KEN 19 Che Royal Borough or Kensington. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH. 1915. Vail & Co., Printers and Stationers, 170, Farringdon Road, E. C. VITAL STATISTICS. The Metropolitan Borough of Kensington covers an area of 2,291 acres, and is co-extensive with the Civil Parish and Registration District of the same name. The Borough is divided into nine wards. South Kensington includes the wards of Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton, and is co-extensive with the South Kensington Parliamentary Division. North Kensington, containing the wards of St. Charles, Golborne, Norland and Pembridge, is not. co-terminous with the Parliamentary Division of the same name, in that it extends northwards to include an area of 100 acres with a population of 3,900 persons which is still allotted, for Parliamentary purposes only, to Chelsea. The rateable value of the Borough is £2, 446,743. The product of a rate at one penny in the £ is £10,180. In the comparison of vital statistics for different districts, those for Kensington are sometimes taken as representing the experience of a good class residential area. For the information of persons who are not familiar with local conditions, it may therefore be stated that it is only the figures for South Kensington which can be interpreted in the above mentioned sense. The northern half of the Borough touches the Harrow Road in the north and the Latimer Road on the East. In each of the four northern wards there are areas of extreme poverty, and the Golborne Ward may be taken as an example of a district in which practically the whole population consists of the working classes, and includes large numbers of semi-destitute persons who have no regular employment. Population .—On the assumption that the decline which took place in the intercensal period 1901-1911, will be somewhat less marked in the current decade, the population of the Borough in the middle of the year 1915 is estimated to have numbered 171,100,* and it is on this figure that the birth-rate and the death rates for the year have been calculated. The estimated populations of North and South Kensington and the several Wards are as follows:— North Kensington 87,276 South Kensington 83,824 St. Charles 22,966 Holland 20,227 Golborne 25,360 Earl's Court 17,492 Queen's Gate 14,286 Norland 20,544 Pembridge 18,406 Redcliffe 19,215 Brompton 12,604 Marriages.—The marriages celebrated during the year numbered 2,126. The number of marriages celebrated annually and the annual marriage rate since 1856 were given in the annual report for 1908, Appendix II., Table A, page 60. Births. —The number of births registered in the district was 2,888, but this figure does not include 186 infants born of Kensington mothers in Queen Charlotte's Lying-in Hospital and other institutions beyond the Borough. The total number of births belonging to the Borough was. therefore, 3,074. The birth-rate expressed as the number of births per 1,000 of the population was 180. Arranged as to sex and legitimacy the births were as follows:- Male. Female. Total. Legitimate 1,434 1,504 2,938 Illegitimate 67 136 69 Total 1,571 3,074 1,503 Still births are not registered and are therefore not included in the above figures. The civil population is estimated by the Registrar-General as being 155,795, thus showing that more than 15,000 of the inhabitants of Kensington have joined the Naval and Military Services. The following Table shows the number of births and the birth-rate in North and South Kensington and in the several Wards, after distribution of the births at the Borough Infirmary, Queen Charlotte's Hospital, and other Institutions. Total Births. Birth-rate per 1,000 of the Population. North Kensington 24.8 2,168 South Kensington 906 10.8 St. Charles 568 24.7 Golborne 744 29.3 Norland 552 26.9 Pembridge 304 16.5 Holland 217 10.7 Earl's Court 226 12.9 Queen's Gate 122 8.5 Redcliffe 219 11.4 Brompton 122 9.7 The Borough 3,074 18.0 The births occurring every year in Kensington have fallen in round numbers from 4,500 in 1880, to 3,070 in the present year. The steady decline in the birth-rate is shown in Table V. Appendix, p. 53, where the number of births and the birth-rates both for London and Kensington are given for each quinquennial period since 1881. The figures for each year were given in the Annual Report for 1908. Illegitimate Births. —The illegitimate births numbered 136, and were equivalent to a rate of 8 per 10,000 persons living. Notification of Births. —The Notification of Births Act, 1907, requires every birth to be notified within 36 hours to the Medical Officer of Health, either by the father of the child or by some person in attendance upon the mother in her confinement, and applies to still-born children as well as to children who are born alive. Out of the 2,888 live births registered as having occurred in Kensington, 2,627 or 91 per cent. were notified to the Medical Officer of Health. The unnotified births accordingly amounted to 261, or 9 per cent. of the number registered during the year. The subjoined figures show that 2,892 births in all were notified. Source of Notification. Number of Births Notified. Still Births. Live Births. Total Births. Midwives 38 1,489 1,527 Parents 379 384 5 Medical Practitioners 634 667 33 Other Persons 125 125 Births in the Borough 2,627 2,703 76 Institutions outside the Borough 3 189 186 Total 2,813 2,892 79 Of the notifications received 186 were forwarded by the London County Council, and related to infants born of Kensington mothers in Queen Charlotte's Hospital or other Institutions beyond the Borough. Deaths.- The corrected number of deaths was 2,651. * The crude death-rate was members of the armed forces of the Crown, leaving 2,636 deaths of civilians, which if the estimated civilian population (155,795) is taken, would give a death-rate of 16.9. The crude death-rate was 15.5 and the standardised death-rate 15.4 per 1,000 living. To obtain the corrected number of deaths, which represents the true mortality among the population, it is necessary to add the deaths of Kensington " residents " occurring beyond the district to the number registered as actually taking place in the Borough, and to substract from the total thus arrived at the deaths of " non-residents " occurring in institutions or other places in Kensington. The following figures show how the corrected number of deaths given above has been obtained:— Total deaths registered in the Borough 3,100 Deaths of residents beyond the Borough 493 3,593 Deaths of non-residents within the Borough 942 Corrected number of deaths belonging to the Borough 2,651 The standardised death-rate is designed to represent the mortality that would have occurred had the age and sex distribution of the population in Kensington been the same as that of the population of the country as a whole in the Census year 1901. The age and sex composition of the population in Kensington is slightly in favour of a high mortality, and the effect of making allowance for these disturbing factors is to reduce the crude death-rate of 15.5 to the standardised rate of 15.4 already given. Where comparisons are instituted between populations with a widely different age and sex composition the use of standardised death-rates is essential, but in Kensington and in the Metropolis as a whole the influence of age and sex is for practical purposes the same, and the crude death-rates shown in the following Table may be accepted as roughly representing the relative mortality in the two areas. Crude Death-rates per 1,000 living. Kensington. London. 1896-1900 16.3 18.5 1901-1905 16.4 14.7 1906-1910 13.8 14.9 1911-1915 14.6 14.0 The number of deaths and the death-rates in Kensingon and London for each quinquennial period since 1881 will be found in Table V. Appendix, p. 53. The number of deaths occurring in each year since the same date and the annual death-rates have been published in the Appendix of the Annual Reports for 1908 and previous years. The number of deaths at all ages with the corresponding death-rates in the Borough, in North and South Kensington and in the several Wards was as follows:— Districts. Number of Deaths. Crude Death-rate per 1,000 inhabitants. North Kensington 1,627 18.6 South Kensington 936 11.2 Unknown 88 St. Charles 16.6 382 Golborne 20.5 521 Norland 22.1 454 Pembridge 270 14.7 Holland 12.2 247 Earl's Court 226 12.9 Queen's Gate 119 8.3 Redcliffe 222 11.6 Brompton 9.7 122 The Borough 2,651 15.5 * This figure includes the deaths of 15 members of the armed forces of the Crown, leaving 2,636 deaths of civilians, which if the estimated civilian population (155,795) is taken, would give a death-rate of 16.9. The mortality in North Kensington was very much greater than in South Kensington, the difference being mainly due to the prevalence of poverty in the former area. It should further be borne in mind that the high death-rates for Golborne and Norland in the North represent averages based on the combined experience of the good and bad areas which the figures embrace ; and for this reason the Ward rates which are in themselves excessive can only be accepted as indicating the incidence of a very much heavier mortality on those streets and neighbourhoods where the inhabitants live in a state of social degradation. Causes of Death. —These are set out in detail in the Appendix. The following list shows certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year:— Cause of Death. Number of Deaths. Principal Zymotic (or epidemic) diseases 260 Epidemic influenza 63 Puerperal fever 3 Phthisis 184 Other tuberculous diseases 49 Cancer 203 Bronchitis 246 Pneumonia 249 Heart diseases 365 Blight's disease 79 Diseases and accidents of parturition 4 Premature birth 39 Accidents 52 Suicide 17 Old age 81 All other causes 757 2,651 The diseases described in the above list as the "principal zymotic diseases," are small-pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) diarrhoea and enteritis. The number of deaths and the death-rates from each of the seven principal zymotic diseases in Kensington together with the zymotic death-rates for London and Kensington will be found in Tables VI. and VII. Appendix, p. 54, arranged in quinquennial periods since 1881. INFANTILE MORTALITY. The deaths among infants under the age of one year numbered 365, the infantile mortality rate being equivalent to 119 deaths per 1,000 births. The following Table shows a'decline in the infantile death-rate from 172 in the quinquennium 1896-1900 to 110 in the years 1911-1915, and a decrease in the rate of 37 per cent, in North Kensington as compared with a.decrease of 43 per cent, in South Kensington. Deaths under one year per 1,000 Births. Period. London. Kensington. The Borough. North. South. 1896-1900 197 131 172 162 1901-1905 114 139 162 144 1906-1910 135 84 114 120 1911-1915 75 110 108 125 The difference between the infantile death-rates recorded in the various districts of the Borough is very marked, as will be seen from the following figures:— District. Deaths under one year. Deaths under one year per 1,000 Births. North Kensington 294 136 South Kensington 71 78 St. Charles 82 144 Golborne 98 132 Norland 91 165 Pembridge 23 76 Holland 106 23 Earl's Court 18 80 Queen's Gate 8 66 Redcliffe 14 64 Brompton 8 66 The Borough 365 119 The figures in the second column of the Table show that the infantile death-rate in North Kensington was 58 in excess of that in South Kensington. The mortality in the Norland district, which contains Notting Dale, was equivalent to 105 deaths per 1,000 births. Causes of Infantile Mortality.—In the following Table the deaths occurring in infants under the age of 12 months during the year 1915 and the two preceding years have been classified according to the nature of the disease which was in each case certified as the cause of death. Cause of Death. Number of Deaths. 1913 1914 1915 Common infectious diseases 28 11 34 Diarrhœa (including enteritis, etc.) 62 47 50 Premature birth 55 38 47 Congenital defects (including injury at birth and atelectasis) 15 20 22 I Wasting and debility 45 42 47 Tuberculous diseases 15 23 30 Syphilis 19 7 13 Bronchitis and pneumonia 79 88 37 Overlaying 6 5 1 Other causes 46 62 40 371 298 365 Illegitimacy. deaths occurred among illegitimate infants. The illegitimate births numbered 136. The mortality among the illegitimate was accordingly equivalent to a rate of 346 deaths per 1,000 births, as compared with a rate of 108 among those born in wedlock. PREVENTION OF INFANTILE MORTALITY. Work with a view to improving the physique of infants and reducing the infantile death-rate is carried out by the Council's Health Visitors and a number of voluntary agencies. During the year the three Health Visitors* have been to the homes of 2,048 newly-born infants, and have paid 3,922 visits or re-visits for the purpose of giving advice in infant management. The first visit is as far as may be possible timed to take place between the 10th and 20th day after the birth of the child, and if the midwife or doctor in charge of the case has ceased attending a printed card of advice is left with the mother. The printed instructions are explained and notes are made on the health of the child and the condition of its home. If the infant is making progress in a satisfactory home, and especially if the mother's previous history as to the ability to nurse and rear her children is good, a second visit may not be necessary. Where, as in the case of a first baby, the mother is in need of further advice, re-visits are paid according to the necessities of each case. Inquiries are also made in the homes of infants who die before the age of 12 months or who are notified as still-born. Necessitous mothers are referred to one of the three dinner centres. Hospital letters are obtained for ailing infants whose parents cannot afford to pay for medical advice, and the fullest use is made of the assistance offered to mothers of the poorer classes by various philanthropic agencies in the Borough. In 315 instances, infants in the Wornington Road district have been referred to the Lancaster Road School for Mothers, and have been visited from the outset by the hospital nurse attached to the School. A summary of the work of the Health Visitors, so far as it admits of tabulation, is given in the subjoined return. District. No. 2.