AC.4351 HAMP61 Metropolitan Borough of hampstead. Report on the Health of the Borough. 1960 R. D. DEWAR, B Sc.. M.B. CH.B. D.P.H. Medical Officer of Health. Metropolitan Borough of hampstead. Report on the Health of the Borough. 1960 R. D. DEWAR, B.Sc., M B., CH.B.. D.P.H. Medical Officer of Health. 2 CONTENTS Page Aged and Infirm Persons 20,67 Atmospheric Pollution 31 Factory Acts, 1937 to 1959 58 Food and Drugs 43,61-64 Health Education 34 Housing 35,65 Infectious Disease 11-17,53 Inspection of the Borough 24,57 London County Council Division 2 70 Mortuary 56 Population; Births; Deaths 9,49-52 Public Health Committee; Staff 7,8 Rodent and Pest Control 29 Swimming Baths 25 Statistical Summary 49 Index 73 3 Public Health Department, 98a, Avenue Road, Hampstead, N. W. 3o 2nd May, 1961. TO THE MAYOR, ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF HAMPSTEAD. Mr. Mayor, Ladies and Gentlemen, I have the honour to present my Annual Report on the Health of the Borough during 1960. Some years ago it was not unusual to find the reports of medical officers of health prefaced by some such expression as "the health of the population has remained satisfactory and steady progress has been maintained in improving conditions". This would seem to imply that the public health department had managed to keep its head above water, that its progress had been uninspired and the results achieved had been equally uninspiring. I hope that this is not true of the Public Health Department of Hampstead although the Borough was not visited by any severe epidemic and although living conditions generally continue to improve. It is not unusual to think of the health services in two parts, the personal health services and the environmental services, and as the personal health services are at present the responsibility of the London County Council it may be thought that the Borough responsibility is only for the environment. This however, is not correct. The Borough services are very much concerned with how people live as well as where they live and indeed with the more general acceptance of good living standards the emphasis is much more on how than on where. Nevertheless a great deal of work is still necessary in ensuring that houses are kept in thoroughly habitable condition. The present law has its limitations and the standard of fitness as defined in Section 4 of the Housing Act, 1957, deals with the house itself and not the mode in which it is occupied. During the past year therefore the Council has decided to make increasing use of 4 Section 9 of the Act and Counsel's opinion which has been obtained is to the effect that a part of a house which is separately let can be regarded as a house for the purposes of this Section. To this extent the standards of fitness can be related to the method of occupation of the house as well as to the house as a whole. There are difficulties in the operation of Section 9 which are mentioned in the part of the report dealing with housing. Towards the end of the year the Noise Abatement Act, 1960, received the Royal Assent. It is of interest to note that it amends one of the provisions of the Public Health (London) Act, 1936, by substituting "noise which is a nuisance" for the words ".... noise which is injurious or dangerous to health". It may be taken that the modern view is that something which is an annoyance sufficient to interfere with ordinary good living conditions should be controlled irrespective of its actual effect on health, or it may be regarded as an appreciation of the fact that the words "injurious or dangerous to health" which occur with surprising frequency in other Acts of Parliament have very largely become a legal fiction. Amendment of this phrase is long overdue not only because statements to this effect are almost always incapable of proof but because it should be made quite clear that conditions which interfere with a persons comfort and sound living conditions ought to be capable of correction long before they affect the persons health, that in fact prevention is better than cure. The words "the working classes" were deleted from the housing legislation because of the unrealistic limitation they imposed. The words "injurious or dangerous to health" might well be amended for the same reason. The number of cases of the more serious infectious disease has been low. Contacts of cases of diphtheria and smallpox notified in other parts of London have caused a good deal of work of investigation but have fortunately not developed into actual cases of these diseases. Notifications of respiratory tuberculosis have however remained high and the drop in the notification rate for the country as a whole over the past 5 or 6 years is only now becoming apparent in Hampstead. A summary of the work of the Department under the various headings is given in the Report which follows, but this does not very adequately represent the amount of work done by the public health inspectors on which the organisation of the Department is based. 5 Much of the work of the district inspectors originates from complaints made by members of the public. These are investigated and if they are found to be justified they are dealt with informally if possible, but if necessary by the legal procedures as laid down in the various Acts of Parliament. Where the Council has no powers of enforcement a great deal is done by persuasion and in fact the great majority of the population are very reasonable people and where it is pointed out that there is a cause for complaint which they can remedy, they are generally willing to do so. From time to time however, unsatisfactory conditions and even cases of injustice do arise which cannot be dealt with either by the existing law or by persuasion. Such cases may arise from changes in social conditions, from new methods or techniques in industry and even from the unforeseen results of legislation as well as other causes. If there is evidence that these are not merely isolated cases, it may go by way of the Public Health Committee, the Council and the Metropolitan Boroughs' Standing Joint Committee with an application for new or amended legislation. If such an application were made the evidence to accompany it would largely be obtained by the public health inspectors. This aspect of the work of the inspectors is of importance because it is only by recognition of these unsatisfactory conditions when they arise and of the gaps in the legislation that the law can be maintained in a proper state to deal with modern conditions. We are fortunate in Hampstead that the inspectors and the district inspectors in particular, take a real interest in the welfare of the people with whom they come in contact, that they do recognise new and unsatisfactory conditions when they occur and that they may be delayed but are never deterred by the absence of legal powers. This approach of the inspectors to their work is in a large measure due to the attitude of the Chief Public Health Inspector and the sense of purpose which he has instilled into the Department over the years is one of the reasons why, unlike most metropolitan boroughs, Hampstead has been able to maintain a full establishment of public health inspectors. The increase in the amount of work on housing which required the appointment of a second housing inspector in October, 1959, has continued and the extension of the Council's scheme of assisted house purchase to include flats has added some problems., 6 The food shops in Hampstead and the manner in which food is handled and dealt with can be regarded with some satisfaction and it compares favourably with other areas. In spite of the occasional lapses and the few unsatisfactory conditions found, the improvement in the standard of food hygiene is a credit to the trade and it fully justifies the Council's action in creating a post of Specialist Food Inspector in 1957. I am much indebted to the Public Analyst, Mr. E. Voelcker, for his continuing advice on all food matters. Progress in health education has been good, the number of lectures and talks given has been increased and there is a greater willingness amongst the various organisations to assist in providing audiences. The other sections do not call for special comment here but mention must be made of the Report of the Royal Commission on Local Government in Greater London which was published in the autumn. It would be inappropriate to comment here on the possible effects in Hampstead of the recommendations on Health matters which are in the Report, but however one may view the recommendations and whatever action the Government may take on the Report, one cannot but admire the penetrating analysis which it contains and be encouraged by the views expressed on local government generally, I am grateful to the Chairman and Members of the Public Health Committee for their help and encouragement, and to the Chief Officers and their staffs for their willing assistance at all times. I am much indebted to my deputy, Dr. M. McQuaid and to my staff as a whole. The Chief Clerk and the Chief Public Health Inspector have greatly assisted in the preparation of this Report but all the members of the staff have throughout the year contributed to making the Public Health Department one of which I can be proud to be the Chief Officer. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, R. DUNCAN DEWAR, Medical Officer of Health. 7 PUBLIC HEALTH COMMITTEE The Worshipful the Mayor (Councillor Miss D. E. Newman, J. P. ) ex-officio member. Chairman: Councillor K. Sames, Ph. D. .F.R.I. C. Aldermen S. A.Boyd, M. S. ,F.R. C.S. Mrs. R. S. G. Carnegie Mrs. F. E. Cayford, J. P. , L. C. C. Councillors Miss D. R. Bailey Miss M. du Mont, M.A. V. A. Bonafont D. F. Ridgley W.K.Evans, M.A. Miss J. Silver G. Finsberg, M. B. E.(Vice-Chairman) L. J. Walker The Chairman of the Housing Committee. REPRESENTATIVES ON OUTSIDE COMMITTEES AND OTHER ORGANISATIONS CONCERNED WITH PUBLIC HEALTH WORK Hampstead Council of Social Service: Aldermen Mrs. R. S. G. Carnegie, E. Snowman, O.B.E.; Councillors Miss D. R. Bailey, R. M, Brodtman, S. P. Pyke. The Hon. Mrs. Ruth Bennett. Hampstead Old People's Housing Trust Ltd.: Alderman E. Snowman, O. B. E. ; Councillors Miss S.H. Ayliff, R. M. Brodtman, J. J. Tobin, M.A., LL. B. , Mrs. H. M. Young. Hampstead Old People's Welfare Association: Aldermen Mrs. R. S. G. Carnegie, R. J. Cleaver, L. C. C.; Councillors Miss S. H. Ayliff, Miss E. Beer, Mrs. D. Davis , Miss M. du Mont, M.A. , D. F. Ridgley, A. E. Skinner. Hospital Management Committees: Archway Group: Mr. A. C. Morson, O. B. E., F. R. C. S. , Mrs. M. J. Oatway, S. R. N. Paddington Group: No. 5 House Committee: Mrs. C. L. Sadler. London County Council Divisional Health Committee. Division 2: Aldermen Mrs. R.S. G. Carnegie; Councillors Miss E. Beer, K. Sames, Ph. D. , F.R.I. C. National Society for Clean Air: Councillor K. Sames , Ph. D. ,F„ R„ I. C. The Medical Officer of Health. London and Home Counties Clean Air Advisory Council Councillor K. Sames , Ph. D. ,F. R. I. C. The Smoke Inspector. 8 STAFF OF THE PUBLIC HEALTH DEPARTMENT Medical Officer of Health: - R.D.Dewar, B. Sc. , M. B. ,Ch. B. ,D. P.E ,Barrister-at-law Deputy Medical Officer of Health: - Miss M. McQuaid, L. R. C. P., L. R. C.S(I)., D. P. H. Chief Public Health Inspector: - J. F. Armstrong (a)(b) Deputy Chief Public Health Inspector:- F.V. Outlaw (a)(b) Specialist Inspectors:Old People's Welfare: Housing: Food: Clean Air Act: Health Education: District Inspectors: D. W. Malcolm (a) G. L. Nicklin (a) R.W.M. Cook (a) Mrs. C, G. Speechley (a)(d)(e)(f) L. E. Trigg (a)(b) R. Clark (a) W, F. Newport (a)(b) E. Ulrich (a)(b)(c) G. L. Nicklin (a) C. F. Pidgeon (a) P. C. F. Griffiths (a)(b) A. M. Norton (a) Student Public Health Inspectors:- H. A, Shitta-bey, L. T. Pithers , Miss C. R. Hughes (from 1. 2. 60) Chief Clerk: - Clerical Staff:G. W. Bedell Mrs. M. C. Rabin A. H. C. Slade J. A. Gilbody Mrs, M. Roe Mrs. G. A. Fletcher Public Analyst:- E. Voelcker, A. R. C. S., F. R. I. C., 1 Tudor Street, E. C. 4. Mortuary Keeper:- S. King Public Health Station Keeper:- H. Howe (a) Public Health 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. 9 POPULATION The Registrar General's estimate of the population of Hampstead at mid 1960 was 98,080, an increase of 1,270 over the previous year as compared with an increase of 330 in 1959. The census of 1951 showed that for the 20 years since the previous census the population of London had been reduced by nearly one quarter from 4.4 millions to 3.35 millions and the plans for slum clearance and redevelopment of London as a whole provided for a further reduction. During this 20 year period, however, the population of Hampstead showed an increase from 88,947 to 95,131 - an increase of 7 per cent.. Only two other boroughs had an increased population, Lewisham (3.5 per cent. ) and Woolwich (0.7 per cent. ). Between 1959 and 1960 the population of the County of London showed a further decrease of 9,500 or 0.3 per cent. Most boroughs also showed a decrease in population but five other boroughs showed an increase although in Hampstead the increase was greater than elsewhere both in number and proportion. The Boroughs showing increases were:- Hampstead 1.3 per cent. Kensington 0.43 " Lambeth 0.35 " Lewisham 0.14 " Stoke Newington 0. 08 " Woolwich 0.46 " BIRTHS During 1960 the number of children born alive was 1,682, an increase of 80 over the previous year. The crude birth rate, that is the number of live births per 1,000 of the population was 17.1 as compared with 16.5 in 1959, and the adjusted birth rate which takes into account the proportion of women of childbearing age and allows comparison with other areas was 12.8, an increase of 0.4. Of the births , 882 were male and 800 were female. The 10 number of illegitimate births was 193 or 11.5 per cento of the total live births, an increase of 0.8 per cento over the previous year. The number of still births also increased by 4 to a total of 30. INFANT MORTALITY Thirty-four children under one year of age died and of these 26 were under one week old. The infant mortality rate (deaths of children under one year per 1,000 live births) was 20, compared with 22 in 1959- DEATHS The total number of deaths of Hampstead residents in 1960 was 1,020 giving a crude death rate of 10.4 deaths per 1,000 of the population and an adjusted death rate for purposes of comparison with other areas of 10.5. In 1959 the crude rate and adjusted rate were both 10.9. There are some differences in the deaths from some particular causes as compared with the previous year, but these are either so small or there are factors which influenced the number in 1960 which makes it unwise to suggest any particular trends. For example, the number of deaths from tuberculosis was 4. This is equal to the 1956 figure which was the lowest ever recorded in the Borough and it is in fact less than half the figure for 1958, but had there been two more deaths the number would have exceeded the average of the last five years. In a similar way the deaths from cancer of the lung have increased from 38 in 1959 to 63 in 1960 but the total for 1959 and I960 (101) is less than the total for 1957 and 1958 (108). There was only one death from influenza (19 in 1959) and the deaths from bronchitis (47) shows a reduction of a quarter. Deaths of Hampstead residents from motor accidents, which did not, of course, necessarily occur in Hampstead, rose from 6 to 13, of which four were of persons over the age of 65 years. Other accidents caused 18 deaths (a reduction of 6) and of these twelve of the people were over 65 years of age, ten being over 75 years. 