ACC 348 KEN 27 The Royal Borough or Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1924 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1924 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. 400—4/25 SUMMARY OF STATISTICS For the yean 1924. Population 178,700 Area of Borough in Acres 2,291 Density of Population per Acre 77 Separate Houses or Self.contained Flats Inhabited 28,051 Separately occupied tenements in the Borough according to the Census of 1921. (This number represents families or households separately occupying their own rooms in 1921) 43,001 No. of mews dwellings 2,091 Houses intended for one family only, which are now occupied (without having been specially adapted) by two or more families . 5,690 Persons per House 6.4 Number of Marriages 1,841 Number of Births 2,908 Birth Rate 16.2 Number of Deaths 2,332 Death Rate 13.0 Infantile Mortality:— Deaths under 1 year 219 Infantile Deaths pet 1,000 Births . 75 Maternal Mortality :— Deaths of Women from Diseases or Accidents associated with Childbirth 5 Maternal Death Rate 1.7 Deaths from Phthisis 120 Phthisis Death Rate 0.67 Deaths from all Forms of Tuberculosis 149 Tuberculosis Death Rate 0.83 Deaths from the Zymotic Diseases 143 Zymotic Death Rate 0.80 Product of a 1d. Rate (Gross) £10,908 Rateable Value £2,617,984 Town Hall, Kensington, W.8. April 30th, 1925. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Ladies and Gentlemen,— I have the honour to submit, for your information, my Annual Report upon the state of the Public Health in Kensington, and a record of the administrative work carried out in the Public Health Department for the year 1924, together with the vital statistics of the Borough. A summary of the work done and action taken under the Factory and Workshops Acts is included. The death rate for 1924 is 13.0 per 1,000 living. This compares favourably with the rate of 14.2 for the present century, but is higher than the rate of 12.3 for the preceding year. The increase over the 1923 rate is mainly due to the number of deaths from measles being increased by 60, from bronchitis by 42, from pneumonia by 41, from cancer by 24 and from heart disease by 30 The deaths from measles, bronchitis and pneumonia occurred principally in the earlier months of 1924 when the weather was unfavourable and treacherous. The 269 deaths from cancer in 1923 created a record for the Borough, only to be broken unhappily by an increase to 293 in 1924. Heart disease was responsible for 322 deaths in 1924. The number of deaths of infants under the age of twelve months for every 1,000 births was 75 in 1924 as against 70 in the preceding year, the increase being due to the large number of deaths from measles, bronchitis and pneumonia in the earlier months of the year under review. The factors which operated unfavourably on the Kensington infant death rate were responsible for an even greater increase in the rates for England and Wales and for London, with the result that the Kensington figure for 1924 compares more favourably with the rates for the country generally and for the Metropolis than has been the case for several years past; in fact, the rate for Kensington in 1924 is identical with that for England and Wales. One of the primary objects of the Annual Report of a Medical Officer of Health is to direct attention to conditions and circumstances affecting the welfare of the Borough which call for the consideration of the Local Authority ; but it is nevertheless desirable that reference should be made to the achievements of the Council in safeguarding the health of the community over which they exercise authority and to statistics which indicate improvements in the Public Health. In this respect the year under review was remarkable in several directions. The steady decline in the number of deaths from tuberculosis has continued and the mortality rate from this disease of 83 per 100,000 population in 1924 is the lowest recorded in Kensington and an improvement on that for London as a whole which is 113. The comparative absence of diphtheria and scarlet fever experienced in 1923 continued throughout 1924, in which year there was only one death from the latter disease. Infant deaths from enteritis fell from 46 in 1923 to 18 in 1924, the latter figure being the smallest for any one year in the history of the Borough. The deaths from enteritis of children under the age of two years was 9.2 per 1,000 births for the large towns of England and Wales, 8.4 for London and 6.4 for Kensington. This is a remarkable improvement in regard to the death rate of a disease which for many years past has taken a heavy toll of infant life in the Borough. Although the Council's Scheme for the prevention and treatment of enteritis, which was put into operation on 1st July, 1924, had satisfactory results, it must be made quite clear that the low number of deaths from this disease is to be attributed mainly to the cold and rainy Summer of 1924, which brought about climatic conditions unfavourable to the spread of enteritis infection. The maternal mortality rate (the number of deaths of mothers as a result of diseases or accidents associated with childbirth for every 1,000 children born) is 1.7. The figures which go to make this rate are so small that a large fluctuation results from the number of deaths being increased or decreased by one or two; but whether the rate of 1.7 for 1924 represents a mere fluctuation or a permanent improvement, it is gratifying to record that the number of deaths of mothers in childbirth, which should be a normal process not attended by danger to life, was the lowest in the history of the Borough with the exception of the last year of the War, when the births were 500 less. The number of illegitimate children born continues to decrease year by year, and the death rate of these infants in 1924 is very much lower than in any previous year. One child infected with ophthalmia neonatorum died as a result of prematurity. With this exception, every case of this disease coming to notice was cured without any damage to sight, the year being the third in succession in which such an entirely satisfactory result has been recorded. 4 Considerable attention has been devoted by the Council and the Public Health Committee throughout the year to the condition of housing accommodation for the working classes in the Borough and, as far as other important duties would permit, the staff of the Public Health Department have directed their time and energy to the task of securing the best possible state of repair and habitability of all dwellings. A detailed statement showing the housing work carried out by the Council appears on pages 69 to 77 of this report. It is appropriate that in presenting this report I should express my appreciation of the full measure of support which has been accorded to me by the Mayor, the Chairmen and Vice.Chairmen of the various Committees, all members of the Council, and the Chief Officers of other Departments, and thank the staff of the Public Health Department for their efficient service and loyal co.operation throughout the year. VITAL STATISTICS The Royal Borough of Kensington as constituted under the London Government Act, 1899, covers an area of 2,291 acres, and is co.extensive with the Civil Parish and Registration District of the same name. The line of demarcation formed by Holland Park Avenue; High Street, Notting Hill Gate; and the Bayswater Road divides the Borough into approximately equal halves described in previous years and in this Report as North and South Kensington respectively. Each of these areas is co.terminous with the Parliamentary division of the same name. The Borough is further sub.divided into nine wards. North Kensington includes the wards of St. Charles, Golborne, Norland and Pembridge, whilst South Kensington is made up of the five other wards, namely, Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton. POPULATION. For 1924 the Registrar.General has estimated the population to be 178,700, and from this figure the populations in the different wards of the Borough have been estimated to be as shown in the following table :— The Borough 178,700 North Kensington 94,169 South Kensington 84,531 Wards. St. Charles . 24,661 Golborne 26,751 Norland 22,464 Pembridge . 20,293 Holland 19,180 Earl's Court 18,202 Queen's Gate 13,996 Redcliffe 20,188 In regard to the social status of the population, it may be said that the majority of the inhabitants in North Kensington belong to the poor class, whilst in South Kensington persons of that class constitute only a small proportion of the population. MARRIAGES. During the year 1,841 marriages were registered, representing a rate of 20'5 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 877 Roman Catholic Church 207 Nonconformist Churches 43 Jewish Church 8 Register Office 706 Total 1,841 BIRTHS. The number of births registered was 2,908, after correction for inward and outward transfers ; and the birth rate for the Borough was 16.2 per 1,000 population. Distributed according to sex and legitimacy the births were as follow:— Male. Female. Total. Legitimate 1,418 1,305 2,728 Illegitimate 94 91 185 Total 1,512 1 396 2,908 5 Table showing the number of births and the birth rates in England and Wales, London Kensington and the various districts in the Borough in 1924, and the rates for the previous five years:— District. 1924. Birth rates in previous years. No. of Births. Birth.rate. 1923. 1922 1921. 1920. 1919. England and Wales 730,286 18.8 19.7 20.6 * 22.4 25.4 18.5 London 85,147 18.7 20.2 21.0 22.3 26.5 18.2 The Borough 2,908 16.2 17.5 17.6 18.7 24.3 16.1 North Kensington 2,040 21.7 22.6 22.9 25.1 32.8 21.7 South Kensington Wards. 777 9.2 10.1 9.8 11.3 13.2 10.3 St. Charles 506 20.5 21.4 23.6 23.8 32.7 21.9 Golborne 673 35.3 26.6 25.5 29.4 38.2 26.6 Norland 557 24.8 24.9 25.7 27.2 35.1 21.9 Pembridge 304 14.9 16.3 15.5 18.6 23.1 14.4 Holland 207 10.8 11.2 11.0 12.3 13.9 8.8 Earl's Court 181 9.9 10.4 10.6 14.1 15.0 13.7 Queen's Gate 96 6.9 6.6 6.9 7.5 8.5 8.1 Redcliffe 196 9.7 12.3 11.0 11.4 14.6 11.8 Brompton 97 7.5 8.7 8.4 10.4 12.9 8.1 Ward unknown 91 ... ... ... ... ... ... The effects of social status on the birth rate are illustrated by the fact that the rate for South Kensington usually is less than half the rate for North Kensington, whilst in 1924 the birth rate for Golborne Ward in the North was nearly four times as great as the rate for the Ward of Queen's Gate in the South. The decline in the birth rate in Kensington since 1881, which is similar to that taking place throughout the country, is shown in the following table :— Period. Birth.rate per 1,000 population. 1881.1885 26.1 1886.1890 23.5 1891.1895 22.0 1896.1900 21.6 1901.1905 20.4 1906.1910 18.7 1911.1915 19.1 1916.1920 17.2 1921 18.7 1922 17.6 1923 17.5 1924 16.2 Notification of Births Act, 1907.—Parents are allowed a period of six weeks within which to register the birth of a child, but the fulfilment of this duty is so frequently postponed until the last few days of this period that the records of the Registrars of Births do not enable Public Health authorities to gain that early knowledge of the birth of children in their districts which is so essential to the success of the work of Health Visitors. This disadvantage arising from delay in birth registration has been met by the Notification of Births Act, which requires all live births and all still births occurring after the twenty.eighth week of pregnancy to be notified within thirty.six hours to the Medical Officer of Health of the district in which they occur. During the year, 2,908 births to Kensington mothers were registered, and of this number 2,744 or 94 per cent, have been notified in accordance with the requirements of the Act. The number of stillbirths notified was 98. 6 The following table indicates the source of notification and the kinds of births notified. Source of Notification. Number of Births Notified. Still Births. Live Births. Total Births. Number notified by Midwives 88 1501 1,589 „ „ „ Parents 5 106 111 „ „ „ Medical Practitioners 25 466 491 „ „ „ Other Persons 14 274 288 Births in the Borough 82 2,847 2,429 Notified from Institutions outside the Borough 16 397 418 Total 98 2,744 2,842 During the year, the Council took legal proceedings against a medical practitioner for failing to notify a birth in accordance with the Notification of Births Act and the Magistrates imposed a fine of 10/. with 10/6 costs. DEATHS. The number of deaths registered in the Borough during the year was 2,758, but this does not represent the true mortality among the population and, in order to obtain the corrected number of deaths which does so represent the true mortality, it is necessary to add the deaths of Kensington "residents" occurring beyond the district to the number registered as actually occurring in the Borough, and to subtract from the total thus arrived at the deaths of "nonresidents" taking place in the institutions provided in Kensington for the reception of sick or infirm persons. Total deaths registered in the Borough 2,758 Deaths of residents in public institutions, etc., beyond the Borough 486 3,244 Deaths of non.residents in public institutions, etc., within the Borough 912 Corrected number of deaths belonging to the Borough 2,332 The corrected number of deaths gives a death.rate of 13.0 per 1,000 living. Table showing the number of deaths and the death.rates in England and Wales, London, Kensington and the various districts in the Borough in 1924, and the rates for the previous five years:— District. 1924. Death.rates in previous years. No. of Deaths. Death.rate. 1923. 1922. 1921. 1920. 1919. England and Wales 473,270 12.2 11.6 12.9 12.1 12.4 13.7 London 55,926 12.1 11.2 13.4 12.4 12.4 13.6 The Borough 2,332 13.0 12.3 13.6 13.8 13.4 15.2 North Kensington 1,315 14.0 12.7 14.7 15.4 14.3 16.6 South Kensington 968 11.4 11.2 11.6 11.2 11.9 13.2 Wards. St. Charles 298 12.1 12.3 12.8 14.6 13.3 15.3 Golborne 361 13.4 12.8 15.9 16.7 13.9 17.5 Norland 383 12.5 15.1 17.2 16.6 16.1 17.3 Pembridge 273 13.4 10.3 12.8 13.3 13.9 16.1 Holland 232 12.1 11.4 12.1 11.6 11.4 12.7 Earl's Court 258 14.1 11.4 14.1 14.6 14.7 15.9 Queen's Gate 129 9.2 9.1 8.1 6.8 9.0 10.5 Redcliffe 230 11.3 13.5 12.2 12.5 13.6 14.7 Brompton 119 9.2 9.4 9.7 9.1 9.6 10.7 Ward Unknown 49 ... ... ... ... ... ... 7 Table showing Kensington death-rates since 1896:— Period. Death-rate per 1,000 living. 1896-1900 16.4 1901-1905 14.4 1906-1910 13.8 1911-1915 14.3 1916-1920 15.6 1921 13.8 1922 13.6 1923 12.3 1924 13.0 Causes of Death.—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 tor the year:— Cause of Death. Number of Deaths. Principal Zymotic (or epidemic) Diseases 143 Epidemic Influenza 67 Puerperal Fever 3 Phthisis 120 Other Tuberculous Diseases 29 Cancer 293 Bronchitis 213 Pneumonia 258 Heart Diseases 322 Bright's Disease 64 Diseases and Accidents of Parturition 2 Premature Birth 33 Accidents 64 Old Age 64 All Other Causes 657 2,332 It will be seen that more than one-third of the deaths, or 913, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 120 deaths. 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) and diarrhœa; together they were responsible for a very substantial number of deaths, the causes of which are very largely preventable. The following table shows the zymotic death rate tor London and Kensington in each of the last five year. Peroid Deaths from Principal Zymotic Diseases per 1000 persons living. kensington. londan 1920 0.95 1.00 1921 1.02 0.98 1922 0.97 1.11 1923 0.9 0.60 1924 0.80 0.73 The higher rate in Kensington in 1924 results from the increase in the number of deaths from measles. Table showing various Causes of Death in 1924, arranged in Four Weekly Periods. Four Weeks ending Measles. Scarlet Fever. Whooping. Cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhœa and Enteritis. January 26 10 - 3 2 5 8 28 27 35 6 February 23 14 — 5 3 28 16 18 40 43 2 March 22 16 — 3 1 18 14 19 33 37 4 April 19 21 — 1 2 3 6 26 16 21 1 May 17 10 — — 1 1 7 19 16 20 — June 14 2 — — 2 1 8 28 9 13 2 July 12 2 — 1 — 1 10 25 10 8 2 August 9 — 1 — 1 — 8 18 7 8 1 Sept. 6 — — — 1 3 6 17 8 4 1 October 4 — — — — — 7 21 4 11 2 November 1 — — 1 — 1 9 21 6 9 6 29 — — — 1 3 8 24 15 17 — Five weeks ding January 3 - - 6 1 3 13 29 22 32 2 Totals 75 1 20 15 67 120 293 213 258 29 8 INFANTILE MORTALITY. During the year 1924, there were 2,908 births and 219 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality rate (deaths of infants under 12 months to each 1,000 births) of 75. The following table gives the births and the infantile deaths and death rates for the year 1924 in England and Wales, London, the Borough and the various Wards of the Borough. District. No. of Births. No. of Deaths of children under 1 year of age. Infantile Mortality rate. England and Wales 730,286 54,557 75 London 87,162 6,163 69 The Borough 2,908 219 75 North Kensington 2,040 178 87 South Kensington Wards. 777 39 50 St. Charles 506 35 69 Golborne 673 67 99 Norland 557 55 98 Pembridge 304 21 69 Holland 207 12 57 Earl's Court 181 7 38 Queen's Gate 96 1 10 Redcliffe 196 14 71 Brompton 97 5 51 Ward unknown 91 2 — In considering the above and subsequent tables it must be remembered that the deaths of infants at any temporary address (institution or private house) to which the mother went for her confinement, and deaths of infants in institutions to which they were transferred for treatment from the place of birth, are allocated to the district of the usual residence of the mother. The increase in the number of deaths from measles, bronchitis and pneumonia, which diseases were prevalent during the very treacherous months of January, February and March, accounts for the higher infant death rate in 1924 recorded throughout the country. INFANTILE MORTALITY RATES, 1896.1924. Period. England and Wales. London. Kenington. 1896-1900 156 162 176 1901-1905 138 139 144 1906-1910 117 114 120 1911-1915 109 110 110 1916 91 89 85 1917 96 104 130 1918 97 108 97 1919 89 85 102 1920 80 75 81 1921 83 80 110 1922 77 74 82 1923 69 60 70 1924 75 69 75 Whilst the infant death rates for 1924 in England and Wales, in London and in Kensington are in each case a little higher than in 1923, the above table shows quite clearly that a steady improvement has been taking place in recent years throughout the country and that the improvement is more noticeable in Kensington than in England and Wales or London, with the result that the Kensington rate is gradually comparing more and more favourably with the rates for other districts. The great improvement in the infant death rate of recent years is most encouraging, and it is to be hoped that it will stimulate both voluntary and official workers to press forward with renewed enthusiasm in a campaign which has been associated with such marked success. 9 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1924. January 29 February 37 March 17 April 14 May 13 June 15 July 12 August 12 September 13 October 20 November 18 December 19 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1924. Causes of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3.4 weeks. Total 4 weeks 1—3 months. 3—6 months. 6—9 months. 9—12 months Total Infant Deaths under 1 year. 1. Common Infectious Diseases (Measles 17) (Whooping Cough 8) (Diphtheria 1) (Chicken.pox 1) — — — — — 1 4 10 12 27 2. Tuberculosis — — — — — — — — — — 3. Pneumonia and Bronchitis — — 1 1 2 14 15 22 16 69 4. Enteritis — 1 1 1 3 3 4 4 4 18 5. Syphilis — — — — — 1 — — — 1 6. Complications of Birth (Injury 4) (Atelectasis 4) 8 — — — 8 — — — — 8 7. Congenital Malformation — — 2 1 3 5 4 3 — 15 8. Premature Birth 27 4 — — 31 1 1 — — 33 9. Atrophy, Debility and Marasmus 9 4 2 2 17 7 1 — — 25 10. Other Diseases (Meningitis 2) (Convulsions 2) (Gastritis 1) (Overlaying 3) (Other Conditions 15) 4 3 — 2 9 4 5 2 • 3 23 Totals 48 12 6 7 73 36 34 41 35 219 Death.rate in each age period per 1,000 births 16.5 41 2.0 2.4 25.1 12.0 11.6 14.1 12.0 75 Percentage of total infant deaths occurring in each age period 21.9 5.4 2.7 3.2 33. 3 16.0 15.5 19.0 16.0 10 DEATHS OF INFANTS UNDER ONE YEAR OF AGE PER 1,000 BIRTHS IN DIFFERENT TYPES OF HOUSES. As pneumonia, bronchitis and enteritis were responsible for over one-third of the infant deaths in 1924, it will be interesting to see how the rates for these diseases vary in accordance with the types of houses occupied by the families in which the deaths occurred. In the following table, a dwelling occupied by one family only, or which has been converted into self-contained flats or maisonettes, is classed as a " private house." The number of these in the Borough is approximately 19,250. A " tenement house " is one let in lodgings to more than one family without being specially adapted for the purpose. Of the 5,690 houses of this class in the Borough, 2,904 are on the Register of Houses let in Lodgings and, consequently, are subject to the Council's by-laws. A "mews dwelling" is a habitation with generally one to three rooms situated over a stable and coach-house. In the majority of cases in South Kensington and some in North Kensington, the stables and coach-houses have been converted into garages. The occupants of mews dwellings vary in type, some are respectable and careful people, whilst others belong to the most careless and indifferent members of the community. There are 2,091 mews dwellings in the Borough. Deaths of Infants from All Causes. Deaths of Infants from Pneumonia and Bronchitis. Deaths of Infants from Enteritis. Boro. N. Ken S. Ken. ' Boro. N. Ken. S. Ken. Boro. N. Ken. S. Ken. I Private Houses— Births 600 273 327 600 273 327 600 273 327 Infant Deaths 32 12 20 10 6 4 1 — 1 „ Death Rates per 53 43 61 16 21 12 1 — 3 1,000 births Tenement Houses— Births 2,002 1,621 381 2,002 1,621 381 2,002 1,621 381 Infant Deaths 179 161 18 50 51 4 17 16 1 Death Rates 89 90 47 27 31 10 8 10 2 per 1,000 births Mews Dwellings— Births 142 69 73 142 69 73 142 1 69 ! 73 Infant Deaths 8 5 3 4 2 2 — — — „Death Rates 56 72 41 28 29 27 — — — per 1,000 births A table similar to the above appeared in the report for 1923 and some of the infant death rate figures led to certain misconceptions, therefore, it was my intention to give in the table this year the births and infant deaths but to make no reference to the rates. As, however, the table when finally prepared did not show any seriously misleading figures I have resolved to include the death rates in order that those members of the Council who desire to make comparisons with previous \ears may do so without difficulty. It must, however, be remembered that when the births and infant deaths for the Borough are divided up into those occurring in private houses, those occurring in tenement houses and those occurring in mews dwellings, and each of these three groups is subdivided further into North Kensington and South Kensington sub-groups, and these sub-groups are still further divided according to the cause of death, the numbers of births and deaths in each subgroup are so small that one death more or less than that recorded would give a difference in the rate which might convey a false impression unless the actual birth and death figures are noted. For example, in the above table it will be seen that there were no deaths in mews dwellings from enteritis during the year, therefore, the rate is nil per 1000. If there had been one death in South Kensington, the rate for the Borough would have gone up to 7 per 1000 and for South Kensington to 14 per 1000, whereas the 17 deaths from enteritis in tenement houses in Kensington give a rate of only 8 per 1000. The example quoted above serves to draw attention to the fact that during the year there was not one death from enteritis amongst 142 children born in mews dwellings. The year 1924 is the third in succession in which there has not been an infant death from such a cause in the South Kensington mews dwellings. There are very few horses kept in that part of the Borough with the result that there is practically no storage of manure on which flies can breed, and this is probably the main reason for the absence of enteritis deaths in the mews dwellings in that half of the Borough. It is encouraging to note, however, that there was a similar absence of deaths in North Kensington mews. The table shows generally a higher death rate in mews dwellings than in private houses and a still higher rate in tenement houses, but before any conclusions are arrived at as to the effect of housing conditions upon the infant death rate, consideration must be given to the fact that negligent, careless, ignorant and poverty-stricken parents generally drift into the worst type of tenement house and mews dwelling. 11 ABOVE STANDARD DEATHS. In almost every area there is a number of infant births and deaths occurring in those betterclass homes where it is reasonable to assume that the children receive every care and all requisite medical and nursing assistance. These are called " above standard " cases and, although it is difficult to make certain that none is included under this heading in which the attention of a Woman Health Officer might prove beneficial, they are not generally visited because, in the first place, the Health Officer may not be welcomed and, in the second place, she can occupy her time more profitably in visiting homes in the poorer quarters. In 1924 the "above standard" births numbered 768 and the deaths 19, giving an infantile mortality rate of 24. The 2,140 births and 200 deaths not " above standard " in 1924 give an infantile mortality rate of 93. The causes of death in the " above standard" cases are as follow :— Pneumonia and bronchitis 3 Infantile debility 3 Premature birth 5 Other causes 8 Total 19 The wards to which the children belonged are :— St. Charles 2 Golborne — Norland 2 Pembridge 2 Holland 5 Earl's Court 1 Queen's Gate — Redcliffe 7 Brompton — Total 19 ILLEGITIMATE INFANT DEATHS. In 1924, 64 per cent. of the births in Kensington were illegitimate and 8.2 per cent. of the infant deaths were of children of this class. The following table compares the legitimate and illegitimate births, infant deaths and infantile mortality rates in Kensington for 1924. Total. Legitimate. Illegitimate. Births 2,908 2,723 185 Infant Deaths 219 201 18 Rate per 1,000 births 75 73 97 One infant found dead in regard to whom no particulars of parentage could be obtained has been classed as illegitimate. There has been a satisfactory decline in the number of illegitimate births in recent years as evidenced by the following table:— 1919 256 1920 274 1921 308 1922 207 1923 205 1924 185 The following table compares the total infantile mortality rate for the Borough in recent years with the illegitimate infantile mortality rate:— 12 Year. Deaths of all children under 1 year of age per 1,000 births. Deaths of illegitimate children under 1 year of age per 1,000 illegitimate births. 1911—1915 110 324 1916 85 211 1917 130 408 1918 97 256 1919 102 180 1920 81 201 1921 110 217 1922 82 135 1923 70 127 1924 75 97 Together with the fall in the number of illegitimate births in recent years there has been, as shown in the above table, a very rapid decline in the death rate of these illegitimate children. This decrease in the illegitimate infant death rate has been much more marked than the fall in the infant death rate of all children. The comparison is shown very clearly in the above table. Maternal Mortality. In 1924 there were only five deaths of Kensington women from diseases or accidents directly connected with child.birth, and this figure represents a death rate of 1.7 mothers per 1,000 births. The rate for London for 1923, the last year for which figures are available, was 3.1. The actual causes of death were:— Accidents of Pregnancy 1 Puerperal Fever 3 Eclampsia 1 5 This return compares favourably with that for the preceding year which included 8 deaths from accidents of pregnancy, 7 from puerperal fever, 1 from haemorrhage, and 1 from embolism. The question of maternal mortality has received considerable attention in Kensington in the past two years, therefore it is desirable to deal briefly with the facilities for safe confinement provided for working class mothers additional to those which are obtainable from doctors in private practice. There are seven Infant Welfare Institutions in the Borough which provide expert ante.natal examinations and advice ; and the Queen Charlotte's Hospital authorities hold a special antenatal clinic at their Nurses' Home in Ladbroke Grove. These ante.natal clinics are being more fully used than hitherto, but it is important to secure a still better attendance of expectant mothers. In 1924, there were 2,908 births in Kensington and of these 768 may be said to have occurred in families which are regarded as " above standard " financially and do not come within the scope of the Council's Maternity and Child Welfare Scheme. In respect of 1,199 of the 2,140 births in families regarded as coming within the scope of the Council's scheme, the expectant mothers received ante.natal advice at the special clinics held at the Queen Charlotte's Nurses' Home and the Infant Welfare Centres. The women who gave birth to the remaining 941 children may have received professional ante.natal attention from private medical men or at hospitals, but it is probable that the majority did not secure for themselves the advantages of that skilled ante.natal advice which is now generally recognised to be of the greatest value. In the report for last year, there was given remarkable statistical testimony of the efficacy of ante.natal attention, it being pointed out that not one of the 17 maternal deaths in 1923 or the 16 similar deaths in 1922 occurred amongst women who had attended the ante.natal clinics. Similarly, not one of the five women who died in Kensington in 1924 was known to have received professional ante.natal advice from any source. This evidence is very encouraging to those voluntary and official workers who are engaged in urging mothers to accept the ante.natal attention which is being offered at the Infant Welfare Institutions in the Borough. The midwifery service in Kensington is satisfactory. The poor in North Kensington are adequately provided for by the well.trained staff of midwives attached to the Queen Charlotte's Hospital Nurses' Home in Ladbroke Grove. Difficult cases found by these midwives are sent immediately to the hospital for in.patient treatment. As there is such an excellent organisation available for the poorest women in North Kensington, the midwives engaged in private practice in the Borough are able to deal with all the mothers who can afford the usual fees. The private midwives are generally satisfactory, and I have no evidence that there is any unqualfied woman in the Borough carrying on a midwifery practice. 13 The arrangements made with the Kensington Board of Guardians in 1922, under which women who show early signs of what might prove to be puerperal fever can be admitted to the St. Mary Abbot's Hospital without delay and without the doctor making an official notification, have been made use of on a number of occasions with the result that women in the preliminary stages of that disease have been treated by the Medical Superintendent with success and in a way which is not practicable in the patients' homes. On page 35 of this report, there is an account of the Council's Maternity Home which was opened on 1st October last. The provision of this Maternity Home completes an organisation, secured by co.operation between various bodies and extension of their efforts, which aims at safety in confinement. The organisation is adequate and efficient, and all that remains is to induce working.class mothers to avail themselves in larger numbers of the facilities which have been provided for the protection of their health by the Council and the various authorities working with them. TABLE SHOWING THE BIRTH RATES, DEATH RATES AND INFANTILE MORTALITY RATES IN THE 29 METROPOLITAN CITIES AND BOROUGHS IN 1924. Births per 1000 Population. Deaths per 1000 Population. Infantile Deaths per 1000 Births. 1. Shoreditch 25.1 Lewisham 10.4 Lewisham 47 2. Bermondsey 24.4 Woolwich 10.8 Hampstead 52 3. Poplar 23.1 Wandsworth 11.0 Stoke Newington 56 4. Southwark 22.5 Fulham 11.1 Wandsworth 56 5. Bethnal Green 22.3 Hackney 11.2 City of Westminster 58 6. Finsbury 21.6 Hampstead 11.4 Hackney 60 7. Stepney 21.4 Stoke Newington 11.4 Battersea 62 8. Deptford 20.7 Greenwich 11.4 Chelsea 63 9. Greenwich 20.2 Camberwell 11.4 Woolwich 65 10. Islington 20.0 City of London 11.5 Lambeth 66 11. Lambeth 19.2 City of Westminster 11.6 Islington 66 12. Camberwell 19.0 Battersea 11.7 Camberwell 70 13. St. Pancras 19.0 Deptford 11.9 Southwark 71 14. Hackney 18.7 Holborn 11.9 Poplar 71 15. Battersea 18.4 Poplar 12.0 Hammersmith 72 16. Fulham 18.4 Hammersmith 12.1 Fulham 72 17. Woolwich 18.1 Bethnal Green 12.2 St. Pancras 73 18. Hammersmith 18.0 Stepney 12.2 Greenwich 74 19. Paddington 17.1 Islington 12.3 Deptford 74 20. Lewisham 16.7 Lambeth 12.5 Kensington 75 21. Stoke Newington 16.6 Paddington 12.9 Stepney 75 22. Kensington 16.2 St. Pancras 12.9 Bermondsey 77 23. Wandsworth 14.9 Kensington 13.0 St. Marylebone 78 24. St. Marylebone 14.6 Chelsea 13.0 Paddington 78 25. Chelsea 14.4 St. Marylebone 13.1 Bethnal Green 78 26. Hampstead 13.6 Bermondsey 13.5 Finsbury 78 27. Holborn 13.4 Shoreditch 13.5 Holborn 83 28, City of Westminster 11.2 Southwark 14.0 Shoreditch 83 29. City of London 7.0 Finsbury 14.1 City of London 115 14 THE PREVALENCE OF DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsoriiy notifiable in Kensington:— Small.pox. Acute Polio-myelitis. Choleia. Glanders. Diphtheria. Anthrax. Membranous Croup. Hydrophobia. Erysipelas. Tuberculosis. Scarlatina or Scarlet Fever. Influenzal Pneumonia. Typhus Fever. Acute Primary Pneumonia. Typhoid or Enteric Fever. Trench Fever. Relapsing Fever. Malaria. Continued Fever. Dysentery. Puerperal Fever. Plague. Ophthalmia Neonatorum. Acute Encephalitis Lethargica Cerebro.Spinal Fever. Acute Polio.Encephalitis. * Zymofic Enteritis. •Zymotic Enteritis in children under 5 years of age became notifiable in Kensington on July 1st, 1924. The other London Boroughs in which this disease is notifiable are Fulham, Finsbury, Poplar. Southwark, Deptford, Greenwich and Woolwich. Table showing Notifications of Infectious Diseases received in 1924, arranged in Four.Weekly Periods. Four Weeks ending Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Puer. peral Fever Pneumonia. Malaria. Encephalitis Lethargica. F. M'etis & Polio. Encephalitis. Smallpox. Cerebro spinal Meningitis. Dysentery. Enteritis. Total. January 26 14 20 — 4 2 — 28 — — — — — — — 68 February 23 16 23 2 4 — 1 25 1 1 1 — 1 — — 75 March 22 16 21 — 2 1 — 18 — 1 — — — — — 59 April 19 12 21 1 7 2 — 18 — 1 — — 1 — — 63 May 17 18 13 2 6 1 — 12 — 7 — — — 1 — 60 June 14 15 11 4 3 1 1 13 2 6 — — — — — 56 July 12 20 19 2 6 3 — 8 — 2 1 1 — — 6 68 August 9 26 12 2 7 — — 1 — 1 4 — — — 6 59 Sept. 6 22 6 2 — 2 — 3 — — 3 — — — 8 46 October 4 32 9 1 6 2 1 4 — 1 l — — — 9 66 November 1 35 13 4 3 — — 9 — — 1 7 72 29 29 11 3 7 — 1 7 — — — — 1 — 4 63 Five weeks ending Jan. 3 26 9 6 4 — 1 11 — 1 — — — — — 58 Totals . 