* No. 3.* 1, 2 and 3. No. 1. Cases. 1st Visit. Re-Visit. Re-Visit. 1st Visit. Re-Visit. Re-Visit. 1st Visit. 1st Visit. Infants 1,029 549 562 755 457 570 1,874 2,048 Ophthalmia 26 48 6 12 10 36 42 96 Tuberculosis 12 8 5 3 7 8 24 19 Puerperal Fever 2 6 1 1 6 4 9 11 Deaths 164 57 57 13 88 31 309 101 Special 351 5 278 25 145 - 774 30 All Cases 1,584 909 809 713 649 3,206 2,131 673 Visits and Re-Visits 2,257 1,362 5,337 1,718 In the northern half of the Borough there are now four " schools for mothers " maintained by voluntary contributions, at three of which any necessitous woman who is nursing her baby can obtain a dinner in the middle of the day at a cost of one penny. At each school weekly consultations are also held and are attended both by nursing mothers and the mothers of bottle-fed babies. At these consultations each baby is weighed and at three schools the weighing is carried out by the Council's Health Visitors, who attend once a week for this purpose, and for the purpose of giving advice. At the fourth school advice is given to the mothers by a lady who is a qualified medical practitioner, and Dr. Carter attends once a week at the other schools to see any child whose progress is not satisfactory. At all four centres sewing classes are held and lectures on infant care are given. In three schools cooking classes have been organised. * Miss MacKay, the Health Visitor for No. 2 District, was absent for the first 3½ months of the year on nursing duties in connection with the Army, and Miss Whitbread. the Health Visitor (temporary) for No. 3 District, resigned her appointment in July to take up a similar position. THE PREVALENCE OF DISEASE THE INFECTIOUS DISEASES. For administrative purposes the epidemic infectious diseases are divided into two classes, those which the householder is obliged by law to notify to the Medical Officer of Health, and those which are not compulsorily notifiable. In Kensington the following diseases are compulsorily notifiable: Small Pox. Typhus Fever. Plague. Relapsing Fever. Cholera. Puerperal Fever. Diphtheria. Cerebro-spinal Fever. Glanders. Erysipelas. Scarlet Fever. Anthrax. Typhoid or Enteric Fever Hydrophobia. Acute Poliomyelitis. Ophthalmia Neonatorum. SMALL POX. One case of Small Pox occurred in Kensington during the year. The sufferer was a tea-planter of Ceylon, aged 25 years, who, with five companions, came to England, via. Bombay, to join H.M. Forces. On the voyage a case of the disease occurred, and was landed from the ship. Upon arrival in Kensington, the patient fell ill on February 11th, the rash appearing on the 14th, the case was at once diagnosed as Small Pox, and removed to the Hospital Ship. Disinfection was immediately carried out, the Medical Officers of Health of the districts in which known contacts resided were communicated with, and the inmates of the house in which the case occurred, revaccinated. No further case broke out. In the Metropolis as a whole during the year 13 cases were notified, viz.: 6 in Fulham, 2 in Greenwich, and one each in Bermondsey, Bethnal Green, Kensington, Paddington and Stepney. DIPHTHERIA. During the year 161 cases of diphtheria were notified (a case rate of 0.94 per 1,000 of the population), and of these 16 proved fatal. The death-rate per 1,000 of the population was 0.09, and the case mortality, 9.9 per cent. The seasonal incidence of diphtheria, with that of scarlet fever and enteric fever is illustrated by the subjoined Table:— Report for four weeks ended No. of Notifications. Diphtheria. Scarlet Fever. Enteric Fever. January 30 11 43 0 February 27 21 24 1 March 27 14 2 33 April 24 8 1 32 May 22 June 19 14 44 2 9 37 2 July 17 9 25 0 August 14 9 39 3 September 11 9 42 1 October 9 10 30 0 November 6 16 27 1 December 4 14 21 2 January 1, 1916 17 17 1 161 414 16 Bacteriological reports on 140 cases of suspected diphtheria were furnished free of charge to medical practitioners, the diphtheria bacillus being found in 39 of the specimens examined. This work is carried out at the Lister Institute and paid for by the Borough Council. In 31 houses where diphtheria occurred defects in the drainage system were reported and remedied at the instance of the sanitary inspector for the district. The following Table shows the number of cases of diphtheria and the mortality during the decennium 1901-1910, and the quinquennium 1911-1915: — Diphtheria in Kensington, 1901-1915. Cases Notified. Case-rate per 1,000 of population. Death-rate per 1,000 of population. Case-mortality per cent. Year. Deaths. 1901—1910 1,850 212 11.5 0.12 1.06 1911—1915 867 1.02 61 0.07 7.0 SCARLET FEVER. During the year 414 cases of Scarlet Fever were notified (a case rate of 2.42 per 1,000 of the population), and of these 11 proved fatal. The death-rate per 1,000 of the population was 0.06, and the case mortality 2.7 per cent. The seasonal incidence of the disease has already been shown with that of diphtheria. The following Table shows the number of cases of Scarlet Fever and the mortality during the decennium 1901-1910, and the quinquennium 1911-1915:— Scarlet Fever in Kensington, 1901-1915. Year. Cases notified. Case rate per 1,000 of population. Deaths. Death rate per 1,000 of population. Case mortality per cent 1901—1910 3,870 2.22 115 0.07 3.0 1911—1915 2,433 2.83 39 0.05 1.6 Defects in the drainage system were found in 33 of the houses where Scarlet Fever occurred. ENTERIC FEVER. The number of cases of Enteric Fever notified during the year was only 16, the number of deaths being two. Such figures are too insignificant to afford a proper basis for discussing the seasonal incidence and the fatality of this disease in Kensington. In the decennium 1901-1910, the receipt of 529 notifications of typhoid fever and the occurrence of 86 deaths gave an annual average of 53 cases and 9 deaths, and in the quinquennium 1911-1915, the notifications (88) and the deaths (17) gave an annual average of 18 cases and 3 deaths. Defects in the drainage system were found in two of the houses where Enteric Fever occurred. PUERPERAL FEVER. Eleven cases of puerperal fever were notified during the year, and of this number 3 proved fatal. Of the 11 notifications, 7 were notified from Kensington Infirmary, 3 by private medical practitioners, and one from a Hospital. When a midwife has been in contact with infection, her washable clothing is boiled and othergvhj clothing is disinfected by the staff of the Public Health Department. As soon as she has disinfected herself, her clothing and her appliances to the satisfaction of the Supervising Authority, she is allowed to resume her work. The premises where puerperal fever has occurred are inspected, but they are not in ordinary circumstances disinfected. OTHER NOTIFIABLE DISEASES. Ophthalmia Neonatorum. Thirty cases of ophthalmia in new-born infants were notified during the year, including 12 by midwives in accordance with the provisions of the Public Health (Ophthalmia Neonatorum) Regulations, 1914, but 2 of these had been notified by medical practitioners, so that the new cases notified by midwives numbered 10. In addition to the notified cases of ophthalmia, 10 infants were reported by the London County Council Inspector of Midwives as suffering from inflammation of the eyes, which did not result in any impairment of vision. The Health Visitors visit every case of inflammation or ophthalmia in their respective districts as soon as the notification is received, and assist the mother of the infant to obtain the necessary treatment. Where the eyes require constant attention the local branch of the Queen Victoria Jubilee Institute has very kindly arranged for their nurses to attend, at the request of the Health Visitors, on children who are under medical treatment in their homes. Similar arrangements have also been made with the Ranyard Nurses, who are prepared to pay four visits daily to cases of ophthalmia in their district on the Hammersmith border of North Kensington. In certain cases it has also been found possible for patients to attend daily at the Western Ophthalmic Hospital in Marylebone, which is within easy access by train from Notting Hill Station. The London Hospital is unfortunately the only public institution in London, with the exception of the Infirmaries, where the mother and child can both be received as in-patients. Where immediate removal to hospital of mother and child is imperative, the Metropolitan Asylums Board ambulances are available without charge for the purpose. Epidemic Cerebro-spinal Meningitis.—Thirty-nine cases of this disease were notified during the year, 21 of males, and 18 of females, and the deaths numbered 21. The following Table sets out the notifications and deaths at certain age-periods:— Age-period. Notifications. Deaths. Under 1 year of age 7 6 Between 1 year and 5 years 13 6 „ 5 years „ 15 7 2 „ 15 „ „ 25 „ 4 1 „ 25 „ „ 45 „ 5 4 45 years and upwards 3 2 Totals 39 21 Thirty-four of the patients were removed for institutional treatment, of whom 18 died. Bacteriological examination was made in 13 cases, ten of which gave a positive result. NON-NOTIFIABLE EPIDEMIC DISEASES. The immense cost which the community is called upon to bear in order that persons suffering from Scarlet Fever, Diphtheria, and certain other notifiable diseases may be removed from their homes and isolated in Hospital diverts in some measure the attention of the public from the very heavy mortality which results from epidemics of the diseases which are not notifiable. The part played by these two artificial classes of disease has accordingly been represented in the following Table of deaths occurring in the year 1915:— Epidemic Diseases. Notifiable. Deaths, 1915. Non-Notifiable. Deaths, 1915. Diphtheria 16 *Measles 110 Erysipelas 3 Whooping Cough 21 Scarlet Fever 11 Influenza 62 Enteric Fever 2 Diarrhœa 99 32 292 Comment on such figures is unnecessary, except to say that they illustrate the urgency of the problem presented by such diseases as diarrhoea and measles without necessarily indicating This disease became notifiable on January Ist, 1916. notification as the solution. The following Table shows the seasonal incidence of deaths from the non-notifiable epidemic diseases and the age periods in which death occurred:- Non-notifiable Epidemic Diseases in 1915. Report for four weeks ended Number of Deaths. Measles. Whooping Cough. Influenza. Diarrhœa & Enteritis. January 30 2 1 3 12 February 27 12 4 13 3 March 27 43 3 11 4 April 24 34 5 11 5 May 22 10 1 3 2 June 19 6 1 2 4 July 17 1 2 1 9 August 14 0 1 1 6 September 11 1 1 0 20 October 9 0 0 0 25 November 6 0 0 2 12 December 4 1 0 3 3 January 1, 1916 0 2 3 3 Total 110 21 62 99 Measles. Whooping Cough. Diarrhœa & Enteritis. Age at Death. Influenza. Under 1 year 9 3 50 25 Under 5 years 101 20 4 73 5 to 15 years 6 1 0 1 15 to 65 years 3 0 29 11 65 years and upwards 0 0 29 14 Total 110 21 99 62 Fatal diarrhoea is seen to be a disease of infancy, increasing in prevalence in the late summer and early autumn. Deaths from measles and whooping cough occur in early childhood; influenza is chiefly fatal in old age and late middle life, the number of deaths showing a marked remission in the summer months. MEASLES. The deaths from Measles numbered 110, 101 of them being of children under 5 years of age. All cases of Measles in children attending the elementary schools are notified by the head teachers and visited by the lady sanitary inspectors. As the result of these notifications and also of the certificates of death, 1,180 visits were paid to cases of the disease. A leaflet is left with the mother of each family attacked calling attention to the serious nature of the disease, and insisting on precautions being taken to prevent the spread of infection. WHOOPING COUGH. The deaths from Whooping Cough numbered 21, all but one of them being of children under 5 years of age. As a result of the system of notifying cases by the head teachers of the elementary schools, 247 visits were made to cases of the disease by the lady sanitary inspectors. An advisory leaflet was left with the mother of each family visited. EPIDEMIC DIARRHŒA. During the year diarrhœa and enteritis caused 99 deaths, as compared with 81 deaths from the same group of diseases in 1914. TUBERCULOSIS. The number of deaths from tuberculosis was 261, the crude and standardised death-rates being 1.53 per 1,000. The mortality in the years 1901-1915 from phthisis, other tuberculous diseases, and all forms of tuberculosis is expressed in the following Table as the number of deaths per 100,000 persons living in the periods to which the death-rates refer. Tuberculosis in Kensington, 1901-1915. Number of Deaths and Death-rate per 100,000 persons living. Period. Phthisis. Tuberculosis—All Forms. Other Tuberculous Diseases. Death-rate. Death-rate. Death-rate. Deaths. Deaths. Deaths. 