11 INFECTIOUS AND OTHER DISEASES The total number of notifications of infectious disease was 314, the lowest number recorded in the Borough for 20 years. This was due mainly to the small number of cases of measles. The number of cases of measles was comparatively low in 1959 and it was anticipated that there might be some increase in 1960 but this was not so. (At the time of writing this report, February, 1961, the weekly totals of measles cases are exceeding the total for 1960. ) The value of notification of measles appears to be in some doubt. Although measles can be prevented or modified by the use of gamma globulins it is only practicable to do so in those cases, fortunately rare, where an infant is suffering from some other serious disease and becomes exposed to infection by measles. Death from measles is nearly always due to some complication of the disease such as broncho-pneumonia which can usually be prevented or controlled by the use of sulphonomide preparations or antibiotics and there is in fact no practicable method of controlling measles on a large scale. Notifications are consequently used almost solely for the compilation of statistics. In Hampstead, by arrangement with the Divisional Medical Officer of the London County Council, visits are made to notified cases of measles by the health visitors and not by the staff of the Public Health Department. The main purpose of such a visit is presumably to obtain the name of the school or schools which the children of the family attend so that the head teacher can be notified in accordance with Section 192(2) of the Public Health (London) Act, 1936. It is assumed that the head teacher probably knows all about the case anyway and there being little or no action which can be taken, the report is probably filed. It would seem therefore that if measles continues to be notifiable one either breaks the law by not finding out the name of the school attended so that the head teacher can be informed or one wastes the time of doctors, health visitors, clerks, etc. in collecting a great deal of information which is put to no practical use. 12 The notification of measles served a useful purpose in the past but its discontinuance is worthy of some study. In the same way the notification of puerperal pyrexia gives misleading figures and the pyrexia which it denotes may in fact have no relation to childbirth. Some modification of the definition is called fof if the notification is to serve the purpose for which it was intended. A table setting out the notifications of the various diseases is included in the statistical section but several diseases call for some additional comment. Smallpox A man who arrived at London Airport from the Far East in October. 1960, presented himself at the Casualty Department of a London Hospital two days after his arrival and was found to be suffering from smallpox. A number of Hampstead residents who had been in contact with the patient including some whose contact was at the Hospital were kept under surveillance and vaccination or re-vaccination was carried out on those who had not been recently protected. Fortunately no secondary cases occurred in Hampstead. Members of the staff of the Public Health Department are particularly liable to come into contact with any case of smallpox which occurs in the Borough and they were re-vaccinated during the year. Diphtheria A case of diphtheria occurred in a young man who was living in a large block of flats owned by the Council. The patient had been immunised as a child and was not seriously ill. Unfortunately the case was not notified until almost three weeks after the onset of the disease by which time the patient who had been living at home had recovered. In view of the considerable contact that the patient had had with other residents of the flats including a large number of children, it was decided that a fairly wide scale investigation was called for. Nose and throat swabs were taken from almost 200 persons who were living in the block of flats 13 or had otherwise been in contact. Fortunately the causative organism was not found in any case but the occurrence did persuade a number of parents of unimmunised children to have their children protected. Typhoid and Paratyphoid Fevers A case of typhoid fever was notified in 1959 in a native of India who had been resident in England for a period of four months. On discharge from hospital he remained an intermittent typhoid carrier and in August, 1960, he again had a clinical attack of typhoid fever. Although the patient made sati sfactory progress he was found whilst in hospital to be also suffering from pulmonary tuberculosis. The other confirmed case of typhoid fever occurred in a family which had arrived by air a few days earlier from Egypt. The family stayed in Paddington for a few days after arrival and during that time the two children were admitted to hospital suffering from typhoid fever. On arriving in Hampstead the mother was taken ill and admitted to hospital suffering from the same disease. All these patients made a good recovery. Another case which was notified as typhoid fever was a man who had been visiting a mental hospital where there were known to be some typhoid carriers. Bacteriological investigations however showed that the infection was paratyphoid fever, the infecting organism being of the type known as dundee. The source of the infection was not discovered. The other case of paratyphoid fever occurred in a man employed by the Medical Research Council as a stoker. Investigation showed no reasonable source of infection at the place of employment and investigation at his home, at a restaurant in Hampstead and at a restaurant in Westminster failed to disclose the source of the disease. Both the cases of paratyphoid fever made a good recovery. Poliomyelitis There were three confirmed cases of poliomyelitis , all of the paralytic type. The first case was of a child of one year of age who arrived 14 by air from Cairo and was sent direct from London Airport to the hospital in October, 1959. The case was apparently not notified at the time of admission to hospital and the absence of notification only came to light when the child was transferred to the Royal National Orthopaedic Hospital at Stanmore in January, 1960. The second case was also in a child (age 1 year 4 months) who contracted the disease in Egypt also during the month of October (but 1960 in this case). The child who had recovered from the acute stage of the illness was not admitted to hospital and could not be traced at the address which was given in Hampstead. The remaining case was in a young married woman of 23 years who had paralysis of the left shoulder girdle. She had not been immunised. She made a satisfactory recovery. Encephalitis There were four cases of acute encephalitis following attacks of mumps. Three cases were in young women in their middle twenties and one in a man of 43 years of age. Tuberculosis The figures for the notification of tuberculosis are not included with the other notifiable infectious diseases and they are also separated in the tables given in the statistical section. The number of new cases of respiratory tuberculosis was 45 males and 16 females and non-respiratory tuberculosis, 2 males and 8 females as compared with 58, 35, 2 and 4 respectively for 1959. A total of 4 persons died from this disease as compared with 8 deaths in the previous year. The notification rates for pulmonary tuberculosis are given in the table below for the period 1948 to 1958 for England and Wales and for Hampstead for the period 1948 to 1960. 15 16 Year Notifications per 100,000 population England & Wales Males Hampstead Males England & Wales Females Hampstead Females 1948 117 130 86 68 1949 119 150 85 78 1950 111 111 82 88 1951 115 139 81 74 1952 112 125 80 95 1953 110 149 77 74 1954 100 122 68 80 1955 92 118 60 63 1956 88 147 55 51 1957 82 152 49 81 1958 76 124 43 57 1959 143 62 1960 110 28 It will be seen that the rate for the country as a whole remained substantially unchanged until 1953 and then over the next five years showed a decrease of about one third for males and one half for females. In Hampstead the rate has been consistently higher than the national average for males and about the same as the national average for females, and that for both males and females the reduction in the rate is only now showing itself. This position applies not only to Hampstead but also to the adjoining boroughs which comprise the north western portion of the County of London. Mention has been made in previous reports of the reduction in the number of deaths from pulmonary tuberculosis due to earlier ascertainment and improved methods of treatment. The improved treatment which has been available in recent years not only reduces the deaths but can in many cases render and keep a patient non-infectious to other people. In a closed community or one where there is little change in the population the reduction in the number of infectious cases shows fairly quickly in the reduction in the number of new cases, but where there is a considerable change in the population as in Hampstead and north western London generally, the effect is much slower. Another factor which affects Hampstead is the susceptibility of different peoples to tuberculosis. Whilst the chances of contracting tuberculosis depend on the individual, it is 17 generally true to say that in the conditions existing here, the Irish are five or six times more likely to become infected with tuberculosis than the English, Cypriots twice as likely and contrary to the usual belief negroes have only the same susceptibility as the English. The last Census showed that more than 25 per cent. of the residents of Hampstead were born outside the United Kingdom. Further reasons for the high figures of notification of tuberculosis in Hampstead are the excellent facilities which are available and the very high standard of medical care which is provided by the general medical practitioners. It is probable that the ascertainment of cases of tuberculosis is better than throughout the country and that in Hampstead there is a smaller proportion of undiagnosed cases. To summarise, the high figures of notifications of tuberculosis in Hampstead are probably due to the changing population, the high proportion of persons born abroad, and the excellent facilities for diagnosis. I am much indebted to the Chest Physician, Dr. G. Shneerson, for his help and advice. MASS X-RAY During September and October the Mass X-ray Unit visited Birchington Road, Iverson Road, Fortune Green, Haverstock Hill, South End Green, High Street and Chalk Farm. In addition to open sessions for the general inhabitants of the Borough, the Unit arranged special private sessions for many local firms. Altogether a total of 4,401 persons was X-rayed. The best response was obtained at Haverstock Hill and Fortune Green. A complete report on the Unit's activities is not yet available. In the event of any suspicious findings being shown on the first X-ray, the patient is recalled for a large X-ray and then if necessary referred to a chest clinic or the patient's private doctor for further examination and tests. The final report is not available therefore until some six months after the Unit's visit. 18 MEDICAL EXAMINATIONS Appointments to the Council's permanent staff are subject to passing a medical examination which includes a satisfactoryrecent chest X-ray. The X-ray is normally carried out by the permanent mass radiography unit at Drayton Park. Examinations are normally carried out by the Medical Officer of Health (or by the Deputy Medical Officer of Health in respect of female staff). Examinations are also carried out from time to time on Hampstead residents who have been appointed to local government posts in other parts of the country. No fee is charged for the examination. Similarly persons appointed to Hampstead but living at a distance are generally examined in their home area in order to save time and expense in travelling. In these cases where the examination is carried out by or on behalf of the medical officer no fee is paid, but if the examination is carried eut by a general medical practitioner a fee is paid in accordance with the scale approved by the British Medical Association. Seventy-four examinations were undertaken during the year. Twenty-five were in respect of new appointments to the staff; 25 were for transfer to the permanent staff; 22 were in connection with special reports which were required because of absence through sickness; 2 were carried out on behalf of other authorities. Five persons were found to be unfit to carry out their duties and were recommended to be placed on superannuation. NATIONAL ASSISTANCE ACT, 1958, SECTION 50 In nine instances the Public Health Department were called upon to arrange the burial of a person who was either without any known relative or the relatives were unable to meet the cost of arranging a private funeral. The total cost of the burials was £ 99; 16s„ 9d. and of this amount £78. 9s. Id. was recovered from the estates of the deceased, from relatives, or from death grants. In 5 instances the expenses were recovered in full; in 2 cases the whole of the expenses, amounting to £ 13* 15s. Od. were written off; in the remaining 2 cases only part of the expenses was recovered and an amount of £ 7. 