281 188 29 59 14 5 157 3 21 10 1 4 1 40 813 Cases of mistaken diagnosis are excluded from tbe above Table Small Pox.—One case of small pox occurred in the Borough during the year, this being the first in Kensington since 1915. The circumstances in connection with the case are as follow. A boy of three years, residing in Willesden, fell ill on 8th June, but the nature of his ailment was not recognised, and the child remained at home in contact with other members of the family. In the last week of June, eight other persons living in the same house became ill, and the disease from which they were suffering was diagnosed as small pox. It then became clear that the boy's illness was small pox, and that these eight persons had contracted this complaint from him. Three of the patients died. On 27th June information was received that a man residing in North Kensington had been in close contact on several occasions with the little boy during his illness. This man and those members of his family who were at home were vaccinated on the same day, and all other occupants of the house were vaccinated on the following day, with the exception of two who were away from home and who were vaccinated on the 30th June. The man was requested to sleep in a bedroom by himself, and remain isolated until it became clear whether he would develop the disease or not. He was not well on the following day, 28th June, but, though there was nothing definite in his symptoms, the house was placed in quarantine. He was a little better on 29th June, but when seen again by myself on the morning of 30th June he was seriously ill and was removed promptly to the Metropolitan Asylums Board Hospital as an early case of small pox. The rash developed after removal and the diagnosis was confirmed on the following day. Having been vaccinated only one day before the onset of the illness, this method of prevention could not protect the man himself at this late stage of the incubation period of [the disease, but isolation of the patient and vaccination of all other members of the household before the patient became infectious undoubtedly safeguarded them. 15 Following the removal of the patient and disinfection of the house, all the occupants were placed under daily medical observation. In addition, numerous Kensington contacts of the Willesden cases were vaccinated and kept under daily observation. No one in Kensington or elsewhere contracted small pox from this patient. During the year other cases occurred in London as shown below:— Chelsea 1 case. St. Pancras 1 case. Westminster 1 case. Scarlet Fever.—The number of cases notified during the year was 281, of which 265 were removed to hospital. The cases notified in the three preceding years were 870, 471 and 205. Although there were 76 more cases than in 1923, scarlet fever was not epidemic at any period of 1924, and for the past two vears the Borough has been fairlv free from this disease. The following table shows the number of cases notified in each four.weekly period during 1924. District. Period No. 1. Period No. 2 Period No. 3 Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8 Period No. 9. Period No. 10. Period No. 11 Period No. 12. Period No. 13. London 740 671 678 712 812 929 « 843 827 807 1131 1208 1136 1233 The Borough 14 16 20 14 20 21 20 30 25 38 44 30 31 North Kensington 8 11 8 12 10 12 16 25 21 32 31 21 18 South Kensington 6 5 12 2 10 9 4 5 4 6 13 9 13 Wards. St. Charles 4 5 1 — — 4 8 10 6 15 14 7 4 Golborne 2 3 3 8 9 4 4 11 10 13 7 6 8 Norland 2 2 2 2 1 4 2 3 4 4 8 3 4 Pembridge — 1 2 2 — — 2 1 1 2 5 2 Holland — 3 3 —. 2 — 2 1 — 2 1 3 Earl's Court 1 — 2 — 2 — — — 1 2 5 3 4 Queen's Gate 2 — 1 1 2 5 — 3 2 —. 2 1 3 Redcliffe 2 2 6 1 4 4 2 — 1 3 3 3 3 Brompton 1 — — — — — — 1 — 1 1 1 — Cases of mistaken diagnosis are not excluded from the above Table. The mildness of the disease is reflected in the low death rate; there was only one fatal case in Kensington during the year. The deaths in the three preceding years were 8, 6 and 2. Four of the 281 cases of scarlet fever notified were patients in the same family as a person who had, within the previous 28 days, returned from hospital after having been treated for this disease. In addition, one of those developing the disease was a member of another family living in the same house as a person who had been discharged from hospital after scarlet fever less than 28 days previously. Cases of this kind are called "return cases," and a very careful investigation was made in each of the 5 with a view to ascertaining the source of infection, but no satisfactory clue could be obtained. Forty-two cases notified as suffering from scarlet fever were found, after admission to hospital, hot to be suffering from any infectious disease at all, with the result that they were returned home. Diphtheria.—One hundred and eighty.eight cases were notified during the year, 183 of which were removed to hospital. The cases notified in the three previous years were 346, 403 and 223. The number of notifications received during the year was smaller than in any other year since the termination of the War The following table shows the number of cases notified in each four.weekly period during 1924:- District. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11 Period No 12. Period No. 13 London 779 742 695 655 741 684 721 606 890 1163 1027 1231 The Borough 24 27 23 27 14 11 21 12 6 10 20 16 15 North Kensington 16 22 16 20 8 7 16 7 3 6 12 12 13 South Kensington 8 5 7 7 6 4 5 5 3 4 8 4 2 Wards. St. Charles 2 5 4 — 3 1 3 4 1 — 3 2 3 Golborne 5 5 7 7 2 3 7 1 — 5 4 5 5 Norland rr / 4 1 8 — 3 6 1 ] — 5 4 2 Pembridge 2 8 4 5 3 — — 1 1 1 — 1 3 Holland 6 4 3 7 1 — 3 1 2 3 3 1 1 Earl's Court 2 — — — — — 2 — — 1 — — Queen's Gate — — 1 — — 1 1 1 — — — — — Redcliffe — 1 3 — 4 3 1 — 1 1 4 3 1 Brompton — — — — 1 — — 1 — — — — — Cases of mistaken diagnosis are not excluded from the above Table 16 The number of Kensington deaths was 15, representing a case mortality of 7.9 per cent. In the three preceding years the deaths were 25, 34 and 14. Three patients developed diphtheria within 28 days of a member of their family having returned from a fever hospital after having been treated for diphtheria, and two others who developed the disease were members of another family living in the same house as a person who had been discharged from hospital after diphtheria less than 28 days previously. On investigation it was found that two of the "primary" or returning cases had nasal discharge after leaving the hospital, and it is possible that in these cases the nasal discharge was responsible for the spread of infection. There is no evidence to show how infection was conveyed in the other cases. Thirty.eight notified cases admitted to hospital were found not to be suffering from diphtheria or any other infectious disease. Owing to the degree of accuracy which has now been secured by bacteriologists in the diagnosis of diphtheria, it is customary to take a throat swab for bacteriological examination in all suspicious cases, and for some years past the Council have paid for such examinations performed at the Lister Institute on behalf of Kensington patients. Sterile swabs are obtained from the Town Hall, and, in order to reduce the interval which occurs from the time the doctor takes the swab to the time he obtains the result, arrangements have been made for medical men to leave inoculated swabs at the Kensington Tuberculosis Dispensary, 119, Ladbroke Grove, before 3.30 p.m., or at the Town Hall, before 4 p.m., on any day (Saturdays, Sundays and Bank Holidays excepted). Swabs so left are collected by one of the Council's messengers, who delivers them at the Lister Institute before 5 p.m. on the same day, and the results are telephoned to the doctors on the following morning. On Saturdays, Sundays and Bank Holidays medical men can send swabs direct to the Lister Institute before 5 p.m. and obtain an equally speedy result. During the year 698 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 70 gave a positive diphtheria result. It is well established that outbreaks of diphtheria may originate from persons who have the germs of the disease in the throat or nose, but show no signs of illness. Such persons are called "carriers" and with a view to discovering the possible existence of any of these in connection with limited outbreaks where the source of infection was unknown, a number of throat and nose swabs were taken by medical men at my request and by myself. These swabs are included in the 698 referred to above. In six of them the germs of diphtheria were discovered. Germs so found in these apparently healthy throats or noses may be of a virulent type (capable of conveying diphtheria infection to other persons) or of an avirulent type (incapable of conveying diphtheria infection to other persons), therefore it is necessary to ascertain the particular type of organism present before submitting the patient to prolonged isolation and treatment. A further examination in each of these six cases revealed the organisms to be virulent in four cases. Three of the four cases were removed to hospital; in the fourth case it was possible to secure satisfactory isolation at home. One of the virulent " carriers " was discovered during an investigation in a boarding house following the notification and removal to hospital of a member of the same household who had fallen ill with diphtheria. The "carrier" was also sent to hospital where she remained until 1st January, 1925, when all evidence that she was infectious had disappeared. Two other members of the same household fell ill a few days after her return home and they were removed to hospital. The original "carrier" was carefully re.examined and again found to have virulent germs of diphtheria in her throat. She was removed to hospital and no further cases occurred. Another of the "carriers" of virulent infection was discovered during an investigation of an outbreak of diphtheria in a private house. A child of the family and two maids had developed diphtheria within a short time. As the usual enquiries failed to ascertain the probable source of infection, swabs were taken from the throats of all members of the household with the result that a maid, who had recently entered upon service at that particular house, was found to be a "carrier'. of virulent diphtheria organisms. After her removal to hospital no further case developed. Under the Anti.toxin Order, 1910, Local Authorities are empowered to supply diphtheria anti.toxin for administration to patients who are too poor to pay, and on signing the necessary declaration that the patient cannot afford specific treatment, a medical man can obtain a free supply from Mr. Worsley, Chemist, at No. 135, Ladbroke Grove, W. 10, or from the Public Health Department at the Town Hall. The anti.toxin is obtainable at all hours of the day and night from Mr. Worsley's premises, and during office hours from the Town Hall. When the Town Hall is closed, applications for anti.toxin can be made to Mr. Sutton, an Officer of the Department, who lives at No. 1, Hornton Place, Hornton Street, (only a few yards from the Town Hall). The Council loan syringes with portable sterilizers to doctors for the purpose of administering the anti.toxin. Medical men administering the Council's anti.toxin to poor persons are, on application to the Medical Officer of Health, paid a fee of 5s. per patient treated. In 1924, the Borough Council supplied 196,500 units of anti.toxin for 43 patients at a cost of £14 14s. 11d. 17 Enteric Fever.—Twenty.nine cases of this disease were notified, 24 being removed to hospital. The cases notified in the three preceding years were 22, 18 and 12. There were three deaths from this cause against 3, 2 and 2 in the preceding years. Twenty.one of the 29 cases were notified from the southern division of the Borough. This heavier incidence in South Kensington is not usual with other infectious diseases, and it is probably accounted for by the facts that water supplies and sanitary arrangements in London generally are very good and that most persons contracting typhoid fever are infected outside the Metropolis. It will be admitted that the residents in the southern portion of the Borough leave the London area more frequently than those in the north, and, consequently, are more exposed to infection by reason of the fact that many outside London districts do not enjoy the same sanitary efficiency. In two cases there was evidence that the disease had been contracted on the Continent and in a number of the others the patients had paid visits to country places just prior to the date of attack. Eight of the cases were notified as paratyphoid fever. Puerperal Fever.—Five cases of this disease were notified in 1924, this being the smallest number of cases since the year 1918. A number of women were sent into St. Mary Abbot's Hospital immediately following an increase of temperature shortly after confinement and they received prompt surgical treatment with the result that signs and symptoms abated and satisfactory recoveries were secured. It is possible that some of these may have become definite cases of puerperal fever in the absence of this treatment. Arrangements for the early admission to St. Mary Abbot's Hospital of suspicious cases of this disease were discussed fully in my report for 1922 and are referred to in this report in the section on Maternal Mortality. Of the five definite cases notified, two were removed to St. Mary Abbot's Hospital, two to the Metropolitan Asylums Board Hospitals, and one occurred in Queen Charlotte's Hospital, the patient having entered that institution for her confinement. There was one death at St. Mary Abbot's Hospital, one at Guy's Hospital and one in the home of the patient. Encephalitis Lethargica.—This disease, commonly known as "sleepy sickness," was prevalent throughout the country during the year, the number of cases notified in England and Wales being 5,063, in London 620, and in Kensington 21. The number of Kensington cases notified was the largest in any one year since notification was introduced in 1918. The following table gives the sex, age, date of notification and result in the 21 cases notified during the year, and shows that the disease in Kensington attacked males and females nearly equally, that it attacked persons of practically all ages in life up to 51 years and that it cropped up in every season of the year. Sex. Age. Date of Notification. Result. 1 Female 9 7th February Recovered 2 „ 45 21st March Died 3 Male 2 5th April „ 4 „ 13½ 23rd April Recovered 5 Female 27 1st May „ 6 Male 33 5th May „ 7 „ 19 6th May „ 8 „ 12 9th May „ 9 Female 22 15th May „ 10 Male 31 16th May „ 11 Female 3 20th May Died 12 „ 39 24th May „ 13 „ 37 5th June Recovered 14 Male 5 6th June Died 15 „ 10 13th June Recovered 16 Female 5 16th June „ 17 „ 51 1st July „ 18 „ 44 14th July „ 19 „ 17 26th September „ 20 „ 21 5th December „ 21 „ 50 18th December „ The disease during the year did not seem to be of such a severe type as was the case four and five years ago, there being 5 deaths in the 21 cases giving a case mortality rate of 23.8 per cent. This figure compares favourably with the figures of 40 and 50 per cent. which were common several years ago. There is good reason to believe that encephalitis lethargica is infectious and, therefore, the disease has been made notifiable: but the degree of infectivity must be very slight, and other occupants of a house in which a case has occured, or is being treated, may be assured that very little risk is run by living in the same dwelling. At the same time it is desirable that association with an infected person should be limited to what is necessary for proper care and nursing, and the patient should be well isolated in a separate room. 18 Multiple cases of the disease in the same household as well as multiple cases in institutions have been observed in this country and elsewhere, but they are not frequent. The fact that in Kensington there has been no evidence of spread of infection during the last five years shows that the degree of infectivity must be low. Every case is carefully investigated with a view to ascertaining whether there has been any contact with a known case of the disease, but no evidence of this kind has so far accrued. Of the 21 cases notified in Kensington in 19'24, there were not two in one house and, indeed, every case was in a separate street except two which occurred in houses well apart in one of the longest streets in the Borough. Ophthalmia Neonatorum.—Fourteen cases were notified during the year, the numbers in the preceding years being 33, 20 and 21. The Women Health Officers take great pains to obtain the best possible treatment. Every case is visited on the day that notification is received in the Public Health Department and visits are paid daily, if necessary, until the child is cured. Attempts are made to secure the child's and mother's admission to hospital and, if these are unsuccessful, arrangements are made for a nurse from the Kensington District Nursing Association, who has been trained in ophthalmia treatment, to visit the home as frequently as is necessary to carry out the nursing instructions of the medical attendant. Care is taken that a medical man is in attendance on every case. One of the 14 notified infants was treated in the St. Mary Abbot's Hospital, 7 were admitted to the Metropolitan Asylums Board Ophthalmia Hospital, 2 were treated in the out.patient departments of hospitals, one at the Baby Clinic, and the remaining 3 were attended at home by general medical practitioners. It is the duty of midwives to report all forms of inflammation of the eye, even when the condition is not ophthalmia neonatorum, and these cases, in addition to pure ophthalmia cases, are dealt with by the Kensington District Nursing Association. In 1924, the ophthalmia neonatorum and inflammation of the eye cases attended by the nurses numbered 52 and the number of home visits paid in connection with these cases was 586. These visits average 11 to each of the 52 patients, and indicate the great, amount of trouble taken with this disease. The visits paid by the Council's Women Health Officers are not included in the 586. In one case the child died of another complaint whilst being treated for ophthalmia, and in every other case the disease has been cured without any damage to sight. There was a similarly splendid record in 1923 and in 1922. These very gratifying results are largely due to the efforts made by the Council's Health Officers to secure hospital treatment for these cases, and to the excellent arrangement which the Borough Council have entered into wich the Kensington District Nursing Association for the home treatment of this disease. Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia, but the only kinds notifiable are acute primary pneumonia and influenzal pneumonia. One hundred and fifty.seven notifications were received, 101 patients being certified as suffering from acute primary pneumonia and 56 from influenzal pneumonia. It is clear that many cases escaped notification. The number of deaths from pneumonia during the year was 258. There were 67 deaths certified to be due to influenza, the deaths from this disease in the three preceding years being 45, 86 and 46. The Sanitary Inspectors and, if necessary, the Women Health Officers visited the homes of all notified cases of pneumonia with a view to giving assistance in connection with isolation, disinfection, etc. Under their agreement with the Council, the Kensington District Nursing Association have rendered valuable help in connection with cases of pneumonia. Malaria.—Three cases of this disease were notified, and investigation revealed that two patients had been soldiers who had contracted the disease whilst abroad during the Great War. The remaining case originated in West Africa. Polio.myelitis and Polio.encephalitis.—These are diseases which attack the central nervous system and may give rise to paralysis; in this respect they are comparable with cerebro.spinal meningitis and encephalitis lethargica. The diseases have long been known, under the name of " infantile paralysis," as a form of paralysis of which sporadic cases occur, chiefly in children and less frequently in adults. In recent years the diseases have occurred in epidemic form, and as they are undoubtedly infectious they have been made compulsorily notifiable. The degree of infectivity, as in the case of encephalitis lethargica, is of a low order and it is only seldom that association can be traced between the cases which are notified. One case in a household is rarely followed by a second. There were ten cases in Kensington during 1924, as against 2, 0 and 5 in the three preceding years, The particulars of the cases are subjoined. 1. Male. Aged 5 years. Notified 14th February. Treated at home. Died. 2. Male. Aged 2 years. Notified 26th June. Still receiving treatment for paralysis at Roehampton. 3. Male. Aged 8 months. Notified 7th July. Still an out.patient of St. Mary's Hospital for paralysis of arm. 19 4. Male. Aged 5 years. Notified 17th July. Still in Queen Mary's Hospital, Carshalton.. 5. Male. Aged 7 years. Notified 28th July. Still in Queen Mary's Hospital, Carshalton. 6. Female. Aged 11 years. Notified 4th August. Died at Queen Mary's Hospital, Carshalton. 7. Male. Aged 1 year. Notified 9th August. Still attending North Kensington (Raymede) Massage Centre for treatment for paralysis. 8. Female. Aged 4 years. Notified 11th August. Still an out.patient of St. George's Hospital. 9. Male. Aged 19 years. Notified 25th August. Last heard of in November. Present address not known. 10. Female. Aged 8 years. Notified 6th September. Still attending North Kensington (Raymede) Massage Centre for treatment for paralysis. There is accommodation for patients suffering from the after effects of polio-myelitis and polioencephalitis at the Queen Mary's (M.A.B.) Hospital, Carshalton, and some cases are accepted at various other hospitals. The North Kensington (Raymede) Massage Clinic, conducted on the premises of the Raymede Infant Welfare Centre, has carried out useful work in connection with treatment of children who suffer from paralysis as a result of these diseases. Cerebro Spinal Meningitis.—There were four cases of this disease notified during the year, particulars of which are subjoined :— 1. Male. Aged 1 year. Notified 1st March. Removed to hospital. Died. 2. Female. Aged 22 months. Notified 9th April. Removed to hospital. Died. 3. Female. Aged 32 years. Notified 7th October. Removed to hospital. Recovered. 4. Female. Aged 1 year. Notified 10th November. Removed to hospital. Recovered. Dysentery.—There was one case of this disease notified, the patient being the wife of a professional man. She had been in India and possibly contracted the disease in that country. There was no spread of infection. Two patients belonging to Kensington died from dysentery at the Hanwell Mental Hospital. They had not resided in the Borough for some time prior to death, but cases of this kind occurring in such an institution are allocated by the Registrar General to the Borough in which the patients lived prior to admission. Zymotic Enteritis.—The number of deaths from this disease in the year 1924 was 29. Eighteen of these were in children under the age of one year, one was in a child of one year of age, and the other ten were in persons over 25 years of age. This disease has been responsible for a very large number of deaths of children for many years past. The following table shows the number of deaths of infants under the age of twelve months attributable to this cause during the last five years:— 1920 58 1921 77 1922 22 1923 42 1924 18 During the year, zymotic enteritis received the careful consideration of the Council and it was concluded that further progress could not be made in preventive work unless the Council's Officers had more precise knowledge enabling them to locate all cases of the disease, to trace their origin and to watch the lines of the spread of infection during the summer months. This knowledge can be obtained by notification, therefore the Council resolved that zymotic enteritis in children under the age of five years should be made a notifiable disease in the Borough. The Minister of Health having given his approval, the disease became compulsorily notifiable on July 1st, 1924. The other Boroughs in London in which this condition is notifiable are Fulham, Finsbury, Poplar, Southwark, Deptford, Greenwich and Woolwich. With notification it is possible to take effective steps in regard to prevention and treatment of the disease, and the following scheme was put into operation on the date it became notifiable. Prevention. The particulars in regard to each notification of enteritis received are telephoned to the appropriate Women Health Officer who visits the home forthwith and gives such advice on measures of prevention as is necessary. She leaves a pamphlet dealing with the prevention and treatment of the disease, and to avoid confusion in the mind of the mother, her advice follows on the lines of the pamphlet with only such modifications as the circumstances of the case indicate. If during the course of their daily work the Women Health Officers hear of any cases through unofficial sources, these are visited at once and if necessary a doctor is called in. 20 The Health Officers pay further visits to the home, but the frequency of these depends upon the severity of the case, the type of home and mother, and the urgency of other work demanding their attention. For six days in July, the Kensington Council of Social Service undertook propaganda work in regard to the prevention of enteritis by the institution of what was called a " Fly Week." This effort was a very valuable adjunct to the efforts being made by the Borough Council. A lecturer accompanied by a van, kindly lent by a North Kensington resident, loaded with practical exhibits, traversed North Kensington from end to end giving instruction to groups of people who gathered round on the best way of dealing, from the point of view of health, with the fly nuisance. The paid lecturer was supported during her campaign by volunteers. The efforts of the Kensington Council of Social Service were supplemented by the Health Visitors who, as far as other work permitted, accompanied the van and assisted the lecturer. Refuse removal and the general scavenging of streets and mewsways are amongst the most important factors in the prevention of enteritis and a description of the preventive work of the Borough Council would not be complete unless reference were made to their efforts in these matters. This section of the report is intended to deal with the prevention and treatment of zymotic enteritis under the scheme controlled by the Public Health Committee on behalf of the Council, and it is, therefore, not necessary to give a detailed statement of the refuse removal and scavenging work carried out. Reference will, however, be made to these matters, which are under the direction of the Works Committee, in the section dealing with Administration. Home Nursing and Treatment. For the purpose of home nursing and treatment, the Council have made use of the facilities offered by the Kensington District Nursing Association, which have proved so excellent in connection with the Council's scheme for dealing with ophthalmia neonatorum. Cases from the point of view of home nursing and treatment by the Council come under the following headings:— (a) Doctor in attendance and nursing assistance from the Council not needed. (b) Doctor in attendance who proposes to treat the case throughout, but such nursing assistance as the Council could offer welcomed. (c) Doctor in attendance who desires the child to go to hospital, or is prepared to hand over the case entirely to officers working under the Council. (d) No doctor in attendance. Cases in Group (a) are visited and advised from the preventive aspect, but no further action is taken by the Council's officers. Cases in Group (b) are visited and arrangements made by the Health Officers for nurses from the Kensington District Nursing Association to attend. (In cases residing in the Golborne Infant Welfare Centre area, the Centre nurse attends). Cases in Groups (c) and (d) require special attention. Most of these cases are children of poor parents who either cannot afford to pay for a doctor or who can pay for a first visit but cannot continue to pay for subsequent visits. Cases in Group (d) include children of parents who, owing to poverty or negligence, fail to obtain medical assistance until the child is moribund. Arrangements are made by the Women Health Officers for nursing assistance to be rendered to cases in Groups (c) and (d) immediately upon ascertaining that such is required. Medical assistance is also obtained from the Board of Guardians or the Council's part time Medical Officer. In the event of a severe outbreak of this disease occurring, or at such other time when there may be any undue pressure of other work to be carried out by the nurses of the District Nursing Association, the Infant Welfare Centres have indicated that they are prepared to allow their staffs of trained nurses to assist in the home nursing of this disease. In preparing their scheme for treatment, the Council recognised that there are certain cases which could be dealt with more satisfactorily if the hospitals of the Metropolitan Asylums Board were made available for the treatment of enteritis, and inasmuch as the Board's hospitals are not so extensively used during the summer months, when zymotic enteritis is more usually prevalent, the Council approached the Board and invited their co.operation. The Board went into the matter very sympathetically and in due course intimated that they were prepared to reserve a number of beds in their hospitals for the treatment of cases of this disease specially recommended by Medical Officers of Health. Several Kensington patients were admitted during the year, but it is hoped to take more advantage of this accommodation in the future. In the past many enteritis patients have been admitted to the wards of St. Mary Abbot's Hospital and the beds of the Metropolitan Asylums Board will prove particularly useful in times of epidemic when the children's wards of St. Mary Abbot's Hospital are full. Medical Assistance. For three months commencing 1st July, the Council retained the part time services of a local medical practitioner who was interested in children's diseases, and who was prepared to make a special study of zymotic enteritis. This doctor made periodical visits to the various Infant Welfare Centres at specified times in the mornings when he was consulted in reference to difficult cases. He also saw cases which were not attended by other doctors. The part time Medical Officer drew up for routine use a scheme of treatment which included intestinal lavage. 