1901-1910 1,966 807 46 2,773 159 113 1911-1915 104 302 1,198 139 896 35 Since 1900 the death-rate from tuberculosis has varied between extremes of 195 per 100,000 in 1904, and 109 in 1910, as compared with a rate of 153 in the year under consideration. In the year under notice the deaths from phthisis (pulmonary tuberculosis) numbered 184, and corresponded to a crude death-rate of 108 per 1,000 living. The deaths from other forms of tuberculosis numbered 77, and were equivalent to a death-rate of 0.5 per 1,000 of the population. The incidence of deaths from tuberculosis on the Wards in the Borough was as follows :- Deaths from Tuberculosis in Wards, 1906-1910, 1915, and 1911-1915. Number of Deaths. Death-rate per 10,000. Pulmonary Tuberculosis. Other Forms. Other Forms. Pulmonary Tuberculosis. District. 1 906-10 1911-15. 1906-10. 1911-15 1915. 1915. 1915. 1915. North Kensington 623 131 638 56 12 15 6 15 6 6 2 South Kensington 252 48 240 18 6 St. Charles 125 25 138 10 11 11 12 4 Golborne 182 45 184 19 14 18 14 7 Norland 222 41 210 17 20 20 20 8 20 10 10 11 5 Pembridge 94 106 11 Holland 73 14 58 5 7 7 6 2 Earl's Court 65 8 56 5 7 5 6 3 3 2 Queen's Gate 26 5 28 4 4 4 Redcliffe 57 15 61 4 6 8 6 2 Brompton 31 6 37 1 5 5 6 1 5 18 3 - - - - Unknown - The Borough 875 184 896 77 10 11 10 5 The death-rate in North Kensington from phthisis was more than twice as great as the rate in the South, and the heaviest mortality in the North under both heads fell on the Ward of Norland. A summary may be given here of the Table in the Appendix, which contains the number of persons dying in the successive age periods of life from tuberculosis:- Deaths from Tuberculosis in Age Periods. Age Periods. Under 5 years. 5 to 15. 15 to 45. 45 and upwards. Total. Number of Deaths from Pulmonary Tuberculosis 4 5 111 184 64 Other Forms of Tuberculosis 53 10 9 5 77 The bulk of the deaths from phthisis occurred to the number of 111 between the ages of 15 and 45 in the best working years of life. A large majority of the deaths from other forms of tuberculosis took place in children under the age of 5 years. The place at which death occurred affords some indication of the provision made in institutions for persons in the last stages of tuberculous disease:- Number of Deaths from Place of Death. Pulmonary Tuberculosis. Other Forms. Kensington Infirmary 60 28 Patient's Home 83 30 General or Children's Hospitals 14 13 Lunatic Asylums 15 4 Brompton Hospital 1 0 Other Institutions for the Sick 8 0 Other places beyond the Borough 3 2 184 77 Total 98, or more than half the total deaths from consumption, and 45, or nearly two-thirds of the deaths from other forms of tuberculosis occurred in institutions for the sick. Notifications Received—The notifications received during the year numbered 974, and have been classified in the following Table:— Number of Notifications. A. (Primary Cases.) B. (School Cases.) C (Admissions to Institutions) D. (Discharges from Institutions.) Total. Pulmonary Tuberculosis 130 120 772 512 10 11 202 Other Forms 166 13 12 Totals 678 23 132 974 141 The notifications on Form A of persons suffering from tuberculosis, and on Form C of patients admitted to residential institutions were received from the following sources:- Phthisis. Other forms of Tuberculosis Source of Notifications. Form A. Form C. Total. Form A. Form C. Total. 16 1 ... Brompton Hospital 21 37 1 District Medical Officers 17 ... 17 ... ... ... Kensington Infirmary 103 31 134 94 ... 94 Other Infirmaries 8 2 10 ... ... ... Kensington Tuberculosis Dispensary 139 ... 139 17 ... 17 Other Dispensaries 7 ... 7 ... ... ... Lunatic Asylums 10 ... 10 1 ... 1 Metropolitan Asylums Board Hospitals and Homes ... 9 5 62 67 9 St. Mary's Hospital 13 ... 13 14 ... 14 Other Hospitals 24 3 27 15 ... 15 Other approved residential Sanatoriums 2 16 18 ... 2 2 Private Medical Practitioners 163 ... 163 24 ... 24 130 642 166 11 177 512 436, or nearly three-fourths of the notices certifying persons as suffering from consumption or notifving the admission of consumptives to residential institutions came from the Infirmary (134), the Tuberculosis Dispensary (139), and from private practitioners (163). Of the notifications of other forms of tuberculosis 153 out of a total of 177 came from the infirmary, hospitals or other institutions for the sick, and only 24 were received from private practitioners. More than half of the notifications of other forms of tuberculosis came from the Kensington Infirmary, and numbered ninety-four. Persons Notified. —During the year 536 persons were notified as suffering from consumption, and 184 as suffering from other forms of tuberculosis. In addition 153 fatal cases of tuberculosis in persons who had been notified prior to 1915 were reported by the Registrar of Births and Deaths. The total number of cases reported to the Department in 1915 was accordingly 873. Cases of Tuberculosis Reported in 1915. Pulmonary Tuberculosis. Other Forms. Source of Information. All Forms. Total Cases. Notified in previous years. Notified in previous years. New Cases. Total Cases. New Cases. Total Cases. Notification Certificates 402 134 536 162 22 184 720 Death Certificates 5 36 153 32 85 117 31 873 Total 434 219 653 193 27 220 The new cases of consumption, that is to say, the cases notified in 1915, without having been notified in any previous year, numbered 402. Thirty-two deaths from consumption also occurred in persons who died unnotified. Non-pulmonary tuberculosis was also certified as the cause of death in 31 unnotified persons. The distribution of the new cases among the several districts in the Borough was as follows: — Distribution of Notified Cases. District. Number of New Cases. Pulmonary Tuberculosis. Other Forms. Total. All Forms. North Kensington 127 423 296 South Kensington 104 29 133 St. Charles 65 28 93 Golborne 98 49 147 Norland 96 38 184 Pembridge 37 12 49 Holland 9 34 43 Earl's Court 24 5 29 Queen's Gate 8 2 10 Redcliffe 24 11 35 Brompton 14 2 16 Unknown 2 6 8 The Borough 402 162 564 In its main features the distribution of the notified cases has been much the same as that of the deaths from tuberculosis. Age and Sex of Persons Notified. Tuberculosis. Under 5 years. 15-25. 25-35. 35-45. 55 and upwards. Total 5-15. 45-55. M F M F M F M F M F M F M F M F A. Pulmonary 6 5 31 27 38 60 39 24 28 15 185 217 36 45 39 9 B. Other Forms 47 28 5 10 3 3 1 2 2 1 1 - 87 75 36 23 Total at ages for both sexes A. 11 67 72 98 78 52 24 402 B. 83 51 15 3 1 162 6 3 The incidence of notification on the two sexes is important, but in pulmonary tuberculosis bears no resemblance to the incidence of the cases which actually occur. The notified males exceed the females up to the age of 15 years, and represent children who were examined in school or taken by their mothers to the tuberculosis dispensary, to hospitals or to private medical practitioners, but at the ages 25-45 there is a deficit in male notifications. There is no such difference between the sexes in the returns of fatal phthisis (v. Appendix) and the explanation is that men at work will not seek medical advice until they are seriously ill, whilst women can generally find time to attend at a hospital in the usual afternoon hours. The provision of evening sessions at tuberculosis dispensaries would accordingly appear to be a measure of the first importance in securing treatment for male patients before they become incurable and a source of danger to others. Forms of Tuberculosis in Persons Notified. Site of Disease. Number of Cases. Lungs 402 Lymphatic Glands other than the Mesenteric 60 Larger Joints and Bones above Wrist and Ankle 16 Vertebral Column (Spine) 7 Smaller Joints and Bones, Wrist, Ankle, Hand, Foot 3 Mesenteric Glands, Bowel, Peritoneum 48 Urinary Organs, Kidney, Bladder 1 Meninges of Brain 14 Skin 6 Other parts 7 Total cases 564 Interpreted, the above figures show that out of 162 persons notified as the subjects of nonpulmonary tuberculosis, 26 were suffering from tuberculous conditions of the spine or other bones and joints, which frequently lead to partial or total crippling and disablement. Work of the Lady Sanitary Inspectors.—For the purpose of making inquiries, offering assistance and giving advice, 405 visits—818 revisits were paid by the Lady Inspectors to the homes of the consumptive persons who were notified to the Public Health Department during the year. In addition, 208 visits were paid for inquiry into cases of tuberculosis other than pulmonary. For the sake of brevity, the action taken during the year for the prevention of consumption may be summarised in tabular form as follows : — I.—The Number of Visits paid during the year. a. First visits after notification (pulmonary) 405 b. Subsequent visits 818 c. Visits to other cases of tuberculosis 208 Total visits paid during the year 1,431 11.—Provision for Home Treatment. Bedsteads and bedding lent 21 III.—Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam 165 Number of rooms disinfected 249 Number of rooms stripped 9 IV.—Children attending the elementary schools and notified to the Medical Officer (Education), London County Council, as living in contact with consumptive persons 213 V.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 115 At the first visit a printed card of advice is left, and the particulars as to the history, home surroundings and treatment obtained are subsequently entered on the case sheets containing the notes of every patient notified. Second visits are paid with the object of obtaining for patients the treatment they require, and of seeing that the advice given is carried out. 144 sputum cups have been purchased by the Council during the year for the use of consumptives. The greater number of these cups have been distributed at the Tuberculosis Dispensary; the remainder have been taken to the homes of consumptive patients by the Lady Inspectors. For the purpose of preventing the spread of infection in families, additional bedsteads with bedding are provided by the Council free of charge, and offered to those who need them by the Lady Inspectors. At the end of the year 21 of the Council's beds were in use. The Tuberculosis Dispensary. —During the year 1915 consumptive persons residing in the Borough to the north of Kensington High Street received treatment at the Tuberculosis Dispensary, 119 Ladbroke Grove. The institution is under vpluntary management, but the Committee includes members of the Borough Council and the Board of Guardians. Provision is made for the medical examination of contacts and the visiting of patients in their homes, both by the Medical Officers and by the Dispensary Nurses. Co-operation with the Public Health Department and various voluntary agencies has been secured by the weekly meeting of Case Committees, which are attended by representatives of voluntary societies and by the Council's Lady Inspectors or Medical Officer of Health. The Board of Guardians.—lmportant work is carried out by the Board of Guardians in the admission to the Infirmary of advanced and highly infectious cases of consumption. Wards are set apart with accommodation for some 60 consumptives, and from the notifications received it would appear that 103 phthisical patients were admitted from homes in Kensington during the year. That many of these patients were in the last and most infectious stages of the disease may be inferred from the fact that 60 deaths from phthisis occurred in the Infirmary during the year. The Insurance Committee -During the year 45 insured consumptives were sent from Kensington by the Insurance Committee for the County of London to residential institutions for the treatment of consumption. Dispensary Scheme of Council.—The Council's scheme for the Dispensary treatment of patients at the Brompton Hospital and u Tuberculosis Dispensary has been approved by the Local Government Board. Publications of the details will be deferred until the scheme in its final form has been approved by the London County Council and agreed to by the institutions concerned, and the Insurance Committee of the County of London. The London County Council's scheme for sanatorium treatment for non-insured persons came into force in August, 1914. During the year 1915, 20 non-insured persons suffering from consumption have been admitted to different residential institutions, a large proportion of these being children. CANCER Cancer caused 203 deaths, and of this number 183 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 121 deaths were attributed; sarcoma was the assigned cause of 11 deaths; 71 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following Table: — Deaths from Cancer, 1915. Parts Affected. Sex. Total. Male. Female. Buccal Cavity, No. 39 9 2 11 Stomach, Liver, etc., No. 40 19 23 42 Peritoneum, Intestines, Rectum, No. 41 21 40 61 Female Genital Organs, No. 42 - 20 20 Breast, No. 43 - 30 30 Skin, No. 44 1 2 3 Other and unspecified Organs, No. 45 15 21 36 Totals 65 138 203 The numbers following the description of the parts affected refer to the classification of causes of death adopted by the Registrar General for use in England and Wales. BACTERIOLOGICAL WORK. The following bacteriological work has been carried out in the Lister Institute at the Council's expense, with a view to assisting medical practitioners in the diagnosis of infectious ailments: — Disease Suspected. Number of Cases. Positive. Negative. Total Diphtheria 101 140 39 Tuberculosis 27 88 115 Enteric Fever - 2 2 Gonorrhœa 1 1 2 Total 67 192 259 TREATMENT OF DISEASE Under Section 77 of the Public Health (London) Act, 1891, the Council may, with the sanction of the Local Government Board, provide or contract with any person to provide a temporary supply of medicines and medical assistance for the poorer inhabitants of their district. In pursuance of these powers and the Board's Anti-toxin Order, diphtheria anti-toxin is supplied by the Council free of charge, and a fee of 5s. is paid to any medical practitioner who administers the Council's antitoxin to a poor person suffering or suspected to be suffering from diphtheria. An Annual subscription of £5 5s. is also paid by the Council to the Kensington District Nursing Association in recognition of their services in rendering temporary medical assistance through their nurses to the sick poor, and particularly to infants suffering from ophthalmia. Section 75 of the Public Health (London) Act, 1891, empowers the Council to provide hospitals or contract for the use of any part of a hospital for the inhabitants of their district. It is under this Section that the Council propose to contract with the Brompton Hospital and the North Kensington Dispensary for the dispensary treatment of non-insured consumptives, and already subscribe to the following institutions: — £ s. d. Brompton Hospital 10 10 0 West London Hospital 5 5 0 Kensington General Hospital 5 5 0 St. Mary's Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 Paddington Green Children's Hospital 5 5 0 Kensington Dispensary and Children's Hospital 5 5 0 Kensington District Nursing Association 5 5 0 Kensal Gospel and Medical Mission 5 5 0 £52 10 0 The subscription to the Kensington District Nursing Association is paid under Section 77 THE FOOD SUPPLY. THE FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are regulated by Section & of the London County Council (General Powers) Act, 1908. Premises where milk is sold are required to be kept in accordance with the Dairies, Cowsheds and Milkshops Order, 1885, and the Regulations made thereunder by the Council. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Proceedings in cases of adulteration are instituted under the Sale of Food and Drugs Acts. MILK SUPPLY. At the end of the year the Register kept by the Council and revised from time to time in accordance with the requirements of the Milkshops Order, 1885, contained the names of 199 persons carrying on the trade of purveyors of milk on premises within the Borough. Under Section 5 of the London County Council (General Powers) Act, 1908, the Council are authorised to remove from or refuse to enter upon the Register the name of any person proposing to sell milk on premises which are for any reason unsuitable for the purpose. Whilst reserving to themselves the right to object to premises on any reasonable grounds, the Council, have by resolution expressed the opinion that the presence in a milkshop of such articles as paraffin, loose pickles, fish, fresh meat, fruit, vegetables or coals constitutes a source of contamination, and renders the shop unsuitable for the sale of milk. During the year 16 applications for registration were received from persons who proposed to sell milk, and in each case the application was granted. The alterations made in the Register of Milk Purveyors during the year 1915 are summarised in the following Table :— The Register of Milk Purveyors. Class of Premises. General Stores. Restaurants. Totals. Milkshops. Transferred 7 1 13 5 Vacated and removed from Register 3 5 1 1 Premises added to Register 3 0 0 3 On Register December 31, 1914 126 201 40 35 On Register December 31, 1915 128 34 199 37 Increase + Decrease — +2 -3 -1 -2 The inspection of dairies and milkshops made during the year numbered 1,250, and notices were served requiring the remedy of defects which were found on 3 of the premises visited. Cowsheds.—The only milk produced within the Borough comes from a small cowshed in the Walmer Road, where ten cows are kept. In the absence of any ground for complaint the occupier's licence was renewed by the London County Council at the licensing sessions held in October. Fifty-five inspections of the premises were made during the year. Ice Cream.—At the end of the year 209 premises were shown in the Register of places within the Borough where ice cream is prepared or sold. Fourteen places have been added to the Register and 2 have been removed during the year, the net result being that the number of premises upon which ice cream is made has been increased by 12. The trade is regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice cream are also required to notify the occurrence of infectious disease amongst their employes, or amongst persons living on their premises. The Act further provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice cream has been obtained. 231 visits to ice cream premises have been made by the inspectors during the year. PLACES WHERE FOOD IS PREPARED. Places in the Borough where food is prepared or sold are entered in a Register under the date on which they were finally inspected and found to comply with the requirements of the London County Council (General Powers) Act, 1908. The following Table shows the number of suchpremises on the Register at the end of the years 1914 and 1915, together with the number added to or removed from the Register during the twelve months to which the report relates: — ' Provision Dealers. Restaurants. Butchers. Fried Fish. Fishmongers. Greengrocers. Others. Total. 254 175 118 43 50 71 14 725 On Register Dec. 31st, 1914 No added 6 0 0 1 1 1 15 6 Removed 2 7 3 0 0 1 0 13 51 258 168 115 44 15 On Register Dec. 31st, 1915... 727 76 The inspections of the above premises during the year numbered 1,151, and resulted in the discovery of the following defects which were remedied after the service of notices: — Number of Defects. Defects found. W.C. defective 13 Drains defective 6 Bedroom adjoins 1 Refuse deposited 6 Want of cleanliness 80 Defective ashpit accommodation 10 Other defects. 36 152 Total number of defects found Bakehouses- There are 85 bakehouses in the Borough, and of this number 06 are underground. As a result of 578 inspections in the year 55 notices were served, the work required in 35 cases being the cleansing of walls and ceilings. Slaughter Houses.—The eight slaughter houses 111 the Borough were again licensed in -» October by the London County Council. They are kept in a cleanly state, and from a structural point of view are nqj open to objection. During the year a considerable number of pigs were killed in the slaughter house in the Waimer Road, and the license was renewed by the London County Council in October on the condition that the premises be not used for the purpose of slaughtering on more than 20 Sundays in the year, that slaughtering on Sundays be carried out in the forenoon only, that the licensee do inform the Council of the Royal Borough of Kensington on the previous day when he intends to slaughter animals on a Sunday, and that on week-days cattle be slaughtered only between the hours of 8 a.m. and 8 p.m. in the months of May, June, July, August and September, and between the hours of 8 a.m. and 6 p.m. during the remainder of the year. The slaughter house inspections for the year numbered 255. Unsound Food .—The unsound food surrendered and destroyed during the year is shown in the following list:— March 27th.—4 barrels of apples. April 29th.—10 stone of lemon soles. August 13th.—3 stone of lemon soles. August 20th.—1 trunk of whiting. August 20th.—1 box of dog fish. SALE OF FOOD AND DRUGS ACTS . Each of the ten Sanitary Inspectors is appointed as an inspector under the above Acts, and is instructed to take samples in any place in the Borough which is not within his own sanitary district. During the year the Inspectors collected 700 samples, of which G8 (or 10 per cent.) were adulterated. Proceedings were taken against 37 persons for adulteration or other offences, the fines and costs inflicted amounting to £64 18s. 6d. The samples collected were as follows:— Samples Collected by the Sanitary Inspectors. Name of Sample Number Taken. Number Adulterated. Milk 9 273 Cream 44 21 Butter 106 2 Cheese ... 10 Flour ... 24 Sausages 41 6 Arrowroot 14 ... Corn Flour 8 ... Sweets 13 1 Potted Meats 11 1 Vinegar 56 10 Bread 24 ... Pearl Barley 12 ... Spirits 29 8 Mustard 6 1 Pepper ... 6 Boric Acid Ointment 6 3 Crushed Linseed 6 ... Bottled Peas 6 6 Fish Paste 5 ... Total 68 700 Margarine and Butter Substitutes —Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts: — Lipton, Ltd. 210 Portobello Road. „ 129, Brompton Road. E. C. Nicholls 19, Church Street. C. E. Webb & Sons 39-41, Brompton Road. Pearks, Ltd 165, Portobello Road. Maypole Dairy Co., Ltd. 196, Portobello Road. Home and Colonial Stores, Ltd. 136, Portobello Road. „ „ 20, Chepstow Mansions. „ „ 71, Notting Hill Gate. „ „ 171, Earl's Court Road. „ „ 98, Golborne Road. Cream Regulations.—The Public Health (Milk and Cream) Regulations, 1912, made by the Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907, came into force on October Ist, 1912. They prohibit absolutely the presence of any kind of preservative in milk or in cream containing less than 35 per cent, of milk fat, and the addition of any thickening substance except sugar to cream of any kind. In the case of cream containing 35 per cent, of fat or more, the effect of the Regulations is to permit the additions of boric acid, borax or peroxide hydrogen, provided the cream so preserved is sold in vessels bearing a label with a printed declaration of the percentage of borax or peroxide which has been used. The additions of any other kind of preservative is prohibited. In all cases the Public Analyst examines milk and cream preservatives. A list is appended for 1915:— Milk and Cream not sold an Preserved Cream. Article. Number of Samples examined for the presence of a preservative Number in which a preservative was reported to be present. Milk 273 1 Cream 44 21 (1) Milk.—ln only one case was a preservative found in the samples of milk examined. The sample was found to contain 0.001384 per cent, by weight of formaldehyde. The vendor was prosecuted and fined £5 and 10s. 6d. costs. (2) Cream. —In forty-four samples of cream —not sold as preserved cream —21 contained preservatives (boric acid) varying from 2-975 grains to 30-989 grains per pound. Proceedings were taken in 12 cases under the Sale of Food and Drugs Acts, and penalties were inflicted to the amount of £10 and 10s. 6d. costs in three cases, £3 and 10s. (id. costs in 6 cases, £5 and 10s. 6d. costs and £1 and 10s. 6d. costs and 10s. and 10s. 6d. costs in the three remaining cases. WATER SUPPLY A summary of the sources of the water taken from the Thames to supply Kensington will be found in the Annual Report for 1912 on page 42. No complaints of the quality of the water supplied were received during the year under consideration. Water Supply to New Houses. -During the year 12 newly-erected houses were inspected and certified before occupation under Section 48 (2) of the Public Health (London) Act, 1891, as having a proper and sufficient supply of water. HOUSING OF THE WORKING CLASSES. HOUSING OF THE WORKING CLASSES The number of inhabited and empty dwellings or tenements in the Borough in the Census year 1911 was as follows:— Dwellings or Tenement. Inhabited. Uninhabited. Dwellings. District. Separately Occupied Tenements. Institutions. St. Charles and Golborne (= North) 11,299 14 203 413 Norland and Pembridge (= Central) 9,463 51 North Kensington (=North and Central) 20,762 65 616 1,474 17,356 204 South Kensington (=South) 2,090 The Borough 38,118 269 The figure 38,118 used in the above Table to represent separately occupied tenements is the figure which represents in the Census returns the number of families or households separately occupying their own homes. Each set of one or more rooms occupied by a separate family in a house let in lodgings has accordingly been shown in the first column of the table as a separate dwelling or tenement. In the Rate Collector's returns a house let in lodgings and occupied by members of more than one family is reckoned as a single house, and computed on this basis the inhabited houses in the Borough in 1915 numbered 27,919. In both returns a self-contained tenement or flat as distinct from a set of rooms in a lodging house has been reckoned separately as an inhabited house or dwelling. The second column of the Table shows the number of institutions and large private establishments used as dwellings in the Borough, and the third column gives the number of uninhabited dwellings. It is not possible to estimate how many of the total number of uninhabited dwellings are available for the working classes, but from inquiries which have been made the number of vacant and available rooms in North Kensington is known, and exceeds 1,000. Lodgings provided by the Council, —The total number of tenements provided by the Council for the working classes under the Housing Acts is shown in the following Table: — Rooms in Tenement. Number of Tenements. Rent per Week. 1 2/6 to 3/6 26 2 5/6 to 7/- 62 3 7/- to 8/- 32 Totals 120 2/6 to 8/- The above tenements provided by the Council are all within the Borough. At the end of the year 117 were let and 3 were empty. Houses Let in Lodgings.