12s. 8d. was written off. 19 DISINFECTION AND DISINFESTATION Although disinfection of bedding, clothing or soiled articles is necessary during the course of a number of diseases, disinfection of a room at the end of an illness is probably only necessary in cases of smallpox and possibly tuberculosis. In almost all other cases a thorough cleansing of the room with soap and water is sufficient to prevent the spread of infection from this source. Nevertheless disinfection of rooms after infectious disease has been carried out so generally and for so many years that it would probably be wrong to refuse disinfection where it is requested. To refuse might well cause apprehension in the minds of some members of the public and in any case whilst disinfection is being carried out there is a good opportunity to emphasise the importance of good lighting, proper ventilation and thorough cleanliness. During the year, 124 rooms were disinfected after infectious disease in 100 premises. Disinfestation of premises infested with vermin has changed considerably during the past fifteen years because of the use of insecticides which continue to act over a period of weeks or months as opposed to those used before the war which had no residual effect and which did not in all cases destroy the insects in the egg stage. Massive infestation is rare today but there are still substantial numbers of cases each year in which a few bugs are found and with the greatly improved standards of housekeeping the finding of a single bug will result in a call for disinfestation, Evidence of infestation is not always found but if bugs or fleas are found in any room which is being sprayed the adjoining rooms are also treated. Cockroaches are also not uncommonly found, particularly in some of the older premises and about one quarter of the rooms treated were dealt with for this reason. A total of 350 rooms in 104 premises were treated during I960. In addition to the ordinary disinfection or disinfestation of premises 47 filthy or verminous rooms were cleared after the death or removal of the occupant. There is still a demand for the disinfection of parcels of clothing prior to dispatch abroad and 143 parcels belonging to private individuals were disinfected to comply with regulations 20 in the receiving countries. The normal charge for this service is five shillings per parcel. Regular visits were also paid during the year to two hospitals for the disinfection of wards and laundry. Since July, 1959 a regular weekly collection of approximately 100 blankets has been made from one hospital. Woollen articles are liable to be damaged if they are subject to repeated sterilization at a high temperature and these blankets are given a modified treatment which has been found by experiment to give a satisfactory degree of disinfection without causing damage. The blankets are folded to meet the requirements of the hospital authorities before being returned. The destruction of wasps' nests is also carried out by the department. Forty-two nests were destroyed, approximately half the number dealt with in the previous year. CARE OF THE AGED The proportion of old people in the community is increasing and advances in medicine ensure that an increasing proportion of people reach old age. Aged persons are usually defined as people who have reached the accepted retiring age of 60 years for women or 65 years for men. Many of these people would not describe themselves as old but in the great majority of cases they have reached the end of their working lives. Some who are fortunate enough to have their own businesses continue working long after the accepted retiring age and others continue in either paid or unpaid occupations, but there are many who have to retire against their will but yet feel that they are capable of paying their way in the world. Some of these people find great difficulty in obtaining employment which is within their capabilities and employers who are required to pay a fixed rate for a particular job naturally prefer a younger person in most cases. There is a point of view that people who have worked regularly for forty years or more are entitled to a rest but many of these elderly people feel not that they are being given a rest, but that they are being placed on the rubbish heap. 21 The Old People's Workshop which is run in conjunction with the Hampstead Old People's Welfare Association provides in a limited way for these unfortunate people. It provides paid work so as to maintain the morale of the old person and it also provides that companionship which was available when they were at work and which disappeared when they retired; it is limited in that it can provide for only a limited number of the elderly. The Workshop in Hampstead has increased by having an afternoon session as well as a morning session and there are hopes of opening another workshop which will serve the eastern side of the Borough. It is encouraging to note that a number of persons who have been employed at the Workshop have managed, after a while, to find re-employment in outside businesses. There are many difficulties in continuing the employment of old people. There must be opportunity for promotion or advancement for the younger people; there are in many cases nationally agreed rates of pay for certain jobs irrespective of the employees capabilities; not all elderly people are prepared to continue working for the same firm for a lower wage even at an easier job. Some firms do provide schemes and the National Insurance Act gives a limited incentive by providing for a higher retirement pension if people continue to work after the normal retiring age, but it would seem that in this age when mechanical power has so lessened the importance of physical strength that some greater effort should be made to provide that skills which have been acquired over many years should not be wasted merely because a person reaches a fixed age - to the mutual benefit of the community and the individual. In spite of what has been said above there are comparatively few elderly persons who are in need of the services which the local authority can provide. The great majority can look after themselves or are given the necessary care by their own relatives or friends. The Borough Council has very limited powers and its main function is to ensure that the old people are made aware of the services which are available, such as domestic help or "meals on wheels" or alternatively, that bodies providing these services are informed of the old person's need. The aim of all these services is, of course, to try and make it possible for the old people to remain in their own homes rather than be admitted to a hospital or an old persons home. "Meals on wheels" , the district nurses and the general medical 22 practitioners do a great deal towards this end and the officers of the National Assistance Board carry out their duties with great kindness and understanding, but probably the most useful of all the services is the provision of domestic helps under the London County Council's scheme. When it is remembered that although some of the needy old people have been reduced to these circumstances through no fault of their own, in other cases the cause is the old person's improvidence, intolerance, intemperance or ill-temper, the kindness and generosity of some of the home helps is beyond praise. During the year 137 new cases were found to be in some need. Cases come to light through relatives, neighbours, friends, doctors, nurses, hospital almoners, National Assistance Board officers and the Council's staff including public health inspectors and rent collectors as well as through other channels. The Old People's Welfare Association takes a very active part in the care of old people throughout the Borough and acts in close cooperation with the Borough Council. National Assistance Act, 1948, Section 47 Although the majority of old people can, with the help of the various services, remain reasonably comfortably in their own homes, in a number of cases it is necessary for them to be removed to a hospital or an old people's home. Some of these elderly people refuse to go. Cases may be of sudden illness or the worsening of a long standing one, or they may be cases which have been known to the department for many years where a relative or friend has become ill or died and the circumstances have changed. Most of these cases can be dealt with by persuasion and it is surprising the number of people who will not listen to the advice of their doctor or friends whom they have trusted for many years but who will take advice from officers of the Public Health Department who may be comparative strangers. In a few cases the threat of an application to Court is necessary but in only two cases was it necessary to make an application to the Court for a Removal Order under Section 47. The first case was a woman of about 80 years of age who occupied two rooms in a house but in fact lived in only one of 23 them. She is a frail little woman who gradually became incapable of looking after herself. Both she and the room became dirty, she complained of abdominal pain after eating but she apparently lived on bread and butter and tea only, she had many falls and at times bruised herself severely. Her only method of heating and cooking was an open fire and she refused to have a fireguard. She strenuously refused all offers of help of any kind. The Magistrates made an Order for her removal to Luxborough Lodge (L. C. C.) and her maintenance there for a period of six weeks. Before the expiry of the Order she settled down and has agreed to remain voluntarily and an extension of the Order was not required. The second case was one of a woman of 83 years of age who was much addicted to alcohol and snuff. Her room was extremely dirty and she refused offers of help but she was given some attention by an adult son, a single man who was normally at work all day. She had a severe fall and her doctor, after the limited examination which she would allow considered that she probably had a fractured femur. In spite of the pain which she was obviously suffering she refused to go to hospital or to be properly examined. An Order was obtained under the urgency provisions of the National Assistance (Amendment) Act, 1951, for her removal to hospital and her detention there for a period not exceeding three weeks# Considerable difficulty was experienced in getting her removed to hospital and on arrival there she flatly refused to be put into a bed. After some time it was possible to examine her and to establish that she had not in fact fractured her femur. Partly in the interest of the other patients and in view of the fact that the Order had not stated any fixed period, but only a period not exceeding three weeks, the hospital authorities considered that the Magistrates Order had been complied with and she was allowed home - much to the distress of the other occupants of the house. After a period of discomfort for everybody she recovered from her injury and reverted to her previous way of life, apparently less affected by her experience than those around her. Early in 1961 the unmarried son who looked after her to some extent, became ill and was taken to hospital and it may well be that this lady will feature again in the next Annual Report. 24 PUBLIC HEALTH LAUNDRY In the past a number of people who were incontinent but who did not require any specialised medical treatment were admitted to hospital because it was not possible to make arrangements for the laundering of the soiled articles. The ordinary commercial laundries cannot accept such articles. If the patient was living in an ordinary household this disagreeable task was usually undertaken at home but where a person, usually an old person, was living alone or with only an equally elderly or ill spouse the position became impossible. Home helps have on occasion done this work in some cases in order to save the patient being admitted to hospital but this is not work which they ought to be required to do. The laundry service which operates from the Public Health Station in Lithos Road provides the necessary services for these cases. It is restricted to cases where through age or illness a person is incontinent and where the laddering cannot be done at home. It has made it possible for many people to remain in their own homes rather than be admitted to hospital and the service is greatly appreciated by the District Nurses, home helps, relatives and friends as well as the patient. The soiled articles are collected, laundered and delivered twice a week and the number of persons using the service at any one time has varied from 29 to 34. The total number of articles dealt with during the year was 12,710. SANITARY CIRCUMSTANCES The Ministry of Health requires that this Report should include information on certain points concerning water supply, swimming baths and sewerage. Water Supply All the drinking water used in the Borough is supplied by the Metropolitan Water Board. There are no private wells in use. Routine examination of the water supply is not carried out by the Council but examinations are carried out if any complaint is received or if there is any reason to suspect the purity of any particular supply. 25 The water supply to the whole of the Borough has been satisfactory both in quality and quantity. No samples of raw water have been examined but three samples for bacteriological examination and four samples for chemical analysis have been taken of drinking water from dwellings where there has been a complaint. All the samples were found to be satisfactory. Some of the water supplied by the Metropolitan Water Board has a plumbo solvent action and the 38th report by the Director of Water Examination gives details of an experiment conducted between 1952 and 1958 using a 60 foot coil of lead piping. The report states "These results show that after the pipe had been in use for about two months, the amount of lead taken up by river-derived water left standing overnight was considerably reduced, and that after one year, the amount taken up overnight was reduced to a more or less constant figure of about 0. 3 mg. /I. However, even with a pipe that has been installed for several years, it is still advisable to run the stagnant water to waste first thing in the morning to obtain an entirely leadfree water. " No form of contamination of the water supply was found which require any action by the Council. All the dwelling-houses in the Borough have a piped supply direct to the houses and none is supplied by stand-pipes. Public Swimming Baths The public swimming baths are situated in Finchley Road and consist of three pools. The Fairfax Pool has a capacity of 100,000 gallons and is open throughout the year. The Goldhurst Pool has a capacity of 90,000 gallons and is open during the summer season only from April until September. The Youth Pool holds 45,000 gallons and is open all the year. The water for all three pools is obtained from the Metropolitan Water Board. There is no private well or other supply. The water for all the swimming baths is subjected to a process of continuous filtration through pressure filters and the water is chlorinated in order to maintain as nearly as possible a concentration of two parts of chlorine per million parts of water. 