21 Record of work carried out under the direction of the Council. Table showing the work carried out during the six months (1st July to 31st December) in which the scheme was in operation :— Number of cases notified 40 Number of visits paid by Health Officers 57 Number of cases nursed by the Staff of the Kensington District Nursing Association 34 Number of visits paid by the Staff of the Kensington District Nursing Association 267 Number of cases in which the part time Medical Officer was consulted 31 At the commencement of the working ot the scheme the part-time Medical Officer gave lectures on treatment, etc., to the nurses of the Kensington District Nursing Association and Infant Welfare Centres and to other Welfare workers. The Medical Superintendent of St Mary Abbot's Hospital entered into co.operation with this officer, and arranged that the treatment prescribed by him should be continued at the Hospital in respect of those cases under the Council's scheme admitted to the Institution. The year was, for experimental purposes, a very bad one. Few cases occurred and, therefore, it is difficult to give any definite opinion as to results to be obtained by the working of the scheme until there has been a further trial. Such records as there are, however, are very satisfactory. Table showing deaths of infants under hve years ot age trom enteritis during the year 1924:— Before 1st July, 1924. Number in St. Mary Abbot's Hospital 7 Number in Baby Hospital 1 Number in Queen Charlotte's Hospital 2 Number in Children's Hospital, Paddington 1 Number attended by private practitioners 3 Total 14 After 1st July, 1924. Number in Children's Hospital, Great Ormond Street (not notified) 2 Number attended by private medical practitioners and notified 2 Number attended by private medical practitioner and not notified 1 Total 5 It will be seen that there was a large reduction in the number of fatal cases in the second half of the year, but the outstanding feature is the complete absence of fatal cases in St. Mary Abbot's Hospital during the last six months. This "is remarkable because for the same period in the three preceding years the deaths from enteritis of children under one year of age in that institution were 36, 7 and 19 respectively. It is well.known that in the past a large number of patients who have been received in St. Mary Abbot's Hospital have been admitted in a moribund condition and it would appear that notification and the treatment received in their homes have had an influence in reducing the mortality amongst infants admitted on account of enteritis. It is satisfactory to be able to record that not one of the cases attended by the part time Medical Officer and the nurses of the Kensington District Nursing Association or the Golborne Centre nurse proved fatal. Erysipelas.—Fifty.nine cases were notified during the year, 27 of which were removed to hospital. The cases notified in the three preceding years were 82, 44 and 67. There were five deaths from this cause, the deaths in the three previous years being 1, 1 and 4. Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no notifiable infectious diseases, other than those to which reference has been made, were notified during the year. NON-NOTIFIABLE DISEASES. Measles.—This disease caused 75 deaths during the year. The epidemic experienced in Kensington in 1924 occurred in the first half of the year. There were 14 deaths in January, 17 in February, 16 in March, 22 in April, 4 in May, 2 in June, and not one in the remaining six months of the year. Twenty-eight of the deaths occurred in the Golborne Ward, 25 in Norland Ward, 8 in St. Charles Ward and 7 in Pembridge Ward. The remaining 7 occurred in South Kensington, not one ward in the Borough escaping a death. The ages of the victims of this disease are shown in the following table:— Age in years 0—1 1 — 2 2—3 3—4 4—5 5 upwards No. of deaths 17 26 9 14 2 7 22 Measles ceased to be compulsorily notifiable in December, 1919, but the Head Teachers of the London County Council schools report to Medical Officers of Health all cases, both of children suffering from measles and of children kept away from school by reason of the disease existing in their homes. In view of the dangerous complications which are liable to follow neglected cases of measles, the Women Health Officers pay a great deal of attention to children suffering from this disease in the poorer quarters of the Borough. Five hundred and ninety.three visits to cases of measles were paid by these officers during the year. The number of cases admitted to hospital was 325. Whooping Cough.—There were 20 deaths from this cause, all the children dying being under the age of 5 years. The deaths in the three preceding years were 22, 27 and 23. The Women Health Officers paid 151 visits to cases of this disease during the year. Cancer.—Cancer caused 293 deaths, and of this number 263 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 239 deaths were attributed; sarcoma and epithelioma were the assigned cause of 21 deaths; 33 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 1924. Parts Affected. Sex. Total. Male. Female. Buccal Cavity 16 2 18 Stomach, Liver, etc. 45 42 87 Peritoneum, Intestines, Rectum ... 17 32 49 Female Genital Organs • • • 42 42 Breast • • • 32 32 Skin 1 • • • 1 Other and unspecified Organs 39 25 64 Totals 118 175 293 The deaths in the several wards, etc., are set out in the following table:— The Borough 293 North Kensington 135 South Kensington 157 Wards. St. Charles 27 Golborne 28 Norland 44 Pembridge 36 Holland 35 Earl's Court 41 Queen's Gate 26 Redcliffe 35 Brompton 20 Ward Unknown 1 The deaths from cancer are gradually growing in number, not only in Kensington, but throughout the whole country, and this disease, with the exception of affections of the heart, is now the commonest cause of death. TUBERCULOSIS. During the year 236 cases of pulmonary tuberculosis and 78 cases of non-pulmonary tuberculosis were notified. The following Table shows the number of cases of both forms of the disease notified in the Borough and the several Wards therein during each year since 1914. 23 District. Years. 1914. 1915. 1916. 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. The Borough 682 564 429 543 432 582 407 374 339 403 314 North Kensington 516 423 300 406 331 445 294 272 233 267 228 South Kensington 138 133 127 137 101 137 113 102 106 136 86 Wards. St. Charles 117 93 75 113 79 104 70 66 48 61 45 Golborne 176 147 106 124 101 150 88 89 80 86 65 Norland ... 162 134 79 102 99 124 93 30 76 85 75 Pembridge 61 49 40 67 52 67 43 37 29 35 43 Holland 35 43 31 41 35 36 36 29 28 26 30 Earl's Court 40 29 40 35 20 31 25 24 24 28 13 Queen's Gate 17 10 14 20 23 16 15 15 20 22 17 Redcliffe 31 35 27 23 16 33 25 19 23 41 15 Brompton 15 16 15 18 7 21 12 15 11 19 11 Ward Unknown 28 8 2 — — — — — — — — It will be noted that there were 89 fewer notifications of tuberculosis in 1924 than in the preceding year; indeed, the number of notifications in 1924 was less than in any year since the introduction of notification. In view of the efforts made by the Council during the past four years to secure notification of all cases, the above table must be regarded as evidence that the disease is becoming less prevalent. Medical practitioners are reporting cases at an earlier stage of the disease than was the case several years ago, but the following figures show that some improvement in this respect is still desirable in order that the Council's machinery for the prevention of the spread of infection may be put into operation at the earliest possible moment:— (1) No. of deaths in Kensington from all forms of tuberculosis in 1924 149 (2) No. of persons dying unnotified or notified at death 30 (3) No. notified within one month of death 11 (4) No. notified within three months of death (excluding those under heading 3) 10 (5) No. notified within six months of death (excluding those under headings 3 and 4) 11 During the course of the year the Council took proceedings against a medical practitioner in respect of his failure to notify a case of tuberculosis, and a fine of £5 and 10s. 6d. costs was imposed. Late notification is not necessarily due to delay on the part of the family doctor, for in only too many cases the patients unfortunately do not consult a medical man until the disease is well advanced. The following summary ot cases notified during 1924 shows the age and sex distribution:— Age periods (Years) 0-1 1-5 5-10 10-15 15-20 20-25 25-35 35-15 45-55 55-65 Over 65 Pulmonary Tuberculosis. Males - 2 2 3 6 14 22 28 23 6 2 Females - - 4 7 13 22 38 24 10 9 1 Non.Pulmonary Tuberculosis. Males 1 6 18 6 6 1 1 - 3 2 2 Females 1 5 8 6 5 2 2 1 2 — — From the above table it will be seen that the disease commonly attacks people at the period of their maximum value to the home, the family and the nation. Apart from causing deaths of persons in the prime of life, it handicaps many by reducing their working capacity for several years before death. It is, therefore, of great economic and hygienic importance that the notification rate and the death rate of this disease are declining rapidly. 24 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1914, together with the number of deaths and death-rates in each year. The Year. Pulmonary Tuberculosis. Other Forms of Tuberculosis. Tuberculosis (all forms). No. of Notifications. No. of Deaths. Deaths per 100,000 persons living. No. of Notifications. No. of Deaths. Deaths per 100,000 persons living. No. of Deaths. Deaths per 100,000 persons living. 1914 501 189 110 181 78 45 267 156 1915 402 183 107 162 77 45 260 152 1916 300 186 122 129 54 35 240 157 1917 445 178 117 98 66 43 244 161 1918 336 203 131 96 47 30 250 161 1919 489 169 107 93 38 24 207 131 1920 293 135 82 114 44 27 179 109 1921 288 153 87 86 32 18 185 105 1922 252 139 78 87 30 17 169 95 1923 280 117 66 123 35 19 152 85 1924 236 120 67 78 29 16 149 83 The last column of the above table shows that the death rate has fallen from 161 pec 100,000 in 1918 to 83 per 100,000 in 1924; the latter is the lowest rate recorded in Kensington. Deaths from Tuberculosis in 1924 Allocated to District of Usual Residence of Patients. Pulmonary Tuberculosis. Other Forms of Tuberculosis The Borough 120 29 North Kensington 83 23 South Kensington 37 6 Wards. St. Charles 19 7 Golborne 15 12 Norland 28 3 Pembridge 21 1 Holland 10 2 Earl's Court 10 3 Queen's Gate 3 — Redcliffe 9 1 Brompton 4 — Ward Unknown 1 — The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary Tuberculosis. Other Forms of Tuberculosis. Patient's Home 41 5 St. Mary Abbot's Hospital 39 6 Baby Clinic Hospital — 2 Brompton Hospital 1 — St. Luke's Home 3 — Outlying Hospitals 26 15 Other places outside the Borough 10 1 DISPENSARY TREATMENT OF TUBERCULOSIS. During the year 1924 no material change in the working of the Dispensary has occurred. There has now been a full year's experience of the centreing of the Dispensary treatment for the whole of the Borough at Ladbroke Grove and this is one factor in the increased number of patients seen and examined for the first time. It is satisfactory to note that complaints due to the increased distance to be covered by patients coming from the South Kensington area are rare, and lapsed attendances are not proportionately greater from that district than from the nearer neighbourhood. Dr. Picard, the Tuberculosis Officer, has continued to act as Visiting Medical Officer to St. Mary Abbot's Hospital and has paid weekly visits to that institution throughout the year. The Tuberculosis Officer has arranged the admission of some cases from the Dispensary to the St. Mary Abbot's Hospital and certain cases admitted to the Hospital from various sources have been transferred by him after due observation to various sanatoria provided by the London County Council. 25 The linking up of the Council's Dispensary with the Tuberculosis Wards of the St. Mary Abbot's Hospital has proved of considerable value both from the curative and preventive aspect and, on behalf of the Tuberculosis Officer and myself, I desire to thank Dr. Remington Hobbs, Medical Superintendent of the Hospital, for the valuable assistance we have received from him and his Assistant Medical Officers. Dr. Picard's work has been attended with success and he has been loyally supported by the Council's Officers, whether working in the Dispensary or visiting the homes of the patients. The number of new cases seen at the Dispensary during the year, with the original diagnosis made, is shown in the following table:— New Cases. Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 182 296 207 181 866 ("Contacts" included in above) (58) (123) (96) (96) (373) New cases with Respiratory Tuberculosis 54 45 2 — 101 (11.6 per cent.) New cases with Non-RespiratoryTuberculosis 3 4 17 13 37 (4.2 „ ) New cases regarded as "Suspects" 32 67 30 26 155 (17.9 „ New eases not suffering from Tuberculosis 93 180 158 142 573 (66.1 „) The total number of new cases, 860, shows a marked increase on the number for 1923, when 786 were seen. The increase affected equally original patients and "contacts." There is a notable decrease in the percentage of definite cases (11.6 per cent) when compared with last year's figure (14.3 per cent.). The percentage of "suspects" and non-tubercular cases is increased. In the above table, a "suspect," whether a "contact" or not, is a doubtful case which could not be diagnosed as definitely tubercular or non-tubercular at the first examination. The following table shows the subsequent disposal of (1) the 155 cases classed as "suspects" in the above table as a result of the first examination, and (2) the 26 cases appearing on the Dispensary books at the end of 1923 as "suspects." Diagnosed as suffering from respiratory tuberculosis 15 Diagnosed as suffering from non-respiratory tuberculosis 4 Discharged as non-tubercular 108 Discharged as having ceased attendance 12 Placed under domiciliary observation or referred elsewhere 10 Remaining on Dispensary books at the end of the year 32 181 Cases were sent to the Dispensary through the following agencies:—the Public Health Department of the Council, the Ministry of Pensions, the London County Council, Hospitals, School Medical Officers, the Invalid Children's Aid Association, the Charity Organisation Society, the Kensington Board of Guardians, the Red Cross Society and private practitioners. The number of cases sent up by doctors increased from 89 in 1923 to 101. The treatment recommended for the cases diagnosed as suffering from tuberculosis, which numbered 157 (116 pulmonary and 41 other forms), was as follows:—Sanatoria, 47; Hospitals, 17; Domiciliary, 31; Dispensary, 34; St. Mary Abbot's Hospital, 7; Convalescent Homes, 4; Kensal House School, 4. In 13, no treatment, beyond advice on rest, work, recreation, diet, etc., together with observation of the progress of the case, was found necessary. The .total number of attendances at the Dispensary during the year was 4,701, and the number of systematic examinations was 2,040. The number of home visits made by the Tuberculosis Officer was 101, and by the Women Health Officers 2,441. Reports on patients sent to Public Authorities numbered 1,625, and to private practitioners 3.29. The increasing use made of the Dispensary by doctors is seen in the growing number of reports sent to them, which went up from 256 in 1923 to the above figure. 26 Sputum examinations numbered 591, a few more than last year; they were from 470 individual cases. The examinations include 27 specimens sent by doctors in the neighbourhood with a request for a report thereon. The number of cases showing tubercle bacilli present in the sputum was 122, or 26 per cent., the remaining 348, or 74 per cent., giving negative results. It is of greater importance to draw attention to the positive or negative condition of the sputum in the new cases diagnosed as suffering from pulmonary tuberculosis. These cases totalled 116—being 101 definite cases on first examination and 15 "suspects" subsequently found to be pulmonary cases, and 55 had a positive sputum, giving a percentage of 47.4. This must be regarded as unsatisfactorily high and suggests that efforts must be continued to discover cases of the disease at an earlier stage if possible. This inference from the sputum specimens is borne out by the clinical findings. MEDICAL CONSULTATIONS AND X-RAY DIAGNOSIS. The arrangements approved by the Ministry of health and the County Council under which the Tuberculosis Officer can consult Visiting Specialists at the St. Mary Abbot's Hospital and send Dispensary patients to that institution for the purpose of X-ray diagnosis have remained in operation throughout the year. DENTAL TREATMENT OF TUBERCULOUS PERSONS. The Council's scheme for the dental treatment of tuberculous persons at the Dispensary has continued to work fairiy satisfactorily. The amount of work done during the year was less than that executed in the previous twelve months, this decrease being mainly due to the fact that no work was carried out for some weeks in the Summer owing to the resignation of the part-time dentist upon his removal from the district. The new dental officer commenced his duties in October and treated patients at his private surgery until he had installed his apparatus at the Dispensary. The provision of dentures and the filling of carious teeth in certain cases of tuberculosis assist very considerably in securing a permanent cure; and it is, therefore, unfortunate that consumptive patients are only with difficulty persuaded to accept the enhanced prospects of recovery offered by the Council. The work done during the year is shown in the following table:— No. of Dentist's attendances at the Dispensary 22 No. of attendances of patients (including attendances at the private surgery of the Dentist) 75 No. of extractions 83 No. of fillings 8 No. of dentures arranged for 9 Extractions and fillings are performed for all patients free of charge, while the cost of the provision of dentures, together with the financial position of the persons receiving them, is reported to the Tuberculosis Care Committee who assess and collect payments on behalf of the Council. Of the 9 patients for whom the provision of dentures was arranged, 3 discontinued their attendances with the result that dentures could not be completed. Of the 6 remaining cases for which dentures were provided, one person was so poor that no charge was made, and in the other 5 cases the assessments totalled £7 5s. The money collected by the Care Committee on behalf of the Council during the year, in respect of dentures provided since the commencement of the dental scheme in 1921, totalled £7 4s. No alteration has been made in the fees payable by the Council to the Dentist, which are as follow:— (1) Separate extractions. Minimum fee of 2s. 6d. (2) Separate fillings. Minimum fee of 5s. (3) Dentures. From £2 5s. for a part set to £4 for a complete set. No fee is paid for extractions previous to the fitting of dentures. The payments to the Dentist during the year amounted to £55 10s., this sum being mainly in respect of work performed in 1923. SUPPLY OF EXTRA NOURISHMENT TO TUBERCULOUS PERSONS. Applications for the supply of extra nourishment to tuberculous persons are dealt with by the Tuberculosis Care Committee and, in order to secure uniformity, the following procedure is adopted in all cases. 1.—Applications are made upon a printed form, on which must be stated the financial circumstances of the family and other relevant particulars. The information is verified by the Women Health Officers who submit their reports to the Committee. 2.—Applications must be accompanied by a recommendation from the Tuberculosis Officer, or the medical practitioner in attendance. 27 3.—In appropriate cases, recommendations are made to the Public Health Committee that grants, usually consisting of supplies of milk and eggs, be made for periods not exceeding 28 days. 4.—If a renewal of the grant be desired, a further medical certificate must be submitted and any alteration in the circumstances of the case is reported by the Health Officer to the Care Committee. As far as possible the Tuberculosis Care Committee confine the grants to patients requiring temporary assistance, chronic cases of poverty being more suitable for relief by the Guardians. Particulars of nourishment granted in 1924:— Number of patients assisted 10 Number of renewals of grants issued 13 No. of pints of milk granted. No. of eggs granted. 581 525 Total estimated cost to the Council of nourishment granted during the year £13 7s. 6d. This expenditure is approved by the Ministry of Health and ranks for the Government grant of 50 per cent. ARTIFICIAL PNEUMOTHORAX TREATMENT. Artificial pneumothorax treatment, which can only be adopted at a well-equipped hospital,, is occasionally recommended in order to stay the progress of somewhat advanced disease. This treatment is carried out for Kensington residents at the Brompton Hospital at a cost of 10s. 6d. for each administration. Treatment is given fortnightly in the early stages, and thereafter less frequently as the case progresses, the whole period of treatment generally occupying about two years. The ordinary poor patient cannot, of course, afford this treatment and, in order that he shall not be precluded from its benefits, the Council have undertaken to bear the cost in suitable cases. When the Lady Almoner of the Hospital considers that a patient is unable to pay, she asks the Council to accept financial responsibility. These applications are placed before the Tuberculosis Care Committee who investigate the home conditions and financial circumstances and make appropriate recommendations to the Public Health Committee. During the year the Council agreed to pay for treatment in six cases, and the estimated net cost is £35 3s. THE BOROUGH TUBERCULOSIS CARE COMMITTEE. The Care Committee have met fortnightly during the year, and the attendance of members has been well maintained. The established principles of social service in aiding the patients after close consideration of the home conditions and financial position, as affected not only by the onset of the disease but during the course of treatment, whether at home or away from home, and upon return from institutional treatment, have been carefully followed, and in many cases real assistance has been given either to the patient or the family or both. This is all the more noteworthy in view of the fact that no fund is available for this purpose. Much time is devoted to a careful assessment of contributions in respect of hospital or sanatorium treatment and dental treatment. Applications for grants of nourishment, usually milk and eggs, have come before the Committee, and the recommendations made to the Public Health Committee have received sympathetic consideration. The Officers of the Committee have remained unaltered, viz.:—Chairman, Councillor Miss A. G. E. Carthew; Vice-Chairman, Councillor Miss M. H. Joseph; Secretary, Miss F. C. Hargrave. Upon the retirement of Miss R. F. Alexander, Miss J. C. Magee was appointed by the Council as one of their representatives on the Committee. The Committee lost by death the valuable services of Miss R. Marwood who was one of the representatives of the Kensington Invalid Children's Aid Association. The vacancy was filled by the appointment of Miss G. A. Home. 28 The constitution and membership of the Committee at the end of the year were as follow:— (1) Borough Council—Dr. H. Robinson, J.P., Chairman of the Public Health Committee, Councillor Miss M. H. Joseph, Councillor Miss M. Drysdale and Miss J. C. Magee. (2) London County Council—Dr. A. W. Sikes, Divisional Medical Officer, and Miss G. M. S. Paddon, District Organiser of the School Care Committees. (3) Kensington School Care Committees—Miss A. Webster. (4) Kensington Invalid Children's Aid Association—Miss G. M. Burton and Miss G. A. Home. (5) Kensington Charity Organisation Society—Mrs. E. Weber and Miss O. A. Nixon. (6) Brompton Hospital—Miss L. C. Marx, Lady Almoner. (7) Kensington Board of Guardians—Councillor Miss A. G. E. Carthevv. (8) Kensington District Nursing Association—Miss E. D. Gibbes. (9) Kensal House School—Miss C. D. Clay. (10) London Insurance Committee—Dr. H. H. Mills. (11) Local Panel Committee—Dr. A. K. Barrett and Dr. A. S. Herbert, (12) Kensington War Pensions Committee—One representative. (13) British Red Cross Society—Mrs. R. H. Burne and Miss F. M. Forbes. (14) British Red Cross Society (Emergency Help Commiltee)—Councillor Miss C. Keeling, J.P., and Miss O. A. Nixon. (15) United Services Fund—Miss M. Pickton. (16) Ex-officio members—The Medical Officer of Health, Tuberculosis Officer and two Women Health Officers. PREVENTIVE WORK IN RELATION TO TUBERCULOSIS. The treatment of tuberculosis is preventive in so far as it cures the patient and renders him non-infectious to others, but, in addition to this method of prevention, the Council, with a view to limiting the spread of disease, undertake various other measures, the most important of which may be briefly referred to here. Examination of Contacts. Special efforts have been made to secure the examination of all "contacts" of notified cases. Of 801 traced, 373 were examined at the Dispensary by the Tuberculosis Officer and 154 were examined by their own doctors or were found to have been recently examined by a School Medical Officer. The remaining 274 either refused examination altogether or ignored repeated requests for attendance. The endeavour started last year to secure a second examination of "contacts "of definitely infectious cases after approximately one year's interval has been continued, especially of young adult "contacts" whose age renders them more vulnerable. The great importance of this step has been demonstrated by the finding of early disease in a few cases upon second examination. The number of "contact" re-examinations, not included in the primary list above, was 105. Home Visiting. The number of home visits paid by the Council's Women Health Officers is shown in the following table:— Women Health Officers. Total. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No 7 Tuberculosis. Pulmonary. First Visits 22 29 22 33 42 43 52 243 Re-Visits 143 145 253 238 90 330 342 1,541 Non-Pulmonary. First Visits 12 13 7 13 8 2 8 63 Re-Visits 45 175 161 134 13 8 58 594 The results of home visiting by tactful nurses are noteworthy and the work of these trained Officers in the Council's service has been an important factor in the progress which has been made in the domain of tuberculous infection and infant welfare work. Women Health Officers play an important part in popular instruction by their visits to the homes of the sick and poor, and their importance as agents for the discovery of early cases of tuberculosis is considerable. 29 Housing conditions form an important element in regard to tuberculosis, and home visits are of importance in this connection. The steeping arrangements are frequently unsatisfactory and the Women Health Officers always enquire into them. Wherever possible, desirable alterations are pointed out and urged upon the family. The following table giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1924 by the Tuberculosis Officer and the number of occupants, ascertained by the Women Health Officers on their visits to the homes, is inserted to show the difficulties experienced in securing home isolation in many cases. No. of Occupants 1 2 3 4 5 6 7 9 9 10 11 12 Rooms 1 10 6 9 3 2 — — — — — — — =30 Cases „ 2 — 12 17 9 7 6 3 2 1 — — — =57 „ „ 3 — 2 5 4 8 1 2 4 — 1 — — =27 „ „ 4 — — 3 2 4 1 1 — 1 — — — =12 „ ,, 5 — — — 1 3 — 1 1 — — — — = 6 „ ,, 6 — — — — 1 — — — — — — — = 1 „ ,, 7 — — — — — — 1 — — — — — = 1 ,, „ 8 — — — 1 — — — — 1 — — — = 2 „ *136 * This total falls 21 short of the total number of cases owing to patients living in boarding houses, private hotels or large private residences not being included. Provision of Bedding for Home Isolation. It is sometimes found that isolation of the patient in the home is not as satisfactory as it could be, owing to the inability of the family to provide sufficient bedclothes to allow him to have a separate bed. In such cases the Council loan beds, bedclothes, etc. if, after enquiry, the circumstances are suitable. At the present time there are 12 patients to whom bedsteads and bedding have been loaned In 4 of these the assistance was given during the past 12 months and the articles loaned in 1924 are as follows:— Bedsteads 4 Bolsters 4 Pillow-slips 8 Blankets 10 Mattresses 4 Pillows 4 Sheets 12 Quilts 4 Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam 119 Number of rooms disinfected 141 Bacteriological Examinations. Specimens of Sputum submitted by Medical Practitioners for bacteriological examination at the Lister Institute at the expense of the Council 208 Sputum Flasks. These are supplied to patients who are infectious, and advice is given in regard to the disposal of sputum. 30 MATERNITY AND CHILD WELFARE. The Borough Council's Scheme of Maternity and Child Welfare work includes the following amongst other activities:— (a) The Home Visiting of expectant and nursing mothers and children by the Council's staff of Women Health Officers. (b) Co-ordination of the work of the Voluntary Maternity and Child Welfare Institutions in the Borough. (c) The subsidisation of the Voluntary Infant Welfare Institutions. (d) The provision of "Home Helps." (e) The provision of Hospital accommodation for infants. (f) The provision of Convalescent Home accommodation for mothers and infants. (g) The provision of home nursing for sick mothers and infants. (h) The supply of milk and meals free or at a reduced price to necessitous mothers and infants. (i) The provision of a Maternity Home. (j) Arrangements for the treatment of ophthalmia neonatorum and zymotic enteritis. (k) The distribution of pamphlets and booklets giving advice on various matters concerning the welfare of mothers and infants. WOMEN HEALTH OFFICERS. The Maternity and Child Welfare duties allotted to the Women Health Officers are as follow:— 1. To visit the homes of all newly-born children amongst the working classes within 21 days after birth, and subsequently as circumstances indicate. 2. To visit the homes and make investigations in regard to still-births and infantile deaths. 3. To visit and give advice to parents in cases of ophthalmia, zymotic enteritis and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever. 5. To investigate applications under the Council's Scheme for the supply of milk and meals free or below cost price. These officers also attend at the Infant Welfare Centres in their respective areas on doctors' consultation days in order to assist in the work and to co-ordinate their efforts with those of the salaried and voluntary workers attached to these institutions. The work performed by the Women Health Officers in 1924 in regard to Maternity and Child Welfare is summarised in the following table:— Description of Work. Health Officers. No. 1 No. 2. No. 3. No. 4. No. 5 No. 6. No. 7. Total. Visits to Infants under the age of 21 days. (First Visits) 10 327 322 294 292 348 365 1,958 Re-visits to Infants under the age of 12 months 119 919 593 850 1,075 638 822 5,016 Visits to Children between 1 and 5 years 406 1,134 1,087 1,333 1,063 1,104 671 6,798 Still-birth Enquiries 2 9 5 13 5 4 14 52 Visits to Ophthalmia Cases 2 3 1 3 2 3 2 16 Return Visits to Ophthalmia Cases 5 3 12 6 9 7 6 48 Visits to Measles Cases 31 116 162 54 72 47 111 593 Visits to Whooping Cough Cases 2 30 56 8 5 4 46 151 Visits to Puerperal Fever Cases 1 3 — 1 1 — 1 7 Visits to Enteritis Cases 1 26 15 3 — 2 10 57 Infantile Death Enquiries 14 35 30 17 23 25 37 181 Investigations re Milk Applications 43 133 53 60 4 81 144 518 Ante-natal Visits 31 85 13 11 47 85 109 381 Half-days at Welfare Centres 15 97 132 145 133 118 140 780 Special Visits 1,339 235 128 195 258 235 206 2,596 The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of this report dealing with these subjects, and a complete record of the work performed by each Woman Health Officer during the year appears in Table VII. of the Appendix. 31 INFANT WELFARE CENTRES. There are seven Voluntary Infant Welfare Centres in Kensington, and the Borough has been mapped out into a similar number of areas with one Centre in each, an attempt having been made to place each home in the area of that Centre most accessible to the mother. The Centres are controlled by Voluntary Committees and two representatives from each of the Voluntary Committees serve on the Advisory Committee to the Council's Maternity and Child Welfare Committee. (The work of the Advisory Committee is set out on Page 41). These institutions are mainly supported by (1) voluntary contributions, (2) grants from the Ministry of Health, and (3) grants from the Borough Council. The medical and nursing staffs are engaged by the Voluntary Committees. A Woman Health Officer is attached to each Welfare Centre and, except at Campden Hill, has an office on the premises where she keeps her records and in which she arranges home visiting work in consultation with the staff and the Voluntary Committee. The principal duties of a Welfare Centre are those of an educational institution—providing advice and teaching for the mothers in the care and management of little children with a view to maintaining them in good health. The guidance and teaching at all Centres is both individual and collective. Individual advice is given at the medical consultations and in the course of home visiting, collective advice being given to mothers by simple class teaching. The work done at the Infant Welfare Centres during the year 1924 is shown in the following table:— Particulars of Work done. Archer Street. Bramley Road with Kenley Street Branch. Campden Hill. Earl's Court. Golborne. Lancaster Road. Raymede. Totals. 1—No. of births occurring in the area of the Centre suitable for Welfare attention 87 644 120 339 320 348 282 2140 2—No. of sessions at which doctor attended for infant consultations 89 200 90 100 98 133 150 860 3—No. of sessions at which doctor attended for special ante-natal consultations 21 24 12 11 — 21 49 138 4—Total number of individual mothers who attended during the year 433 730 82 192 398 688 404 2927 5—Number of individual mothers who attended ante-natal sessions during the year 45 64 31 53 43 58 93 387 6—Total number of individual children who attended during the year (Old) 266 420 108 195 269 299 313 1870 ,, ,, ,, (New) 190 448 91 135 268 360 293 1785 7—Number seen by doctor at consultations— 1. Ante-natal mothers 61 117 82 129 93 195 320 997 2. Post-natal mothers 249 322 8 326 257 450 676 2288 3. Children 2355 5067 2019 3046 2434 4369 4860 24150 3—Average number seen by doctor at consultations— 1. Ante-natal mothers 2.9 3 7 11 — 9.7 6.4 2. Post-natal mothers 2.8 1.6 — 3 2.6 3.4 4.5 3. Children 26 25 22 30 24 329 32 9—Number of individual children weighed during the year 456 864 199 330 537 659 606 3651 10—Total weighings 2715 6647 2019 3755 4413 5544 9035 34128 11—Number of first visits paid by salaried workers to— 1. Expectant mothers 23 150 12 34 134 68 150 571 2. Children 20 51 121 8 254 — — 454 12—Total number of home visits paid by salaried workers to— 1. Expectant mothers 87 189 34 88 170 135 404 1107 2. Children 1739 1327 775 1461 4198 1646 2760 13906 13—Number of home visits paid to children by voluntary workers — 1. First visits — — — — — 28 — 28 2. Total visits — 248 — — — 108 — 356 The home visiting figures do not include visits paid by the Council's Women Health Officers. 