—The number of houses let in lodgings on the Council's register at the end of the year was 2,0G5, as compared with 2,071 at the end of 1914, the difference being due to the removal of six houses therefrom. The effect of registration is to render the premises subject to the requirements of the Council's Bye-Laws made under Section 94 of the Public Health (London) Act, 1891, as extended by Section 16 of the Housing, Town Planning, etc., Act, 1909, with respect to houses intended for the working classes, and let in lodgings or occupied by members of more than one family. The inspections and re-inspections of the registered lodging houses in the Borough numbered 7,340. Notices requiring the remedy of defects found were served in 781 instances, and 48 cases of overcrowding were abated. The owners of six lodging houses were summoned for breaches of the lodging house bye-laws, or failure to carry out sanitary works required by the inspectors. Furnished Rooms. —Of the 2,065 lodging houses on the Council's Register, 187 were in 1912 let in furnished rooms, the rent charged being at the rate of Is. per room for one night, or 6s. for a complete week. A complete list of the furnished lodging houses in the Borough will be found in the Appendix of the Annual Report for 1912 which on page 47 contains a summary showing the streets in which such houses are situated, and the number of such houses in each street. The following figures show the number of houses let in furnished rooms at Is. per night in the different parts of the Borough:— Norland Ward 143 St. Charles Ward 17 Pembridge Ward 24 Golborne Ward 2 Holland Ward 1 Other Wards 0 Total 187 Notting Dale Special Area in the Norland Ward 103 In 70 of the above 187 houses, unfurnished as well as furnished rooms were being let in 1912, the remaining 117 houses being let furnished throughout. The inspection of houses let in furnished lodgings during the year numbered 1,435. Common Lodging Houses.—The Common Lodging Houses in the Borough number 22, and contain accommodation for 673 persons. From the following Table it will be seen that 19 of these houses are situated in the Norland Ward:— Common Lodging Houses. No. of Lodgers, for which licensed in 1915. Ward. Name of Keeper. Address of Common Lodging House. Male. Female. Total. Golborne Norland Madden, James 194, Kensal Road 75 75 Rusha, Alfred 18, Bangor Street 24 24 Do. 20, do. „ 45 45 Reynolds, Charles 35, do. 22 „ 22 Nagle, William 5, do. 44 „ ... 44 Do. 7, do. „ ... Hankins, George 10, Crescent Street „ 25 25 Do. 28, do. 54 „ Do. 30, do. 54 „ ... Do. 40, do. „ 25 25 Rusha, Alfred 25, do. „ ... 57 Do. 27, do. 57 „ Do. 31, do. 58 „ Do. 33, do. ... 58 „ 66 Davis, Sagel 66, St. Ann's Road „ 66 Rusha, Alfred 34, Sirdar Road ... „ Do. 36, do. 53 53 „ Do. 48 „ 38, do. Do. 48 „ 40, do. ... Code, George 12, Penzance Place „ 43 43 Holland „ Redman, Emma 24, Peel Street 34 Do. 34 22, do. ... Totals 401 ... ... ... ... ... ... ... 272 673 In four streets in the Notting Dale area there are six houses capable of receiving 229 single women and six houses licensed to accommodate 292 single men. It is difficult to avoid the conclusion that the presence of this population of 500 persons, who for the most part come from the lowest ranks of society, must necessarily constitute an effective bar to the progress of social reform in the neighbourhood where the common lodging houses are situated. The inspection of common lodging houses is carried out by the inspectors of the London County Council, who exercise effective control under a system of annual licensing. If a house is not kept in conformity with the bye-laws, the renewal of the licence can be refused, and in this way the necessity for resorting to the cumbersome procedure of prosecution for each offence as it arises is avoided. The adoption of a similar system of annual licensing would materially strengthen the hands of the Sanitary Inspectors in dealing with the worst class of houses let in furnished lodgings, and special powers for the control of such houses are urgently needed. Housing (Inspection of District) Regulations, 1910. —By these regulations the Local Government Board have prescribed the methods to be adopted by Local Authorities in causing inspections of their districts to be made with a view to ascertaining whether any dwelling houses therein are unfit for habitation. The ten District Sanitary Inspectors and the Chief Sanitary Inspector have been designated by the Council as the officers to undertake the preparation of lists of houses, and to make the necessary inspections under the direction and supervision of the Medical Officer of Health. Three hundred and sixteen houses were inspected, and in 284 cases defects were remedied, and in the remaining 32 cases the conditions noted did not call for action. Closing Orders.—During the year 9 houses were represented by the Medical Officer of Health with a view to Closing Orders being made, and in 6 cases Closing Orders were determined, the houses having been rendered fit for human habitation. Underground Rooms.—ln 12 cases illegal occupation was discovered in underground rooms. House to House Inspection.—ln addition to the inspections which have been carried out with the formalities required by the Housing (Inspection of District) Regulations, 1910, routine house to house inspections have been made during the year for the purpose of detecting and securing the remedy of sanitary defects. Excluding the inspections of registered lodging houses for the purpose of enforcing the lodging house bye-laws, the total number of house to house inspections proper amounted to 1,774. Water Supply in Lodging Houses.—ln response to notices served under the London County Council General Powers Act, 1907, an additional supply of water was provided in 56 lodging houses above the level of the ground floor. In the greater number of cases in addition to the water tap a sink was also supplied. Customs and Inland Revenue Acts.—Under these Acts 63 certificates were granted by the Medical Officer of Health during the year, in respect to 63 tenements in 31 houses containing a total number of 80 separate dwellings. FACTORIES AND WORKSHOPS. FACTORIES AND WORKSHOPS. Section 132 of the Factory and Workshop Act, 1901, requires the Medical Officer of Health of every District Council to report specifically on the workshops and workplaces in his district, and to send a copy of his annual report to the Secretary of State. The total number of workshops on the Council's register is 1,870. Workshops where men are employed are placed under the supervision of the sanitary inspector in whose district they are situated; workshops where women are employed are inspected by the two lady sanitary inspectors, who also visit the premises of homeworkers and inspect the sanitary conveniences reserved for women in workshops, railway stations and other public places in Kensington. The factories in the Borough number 246, and are inspected and regulated by H.M. Inspectors under the Home Office. The Sanitary Inspectors of the Borough Council are, however, required to ensure the provision of suitable and sufficient sanitary conveniences in factories as well as in workshops. WOMEN'S WORKSHOPS. Report of Lady Inspectors. —" The number of workshops and factories at which female labour was employed at the end of 1915 was 918, 346 (mostly laundries) being in North Kensington, and 572 (mostly dressmakers) in South Kensington. During the year 44 workshops were added to the register and 13 were removed. "The subjoined Table summarises particulars of the 66 factories and 852 workshops on the register at the end of the year in North Kensington and South Kensington respectively. Workshops, etc. North Kensington. South Kensington. Total for Whole Borough Dressmakers. Laundries. Miscellaneous. Total. Dressmakers Laundries. Miscellaneous. Total. 200 346 409 No. on Register 69 77 8 155 572 918 114 635 121 870 750 26 213 980 No. of Rooms therein 1,859 "The number of persons employed varies with the period of the year, being, of course, greatest during the 'season': it exceeds 10,000. HOME WORK. An analysis of the outworkers registered, shows that some are employed on premises which are factories or workshops within the meaning of the Factory and Workshops Act, 1901, others work in domestic workshops, whilst the remainder are the genuine " Home Workers " engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The number of outworkers belonging to each of these three classes is shown in the following Table:— Home Work. Outworkers in Workshops or Factories 116 Outworkers in Domestic Workshops 32 Outworkers in their own Homes 200 Total number of Outworkers 348 The appended Table summarises the work of the year, so far as it is capable of being expressed in this form: — Premises Visited. Number of Visits and Inspections. No. 1 District. No. 2 District. The Borough. 12 8 20 Factories 190 349 539 Workshops 185 24 209 Outworkers' Premises 27 59 Other Workplaces 86 414 854 Total Inspections 440 15 24 39 Intimation Notices issued 8 8 Statutory Notices served ... ... Summons issued ... ... MEN'S WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 952. The factories at which men alone were employed numbered 180. It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, drainage of floors, the exhibition of abstracts and certain other matters do not apply to workshops conducted on the system of not employing children, young persons or women. In London, both in factories and workshops, the provision of sanitary conveniences is regulated by Section 38 of the Public Health (London) Act, 1891, the standard adopted being that required ljy the Sanitary Accommodation Order of 4th February, 1903. The following Table shows the various trades and occupations carried on in the men's workshops now on the register and in the 180 factories. Trade or Business. Workshops. Factories. Total. 4 Aerated water manufacturer _ 4 73 85 Baker 12 Basket-maker 6 _ 6 Blacksmith 36 1 37 172 8 180 Bootmaker 118 127 Builder 9 Cabinet-maker and Joiner 53 3 56 Carver and Gilder 9 9 37 41 4 Coach-builder 17 17 Cycle-maker _ 11 Electric Generating Works 11 11 13 Firewood-manufacturer 2 2 2 French Polisher 6 4 10 Marble Mason 7 28 21 Printer 19 _ 19 Saddler Tailor 104 104 Trunk-maker 20 20 Umbrella-maker 5 5 11 11 Undertaker 29 32 Upholsterer 3 48 3 51 Watchmaker ... 15 15 Wig Maker _ 16 16 Sausage Maker 154 233 79 Sundry businesses Total 952 1,132 180 _ _ _ _ _ _ _ _ SANITARY WORK SANITARY WORK. Dust Removal. House refuse is collected once a week and is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharf in Kensal Road. The period of seven days is the maximum period during which the Council are permitted by the Public Health (London) Act, 1891, to allow refuse to accumulate on premises within their district. Trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the same Act. Fish offal and other offensive trade products, which could be removed on application as trade refuse, are for the most part removed and sold by the persons to whom this class of refuse belongs. In compliance with notices served by the Sanitary Inspectors, 451 new moveable ash-bins of galvanised iron have been provided during the year, and 106 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. Drainage Work — All drainage work in connection with new buildings is carried out under the supervision of the Borough Engineer, who also supervises the construction of drains on existing premises where the work is undertaken by the owner on his own initiative. The reconstruction of drains found to be defective by the sanitary inspectors is carried out under their supervision, plans of any proposed alteration being submitted in the first instance to the Borough Engineer and then handed on to the Public Health Department. During the year 66 house drains have been reconstructed under notices served by the Sanitary Inspectors. Nuisance from Smoke. 250 observations of chimney shafts in the Borough were made, and notices were served in six instances where black smoke was seen issuing in such quantities as to be a nuisance. In no case was it found necessary to institute legal proceedings to procure the abatement of nuisance from black smoke. Public Conveniences. The Council provide six public lavatories containing water-closets: one is for men only, and in five accommodation is provided for both sexes. In addition there are 12 urinals for men under the charge of the Council. In the women's lavatories there is free accommodation for those who are unable to pay. There are also conveniences for women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the Lady Sanitary Inspectors. Sanitary Inspection.