26 The filters used can deal with the total capacity of the pools every four hours and they require cleaning by "back washing" once or twice a week according to the use which is made of the baths. Water used for cleaning the filters in this way runs to waste and is replaced by fresh water from the Metropolitan Water Board. The quantity of water so replaced amounts to about one fifth of the capacity of the bath in the case of the Youth Pool and from one fifteenth to one tenth of the capacity of the two larger baths. In addition to this regular partial replacement of the water the Goldhurst Pool is completely emptied at the end of each summer and the two other pools are emptied every 12 to 18 months for cleaning. Samples of the swimming bath waters are taken regularly for chemical and for bacteriological examination. During I960 ten samples were taken for chemical analysis and 52 samples were taken for bacteriological examination. In all cases the results of examination were satisfactory. Sewerage All the houses in Hampstead are connected to the main drainage system, the sewerage passing eventually to the London County Council's main sewers and to the sewage disposal works outside the Borough. Major reconstruction works to prevent as far as possible the danger of flooding after heavy storms were completed some years ago and have proved satisfactory. No new schemes for sewerage within the Borough are contemplated at the present time. London County Council (General Powers) Act, 1955. Section 27 This section is of considerable benefit to the Department as it cuts out the unreasonable delay often associated with the service of the usual nuisance notices. Essential pre-requisites to the service of such notices are: (a) the Council must be satisfied that the house is in such a state as to be a nuisance or injurious or dangerous to health and (b) having regard to all the circumstances unreasonable delay would be occasioned by the procedure prescribed by the usual nuisance notices. 27 Notices were served in four cases and in two of them the work was executed by the Council in default of the owner at a cost of £36. 10s. Od. This amount is, of course, recoverable and is a Charge on the premises. London County Council (General Powers) Act, 1925. Section 33 Colas Mews Site In view of the unsatisfactory, detrimental and often insanitary condition of the above site caused mainly by street traders, a notice was served by the Town Clerk requiring the site to be fenced off. The site is still mis-used and the fencing has had to be renewed on very many occasions. There is little doubt the site will continue to be a source of nuisance and complaint until it is fully redeveloped. Public Health (London) Act, 1936. Section 40 as amended by Section 6 and Schedule of the London County Council (General Powers) Act, 1951. Drainage. Work was executed by the Council's contractors to the value of £ 1,100 in four cases of the necessary renewal of defective drainage. In each case the owner undertook by agreement to repay the cost to the Council by instalments. Unfortunately, many property owners do not realise the full extent of their liability in respect of underground drainage matters and it often comes as quite a shock when they are informed that the drain under the public pavement and roadway is often their responsibility until it reaches the sewer in the middle of the road. As the sewers in Hampstead are often very deep up to 50 feet in some instances - the cost of the renewal of such a defective drain, together with the necessary making good of the surface of the road and pavement, may well amount to over £500. Very few owners appear to be aware of this contingency. Public Health (London) Act, 1936. Section 93 Removal of Obnoxious Matter In four instances accumulations of refuse were removed from premises after the failure of owners to comply with forty-eight hour statutory notices. The cost incurred has been reimbursed by the owners. 28 Barbers and Hairdressers Barbers and Hairdressers premises are registered under the model Byelaws made by the Council under Section 18, London County Council (General Powers) Act, 1954. One hundred and thirty-two inspections were made and in no instance was it found necessary to serve written notice, such minor defects as were found being dealt with on the Inspector's verbal request. The number of premises on the register at the end of the year was 85. Shops Act, 1950 Lighting, washing facilities, facilities for taking meals, temperature, ventilation and sanitary conveniences are now the responsibility of the Borough Council although the London County Council still operate such powers in respect of seven premises licensed for public entertainment. Seventy-seven inspections were made of shop premises and all were found to comply reasonably with the provisions of the Act. 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. No contravention of the Act was reported. Oil Burners (Standards) Act, I960 This Act came into operation on 1st January, 1961. Several cases occurred in the Borough of oil heaters causing fires and it is hoped that the new legislation will prevent these occurrences in the future. It is anticipated that the main problem will be in persuading persons who already own oil heaters to have the necessary alterations carried out to bring the heaters up to the required safety standard. 29 The Rag Flock and Other Filling Materials 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. One inspection was carried out which showed the premises to be in a satisfactory condition. Common Lodging Houses There are no common lodging houses in the Borough. Road Traffic Act, 1956, Section 42 There is only one shop in the Borough retailing protective helmets for motor cyclists to which this Section applies. Visits were paid and all helmets found to conform to the British Standards Specification. PREVENTION OF DAMAGE BY PESTS ACT, 1949 Destruction of Rats and Mice At least 1,105 properties were surveyed during the year, either because of complaint or for the purpose of ascertaining the possibility of the spread of infestation. In all, some 788 properties were treated and the rodents exterminated. Whilst there has been an increase in the number of complaints regarding mice, the number of rat infestations has fallen since last year by approximately 38 per cent. This may well be due to the very wet summer. It is also interesting to note that surface rat infestations appear to bear little, if any, relationship to sewer infestations. There were, however, nine cases in all where drainage was found to be defective, necessitating partial or complete renewal of the drains before the infestations could be determined. 30 SUMMARY OF SURFACE TREATMENT No. of properties inspected as a result of: Local Authority Dwellings (including Council properties) All other (including business premises) Total Notification 1 764 23 788 Survey - 341 - 341 T otal inspections including reinspections 6 4,347 79 4,426 No. of properties infested by: Rats 1 259 5 265 Mice 505 18 523 Control of Rats in Sewers I am indebted to the Borough Engineer and Surveyor for particulars in regard to the control of rats in sewers. It has been the policy to bait the sewers twice a year but owing to the pressure of other work and the shortage of staff it was only possible to carry out one such service in the year under review. During 1959 in conformity with the wishes of the Ministry of Agriculture Fisheries and Food, we departed from our usual practice of poisoning with zinc phosphide and arsenious oxide in the sewers and experimented with the use of an anti-coagulant "Warfarin". This was contained in polythene bags suspended in the manholes and entrances from step-irons s etc. The result of the first such treatment appeared to be unsatisfactory but nevertheless it was decided to continue the experiment. The results were as follows Number of manholes baited 735 Number of manholes showing partial take 117 Number of manholes showing complete take 1 31 Partial takes trebled those of 1959 and there was one complete take compared with nil previously. Comparative figures when zinc phosphide was used were:- Partial takes 290 Complete takes 60 The Warfarin experiments although unconvincing are worthy of continuation. The effect of sewer surcharges, etc. on the use of captive polythene bags as opposed to free baiting with zinc phosphide has still to be assessed. There is also the question of the resistance of rodents to certain poisons to be considered. ATMOSPHERIC POLLUTION This work is carried out by Mr. E. Ulrich with two assistants Miss B. P. Dimmock and Mr. J. A. Woodman. As in previous years the Department's work in connection with air pollution can be grouped Tinder three main headings. Investigation of Atmospheric Pollution Cooperation with the Department of Scientific and Industrial Research continued throughout the year. Daily readings of smoke and sulphur dioxide concentration were taken from the continuous filter at the Health Department and monthly analyses of measured rainfall collected in the standard deposit gauge were also provided for the Department of Scientific and Industrial Research. Readings from the deposit gauge, together with further information on sulphur activity in the air have also been taken and passed on to the Department of Scientific and Industrial Research since 1953 as part of the build-up of a picture of the distribution of air pollution over the whole of the country. It is now known that the information provided by the deposit gauge and the lead peroxide candle is extremely localised in its application and should only be taken as definitive of the degree of air pollution existing close to that particular instrument. The readings from any one such instrument cannot therefore be taken as an indication of the pollution levels for the area and even the average of readings from several instruments will give only a very approximate figure. A further drawback is that the 32 deposit gauge and lead peroxide candle give only monthly figures and there can be no indication from them of the day-to-day variations. Whilst the instruments may still be of use for obtaining purely local information it did not seem to be reasonable to continue their use solely to enable the monthly reports to be sent to the Department of Scientific and Industrial Research and readings were discontinued on 31st December, I960. There have been improvements in the continuous filter which by means of a small electrically operated pump draws a measured amount of air through a piece of filter paper to remove the smoke particles and then through a solution of hydrogen peroxide to absorb the oxides of sulphur. There has been more particularly improvement in assessing the density of the stain on the filter paper which gives a measure of the amount of smoke in the air and it is hoped that this will lead to a much more accurate assessment of the effects of smoke control procedure. Smoke Nuisances A total of 37 alleged or actual smoke nuisances were investigated during the year. These included garden bonfires, smuts and fumes from domestic oil-fired boilers, emissions from a cinema chimney and burning on building sites. No prosecutions proved necessary and indeed very little formal action was taken. Almost invariably it is found that practical advice and the suggestion that a question of being unneighbourly arises is fully effective and there is no doubt that causing smoke in any quantity is increasingly being accepted as anti-social. The two chronic individual aggravations in this borough remain as before. The plant at a hospital continues to emit quantities of dark smoke at frequent intervals in spite of every cooperation from the staff operating it. Variations of fuel and running adjustments prove mainly ineffectual while a quite basic and fairly costly modification to the air-feed system appears to have improved matters in some respects but worsened them in others. Plans are already in hand for the complete reconstruction and modernisation of the hospital and while contact with the management board, and occasionally some pressure, have been maintained, it cannot be considered reasonable to require replacement of the out-worn boiler plant at this time. 33 The vent shafts from the numerous railway tunnels which traverse beneath a large part of the borough have inevitably continued to cause annoyance. Increasing use of diesel locomotives is reducing the amount of visible smoke and the Government's decision to go ahead with electrification of the main line to the north-west will eventually reduce this problem to tolerable proportions. Smoke Control Areas The No. 1 Control Order became operative on the 1st September, 1959 and the No. 2 Order on the 1st November, 1959. Observations over the winter months at the end of that year and the beginning of this showed that the orders were almost entirely effective. There were some instances of householders using up existing stocks of coal and a few others who claimed they had no knowledge of the Order. Claims for conversion grants have been considerably fewer and costs per conversion have been higher than anticipated (and estimated) and, as this circumstance now appears to be the general rule, allowance for it will be made in subsequent areas. A Smoke Control Order (No. 3) was made in October covering some 7,000 premises and confirmation by the Minister is awaited with proposed date of operation to be 1st October, 1961. Approximately 11,000 visits were made in connection with this one smoke control area. Despite this large number of visits it has been impossible to gain entry into all the dwellings for the purpose of inspection. Reasonable estimates of the amount of fuel now used and probable requirements of smokeless fuels are, of course, necessary before the Minister can confirm an Order but some modification of the procedure would seem to be desirable to effect a fair balance between pure guesswork on the one hand and the expenditure of an inordinate amount of working time on arriving at an estimate which may in fact be far from correct. The detailed survey of Area No. 4 which comprises some 3,700 houses in the eastern part of the borough was started in the late autumn and a serious attempt is being made to reduce the number of ineffective visits by the use of reply paid cards which the householders are asked to fill in and return. Increased publicity is also necessary if the cooperation of the residents is to be obtained. 34 HEALTH EDUCATION Health education is a part, and an important part of the work of every public health inspector, but it is generallylimited to advice given to separate individuals. During the year a substantial effort has been made to promote health education amongst groups of people. A comprehensive programme has been devised covering Home Safety, the Work of the Public Health Inspector, Nutrition, Diet, Food Hygiene, Food Sampling, Water Supply, Infectious Disease, Old Age and Hygiene in the Home. All the subjects are supported with visual lecture aids including film strips, slides, photographs, etc. Every Church Group and the several social and political organisations in the borough have been notified of the lecture and demonstration services available and an encouraging response has been received. The average age of audiences has been relatively high and an attempt has been made throughout the year to promote Home Safety as the Department's principal theme. The Women's Voluntary Services and the British Red Cross Society have both included lectures and demonstrations from this Department in their programmes and discussion groups in youth organisations have been held Tinder our leadership. The year's activity in this field has reinforced the impression for the need for education of the public in health matters, particularly in the prevention of disease or accident. It has also shown that the difficulty in securing an audience is still the primary problem. When once a lecture or demonstration has been given and some interest aroused there is no difficulty in arranging others for the same group, but arranging the first meeting often involves a lot of hard work. We are fortunate in that Mr. Nicklin who is mainly responsible for this aspect of the Department's activities has a particular aptitude for the work, which is recognised not only in Hampstead but by his colleagues throughout London. Early in the year he gave a paper entitled "Techniques in Health Education" at the Hampstead Town Hall to the Public Health Inspectors' Association, which was also attended by Members of the Council and at which the Mayor very kindly presided. He also took part in a joint paper on "Health Education and Public Relations" delivered at an inspectors week-end school at Clacton. 