32 General Observations on the Work of the Infant Welfare Centres. Infant Consultation Sessions are held by medical officers in all Centres in the afternoons fronr 2 to 4 p.m. At the Lancaster Road Centre there is a session held on Thursday mornings from 10 a.m. to 12 noon. At four Centres there are two sessions per week; at two Centres three sessions per week; and at Bramley Road there are three in addition to the weekly session at the Branch in Kenley Street. The Centres are in every case fortunate in having very able and keen medical officers who show considerable interest in their work. Special Ante-natal Sessions are held at all except the Golborne Centre where expectant mothers are seen privately on infant consultation days. The work of ante-natal consultations is growing as it becomes better known amongst mothers, and, in view of the excellent arrangements made by the Voluntary Committees, it is to be hoped that mothers will take full advantage ot them, and thus remove as far as possible all danger of disease and accident in their confinements. Home Visiting.—Before the Maternity and- Child Welfare work in the Borough was co-ordinated, overlapping in home visiting by the workers of the Municipal and Voluntary bodies occurred, but since the inauguration of the present system, this waste of effort and source of annoyance to parents has been completely avoided. The Council's Women Health Officers receive all notifications of birth, and these are transferred to History Cards. They pay "first visits" to infants in order to ascertain certain information required by the Council in respect of births. If the mother of the child is in regular attendance at an Infant Welfare Centre, the Hsalth Officer transfers the History Card to the Welfare Sister who pays the subsequent home visits. Apart from "first visits," the Council's Health Officer confines her attention to cases not in attendance at Welfare Centres or to difficult cases transferred back to her by the Welfare Sister. Dental Treatment.—All the Infant Welfare Centres provide dental treatment (including the supply of dentures) for expectant and nursing mothers who are unable to pay the fees usually charged by private dentists. Each Welfare Centre endeavours, as far as possible, to make the scheme of dental treatment practically self-supporting by charging such fees as the mothers can pay and by obtaining the dentures at a very low rate. Although the dentures are generally not more than £4 to £5 for a complete set, they are very well made and give considerable satisfaction. TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE VARIOUS CENTRES IN 1924. Centre No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other Treatments. Archer Street 86 201 98 59 8 16 Bramley Road 59 168 267 38 14 17 Campden Hill 1 3 3 — 1 — Earl's Court 134 402 312 99 53 18 Golborne 30 80 37† 1 2 — Lancaster Road 55 135 23† 12 6 46 Raymede 317 707 308t 21 23 11 † These figures represent the number of times gas was administered and not the number of teeth extracted. Details Concerning Individual Centres. Archer Street Infant Welfare Centre. This Centre serves the southern part of the Pembridge Ward. Infant consultations are heid by the Medical Officer on two afternoons in each week and ante-natal and dental clinics are each held twice monthly. In addition to these activities a Sewing Class is held weekly and there are Boot, Clothing, Blanket, Maternity and Denture Clubs connected with the institution. The lease of the premises on the south side of Archer Street, which had been occupied since the Centre opened, came to an end in the summer, and new accommodation was secured on the opposite side of the street. The new Centre building is much more satisfactory in every way. The building has been purchased by Mrs. Sidney G. Brown, the Chairman of the Committee, who has spent a considerable sum of money in adapting it for its present use. During the interval between the closing of the old Centre and the opening of the new one the work was carried out at "The Venture," in Portobello Road. The total attendances of mothers during the year 1924 were 734, and those of children were 3,338. 33 Bramley Road Infant Welfare Centre. This Centre serves the Norland Ward and part of the St. Charles Ward, and has within its area one of the poorest districts in the Borough. It is the oldest of the Kensington Centres, having been established as far back as 1907. In fact it is one of the pioneer centres in the Country. In 1919, the work of this Centre had grown to such an extent that it was found necessary to open a Branch at the premises of the Kensington District Nursing Association in Kenley Street. Three infant consultation sessions are held weekly at Bramley Road and one at the Kenley Street Branch. Ante-natal clinics are held fortnightly. Arrangements are made for dental work to be carried out at the Minor Ailment Centre which is conducted on the Nursing Association's premises in Kenley Street. Knitting and Sewing Classes are held weekly, also a Maternity Club and Dental Savings Bank. The total attendances of mothers during the year were 1,585, and of children 6,928. Campden Hill Infant Welfare Centre. This Centre, to which the Holland Ward is allotted, is housed in splendidly equipped premises which were specially erected for the purpose. Infant consultations are held twice weekly and ante-natal clinics once monthly. Knitting and Sewing Classes are held weekly and baths are provided for mothers. The Committee have an arrangement with a local dentist under which mothers can be sent to his private surgery for dental treatment. The total attendances of mothers during the year were 385, and of children 2,025. Special meetings for fathers are arranged from time to time. Earl's Court Infant Welfare Centre. The Welfare work for poor mothers and children in the Queen's Gate, Earl's Court, Redcliffe and Brompton Wards is performed at this institution. As most of the houses and flats in these Wards are occupied by persons who can afford private medical advice and treatment, one Centre is found sufficient; but owing to the large area to be covered, some mothers have to travel considerable distances to reach the Centre in Warwick Road. The size of the area increases the difficulty of home visiting. Infant consultations are held twice weekly, dental clinics once weekly, and ante-natal clinics once monthly. There is a Maternity Club. The total attendances of mothers during the year were 673, and those of children 4,026. Golborne Infant Welfare Centre. This Centre serves that part of the Golborne Ward north of the Great Western Railway main line. Although the area allotted to the Centre is small, it is one of the most densely populated districts in London. The people living in this district are generally poor and there is a very wide scope of work for the Welfare Centre Infant consultations are held twice weekly and ante natal cases are seen privately at these consultations. Mothers and children receive dental treatment at the Raymede Dental Clinic. Sewing and Cooking Classes are held, and dinners are provided for necessitous mothers free of cost or at reduced prices. A trained nurse is employed by the Committee of the Centre to assist in the home nursing of expectant and nursing mothers and sick infants. There is an average daily attendance of 31 children at the Day Nursery attached to this Centre. The total attendances of mothers during the year were 1,759 and those of children 5,343. Lancaster Road Infant Welfare Centre. This Centre serves parts of the Golborne, St. Charles and Pembridge Wards. Infant consultations are held three times a week and ante-natal clinics twice monthly. Dressmaking and Sewing Classes are held weekly. Dinners are provided free of cost or at reduced prices for necessitous expectant or nursing mothers. Dental treatment was provided at the Minor Ailment Centre in Kenley Street up to September, when a dental clinic was established on the premises of the Centre in Lancaster Road. Mothers have appreciated this change, and the attendances for dental treatment increased considerably in the latter part of the year. Various clubs are organised for the benefit of mothers. A special feature of this Centre is the Father's Council, which was instituted in 1922, and was the first of its kind to be formed in the Country. The objects of the Council are (1) to bring home to fathers the responsibilities that rest upon them in giving the child a proper start in life, (2) to advance the interests of the Centre, and (3) to raise funds for the Centre by means of entertainments, etc. They are a most energetic body of men, and are taking a keen interest in the working of the institution. Many odd jobs and some decorating work have been done by them at the Centre in their leisure hours. The total attendances of mothers at the Centre were 4,953, and those of children 6,396. The daily number of infants received in the Day Nursery attached to this Centre averages 24. 34 Raymede Infant Welfare Centre. This Centre serves parts of the St. Charles and Golborne Wards, and is one of the largest institutions in Kensington. The corner house, in which the Centre is established, is particularly well adapted for the work to be carried out. Infant consultations are held on three afternoons each week and ante-natal sessions every Friday. A dental clinic is attached to the Centre. Sewing Classes are held weekly. Dinners are provided free of cost or at reduced prices for necessitous mothers and children. Various clubs for the benefit of mothers are organised. Special meetings for fathers are arranged from time to time. The total attendances of mothers during the year were 5,929, and those of children 12,230. In 1923, a Children's Massage, Medical Gymnastics, and Electrical Treatment Clinic was established on the premises at this Centre. THE BABY CLINIC, No. 92, TAVISTOCK ROAD. In the early part of the year the Committee of this institution acquired new and more commodious premises at No. 92, Tavistock Road, and on loth July, 1924, they were formally opened by the ex-Prime Minister, Mr. Ramsay Macdonald. The Baby Clinic acts both as a Treatment Centre and Infant Welfare Centre, but it is not an Infant Welfare Centre in the same sense as the other seven; nevertheless, much valuable work is performed. The following are the records for the year ending December 31st, 1924:— Number of sessions at which doctors attended for infant consultations 150 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 51 Total number of individual mothers who attended during year 159 Total number of individual children who attended during year (Old) 784 (New) 708 Total attendances at Centre of mothers for all purposes (excluding the accompanying of children) 459 Total attendances of children at Centre for all purposes 9,670 Number seen by doctor at consultations:— 1. Ante-natal mothers 255 2. Post-natal mothers 204 3. Children 6,750 Average number seen by doctor at consultations:— 1. Ante-natal mothers 5 2. Post-natal mothers 4 3. Children 45 Number of individual children weighed 1,492 Total weighings 6,750 Collective instruction by lectures is not undertaken at Tavistock Road, also, there is little home visiting. Under an arrangement with the County Council, certain minor defects and ailments discovered in children at the school medical examinations are treated at this Clinic and much useful work in this direction is being carried out. LADBROKE ROAD BABY IN-PATIENT HOSPITAL. This institution, which was opened in 1919, has 19 beds for the treatment of sub-acute and chronic diseases. Records for the year 1924:— Number of infants in residence at commencement of year 16 Number of admissions during the year 90 Number of discharges during the year 82 Number of deaths during the year 7 Number in residence at end of year 17 Average duration of stay in hospital 55 days As in previous years the Council made a grant of £200 to the Authorities of the Hospital towards the maintenance for a further period of twelve months of two beds therein, to be placed at the disposal of the Infant Welfare Centres serving the Borough, the grant to be subject to the same conditions as in 1923, viz: that provision shall be made for the doctors in attendance at the Centres to continue in the hospital, if they so desire, the supervision of the cases recommended by them, and that the Medical Officer of Health shall continue a representative of the Council on the Committee of Management and shall be furnished with the names and addresses of patients admitted from within the Borough, together with the dates of their admission and discharge. Although two beds are reserved for children recommended from the various Kensington Welfare Centres, all the beds are available for children belonging to the Borough. 35 ARTIFICIAL SUNLIGHT TREATMENT. Since April, 19.24, an ultra-violet ray lamp has been in use in the Ladbroke Road Baby In-Patient Hospital. Even in a short period of nine months information has been obtained which shows its value in the treatment of certain diseases and conditions of ill-health. Dr. W. A. Hislop, one of the Medical Officers of the Hospital, has kindly supplied me with the following interesting information in regard to this specialised form of treatment:— "As most of the cases in the Hospital are suffering from rickets and wasting diseases, the type of Lamp selected for use was the Mercury Vapour Air-cooled Lamp. Exposures to the Light are made for a very short time at first—from two to three minutes —at a fixed distance from the Lamp and with a fixed strength. The time of exposure is gradually increased according to the reaction of the patient, and the administration, at first on alternate days, becomes daily. The reaction, or response of the patient, to the Light is definite. Some hours after exposure an erythema, or redness of the skin, appears, and according to the degree of this, the length of the next exposure is judged. This redness varies with persons as well as with the time, distance and strength of the exposure, and it is this first factor—the personal variation—that makes it necessary to begin with very short exposures, till the intensity of the response is discovered. With repeated exposures there follows pigmentation or sunburn, more or less marked with different patients, similar to the varying response of people to the rays of the sun. It has been demonstrated that the dark-complexioned respond more readily and can take longer doses of the Lamp than the fair, while some children do not sunburn at all, but tend to blister. With these latter it has been found that the length of exposure has to be advanced very slowly, and occasionally no advance is possible. Two such have been noted. During the administration, all the patients have their eyes protected; the larger children wear Crookes glasses, and the smaller ones have their eyes suitably bandaged. The staff working in the lamp room are likewise protected. The accommodation in the Hospital is limited, and treatment has been confined to in-patients, so that the majority of cases dealt with have been rachitic, debilitated or wasted. The treatment of rickets has shown very satisfactory results and it is estimated that, along with suitable dietetic treatment, two months is sufficient to effect a cure. It is to be hoped that in the future, as cases of rickets come under treatment at an earlier stage, more rapid results may be obtained. By definite comparison it has been shown that cases of general debility following underfeeding, neglect and malnutrition, have increased in weight, improved in muscular tone and general fitness, more rapidly when the general Hospital treatment is accompanied by Light treatment. Beyond the definite remedial effects, above described, there is the wider question of the preventive action of this form of treatment. Better than curing a rachitic, or hastening the recovery of a wasted child, would be the prevention of such conditions. To help towards this, much greater opportunities of getting Light treatment will be necessary. In the hope, therefore, of making a beginning towards this aim, a second Lamp of the same type has now been installed in the Baby Clinic, Tavistock Road, North Kensington, not only on the remedial, but on the broader preventive basis. There it will be possible to treat out-patients in considerable numbers, and it is hoped by this means to reduce the number of rachitic and debilitated children, who now require Hospital treatment, and further to treat other diseases in their early stages." KENSINGTON MATERNITY HOME. During the year, the Council considered the question of providing accommodation for the confinement of women who live in small flats and tenement houses which lack adequate facilities for this purpose and they approached the Kensington Board of Guardians with a view to ascertaining whether special accommodation could be found at St. Mary Abbot's Hospital. The Board gave the matter their sympathetic attention and decided to place at the disposal of the Borough Council a detached ward of ten beds in the southern portion of their grounds. Such an arrangement involves no capital expenditure on the part of the Council in the erection of a special municipal maternity hospital, but nevertheless it provides accommodation which is entirely satisfactory for those expectant mothers in whose case the need of improved facilities for safe confinement has been keenly felt for some time. The Council decided that the ward should be called the "Kensington Maternity Home," and that the accommodation should be available for married women of all classes whose home conditions are not suitable or convenient for their impending confinement, and who cannot afford to pay the fees charged in private nursing homes. The necessary minor structural alterations having been made and the equipment provided, the Maternity Home was opened on 1st October, 1924. 36 Terms on which the Guardians provide the necessary accommodation and staff. The principal items in the agreement between the two authorities in regard to the Maternity Home are as follow:— (1) That the scheme be put cn trial experimentally for a period of six months in the first instance. (2) That the Guardians do not incur any capital expenditure in connection with the scheme. (3) That the Medical Superintendent of St. Mary Abbot's Hospital be authorised to obtain any further medical and non-resident nursing assistance that may be required. (4) That for each maternity case admitted a charge be made upon the Borough Council at the rate of 5/- per day, in addition to the cost of the additional medical staff, if any, and the extra nursing staff required. (5) That cases be admitted to the Maternity Home upon the recommendation of the Medical Officer of Health and the Medical Superintendent of St. Mary Abbot's Hospital. The details of the scheme, which was finally approved by the Ministry of Health, are as follow:— Admission of Patients. Expectant mothers attending Kensington Infant Welfare Institutions make application for admission to the Maternity Home to the Sister at the Infant Welfare Centre they attend. Expectant mothers not in attendance at Infant Welfare Institutions must make application at a Welfare Centre or apply to the Medical Officer of Health, Town Hall, Kensington, W.8. After the printed application form has been filled in, the patient is referred to the ante-natal doctor at the Infant Welfare Centre of the area in which she resides, for report and recommendation. The ante-natal doctor makes observations in the space provided on the application form, and, after such further enquiries as are indicated, the form is sent to the Medical Officer of Health. Any patient who does not desire to attend a Welfare Centre can have the ante-natal report filled in by her own physician. After review by the Medical Officer of Health, the applications are placed before the Maternity and Child Welfare Committee who recommend admission to the Home in suitable cases. When the application is accapted, the patient is notified by letter that a bed will be available for her at or about the time of her expected confinement. Other particulars in regard to admission are forwarded to her at the same time. The Sister of the Welfare Institution is also informed and asked to assist the mother in making preparations to enter the Home. Charges. The following is the scale of maximum fees payable, but in each case the Maternity and Child Welfare Committee consider the circumstances of the family and make such reduction of the fees to be paid as the financial position of the family indicates to be necessary or desirable. Amount of Family Income after deducting Rent and Insurances Charges per week Under £2 Os. Od. To be fixed by Committee Between £2 Os. Od. and £2 10s. Od. £1 l1s. 6d. £2 10s. Od. and £3 Os. Od. £2 2s. Od. „ £3 Os. Od. and £3 10s. 0d £2 12s. 6d. £3 10s. Od. and £4 Os. Od. £3 3s. Od. Note.—The above charges are based on the assumption that applicants receive one Maternity Benefit only, and that the family consists of not more than one child. The charges are increased by 10s. Gd., if husband and wife are both eligible for Maternity Benefit; and decreased by 10s. 6d. (subject to a minimum charge of £1 lis. 6d. per week for all groups except incomes under £2), (a) if neither husband nor wife is eligible for Maternity Benefit, or,and (b) the family consists of more than one child. Collection of Fees. (a) Mothers in regular attendance at Infant Welfare Centres. A lady nominated by the Committee of the Infant Welfare Centre collects the contributions of patients recommended for admission from that Institution and pays the amounts collected to the Borough Council. 37 When an assessment has been made, one collection card is forwarded to the mother and another to the lady collector. Contributions made by the mother are recorded on each card, and after payments have been completed, both cards are forwarded to the Medical Officer of Health, when a receipt for the whole amount is sent to the mother. Regular weekly payments in advance towards the cost of the confinement in the Maternity Home are encouraged, and such payments usually commence as soon as the mother has been informed that her application for admission has been accepted. (b) Mothers not in attendance at an Infant Welfare Centre. Patients not in attendance at an Infant Welfare Centre make their payments direct to the Borough Treasurer, Town Hall, W.8. Removal of Emergency Cases. In cases of emergency, application for an ambulance may be made to the Metropolitan Asylums Board (Telephone No. City 7200). The charge for this ambulance is defrayed by the Borough. Council and reported to the Maternity and Child Welfare Committee who may require the patient to contribute part or whole of the fee if her circumstances allow. Registration of Births. Births are registered as having taken place at No. 28, Marloes Road. Discharge of Patients. On discharge of a patient from the Home the Medical Superintendent's report is forwarded to the Medical Officer of Health, who transmits to the doctor originally sending the case such information in regard to the after-care as may be desirable. Statement of Work Done, etc. The demand for accommodation in the Maternity Home has been greater than was anticipated and the provision made by the Council is proving exceedingly popular with mothers in the Borough. During the last three months of the year, there were thirty-five applications accepted by the Maternity and Child Welfare Committee and thirteen of the expectant mothers were admitted before December 31st. In eight cases the children were born and the mothers had taken their discharge before the end of the year. The assessments made in respect of the thirty-five applications accepted totalled £85 14s. Od. and the payments received by the Council before the end of the year totalled £40 16s. 3d. In ten cases the assessment had been completely paid by December 31st. These figures are satisfactory when the late date at which the institution was opened is remembered. Shortly after the end of the year applications came in more rapidly and on one or two occasions all the beds have been occupied. Several of the patients on discharge have written letters of gratitude to officers of the Council and sisters at the Infant Welfare Centres and all have spoken very highly of the care and attention they have received from the Medical Superintendent and his staff. The Guardians' account for the three months during which the Home was open amounts to £48 0s. Od. QUEEN CHARLOTTE'S HOSPITAL MIDWIFERY CENTRE AND ANTE-NATAL CLINIC. No. 176, LADBROKE GROVE. Midwifery Arrangements. The number of home confinements attended by the staff at the Queen Charlotte's District Nurses' Home during 1924 was 873, and 811 of these were Kensington cases. Ante-Natal Clinic. This Clinic was opened by the Queen Charlotte's Hospital authorities in 1921 at their District Nurses' Home, which is situated a little north of the Ladbroke Grove Railway Station—a point easily accessible to the majority of North Kensington mothers. The record of work for 1924 is as follows:— Number of individual expectant women who attended the ante-natal sessions 930 Number of Kensington cases 812 Number from other Boroughs 118 Total number of attendances of all ante-natal cases 1,472 The medical work at this ante-natal clinic is performed by the doctors attached to the Hospital. 38 DAY NURSERIES. The following table shows a record of children's attendances at the five Day Nurseries in the Borough in the year 1924. Golborne. Kensal Crcche (Medical Mission) Lancaster Road. Notting Hill Day Nursery St. Clement's, Treadgold St. Totals 1. Whole day attendances of children under 3 years of age 4704 2738 2582 8621 2952 21597 2. Whole day attendances of children over 3 years of age 2018 720 1493 4139 1471 9841 3. Total whole day attendances 6722 3458 4075 12760 4423 31438 4. Charges made for each attendance of a child 10d. 9d. 9d. 8d. 1/- — 5. Half-day attendances of children under 3 years of age — 337 599 — 936 6. Half-day attendances of children over 3 years of age — 195 334 — 529 7. Total half-day attendances — 532 933 — — 1465 8. Charges made for each attendance of a child — 5d. 6d. — — — 9. Average daily attendance of children 31 18 24 54 20 — HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. A record of work done in 1924 is shown in the following table:— 4C6, Uxbridge Road. 2, Upper Phillimore Place Totals 1. No. of expectant or nursing mothers in residence at commencement of year 9 8 17 2. No. admitted during the year 12 22 34 3. No. remaining in residence at the end of the year 10 7 17 4. Average duration of stay before confinement (in days) — 55 — 5. Average duration of stay after confinement (in days) 157 74 — 6. No. of infants and children under 5 years of age in residence at beginning of year 9 4 13 7. No. admitted during the year 12 19 31 8. No. remaining in residence at end of year 10 4 14 9. Average duration of stay (in days) 157 74 — No. 466, Uxbridge Road is in the Borough of Hammersmith, but the Home is in every other sense a Kensington Institution. It is controlled by a Voluntary Committee of Kensington ladies and gives preference to Kensington girls. MOTHERCRAFT TRAINING SOCIETY (29-31, TREBOVIR ROAD). This institution receives patients from all parts of the country and does not provide for Kensington cases any more than for those from other districts; therefore, although situated in the Royal Borough, it cannot be regarded as a Kensington institution in the same sense as the other units dealt with in this report. Besides giving treatment to children and advice to mothers, particularly in regard to dietetic errors, the institution is a teaching centre for practical training in Child Welfare. The courses of instruction are intended for general hospital nurses, maternity nurses and welfare workers. STATISTICS FOR THE YEAR ENDED 31st DECEMBER, 1924. No. of Infants in the Institution at the beginning of year 21 No. admitted during the year 94 No. discharged during the year 86 No. died during the year 9 No. in residence at the end of the year 20 Average duration of stay of Infants in the Institution— Malnutrition Cases 65 days Breast Feeding Cases (Infants and Mothers) 26 days 39 No. of Infants receiving out-patient treatment— New Cases 879 Attendances 4,961 No. of Mothers in the Institution at the beginning of the year 10 No. admitted during the year 44 No. discharged during the year 44 No. in at the end of the year 10 Average duration of stay of each mother in the Institution 26 days No. of Mothers receiving out-patient treatment in connection with the re-establishment of breast-milk 334 Owing to the lease of the premises in Trebovir Road expiring, this institution is about to remove to new buildings in the Borough of Hornsey. Excellent pioneer work has been carried out by the Mothercaft Training Society but the number of Kensington patients treated each year has been small, and the removal will not reduce to any appreciable extent the adequacy of the Child Welfare services available to Kensington mothers. Those children in need of the specialised form of treatment given will still be able to attend the institution after removal to Highgate Hill. NATIONAL CHILDREN'S ADOPTION ASSOCIATION HOSTEL. (Tower Cressy, Campden Hill). This institution is situated in the Borough, but the work is national rather than local. Unwanted infants are received from various parts of the country and are cared for until adopted by some reputable person. RECORD OF WORK DONE IN 1924. Number of children in the institution at the commencement of the year 19 Number admitted during the year 100 Number discharged during the year 104 Number in residence at the end of the year 15 Average duration of stay of each child in the institution 44 days THE CREAGH NURSERY TRAINING SCHOOL. (No. 38, Holland Villas Road). This institution was opened in 1923, and has accommodation for 28 infants. As in the case of the National Children's Adoption Association Hostel at Tower Cressy, unwanted infants are received from various parts of the country, and cared for until adopted by some reputable person; in addition, young ladies are trained in mothercraft. RECORD OF WORK DONE IN 1924. Number of children in the institution at the commencement of the year 22 Number admitted during tne year 36 Number discharged during the year 36 Number in residence at the end of the year 22 Duration of stay of each child in the institution 7 months CONVALESCENT HOMES. In 1924, the Borough Council paid subscriptions of £16 16s. 0d. to the Evelyn Convalescent Cottage Home, Wargrave, Berkshire, and £8 8s. Od. to the Hambledon Cottage Home, Surrey. In addition £2 2s. Od. were paid to the Taplow Convalescent Home for one bed in that institution when the Evelyn Home was closed. During the summer months, thirteen mothers with their babies and two without babies were sent to one or other of these Convalescent Homes for a fortnight's holiday. HOME HELPS. One application for a Home Help under the Council's scheme was granted during the year. HOME NURSING. Nurses of the Kensington District Nursing Association undertake, when requested by the Medical Officer of Health, the home nursing of measles, german measles, whooping cough, ophthalmia, zymotic enteritis, tuberculosis and any other disease for which nursing assistance is required, In addition, the Association retain on their staff a trained nurse who is also a qualified midwife and who is available for the nursing of certain maternity and ophthalmia cases in which it is inadvisable, from the point of view of the spread of infection, for a midwife to continue in attendance. 40 The nurses carry out their work with enthusiasm and ability, and those doctors who are called upon to attend the poor in the Borough appreciate very much the splendid assistance they get from these trained women. They are always willing to attend at any time they are called upon, and throughout the whole year the officers of the Public Health Department have not had one case where a request for nursing assistance has not been met promptly, even in times of pressure. The very important part the nurses take in connection with the Council's schemes for the treatment of ophthalmia neonatorum and zymotic enteritis is referred to on pages 18 and 20. of this report. For the splendid services rendered, the Council paid to the Association in 1924 a grant of £200. The following is a table of cases attended and visits paid by nurses of the Kensington District Nursing Association from January 1st to December 31st, 1924:— Cases. Visits. Maternity Cases - 64 1,025 Pneumonia 162 2,900 Ophthalmia Neonatorum and other Inflammations of the Eyes of Newly-born Children 52 586 Influenza 20 250 Zymotic Enteritis 34 267 Tuberculosis 35 575 Measles 50 1,193 Septicaemia 2 28 Whooping Cough 12 148 Erysipelas 6 53 Totals 437 7,025 A trained nurse is employed by the Golborne Infant Welfare Centre to undertake home nursing of expectant and nursing mothers and infants in the very poor area allocated to that Centre. In order to avoid overlapping with the nurses of the Kensington District Nursing Association, the work of the Golborne Home Nurse has been mapped out by the Honorary Secretary of the Golborne Centre, the Superintendent of the Nursing Association and myself, and the rules laid down have been found to work quite satisfactorily. Certain types of cases have been attended by the Golborne Nurse and others by the nurses of the Association, and as a result of close co-operation and consultation, there has been no trouble whatever in deciding the sphere of work for the staff of each organisation. The cases attended and visits paid by the Golborne Home Nurse during the past year are given in the following table:— Oases Attended. Visits Paid. Adults 11 163 Children under 5 years of age 301 2439 Bronchitis 73 492 Ear Discharges 44 879 Measles 21 166 Minor Ailments 163 902 SUPPLY OF EXTRA NOURISHMENT TO MOTHERS AND CHILDREN. The distribution of extra nourishment to mothers and children is part of the Council's Maternity and Child Welfare Scheme, but at the suggestion of the Ministry of Health the record of the work done is given under the "Food Supply" section of this report and will be found on page 51. 