—A complete list of members of the staff of the Public Health Department will be found on the page following the title page of this report. For the purposes of sanitary inspection the Borough is divided into districts, one of which is allotted to each of the ten male sanitary inspectors, who carry out duties under the Public Health Act, the Housing Acts, 1890-1909, the Sale of Food and Drugs Acts, the Rag Flock Act, 1911, the London County Council General Powers Acts, and so far as men's workshops are concerned under the Factory and Workshop Act, 1901. There are two women sanitary inspectors, whose duties consist in the inspection of workshops where women are employed, and in visiting cases of measles, whooping cough and consumption. The work of the three health visitors consists in visiting mothers of the poorer classes and advising them in the care and management of their infants, in visiting cases of ophthalmia in newly-born infants and in assisting with the work at three of the schools for mothers. A summary of the work of the sanitary inspectors will be found in Table X., Appendix, p. 62. LEGAL PROCEEDINGS. Legal proceedings were instituted in 18 cases, particulars of which are summarised in the following lists: — Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Local Management Act and Housing, Town Planning, etc., Act, 1909. Date. Name and Address of Defendant. Offence. Result J. T. Smith, 20, Finsbury Square Failure to carry out sanitary requirements roadway opposite Nos. 1-4, Kensington Crescent Mar. 16th. Order made for works to be carried out within one month. „ H. Yendall, 5, Waverley Road Failure to carry out sanitary repairs at 22, Treverton Street Summons withdrawn, the works having been completed. Name and Address of Defendant Result. Date. Offence. Mar. 16th R. Bell, 1, Goldney Road, W. Failure to carry out sanitary repairs at 84, Wornington Road Order to execute work in 28 days. H. J. Chaper, 298, Ladbroke Grove Failure to carry out sanitary repairs at 3, Branstone Street Order to execute work in 7 days. Failure to carry out sanitary repairs at 10, Treverton Street Order to execute work in 7 days. Do. April 6th Do. Failure to comply with Justices' Order to carry out sanitary repairs at 3, Branstone Street Fined £5. Do. Failure to comply with Justices' Order to carry out sanitary repairs at 10, Treverton Street Fined £5. April 20th J. Hollingsworth, Harwood House, Walham Green Failure to clear choked drain at 6, North Street Summons withdrawn, the work having been carried out. May 4th S. Stanley, 8, Chepstow Crescent Failure to provide a proper supply of water to 8, Chepstow Crescent Order made for a proper supply of water to be provided within 7 days. June 15th A. B. Hemmings, 200, Fulham Road For having sold bread which was unsound, unwholesome, or unfit for the food of man Two summonses were issued. Fined £15 on the first summons, £10 on the second, with 10s. costs. July 6th Mrs. Ellis, 14, Queen's Road Failure to remedy dampness at 99, Clarendon Road Summons adjourned sine die. Premises vacated. Oct. 19th J. Bain, 24, Westgate Terrace Failure to provide a proper supply of water to 24, Westgate Terrace Closing order to be made if water supply is not reinstated within 7 days Failure to provide a proper supply of water to 8, Archer Street Closing order to be made if water supply is not reinstated within 7 days Nov. 16th M. Golien, 8, Archer Street Failure to carry out certain sanitary works at 27, Norland Square Order to execute work in 14 days. Dec. 7th Mrs. Dewhirst, 27, Norland Square Order to execute work in 14 days. Do. Failure to carry out certain sanitary works at 3, Darnley Road F. F. Plantagenet-Brome, 40, Stratford Road Failure to carry out certain sanitary works at 40, Stratford Road Order to execute work within one month. „ Failure to carry out certain sanitary works at 57, Southam Street Fined 40s. and order made for work to be carried out within 14 days. Dec. 21st E. Elson, 93, Woodchester Street „ „ „ „ DISINFECTION. Bedding is disinfected at the Council's disinfecting station at Wood Lane by exposure to si earn under a pressure varying between 15 and 18 lbs. for 20 minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. for ten minutes in the rotary washing machine. Cloth stuffs, dresses, etc., are disinfected by formalin vapour in the heated chamber of the steam disinfector. A formalin cupboard has been constructed for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms are disinfected by fumigation with the formalin vapour generated by pouring 8 ounces of commercial formalin (a fluid containing 40 per cent of formic aldehyde) over 4 ounces of permanganate of potash crystals supplied for the purpose in the form of a solid block. With these quantities 70 grammes of gaseous formaldehyde are produced, an amount which is sufficient to disinfect any room measuring less than 2,000 c.ft Rooms vacated by consumptive persons are first sprayed with per cent, solution of formic aldehyde (formalin 2 ounces to 1 gallon of water), and then sealed and fumigated with formalin vapour. The following Table shows the number of disinfections carried out for various diseases during the year:— Disinfection, 1915. Rooms Disinfected. Premises Disinfected Disinfections at Wood Lane Nature of Infection. 487 Scarlet Fever 396 416 Diphtheria 200 168 155 21 Enteric Fever 16 15 Measles 267 181 19 Consumption 249 209 165 Vermin 165 152 148 200 Other Diseases 123 166 1,589 Totals 1,245 1,084 Year. Weight of Articles sent from Premises. Number of Disinfections at Wood Lane. Tons. Cwts. Qrs. Lbs. 1909 5 2 23 33 789 1910 27 7 3 12 638 1911 14 2 677 27 6 1912 32 3 1 1 786 1913 38 15 0 8 983 1914 19 1 11 69 1,769 1915 45 10 24 1,084 2 The following number of articles was dealt with at the Wood Lane Disinfecting Station during the year:— Articles disinfected only 14,850 Articles disinfected and washed free of charge 2,049 Total articles dealt with in 1915 16,899 CLEANSING STATION In November, 1913, the Council took over for use as a station for the cleansing of verminous persons the Casual War-ids in Mary Place at an annual rent of £80. For more than three years the Metropolitan Asylums Board have had no occasion to accommodate casuals in the wards, and it is not likely that the wards will again be required for this purpose. In the receiving rooms six baths are provided, three on the ground floor and three on the first floor. The Council have installed in the wards adjoining the bath room on the ground floor a machine for disinfection by steam at a temperature of 212 degrees F. under atmospheric pressure. The cost of the machine was £80, and the cylindrical disinfecting chamber is 5 ft. in length with a diameter of 2 feet. The station has been staffed by the appointment of a married couple who reside on the premises. The husband receives 20s. a week as superintendent of the station, and is responsible for the working of the disinfector and the bathing of adult males. The wife receives 15s. a week and is required to bathe females and children. The superintendent was called up for Naval Service at the outbreak of the war, and a temporary man has been appointed in his place. Under a contract with the Education Authority the Borough Council have agreed to receive verminous children sent to the station by the school nurses from the elementary schools. For the use of the station and its equipment the Borough Council receive payment at the rate of 2s. for each child cleansed. Technically in accordance with the provisions of the Childrens' Act, 1908, children sent from the elementary schools are cleansed by the school nurse in the employ of the London County Council, who attends at the station for the purpose, and is responsible under her employers for the effective use of the apparatus provided. In practice the actual work of bathing and disinfecting garments is carried out by the Borough Council's servants under the supervision of the school nurse. For adults and children not sent from the elementary schools the superintendent and his wife are responsible, and for the cleansing of such cases no charge is made. The following Table shows the work carried out at the station for the year 1915:— Children cleansed 502 Adults cleansed 390 Baths given 1,641 Verminous Rooms. —137 verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council (General Powers) Act, 1904, 148 beds were disinfected, 6 verminous beds were destroyed, and 62 dirty beds were cleansed. Rag Flock Act, 1911.—Four samples of rag flock were taken analysed and reported on during the year. They contained 12, 10, 8 and 7 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. PUBLIC BATHS AND WASHHOUSES The subjoined particulars set forth the use made of the Public Baths and Washhouses during 1915 and the three preceding years by washers and bathers.— Year. Washers. Bathers. 1912 76,052 142,685 1913 157,383 74,757 1914 202,668 75,144 1915 139,707 81,024 MORTUARY AND CHAPEL OF REST During the year 249 bodies were deposited at the Mortuary under the following circumstances:— 1. At the request of the relatives of the deceased 32 2. At the request of undertakers, mainly at the instance of the relieving officers 15 3. At the request of the coroner (inquest cases): — Cases of sudden death 109 Cases of violent death 77 186 4. Brought in by the Police—Persons found dead 9 Accident cases 7 16 5. On account of death due to infectious disease 0 Total number of bodies received 249 In 138 of the above cases post mortem examinations were made under the coroner's warrant. The number of bodies deposited in 1915 and the six preceding years, together with the number of inquests held and the number of post mortem examinations made in the Mortuary is shown in the following Table: — Number of Bodies taken into the Mortuary. No. of bodies upon which Coroner's inquests were held. No. of bodies upon which post-mortem examinations were made. No. of bodies received at the Mortuary. Year 181 110 1909 263 1910 233 145 103 118 1911 261 177 1912 238 151 107 132 1913 239 151 1914 242 177 127 138 1915 249 202 Unnecessary inconvenience having been caused by numerous applications from undertakers for the reception of bodies late at night, the period during which bodies will be received, except in case of emergency, has been limited on the recommendation of the Cemetery and Open Spaces Sub-Committee to the hours between 8 a.m. and 8 p.m., and undertakers have been notified to this effect. During the year 59 bodies were deposited in the Chapel of Rest, Avondale Park. Fiftyfour bodies were deposited in the previous year. VACCINATION. Through the courtesy of Mr. Berry, the acting vaccination officer, I am able to publish the following summary of the official returns respecting the vaccination of children whose births were registered in 1914. Out of a total number of 3,036 infants born 407 were not vaccinated on account of " conscientious objection " on the part of the parents, and 209 remained unvaccinated through " removal to places unknown." The total number of cases not finally accounted for or not vaccinated through " conscientious objection " on the part of the parents thus amounted to 616, or to 20 per cent, of the births registered as compared with losses of less than 7 per cent, in each of the five years 1904-1908. The number successfully vaccinated amounted to 2,149, or 70 per cent, of the total births, and 195 infants died before the operation of vaccination had been performed. APPENDIX. APPENDIX. Local Government Board Tables I —IV. TABLE I. Vital Statistics of Whole District during 1915 and previous Years. Year. Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District Uncorrected Number. Nett. of Nonresidents registered in the District. of Residents not registered in the District. Under 1 Year of Age At all Ages. Number. Rate. Number. *Rate. Number. Rate per 1,000 Nett Births Number. Rate. 1 3 6 7 2 4 5 8 9 10 11 12 13 1910 172,730 3,007 3,190 18.5 345 108 2,204 12.8 2,524 635 315 14.6 1911 3,037 3,223 18.7 2,712 722 399 435 2,389 13.9 172,300 15.7 135 1912 3,068 3,318 19.3 2,524 14.7 683 446 305 92 2,287 13.3 172,000 1913. 171,700 3,173 19.4 371 111 2,409 14.0 3,335 2,614 15.2 695 490 1914 3,019 3,153 18.4 2,624 15.3 767 432 298 95 2,289 13.4 171,400 3,100 199 942 493 1915 †155,795 2,917 3,074 19.7 365 119 2,636 16.9 Rates calculated per 1,000 of estimated population. Civil Population as estimated by the Registrar-General, and upon which the rates in this Table are based. At Census of 1911. Area of District in acres (exclusive of area covered by water) 2291 Total population at all ages 172,317 Total families or separate occupiers 38,118 TABLE II. Cases of Infectious Disease notified during the Year, 1915. Notifiable Disease. Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Norland. Pembridge. Holland. Earl's Court. Brompton. Redcliffe. Queen's Gate. Golborne. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. ... ... ... ... ... 1 J ... Small-Pox. 1 ... ... ... 1 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... I"" ... ... ... ... ... ... 19 39 11 19 15 22 11 4 Diphtheria (including Membranous croup) 161 ... 44 71 23 16 7 ... 21 143 16 12 10 9 7 4 2 4 1 5 10 31 11 Erysipelas 89 6 27 23 21 6 100 222 26 4 1 83 105 35 18 29 32 11 Scarlet fever 414 55 72 29 382 ... ... ... ... ... ... ... ... Typhus fever ... ... ... ... ... ... ... 2 2 2 6 ... 1 2 Enteric fever 16 1 3 4 7 1 ... 1 11 Continued fever 1 ... ... ... 1 ... ... ... 1 ... ... ... ... Puerperal fever 11 ... ... ... 1 10 ... ... 2 ... 1 ... 4 1 2 1 9 Cerebro-Spinal Meningitis 39 13 8 3 2 1 3 9 7 3 5 3 5 1 7 5 34 Poliomyelitis 1 ... 1 ... ... ... ... 1 ... ... ... ... ... *Pulmonary Tuberculosis 402 1 10 67 176 9 65 98 37 34 8 24 14 72 67 96 24 188 28 49 38 12 9 5 2 11 2 †Other forms of Tuberculosis 162 54 51 8 5 ... 29 15 105 Ophthalmia Neonatorum 30 ... ... ... ... ... 8 11 3 1 2 1 2 1 1 30 6 8 12 4 2 2 3 2 Chickenpox 55 7 18 23 5 2 ... 13 9 4 Totals. 1382 241 450 188 117 904 85 279 22 232 350 253 124 118 89 66 101 41 In 2 cases the Ward was unknown. In 6 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE III.* Causes of, and Ages at, Death during the Year 1915. Causes of Death Nett Deaths at the subjoined ages of "Residents" whether occurring within or without the District. Total Deaths whether of " Residents " or " Non-Residents" in Institutions in the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. Certified 2,634 364 161 112 66 84 302 634 911 - All causes Uncertified 2 1 - - - - 1 - - - Enteric Fever ... ... 1 ... ... 2 1 ... Small-pox ... ... ... ... ... ... ... Measles 110 25 47 29 6 2 ... 1 ... 37 Scarlet Fever ... 3 4 11 1 2 ... 1 Whooping-Cough 21 9 3 8 1 ... ... ... 20 Diphtheria, and Croup 16 3 4 7 2 Influenza 62 3 1 ... 1 10 18 29 3 Erysipelas 3 1 ... 1 ... ... 1 6 Phthisis (Pulmonary Tuberculosis) 183 1 2 1 5 27 54 10 83 245 Tuberculous Meningitis 28 2 6 11 6 1 1 1 16 Other tuberculous diseases 49 20 6 8 4 4 3 3 1 41 Cancer, Malignant disease 203 ... ... ... ... ... 101 82 20 166 Rheumatic Fever 5 ... 1 1 3 3 Meningitis 47 19 8 5 7 2 4 1 1 32 Organic Heart Disease 336 ... 