35 HOUSING There are virtually no areas remaining in Hampstead which can be dealt with under slum clearance procedure. There are still several small areas which were included in the slum clearance programme and in which some of the dwellings are still occupied. None of these areas is suitable for redevelopment and some of the dwellings have been so improved that they are not now representable. The remainder will be dealt with by closing or demolition orders as and when it is possible to rehouse the occupants if they are not previously improved. The absence of areas suitable for clearance does not mean that there are no unsatisfactory dwellings in Hampstead. There are many well built and substantial dwellings which in themselves are not unfit but which are so occupied as to create unsatisfactory living conditions. The Government's proposals concerning houses in multi-occupation may well be a great help in dealing with these cases. In addition, particularly in the Hampstead Village area, there are many small houses which are extremely crowded with very narrow streets and in some cases in a poor state of repair. A great many of these houses have been listed as being of historical or architectural merit and there is no doubt that if this area were redeveloped with wider streets and less crowded houses, the whole character of the district would be changed - and the local feeling is that the change would be for the worse. These small houses command a high price although it is often necessary to spend in addition to the cost price a sum comparable with the cost of building a new house, in order to put them into a satisfactory state. A number of these houses are occupied by tenants at controlled rents with security of tenure. The value of the property which is so occupied may be insufficient to allow for all the necessary repairs to be carried out at a reasonable cost. Irrespective of the architectural merit of the premises, a demolition order is usually impracticable because of the condition of adjoining properties and if a closing order is made and the house vacated, there is an immediate increase in the value of the property so that the expenditure of some thousands of pounds on repair is "reasonable". 36 Although the Council has no legal liability for the rehousing of the occupants from a house on which a closing order has been made, in the interests of the tenants the moral responsibility is usually accepted. The effect of a closing order would, therefore, be that a private owner would have the value of his property tremendously increased at the expense of persons on the Council's housing waiting list although there would also be an unfit house made fit. In practice the Council has not been asked to make closing orders on this type of property but a number of owners have made offers to tenants of sums of money, and occasionally quite substantial sums, to vacate the premises and some of them have accepted. People who live in Hampstead are rightly and understandably most anxious that the charm and character of the older part of the town should be preserved. Preservation means, of course, that some things which are bad are preserved along with fhe good and there have been considerable difficulties in some cases in providing adequate natural lighting and ventilation in some of the renovated houses and there have been other problems connected with the preservation of the external appearance and with the extremely limited sites which some of the houses occupy. The renovations have, however, usually been most skilfully carried out and the standard of workmanship has been generally high. A problem in Hampstead which is perhaps more difficult of solution than in many other areas is the shortage of garages. The large number of cars left in the street at night gives some idea of the extent of this shortage* Many of the large houses which were built in the early part of the century are in terraces or built so closely together that there is no possibility of providing a garage or space for a garage without major alterations to the house. Although motor cars were in use at the time when the houses were built, the cars and the horse drawn carriages were presumably relegated to mews which have now no connection whatever with the houses which they used to serve. Many of the houses are very well built and with reasonable maintenance will last for another fifty years and there is no reason to suppose that the use of the motor car will decline. The use and possession of a car is bound up with our standard of living and unless some solution to the garage problem can be found it may be that it will have some effect on the type of occupation of houses in some parts of the Borough. 37 A considerable amount of building has been carried out in Hampstead. The number of new dwellings (houses and flats) built by private enterprise in I960 was 55 (19 premises). The Borough Council has been very largely concerned in dealing with the problems of the derequisitioning of houses and has provided 449 dwellings (134 premises) by the conversion or repair of existing houses. During the year 27 new flats were completed and schemes for the redevelopment of the Fleet Road area and parts of the Abbey Estate are in an advanced stage. Housing Act, 1957. Section 9 For some years the repair of houses required by the Council has been largely confined to those cases in which the tenant has made complaint and action is generally taken under that part of the Public Health (London) Act, 1936 which deals with statutory nuisances. This procedure, however, has its limitations and whilst a great deal of work of repair is undoubtedly done of which the Council is unaware, much remains undone because the tenants, with or without security of tenure, are often unwilling to complain to the Council because of possible repercussions from the landlord. This applies particularly, of course, to furnished tenancies. The Public Health Committee has therefore agreed that an increased number of houses should be inspected where it is thought that defects exist, although no complaint has been received and that greater use should be made of Section 9 of the Housing Act, 1957. This Section allows for the service of a notice requiring works to be done if a house is unfit for human habitation and if it can be made fit at reasonable cost. Unlike the Public Health (London) Act it can be used where a house is unoccupied and it does allow for certain items to be included which could not be dealt with by a nuisance notice. In addition, the subsequent sections of the Act allow the Council to carry out the necessary works in default. On the application of Section 9 of the Housing Act, 195 7 to a part of a building, there appeared to be some doubt and Counsel's opinion was obtained. This was to the effect that a part of a house which was separately let was a "house" for the purposes of this Section. It follows that any separate letting 38 even if it be only one room, can be required to comply with the standards as set out in Section 4 of the Act, Reasonable compliance with this Section is taken to be that there shall be a piped water supply with a sink and proper drainage for each "house" and that the watercloset shall be reasonably accessible and available, meaning that it shall not be at a further distance than one storey of the building from the floor or floors on which the "house" is situated, it shall not be necessary to pass through a room or rooms let to another person and that the watercloset shall not be shared by more families than is reasonable. The standard for the number of families to share a watercloset has been agreed by all Metropolitan Borough Councils and is that where practicable there should be one watercloset per family and that as a minimum there should be one watercloset for eight persons or for four rooms. There are, however, several severe drawbacks to this procedure, the first being delay. Under the nuisance procedure an intimation notice can be served at once and a statutory notice as soon as approval is given by the Public Health Committee and in practice the majority of cases are dealt with without the necessity of serving a statutory notice. Under Section 9, the notice cannot be served until the case has been considered by the Committee and as the Council may in the future be involved in some liability if the work is carried out in default, it is generally necessary to serve a notice under Section 170 of the Housing Act, 1957 to ensure that there is full and correct information as to the ownership of the property. It is also necessary to carry out a detailed survey of the whole house, to prepare a schedule of works to be done and to make an estimate of the cost of these works. A valuation of the property must also be obtained because the Committee must be satisfied that the work can be done at reasonable cost before the notice is served. In deciding whether the repairs can be carried out at a reasonable cost the Council, having regard to a number of Court decisions 8 has decided that where the cost of repairs is less than 70 per cent, of the value that the house would have when the repairs are done, this may be considered reasonable. A reasonable time must be allowed for the work to be done and this must be not less than three weeks and where a good deal has to be done a longer period must be allowed. 39 The owner is, of course, entitled to appeal to the Court if he considers that the notice is unreasonable on the grounds that the work required to be done is excessive or that it cannot be done at a reasonable cost« If the work is not done by the owner or other person on whom the notice is served, the Council maydo the work in default* In order to ensure that the cost of the work is reasonable several tenders must be obtained and to do this a much more detailed specification of the work must be prepared including such things as the quality of the material used. All this procedure can lead to a very considerable delay and it is, therefore, not surprising that where a housing defect is causing much discomfort to a tenant the much quicker and simpler procedure under the Public Health (London) Act is commonly used although the final results are less satisfactory. In addition to the extra amount of work involved in getting the repairs carried out, and this may be considerable where the work is carried out by the Council in default, the Treasurer's Department has a great deal to do in default cases and although the financial position of the Council is safeguarded it may take a long time before the whole of the expenses incurred are recovered. Difficulties also arise where the responsibility for repairs has been passed to a tenant by a tenancy agreement. The number of agreements making the tenant responsible for repairs is increasing and it would obviously be unjust in the case of short leases to require the tenant to carry out major repairs which have been made necessary by the lack of maintenance by the freeholder or head lessee over many years. Proposed new legislation is likely to overcome this difficulty in the future. Summary of action taken under Section 9 The following table gives details of the premises reported as being suitable for action in accordance with the above mentioned repairs section:- The cases came to light as the result of house-to-house surveys carried out by the district public health inspectors and the housing inspector. The remaining houses inspected in this way - 173 - were dealt with whenever necessary by the service of notices under the Public Health (London) Act, 1936. 40 Action taken under Section 9 Road Estimated value of house Estimated cost of repairs Result Ariel Road £ 1,700 £430 Work in progress by owner. Ariel Road £2,500 £610 do. Belsize Road £3,000 £ 1,200 Work completed by owner. Fleet Road £750 £370 Work in hand by owner. Fordwych Road £3,000 £ 1 ,450 Notice served. Gas cony Ave. £ 1,980 £690 Work being carried out by Council in default of owner Iverson Road £3,250 £ 1,200 do. Lowfield Road £700 £294 Work completed by owner. Lowfield Road £ 1,500 £500 do. Lowfield Road £700 £240 do. Loveridge Rd. £2,500 £310 do. Loveridge Rd. £2,600 £ 1,100 Work in progress by owner. May grove Rd. £2,100 £700 do. Priory Terrace £3,180 £2,513 Premises now vacant. Owner to improve and convert. Ravenshaw St. £ 1,500 £450 do. It will.be seen that the estimated cost of repairs necessary in these 15 cases varied greatly - from £240 to £2,513 - but in no case was the cost adjudged to be unreasonable having regard to the value of the property concerned. In only two cases did the owners default and the Council was obliged to prepare specifications for tenders and to instruct builders to proceed with the works on their behalf. Housing Act, 1957. Sections 36 and 90 Whilst increasing use is being made of Section 9, it has been found that there are considerable drawbacks to the use of Sections 36 and 90 which are intended to deal with houses which are in multiple occupation. 