41 GRANTS TO MATERNITY AND CHILD WELFARE INSTITUTIONS PAID BY THE BOROUGH COUNCIL FOR THE YEAR 1924. £ s. d. The Archer Street Infant Welfare Centre 107 0 0 The Bramley Road „ „ „ (with Kenley Street Branch) 233 0 0 The Campden Hill „ „ „ 82 0 0 The Earl's Court „ ,, ,, 107 0 0 The Golborne 157 0 0 The Lancaster Road „ „ „ 157 0 0 The Raymede 167 0 0 Evelyn Convalescent Cottage Home 16 16 0 Hambledon Cottage Home 8 8 0 Taplow Convalescent Home 2 2 0 The Ladbroke Road Baby Hospital 200 0 0 Kensington Board of Guardians (Maternity Home) 4S 0 0 The Kensington District Nursing Association 200 0 0 These grants have been sanctioned by the Minister of Health, with the result that 50 per cent, will be refunded to the Council by the Government in all except the last mentioned, in respect of which the Government's contribution is £75. GRANT TO HOSPITALS, ETC. In addition to the above mentioned grants, the Council gave the following subscriptions during the year. £ s. d. West London Hospital 10 10 0 Kensington and Fulham General Hospital 5 5 0 St. Mary's Hospital 10 10 0 Paddington Green Children's Hospital 5 5 0 Kensington Dispensary and Children's Hospital 5 5 0 Kensal Gospel and Medical Mission 5 5 0 Chelsea Hospital for Women 5 5 0 Brompton Hospital for Consumption 10 10 0 Kensington District Nursing Association 5 5 0 Western Ophthalmic Hospital 5 5 0 These subscriptions are not strictly in respect of Maternity and Child Welfare work, but this is the most suitable place in this report in which to record them. The sanction of the Ministry of Health is not applied for in respect of these subscriptions and no Government contribution is received. HOSPITAL LETTERS. In return for subscriptions, the Council receive a number of hospital letters which entitle patients to treatment. In addition, some private subscribers forward their letters to the Town Hall, knowing that they will be distributed to the most needy people by the Council's Health Officers, who have an intimate knowledge of the poor. The number of hospital letters issued to Kensington poor people during the year by officers of the Public Health Department was 708, and in each case careful enquiry was made in order to make certain that the patient was a deserving one. THE WORK OF THE ADVISORY COMMITTEE TO THE MATERNITY AND CHILD WELFARE COMMITTEE. This Committee was formally constituted by the Council in 1920, and is composed of two representatives appointed by each of the seven Infant Welfare Centres with two appointed by the Tavistock Road Baby Clinic. In November, on the re-election of the Committee by the Council, Lady Maurice, who became Chairman in 1923, was again voted to that position. Mrs. H. T. Carnegie was selected for the position of Vice-Chairman in place of Miss Grace B. Wood, who resigned her position on the Committee on leaving London. The primary object of the Advisory Committee is to secure the co-ordination of the work of the various Welfare Centres and Baby Clinic and co-operation between these voluntary organisations and the Borough Council; and the successful manner in which these difficult problems have been solved has fully justified the existence of this body. As a result of their investigations and deliberations, a series of recommendations were forwarded to the Council's Maternity and Child Welfare Committee during the year ; these dealt mainly with (1) the establishment of the Kensington Maternity Home, (2) the notification of zymotic enteritis, (3) health propaganda, and (4) the need of a new Infant Welfare Centre in the Notting Dale area. The recommendations have proved very helpful to the Maternity and Child Welfare Committee, and many have been adopted by the Council. 42 During the year the Advispry Committee gave a considerable amount of time to the promotion of the Kensington Infant Welfare Exhibition, which was held at the Town Hall, on November 12th. All Infant Welfare Centres and the "Baby Clinic" took part in the Exhibition in the large hall, which the Council kindly placed at the disposal of the Advisory Committee free of charge. The "Archer Street" Centre displa-ved the work of their Dental Clinic; "Bramley Road" the Weighing of Babies; "Campden Hill" the Doctor's Consultations ; "Earl's Court "Garments for Children; "Golborne" the Day Nursery; "Lancaster Road" the Fathers' Council; "Raymede" the Massage Clinic, and- the " Baby Clinic " Light Treatment. The Gas Light and Coke Company showed their Anti-Smoke Exhibition ; the Kensington District Nursing Association provided an exhibit and the National Council for Infant and Child Welfare sent their Travelling Exhibition. Nine competitions for fathers and mothers of children attending the various Centres were arranged and so popular did they prove that over 600 entries were received. Her Royal Highness Princess Louise, Duchess of Argyll, visited the exhibition and graciously presented the prizes to the winners. In addition to a prize, each successful competitor received a Certificate of Merit personally signed by Her Royal Highness. The Exhibition proved to be a conspicuous success, and so great was the attendance of the public that the Advisory Committee contemplate organising a similar event to be open over a period of three or four days in the early part of 1926. In connection with the Exhibition, there was a combined Annual General Meeting of the Kensington Infant Welfare Institutions. The Mayor or Kensington, Alderman Archibald J. Allen, Esq., J.P., presided and speeches were made by Mr. Percy Gates, M.P., Mrs. H. T. Carnegie and Mr. Pett Ridge. The Mayor kindly gave permission for the meeting to be held in the Council Chamber. A large amount of routine work in connection with the administration of the Infant Welfare Centres has been successfully carried out by the Advisory Committee during the year. FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are regulated by Section 8 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.—The Dairies, Cowsheds and Milkshops Order, 1885, requires the Council to keep a Register of persons from time to time carrying on the trade of dairymen or purveyors of milk and provides that a person may not carry on the trade unless he is registered. 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 selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. In November, 1920, the Council resolved that the presence upon any premises of such articles as (1) paraffin, (2) loose pickles, (3) vinegar (except in sealed bottles), (4) fish, (5) meat of all forms (except when in sealed tins or glass), (6) fruit, (7) vegetables, (8) coals or coke, and (9) wood (except in bundles, provided the same be not kept in the milk store) would constitute a source of contamination rendering the said premises unsuitable for the sale of milk, and the registration of persons entitled to carry on the trade of a purveyor of milk in Kensington has been subject to the resolution being complied with. Section 2 of the Milk and Dairies (Amendment) Act, 1922, empowers the Council to refuse to enter any person's name on the Register or to remove his name from that Register, if they are satisfied that the public health is or is likely to be endangered by any act or default of his in relation to the quality, storage or distribution of milk. One name was removed from the Register in 1924 after due consideration by the Public Health Committee. During the year 21 applications for registration were received from persons who proposed to sell milk, and all but one were granted. The alterations made in the Register of Milk Purveyors in 1923 are summarised in the following table:— Class of Premises. Milkshops. General Stores. Restaurants. Totals. Transferred 8 5 1 14 Vacated and removed from Register 5 — — 5 Premises added to Register 5 — 1 6 On Register December 31st, 1923 121 21 33 175 On Register December 31st, 1924 121 21 34 176 Increase + Decrease — + 0 1 +1 +1 43 It will be seen that 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, contained the names of 176 persons carrying on the trade of purveyors of milk on premises within the Borough. The inspections of dairies and milkshops made during the year numbered 602, and notices were served requiring the remedy of defects which were found on 8 of the premises visited. Milk (Special Designations) Order, 1923.—The Minister, in exercise of the powers conferred upon him by Section 3 of the Milk and Dairies (Amendment) Act, 1922, has issued an Order, which prescribes the conditions subject to which licences may be granted for the sale of milk as " Certified," " Grade A (Tuberculin Tested)," "Grade A," or "Pasteurised." Licences may be granted to two classes of persons, namely:— (1) Those who sell milk either by wholesale or retail; and (2) "Producers," i.e., persons owning or having control of herds from which milk is sold. Under the Order the Council are authorised to grant licences to persons other than a producer to sell milk under any of the special designations above mentioned. Every licence granted is valid for a period ending on the 31st day of December in the year in respect of which it is granted. The Order lays down a schedule of fees to be paid by applicants for licences. The licences granted in 1924 were as follows:— (a) Dealers'licences to use the designation "Certified Milk" 50 (b) Dealers'licences to use the designation "Grade A (Tuberculin Tested) Milk" 25 In each case the licence has been granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments within the Borough. In order to ascertain whether the specially designated milk being sold in the Borough complies with the standards prescribed by the Order of 1923, fourteen samples of "Certified Milk" and three samples of "Tuberculin Tested Milk" have been submitted to the Clinical Research Association for bacteriological examination. Each sample was found to have a degree of purity higher than that laid down in the Order, except in one case of "Certified Milk," where the number of bacteria per c.c. was 34,000, the maximum number allowed by the Order being 30,000 per c.c. On receiving this result, the premises in Kensington from which the sample was obtained were very thoroughly inspected, but no fault could be found in regard to either the storage or the distribution on the part of the retailer. The iacts were reported to the Ministry of Health. The Public Health (Condensed Milk) Regulations, 1923, and Public Health (Dried Milk) Regulations, 1923. The former Regulations, which prescribe the labelling and composition of Condensed Milk, came into operation on November 1st, 1923; and the latter, which prescribe the labelling and composition of dried milk, came into operation on May 1st, 1924. In London, these Regulations are enforced by Metropolitan City and Borough Councils. Every tin or other receptacle containing condensed milk or dried milk must bear a label upon which is printed a declaration in prescribed form. All condensed milk must contain not less than the appropriate percentages of milk fat and milk solids as specified in the following table:— Description of Condensed Milk. Percentage of Milk Fat. Percentage of all milk solids including fat. Full cream, unsweetened 9.0 31.0 Full crearn, sweetened 9.0 31.0 Skimmed, unsweetened — 20.0 Skimmed, sweetened — 26.0 Sixteen samples of condensed milk were taken during the year and each was found to comply with the Regulations in every respect. Dried milk must contain not less than the appropriate percentages of milk fat as specified in the following table:— Description of Dried Milk. Percentage of Milk Fat. Dried full cream rnilk 26 Dried three-quarter cream milk 20 Dried half-cream milk 14 Dried quarter-cream milk 8 Twelve samples of dried milk were taken during the year and each was found to comply with the Regulations in all respects. 44 Addition of Colouring Matter, etc., to Milk.— Section 4 of the Milk and Dairies (Amendment Act, 1922, prohibits the addition of any colouring matter or water, or reconstituted milk, or skimmed or separated milk, to milk intended for sale. This Section enables the Council to dea with cases in which additions are made for fraudulent purposes, but in which difficulty is experienced in proving that the mixture is sold as milk. Not one of the three hundred and forty-six samples of milk analysed in 1924 was found to contain colouring matter. Milk Utensils in Infected Houses.—The practice commenced in 1922 of sending information to milk retailers supplying milk to houses in which cases of infectious disease are being nursed at home was continued throughout the year, and from the date of the receipt of my notification to the date of a later communication stating that the house is free from infection, no milk vessel belonging to the dealer has been allowed to enter the home in question. The procedure seems to meet with general favour and the dealers invariably express their thanks for the information received. Ice Cream.—At the end of the year 163 premises were shown in the Register of places within the Borough where ice cream is prepared or sold, twenty-seven having been removed during the year. The trade is mainly 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 among their employees or 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. Two hundred and eighty-three visits to ice cream premises have been made by the inspectors during the year. The powers under the Public Health (London) Act, 1891, and the London County Council (General Powers) Act, 1902 and 1908, enable the Council to exercise efficient control where the vendors and premises are known, but, inasmuch as ice cream may be made under unsatisfactory conditions on premises other than those where it is stored, a system of compulsory registration of premises where the commodity is manufactured, stored or sold and of itinerant vendors of ice cream, should be introduced. In addition, byelaws are needed to secure the sale of ice cream from street barrows being conducted under clean conditions. Bakehouses.—There are 90 bakehouses in the Borough, and of this number 67 are underground. As a result of 273 inspections, which were made during the year, 7 notices were served for the cleansing of walls and ceilings. Slaughter Houses.—These are licensed annually by the County Council in the month of October. At the beginning of the year there were six slaughter houses in the Borough, but at the October meeting licenses were renewed in respect of five only. This was due to the fact that the proprietor of the sixth slaughterhouse had died earlier in the year and an application for re-licensing was not submitted in this case. The five slaughter houses now licensed are kept in a cleanly condition, and from a structural point of view are not open to objection. During the year a considerable number of pigs were killed in the slaughter house in Walmer Road, and the license was renewed by the London County Council in October on 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 294. Bye-laws prescribing humane slaughtering came into operation in London during the year and approved methods have been adopted at each of the slaughter houses in the Borough. Other Places Where Food is Prepared—In addition to the above-mentioned food premises, places in the Borough where food is prepared for or exposed for sale are entered in a Register under the date on which they were finally inspected and found to comply with the requirements of the County Council (General Powers) Act, 1908. The following table shows the number of such premises on the Register at the end of the years 1923 and 1924, together with the number added to or removed from the Register during the twelve months to which the report relates:— 45 Provision Dealers. Restaurants. Butchers, Fried Fish. Fishmongers. Greengrocers. Others. Total. On Register Dec. 31st, 1923 315 209 109 40 49 112 17 851 No. added 7 15 0 0 1 3 5 31 Removed 3 4 0 0 1 1 2 11 On Register Dec. 31st, 1924 319 220 109 40 49 114 20 871 The inspections of the above premises during the year numbered 1,630, and resulted in the discovery of the following defects which were remedied after the service of notices:— Defects found. Number of Defects. W.C. defective 1 Drains defective 3 Want of cleanliness 24 Defective ashpit accommodation 12 Other detects 19 Total number of defects found 59 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— Apples(half barrel)1 Bream(stones)6 Catfish(stones)8 Cream(tins)3 Eels (stones) 13 Fish (tins) 101 Fruit(tins)140 Haddock (box) 1 Hake(stones)5 Meat (tins)14 Milk (tins) 141 Mixed Fruit - (stones) 8 Mussels(sacks)3 Pears(bushel)½ Pigs(carcase)1 Pigs' Plucks 3 Plaice (stones) 6 Rabbits (Frozen)30 Skate (stones)36 Soup(tins)4 Tomatoes(box)1 Vegetables - (tins) 160 SALE OF FOOD AND DRUGS ACTS. Each of the ten Sanitary Inspectors is appointed 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. The samples procured are of two kinds, namely, formal and informal. 46 (a) Formal Samples.—These are samples which are taken strictly in conformity with the requirements of the Sale of Food and Drugs Act, 1875, and during the year the Inspectors collected 703, of which 36 or 5.1 per cent, were adulterated. Particulars of formal samples collected are as follow :— Nature of Sample. Number Taken. Number Adulterated. Arrowroot4 Brawn202 Bread 6 British Wine 9 3 Butter 49 1 Cheese32 Cocoa13 Coffee21 Coffee & Chicory 1 Coffee & Chicory Essence 2 Condensed Full-Cream Sweetened Milk 2 Condensed Full-Cream Unsweetened Milk 5 Condensed Tomato 1 Cornflower10 Corned Beef 1 Cream 11 1 Custard Powder 5 Dried Half-Cream Milk 2 Dried Milk 4 Flour 14 Golden Syrup 4 Ground Ginger 7 Ground Rice 8 Ice Cream1 Jam2 Lard 22 Lemon Curd 1 1 Malt Vinegar 8 1 Margarine 11 Meat Paste 6 1 Milk 256 5 Mincemeat31 Mustard 3 Mustard Mixture 4 Olive Oil 9 Peas (Tinned)11 Pepper18 Potted Fish 1 Potted Meat 12 Prescriptions7 2 Preserved Cream 1 1 Raspberry Fruit Syrup 1 1 Rice3 Rum2 Sausages 31 9 Self-raising Flour 1 Sponge Cakes 14 2 Sweets8 Tapioca2 Tea6 Tomato Sauce 1 Vinegar242 Whisky92 Wood Vinegar 4 Total 703 36 47 (6) Informal samples.—These are taken without compliance with the strict formalities of the Food and Drugs Act and serve to show the conditions obtaining without disclosing to the vendor the fact that samples are being taken for analysis. Particulars of informal samples collected are as follow:— Nature of Sample. Number Taken. Number Adulterated. Brawn 11 2 Butter 26 1 Cakeoma 1 ... Cheese 13... Chocolate Powder 1 ... Cocoa 1... Coffee 4 ... Coffee and Chicory 1 ... Coffee and Chicory Essence 1 ... Condensed Full Cream Sweetened Milk 1 ... Condensed Skimmed Sweetened Milk 3 ... Condensed Full Cream Unsweetened Milk 5 ... Condensed Tomato 2 2 Cornflour 2 ... Cream 31 Custard Powder 10 ... Dried Full Cream Milk 2 ... Dried Milk 6 ... Fish Paste 1 ... Flour 3... Hot Milk 1 ... Lard 8... Lemonade Powder 2 ... Lemon Curd and Cheese 5 2 Lemon Squash 1 1 Margarine 19 1 Marmite 1... Meat Paste 5 ... Milk 90 4 Milk of Sulphur 1 ... Mustard 2 ... Mustard Mixture 1 ... Olive Od 2 ... Pepper 4... Potted Meat 6 ... Potted Shrimp 1 ... Prescriptions 32 Preserved Cream 2 ... Salad Oil 1 ... Sausages 1810 Self Raising Flour 1 ... Soft Cheese 4 ... Sponge Cakes 18 3 Sweets 1 ... Tomato Sauce 1 1 Whisky 21 Total 297 31 No legal proceedings can be taken in respect of an informal sample, but, when adulteration is discovered, formal samples are obtained immediately and necessary action taken. 48 Summary of the Results of Analysis of the 67 Adulterated Formal and Informal Samples, together with a record of the action taken by the Council. Article Analysed. Nature and Amount of Adulteration. Action taken Brawn 7.4 grains of boric acid per pound No action Brawn 7.0 grains of boric acid per pound No action Brawn 6.6 grains of boric acid per pound Informal sample Brawn 7.9 grains of boric acid per pound Informal sample British Wine 2.8 grains of salicylic acid per pint No action British Wine 0.8 grains of salicylic acid per pint No action British Wine 0.3 grains of salicylic acid per pint No action Butter 25 per cent, of foreign fat Proceedings. Fined £1 and 10s. 6d. costs Butter 30 per cent, of foreign fat Informal sample Condensed 2.2 grains of tin per pound Informal sample Tomato Condensed 0.8 grains of tin per pound Informal sample Tomato Cream 13.0 grains of boric acid per lb. No action Cream 15.8 grains of boric acid per lb. Intormal sample Lemon Cheese 0.3 grains of salicylic acid per lb. Informal sample Lemon Cheese 0.2 grains of salicylic acid per lb. Informal sample Lemon Squash 0.6 grains ol salicylic acid per pint Informal sample Malt Vinegar 8.5 per cent, of the required acetic acid deficient Proceedings. Ordered to pay 10s. 6d. costs Margarine 25 per cent, of butter fat - Informal sample Meat Paste 9.0 grains of boric acid per pound Vendor cautioned Milk 5 per cent, of the required fat deficient Vendor cautioned Milk 4 per cent, of the required fat deficient Vendor cautioned Milk 3 per cent, of extraneous water - Vendor cautioned Milk 5 per cent, of extraneous water - Vendor cautioned Milk 4 per cent, of the required fat deficient Vendor cautioned Milk 2.2 per cent, of extraneous water Informal sample Milk 1 per cent, of extraneous water - Informal sample Milk 8 per cent, of the required fat deficient Informal sample Milk 2.5 per cent, of extraneous water Informal sample Mincemeat 0.4 grains of salicylic acid per lb. Vendor cautioned Peas (Tinned) T5 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £2 and 10s. 6d. costs Prescription 34.9 per cent, of the required Sulphate of Quinine deficient Proceedings. Fined £5 and 10s. 6d. costs Prescription 20 per cent, of the required sodium bi-carbonate deficient Proceedings Dismissed Prescription 13'3 per cent, sodium bi-carbonate deficient Informal sample Prescription 163 grains "thymol" per fluid ounce in excess Informal sample Preserved Cream 22.0 grains of boric acid per lb. Informal sample Preserved Cream 15.9 grains of boric acid per lb. Vendor cautioned Raspberry 2.7 grains of salicylic acid per pint Vendor cautioned Fruit Syrup Sausages 16.9 grains of boric acid per lb. Informal sample Sausages 18.5 grains of boric acid per 1b. Informal sample Sausages 8.9 grains of boric acid per lb. Informal sample Sausages 16.2 grains of boric acid per lb. Informal sample Sausages 12.2 grains of boric acid per lb. Informal sample Sausages 5.9 grains of boric acid per lb. Informal sample Sausages 13.3 grains of bori : acid per lb. Informal sample Sausages 13.5 grains of boric acid per lb. Informal sample Sausages 19.8 grains of boric acid per lb. Informal sample Sausages 15.8 grains of boric acid per lb. Informal sample Sausages 19.3 grains of boric acid per lb. Proceedings. Fined £3 and 10s. 6d. costs Sausages 13.8 grains of boric acid per lb. Vendor cautioned 49 Article Analysed. Nature and Amount of Adulteration. Action taken. Sausages 12.5 grains of boric acid per lb. Vendor cautioned Sausages 4.3 grains of boric acid per lb. No action Sausages 18.5 grains of boric acid per lb. Proceedings. Fined £5 and 10s. 6d. costs Sausages 15.8 grains of boric acid per lb. Vendor cautioned Sausages 14.8 grains of boric acid per lb. No action Sausages 14.5 grains of boric acid per lb. Vendor cautioned Sausages 14.0 grains of boric acid per lb. Vendor cautioned Sponge Cake 5.9 grains of boric acid per lb. Informal sample Sponge Cake 11.1 grains of boric acid per lb. Informal sample Sponge Cake 7.8 grains of boric acid per lb. Informal sample Sponge Cake 9.4 grains of boric acid per lb. Vendor cautioned Sponge Cake 4.4 grains of boric acid per lb. Vendor cautioned Tomato Sauce 0.3 grains of salicylic acid per pint Informal sample Vinegar 5 per cent. of the required acetic acid deficient Vendor cautioned Vinegar 3.5 per cent. of the required acetic acid deficient Vendor cautioned Whisky 48.1 degrees under proof Informal sample Whisky 47.0 degrees under proof No action Whisky 42.4 degrees under proof No action It will be seen that proceedings were taken in seven cases, the tines and costs amount in to £25 3s. 0d. COMPOSITION OF MILK SUPPLIED IN KENSINGTON. It is well known that the "limits" of 3 per cent. of fat and 8.5 per cent. of non-fatty solids, which are taken by the Ministry of Agriculture as the primary criteria of genuineness of milk, are figures very much below those found in normal cow's milk. The following may be taken as the average composition of cow's milk :— Water 87.4 per cent. Fat 3.7 „ „ Non-fatty solids 8.9 „ „ Of 256 formal samples of milk taken under the Food and Drugs Act in 1924, only 5 were certified by the Public Analyst as adulterated, i.e., containing less than 3 per cent. of fat or 8.5 of non-fatty solids. These particulars, however, do not give any indication of the general quality of the milk supplied in Kensington, therefore, it will be interesting to note the average composition of the samples taken in the Borough during the year. These figures are given in the following table:— Average Composition of Formal Milk Samples taken in 1924. Months. Number of Formal Samples Taken. Average Composition of all Samples Submitted, Genuine and Adulterated. Average Composition of Genuine Samples. Ministry of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat Percentage of Milk Fat. Percentage of Solids not Fat. January 26 3.55 8.86 3.58 8.86 February 17 3.65 8.92 3.65 8.92 March 21 3.55 8.85 3.59 8.87 April 1 3.16 8.67 3.16 8.67 May 34 3.57 8.85 3.57 8.85 June 29 3.58 8.81 3.58 8.81 3.0 8.5 July 37 3.69 8.74 3.69 8.74 August 6 3.60 8.79 3.60 8.79 Average Composition, of Normal Cow's Milk. September 19 383 8.92 3.83 8.92 October 24 3.81 8.86 3.98 8.89 November 18 3.86 8.85 3.86 8.85 Percentage of Milk Fat. Percentage of Solids not Fat. December 24 3.69 8.87 3.69 8.87 Averages for the Year 256 3.67 8.84 3.69 8.84 3.7 8.9 50 It is interesting to note that the average fat content of Kensington samples exceeded the Ministry of Agriculture standard by over 20 per cent. or, in other words, the samples would have been returned as genuine by the Public Analyst even though about 20 per cent. of the fat might have been removed by a fraudulent vendor. The table shows that the average fat and non-fatty solid content for each month of the year is well above the legal standard and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content as low as 3 per cent. Cream Regulations.— The Public Health (Milk and Cream) Regulations, 1912, made by 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 1st, 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 of any kind except sugar to cream. In the case of cream containing 35 per cent. of fat or more, the effect of the Regulations is to permit the addition of boric acid, borax or hydrogen peroxide, 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 addition of any other kind of preservative is prohibited. These Regulations were amended by the Public Health (Milk and Cream) Regulations, 1917, so as to limit the boric acid and borax which may be added to cream containing 35 per cent. or more of fat, to an amount not exceeding 0.4 per cent. by weight of the cream. These amending Regulations also provide that the declaratory label must state that the cream is not suitable for infants or invalids. On the ground that the addition of preservatives in any quantity to cream is unnecessary, the Council have taken no action under these Regulations. In all cases of milk and cream samples submitted to the Public Analyst, an examination for preservatives is made, and if any be found, the Public Health Committee consider the question of instituting proceedings under the Food and Drugs Act, even though in the case of borax or boric acid in cream the amount found be less than that allowed by the amending Regulations. 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. 145Brompton Road. E. C. Nicholls 19, Church Street. Maypole Dairy Co., Ltd. 196, Portobello Road. Home and Colonial Stores, Ltd. 136, Portobello Road. „ „ „ 184, Portobello Road. „ „„ 20, Chepstow Mansions. „ ,, „ 71, Notting Hill Gate. „ „ „ 171, Earl's Court Road. „ „ „ 98, Golborne Road. Pearks, Ltd. 76, Golborne Road. „ 62, Princes Road. ,, 165. Portobello Road. Sale of Food Order, 1921.—This Order placed upon Local Authorities certain duties in regard to— (1) the sale of bread and tea by weight. (2) the labelling of imported produce, (3) the composition of jam and marmalade, dripping, margarine, and other edible fats. The provisions of that part of the Order dealing with the sale of bread and tea by weight are administered by the London County Council, but the Borough Council are required to enforce the remaining sections of the Order. Since this Order was published an Amending Order has been issued, which cancels certain sections of the original, with the result that the only part now to be enforced by the Borough Council is that which relates to the labelling of imported produce (lard excepted). A further Amending Order, dated September 1st, 1922, removes bacon and ham from the list of imported foods which must not be exposed for sale by retail unless they bear a label containing the words " Imported" in letters easily readable by customers. Under the Expiring Laws Continuance Act, 1924, the Order, with the amendments above indicated, is continued in force until December, 1925. FOOD POISONING. No instance of food poisoning was brought to my notice during the year. 51 PRESERVATIVES AND COLOURING MATTER IN FOOD. The Final Report of the Departmental Committee on the Use of Preservatives and Colouring Matter in Food was issued during the course of the year. The recommendations of the Committee are generally in accordance with the views put forward by the Council and, therefore, justify fully the past action of the Council in maintaining a high standard of stringency in regard to the enforcement of the provisions of the Sale of Food and Drugs Acts. Following the consideration of the Final Report, the Council addressed a communication to the Minister of Health pressing for the early introduction of legislation for giving effect to the recommendations contained therein. It was also resolved that, pending the introduction of legislation based on the findings of the Departmental Committee, the Council should re-establish the policy maintained for many years past in regard to the administration of the provisions of the Sale of Food and Drugs Acts, and a general intimation to this effect was conveyed to the traders in the Borough. In regard to the presence of copper sulphate in tinned vegetables, it may be said that the Council's action has been particularly beneficial. In the year 1923, twenty-four samples of tinned peas or beans, taken under the Sale of Food and Drugs Acts, were found to contain copper sulphate, and in ten cases the Council took proceedings and obtained convictions. During 1924, only one tin of peas containing copper sulphate was obtained. It may be said, therefore, that the Council's action has practically eliminated the trade in copper sulphated tinned vegetables in Kensington. Traders have become aware of the Council's action and have withdrawn their stocks from sale, with the result that the Kensington public have received very considerable protection. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The Council's scheme for the supply of milk to expectant and nursing mothers and infants under the age of five years, and the supply of dinners to expectant and nursing mothers has been described in detail in previous reports, and no modification has been required during the past twelve months. In the year 1924 there were 400 grants of milk made by the Council's Milk SubCommittee. One hundred and fifty-five of the grants were in response to new applications, and the remaining 245 were renewals of grant. Twenty-two applications for dinners were granted; 11 of these were new applications, and 11 renewals. Particulars of Fresh Milk supplied under the Council's Scheme. No. of pints of Milk granted. Price per pint paid by Recipients. Estimated Cost to Council. 10,080 Free £ s. d. 144 2 0 Particulars of Dried Milk supplied Free or below Cost Price under the Council's Scheme. No. of packets of Milk granted. Price per lb. packet paid by Recipients. Estimated Cost to Council. 