 Outworkers 53 Overcrowding 50 Pet Animals Act, 1951 58 Pharmacy & Poisons Act, 1933 38, 53 Pleasure Fair By-laws 56 Population 2, 20 Prevention of Damage by Pests Act, 1949 54 Public Analyst's Report 44 Public Conveniences 45 Public Health Committee 17 Public Health Laboratory 25, 42 Public Mortuary 27 68 PAGE Rag Flock etc. Act, 1951 38, 59 Rateable Value 2, 20 Rehousing 38, 49 Retirement Pensions 2 Rodent Control 54 Sampling 4l, 42 Sanitary Circumstances of the Area 36 Scables 26 School Treatment Centres 61 Sewers, Rodent Control 55 Shops Act, 1950 38 Smallpox 23 Smoke Abatement 30, 35 Speech Therapy Centre 61 Staff: Publi c Hea1th Department 18 Inspectorial 36 Medical Examination 27 Statistics: Sanitary Circumstances 37 Vital 20 Statutory Notices 38 Stillbirths 20 Structurally Separate Dwellings 20 Suicides 5,8 Swimming Bath Water 58 Tuberculosis: Chest Clinic 62 Mass X-ray 24 Notification and Deaths 24 Underground Bakehouses 51 Unsound Food 45 Verminous Persons 26 Water Supply 54 Women's Voluntary Service 63