41 One of the major problems in Hampstead is that many large and substantial houses which were built originally for single family occupation have now been let to a number, and sometimes a large number of families without sufficient increase in the sanitary facilities available. Section 36 allows a local authority to require , inter alia, the provision of additional water supplies and additional waterclosets but the owner is given the alternative of reducing the number of occupants rather than providing the additional amenities. Moreover if the owner chooses this alternative, the tenants lose their protection under the Rent Acts. With the continued shortage of houses in London and the considerable increases in the rents of privately owned properties some landlords are only too anxious to obtain vacant possession of houses or even rooms which are subject to controlled tenancies and it is not unlikely that a notice served under Section 36 would be used for this purpose even if the necessary additional amenities were provided at a later date. In these circumstances the Council would hesitate to serve a notice which would lead to the eviction of tenants whom the Council could not rehouse except at the expense of those already on the waiting list. Section 90 concerns the number of people occupying a house and action under it would again lead to the eviction of some tenants. The main difficulty with this Section is that action cannot be taken until the over-occupation of the premises has occurred. If the Housing Bill which was published in February, 1961 , becomes law in its present form it will remove these difficulties. Loans for House Purchase and Improvement Grants A number of houses are put in good repair and brought up to a satisfactory standard by the operation of the Council's scheme for granting loans for house purchase under Section 43 of the Housing (Financial Provisions) Act, 1958. As the property is the security for the Council's loan it is important that the property should be put in a good state of repair, have all the proper amenities and be maintained in a satisfactory way throughout the term of the loan. The owners, who must also be occupiers of at least part of the premises, are usually only too willing to meet the requirements of the Council and to agree to a proper occupation of those parts of the premises which are let to tenants. 42 Similar results are achieved to those which would be obtained by the service of notices under Section 9 of the Housing Act, 1957. It is because of the repair, improvement and maintenance aspects of the scheme that the surveys and reports which are necessary before a loan can be approved &re made by the Housing Inspector. The Council's scheme has been extended to include loans for the purchase of leases on flats and whilst this does present some additional problems, it assists to a small degree in the maintenance and improvement of the whole block of flats as well as the particular flat which is the subject of the loan. On somewhat similar grounds surveys of houses where there has been an application for a discretionary improvement grant under Section 30 of the Housing (Financial Provisions) Act, 1958 or a standard grant under Section 4 of the House Purchase and Housing Act, 1959, are dealt with by the Public Health Department. Whilst the applications for loans for house purchases are quite high the number of applications for improvement grants are comparatively low. Presumably all the house agents dealing with local property know of the Council's scheme for loans and in their Applications for Loans for House Purchase Year Received Granted Refused or withdrawn or under negotiation at end of year 1959 130 52 78 1960 126 45 81 Total since 1951 692 380 312 Applications for Improvement Grants - Standard & Discretionary 1959 37 12 25 I960 48 25 23 Total since 1954 163 90 73 43 own interest as well as that of their clients they bring it to the attention of prospective purchasers. The provisions for making improvement grants do not appear to be so well known in spite of the publicity which has been promoted by the Council. It may be that the builders who are more generally concerned with improvements, are either not as well informed or that they do not see the same need or obligation to advise their clients as the house agents do with regard to purchase. INSPECTION AND SUPERVISION OF FOOD The great increase in the prepacking of many commoner foods brought about by the adoption of self-service methods has necessitated close observation and frequent sampling to check their contents and the correctness of their labelling. Many new varieties of canned and packeted food have appeared on the market during the year, most of which are of foreign origin. These commodities are continually being submitted, informally, to the Public Analyst for approval as they appear in local shops. On the whole, the results have been reasonably satisfactory and importers have immediately arranged to rectify any errors of omission or commission, particularly with regard to the labelling requirements of the Food and Drugs Act, 1955. There appears to have been an increase locally in the number of complaints of "foreign bodies" in food, dirty milk bottles, the sale of mouldy articles of food and the like. All these complaints were thoroughly investigated and where the offences occurred in articles manufactured outside the borough, a report was obtained from the Medical Officer of Health in whose area the food premises were situated. Legal proceedings were authorised in respect of five such offences but the cases were not heard until 1961. Chemical Sampling of Foods Mr. Eric Yoelcker, A. R. C.S. , F.R.I.C. , Public Analyst to the Borough, has examined and reported upon 501 samples which can be classified under the following broad headings:- 44 Milk, cream, butter, margarine ... 24 Cheese, cheese spread ... 39 Fish, shellfish, fish products ... 31 Meat, meat products ... ... 100 S oup .*. .•. 4 Vegetables, fruits ... ... 44 Fruit drinks, juices, syrups ... 25 Sauces, pickles, oils, spices, flavourings, etc. ... ... 56 Jam, honey, syrup ... ... 10 Flour, flour products, cakes, puddings 26 Beverages ... ... 7 Spirits ... ... 43 Nuts ... ... 11 Ice cream, water ice ... 26 Sweets, confectionery ... 35 Rice ... ... 5 Miscellaneous ... ... 15 ToT Eleven samples of milk proved satisfactory, the average milk fat content being 3. 51 per cent. The legal minimum is 3 per cent. Two dirty milk bottles were examined to ascertain the nature of the contamination. There were 21 adulterated or unsatisfactory samples, details of which are given in the Statistical Summary. Bacteriological Sampling The trend towards the self-service store has become more marked and appears to have contributed considerably towards the maintenance of a higher bacteriological standard for perishable goods since such premises have of necessity to be provided with adequate refrigerated storage and display cabinets. Unintelligent use of refrigeration is responsible for considerable spoilage of food and when equipment breaks down losses in surrendered food are considerable. In fact, they account for a considerable proportion of the unsound food specified in the Statistical Summary. One of the principal dangers in this new retailing system lies in the failure to "rotate" stocks systematically. This 45 may result in food, the condition of which is obscured by its wrapping, being sold for consumption long after it has ceased to be wholesome. Details of samples taken also appear in the Statistical Summary. Food Hygiene (General) Regulations, 1960 These Regulations amend and consolidate the Food Hygiene Regulations, 1955 to 1957 and bring within their scope the handling and service of food on board "home-going" ships, and certain other vessels, docks, warehouses, cold stores, carriers premises and other special types of premises which were excluded from the original Regulations. Inspections of all types of food premises to ensure compliance with the Regulations are made by the Food Inspector and the District Public Health Inspectors. The requirements relating to the protection of food from the risk of contamination, personal cleanliness, the carrying and wrapping, etc. of open food and the notification of infections are still strictly enforced. Written letters of caution were sent to twenty shopkeepers and street traders regarding breaches of Regulation 9(e) which states:- "A person who engages in the handling of food shall while so engaged refrain from the use of tobacco or any other smoking mixture or snuff while he is handling any open food or is in any food room in which there is open food". Legal proceedings in respect of smoking offences in food premises resulted as follows:- Greengrocery Assistant (4th offence) Fined £5. Costs £1. 1s. 0d. Greengrocer " £2. " £1. 1s. 0d. Street Trader " £2. " £2. 2s. 0d. A second street trader also prosecuted for a similar offence was impersonated in Court by another street trader and the summons was therefore ineffective. Efforts have been made to trace the original offender but he appears to have foresaken street trading, at least in the Kilburn area. 46 Generally street food traders appear particularly to resent the prohibition of smoking imposed by these Regulations, so much so that on more than one occasion the inspectors were threatened with physical violence when attempting to caution offenders. In view of the general difficulties associated with street traders, the Council decided by Resolution that Section 22 of the Food and Drugs Act, 1955 which requires an itinerant vendor of ice cream to display his name and address on his vehicle or container, should be extended to cover itinerant vendors of any food. * Special waterproof cards containing names and addresses were then printed and handed to each of the known street food traders for display on their barrows and/or containers. It was possibly significant that towards the end of the year there appeared to be a marked reduction in the number of "barrow boys" serving food in the Colas Mews area, also the number of traders who appear to have permanent pitches on the forecourts of Kilburn High Road had likewise diminished. This may be purely temporary but I feel in view of the lack of cooperation from these traders on hygiene matters particularly, it is a move in the right direction. Catering Hygiene - Hampstead Heath Fairs The Food Inspector together with other members of the inspectorial and manual staffs, has as usual devoted much time and attention to the catering hygiene of the traditional Hampstead Heath Fairs throughout the period of Easter, Whitsun and August Bank Holidays. Extensive sampling, both chemical and bacteriological has been undertaken and the stalls and vans repeatedly visited to ensure full compliance, as far as possible, with the Food Hygiene Regulations. During peak business periods, conditions under which food is handled and consumed inevitably deteriorate under the difficult local conditions existing. It is unlikely that ideal hygienic conditions will obtain with the restricted space and facilities available in vans and stalls on the present clinker and ash standing. Unless there is to be a radical change in the lay-out of the refreshmeitareas involving some form of permanent properly 47 paved area with a water supply away from the dust and fumes of the fairground machinery, it is useless to expect substantial improvement. It is obvious, however, that this will be unacceptable from many aspects and in the meantime the results are not altogether disheartening. Samples taken - Bacteriological Satisfactory Unsatisfactory 93 76 17 Nine of the unsatisfactory samples were shellfish and attempts are still being made in cooperation with the Fishmongers Company to try and ascertain the point at which the contamination revealed by the high plate count, takes place. Only one ice cream out of 24 samples taken was found to be Grade 4 and the attention of the manufacturer was drawn thereto. A subsequent sample was Grade 1. Samples taken - Chemical Satisfactory Unsatisfactory 66 66 Nil Underground Bakehouses The single underground bakehouse remaining in the borough has been issued with a quinquennial Certificate of Suitability under the Factories Act, expiring on the 31st March, 1964. Regular visits are paid in order to ensure the maintenance of a satisfactory hygienic standard of production. Meat There is no slaughterhouse in the borough. A regular inspection of shops and cold stores has been maintained. Ice Cream No ice cream is manufactured in Hampstead. Fourteen premises were registered for the sale of ice cream under Section 16 of the Food and Drugs Act, 1955. In each case the ice cream is wrapped. The total number of premises registered is 259. 48 Twenty-three samples of ice cream were examined by the Public Analyst. The average fat content was 9. 93 per cent. ; the lowest fat content was 7. 79 per cent. Bacteriological examination was made of 24 samples, of which 1 was unsatisfactory and appropriate action was taken. Cooked Foods Sixty-five premises are registered for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food, comprising the following types of premises:grocers, provisions, butchers, delicatessen, factory, fried fish, cafe, cinema. Unsound Food One hundred and thirty-six certificates were issued in respect of unsound food. The items of food concerned are listed in the statistical summary. Where possible, unsound food is salvaged for use either for animal feeding stuff, soap manufacturing or other industrial purposes. Other condemned food is either destroyed at the Public Health Station or removed to the Council's Dust Wharf for disposal with other trade refuse. 49 STATISTICAL SUMMARY Area of Borough 2,265 acres No. of structurally separate dwellings, Census 1951 23,010 No. of private households , Census 1951 35,970 No. of separate rating assessments of dwelling houses 23,702 Rateable Value, March I960 £2,242,780 Sum produced by Id. rate £ 9,064 Population: Registrar General's Estimate mid-1960 98,080 Estimated iPopulation of Children 30th June, 1960:Under 1 1-4 Total under 5 5 - 14 Total under 15 1,560 4,440 6,000 8,600 14,600 Live Births: Legitimate: Males 785 Females 704) Illegitimate: " 97 " 96) Total:- 1,682 Live birth rate per 1,000 population 17. 1 Illegitimate live births per cent, of total live births 11. 5 Area Comparability Factor 0.75 Adjusted birth rate 12.8 Still-births: Males 20. Females 10 Total:- 30 Still-birth rate per 1,000 live and still-births 18 Total live and still-births 1,712 Infant Deaths: Males 17. Females 17 Total:- 34 Neo-natal deaths (first 4 weeks of life)(M. 13. F„ 14.) 27 Early Neo-natal deaths (first week of life)(M.. 13, F. 13. ) 26 Infant Mortality Rates: All Infants per 1,000 live births 20 Legitimate infants per 1,000 legitimate live births 18.8 Illegitimate infants per 1,000 illegitimate live births 31. 1 Neo-natal deaths per 1,000 live births. 16. 0 Early Neo-natal deaths per 1,000 live births 15.5 Perinatal Mortality Rate (still -births & deaths under 1 week per 1,000 live and still-births) 32. 7 Maternal deaths (including abortion) 1 Maternal mortality rate per 1*000 live and still-births 1 Deaths: Males 442. Females 578 Total:- 1,020 Death rate per 1,000 population 10.4 Area Comparability Factor 1.01 Adjusted death rate 10.5 CAUSES OF DEATH i960 Cause of Death Total Males MALES - AGES Total Females FEMALES - AGES Total Males & Females 0 - 1 - 5 - 15 ~ 25 - 45 . 