142 Free £ s. d. 11 7 0 Particulars of Dried Milk supplied at Cost Price under the Council's Scheme. Name of Welfare Centre at which the dried milk was distributed. No. of 1lb. packets sold. Value of milk sold. Archer Street - 1,737 £ s d. 124 11 10 Bramley Road 1,167 93 17 2 Golborne 151 11 6 6 Lancaster Road 1,038 74 12 6 Raymede 2,187 164 0 6 — 6,280 468 8 6 52 Particulars of Dinners supplied under the Council's Scheme. No. of Dinners granted. Price per Dinner paid by Recipients. Estimated Cost to Council. 420 Free £ s. d. 10 0 0 The Mutual Registration of Assistance Society (a branch of the Charity Organisation Society) have been of considerable help to the Council's Milk Sub-Committee in providing information of the assistance being given by other bodies to applicants for milk at a reduced price or free of cost, and the Council acknowledge the value of the work by making an annual grant of £10 to the Society. The Council's Milk Sub-Committee work in close co-operation with the Board of Guardians and a scheme has been formulated whereby milk and dinners recommended by the Milk SubCommittee are supplied by the Board to certain nursing mothers who are already in receipt of Poor Law relief. This scheme obviates the undesirable practice of a person being granted a somewhat similar form of relief by two different authorities. The dried milk and dinners supplied during the year by the Board of Guardians under this scheme are shown below :— No. of packets of Dried Milk supplied. Cost to the Board of Guardians. No. of Dinners supplied. Cost to the Board of Guardians. 34 £2 9 6 25 £12 6 NOTE.— The figures for fresh milk supplied by the Guardians after recommendation by the Milk Sub-Committee cannot be given separately. 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 1,451. Workshops where men only 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 Women Health Officers, who also visit the premises of home-workers and inspect the sanitary conveniences reserved for women in railway stations and other public places in Kensington. The factories in the Borough number 279, 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. MEN'S WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 928. The factories at which men alone were employed numbered 216. 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 by the Sanitary Accommodation Order of 4th February, 1903. Accommodation Order of 4th February, 1903. The following table shows the various trades and occupations carried on in registered workshops and factories where men alone are employed:— 53 Trade or Business. Workshops. Factories. Total. Aerated water manufacturer 1 15 16 Baker 58 31 89 Basket maker 6 - 6 Blacksmith 31 1 32 Boot maker 161 9 170 Builder 93 9 102 Cabinet maker and joiner 41 3 44 Carver and gilder 8 - 8 Coach builder 20 3 23 Cycle maker 11 - 11 Electric generating works - 6 6 Engineer 55 50 105 Firewood manufacturer 15 1 16 French polisher 3 - 3 Marble mason 8 3 11 Marine stores 23 - 23 Metal worker 17 5 22 Printer 4 24 28 Rag flock dealer 47 - 47 Saddler 19 - 19 Tailor 117 - 117 Trunk maker 17 - 17 Umbrella maker 4 - 4 Undertaker 10 - 10 Upholsterer 32 3 35 Watch maker 35 3 38 Wig maker and hairdresser 9 - 9 Sausage maker 1 17 18 Sundry businesses 82 33 115 Total 928 216 1,144 WOMEN'S WORKSHOPS. The number of workshops and factories at which female labour was employed at the end of 1924 was 586, 183 in North Kensington and 403 in South Kensington. The number of persons employed varies with the period of the year, being, of course, greatest during the "season" 54 The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. Workshops. Factories. Total. Art needlework 5 - 5 Blind maker 2 - 2 Blouse maker 6 - 6 Boot maker and repairer 1 1 2 Cabinet maker - 1 1 Cardboard-box maker 1 - 1 Carpet maker 1 - 1 Chemist 1 - 1 Cigarette maker 1 - 1 Corset maker 8 - 8 Draper 1 - 1 Dressmaker and ladies' tailor 253 2 255 Dyer and cleaner 4 1 5 Eyelet-hole maker - 1 1 Fancy work and painting 3 - 3 Florist 12 - 12 Furrier 19 - 19 Hairdresser 17 - 17 Invisible mending 3 - 3 Jeweller 1 2 3 Lace worker 5 - 5 Lampshade maker 2 - 2 Laundry 43 47 90 Machinist 2 - 2 Milliner 42 - 42 Non-inflammable composition manufacturer - 1 1 Outfitter 10 - 10 Pastry cook 1 - 1 Photographer 11 - 11 Pictorial advertisements 1 - 1 Picture frame maker - 1 1 Pipe maker - 1 1 Powder puff maker 1 1 2 Printing - 2 2 Restaurant 3 - 3 Scarf maker 1 - 1 Shirt maker 1 - 1 Surgical supplies - 1 1 Sweet maker 1 - 1 Tailor 42 - 42 Toilet requisites 1 - 1 Toy maker 2 - 2 Typist 1 - 1 Umbrella maker 2 - 2 Upholsterer 10 - 10 Weaving 2 - 2 Wig maker 1 - 1 Wire brush maker - 1 1 Total 523 63 586 HOME WORK. Of the 252 outworkers registered, 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:— Outworkers in Workshops or Factories 39 Outworkers in Domestic Workshops 50 Outworkers in their own Homes 163 Total number of Outworkers 252 55 The factories and workshops referred to in the above list are included in the tables which show the trades carried on in the factories and workshops on the Council's register. The nature of the work given out to the 163 home workers on the register is as follows:— Tailoring 87 Dressmaking 31 Drapery 6 Bootmaking 11 Woollen garment making 6 Furrier 2 Linen working 3 Blouse making 3 Millinery 3 Shirtmaking 2 Cleaning 1 Embroidery 1 Lampshade making 1 Underwear 1 Outfitting 5 163 No cases of infectious disease were reported during the year from premises where home work was carried on. The appended Table summarises the work for the year of the Women Health Officers under the Factory and Workshops' Acts, so far as it is capable of being expressed in this form:— 1. No. of Factory Inspections 91 2. „ Workshop „ 572 3. „ Home Workers Inspections 100 4. „ Work Place „ 19 Home Office Tables. The following tables contain a summary of the inspections made and the defects found and remedied in workshops and factories within the Borough, where men, women, young persons or children are employed. In Table IV. the chief classes of workshops are set forth. Table V. shows the number of cases in which action was taken in matters referred to the Council by H.M. Inspectors. I.—Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 246 26 - Workshops (including Workshop Laundries) 889 57 2 Workplaces (other than Outworkers' premises included in Table 3 of this Section of the Report) 295 6 - Total 1430 89 2 56 II—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:-* Want of cleanliness 71 71 - 2 Want of ventilation 4 4 - - Overcrowding 1 1 - - Want of drainage of floors 4 4 - - Other nuisances 5 5 - - Sanitary accommodation insufficient - - - - unsuitable or defective 17 17 - - not separate for sexes 1 1 - - Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other Offences - - - - (Excluding offences relating to outwork which are included in Table 3 of this Section of the Report.) Total 103 103 - 2 * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 57 III.- Home Work. NATURE OF WORK. (1) OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES. SECTIONS 109. 110. Lists received from Employers, Notices served on Occupiers as to keeping or sending lists. (8) Prosecutions. Instances (11) Notices served. (12) Prosecutions (13) Instances. (14) Orders made (s. 110). (15) Prosecutions (Sections 109, 110). (16) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (101 Lists. (2) Outworkers. Lists. (5) Outworkers. Contractors. (3) Work men. (4) Contractors. (6) Workmen. (7) Wearing apparel— making, &c. 26 24 266 1 - 6 29 - - - - - - - - cleaning and washing 2 17 1 - - - 2 - - - - - - - - Household linen 1 6 1 - - - 2 - - - - - - - - Lace, lace curtains and nets 2 - 5 - - - 4 - - - - - - - - Furniture and upholstery 1 - 2 - - - - - - - - - - - - Bootmaking, etc. 4 6 14 1 - 4 9 - - - - - - - - Furs 2 - 18 1 - 1 5 - - - - - - - - Umbrellas, etc. 1 1 1 - - - 1 - - - - - - - - Total 39 54 308 3 - 11 52 - - - - - - - - 58 IV.— Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. Dressmakers and Ladies' Tailors 253 Workshop Laundries 43 Workshop Bakehouses 53 Other Workshops 1,097 Total number of workshops on Register 1,451 V.— Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) - Notified by H.M. Inspectors 14 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Reports (of action taken) sent to H.M. Inspectors 14 Other - Underground Bakehouses (s. 101) :— Certificate granted during the year - In use at the end of the year 67 59 ADMINISTRATION. In addition to the record of work under each of the preceding headings of this report, it is necessary to submit a summary of certain of the main branches of Public Health administration. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officers.— No change in the medical staff of the Public Health Department occurred during the year. Male Sanitary Inspectors.— The normal staff is ten District Inspectors. For the purposes of sanitary inspection, the Borough is divided into ten districts, one of which is allotted to each of the ten inspectors, who carry out duties under the Public Health Acts, the Housing Acts, the Sale of Food and Drugs Acts, the London County Council (General Powers) Acts and, so far as men's factories and workshops are concerned, under the Factory and Workshops Act. Mr. Henry Dawes, who is the Sanitary Inspector for No. 10 District (Brompton area), holds the position of Senior Sanitary Inspector in accordance with the requirements of Section 7 of the Public Health (Officers) Act, 1921. In addition to his ordinary work as a District Inspector, he carries out special duties under the Rag Flock Act and under the Milk (Special Designations) Order. Consequent on the Council's Special Housing Resolutions of 11th January, 1923, a Temporary Sanitary Inspector was engaged throughout the year in the inspection, measuring up and registration of houses let in lodgings and in issuing the necessary Sanitary Notices required to bring these houses up to the standard of habitability decided upon by the Council. With a view to speeding up this work, the Council, in the early part of the year, appointed a second Temporary Sanitary Inspector who commenced duty on 14th April, 1924. These two Temporary Officers have been engaged in the Golborne, St. Charles and Norland Wards. A summary of the work of the Sanitary Inspectors will be found in Tables Nos. VI and VIa of the Appendix, columns 4a and 5a in each table representing the work of the two Temporary Officers. Women Health Officers.— There are nine ladies appointed as Women Health Officers. Seven are engaged in the work of visiting mothers of the poorer classes and advising them in the care and management of their infants, and in assisting with the work of the seven Infant Welfare Centres. They also devote a portion of their time to the inspection of factories and workshops where women are employed, and in visiting cases of ophthalmia, enteritis, measles, whooping cough and consumption. Two Women Health Officers (Miss Hargrave and Miss Haycock) are employed on in-door work at the Dispensary. During the year, Mrs. Neve, who had been in the Council's serv'ce since 1922, resigned her office in order to study for a medical degree. She was succeeded by Miss Hamilton. Clerical Staff.—There are seven clerks and a shorthand-typist, a fifth class Clerk having been added to the staff in order to cope with the increase of work thrown on the Public Health Department in connection with housing. Mr. E. R. Hill, Chief Clerk in the Public Health Department, died on the 13th January, 1925, after a brief illness. Mr. Hill had been in the service of the Council for a period of over 36 years and discharged his duties with ability and zeal. In addition to performing the work attached to the position of Chief Clerk in the Department, he had been responsible for many years for the compilation of the statistics and the preparation of the tables which appear in my Annual, Monthly and other Reports. His skill as a statistical officer was marked and his loss will be severely felt. Other Staff—There are :— (a) Five Disinfectors, including a man who acts as engineer. (b) A Mortuary Keeper. (c) A Sanitary Labourer who assists in drain testing. (d) A Superintendent and Matron of the Medicinal Baths. (e) A Rat Officer. The Council lost a loyal officer in the death of Mr. William C. Webber, the Superintendent of the Medicinal Baths, on 20th June, 1924, following an operation. The vacancy thus created was filled by the appointment of Mr. Ernest McNie. Particulars of the staff, as required by the Ministry of Health Circular No. 359, appear in Table IX of the Appendix. LEGAL PROCEEDINGS. Legal proceedings were instituted in 73 cases, particulars of which are summarised in the following list:— 60 Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Local Management Act, and Housing. Town Planning, etc., Acts, 1890-1923, etc. Date of Hearing of Summons. Offence. Magistrates' Decision. January 15th Unlawfully permitting to be occupied the front under-ground room at 159, Portland Road. Summons withdrawn, the illegal occupation of the front under-ground room having been discontinued. ,, ,, Unlawfully permitting to be occupied the front under-ground room at 159, Portland Road. • Summons withdrawn, the illegal occupation of the front under-ground room having been discontinued. ,, ,, Unlawfully occupying the front under-ground room at 159, Portland Road. Summons withdrawn, the illegal occupation of the front under-ground room having been discontinued. ,, ,, Failure to comply with the magistrates' order in regard to 2, Tottenham Street. Fined £1 16s. February 5th Failure to carry out sanitary repairs at 9, Ladbroke Grove. Summons withdrawn, work having been carried out. ,, ,, Failure to carry out sanitary repairs at 49, Bramley Road. Order made for work to be carried out within 14 days. ,, ,, Failure to repair and make sound the drain at 317, Kensal Road. Summons dismissed. March 4th Allowing a dog to deposit its excrement upon the public footway. Fined 10s. March 18th Failure to clear a choked water closet at 14, All Saints' Road. Summons withdrawn, work having been carried out. ,, ,, Failure to carry out sanitary repairs at 32, Bevington Road. Order made for work to be carried out within 14 days. ,, ,, Failure to make sound the roof at 105, Clarendon Road. Summons withdrawn, work having been carried out. ,, ,, Failure to provide an efficient supply of water to premises at 16, All Saints' Road. Closing order made, to become operative if water supply not reinstated within 7 days. April 1st Failure to comply with by-laws for houses let in lodgings at 46, Blechynden Street. Summons withdrawn, indecent occupation having been discontinued. April 15th Failure to comply with by-laws for houses let in lodgings at 9, Calverley Street. Summons withdrawn, indecent occupation having been discontinued. May 6th Failure to carry out sanitary repairs at, Portobello Road. Order made for work to be carried out within 28 days. May 20th Failure to make sound the roof at 104, Acklam Road. Order made for work to be carried out within 14 days. ,, ,, Allowing a dog to deposit its excrement upon the public footway. Fined 10s. ,, ,, Failure to carry out sanitary repairs at 45, Testerton Street. Order made for work to be carried out within 14 days. 61 Date of Hearing of Summons. Offence. Magistrates' Decision. May 20th Failure to comply with by-laws for houses let in lodgings at 45, Testerton Street. Fined £5. ,, ,, Failure to carry out sanitary repairs at 306, Kensal Road. Order made for work to be carried out within 14 days. ,, ,, Failure to carry out sanitary repairs at 308, Kensal Road. Order made for work to be carried out within 14 days. ,, ,, Failure to carry out sanitary repairs at 1, Adela Street. Order made for work to be carried out within 14 days. June 17th Failure to discontinue keeping fowls at 7, Colville Terrace. Order made to discontinue within 28 days. July 15th Failure to carry out sanitary repairs at 14, All Saint's Road. Summons withdrawn, work having been carried out. ,, ,, Failure to pay expenses of work carried out by Council in default under Section 28 H. T. P. Act, 1919, at 35 and 37, Bangor Street. Order made for payment plus 5% interest, and costs. ,, ,, Failure to provide a proper supply of water to the upper storeys at 9, Manchester Road. Order made for work to be carried out within 14 days. ,, ,, Failure to carry out sanitary repairs at 9, Manchester Road. Order made for work to be carried out within 14 days. ,, ,, Failure to clear choked drain at 93, Golborne Road. Older made for work to be carried out within 7 days. July 29th Failure to carry out sanitary repairs at 66, Lancaster Road. Order made for work to be carried out within 6 weeks. ,, ,, Failure to comply with by-laws for houses let in lodgings at 7, Wornington Road. Summons withdrawn, work having been carried out. ,, ,, Failure to carry out sanitary repairs at 7, Wornington Road. Order made for work to be carried out within 14 days. ,, ,, Failure to comply with by-laws for houses let in lodgings at 11, Wornington Road. Summons withdrawn, work having been carried out. ,, ,, Failure to carry out sanitary repairs at 11, Wornington Road. Order made for work to be carried out within 21 days. ,, ,, Failure to provide proper dust bin accommodation at 18, Cromwell Crescent. Summons withdrawn, dust bin having been provided. ,, ,, Failure to ventilate trap to water closet at 63, Bramley Road Fined £2. ,, ,, Failure to carry out sanitary repairs at 105, Portobello Road. Order made for work to be carried out within 28 days. ,, ,, Failure to carry out sanitary repairs at 13, Manchester Road. Order made for work to be carried out within 28 days. 62 Date of Hearing of Summons. Offence. Magistrates' Decision. July 29th Failure to comply with by-laws for houses let in lodgings at 15, Manchester Road. Fined £2. ,, ,, Failure to provide a proper supply of water to the upper storeys at 15, Manchester Road. Fined £2. ,, ,, Failure to carry out sanitary repairs at 15, Manchester Road. Order made for work to be carried out within 28 days. ,, ,, Failure to carry out sanitary repairs at 297, Kensal Road. Order made for work to be carried out within 28 days. ,, ,, Allowing a dog to deposit its excrement upon the public footway. Fined 5s. ,, ,, Allowing a dog to deposit its excrement upon the public footway. Fined 10s. Sept. 23rd Failure to comply with by-laws for houses let in lodgings at 13, Manchester Road. Fined £2. ,, ,, Failure to provide a proper supply of water to the upper storeys at 13, Manchester Road. Fined £2. ,, ,, Failure to comply with by-laws for houses let in lodgings at 297, Kensal Road. Summons withdrawn, work having been carried out. ,, ,, Failure to provide sufficient watercloset accommodation at 4, Rillington Place. Fined £1. ,, ,, Failure to carry out sanitary repairs at 95, Elgin Crescent. Order made for work to be carried out within 14 days. ,, ,, Failure to carry out sanitary repairs at 167, Portland Road, Order made for work to be carried out within 14 days. October 7th Failure to comply with by-laws for houses let in lodgings at 12, Bolton Road. Summons withdrawn. ,, ,, Failure to carry out sanitary repairs at 73, St. Ervans Road. Order made for work to be carried out within 21 days. October 21st Failure to comply with by-laws for houses let in lodgings at 167, Portland Road. Summons withdrawn, work having been carried out. ,, ,, Failure to provide sufficient W.C. accommodation at 167, Portland Road. Summons withdrawn, number of occupants having been reduced. ,, ,, Failure to comply with by-laws for houses let in lodgings at 15, Appleford Road. Summons withdrawn, work having been carried out. ,, ,, Failure to discontinue keeping fowls at 59, Southam Street. Order made to discontinue within 14 days. 63 Date of Hearing of Summons. Offence. Magistrates' Decision. October 21st Failure to cleanse slaughterhouse at 10a, Lancaster Mews. Fined £2 and order made to cleanse within 14 days. ,, ,, Failure to provide sufficient dustbin accommodation at 70, Cornwall Road. Summons withdrawn, dustbin having been provided. ,, ,, Failure to comply with magistrates' order to carry out sanitary repairs at 105, Portobello Road. Fined £2. ,, ,, Failure to notify a case of tuberculosis at 62, Clarendon Road. Fined £5, and 10s. 6d. costs. ,, ,, Failure to notify the birth of a child at 183, Ladbroke Grove. Fined 10s., and 10s. 6d. costs. November 4th Removing offensive matter through the public streets during prohibited hours. Fined £2. ,, ,, Failure to comply with by-laws for houses let in lodgings at 57, Southam Street. Fined £2. ,, ,, Failure to carry out sanitary repairs at 57, Southam Street. Order made for work to be carried out within 14 days. ,, ,, Failure to carry out sanitary repairs at 6, Gledhow Gardens. Order made for work to be carried out within 14 days. November 18th Failure to cleanse verminous rooms at 57, Southam Street. Summons withdrawn, work having been carried out. ,, ,, Failure to cleanse verminous rooms at 31, Talbot Grove. Fined £2. ,, ,, Failure to discontinue keeping fowls at 18, Sylvester Mews. Summons withdrawn. December 2nd Failure to comply with magistrates' order in regard to 57, Southam Street. Fined £2. ,, ,, Failure to provide sufficient W.C. accommodation at 175, Portland Road. Fined £2. ,, ,, Failure to provide sufficient dustbin accommodation at 9. Talbot Grove Summons withdrawn, dustbin having been provided. ,, ,, Failure to carry out sanitary repairs at 42, Southam Street. Order made for work to be carried out within 14 days. December 16th Failure to provide sufficient W.C. accommodation at 8, Testerton Street. Fined £5. ,, ,, Failure to carry out sanitary repairs at 84, Abingdon Villas. Summons withdrawn, work having been carried out. In addition to the above, there were issued under the Food and Drugs Acts 7 summonses, particulars of which are given on pages 48 and 49. 61 DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane by exposure to steam under a pressure varying between 15 and 20 lbs. above atmospheric pressure for fifteen minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. above atmospheric pressure for ten minutes in a rotary washing machine. A formalin cupboard is used for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms vacated by persons suffering from infectious disease are disinfected by gaseous formaldehyde, which is generated by the volatilisation of paraform tablets, 20 tablets being used for each 1,000 cubic feet of room space. Verminous rooms are disinfected by the burning of 8 lbs. of sulphur for each 1,000 cubic feet. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1924. Nature of Infection. Premises Disinfected. Rooms Disinfected. Disinfections at Wood Lane. No. of Articles Disinfected.[/###/] Smallpox 1 14 l 208 Scarlet Fever 313 425 321 5,283 Diphtheria 227 310 212 3,237 Enteric Fever 33 65 46 987 Measles 160 226 21 420 Consumption 106 141 119 1,227 Vermin 152 203 130 1,455 Other Diseases 213 288 291 2,989 Total 1,205 1,672 1,141 15,806 * This table does not include the work carried out at Wood Lane on behalf of the Paddington Borough Council. The total weight of the bedding, clothing, &c., of Kensington residents disinfected was 36 tons, 13 cwts., 2 qrs. and 14 lbs. The number of articles disinfected was 14J926 and the number disinfected and washed, 880. The laundry work for the Medicinal Baths is performed at the Disinfecting Station and this work involved in 1924 the washing of 12,916 towels, 499 sheets and 44 dressing gowns and blankets. From January, 1923, to March 31st, 1924, the steam disinfection of clothing, bedding and other articles required in connection with infectious disease in Paddington was carried out on behalf of the Council of that Borough at the Kensington Borough Council's Wood Lane Disinfecting Station at a charge of 15s. 0d. per cwt. of articles disinfected. The total weight of Paddington articles dealt with during January, February and March of 1924 was 5 tons, 4 cwts., 3 qrs., 15 lbs., and the Kensington Council received £78 13s. 2d. in respect of this work. The Paddington Authority, having found that the work carried out by. the Kensington Authority was satisfactory, entered into an agreement with the Council for the disinfection of all articles removed from Paddington homes to be performed at the Kensington Disinfecting Station for a period of twelve months commencing on April 1st, 1924, this period to be continued from time to time as may be agreed upon. As the Paddington Council require certain of the articles to be washed after disinfection, the charge was fixed at 20s. 0d. per cwt. of articles dealt with, but there is a proviso in the agreement that the minimum payment per annum is to be £700. The weight of articles dealt with from April 1st, to December 31st, 1924, under this new agreement amounted to 15 tons, 3 cwts., 1 qr., 12 lbs. The Paddington Authority are responsible for the Collection and removal of the articles to the Council's Wood Lane Station, and for the subsequent return of these articles to the homes in Paddington, the Kensington Authority merely carrying out the disinfection at the Station. DISINFECTION OF LIBRARY BOOKS. In view of the difficulty of securing efficient disinfection of books, the Libraries Committee authorise the Medical Officer of Health to destroy all Public Library volumes removed from infected houses; this gives Kensington borrowers protection from infection from the Council's' books. Books from private subscribing libraries found in infected houses are dealt with as follows : (a) Books which have not been exposed to infection. —Disinfected by formalin vapour and returned to the subscriber. (b) Books which are believed to be infected. —A notification is sent to the Librarian. The holder is informed that the books will not be accepted at the Library and that they can be disinfected by formalin or destroyed at his option ; he is advised that destruction is the only really safe method of dealing with the books but that this will only be carried out on the understanding that the Council will not pay compensation. 65 The number of books from the Kensington Public Libraries destroyed during the year by the officers of the Public Health Department was 55 ; the number of private library books destroyed was 12 ; and the number disinfected by formalin and returned to the householders was 13. VERMINOUS ROOMS CLEANSED BY LANDLORDS. Seven hundred and fifty-eight verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council (General Powers) Acts, 1904 and 1922. This number is in addition to the 203 verminous rooms disinfected by the Council's officers. DUST REMOVAL. House refuse is collected at least once a week in all areas in the Borough but more frequent collections are undertaken in certain special areas. The refuse is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharves in Kensal Road and Lots Road. Trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the Public Health (London) Act, 1891. 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, 787 new movable ash-bins of galvanised iron have been provided during the year, and 103 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. REFUSE REMOVAL FROM MEWS. The common dustbins installed by the Council in 1921, in 21 mewsways in North Kensington at the expense of the owners, have continued to prove a satisfactory arrangement for storing house refuse in these particular mews in which there is a number of dwellings, stables and costermongers' stores. There is, however, some difficulty experienced in dealing with refuse in these so-called " mixed " mewsways, because, although the house refuse is provided for in separate bins, it is still a common practice to place trade refuse, especially decomposed fruit and vegetables, into the manure pits and crates, with the result that those persons who have contracted to remove the manure object to removing a mixture of manure and trade refuse. Many of those who dump objectionable trade refuse in the pits and crates are strangers or unknown persons who visit the mewsways at night time for the purpose. Not uncommonly the pits and crates rapidly become full and overflowing as a result of this practice, and the mewsways become littered with refuse. The problem of securing hygienic conditions in these " mixed " mewsways received the close attention of the Public Health Committee and, following a consultation with the then Chairman of the Works Committee, they directed that the officers in the Public Health Department should make a concentrated effort during the summer and autumn months to secure an improvement. The Borough Engineer's staff gave very valuable assistance, and the combined efforts of the two Departments were attended with satisfactory results. The Borough Engineer undertook a more intensive surface sweeping of the mewsways, with the result that there was a general appearance of tidiness, and no complaints arose in regard to decomposing trade and other refuse deposited on the mewsway surfaces. Collections of house refuse were made at least twice weekly in all North Kensington mews. In pursuance of the provisions contained in Section 36 of the Public Health (London) Act, 1891. bills were posted in North Kensington mewsways giving notice that the Council required manure and other refuse matter from mews and stables to be removed three times weekly. A handbill giving similar information was delivered at each stable in the North Kensington mewsways. The officers of the Public Health Department made it a special duty to see that the Council's directions were observed, and they served notices requiring the removal of many insanitary and defective brick manure pits and the repair of other receptacles. With a view to remedying matters still further, steps were taken throughout the year to prevent the inhabitants keeping hens and ducks in mewsways, and this action has resulted in some improvement. The improved conditions obtained can only be maintained with considerable difficulty, owing to the callous manner in which refuse is deposited in the mewsways; but with the continuance of the vigilance recently exercised and the maintenance of the close working arrangement between the officers of the Borough Engineer's and Public Health Departments, and especially with the assistance of public opinion among the inhabitants concerned, it is hoped to check still further this type of nuisance. 66 DRAINAGE WORK. 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 43 house drains have been reconstructed under notices served by the Sanitary Inspectors. PUBLIC CONVENIENCES. The Council provide six public lavatories containing water-closets; two are for men only, and in four 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 men and 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 Women Health Officers. BACTERIOLOGICAL WORK. The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.I, for the bacteriological examination, at the expense of the Council, of specimens from Kensington cases sent to them by medical practitioners in regard to diphtheria, tuberculosis, typhoid fever, syphilis and other diseases. The examinations in 1924 were as follow :— Disease suspected. No. of examinations. No. of positive results. Diphtheria ... 698 70 Tuberculosis - - - 208 33 Typhoid Fever 16 3 Gonorrhoea 4 — Dysentery 1 — In addition to these examinations at the Lister Institute, 591 specimens of sputum were examined at the Tuberculosis Dispensary. Facilities for the examination of cerebro-spinal fluid in suspected cases of cerebro-spinal fever, etc., are available to the Council's Public Health Department through the London County Council's Laboratory and for the examination of suspected foodstuffs and of blood in suspected malaria cases through the Ministry of Health. PUBLIC BATHS AND WASH-HOUSES. There are at the Public Baths, a Men's First Class Swimming Bath with a capacity of 120,000 gallons, a Women's First Class Swimming Bath with a capacity of 45,000 gallons, and a Second Class Men's Bath and Second Class Women's Bath each of which holds 45,000 gallons. The charge for admission to the First Class Baths is 8d.; 3d. is charged fcr admission to the Second Class Baths, children being admitted at half price. There are 13 Men's and 7 Women's First Class Slipper Baths and 34 Men's and 20 Women's Second Class Slipper Baths. The charge for a First Class Warm Slipper Bath is 8d., and for a Second Class, 3d., whilst the charges for a First Class Cold Slipper Bath and for a Second Class Cold Slipper Bath are 4d. and l$d. respectively. There are 6 special Warm Baths for the use of which a charge of 1/- is made. The number of bathers using the Swimming Baths and Slipper Baths in the last five years is shown in the following table:— Year. Bathers. 1920 319,991 1921 292,464 1922 245,374 1923 251,069 1924 257,056 In the Wash-house or Laundry Department, there were 90 wash-tubs in use in 1924. In order to prevent the wash-tubs being used by professional laundry-women, to the exclusion of women doing their own family washing, the prices to be paid by a user of a wash-tub are as follows:— 2d. for each of the first four hours on any one day. 4d. for the fifth hour on any one day, and 6d. for the sixth and every succeeding hour on any one day. 67 The number of women using the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1920 88,207 1921 103,207 1922 100,546 .1923 110,252 1924 109.502 During the year four small washing machines were installed, The charges for the use of these machines is a fee of 6d. for a period not exceeding half an hour, or 9d. per wash not exceeding a period of one hour with a fee of 6d. for every additional half hour or less period. The number of women using these machines was 1,450. MORTUARY AND CHAPEL OF REST. During the year 89 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of relatives or friends of the deceased 67 At the request of undertakers 3 By the Police 19 89 In 16 cases, post-mortem examinations were made under the Coroner's warrant. Twenty-nine bodies were deposited in the Chapel of Rest, Avondale Park. RAG FLOCK ACT, 1911. Four samples of rag flock were analysed and reported on during the year. They contained 19, 29, 30 and 21 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. The Public Health Committee directed that cautions be issued in respect of the two samples containing 29 and 30 parts respectively. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-23. Applications made to the Council for certificates under the Rent and Mortgage Interest (Restrictions) Acts, 1920-1923, totalled 34, and 20 certificates were granted. The figures for preceding years are as follow:— Year. Applications. Certificates granted. 1920 10 2 1921 42 21 1922 19 9 1923 38 17 This comparative failure by tenants to attempt to make use of the provisions of the Acts is probably due mainly to the fact that most houses in a defective state of repair come under the notice of the Sanitary Inspectors, who put the Public Health Acts into operation. CLEANSING OF VERMINOUS PERSONS ACT, 1897. The cleansing of verminous persons is carried out at the Medicinal Baths, Blechynden Mews. In ly20 an agreement was entered into with the London County Council, which provides for the use of the Medicinal Baths by the County Council for the cleansing of children attending elementary schools in and around Kensington. Under this agreement the County Council guarantee to the Borough Council a minimum payment of £450 per annum for a period of five years. Technically, in accordance with the provisions of the Children 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 to her employers for the effective use of the apparatus provided. In practice, the actual work of bathing and disinfecting garments is executed by the Borough Council's servants under the supervision of the School Nurse. A further agreement in regard to the cleansing of verminous inmates of common lodging houses was made with the County Council in 1920, in which the Borough Council have agreed to cleanse verminous inmates from Kensington common lodging houses free of charge and to bath those sent by the London County Council officers from common lodging houses in neighbouring boroughs at a rate of a 1/- per bath. The cleansing of Kensington persons not sent by officers of the County Council is performed free of charge under the direction of the Medical Officer of Health. Arrangements have been made with the Councils of the neighbouring Boroughs of Hammersmith, Paddington and Fulham for the cleansing of residents (other than school children 68 and lodging-house cases) of those Boroughs at the Medicinal Baths, on the recommendation and under the responsibility of the Medical Officer of Health of the Boroughs in which the persons reside. The Councils of these three Boroughs have agreed to pay Is. per bath and to indemnify the Council of the Royal Borough against any claim which a Hammersmith, Paddington or Fulham person may bring, in respect of any treatment given at the Medicinal Baths. The record of work done at the Medicinal Baths during the year is as follows :— Total Cleansings. Scabies— Adults 66 Schoolchildren 233 Children under five years 33 Verminous Conditions:— Adults 55 Schoolchildren ...... 3,981 Children under five years 10 Other Conditions— Adults 9 Schoolchildren ...... — Children under five years 4 Total 4,391 The high pressure steam disinfector at the Medicinal Baths is proving of great value, and an attempt is being made to disinfect as much clothing and bed linen as possible during the personal cleansings, in order to obviate, as far as possible, re-infection of persons cleansed on return to their homes. In addition to the disinfection of the clothing worn by persons or. their visit to the Medicinal Baths, 305 blankets and sheets, 196 articles of night clothing, and 134 other articles have been dealt with. Of the 4,214 school children dealt with at the Medicinal Baths in 1924 only 203 were compulsory cases, the remainder attending voluntarily. The steady improvement in the general cleanliness of schoolchildren is most encouraging. At the 3,981 cleansings in 1924, only 69 children were found to be infested with lice, the remainder showing only eggs of lice on their heads or clothing. FOULING OF FOOTPATHS BY DOGS. The Council's by-law dealing with the fouling of pavements by dogs continues to be useful and the condition of footpaths has improved considerably since this measure came into operation in 1921. Two officers of the Council's Public Health Department make observations and during 1924 they reported five breaches of the by-law to the Public Health Committee. Summonses were taken out in each case. In three cases a fine of 10s. was imposed ; in the fourth the fine was 5s. ; but the summons could not be served in the remaining case owing to the fact that the offender had given a false name and address to the Council's officer. THE RATS AND MICE (DESTRUCTION) ACT, 1919. In the Borough, the Borough Council are the authority required to execute and enforce this Act ; but the London County Council are responsible for rat repression in sewers vested in the County Council. The Borough Council are also required to observe the requirements of the Act in respect of any land of which they are the occupiers. The Borough Council may, within their own area, give instructions by public notice as to the most efficient methods that can be adopted both individually and collectively with a view to the destruction of rats and mice. Also, in the event of the occupier failing to take necessary action, the Council may serve notice requiring him to take steps for the purpose of destroying rats and mice and of preventing his land or premises becoming infested, or, after 24 hours' notice, they may enter the premises, carry out the work and recover any reasonable expenses from him. The Council have delegated their powers under the Act to the Public Health Committee, and each Sanitary Inspector makes inspections in his district for the purpose of detecting rat-infested premises and reports to the Medical Officer of Health cases in which the occupiers are not taking all practical steps to destroy the rats or to prevent their premises becoming infested. A Rat Officer is employed at a wage of £4 per week to assist in the work of rat destruction under the supervision of the Sanitary Inspectors. He has carried out good work during the year as is evidenced by the following table :— 69 Number of individual Premises visited by the Rat Officer on receipt of complaint - 287 Total number of visits paid - 2,813 Number of Poison Baits laid during the year 55,480 „ „ disappeared 50,750 „ ,, removed by the Rat Officer 4,730 Number of premises where concreting of basement floors has been carried out under the direction of Sanitary Inspectors to prevent ingress of rats ... 53 Number of premises where other repairs have been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 109 Number of sewer defects allowing egress of rats made good - 9 Number of Statutory Notices served under the Rats and Mice (Destruction) Act, 1919 7 Number of premises cleared of rats 251 An account of the methods adopted by the Rat Officer appears in the report for 1923. During the National Rat Week Campaign, held in November, the Borough Engineer kindly placed at my disposal the gang of flushers for the purpose of laying poison baits in sewers. (J*."'tjThe baits were placed in the side entrances to the sewers, which are generally connected with the sewers by galleries and are about ten leet distant therefrom. As the galleries fall about four feet from the entrance level to the sewer level, it will be seen that the baits were well above the general level of the water. Fifteen thousand baits were laid at a number of entrances, and all disappeared. HOUSING OF THE WORKING CLASSES. DENSITY OF POPULATION IN LONDON, KENSINGTON AND THE VARIOUS DISTRICTS OF THE BOROUGH AT THE 1921 CENSUS. Area in statute acres Total Population. Persons per acre. *Residential area in acres. ns per Residential acre. Persons. Males. Females. London 74,850 4,484,523 2,071,579 2,412,944 60 34,883 129 The Borough 2,290 175,859 67,805 108,054 77 1,351 130 N. Kensington 902 92,672 41,251 51,421 103 499 186 S. Kensington 1,388 83,187 26,554 56,633 60 852 97 Wards. St. Charles 401 24.268 10,836 13,432 61 140 173 Golborne 113 26,329 12,718 13,611 233 72 366 Norland 195 22,106 9,922 12,184 113 142 156 Pembridge 193 19,969 7,775 12,194 103 145 138 Holland 484 18,874 6,087 12,787 39 283 67 Earl's Court 244 17,912 5,997 11.915 73 163 110 Queen's Gate 173 13,777 4,145 9,632 80 118 117 Redcliffe 27J 19,865 6,497 13,368 73 170 117 Brompton 216 12,759 3,828 8,931 59 118 108 * The residential area is the total area less (1,) roads, (2) open spaces, and (3) land covered by buildings other than dwellings. 70 PRIVATE FAMILIES AND DWELLINGS AT THE 1921 CENSUS. - Private Families. Population in Private Families. Structurally Separate Dwellings Occupied. Rooms Occupied. Persons per Room. London... 1,120,897 4,243,838 701,035 4,057,271 104 Kensington 43,001 158,399 27,806 194,381 0-81 North Kensington 23,630 87,987 12,413 77,061 114 South Kensington 19,362 70,412 15,393 117,320 0-60 Wards St. Charles 6,176 23,017 3,626 21,736 1-06 Golborne 6,481 25,998 2,817 15,855 1-64 Norland 5,906 21,391 2,839 18,452 116 Pembridge 5,076 17,581 3,131 21,018 0*84 Holland 4,541 17,469 3,861 29,126 0-60 Earl's Court ... 4 869 15,401 3,535 23,935 065 Queen's Gate ... 2,357 9,738 2,253 17,861 0*54 Redcliffe 4,985 17,423 3,477 28.047 0-62 Brompton 2,610 10,381 2,267 18,351 0-57 DEFINITIONS OF TERMS USED IN THE ABOVE TABLE. Private Family.—Any person or group of persons in separate occupation of any premises or part of premises is treated as a separate family, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) Institutions, or (ii) Business establishments or boarding-houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings.—A structurally separate dwelling is defined as any room or set of rooms, intended or used for habitation, having separate acccss either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit. A private house which has not been structurally subdivided is similarly a single unit, whether occupied by one family or by several families; thus, a house-let in-lodgings without being specially adapted for the purpose is one dwelling only. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least three rooms and is more than one quarter of the whole. The dwellings shown in this Table are those occupied by private families only. Rooms.—The rooms enumerated are the usual living rooms including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. HOUSING ACCOMMODATION PROVIDED BY THE COUNCIL BEFORE THE WAR. The number of tenements for the working classes provided, prior to the War, by the Council under the Housing Acts, is shown in the following table:— Rooms in Tenement. Number of Tenements. Rent per Week 1 26 3/4 to 4/8 2 62 7/3 to 9/7 3 32 10/- to 11/- Totals 120 3/4 to 11/- These tenements are situated in Kenley Street, Hesketh Place and Kuncorn Place, abutting on Avondale Park in the Notting Dale district. In October, these tenements were placed under the " Octavia Hill" system of management. It is too early to speak definitely of the results of this change, but it may be mentioned that the women house property managers engaged by the Council are those who have for many years successfully controlled all the property in Notting Dale owned by the Improved Tenements Association and the Wilsham Housing Trust. HOUSING ACCOMMODATION PROVIDED BY THE COUNCIL SINCE THE WAR. The provision of additional housing accommodation under the Housing, Town Planning, etc., Act, 1919, and amending Acts, has been delegated by the Council to a Special Housing Committee, which Committee have been given all the powers possessed by the Council in regard to the preparation and execution of housing schemes except the power to borrow money or make a rate. 71 After considering a report submitted by the Medical Officer of Health in 1919, which indicated that 314 houses would be required to meet the needs of the Borough, the Special Housing Committee prepared three schemes which were approved by the Council and the Ministry of Health. The following statement shows the new accommodation provided during the last five years or in course of provision in connection with these three schemes, together with the approximate expenditure. Cottages 49 Flats 150 Flats and maisonettes (conversions) 102 301 £ s. d. Acquisition and conversion of houses in Powis Square, Colville Terrace, Elgin Crescent, Ladbroke Grove, Bassett Road and Adair Road, into 102 flats and maisonettes ... 84,517 12 6 Avondale Park Gardens and Mary Place Scheme— Provision of 32 Cottages, including cost of site and road and sewer works 42,193 9 1 St. Quintin Estate Scheme— Cost of land, fencing &c. 14,512 7 0 Construction of roads and sewers 12,677 2 1 Buildings— Section 1. 36 flats and 4 cottages) 60,205 10 1 2. 40 „ 4 „ ) 22,500 0 0 * „ 3. 38 „ 5 „ (estimated) 22,500 0 0 t „ 4. 36 „ 4 „ „ 22,500 0 0 £258,606 0 9 * The Architects final certificate in respect of this section has not yet been issued, f Buildings in course of erection. Note.—On the St Quintin Estate site there is room for about 35 more houses, to comprise the fifth section of the St. Quintin Scheme, which will be commenced shortly. The total annual rentals (exclusive of rates and taxes) of the new accommodation already occupied is approximately £11,500, and accommodation has been found therein for approximately 1,440 persons. In addition to the new housing accommodation provided, a defective house was acquired by the Council in 1923 and made fit for occupation by four families. Details of similar work carried out in 1924 appear on page 75 of this report. HOUSING ACCOMMODATION PROVIDED SINCE THE WAR BY PRIVATE ENTERPRISE. The late Dr. Schuster's housing programme, now being continued by the Wilsham Housing Trust, has resulted in the provision since the War of 17 cottages, 2 houses and 37 flats, all situated in the Notting Dale district. In addition, a building which was formerly a public-house has been converted into four self-contained flats, and a further four flats are under construction at the present time. The Improved Tenements Association, Ltd., a company established in 1900 for the acquisition of house property in certain poor parts of the Borough, with the object of providing better housing of the working classes, have acquired since the War 3 houses in Southam Street, 10 in Sirdar Road, 4 in Heathfield Street, 5 at the junction of Bangor Street and Sirdar Road, and 12 in St. James' Place. These have been considerably improved since being taken over. This company now have under satisfactory management 63 houses in the poorer quarters of the Borough. A public-house has been purchased by a Kensington resident and converted during the last six months into six flats. In the period subsequent to the War 8 houses—6 in the northern part of the Borough and 2 in the south—have been erected by private enterprise. The houses purchased by the Improved Tenements Association and some of those mentioned in connection with the Wilsham Housing Trust cannot be regarded as entirely new accommodation, because they did exist previously, but the accommodation has been very much improved and increased. Again, although not strictly within the definition of new housing, additional accommodation has been provided in various parts of the Borough by the conversion of a number of single family houses into self-contained flats or maisonettes by private individuals and companies. 72 COMMON LODGING HOUSES. The Common Lodging Houses in the Borough number 8 and contain accommodation for 416 persons. Ward. Name of Keeper. Address of Common Lodging House. No. of Lodgers for which licensed in 1924. Male. Female. Total. Golborne Madden, James 194, Kensal Road 75 75 Norland Rusha, Alfred 18 & 20, Bangor Street — 69 69 „ Woodhouse, Jane E. 10, Crescent Street — 25 25 „ Hankins, John Wm. 28 & 30, do. 54 — 54 „ Woodhouse, Jane E. 40, £o. — 25 25 „ Rusha, Alfred 25 & 27, do. — 57 57 „ Davis, Mark 66, St. Ann's Road 66 — 66 „ Rusha, Alfred 34 & 36, Sirdar Road - 45 45 Totals 195 221 416 73 Although these powers are valuable they are limited, and do not enable any constructional work to be enforced. The by-laws which are provided for in Section 2G of the Housing Act of 1919 are urgently needed in Kensington, but in spite of the repeated representations of the Borough Council they have not yet been sanctioned by the London County Council. The inspections and re-inspections of registered houses let in lodgings in the Borough during the year 1924 numbered 11,081. The owners of 40 of these houses were summoned for breaches of the special bylaws or for failure to carry out sanitary works required by the Council. Houses Let in Furnished Rooms.—These houses constitute the most unsatisfactory and undesirable form of housing accommodation, and it is therefore pleasing to note that the number of dwellings of this type in the Borough is gradually diminishing. In 1912 there were 187, and at the end of 1924 the number was reduced to 83. These 83 are situated in the following parts of the Borough:— Norland Ward 46 St. Charles Ward 14 Pembridge Ward 11 Golborne Ward 12 83 The average rent charged is 7s. a room per week including the use of such furniture as the owner provides. In 1924, the total number of inspections of these houses made by the Sanitary Inspectors was 654. HOUSE REPAIRS AND IMPROVEMENTS IN HOUSING CONDITIONS. This subject has received the careful attention of the Council throughout the year, and the Public Health Committee have devoted a considerable amount of time to the task of securing the standard of habitability in all houses, particularly those of the " tenement" class, laid down by the Council in January, 1923. The work carried out by the Public Health Committee in pursuance of the Council's Housing Policy can be described briefly under the following headings :— (1) Registration of houses let in lodgings. (2) Improvements in houses being placed on the Register. (3) Improvements in houses let in lodgings which were on the Register on January 1st, 1923. (4) Closing Orders in respect of underground rooms. (5) Closing Orders in respect of houses unfit for habitation. (6) Work under Section 28 of the Housing, Town Planning, etc., Act, 1919. (7) Work under Part III. of the Housing of the Working Classes Act, 1890. (8) General Summary. (1) Registration of Houses Let in Lodgings. In January, 1923, the Council resolved to appoint a Temporary Sanitary Inspector to enable the inspection, measuring up, etc., to be carried out in those houses proposed to be placed on the Council's Register of Houses Let in Lodgings. The Inspector appointed commenced duty in the Golborne Ward on May 1st, 1923, and his work in that year is dealt with in my previous report. Early in 1924, the Council appointed a second Temporary Sanitary Inspector for the purpose of speeding up registration, and this officer commenced work in the St. Charles Ward on April 14th of that year. During the course of 1924, 576 houses were inspected in detail and measured up, and of thisnumber 476 were placed on the Council's Register. These 476 houses were in the Golborne, St. Charles and Norland Wards. The total number of houses registered on December 31st, 1924 was 2904. (2) Improvements in Houses being placed on the Register. At the time of measuring up for the purpose of registration, the Temporary Sanitary Inspectors prepare a list of all defects found and improvements required, and issue Intimation Notices calling for the necessary repairs and alterations. The details in regard to each house are reported at the fortnightly meetings which are specially held for this purpose by the Public Health Committee, who, in necessary cases, give directions for the issue of Statutory Notices with a view to bringing the houses up to the highest reasonable standard of habitability attainable under present legislation. The drains are tested in every case and notices served in respect of defects found. The number of visits paid in 1924 by the two Temporary Sanitary Inspectors was 2,943 and the notices served are as follow:— Intimation Notices 671 Statutory Notices 106 Final Notices 68 Summonses 13 74 The repairs and improvements secured as a result of the work of the two Temporary Sanitary Inspectors during 1924 are set out in the following table:— House drains reconstructed 4 Defective drains repaired 6 House drains cleansed 8 Water-closets re-constructed, repaired, etc. 24 Do. supplied with water 26 Do. new provided 8 Soil-pipes ventilated, repaired, etc. 37 Do. new provided 4 Cisterns cleaned, covered, etc. 26 Yards, areas paved, drained, repaired 78 Dustbins provided 65 Ashpits abolished 4 Accumulations of filth, &c., removed 1 Overcrowding abated 1 Roofs repaired 166 Houses provided with water above basement floor 98 Dampness in dwellings remedied 171 Other sanitary improvements 804 The last item includes the cleansing of walls and ceilings and the disinfestation or verminous rooms in every case where found necessary. The items given in the above table were those completed during 1924. During the course of the year, 509 houses, in which all the repair work had been completed, were transferred from the supervision of the Temporary Sanitary Inspectors to the District Sanitary Inspectors in whose areas the houses were situated. At the end of the year work was in progress at a number of houses and 64 of these were brought up to standard and handed over to the District Inspector in the first few weeks of 1925. The remedies secured in these cases will be recorded in the report for 1925. (3) Improvements in Houses Let in Lodgings on the Register on 1st January, 1923. In February, 1923, each of the ten District Sanitary Inspectors commenced the work of inspecting each month ten of the "tenement" houses on the Register at the beginning of 1923. After each inspection, necessary Intimation Notices are served and the details are reported to the fortnightly meetings of the Public Health Committee who give directions for the issue of any Statutory Notices required to bring the houses up to standard. This work is in addition to the normal routine duties carried out by the ten District Sanitary Inspectors. The following table shows (1) the number of houses let in lodgings on the Council's Register in each of the ten Inspector's areas on 1st January, 1923, (2) the number of these dealt with in 1923 and reported upon last year, (3) the number dealt with in 1924, and (4) a statement of the main requirements called for in the notices issued in 1924:— District. No. of houses on Register at commencement of 1923. Number dealt with in 1923. Number dealt with in 1924. Particulars of the main requirements called for in Notices served in regard to the 1,003 houses inspected in 1924. Additional W.C. accommodation required. Installation of supply of water on upper storey. Cleansing. General repairs. 1 246 101 120 2 10 31 78 2 359 125 184 7 7 184 172 3 250 102 125 3 48 4 17 4 244 106 131 17 47 101 109 5 196 98 90 — 1 70 50 6 36 35 — — — — — 7 336 116 135 — 39 74 53 8 167 107 60 — 1 5 24 9 298 85 158 — 3 88 49 10 37 37 — — — — 2,169 912 1,003 29 156 557 552 From the above table it will be seen that 912 of the 2,169 houses were dealt with in 1923 and 1,003 in 1924. This left 254 houses awaiting attention on 1st January, 1925, and it is hoped to inspect all of these and issue the necessary notices before the end of April, 1925. 75 (4) Closing Orders in respect of Underground Rooms. An underground room is any room of a house the floor of which room is more than three feet below the surface of the footway of the adjoining street or of the ground adjoining or nearest to the room. The Council have special but limited powers in regard to these rooms. The majority of back basement rooms in Kensington are not technically underground and in other cases where the rooms appear to be underground the Council's powers are not for one reason or another enforceable. Three hundred and fifty eight underground rooms were specially inspected in 1923 and they were reported upon last year. Of the 362 underground rooms inspected and measured up in 1924, there were 65 which did not comply with the Regulations and in regard to which the Council s powers could be put into operation. In 14 cases illegal use of the rooms was discontinued or the necessary structural alterations were carried out by the owners on receipt of the Council's notices. In the remaining 51 cases the Council issued Underground Room Closing Orders which prohibit the use of the rooms for sleeping purposes until they are so altered as to comply with the Regulations. These Closing Orders were complied with in all except two cases. In these two, the owner failed in an attempt to obtain a Magistrates' Ejectment Order against the tenants and at the end of the year nothing had been done. (5) Closing Orders in respect of Houses Unfit for Habitation. A local authority can prohibit the occupation of a house in a state so dangerous or injurious to health as to be unfit for human habitation; but, in view of the difficulty of finding alternative accommodation for the displaced tenants, the Council endeavour to secure habitable conditions by the full use of all their powers before resorting to the issue of Closing Orders under Section 17 of the Housing, Town Planning, etc., Act, 1909. In 1924, two Closing Orders were issued and both became effective. In due course, the Council notified the owners that they proposed to consider the question of demolition, and on receiving this intimation, the owner in each case undertook to repair the property. It is hoped shortly to determine the Closing Orders on the houses becoming habitable. (6) Work under Section 28 of the Housing, Town Planning, etc., Act, 1919. This Section provides that if the owner of a house suitable for the working classes fails to keep that house in all respects reasonably fit for habitation, the Council may require him to execute such works as are necessary. The owner can appeal, and may, in certain circumstances, close the house, but if he neither exercises his rights nor carries out the repairs, the Council can do the work and recover the cost with interest, the Council's expenses becoming a first charge on the premises, including the freehold. Section 28 has been considerably strengthened by Section 10 of the Housing, etc., Act, 1923, which gives the Council the powers and remedies of a mortgagee under the Conveyancing Acts, 1881-1922, for the purpose of recovering their expenses. Section 10 also defines the appeals of which the owner may take advantage, and prescribes the times within which they must be made, with the result that certain doubts which existed in regard to the interpretation of Section 28 have been removed and the Council feel much more secure in availing themselves of the powers granted thereunder. In 1924, Section 28 notices were served in respect of 32 houses. In 20, the houses were repaired by the owners to the satisfaction of the Council; in six, the repairs are now in hand ; and in the remaining six, which are a row of houses in one ownership, the extended time allowed to the landlord in which to carry out the repairs specified in the notices expired on 25th March, 1925. In not one case during 1924 was it necessary for the Council to step in and carry out the repairs required. (7) Work under Part 111. of the Housing of the Working Classes Act, 1890. During 1924, the Council purchased four dilapidated houses in the Notting Dale area and two derelict houses in the Golborne Ward; these are now being converted into 24 flats. The Council also acquired a block of eighteen defective tenement flats with an adjoining vacant piece of land, and have now under consideration a scheme for the demolition of the flats and the provision of housing accommodation for the working classes on the cleared site and the adjoining vacant land. (8) General Summary. The work outlined above may be regarded as mainly an addition to the normal work such as was carried on in previous years, and it does not indicate the full measure of improvement in housing conditions which has been effected. During the year the ten District Sanitary Inspectors have spent as much time as could possibly be spared on housing duties, and very active steps have been taken with a view to securing remedies for the defects discovered in the houses visited. It will, therefore, be useful to give a general summary of all the housing work carried out in the year by the officers of the Public Health Department, including the routine housing work of the Department and that performed in pursuance of the Council's Special Housing Policy of 1923. 76 HOUSING STATISTICS FOR 1924. 1.—Unfit Dwelling-houses. Inspection—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,927 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 1,584 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 (4) Number of dwellmg houses (exclusive of those referred to under the preceding heading) found not to be in all respects reasonably fit for human habitation 3,797 2.—Remedy of Defects without Service of Formal Notices. No. of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 215 3.—Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling houses in respect of which Notices were served requiring repairs 32 (2) Number of dwelling houses which were rendered fit:— (a) By owners 20 (b) By Local Authority in default of owners Nil (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 3,530 (2) Number of dwelling houses in which defects were remedied:— (a) By owners 3,457 (c) By Local Authority in default of owners Nil C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909. (1) Number of representations made with a view to the making of Closing Orders— Dwelling-houses 2 Underground Rooms 65 (2) (a) Number of dwelling houses in respect of which Closing Orders were made 2 (b) N umber of underground rooms in respect of which Closing Orders were made 51 (3) Number of dwelling houses in respect of which Closing Orders (made before January 1st, 1924,) were determined, the dwelling houses having been rendered fit 4 (4) Number of dwelling houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil In carrying out the work indicated in the above table, the Council's Sanitary Inspectors paid 26,038 visits to houses during the year, and the principal improvements secured are given below:— Houses cleansed 1198 House drains re-constructed 43 Defective drains repaired 151 House drains cleansed 372 Water closets re-constructed, repaired, &c., 596 „ „ supplied with water 343 „ „ new provided 78 Soil-pipes, ventilated, repaired, &c., 136 „ new provided 51 Cisterns cleaned, covered, &c., 246 Yards, areas paved, drained, repaired 432 Dustbins provided 787 Ashpits abolished 103 Accumulations of filth, &c., removed 395 Animals removed 37 Overcrowding abated 31 Underground rooms, illegal occupation discontinued 42 Roofs repaired 861 77 Houses provided with water above basement floor 368 Dampness in dwellings remedied 470 Other important repairs 2010 Houses repaired under Section 28 of the Housing Act of 1919 20 An attempt to secure a higher standard of habitability in the houses of the working classes in a large Borough must necessarily proceed slowly, but there is now distinct evidence that the Council's efforts of the last two years are bearing fruit. Owners of working class property have, on the whole, responded very satisfactorily to the increased demands of the Council, and the task of the officers of the Public Health Department has been considerably lightened by the ready co-operation of a large number of those who are responsible for the control of houses in the poorer quarter of the Borough. The general improvement which is clearly noticeable imposes an obligation on the Council's officers to exercise constant vigilance with a view to preventing unnecessary deterioration arising from the neglect of careless tenants. With perseverance and the continued goodwill ot all concerned, the encouraging progress noted will be maintained, with the result that the inhabitants will enjoy better health and greater happiness. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 78 APPENDIX. TABLE I. Vital Statistics of Whole District during 1924 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 2 3 4 5 6 7 8 9 10 11 12 13 1919 ‡164,470 B 157,886 D 2,281 2,653 16.1 3,429 18.3 1,454 438 270 102 2,413 15.2 1920 ‡165,496 B 164,177 D 3,997 4,020 24.3 2,436 14.8 753 510 825 81 2,193 13.4 1921 175,859 (Census) 3,159 3,288 18.7 2,656 15.1 727 496 368 110 2,425 13.8 1922 179,100 2,993 3,152 17.6 2,814 15.7 894 507 257 82 2,427 13.6 1923 178,500 3,042 3,121 17.5 2,551 14.3 839 484 218 70 2,196 12.3 1924 178,700 2,591 2,908 16.2 2,759 15.5 880 453 219 76 2,332 13.0 * Rates calculated per 1,000 of estimated population. ‡ B. Population as estimated by the Registrar-General for the calculation of Birth rate. D. „ „ „ „ „ „ „Death rate. At Census of 1021. Area of District in acres (exclusive of area covered by water)2291 Total population at all ages175,859 Total families or separate occupiers 43,001 79 TABLE II. Cases of Infectious Disease notified during the Year, 1924. 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. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-Pox 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... 1 Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 188 3 67 77 22 15 4 ... 27 45 35 19 34 5 4 15 4 183 Erysipelas 59 ... 