2 10 30 96 198 216 Bronchitis 246 32 8 4 9 48 145 168 ... Pneumonia (all forms) 248 56 39 27 12 4 25 38 47 108 Other diseases of Respiratory Organs 62 6 1 1 1 1 7 11 34 31 Diarrhoea and Enteritis 99 50 20 3 1 1 8 14 2 54 Appendicitis and Typhlitis 12 ... ... 3 ... 3 5 1 3 Cirrhosis of Liver 35 ... ... 1 ... 17 17 15 ... Alcoholism 8 ... ... 2 ... 1 5 3 Nephritis and Bright's Disease 81 1 ... ... 10 25 1 44 42 Puerperal Fever 3 ... ... 3 ... 2 ... Other accidents and diseases of Pregnancy and Parturition 4 ... ... ... 4 ... ... 2 Congenital Debility and Malformation including Premature Birth 96 1 1 ... ... ... 92 2 27 Violent Deaths, excluding Suicide 52 6 3 2 5 3 14 9 10 36 3 Suicide 17 ... ... ... 4 7 3 ... Other Defined Diseases 41 11 68 291 596 1 6 15 163 271 Diseases ill-defined or unknown 1 ... ... ... 1 ... ... ... 303 84 634 911 1,547 2,636 161 112 66 365 15 deaths of members of H.M. Forces have been excluded from this Table. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... TABLE IV. INFANT MORTALITY DURING THE YEAR 1915. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths UNDER One Year. All Causes. Certified 16 6 68 69 71 59 364 56 19 97 Uncertified ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Small-pox Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 1 9 14 25 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 7 1 9 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... 1 ... 1 1 ... ... ... 2 Abdominal Tuberculosis ... ... ... ... ... 3 9 3 2 17 Other Tuberculous Diseases ... ... ... ... ... 1 ... 3 ... 4 Meningitis (not Tuberculous) ... 2 ... 1 3 3 6 3 4 19 Convulsions ... ... ... 1 1 3 1 2 2 9 Laryngitis ... ... ... ... ... 1 ... ... ... 1 Bronchitis ... 1 ... ... 1 10 9 7 5 32 Pneumonia (all forms) 1 2 2 ... 5 9 7 18 17 56 Diarrhœa ... ... 2 1 3 5 6 5 2 21 1 29 1 11 4 4 Enteritis ... ... ... 9 5 Gastritis 1 ... ... ... 1 ... 3 1 ... 3 ... ... 3 1 ... 7 Syphilis ... 1 2 ... ... ... ... Rickets ... ... ... ... ... ... 1 Suffocation, overlaying ... ... ... ... 1 ... ... ... ... ... Injury at birth 4 ... ... 4 ... 4 ... ... ... Atelectasis ... ... ... 4 ... ... ... ... 4 4 Congenital Malformation 4 ... 2 2 5 3 12 1 ... ... Premature Birth 27 6 36 ... ... ... 38 ... 2 3 Atrophy, Debility, and Marasmus 13 4 7 8 1 22 2 3 42 4 7 7 Other causes 2 2 1 4 5 27 2 4 ... 56 19 69 365 6 97 69 71 59 16 Nett Births in the year legitimate, 2,938. legitimate infants, 318. Nett Deaths in the year of illegitimate, 136. infants, 47. TABLE V. Births and Deaths in Kensington; Birth-rates and Death-rates; and Infantile Mortality 1881-1915 in London and Kensington. Deaths under One Year. Birth Rate per 1,000 living. Death Rate per 1,000 living. Deaths under One Year per 1,000 Births. Number of Births. Number of Deaths. Kensington. London. Kensington Period Kensington. London. London. 21.0 150 150 1881-1885 21,383 34.3 26.1 13,438 16.4 3,211 13,816 1886-1890 19,428 32.1 23.5 19.7 16.7 3,060 153 157 18,512 167 1891-1895 30.8 22.0 14,235 19.8 16.9 3,105 156 1896-1900 18,665 29.7 21.6 14,075 18.5 16.3 3,203 162 172 1901-1910 35,062 27.5 20.0 24,917 15.6 14.3 4,644 126 132 1911 3,223 24.8 18.7 2,389 15.0 13.9 435 129 135 1912 3,318 24.5 19.3 2.287 13.6 13.3 305 91 92 1913 3,335 24.5 19.4 2,409 14.2 14.0 371 105 111 1914 3,153 24.3 18.4 2.289 14.4 13.4 298 104 95 1915 3,074 22.5 18.0 2,651 16.0 15.5 365 112 119 Note I.—The decennial rates for the years 1901-1910 have been obtained by halving the sum of the quinquennial rates shown in the Annual Summary on the same pages for the years 1901-1905 and 1906-1910. Note 2.—The method adopted for obtaining the rates for Kensington was fully explained in the footnote which was appended to the above Table in the Annual Report of the Medical Officer of Health for the year 1911. TABLE VI. Deaths from the Principal Epidemic Diseases, 1881-1915. Deaths from the Seven Principal Epidemic Diseases. Period. Diphtheria Whooping- Cough Enteric Fever. Small Pox Measles. Scarlet Fever. Diarrhœa and Enteritis (all ages). Diarrhœa and Enteritis (under 2 years.) 1881-1885 326 153 96 427 115 - - 107 1886-1890 1 442 135 305 387 77 - - 92 - 9 306 1891-1895 297 152 312 678 874 - 262 1896-1900 0 448 105 249 87 432 1901-1910 579 1,110 - 13 115 212 86 184 0 93 3 54 150 1911 20 4 0 5 4 1912 27 5 25 70 36 7 29 6 108 81 82 1913 0 3 81 62 7 1 0 17 13 1914 15 1915 0 110 11 16 21 2 99 70 TABLE VII. Death-rate in Kensington, per 1,000 persons living, from each of the Seven Principal Epidemic Diseases. 1881-1915. Diarrhoea and Enteritis (under 2 years). Period. Smallpox. Measles. Diphtheria. Whooping Cough. Diarrhœa and Enteritis (all ages). Scarlet Fever. Enteric Fever. 1881-1885 0.13 0.39 0.19 0.12 0.52 0.17 - - 0.00 0.53 0.16 1886-1890 0.47 - 0.37 0.10 - 1891-1895 0.01 0.12 - 0.35 0.37 0.81 0.18 0.36 0.12 0.29 1896-1900 0.00 O.11 1.01 - 0.52 0.30 0.07 0.12 0.25 0.05 0.01 - 1901-1910 0.33 0.64 0.02 0.87 0.54 0.02 0.12 0.31 1911 0.00 1.07 1912 0.00 0.03 0.16 0.03 0.15 0.02 0.21 0.41 1913 0.00 0.02 0.04 0.48 0.17 0.03 0.47 0.63 0.09 1914 0.00 0.10 0.08 0.04 0.36 0.00 0.47 0.64 0.01 0.58 0.41 1915 0.00 0.06 0.09 0.12 TABLE VIII.* Causes of Death at different periods of life in the Year 1915. CAUSES OF DEATH. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 65 years and upwards. Totals- Above 5 Years. Classification No. 45 and under 65 years. Total M F M F F M M F Total M F M F F M F M F M Total M F F M I. GENERAL DISEASES. Enteric Fever 1 2 2 ... 1 ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 ... 25 13 50 51 101 2 ... 1 ... 6 9 Measles 6 110 53 57 15 10 22 16 3 3 ... ... ... ... 3 1 ... Scarlet Fever 7 11 5 6 ... ... 2 2 2 4 3 7 1 ... ... 2 ... ... 1 ... ... 1 3 4 1 ... ... Whooping-Cough 8 21 8 13 4 5 2 2 6 8 12 20 ... 1 ... ... ... ... ... ... ... 1 1 2 1 3 1 ... ... ... 2 Diphtheria 9A 16 6 1 ... ... 1 3 4 7 1 6 1 ... ... ... 7 9 ... ... ... 58 Influenza 10 62 30 30 2 1 ... ... 1 2 2 4 ... 1 7 3 9 9 11 18 28 30 Dysentery 14 3 2 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... 2 1 3 ... ... ... ... Erysipelas 18 3 2 1 ... 1 ... ... ... ... 1 1 ... ... 1 ... ... 1 ... 2 ... 2 ... ... Other epidemic diseases (Rothel) 19 1 ... 1 ... ... 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Pyæmia, Septicæmia æ 20 3 1 2 1 ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 2 ... ... ... 2 2 ... Tetanus 24 1 ... 1 ... 1 ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Actinomycosis 25 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 55 Pulmonary Tuberculosis 28AB 178 98 80 1 ... 2 ... 1 1 3 4 2 2 6 18 52 30 33 21 4 6 97 77 174 ... Acute Miliary Tuberculosis 29B 5 1 4 ... ... ... ... ... ... ... ... 1 ... ... 3 ... 1 ... ... ... 1 4 5 ... ... 7 7 Tuberculous Meningitis 30 28 19 9 2 ... 3 3 4 12 19 1 2 1 ... 1 ... 1 ... ... ... 7 2 9 Tuberculosis of Peritoneum, &c. 31AB 33 17 16 10 7 4 1 2 3 16 11 27 ... 2 1 ... ... 2 ... 1 ... ... 1 5 6 Tuberculosis of Joints 33 3 2 1 ... ... ... ... ... 1 ... 1 1 ... ... 1 ... ... ... 1 ... 2 ... 2 ... ... ... ... 1 ... ... ... Tuberculosis of other organs 34 2 2 ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... 1 ... 1 ... ... ... ... Disseminated Tuberculosis 35 11 4 7 1 2 1 1 1 4 5 2 ... 1 3 3 6 ... ... ... 2 1 Rickets 36 1 1 ... ... ... 1 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 37 14 7 7 5 2 ... 1 ... ... 5 3 8 ... ... ... ... 1 3 ... ... 2 6 ... 2 4 Ophthalmia Neonatorum 38 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer 39-15 203 65 138 ... ... ... ... ... ... ... ... ... ... ... ... ... 15 33 27 55 65 5 68 138 203 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other tumours 46 1 ... 1 ... ... ... ... ... ... ... ... Rheumatic Fever 47 5 2 3 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... 1 2 ... ... 1 3 1 4 ... ... ... ... ... ... ... ... ... Chronic Rheumatism, &c. 48 AB 5 2 3 ... ... ... ... ... ... ... 2 3 2 3 5 ... Gout ... ... ... ... ... ... ... ... ... ... ... 480 5 4 1 ... ... ... ... ... ... 1 4 4 1 5 ... ... 5 13 10 Diabetes 50 30 10 20 ... ... ... ... ... ... ... ... ... ... 1 2 5 4 20 30 ... Exophthalmic goître ... ... ... ... ... 51 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Addison's Disease. 52 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Leucocythæmia, &c. 53AB 2 ... 2 ... ... ... ... ... ... 2 ... 2 2 31 36 109 103 12 19 15 26 68 59 86 115 55 96 236 315 Carried forward 763 345 418 43 29 35 38 212 551 15 Deaths of members of H.M Forces have been excluded from this Table. 62 3 2 1 1 2 1 3 2 5 Locomotor Ataxy 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Spinal Cord 63AB 1 1 ... 3 4 8 4 12 12 8 4 ... ... ... ... ... ... ... ... ... 3 ... ... ... ... Cerebral Hæmorrhage, Apoplexy 64AE 53 ... 1 ... 5 16 18 22 29 38 53 91 91 38 ... ... ... ... ... ... ... ... ... ... ... 65 6 3 3 1 1 2 2 8 3 6 Softening of Brain ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paralysis without specified cause 66AC 6 ... 4 2 6 6 10 10 16 10 ... ... ... ... ... 4 ... ... ... ... ... ... ... ... 67 11 3 ... 1 8 3 2 11 3 General Paralysis of the Insane 14 ... ... ... ... ... ... ... 14 ... ... ... ... ... ... ... Other forms of Mental Alienation 68 5 1 1 1 1 1 4 5 4 ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... 69 13 7 6 1 3 2 1 7 6 13 Epilepsy ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... 4 8 4 12 ... ... 1 ... ... ... Infantile Convulsions under 5 years 71AB 12 8 6 3 2 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Chorea 72 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Neuritis 1 2 1 2 3 73 3 ... ... ... ... ... ... ... ... 1 1 ... 1 ... ... ... ... ... ... ... Other Diseases of the Nervous System 5 2 1 4 74AD 10 5 ... 1 ... ... 1 1 ... ... ... 2 1 1 2 5 9 ... I I I ... ... 1 1 1 ... ... 3 Other Diseases of the Ears 76B 4 4 ... 1 1 ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... Total for Diseases of the Nervous System, and of the Organs of Special Sense 118 12 5 6 4 1 27 19 4 5 4 18 16 34 32 33 42 94 99 193 239 18 5 121 46 III.—DISEASES OF THE CIRCULATORY SYSTEM. 2 2 ... ... ... ... ... 1 3 Pericarditis 77 4 2 ... ... 1 1 1 ... ... ... ... ... 2 1 ... ... Acute Endocarditis 78AC 9 1 3 1 3 4 5 9 4 5 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Valvular Disease 51 2 3 6 5 21 22 43 51 73 79A 124 73 ... ... ... 1 21 124 ... ... ... ... ... ... ... Fatty Degeneration of the Heart 79B 49 22 ... ... ... ... 1 2 2 7 18 16 27 22 49 27 ... ... 3 ... ... ... ... ... ... 649 123 259 23 526 Carried forward 1203 1203 554 61 41 40 35 38 86 128 201 418 44 38 136 16 26 95 156 175 944 IV.—DISEASES OF THE RESPIRATORY SYSTEM. 3 87AC 5 3 1 ... ... 2 ... 1 ... 1 ... ... ... ... 2 1 1 1 1 ... ... 2 - Diseases of the Larynx 1 Diseases of the Thyroid Body Biliary Calculi 114 Other Diseases of the Liver 115 Peritonitis (cause unstated) 117 Other Diseases of the Digestive System 118 Total for Diseases of the Digestive System VI.—NON-VENEREAL DISEASES OF THE GENITO-URINARY SYSTEM AND ANNEXA. 119 2 1 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Acute Nephritis ... ... ... 1 4 6 21 23 11 13 36 43 79 Bright's Disease, &c. 120AB 79 36 43 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... 2 Other Diseases of the Kidney 122AD 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Calculi of the Urinary Passage 123 2 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 7 2 9 2 11 Diseases of the Bladder 124 11 9 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... 4 ... 4 Diseases of the Prostate 126 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... 3 3 Uterine Tumour 129 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of the Uterus 130 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Ovarian Cyst 131 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of the female genital organs 132 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for non-Yenereal Diseases of the Genito Urinary System and Annexa 6 26 17 106 54 52 ... ... ... 1 8 24 23 53 52 105 1 ... ... ... ... ... ... 1 1 30 47 145 131 308 304 325 830 1000 1830 38 480 Carried forward 2353 1101 1252 145 114 78 78 48 60 271 252 523 22 142 71 71 30 22 26 36 11 8 2 3 2 2 87 43 44 2 1 12 12 29 31 114 115 229 3 1 2 ... ... 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 7 3 4 1 ... 2 3 ... ... ... ... ... 1 4 2 2 ... ... 1 ... 1 2 5 6 11 9 5 4 3 1 2 2 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 4 9 4 2 2 I J 1 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 4 1 ... 142D ... ... ... ... ... 1 1 Other Gangrene ... ... ... ... ... ... ... 1 ... ... ... ... 1 Carbuncle 143 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... 1 2 ... ... ... 3 Phlegmon, Acute Abscess 144AB 6 3 ... ... ... ... ... ... ... ... 2 1 2 ... 3 6 ... ... ... Diseases of the Integumentary System 145 1 1 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 3 ... ... ... 1 ... ... ... 1 Suicide by Hanging 157 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 Suicide by Drowning 158 2 ... 2 ... ... ... ... ... ... ... ... Suicide by Firearms 2 2 ... 159 ... ... ... ... ... 1 1 ... ... ... 2 2 Suicide by Cutting or Piercing Instruments 160 5 3 2 ... ... ... ... 1 ... ... 2 2 ... 3 2 5 ... ... ... ... ... ... Suicide by jumping from high place 161 1 ... 1 ... ... ... ... ... ... ... ... 1 ... 1 1 Other Acute Poisoning 165 1 1 1 ... ... ... ... ... ... 1 1 ... ... ... ... ... ... Burns 167 8 3 5 1 ... 1 1 ... 2 1 3 ... ... ... 1 1 1 ... 2 1 4 5 Absorption of Deleterious Gases (Overlain, etc.) 168 5 3 2 2 2 ... ... ... 2 2 4 ... ... ... ... 1 ... ... ... ... 1 ... 1 Accidental Drowning 169 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 Injury by Fall 172 8 5 3 ... ... ... 2 1 2 1 1 4 3 7 1 ... ... 1 1 Injury by other Crushing (vehicles, railways, &c.) 175 25 14 11 5 ... 