65 - 75 - 0 - 1 - 5 - 15 " 25 - 45 - 65 - 75 - Tuberculosis respiratory 2 - - - - 1 - 1 - 2 - - - - 1 - - 1 4 Tuberculosis other - - - - - - - - - - - - - - - - - - - Syphilitic disease - - - - - - - - - 1 - - - - - 1 - - 1 Diphtheria - - - - - - - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - - - - - - - Meningococcal infections - - - - - - - - - - - - - - - - - - - Acute poliomyelitis - - - - - - - - - - - - - - - - - - - Measles - - - - - - - - - - - - - - - - - - - Other infective and parasitic diseases 2 1 - - - - 1 - - 1 - - - - - 1 - - 3 Malignant neoplasm, stomach 11 - - - - 1 3 4 3 13 - - - - 1 4 4 4 24 Malignant neoplasm, lung, bronchus 49 - - - - 1 24 11 13 14 - - - - - 7 2 5 63 Malignant neoplasm, breast - - - - - - - - - 25 - - - - 3 11 9 2 25 Malignant neoplasm, uterus - - - - - - - - - 12 - - - - 1 4 3 4 12 Other malignant and lymphatic neoplasm 58 - - - - 5 16 17 20 60 - - - - 3 18 12 27 118 Leukaemia, aleukaemia 2 - - - - - - 1 1 4 - - - - - 1 1 2 6 Diabetes 2 - - - - - - 1 1 2 - - - - - - - 2 4 Vascular lesions of nervous system 46 1 - - - - 16 16 13 77 - - - - - 11 22 44 123 Coronary disease angina 103 - - - - 7 39 27 30 112 - - - - - 11 31 70 215 Hypertension with heart disease 2 - - - - - - - 2 10 - - - - - 1 4 5 12 Other heart disease 29 - - - - 1 5 6 17 58 - - - - - 2 12 44 87 Other circulatory disease 10 - - - - - 2 2 6 29 - - - - - 2 4 23 39 Influenza 1 - - - - - 1 - - - - - - - - - - - - Pneumonia 24 2 - - - - 4 5 13 24 1 - - - - 2 3 18 48 Bronchitis 30 1 - - - - 5 10 14 17 1 - - - - - 2 14 47 Other diseases of respiratory system 2 - - - - - 1 - 1 4 - - - - - - 1 3 6 Ulcer of stomach and duodenum - - - - - - - - - 4 - - - - - - 2 2 4 Gastritis,enteritis and diarrhoea 2 - - - - 1 1 - - 8 1 - - 1 - 2 - 4 10 Nephritis and nephrosis - - - - - - - - - 3 - - - - 1 - 1 1 3 Hyperplasia of prostate 6 - - - - - - 2 4 - - - - - - - - - 6 Pregnancy,child birth,abortion - - - - - - - - - 1 - - - - 1 - - - 1 Congenital malformations 3 2 - - 1 - - - - 3 2 - 1 - - - - - 6 Other defined and illdefined diseases 35 10 - 1 1 - 6 10 7 59 12 1 - - 2 11 11 22 94 Motor vehicle accidents 6 - - - 2 2 - 1 1 7 - - - - 2 3 2 - 13 All other accidents 7 - 1 - - 1 2 - 3 11 - - - - 1 1 2 7 18 Suicide 10 - - - - 5 3 2 - 17 - - - 1 8 4 2 2 27 lomicide and operations of war - - - - - - - - - - - - - - - - - - - TOTAL:- 442 17 1 1 4 25 129 116 149 578 17 1 1 2 24 97 130 306 1020 52 Year Population Birth Rate Death Rate Infant Mortality Rate Maternal MortalityRate 1900 81,230 20. 0 11. 3 104 2 1905 83,430 16. 1 9. 3 94 4 1910 85,210 14. 0 8. 6 60 1 1915 81,760 15. 3 12. 1 76 4 1920 91,519 17. 1 9.4 48 2 1925 88,040 12. 2 10. 5 55 5 1930 84,830 11. 8 11. 5 58 6 1931 87,740 11. 2 11. 7 61 2 1932 90,130 10. 9 11. 6 54 2 1933 90,380 9. 6 11. 0 38 NIL 1934 90,000 10.4 11. 3 53 4 1935 90,600 11. 0 11. 2 49 1 1936 90,700 11.5 11. 3 66 3 1937 90,690 11. 2 11. 6 54 3 1938 90,480 11. 7 11.4 57 1 1939 90,170 10. 9 11. 6 38 1 1940 71,520 11. 1 16. 2 49 5 1941 58,760 10. 9 15. 9 59 1 1942 63,240 14. 5 14. 2 49 5 1943 69,320 16. 6 14. 3 43 2 1944 69,840 16. 1 14. 6 62 1 1945 74,390 16. 2 13.4 42 2 1946 89,720 17.4 11. 8 36 1 1947 95,650 18. 1 11. 2 29 2 1948 95,480 15. 7 10. 3 29 1 1949 97,090 14. 7 10. 5 29 2 1950 97,400 15.5 10. 0 19 1 1951 97,750 14.5 11.5 27 1 1952 97,700 14. 9 11. 2 24 NIL 1953 97,970 14. 5 11. 8 16 1 1954 98,210 14. 7 9. 1 17 1 1955 97,710 14. 1 10. 0 17 NIL 1956 97,580 15. 1 10. 5 23 1 1957 97,130 15.4 10. 5 18 1 1958 96,480 15.5 11.1 21 NIL 1959 96,810 16. 5 10. 9 22 NIL 1960 98,080 17. 1 10. 4 20 1 53 INFECTIOUS DISEASE DISEASE Notifications Removed to Hosp. I960 Deaths I960 1956 1957 1958 1959 I960 Diphtheria - - 1 1 1 - - Dysentery 35 26 60 79 48 10 - Encephalitis: Acute Infective 2 1 - - - _ - Post Infectious 2 - 1 1 4 4 _ Erysipelas 7 13 5 8 6 4 - Food Poisoning 15 10 15 26 23 11 — Malaria - 1 - - - - - Measles 243 829 706 344 86 6 - Meningococcal Infection 2 - 1 2 3 3 - Ophthalmia Neonatorum: Hampstead residents 4 8 6 11 _ - - Non-residents 3 19 3 14 5 5 - Paratyphoid Fever - - 1 • 2 2 - Pneumonia 54 48 40 47 12 4 2 Poliomyelitis: Non- Paralytic - 4 - 3 - - - Paralytic 2 11 2 2 3 2 - Puerperal Pyrexia: Hampstead residents 14 26 30 19 7 7 - Non-residents 31 59 39 34 21 21 - Scabies 25 13 13 17 15 - - Scarlet Fever 32 55 51 37 18 3 - Typhoid Fever 1 3 2 5 2 2 - Whooping Cough 94 109 21 37 58 8 - TOTAL: - 566 1235 997 687 314 92 2 TUBERCULOSIS Age Periods Respiratory Non-Respiratory New Cases Deaths New Cases Deaths M F M F M F M F 0 1 - - — - t— — — 1 — — — _ _ — _ — 5 — — - - — — — — 15 9 5 - - - 1 - — 25 22 8 1 1 2 6 - - 45 12 2 - - - 1 - — 65 1 — 1 - — — - — 75 - 1 - 1 - - - — TOTAL:- 45 16 2 2 2 8 - - 54 FOOD POISONING 1st Qtr. 2nd Qtr. 3rd Qtr. 4th Qtr. Total Cases notified 4 5 8 6 23 Otherwise ascertained - 2 1 - 3 Deaths - - - - - Outbreaks No, of Outbreaks Cases Otherwise Total Family Other Notified Ascertained Cases Agent identified 4-72 9 Agent not identified 2 - 4 - 4 Single Cases Cases Otherwise Total Cause Notified Ascertained Cases Salmonella Typhimurium 5 - 5 Salmonella Newport 2 - 2 Enteriditis 2 - 2 Heidelberg 1 - 1 Tennessee - 1 1 Staphylococci Aureus 1 - 1 Not identified 1 - 1 Salmonella Infections not Food-borne NIL. BACTERIOLOGICAL EXAMINATIONS (Infectious Diseases) Throat/Nose Swabs: No. of Examinations Diphtheria Bacilli found Nil Haemolytic Streptococci found 20 Negative 210 Faeces: Shigella found 49 Salmonella found 11 Negative 223 513 55 HAMPSTEAD BOROUGH COUNCIL CLEANSING CENTRE f Verminous Conditions Scabies Cases Treatments Cases T reatments Adults 5 5 5 10 Children - - - - Contacts 1 1 3 3 (The L. C. C. School Clinic closed as from 1st April, I960,) London County Council (General Powers) Act, 1953 Persons cleansed at home Nil DISINFECTION AND DISINFESTATION No. of calls by borough van 6,631 No. of articles passed through steam chamber 8,615 No. of rooms disinfested after vermin 350 No. of rooms disinfected after infectious disease 124 No. of rooms cleansed after death or removal 47 Parcels of clothes for despatch abroad 143 Articles on medical loan collected and disinfected on behalf of London County Council 18 PUBLIC HEALTH LAUNDRY A twice weekly service is in operation and 1,737 bags of laundry have been dealt with during the year. The number of calls made by the van was 2,930. Articles Laundered: Draw Sheets 3,464 Shirts ... 295 Sheets 2,046 Vests ... 796 Blankets 195 Towels ... 1,576 Pillow-cases 1,772 Pants ... 774 Nightdresses and Pyjamas 1,792 Total Articles 12,710 The number of people using the laundry service has varied from 29 to 34 per month. 56 PUBLIC MORTUARY, NEW END Bodies admitted by order of:- Coroner 241 Ambulance 28 Police 4 Marie Curie Hospital 3 Public Health Department 3 279 Causes of death:- Natural Causes 230 Suicides: - Coal Gas Poisoning 15 Drugs 8 Railway 1 Drowning _2 26 Accidental: - Coal Gas Poisoning 3 Crushing by lorry 1 Burns 1 Railway 2 Traffic _2 9 Misadventure: - Burns 1 Open Verdict:- Burns 1 Drowning 2 Post Operative 8 Stillborn 1 Bodies brought for accommodation 2 279 No. of post mortem examinations carried out 277 Of the 279 bodies admitted to the Mortuary, 233 were of Hampstead residents. 57 PUBLIC HEALTH INSPECTION Inspections; Housing defects 835 Loans for house purchase 181 Improvement grants 92 Housing Act, 1957. Repair of unfit houses 122 Demolition & Closing Orders 10 Overcrowding 40 Rent Act, 1957. Certificates of Disrepair 7 House-to-House 66 Underground rooms (other than Closing Orders) 55 Accumulations of refuse 147 Dustbins 69 Nuisance from trees 10 Nuisance from bonfires 19 Improper keeping of animals 3 Noise 46 Smoke (Timed observations) 211 Other nuisances 147 Re -inspections: 6,055 Inspections: Railway premises 1 Public buildings, Hospitals, etc. 2 Clubs, Institutions, etc. 12 Offices, Business premises 11 Bombed site or open space 18 Mews or Stable Yard 60 Private Roads or Passageways 73 Re -inspections: 366 Inspections: Drainage work; Under Notice 29 V oluntary 322 Installation of Heating Apparatus 245 Housing Applications 237 Aged or Infirm Persons 207 Infectious Disease 346 Special Surveys: Smokeless Zones 8,894 Overcrowding 9 Infestations: Rodent 1,105 Other 263 Re-inspections: 5,195 58 FACTORIES ACTIS,1937 to 1959 No. on Register Inspections Re-inspections Written Notices Factories in which Ss. 1,2, 3,4 and 6 are to be enforced by local authority 220 109 64 21 Factories not included above in which S. 7 is enforced by the local authority 337 127 246 22 Other premises in which S. 7 is enforced by the local authority (excluding outworkers premises) 4 4 3 - TOTAL: - 561 240 313 43 No prosecutions were undertaken during the year. Inspections: Foodshops and stalls 1,096 Shops other than food shops 13 Shops Act 77 Merchandise Marks Act 39 Hairdresser 132 Pet Animals 4 Pharmacy & Poisons 24 Rag Flock 1 Fairground 15 Re-inspections: 957 Lectures, discussions, talks 27 Total complaints received 1,302 Informal Notices (verbal notice, letter) 222 Intimation Notices served 342 Statutory Notices served 125 Attendances at Court or Inquiries 8 59 Defect F ound Remedied Referred To Ho Ma Inspector By H. M. Inspector Want of Cleanliness (S. 1) 19 19 - 4 Overcrowding (S. 2) 2 2 - - Unreasonable temperature (S. 3) - - - - Inadequate ventilation (S. 4) 2 2 - 1 Ineffective drainage of - - floors (S. 6) 1 1 - - Sanitary conveniences (S. 7) - - (a) Insufficient 4 4 - - (b) Unsuitable or defective 15 15 - 2 (c) Not separate for sexes - - - - Other offences against the Act 2 2 2 - (Not including offences - - - - relating to outworkers) - - - - TOTAL:- 45 45 2 7 No prosecutions were undertaken during the year. OUTWORKERS No. of Hampstead firms making return 16 Total Outworkers notified by Hampstead firms 254 Outworkers resident in Hampstead (included in above) 88 Outworkers notified to us from other boroughs 63 Visits paid by Public Health Inspectors 82 Classes of Work Outworkers Wearing Apparel - making, etc. cleaning and washing 86 Household linen 3 Curtains and furniture hangings 2 Furniture and upholstery 1 Artificial flowers 6 Paper bags 2 Making of paper boxes or other receptacles 1 Carding, etc. of buttons, etc. 2 Stuffed toys 8 Basket making 10 Cosaques, Christmas stockings, etc. 25 Lampshades 5 TOTAL:- 151 No cases of default in sending lists or instances of work in unwholesome premises. No notices served or prosecutions undertaken. 60 PET ANIMALS ACT, 1951 New Licences issued Licences discontinued - Licences renewed 4 Visits by Public Health Inspectors 4 PHARMACY & POISONS ACT, 1933 New Licences issued 4 Licences renewed 95 Ceased to sell poisons or removed 3 No. on Register at end of year 99 Visits by Public Health Inspectors 24 EXAMINATION OF WATER Chemical Analysis Bacteriological E xa minati on Swimming bath water 10 52 Tap water 4 3 All the above samples were satisfactory. Two samples of water from basements were examined after complaints of defective drainage in an endeavour to trace the source of the water. LEGAL PROCEEDINGS Date of Hearing Nature of Offence Result of Proceedings 12. 2. 60 Vale of Health Fairground. Failure to provide suitable sanitary accommodation for public use. Both defendants fined £2. Costs £2. 2s. 0d. 4. 11. 60 Goldhurst Terrace. Smoking whilst handling food. Fined £5. Costs £ 1. Is. 0d. 4. 11. 60 Midland Crescent. Smoking whilst handling food. Fined £ 2. Costs £ 1. Is. 0d. 61 FOOD PREMISES The total number of foodshop premises is 865, There are 329 shops with multiple trades and in the following table these have been entered once tinder each type of trade carried on. No. on Register Primary inspections Baker, Patisserie 49 56 Butcher 90 62 Canteens and Clubs 65 21 Confectioner 131 61 Delicatessen and Grocer 192 97 Fishmonger 24 13 Fried Fish 6 6 Greengrocer 89 58 Ice Cream 259 145 Milkshop and Dairy 65 30 Off Licence 45 14 Public House 53 31 Refreshment House 60 19 Restaurant, Snack Bar 132 55 Street Trader or Stallholder 56 520 Chemists 29) 8 Factory 3) Herbalist 2) Fairground 1) 1,351 1,196 957 revisits were paid to shops (including shops other than foodshops). PREMISES REGISTERED UNDER SECTION 16, FOOD & DRUGS ACT, 1955 Ice Cream Potted , pre s s ed , pickled or preserved food Confectioners and Tobacconists 80 Butchers 2 Grocers and Delicatessen 14 Fishmongers 5 Grocer & Delicatessen 57 Garages 1 Provisions 4 Bakers 8 Butchers 36 Restaurants 42 Florists 1 Factory 2 Dairies 22 Kiosks & Stalls 5 Fried Fish 6 Stores 6 Club 1 Fish Shop 1 Off Licences 3 TOTAL; - 259 Cinemas _2 Patisserie 1 TOTAL: - 65 Greengrocers 25 62 BACTERIOLOGICAL EXAMINATION OF FOOD Nature of Sample No. of samples Satisfactory Unsatisfactory Caramel Pudding 1 1 - Cooked meats,meat products 26 18 8 Dates 1 1 - Herring 1 - 1 Ice Cream,Water Ice,Lollies 31 30 1 Liver Cheese 1 1 - Meat Cheese 1 1 - Milk 11 11 - Rolls .Sandwiches 5 4 1 Shellfish 48 44 4 Toffee Apples 2 2 - Watercress 1 1 - Drinking Water 3 3 - 132 117 15 A note on the bacteriological examination of food appears on page 44. MILK SUPPLY Milk (Special Designation) Regulations Dealers (Premises in Hampstead) Supplementary (Premises outside Hampstead) No. of milk sellers 65 31 Licences issued:- Pasteurised 58 27 Tuberculin Tested 42 26 Sterilised 58 30 Milk Examination Pasteurised Methylene Blue and Phosphatase Tests 11 Chemical Analysis 11 All the samples were satisfactory. In five of the samples it was not possible to obtain an accurate methylene blue test as the atmospheric shade temperature was more than 65 degrees. 63 ADULTERATED OR UNSATISFACTORY SAMPLES Article Offence and action taken Plum Jam Mould growth and deficient in soluble solidsRetailer warned. Steak and Onion Pie Deficient in meat. Further samples taken were satisfactory. Instant Milk False description. Stock withheld from sale and returned to importers,. Austrian Lites Contained undeclared carbohydrates. Stock withheld from sale and returned to importers. Triple Cream Cheese False description, Withdrawn from sale. Importers warned. Christmas Cake Contained sand and siliceous matter. Manufacturer and retailer warned. Cream Cheese Deficient in fat. Formal samples taken were satisfactory. Beef Sausages Contaminated by violet dye. Manufacturer warned. King Edward Potatoes Fal se description. Retailer warned. Bread Contained foreign matter (oil or grease). Baker warned. Milk (3 cases) 1 & 2. Bottle contained dust and dirt. 3. Contained mould spores and hyphae. Fined £50 each on 3 summonses under Milk & Dairies Regs, and £10 each on 3 summonses under S. 2 Food Drugs Act, 1955. Costs £50. Red Cabbage Contained undeclared salt. Additional labels provided by importers. Red Cabbage Contained undeclared fat. Additional labels provided by importers. 64 ADULTERATED OR UNSATISFACTORY SAMPLES - contd. Article Offence and action taken Coconut Candy Contained mould spores and hyphae. Retailer warned. Stock withdrawn. Soda Water Devoid of carbon dioxide. Retailer warned. Iced Coffee Concentrated Viennese Coffee extract. Not coffee at all. Producer warned. Label altered. Rum T ruffle s Contained no rum. Producer warned. Label altered. Aspirin Deficient in acetyl salicylic acid« Formal samples taken were satisfactory. Minced Beef Misleading label. Retailer warned. Label altered. UNSOUND FOOD One hundred and thirty-six unsound food certificates were issued covering the following items:- Butter 1 lb. Cereals 41 cartons Cheese 3^whole cheeses. 13½1bs. Coff ee 1 tin F lSh 42 tins. 52 cartons F ruit 423 tins. 302j lbs. 67 jars. 60 cartons Jam 4 jars Meat products 426 tins. 38 cartons. 813½ 1bs. P oultry 10 lbs. Milk, cream 25 tins Oriental fruits .pickles , spices 17 tins. 9 jars. 44 cartons Purees, juices 31 tins. 9 tubes Soups 24 tins Vegetables 163 tins. 181 cartons. 