2 4 6 15 22 10 9 13 9 12 5 1 5 2 3 27 Scarlet fever 281 7 99 125 31 16 3 ... 04 70 87 18 17 20 22 29 4 265 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 29 ... 7 7 10 5 ... 1 3 2 2 7 6 1 2 5 24 Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 5 ... ... ... 2 3 ... ... ... 3 1 ... ... ... ... 1 ... 5 Encephalitis Lethargica 21 ... 2 6 4 6 3 ... 2 5 8 ... 2 ... 1 1 2 13 Cerebro-Spinal Meningitis 4 ... 3 ... ... 1 ... ... 1 1 1 1 ... ... ... ... ... 4 Poliomyelitis and Polio- Encephalitis 10 1 3 5 1 ... ... ... 1 ... 4 1 2 1 ... 1 ... 8 Pulmonary Tuberculosis 236 ... 2 16 55 112 48 3 30 40 58 36 24 11 13 13 11 112 Other forms of Tuberculosis 78 2 11 38 14 4 7 2 15 25 17 7 6 2 4 2 36 Ophthalmia Neonatorum 14 14 ... ... ... ... ... ... 4 5 1 1 2 ... 1 ... ... 7 Primary Pneumonia 101 ... 15 19 8 25 16 18 18 35 14 12 5 4 5 3 5 40 Influenzal Pneumonia 56 6 16 3 3 20 5 3 15 22 6 6 1 2 2 2 ... 14 Malaria 3 ... ... ... ... 3 ... ... 1 ... ... 1 1 ... ... ... ... ... *Enteritis 40 17 23 ... ... ... ... ... 6 19 13 ... 2 ... ... ... ... 6 Totals 1127 50 243 300 153 231 114 36 195 286 206 116 108 52 59 71 34 745 "Notifiable only in children under the age of 5 years. 80 TABLE III. Causes of, and Ages at, Death during the Year 1924. Causes of Death Nett Deaths at the subjoined ages of "Residents'' whether occurring withi or without 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 ALL CAUSES 12,332 219 93 82 59 67 220 615 977 Enteric Fever 3 ••• ••• ••• 1 1 ••• 1 ••• Small-pox ••• ••• ••• ••• ••• ••• ••• ••• ••• Measles 75 17 26 25 5 ••• 2 ••• ••• Scarlet Fever 1 ••• ••• ••• 1 ••• ••• ••• ••• Whooping-Cough 20 8 4 8 ••• ••• ••• ••• ••• Diphtheria 15 1 4 6 3 1 ... ... ... Influenza 67 1 3 ••• ••• 3 8 18 34 Encephalitis Lethargica 5 ••• 1 1 1 ••• 1 1 ••• Meningitis 4 2 2 ••• ••• ••• ••• ••• ••• Tuberculosis of Respiratory System 120 ••• ••• ••• 3 26 57 32 2 Other tuberculous diseases 29 4 4 11 4 3 2 1 ••• Cancer, Malignant disease 293 ••• ••• ••• 1 5 25 138 124 Rheumatic Fever 6 ••• ••• 1 1 1 2 1 ••• Diabetes 13 ••• ••• ••• ••• 1 ••• 5 7 Cerebral Hœmorrhage, etc. 91 2 ••• ••• 1 ••• 2 33 53 Heart Disease 322 ••• ••• ••• 4 6 13 85 214 Arterio-sclerosis 116 ••• ••• ••• ••• ••• 2 27 87 Bronchitis 213 10 3 1 ••• ••• 10 56 133 Pneumonia (all forms) 258 59 43 20 7 2 13 49 65 Other respiratory diseases 39 ••• ••• 2 2 ••• 1 10 24 Ulcer of Stomach or Duodenum 19 ••• ••• ••• ••• ••• 4 12 3 Diarrhœa, etc. 29 18 1 ••• ••• ••• 1 7 2 Appendicitis and Typhlitis 8 ••• ••• ••• 1 ••• 4 1 2 Cirrhosis of Liver 11 ••• ••• 1 ••• ••• 2 5 3 Acute and Chronic Nephritis 5 ... ••• ••• ... ••• 2 1 2 Puerperal Sepsis 3 ... ••• ••• ••• ••• 3 ••• ••• Other accidents and diseases of Pregnancy and Parturition 2 ••• ••• ••• ••• 2 ••• ••• Congenital Debility and Malformation, Premature Birth 85 83 ••• 1 1 ••• ••• ••• ••• Suicide ••• ••• ••• ••• ••• 11 7 2 Other deaths from violence 64 7 1 5 9 3 7 14 18 Other Defined Diseases 394 6 1 14 15 45 111 202 Causes ill-defined or unknown 2 1 ••• ••• ••• ••• 1 ••• ••• 81 TABLE IV. INFANT MORTALITY DURING THE YEAR 1924. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cacse of Death. 1 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 48 12 6 7 78 35 32 41 38 219 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... 1 1 Measles ... ... ... ... ... 1 ... 7 9 17 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 2 1 5 8 Diphtheria and Croup ... ... ... ... ... 1 ... ... ... 1 Erysipelas ... ... ... ... ... ... ... .... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... ... ... ... Abdominal Tuberculosis ... ... ... . .. ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... 1 1 ... ... 1 ... 2 Convulsions 1 ... ... ... 1 ... 1 ... 2 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... 1 1 2 3 1 3 10 Pneumonia (all forms) ... ... ... 1 2 13 8 22 14 59 Diarrhœa ... ... ... ... ... ... 2 1 ... 3 Enteritis ... 1 ... 1 3 3 2 3 4 15 Gastritis 1 . . ... ... 1 ... ... ... ... 1 Syphilis ... ... ... ... ... 1 ... ... ... 1 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying ... 1 ... ... 1 1 1 ... ... 3 Injury at birth 4 ... ... ... 4 ... ... ... ... 4 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformation ... ... ... 1 3 5 4 3 ... 15 Premature Birth 27 4 ... ... 31 1 1 ... ... 33 Atrophy, Debility, and Marasmus 9 4 2 2 17 7 1 ... ... 25 Other causes 2 2 ... ... 4 ... 8 ... 3 15 48 12 6 7 78 85 82 40 39 219 Nett Births in the year. legitimate, 2,723. illegitimate, 185. Nett Deaths in the year of legitimate infants, 201. illegitimate infants, 18. 82 TABLE V Causes of Death at different periods of life in the Tear 1924. CAUSES OF DEATH. Classification No. 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. 45 and under 65 years. 65 years and upwards. Totals— Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total I. GENERAL DISEASES. Enteric Fever 1 3 1 2 ... ... ... ... ... ... ... ... ... 1 ... .... 1 ... ... ... 1 ... ... 1 2 3 Blackwater Fever 4 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Measles 6 75 38 37 8 9 13 13 13 12 34 34 68 3 2 ... 1 1 ... ... ... 4 3 5 Scarlet Fever 7 1 ... 1 .. . ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Whooping-Cough 8 20 7 12 3 5 2 2 2 6 7 13 20 ... ... ... . . ... ... ... ... ... ... ... ... ... Diphtheria 9A 15 7 8 ... 1 2 2 2 4 4 7 11 2 ... 1 ... ... ... ... ... ... 3 1 4 Influenza 10 67 27 40 ... 1 1 2 ... ... 1 3 4 ... ... 2 1 7 1 8 10 9 25 26 37 63 Dysentery 14 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 Erysipelas 18 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 2 3 2 5 Chicken Pox 19C 1 ... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... . .. ... ... ... ... ... ... ... ... Pyaemia, Septicaemia 20B 7 6 1 1 ... ... ... 1 ... 2 ... 2 1 ... ... 2 1 1 ... ... 4 1 5 Pulmonary Tuberculosis 28AB 120 65 55 ... ... ... ... ... ... ... ... ... 1 2 13 13 29 28 22 10 ... 2 65 55 120 Miliary Tuberculosis 29B 8 6 2 ... ... ... ... 2 ... 2 ... 2 3 2 1 ... ... ... ... ... ... ... 4 2 6 Tuberculous Meningitis 30 13 8 5 ... ... 2 1 1 1 3 2 5 3 2 ... 1 .1 . , 1 ... ... ... 5 3 8 Tuberculosis of Peritoneum, &c. 31B 5 3 2 ... ... 1 ... ... ... 1 1 1 ... ... 1 ... 1 ... ... 1 ... 2 2 4 Tuberculosis of Spinal Column 32 1 ... 1 ... ... ... ... ... ... ... ... ... ...' ... ... ... ... 1 ... ... ... ... ... 1 1 Tuberculosis of Joints 34 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Tuberculosis of other Organs 35 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... . . . ... ... ... ... ... 1 1 Syphilis 37 3 2 1 ... 1 ... ... ... ... ... 1 l ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Other Venereal Diseases 38C 1 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer 39-45 293 117 176 ... ... ... ... ... 1 ... 1 1 ... ... 5 ... 8 17 50 88 54 70 117 175 292 Other Tumour3 46 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 Rheumatic Fever 47 6 3 6 ... ... ... ... ... 1 ... 1 1 1 ... 1 ... 1 1 ... 1 ... ... 3 2 5 Chronic Rheumatism, &c 48B 8 1 7 ... ... ... ... ... ... ... ... ... . . 1 ... ... ... ... . . . ... 2 1 5 1 7 8 Diabetes 50 13 2 11 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 4 1 6 2 11 13 Exophthalmic Goitre 51 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 . . . 2 ... 1 ... 6 6 Lencocythæmia, &c. 53AB 9 6 3 ... ... ... ... ... 1 ... 1 1 ... ... ... ... 2 2 2 ... 2 ... 6 2 8 Anaemia Chlorosis 54 10 3 7 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 3 1 3 3 7 10 Other General Diseases 55 2 ... 2 ... ... ... ... 1 ... 1 1 ... ... ... ... ... 1 . . . ... ... ... 1 1 Alcoholism 56 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 2 1 3 Total for General Diseases 702 310 392 12 19 21 20 21 27 54 66 120 16 10 24 21 54 59 90 122 72 114 256 326 532 83 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 Years. 5 and under 1-5 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards Totals— Above Five Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 702 310 392 12 19 21 20 21 27 54 66 120 16 10 24 21 54 59 90 122 72 114 256 326 582 II.—DI8EASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. E"cephalitis Lethargica 60 5 1 4 ... ... ... 1 ... 1 ... 3 2 1 ... ... ... ... 1 ... 1 ... ... 1 2 3 Meningitis 61BO 4 2 2 1 1 1 1 ... ... 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Locomotor Ataxy 62 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... 5 ... 5 Other Diseases of the Spinal Cord 63AB 17 7 10 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 4 5 2 4 7 10 17 Cerebral Haemorrhage, Apoplexy 64 A E 91 36 55 2 ... ... ... ... ... 2 ... 2 ... 1 ... ... ... 2 12 21 22 31 34 55 89 Softening of the Brain 65 6 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 3 2 4 6 Paralysis without specified cause 60AC 15 10 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 7 5 10 5 15 General Paralysis of the Insane 67 10 8 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 4 .. 4 2 ... ... 8 2 10 Other forms of Mental Alienation 68 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Epilepsy 69 10 2 8 ... ... ... ... ... ... 1 ... 1 ... 1 ... 1 1 2 ... 2 ... 2 1 8 9 Infantile Convulsions under 5 years 71A 2 1 1 1 1 ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Anorexia 78 A 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Other Diseases of the Nervous System 74AD 6 2 4 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 9 ... 1 2 4 6 Cellulitis of Orbit 75 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Other Diseases of the Ears 76B 6 4 2 ... ... ... ... 1 ... 1 ... 1 1 ... 1 ... ... ... 1 1 ... ... 3 1 4 Total for Diseases of the Nervous System, and of the Organs of Special Sense 181 80 101 4 2 2 2 1 1 7 5 12 3 3 2 3 5 5 29 38 34 46 73 96 169 III.—DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 2 ... 2 Acute Endocarditis 78B 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... 1 3 2 5 Valvular Disease 79 A 120 44 76 ... ... ... ... ... ... ... ... ... 2 1 2 4 2 7 18 18 20 46 44 76 120 Fatty Degeneration of the H eart 79B 23 6 17 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 8 4 8 6 17 23 Other Organic Diseases of the Heart 79C 163 62 101 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 16 18 46 82 62 101 163 Angina Pectoris 80 9 6 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 3 6 3 9 Carried forward 1204 513 691 16 21 23 22 22 28 61 71 132 22 14 28 28 63 73 159 205 180 300 452 620 1072 84 TABLE V-continued. CAUSES OF DEATH Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under S Years. 5 and under IS years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 years and upwards. Totals— Above 5 Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1204 513 691 16 21 23 22 22 28 61 71 132 22 14 28 28 63 73 159 205 180 300 452 620 1072 DISEASES OF THE CIRCULATORY SY STEM—continued. Arterial Sclerosis, &c. 81AC 116 57 59 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 14 13 42 45 57 59 116 Cerebral Embolism and Thrombosis 82A 12 5 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 6 5 7 12 Other Embolism and Thrombosis 82 B 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... 1 1 2 Status Lymphaticus 84 A 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 J r Tachycardia 85 AC 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 2 1 3 Total for Diseases of the Circulatory System 456 188 268 ... ... ... ... ... ... ... ... ... 3 2 2 4 6 10 55 61 122 191 188 268 456 IV.—DISEASES OF THE RESPIRATORY SYSTEM. • Diseases of the Larynx 87 1 ... 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 1 Myxœdema 88 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 Bronchitis 89 213 89 124 6 4 1 2 ... 1 7 7 14 ... ... ... ... 6 4 28 28 48 85 82 117 199 Broncho-pneumonia 91 159 71 88 28 26 20 19 7 6 55 51 106 ... 1 ... ... 1 1 4 12 10 23 16 37 53 Lobar-pneumonia 92A 56 33 23 ... 2 2 1 1 1 3 4 7 1 ... ... ... 8 1 14 9 7 9 30 19 49 Pneumonia (type not stated) 92 B 43 22 21 2 1 ... 1 3 2 5 4 9 2 3 ... ... 2 ... 6 4 7 9 17 17 34 Pleurisy 93 4 3 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... 1 ... 2 ... 3 ... 3 Empyema 93A 1 ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Pulmonary Congestion 94 21 7 14 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 2 6 11 7 14 21 Asthma 96 5 3 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 1 3 2 5 Emphysema 97 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 4 ... 4 Fibroid Disease of Lung 98A 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 3 Other Diseases of the Respiratory System 98B 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Total for Diseases of the Respiratory System 513 234 279 36 33 23 23 11 12 70 68 138 4 6 1 1 18 6 58 58 83 140 164 211 375 Carried forward 1851 812 1039 52 54 46 15 33 40 131 139 270 26 21 29 29 83 80 232 279 311 491 681 900 1581 8 5 TABLE V.— continued. CAUSES OF DEATH. Classification No. 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. 45 and under 65 years. 65 years and upwards. Totals-Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1851 612 1039 52 54 46 45 33 40 131 139 270 26 21 29 29 83 80 232 279 311 491 681 900 1581 V.—DISEASES OF THE DIGESTIVE SYSTEM. Tonsillitis 100 A. 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 ... 2 Diseases of Oesophagus 101 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... ... ... 1 ... 1 1 Perforating Ulcer of the Stomach 102 19 11 8 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 8 4 ... 3 11 8 19 Inflammation of Stomach 103A 4 2 2 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 ... 1 1 ... 1 2 3 Diarrhoea and Enteritis 101 & 105 29 14 15 10 8 ... 1 ... ... 10 9 19 ... ... ... ... ... 1 2 5 2 ...... 4 6 10 Appendicitis 108 8 4 4 ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 1 ... ... 2 4 4 8 Hernia 109A 9 2 7 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 6 2 7 9 Intestinal Obstruction 109 B 15 7 8 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... ... 1 2 1 3 6 6 8 14 Other Diseases of the Intestines 110 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 ... 3 Hydatid Liver 112 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Cirrhosis of the Liver, &c. 113 11 7 4 ... ... ... ... 1 ... 1 ... 1 ... ... ... ... 2 ... 2 3 2 1 6 4 10 Biliary Calculi 114 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 2 4 Other Diseases of the Liver 115 7 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 1 1 4 3 7 Peritonitis (cause unstated) 117 2 ... 21 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Other Diseases of Digestive System 118 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 1 2 3 Total for Diseases of the Digestive System 118 59 59 12 8 ... 1 1 ... 13 9 22 ... 1 2 1 10 8 22 19 12 21 46 50 96 VI.— NON-VENEREAL DISEASES OF THE GENITO URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 5 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 1 1 4 5 Bright's Disease, &c. 120A 64 31 33 ... ... ... ... ... ... ... ... ... 1 ... 1 1 5 4 9 10 15 18 31 33 64 Other Diseases of the Kidney 122D 7 ... 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 5 ... 7 7 Calculi of the Urinary Passages 123 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 Diseases of the Bladder 121 10 8 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 6 1 8 2 10 Diseases of the Urethra 125 6 6 ... ... ... ... ... ... ... ... ... ... ... ... ... .. ... 6 ... ... ... 6 ... 6 Diseases of the Prostate 126 6 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 ... 6 ... 6 Cellulitis of Scrotum 129 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Septic Endometritis 130 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Ovarian Cyst 131 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Double Pyosalpinx 132 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 Total for non-Venereal Diseases of the Genito-Urinary System and Annexa 104 54 50 ... ... ... ... ... ... ... 1 ... 1 1 5 10 21 13 26 26 54 50 104 Carried forward 2073 925 1148 64 62 46 46 34 40 144 148 292 27 22 32 31 98 98 275 311 349 538 781 1000 1781 86 TABLE Y.—continued. CAUSES OF DEATH. Classification No. 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. 45 and under 65 years. 65 years and upwards. Totals— Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 2073 925 1148 64 62 46 46 34 40 144 148 292 27 22 32 31 98 98 275 311 349 538 781 1000 1781 VII.—THE PUERPERAL STATE. Accidents of Pregnancy 134 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Puerperal Fever 137 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 3 Eclampsia 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Total for Diseases of the Puerperal State 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... 5 5 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142AD 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 3 ... 4 4 Carbuncle 143 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Phlegmon, Acute Abscess 144 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 1 ... 2 3 5 Diseases of the Integumentary System 145BD 3 ... 3 ... 1 ... ... ... ... ... 1 1 ... ... ... ... .... ... ... 1 ... 1 ... 2 2 Total for Diseases of the Skin and of the Cellular Tissue 13 3 10 ... 1 ... ... ... ... ... 1 1 ... ... ... 1 ... ... 2 4 1 4 3 9 12 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION 146 7 6 2 4 ... ... ... ... 1 1 1 1 2 ... 1 ... ... ... ... 1 1 ... 1 1 3 4 X.—M ALFORM ATIONS. Congenital Malformation 150 AD 17 7 10 7 8 ... ... ... 1 7 9 16 ... 1 ... ... ... ... ... ... ... ... 1 1 XL—DISEASES OF EARLY INFANCY. Premature Birth 161A 33 14 19 14 19 ... ... ... ... 14 19 33 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility and Marasmus ... 151B 25 14 11 14 11 ... ... ... ... 14 11 25 ... ... ... ... ... ... ... ... ... ... ... ... ... HtEmorrhage of Umbilical Cord 152A 1 ... 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 4 2 2 2 2 ... ... ... ... 2 2 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 4 3 1 3 1 ... ... ... ... 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 153 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 68 34 34 34 34 • . • ... 34 34 68 Carried forward 2182 971 1211 105 105 46 46 35 42 186 193 379 27 24 32 32 98 103 278 316 350 543 785 1018 1803 87 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. T otals— Under 5 5 ears. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 years and upwards. Totals Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 2182 971 1211 105 105 46 46 35 42 186 193 379 27 24 32 32 98 103 278 316 350 543 785 1018 1803 XII.—OLD AGE. Old Age 154AB 64 25 39 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 25 39 25 39 64 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 156 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Suicide by Asphyxia 156 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 4 ... 4 Suicide by Hanging 157 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 1 3 4 Suicide by Drowning 158 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Suicide by Firearms 159 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Suicide by Cutting or Piercing Instruments 160 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... 3 ... 3 Suicide by Jumping from High Place 161 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Suicide by Crushing 162 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... l ... 3 ... ... Other Acute Poisonings 165 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... .. ... ... ... 1 ... 1 Burns ... 167 4 1 3 ... 1 ... 1 1 1 1 3 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Absorption of Deleterious Gases (Overlain, &c.) 168 10 6 4 5 2 ... ... ... ... 5 2 7 ... ... 1 ... ... ... ... 2 1 ... 2 2 4 Accidental Drowning 169 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 2 4 Injury by Fall 172 20 14 6 ... ... ... ... ... ... ... ... ... 3 1 2 3 ... 3 2 3 3 14 6 20 Injury by other Crushing (vehicles, railways, See.) 175 24 11 13 ... ... ... ... 1 2 1 2 3 3 1 ... ... 1 1 2 3 3 6 9 11 21 Homicide by Other Means 184 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 l Total for Affections produced by External Causes 84 51 33 5 3 ... 1 2 3 7 7 14 6 2 3 ... 13 5 12 9 10 10 44 26 70 XIV.—ILL DEFINED CAUSES. 189DF 2 2 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Grand Totals 2332 1049 1283 111 108 46 47 37 45 194 200 394 33 26 35 32 112 108 290 325 385 592 855 1083 1938 88 TABLE VI. Summary of Inspections, &c., done by the Male Sanitary Inspectors during the year 1924. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT Grand Total 1. 2 3 4 4a 5 5a 6 7 9 9 10 Complaints received 340 167 150 239 26 152 — 236 122 193 265 203 2093 Public Health (London) Act, 1891. Houses inspected on complaint '239 62 177 229 21 143 27 388 128 186 262 193 2055 „ after Infectious Disease 132 131 46 96 — 80 5 63 63 60 81 17 774 Primary Routine House Inspections 2 21 31 57 — 86 1 — 69 234 87 141 729 Re-inspections 1130 168 1002 1316 — 1185 — 1311 1286 800 1274 796 10268 By-Laws re Houses Let in Lodgings Complaints received 102 105 15 30 — — 9 4 13 2 7 287 First Annual Inspection (Furnished Houses) 12 9 46 9 7 83 Re-inspections „ „ 34 27 229 111 — — — 170 — — — — 571 First Annual Inspection (Unfurnished Houses) 314 309 273 163 — 96 — 9 134 67 199 87 1651 Re-inspections „ „ 717 1304 439 943 — 757 — 185 525 153 444 366 5833 Housing Acts, 1890 1919. Initial Inspections 127 197 175 132 225 — 299 1 153 75 147 53 1584 Re-inspections 9 60 138 39 1126 17 1293 168 11 — — 195 3056 Underground Living Rooms. Primary Inspections 109 192 — 84 47 — 189 — — — 12 31 664 Re-inspections — 136 — 52 76 2 — 4 — 3 202 475 Drainage. House Drains Tested and Inspected 12 186 183 52 206 17 299 20 20 20 62 11 1088 Re-inspections 1 310 25 14 39 45 24 2 — 3 20 35 618 Inspections of Workshops 8 14 27 30 — 7 13 48 162 38 101 448 „ Factories 18 16 11 21 — — — 10 57 10 18 161 „ Bakehouses 34 36 31 22 — 20 5 12 29 63 21 '273 „ Slaughterhouses — 56 152 5 — — — 37 44 — — — 294 „ Dairies, Cowsheds and Milkshops 31 32 37 68 — 54 56 106 43 110 65 602 „ Ice Cream Premises 20 27 32 30 15 24 32 24 37 42 283 „ other Food Premises 121 188 46 130 320 1 202 103 71 229 219 1630 „ Mews 307 193 473 353 — 450 — 316 241 468 599 443 3843 Smoke Observations 52 8 7 16 — — 4 13 44 73 60 277 Other Inspections 574 250 183 372 152 203 83 179 209 408 220 241 3074 Food and Drugs Acts, &c. Samples taken (formal & informal) — 135 125 86 — 39 — 240 125 125 — 125 1000 Notices Issued. Public Health (London) Act, 1891. Intimations 360 405 295 513 276 234 395 252 167 109 354 170 3530 Statutory Notices 79 106 42 164 65 67 41 47 45 21 64 28 769 Final 19 44 8 59 22 20 46 — 14 3 7 7 24» Summonses issued — 14 — 23 6 8 7 4 — 1 2 — 65 Housing Acts, 1890 1919 Sect. 36, 1909 — — 26 5 1 — 2 — — — — — 34 Sect. 17, 1909 — 51 — 1 — 1 — — — — — — 53 Sec. '28, 1919 — 6 8 1 — — — 4 13 — — — 32 Underground Room Habitation — Removal of Manure 2 1 — — — — — — — — — 10 13 Smoke Nuisance Orders 1 — — — — — — — — — — — 1 Rent Restrictions Act Certificates 1 1 — 9 — 1 — 5 1 — 1 1 20 Special Notices included under Public Health (London) Act, 1891, relating to Factories — — — — — — — — — — — — — ,, Workshops — — — — — — — — 1 1 1 1 4 „ Bakehouses — — — 1 — — — — — — 3 3 7 Other Notices 2 — — — — — — — — — 3 1 6 Report of Wasteof Water to M.W.B. 5 25 4 18 4 — 2 6 1 2 23 6 96 „ Dangerous Structures to L.C.C. 5 11 — 15 3 — 1 4 6 — 3 1 49 89 TABLE VIA. Summary of Works completed by the Sanitary Inspectors during the Year 1924. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Grand Total 1 2 3 4 4a 5 5a 6 7 8 9 10 House Drains re-constructed 6 4 — 3 4 3 — 4 2 3 13 1 43 Defective Drains repaired 20 24 9 10 4 2 2 12 7 2 30 29 151 House Drains cleansed 34 35 14 9 6 11 2 30 5 17 120 89 372 Water-closets reconstructed, repaired, &c. 147 102 52 42 16 68 8 17 27 17 35 65 596 Water-closets supplied with water 10 8 5 27 10 84 16 2 14 6 107 54 343 Water-closets, new, provided 2 7 6 6 7 4 1 — 3 1 36 5 78 Soil-pipes ventilated, repaired, &c. 5 6 1 10 17 4 20 4 2 — 61 6 136 Soil-pipes, new, provided 5 4 1 4 2 4 2 1 2 2 21 3 51 Cisterns cleaned, covered, &c. 17 42 2 8 12 4 14 — 18 7 98 24 246 Yards, Areas paved, drained, repaired 53 87 21 31 21 17 57 12 25 12 33 63 432 Dustbins provided 97 112 90 66 23 66 42 15 29 34 126 87 787 Ashpits abolished 6 14 14 1 3 — 1 2 4 4 27 27 103 Accumulations of filth, &c., removed 31 57 2 7 — 29 1 15 — 19 17 217 395 Animals removed 7 8 2 8 — 5 — — — — — 12 37 Overcrowding abated — 13 1 5 1 1 — 3 — 4 3 — 31 Underground Rooms, illegal occupation discontinued 3 52 — 5 — — — — 1 — 1 3 65 Roofs repaired 109 88 50 90 69 78 97 32 23 46 137 42 861 Houses provided with water above basement floor 24 21 76 56 90 3 8 2 41 22 12 13 368 Dampness in Dwellings remedied 70 41 10 84 45 33 126 2 4 12 17 26 470 Houses closed under Sect. 17, Housing Act, 1909 — 1 — 1 — — — — — — — — 2 Repairs of Houses completed under Sect. 28, Housing Act, 1919 — 6 — 1 — — — — 13 — — — 20 Infectious Disease Cases removed 140 94 30 83 — 61 1 29 59 26 74 8 605 Houses Disinfected after Infectious Diseases (including Bedding, Clothing, &c,) 113 115 26 117 — 63 1 54 81 76 129 45 820 Rooms in such Houses, disinfected after Infectious Disease 135 170 30 122 — 71 1 122 154 107 236 84 1,232 Houses cleansed under Houses Let in Lodgings By-laws 99 221 57 76 — 102 — 4 115 16 113 11 814 Verminous Houses cleansed (including Bedding, Clothing, &c 107 65 33 51 44 13 25 10 14 6 8 8 384 Verminous Rooms cleansed in such Houses 308 98 83 58 86 12 59 13 19 8 8 6 758 Dirty Bedding cleansed 6 — 6 11 — .— — 6 — — — 1 30 Dirty Bedding destroyed 2 1 1 — — — — 2 — — 1 1 8 Other Sanitary Works executed 93 190 177 171 430 179 374 63 78 21 25 209 2,010 90 TABLE VII. The Work of the Women Health Officers for the Year 1924. HEALTH OFFICERS Total. 1 2 3 4 5 6 7 Child Welfare- First Visits to Infants 10 327 322 294 292 348 365 1,958 Return Visits to Infants 119 919 593 850 1,075 638 822 5,016 Visits to Children between 1 and 5 years 406 1,134 1,087 1,333 1,063 1,104 671 6,798 Stillbirth Enquiries 2 9 5 13 5 4 14 52 Visits to Ophthalmia cases 2 3 1 3 2 3 2 16 Return Visits to Ophthalmia cases 5 3 12 6 9 7 6 48 Visits to Measles cases 31 116 162 54 72 47 111 593 Visit to Whooping Cough cases 2 30 56 8 5 4 46 151 Visits to Puerperal Fever cases 1 3 — 1 1 — 1 7 Visits to Enteritis cases 1 26 15 3 — 2 10 57 Infantile Death Enquiries 14 35 30 17 23 25 37 181 Milk Investigations 43 133 53 60 4 81 144 518 Ante-Natal Visits 31 85 13 11 47 85 109 381 Half-days at Welfare Centres 15 97 132 145 133 118 140 780 Special Visits 1,339 235 128 195 258 235 206 2,596 Tuberculosis— Pulmonary.—First Visits 22 29 22 33 42 43 52 243 Re-Visits 143 145 253 238 90 330 342 1,541 Non-Pulmonary—First Visits - 12 13 7 13 8 2 8 63 Re-Visits 45 175 161 134 13 8 58 594 Factories arid Workshops Act. « Inspections of Factories 8 28 40 3 2 7 3 91 Inspections of Workshops 255 22 28 6 194 24 43 572 Inspections of Outworkers' Premises 9 1 9 23 — 31 27 100 Inspections of other Workplaces 2 — — — — 11 6 19 Total Visits 2,517 3,568 3,129 3,443 3,338 3,157 3,223 22,375 Notices issued under the Public Health Act— Intimation Notices — — 3 — — 1 — 4 Statutory Notices — — — — — — — — Final Notices — — — — — — — — Summonses — — — — — — — — 91 TABLE VIII. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1923. DATE. t Registration Sub-Districts comprised in Vaccination Officer's District. Number of Birfhs returned in Birth List Sheets. Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), viz.: Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Success fully Vaccinated. Column II. Column V. Dead, Unvaccinated. Postponement by Medical Certificate. Removed to other Districts and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Total Number of Certificates of Successful Vaccination received during the Calendar Year, 1924. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1923 1 2 3 4 6 7 8 9 10 1st January to 31st Dec. North 1,860 1,267 4 316 95 26 40 102 10 2,115 South 877 638 2 84 36 10 46 56 5 Total 2,737 1,905 6 400 131 36 86 158 15 92 TABLE IX. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1924. (as required by Ministry of Health Circular 359). Medical Officer of Health and Administrative Tuberculosis Officer. Year of Appointment James Fenton, M.D., D.P.H. 1920 Assistant Med A. W. K. Picard, M.D. 1922 Clerical Staff. Edward R. Hill (Chief Clerk) 1888 James H. Wilson 1902 Horace A, Hillam 1891 William Gascoyne 1919 John C. Minter 1917 John S. Russell 1923 Donald J. Hunt 1924 John S. Wheeler 1924 Sanitary Inspectors. *Henry Dawes (Senior Inspector) 1893 •Nelson Males 1897 •Charles G. Sexton 1898 •Thomas Cutting 1900 •James R. Bagshaw 1901 •Edward J. Bennett 1901 •George W. McQuinn 1901 •Joseph H. Fowles 1902 tjohn McDermid ..: 1920 tHubert J. Green 1922 ^Leslie W. Burrell 1923 IWilliam G. J. Sutton 1924 Women Health Officers. Miss E. Mackay 1909 Miss F. C. Hargrave 1910 Jt*Miss E. Dixon * 1917 Mrs. E. E. Buck 1918 J+*Miss W. H. E. Whitbread 1920 t*Mrs. V. A. Ross 1921 }t*Miss E. M. Law 1922 Miss A. E. Haycock 1922 J Miss E. E. Hamilton 1924 Mortuary Keeper. William Sutton ... 1907 Disinfecting Staff. Albert Nunn (Chief Disinfector) 1906 William Cambridge 1906 Frank Chillcott 1906 George H. I. Harris 1914 Alfred W. Newman 1924 Medicinal Baths Staff. Ernest McNie (Superintendent) 1924 Mrs. R. Webber (Matron) 1913 Rat Officer. George Bridge 1920 Drain Testing Assistant. William Clancy 1903 * Certificate of the Royal Sanitary Institute. Examination Board. † Certificate of the London Sanitary Inspectors ‡ Certified Midwife. All the Women Health Officers have undergone 3 years General Hospital Training and have secured the certificate of general nursing proficiency Exchequer grants equal to half the salary paid are received by the Council in respect of the Medical Officers, the Sanitary Inspectors, the Women Health Officers and Mr. Russell. INDEX. PAGE Administration 59 Advisory Committee to the Maternity and Child Welfare Committee— Work of the 41 Archer Street Infant Welfare Centre 32 Artificial Pneumothorax Treatment 27 „ Sunlight Treatment 35 Baby Clinic, Tavistock Road 34 Bacteriological Work 66 Bakehouses 44 Birth Rates, Death Rates, and Infantile Mortality Rates in 29 Metropolitan Cities and Boroughs (Table) 13 Births 4 Bramley Road Infant Welfare Centre 33 Campden Hill Infant Welfare Centre 33 Cancer 22 Cerebro-spinal Meningitis 19 Chapel of Rest 67 Cleansing of Verminous Persons Act, 1897 67 Closing Orders 75 Common Lodging Houses 72 Convalescent Homes 39 Council's Housing Programme 70 Creagh Nursery Training School 39 Cream Regulations 50 Day Nurseries 38 Deaths 6 „ Causes of (Tables) 7 and 80 „ Causes of at age periods (Table V. Appendix) 82 Dental Treatment of Tuberculous Persons 26 Dinners, Supply of 52 Diphtheria 15 Disinfection 64 Dispensary Treatment of Tuberculosis 24 Dogs, Fouling of Pavement by 68 Drainage Work 66 Dust Removal 65 Dysentery 19 Earl's Court Infant Welfare Centre 33 Encephalitis Lethargica 17 Enteric Fever 17 Erysipelas 21 Extra Nourishment, Mothers and Infants 51 Extra Nourishment, Tuberculous Persons 26 Factories and Workshops 52 Food Supply 42 Furnished Rooms 78 Golborne Infant Welfare Centre 33 Grants to Hospitals 41 Grants to Maternity and Child Welfare Institutions 41 Health Officers, Statistics of Work done during year (Table VII. Appendix) 90 Health Officers (Female) Duties and Work of 30 Home Helps 39 Home Nursing by Golborne Centre Nurse 40 Home Nursing by Kensington District Nursing Association 39 page Home Office Tables (Factories and Workshop)s 55 Homes for Deserted, Widowed or married Mothers and their Children 38 Home Work (Factories and Workshops) 54 Hospital Letters 41 Houses, Let in Lodgings 72 Housing of the Working Classes 69 Housing, Repairs and Improvements 73 Housing Statistics for 1924 76 Ice Cream 44 Illegitimate Children, Births and Deaths of 11 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923 67 Infantile Mortality 8 Infant Welfare Centres 31 Infectious Disease, Cases notified during the year (Table II. Appendix) 79 Influenzal Pneumonia 18 Ladbroke Road Baby Hospital 34 Lancaster Road Infant Welfare Centre 33 Legal Proceedings 59 Malaria 18 Margarine and Butter Substitutes 50 Marriages 4 Maternal Mortality 12 Maternity and Child Welfare 30 Maternity Home 35 Measles 21 Men's Workshops 52 Midwifery Arrangements 37 Milk, Dried, Supply of 51 „ Fresh „ 51 „ Supply „ „ 42 Milk Supply for Expectant and Nursing Mothers 51 Mortuary 67 Mothercraft Training Society 38 National Children's Adoption Association Hostel 39 Non-notifiable Diseases 21 Notifiable Infectious Diseases 14 Notification of Births Act, 1907 5 Ophthalmia Neonatorum 18 Pneumonia 18 Polio-encephalitis 18 Polio-myelitis 18 Population 4 Preservatives and Colouring Matter in Food 51 Prevalence of Disease 14 Provision of Bedding, Tuberculous Persons 29 Public Baths and Washhouses 66 Public Conveniences 66 Public Health Department Staff 59 Puerperal Fever 17 Queen Charlotte's Hospital, Midwifery Centre and Ante-natal Clinic 37 INDEX—continued. PAGE Rag Flock Act, 1911 67 Rats and Mice (Destruction) Act, 1919 68 Raymede Infant Welfare Centre 34 Refuse Removal from Mews 65 Sale of Food and Drugs Acts 45 Sale of Food Order, 1921 50 Samples (Adulterated) results of analyses 48 „ (Formal) taken 46 „ (Informal) „ 47 Sanitary Inspectors (Male), Summary of Work done during the Year (Tables VI. and VIa. Appendix) 88-89 Scarlet Fever 15 Slaughter-houses 44 Small-Pox 14 Statistics, Summary of 2 Tuberculosis' 22 „ Care Committee 27 PAGE Unsound Food 45 Vaccination Officer—Return for 1922 (Table VIII. Appendix) 91 Verminous Rooms Cleansed 65 Vital Statistics 4 „ „ for whole District, 1924, and previous years (Table I. Appendix) 78 Whooping Cough 22 Women's Workshops 53 X-ray Diagnosis of Tuberculous Persons 26 Zymotic Enteritis 19