1 1 3 3 2 3 2 3 13 10 23 ... ... ... 1 1 ... 1 1 2 ... ... ... ... 1 ... 1 ... ... ... 1 1 Homicide 183&184 2 1 1 1 ... ... 1 1 Fractures (cause not specified) 185 2 1 1 ... ... 1 ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 Total for Affections produced by External Causes 69 33 36 4 2 1 2 2 ... 7 4 11 8 8 6 7 29 29 58 5 ... 2 8 10 4 XIV.—ILL-DEFINED CAUSES. 189F 1 ... 1 ... ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Grand Totals 2636 1419 200 165 80 81 61 331 307 638 28 38 32 52 155 319 315 886 1112 1998 1217 51 148 352 Cause not specified 559 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... 1 ... ... 1 ... ... TABLE IX.—PROCEEDINGS DURING 1915. NUMBER OF PLACES. Number of prosecutions, 1915. Number of inspections, 1915. Number of notices, 1915. PREMISES. On register at end of 1914 Removed in 1915. On register at end of 1915. Added in 1915. Milk premises 201 5 199 1,250 — 3 3 Cowsheds — — 1 55 — 1 10 2 8 4 — Slaughter-houses 255 Other offensive trade premises Nil — — — — — Ice cream premises 197 14 209 231 — 2 Registered houses let in lodgings 2,071 — 6 2,065 7,340 (a)*58 (b)†723 (a)*0 (b)†6 Total number of intimation notices served for all purposes, 1,854. *(a) For overcrowding. †(b) For other conditions. Overcrowding—1915. Number of dwelling rooms overcrowded 48 Number remedied 48 Number of Prosecutions 0 Underground rooms— Illegal occupations dealt with during year 12 Number of rooms closed 12 Insanitary houses — Number closed under the Public Health (London) Act, 1891 0 Number closed under the Housing of the Working Classes Act 9 Number of premises cleansed under Section 20 of L.C.C. (General Powers) Act, 1904 437 Shelters provided under sec. 60 (4) of the Public Health (London) Act, 1891 — Number of persons accommodated during the year No shelter Revenue Acts — Number of houses for which applications for certificates were received during year 31 Number of tenements comprised therein 63 Number of tenements for which certificates were (a) granted 63 (b) refused 0 Number of prosecutions under By-laws under Public Health Act, 1891 — (a) For prevention of nuisance arising from snow, ice, salt, filth, &c.— (b) For prevention of nuisance arising from offensive matter running out of any manufactory, etc. — (c) For the prevention of keeping of animals in such a manner as to be injurious to health 0 (d) As to paving of yards, etc., of dwelling houses 0 (e) In connection with the removal of offensive matter, etc. 0 (f) As to cesspools and privies, removal and disposal of refuse, etc. — (g) For securing the cleanliness of tanks, cisterns, etc. — (h) With respect to water closets, earth closets, etc. 0 (i) With respect to sufficiency of water supply to water closets — (j) With respect to drainage, etc. (Metropolis Management Act, section 202) — (k) With respect to deposit of plans as to drainage etc. (Metropolis Management Acts Amendment (By-laws) Act, 1899) 0 Mortuaries — Total number of bodies removed 308 Total number of infectious bodies removed 0 — — — — 61 TABLE X. Summary of the Work done by the Sanitary Inspectors during the Year 1915. DESCRIPTION OF WORK, Etc. NUMBER OF DISTRICT. Grand Total. 1 2 6 7 8* 9 10 3 4 5 Complaints received 177 106 45 246 31 83 1,250 70 132 116 244 House to House Inspections 297 109 82 89 132 288 148 496 1,774 136 7 Houses Inspected on Complaint 517 365 258 253 444 559 420 53 415 199 3,483 Re-inspections of Houses 571 670 1,154 1,194 1,053 1,411 1,009 435 1,121 791 9,409 Inspections of Lodging Houses (Unfurnished) 1,284 993 277 778 780 144 603 74 645 327 5,905 Inspections of Lodging Houses (Furnished) 35 947 173 280 - - 1,435 Houses cleansed, &c. 120 401 103 143 117 101 246 14 140 55 1,440 Verminous Rooms cleansed 143 47 72 77 52 17 14 7 8 437 Dirty bedding cleansed 5 26 11 12 5 2 1 - 62 „ „ destroyed 1 - 4 - 1 - - - 6 Overcrowding abated 12 9 6 - 3 3 14 - - 1 48 Underground Rooms, illegal occupation discontinued 1 - 2 4 2 - 1 1 12 1 2 2 2 66 House Drains re-constructed 6 15 12 7 6 11 3 Defective Drains repaired 28 23 10 7 2 25 10 6 25 9 145 House Drains cleansed 29 111 17 168 12 2 46 14 16 20 335 Water-closets constructed, repaired, &c. 142 16 72 14 44 37 512 51 57 40 39 „ Supplied with water 5 135 1 56 54 1 33 1 36 8 330 „ new, provided - 3 1 4 4 5 2 29 48 Soil-pipes ventilated, repaired, &c. 5 18 1 3 1 2 3 1 13 1 48 2 17 2 46 „ new, provided 2 3 7 4 8 1 Cisterns cleansed, covered, &c. 23 66 22 42 5 225 8 13 29 17 Yards, Areas paved, drained, repaired 42 27 28 37 33 29 29 4 50 3 282 Dustbins provided 78 84 23 28 8 12 48 5 65 11 362 Ashpits abolished 47 13 8 1 3 35 28 135 Accumulations of filth, &c., removed 45 5 43 7 41 259 27 15 6 53 17 Animals removed 4 1 6 2 11 - 3 - 37 7 3 Other Sanitary Work executed 17 572 100 87 65 90 150 10 77 47 1,215 Workshops &c., Inspections of 42 33 55 124 63 59 32 65 79 199 751 Factories, Inspections of 9 12 8 38 8 30 22 10 23 160 Bakehouses, Inspections of 95 82 57 32 77 67 21 2 66 79 578 Slaughter-houses, Inspections 3 - - 255 21 97 41 38 55 1 „ „ Notices - 1 2 - 4 Dairies, &c., Inspections 153 52 111 202 212 126 32 32 235 95 1,250 „ Notices 3 - 3 - Ice Cream Vendors, premises, Inspections 17 46 34 25 35 41 6 23 4 231 „ „ Notices 1 - - - - - 1 Other Places where Food is prepared, Inspections of 185 139 58 15 111 130 1,151 242 64 152 55 Smoke observations 102 36 - - 89 6 10 7 250 Nuisances from smoke observed 3 1 2 - 6 Mews, Inspections of 928 706 512 332 242 529 5,566 655 588 193 881 Other inspections 59 316 21 191 8 71 120 120 906 Notices issued Written intimations 233 290 154 266 119 157 195 36 301 103 1,854 44 Statutory 45 58 56 13 54 41 10 32 24 377 Lodging House 1 92 31 781 82 163 104 117 70 27 94 Removal of Manure 1 3 24 2 6 - 12 Sanitary Works completed 755 1,665 460 591 443 480 710 82 637 227 6,050 1 1 1 2 - 18 1 Legal Proceedings—Number of summonses issued 5 4 1 2 The Inspector of this District was absent on Military Service from April 24th. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - INDEX. Page Adulteration of Food 27 Appendix 49 Area of the Borough 8 Baths and Washhouses 44 Births and Birth Rates 3 Births, Notification of 4 Births and Birth Rates, Tables I. and V. 49 & 53 Cancer 20 Cerebro-spinal Meningitis 13 Chapel of Rest for the Dead 45 Cleansing of Children and Verminous Persons 44 Common Lodging Houses 32 Consumption 15 Cow House 25 Cream Regulations, 1912 28 Customs and Inland Revenue Acts 33 Dairies and Milkshops 25 Deaths and Death Rates— In Districts 5 From Principal Causes 6 From Zymotic or Principal Epidemic Diseases 6& 13 Among Infants 6 Deaths and Death Rater., Tables— 1910—1915 Table I 49 Causes of at Ages, Summary, Table 111 51 Infantile Mortality, Table IV. 52 Causes of by Sexes at ages, Table VIII. In Quinquennia, 1881 —1910 Table V. 53 Principal Epidemic Diseases, Deaths from, Table VI. 54 Principal Epidemic Diseases Death Rates, Table VII. 54 Diarrhoea 14 Diphtheria 11 Disinfection 43 Drainage Work 41 Dust, Removal of 41 Enteric Fever 12 Enteritis and Diarrhoea 14 Factories and Workshops 37 Food Supply 25 Food, Adulteration of 27 Furnished Rooms 82 Health Visitors 8& 41 Home Work 37 Houses let in Lodgings 31 Houses, Number Inhabited 31 Housing (Inspection of District) Regulations, 1910 83 Housing of Working Classes 31 Ice Cream Vendors 26 Illegitimate Births 4 Infantile Mortality 6 Infectious Diseases 11 Notification and Removal, Table 11. 50 Inhabited Houses, Number of 31 Inspection, Sanitary 41 Inspectors, Work of, Summary, Table X. 62 Inquests 45 Page Lavatories, Public 41 Legal Proceedings 41 Local Government Board Tables I.—IV. 49-52 Lodging Houses— Common Lodging Houses 32 Houses Let in Lodgings 31 Provided by the Council 31 London County Council Summary of Work, Table IX. 61 Margarine 27 Marriages 3 Measles 14 Milkshops 25 Milk Supply 25 Mortuary 44 Notifiable Diseases 11 Notification of Births 4 Ophthalmia Neonatorum 13 Outworkers' Premises 37 Phthisis 15 Population 3 Distribution in Wards 3 Prosecutions 41 Public Health (Tuberculosis) Regulations 16 Public Health (Milk and Cream Regulations), 1912 28 Puerperal Fever 12 Rag Flock Act, 1911 44 Refuse, Removal of 41 Registered Lodging Houses 31 Sale of Food and Drugs Acts 27 Sanitary Inspection 41 Sanitary Inspectors' Work, Table X. 62 Scarlet Fever 12 Schools for Mothers 8 Slaughter Houses 26 Small Pox 11 Smoke Nuisances 41 Tuberculosis— Dispensary 19 Notification 16 Provision of Beds 19 Regulations 16 Site of Disease 18 Typhoid Fever 12 Underground Rooms 38 Unsound Food 27 Vaccination 45 Verminous Persons, Articles and Rooms 44 Water Certificates 28 Water Supply 28 Whooping Cough 14 Workshops and Factories 37 Zymotic or Principal Epidemic Diseases 6& 18 Deaths from in Quinquennial Periods, Table VI 54 Death Rates from in Quinquennial Periods, Table VII. 54 PUBLIC HEALTH DEPARTMENT STAFF. Chief Sanitary Inspector. George M. Pettit. Sanitary Inspectors. J.R. Bagshaw. E.J. Bennett. T. Cutting. H. Dawes. J.H. Fowles. A.E. Friend. *G.W. McQuinn. N. Males. C.G. Sexton. J. Steward. Lady Sanitary Inspectors. *Miss N.T.F. de Chaumont. Miss G.A. Looker. Health Visitors. *Miss E. MacKay. Miss F.C. Hargrave. †Miss W.H.E. Whitbread (Temporary). Clerks in the Department. E.K. Hill. H. A. Hillam. ‡W. J. Essex. C. S. Sewell. *J.H. Wilson. Mortuary Keeper. W. Sutton. Staff for Disinfection. W. Cambridge (Engineer), A. Nunn, F. Chillcott, *G.H.I. Harris. Staff of Cleansing Station. *W. C. Webber (Superintendent), Mrs. Webber. Medical Officer of Health. *J. E. Sandilands, M.D., D.P.H. *Engaged on Military or Naval Service for the whole or portion of the year. ‡Resigned in July. ‡Resigned in October. VITAL STATISTICS To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington.1 My Mayor, Ladies and Gentlemen, — I have the honour to submit the Annual Report of the Medical Officer of Health, which contains, in accordance with the Regulations of the Local Government Board, a summary of the action taken for the prevention of disease, and an account of the sanitary state of the Royal Borough during the year 1915. In August, 1914, owing to the outbreak of war, your Medical Officer of Health, Dr. J. E. Sandilands, was called up as a member of the Territorial Forces, to undertake active military duties in the field; and early in the autumn of 1914 your Council appointed me as Acting Medical Officer of Health during Dr. Sandilands' absence. During the year 1915, Miss Whitbread, Temporary Health Visitor, and Mr. Essex, Clerk, resigned their offices; Mr. McQuinn, Sanitary Inspector, was absent on war service from the 28th April; Mr. Wilson, Junior Clerk, and Mr. Webber, Superintendent of the Cleansing Station, the whole of the year; Miss de Chaumont, Lady Sanitary Inspector, from the 15th September; Miss Mackay, Health Visitor, the first quarter of the year; and Mr. Harris, Disinfector, has also recently enlisted. Notwithstanding the decrease of personnel, the work of the Department has been carried on with its usual efficiency, and this result is due to the zeal and loyalty of the staff, and more especially to the unremitting attention of the Chief Sanitary Inspector, Mr. G. Pettit, to whose long experience and intimate acquaintance with all the sanitary circumstances of the Borough I am greatly indebted in carrying out the duties of Acting Medical Officer of Health. I have the honour to be, Your obedient Servant, LOUIS C. PARKES. 19th July, 1916. TABLE OF CONTENTS. A. —Vital Statistics. E—Factories and Workshops. Page Page Population 3 Women's Workshops 37 Births 3 Home Work 37 Deaths 5 Men's Workshops 38 „ from Zymotic Diseases 6 „ of Infants 6 Infantile Mortality, Causes of 7 F.—Sanitation. B.- Prevalence of Disease. Dust Removal 41 Drainage Work 41 Infectious Diseases 11 Nuisance from Smoke 41 Small Pox 11 Public Lavatories 41 Diphtheria 11 Sanitary Inspection 41 Scarlet Fever 12 Enteric Fever 12 Legal Proceedings 41 Disinfection 43 Puerperal Fever 12 Cleansing Station 44 Ophthalmia Neonatorum 13 Cerebro-Spinal Meningitis 13 Rag Flock Act, 1911 44 Public Baths and Washhouses 44 Measles 14 Whooping Cough 14 Public Mortuary 44 Vaccination 45 Epidemic Diarrheœa 14 Tuberculosis 15 Cancer 20 G. —Appendix. C. —Food Supply. Milk Shops 25 Local Government Board Tables Ice Cream Vendors 26 Table I.—Vital Statistics, 1915 and Previous Years 49 Places where Food is Sold 26 Table II. —Infectious Diseases 50 Bakehouses 26 Table III. —Causes of Death 51 Slaughter Houses 26 Table IV. —Infantile Mortality 52 Unsound Food 27 Sale of Food and Drugs Acts 27 London County Council Summary. Cream Regulations, 1912 28 Table IX. —Proceedings during 1915 61 Water Supply 28 D.—Housing. Other Statistical Tables. Inhabited Houses 31 Table V. —Births and Deaths in Quinquennial Periods 53 Council's Lodging Houses 31 Table VI. —Zymotic Deaths in Quinquennial Periods 54 Houses Let in Lodgings 31 Furnished Rooms 32 Table VII. —Zymotic Death Rates in Quinquennial Periods 54 Common Lodging Houses 32 Housing (Inspection of District) Regulations 1910 33 Table VIII. —Deaths, Sex, Age and Cause 55 Underground Rooms 33 Table X.-Work of Sanitary In spectors 62 Customs and Inland Revenue Acts 33 SUMMARY OF STATISTICS, For the year 1915. Population (Estimated) 171,100. Area of Borough in Acres 2,291 75 Density of Population per Acre 27,919 Houses Inhabited Persons per House 6-1 Number of Marriages 2,126 Number of Births 3,074 Birth Rate 18.0 Number of Deaths 2,651 Crude Death Rate 15.5 15.4 Standardised Death Rate Infantile Mortality:— Deaths under 1 year 365 Infantile Deaths per 1,000 Births 119 Deaths from Phthisis 184 Phthisis Death Rate 1.08 Deaths from the Zymotic Diseases 260 Zymotic Death Rate 1.52