7,952 lbs. 65 HOUSING Dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 1,604 Dwelling-houses (included in above) which were inspected and recorded under the Housing Consolidated Regs. 1925-1932. (House-to-House inspection) 188 Dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 10 Dwelling-houses found not to be in all respects fit for human habitation 725 HOUSES IN CLEARANCE AREAS AND UNFIT HOUSES ELSEWHERE Houses Demolished Clearance Areas, Housing Act, 1957 NIL Not in Clearance Areas NIL Unfit Houses Closed Under Sections 16, 17 and 35, Housing Act, 1957 NIL Parts of Buildings closed (Section 18) 10 Persons displaced 16 Families displaced 5 Unfit Houses made fit and Houses in which Defects were Remedied By Owner By Local Authority After informal action by local authority 725 NIL After formal notice: Public Health Acts 104 2 Housing Act, 1957 6 NIL* Under Section 24, Housing Act NIL NIL * Work in progress on 2. No action was taken under Sections 17, 34, 46, 48 and 53 of the Housing Act regarding Unfit Houses in Temporary Use. No houses in Clearance Areas were purchased by agreement. 66 OVERCROWDING Dwellings Families Adults Children On register 31. 12.59 212 212 538 331 New cases I960 35 35 83 61 247 247 621 392 Rehoused I960 22 22 68 29 On register 31. 12. 60 225 225 553 363 CERTIFICATES OF DISREPAIR Applications for certificates 5 Applications withdrawn or cancelled NIL Certificates refused NIL Authority to issue certificates - (a) in respect of some but not all defects 1 (b) in respect of all defects 4 5 Undertakings given by landlords 2 Undertakings refused NIL Certificates issued 3 Applications for cancellation of certificates 1 Objections by tenants to cancellation of certificates NIL Decisions to cancel in spite of tenants objection NIL Certificates cancelled 1 HOUSING ACT, 195 7. SECTION 9 Repair of Insanitary Houses Out of 188 premises surveyed by the Housing Inspector and the District Public Health Inspectors, fifteen were subsequently reported to the Public Health Committee as being unfit and suitable for action under Section 9. Appropriate action under the Public Health (London) Act was taken with the remainder. REHOUSING Visits and revisits in connection with the investigation of 231 rehousing applicants 548 No. of reports submitted to Hampstead Housing Manager 214 No. of reports submitted to Other Boroughs 17 67 THE CARE OF THE AGED Agencies concerned with the Care of the Aged Hampstead Old People's Welfare Association, Miss O. Courtney Jones, 107 Kingsgate Road, N.W.6. MAI 365 2 Hampstead Council of Social Service, Burgh House, New End Square, N. W. 3. HAM 0049 107 Kingsgate Road, N. W. 6. MAI 2007 Hampstead Old People's Housing Trust Ltd. , Mrs. B. Gibson, 7 Harley Road, N. W. 3. PRI 2950 Women's Voluntary Services, 119 Cholmley Gardens, N. W„ 6. HAM 9552 British Red Cross Society, 98 Avenue Road, N. W„ 3. HAM 7171 National Assistance Board, Old Post Office, Downshire Hill, N. W. 3. HAM 9027 Ministry of Pensions & National Assistance, 30 Euston Square, N„ W, 1. - for N. W. 3. area only EUS 6451 122 Kilburn High Road, N. W. 6. - for N. W. 6. and N. W. 2. area MAI 0804 Home Help Organiser (L. C. C.) 251 Finchley Road, N. W. 3. HAM 4136 Welfare Officer (Applications for residential accommodation for persons in need of care and attention) 5 Princes Row, S.W„1. VIC 0162 Admitting Officer (Enquiries regarding inmates of Luxborough Lodge), 5 Princes Row, S. W. 1. VIC 0162 Public Health Department, Specialist Health Inspector, Mrs. C. G. Speechley, 98a, Avenue Road, N.W.3. HAM 7171 Divisional Medical Officer, London County Council, 313 Harrow Road, W. 9. CUN 4815 68 Services provided for Aged Persons Laundry. For incontinent persons only. Applications to the Medical Officer of Health. 98a, Avenue Road, N. W, 3. HAM 7171 Meals. Delivered twice weekly by British Red Cross Society and Women's Voluntary Services. Dinner Clubs. These are held at - St. Stephen's Church Hall, Pond Street, N. W.3. on Tuesday, Wednesday, Thursday, 12 noon. Health Institute, 107 Kingsgate Road, N. W. 6. on Tuesday, Wednesday, Thursday, Friday, 12 noon. Library. Books provided by the Borough Council are delivered fortnightly to homebound old people. A member of the library staff accompanies the van. Holidays. Arranged by the Hampstead Old People's Welfare Association. Chiropody Service. Weekly sessionsare held in N. W. 6 and N. W. 3. The Rotary Club of Hampstead provide transport to the clinic for those too frail to traveL Patients who are unable to attend the clinic even by car, are visited and treated in their own homes. Appointments for treatment are made on application to the Hampstead Old People's Welfare Association. Baths. Old Age Pensioners are allowed to use the slipper baths at the Central Baths, Finchley Road, and the Branch Baths at Flask Walk and Palmerston Road, free of charge at any time. Homes. Information obtainable from the Medical Officer of Health, 98a, Avenue Road, N. W. 3, the Hampstead Old People's Welfare Association, 107 Kingsgate Road, N. W. 6, or the Old People's Homes Committee, 296 Vauxhall Bridge Road, S. W. 1. VIC 9977 Workshops for the Elderly, 107 Kingsgate Road, N. W. 6. Organised by the Hampstead Old People's Welfare Association. 69 Hospital Care. Application should be made by the patient's doctor to Dr. Exton Smith, Whittington Hospital, Highgate Wing, Dartmouth Park Hill, No 19° ARC 3070. In cases of difficulty further advice can be obtained from the Medical Officer of Health, 98a, Avenue Road, No Wo 3o HAM 7171. Ext, 275. Medical Loan. Items of medical equipment are available on loan from the Divisional Office, London County Council or the British Red Cross Society. Darby and Joan Clubs St. Stephen's Hall, Pond Street, N. W. 3. Wednesdays 2 - 4.30 p.m. Holy Trinity Church Hall, Finchley Road, N. W. 3. Unitarian Church Hall, Quex Road, N. W. 6. Tuesdays 2 - 4 p. m. Thursdays 2 - 4 p. m. St. James Halls Netherwood Street, N. W. 6. Wednesdays 2 - 4 p. m» Brondesbury Fellowship Meris Club 107 Kings gate Road, N. W. 6. Daily 2 - 5 p. m. Good Companions Club Burgh House, New End Square, N, W, 3. Mondays 5 -8 p.m. Good Neighbours Club 51 Belsize Square, N, W. 3. Wednesdays 2.30 - 5 p.m. Burgh House Club Burgh House, New End Square, N. W. 3. Daily 2 - 7 p. m. Friendship Clubs Belsize Club, 22 Eton Villas , N. W. 3. Monday afternoons. The Synagogue, Dennington Park Road, N. W. 6. Thursday afternoonso 70 Broadhurst Club, Levine House, Broadhurst Gardens, N. W. 6. The Day Club, 51 Belsize Square, N» W„ 3. Maccabi (Retired Jewish Gentlemen) 73 Compayne Gardens, N. W. 6. Congregational Church Hall, Lyndhurst Road, N. W. 3. Monday and Wednesday evenings. Monday and Thursday, Thursday 2. 30 - 5 p. m. Thursday afternoons. LONDON COUNTY COUNCIL, DIVISION 2, PUBLIC HEALTH DEPARTMENT Divisional Medical Officer:- H. Leslie Oldershaw.M. D. ,B, Sc» ,D„P„H» 313 Harrow Road, W. 9. CUN 4815. Hampstead Sub-Office: - 251 Finchley Road, N. W. 3. HAM 8450 Clinics, Day Nurseries and School Treatment Centres L, C. Co Day Nurseries (normally open all day, Monday to Friday) W oodchurch Parkhill Pond Street 11/13 Woodchurch Road, N.W.6. 2 Parkhill Road, N. W, 3, 27/29 Pond Street, N. W. 3. MAI 2937 GUL 4233 HAM 1686 A list of private day nurseries can be obtained from the Hampstead Sub-Office, 251 Finchley Road, N. W. 3. Maternity and Child Welfare Centres 60 West End Lane, N.W. 6. 2 Parkhill Road, N. W. 3. Hampstead Wells, Christchurch Hill, N.W.3. 3/5 Daleham Gardens, N. W. 3. 9 Solent Road, N. W. 6. MAI 5381 GUL 4759 HAM 9534 SWI 3424 HAM 5978 Welfare Foods (National dried milk, orange juice, cod liver oil, etc.) are obtainable from these centre. School Treatment Centres Kilburn Treatment Centre, 107 Kingsgate Rd,N. W. 6. Dental Clinic, Lithos Road, Finchley Road, N.W.3. MAI 3005 HAM 4763 71 Speech Therapy Centre Welfare Centre, 60 West End Lane, N. W. 6. MAI 5381 Immunisation and Vaccination Clinics Smallpox Vaccination: 60 West End Lane, N. W. 6. Friday 2 p.m. 2 Parkhill Road, N. W. 3. Monday 9.45 - 10.45 a. m. 3/5 Daleham Gardens , N. W. 3. Thursday 10-11 a. m. Diphtheria and Poliomyelitis Inoculations: 60 West End Lane, N. W. 6. Tuesday 10 - 11 a.m. 2 Parkhill Road, N. W. 3. Monday 9. 45 - 10.45 a. m. 3/5 Daleham Gardens, N. W» 3. Thursday 10 - 11 a.m. Diphtheria and Poliomyelitis Inoculation of babies can also be dealt with at the Maternity and Child Welfare Centres by arrangement. Domestic Help Service Home Help Organiser, 251 Finchley Road, N. W. 3. HAM 4136 District Nursing Associations Hampstead District Nursing Association, 3 Pond Street, N. W. 3. HAM 6406 Kilburn & W. Hampstead District Nursing Assoc. , 20 Dennington Park Road, N. W. 6. HAM 4232 Further information regarding the Care of Mothers and Young Children, Child Minders and Day Nurseries, Health Visiting, Family Planning, Recuperative Holidays, Foot Clinics, Tuberculosis Care and After-care, care of persons suffering from illness or Mental Defectiveness, Treatment Centres for School Children, etc, may be obtained from The Divisional Medical Officer, London County Council, 313 Harrow Road, W. 9. 72 APPENDIX Since the completion, of the foregoing Annual Report the final figures for the Mass X-Ray Survey (report page 17) and details of Accidents in the Home during I960 have been received. TUBERCULOSIS SURVEY The figures relate to less than five per cent, of the population and do not necessarily represent a true cross section. It would therefore be unwise to draw any firm conclusions from these figures. Firms Men W omen General Public Men W omen Total No. X-Rayed 1,246 398 1,302 1,455 4,401 No. active Pulmonary Tuberculosis - - 2 1 3 No. Pulmonary Tuberculosis under observation 1 1 - 1 3 No. Lung Cancer 4 - - - 4 ACCIDENTS IN THE HOME The number and types of accidents given on the next page give only an indication of the number and kind of accidents which occur because it is limited, not only to those which result in the patient being taken to hospital, but to those who have to be taken to hospital by ambulance. So, for example, accidents involving injury to a leg may be fairly fully represented, whereas injuries to a hand would not necessarily be included-, Full information of the total number of accidents which occur is extremely difficult to collect and the information supplied by the London County Council though necessarily incomplete, is a very useful guide to those measures which might be taken to reduce accidents. 73 ACCIDENTS IN THE HOME - Comparative figures 1959-1960 Cause of Accident 1959 I960 1959 I960 L, C. C. Div. 2* County of London Fall On stairs 210 208 1,175 1,221 From ladder 22 13 134 113 From chair 30 41 237 199 Outside (i. e. windows balconies, roofs, etc.) 54 55 300 234 In garden 18 16 305 251 In bath 3 3 27 18 From one level to another (i.e. tables, boxes, beds) 77 60 386 348 On same level (i. e. in room over objects) 172 170 1,004 888 Unspecified 337 401 2,369 2,868 Hit by object 19 22 172 184 Cooking Stove (saucepans .water ,fats , etc. ) 14 12 125 108 T eapot 3 7 55 53 Other boiling water 7 21 134 129 Electric Shock 4 2 26 26 Poisoning (including foreign objects) 43 36 255 318 Gassing 51 28 188 137 Knife-like Wounds (including spikes and cuts from glass) 45 30 327 321 Fires 15 23 128 141 Windows (trapping) 2 6 34 47 Suffocation 4 4 21 17 Not specified 59 41 412 326 TOTAL:- 1,189 1,209 7,814 7,947 Rate per 10,000 population 23. 4 24. 1 24. 4 24. 9 * Division 2 - Hampstead, Paddington, St. Marylebone, St. Pancras and Westminster. 74 INDEX PAGE Accidents in the Home 72 Aged Persons: Care of the Aged 20, 67 Cleansing of 55 Laundry Service 24, 68 Area of Borough 49 Area Comparability Factors 49 Atmospheric Pollution 31 Bacteriological Examinations: Food 44,62 Infectious Disease 54 Swimming Bath Water 26, 60 Bakehouses 47,61 Barbers and Hairdressers 28,58 Bathing Centre 55 Baths, Old Persons 55, 68 Births, Birth Rate 9,49 British Red Cross Society 67 Burials 18 Catering Hygiene 46 Certificates of Disrepair 57, 66 Chemical Analysis: F ood 43,63 Swimming Bath Water 26, 60 Chiropody Service 68 Clean Air Act, 1956 31 Cleansing Station 55 Clearance Areas 35, 65 C linics 70 Closing Orders 35 , 57,65 Clubs, Old Persons 69 Colas Mews Site 27 Common Lodging Houses 29 Complaints 57 Cooked Meats 48,61 Council Representatives of other Organisations 7 Darby and Joan Clubs 69 Day Nurseries 70 Deaths 10, 49,56 75 PAGE Demolition Orders 57 Dinner Clubs 68 Disinfection and Disinfestation 19, 55 District Nursing Associations 71 Division 2, London County Council 70 Divisional Health Committee 7 Domestic Help Service 71 Drainage 57 Dwellings: Rate Assessments 49 Structurally Separate 49 Factories Acts: Inspections 58 Outworkers 59 Underground Bakehouses 47 Fair, Hampstead Heath 46 Food Inspection, Sampling, etc. 43-48, 61-64 Food Poisoning 54 Foot Clinics 68 Hairdressers and Barbers 28, 58 Hampstead Council of Social Service 67 Hampstead Heath Fair 46 Hampstead Old People's Housing Trust Ltd. 67 Hampstead Old People's Welfare Association 67 Health Education 34 Heating Appliances (Fireguards) Act, 1952 28 Home Help Organiser 67 Homes, Old Persons 68 House-to-House Inspections 57 Housing 35-43, 65, 66 Ice Cream 47, 61 Improvement Grants 41, 57 Immunisation and Vaccination Clinics 71 Infant Mortality 49 Infectious Diseases 11, 53 Inspection of the Borough 57 Intimation Notices 58 Laundry Service 24, 55 Legal Proceedings 45, 60 76 PAGE Loans for House Purchase 41, 57 London County Council, Division 2 70 London County Council (General Powers) Act, 1925 S. 33 27 do. 1955 S. 27 26 do. 1954 S. 18 28, 58 do. 1953 S. 43 55 Mass X-Ray 17, 72 Maternal Mortality 49 Maternity & Child Welfare Centres 70 Medical Examinations, Staff 18 Milk 44, 61, 62 Ministry of Pensions and National Insurance 67 Mobile Meals Service 68 Mortuary 56 National Assistance Act, 1948, Section 50 18 do. Section 47 22 National Assistance Board 67 Noise Abatement Act, I960 4 Oil Burners (Standards) Act, I960 28 Old Persons 20, 67 Outworkers 59 Overcrowding 66 Pet Animals Act, 1951 58, 60 Pharmacy and Poisons Act, 1933 58, 60 Population 9,49 Prevention of Damage by Pests Act, 1949 29 Public Analyst's Report 43, 63 Public Health Committee 7 Public Health Laboratory 44 , 54 , 62 Public Health Laundry 24, 55 Public Health (London) Act, 1936 Section 40 27 do. Section 93 27 Public Mortuary 56 Rag Flock, etc. Act, 1951 29, 58 Rateable Value 49 Rehousing 57, 66 Rent Act, 1957 57, 66 77 PAGE Road Traffic Act, 1956, Section 42 29 Rodent Control 29 Sampling 43, 63 Sanitary Circumstances of the Area 24, 5 7 Scabies 55 School Treatment Centres 70 Sewerage 26 Sewers, Rodent Control 30 Shops Act, 1950 28, 58 Slum Clearance 35 , 65 Smoke Abatement 31 Smoking in Foodshops 45 Speech Therapy Centre 71 Staff: Medical Examination 18 Public Health Department 8 Statistics: Public Health Inspection 57 Statistical Summary 49 Statutory Notices 58 Stillbirths 49 Structurally Separate Dwellings 49 Swimming Baths 25,60 Tuberculosis 14, 53 Underground Bakehouses 47 Unsound Food 48, 64 Vaccination and Immunisation Clinics 71 Verminous Persons 55 Water Supply 24, 60 Welfare Centres 70 Welfare Office, L. C. C. 70 Women's Voluntary Service 67 Workshop, Old People's 21 , 68