KEN 29 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1926 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. 150—6/27 SUMMARY OF STATISTICS For the year 1926. Population 180,000 Area of Borough in Acres 2,291 Density of Population per Acre 78 Separate Houses or Self-contained Flats Inhabited 30,574 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 5.9 Number of Marriages 1,743 Number of Births 2,717 Birth Rate 15.1 Number of Deaths 2,305 Death Rate 12.8 Infantile Mortality:— Deaths under 1 year 164 Infantile Death Rate per 1,000 Births 60 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 9 Maternal Death Rate 3.3 Deaths from Phthisis 130 Phthisis Death Rate 0.72 Deaths from all Forms of Tuberculosis 160 Tuberculosis Death Rate 0.89 Deaths from the Zymotic Diseases 110 Zymotic Death Rate 0.61 Product of a 1d. Rate (Gross) £1 2,094 Rateable Value £2,902,581 Town Hall, Kensington, W.8. June 1st, 1927. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lords, Ladies and Gentlemen,— I have the honour to submit, for your information, my Annual Report for 1926 upon the state of the Public Health in Kensington. The Sanitary Officers' Order, 1926, prescribes that a Medical Officer of Health shall, as soon as practicable after the end of the year, make an annual report on the sanitary circumstances, sanitary administration and the vital statistics of the district, containing in addition to any other matters upon which he may consider it desirable to report, such information as may from time to time be required by the Minister of Health. The Minister, in the exercise of his powers under this Order, has directed that the Medical Officer of Health's Annual Report for 1926 shall be an Ordinary Report, that is, a Report of a more simple character than the full Survey Report which it was my duty to prepare last year. In accordance with the Minister's instructions, the present Report deals with the statistics of the year and reviews fully only those noteworthy conditions which were not dealt with adequately in the preceding Survey Report and important circumstances which have arisen subsequently to the preparation of that Survey Report. The year under review was satisfactory from the public health standpoint, the most noteworthy fact being the decline in the infantile death rate to 60 from 78 for 1925. The rate for 1926 is the lowest in the history of Kensington. It is lower than the rate for England and Wales and for that of London as a whole, and its publication will give considerable encouragement to those ladies and gentlemen who give voluntarily so much valuable time and thought to Maternity and Child Welfare work in Kensington. For the second time on record the Kensington death rate for all ages was under 13 per 1,000, the previous occasion of a similarly low rate being in 1923. The fall in the death rate from phthisis received each year since 1918 continued in 1926. At the present time the death rate from all forms of tuberculosis is nearly half the rate prevailing ten years ago. 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 ViceChairmen of the various Committees, all members of the Council, and the Chief Officers of other Departments, and of thanking 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. 4 POPULATION The population of the Borough as ascertained at the Census in 1921 was 175,859, but there hasbeen an increase since that date and for 1926 the Registrar-General has estimated the population to be 180,000. From this latter figure the inhabitants in the different Wards of the Borough have been estimated to be as shown in the following table — The Borough 180,000 North Kensington 94,852 South Kensington 85,148 Wards. St. Charles 24,841 Golborne 26,944 Norland 22,626 Pembridge 20,441 Holland 19,319 Earl's Court 18,335 Queen's Gate 14,097 Redcliffe 20,337 Brompton 13,060 At the 1921 Census, there were 67,805 males and 108,054 females. In Kensington, as in London, the numbers of males and females under the age of 15 years are approximately the same, whereas over that age females preponderate considerably. In London, there are 116 females to 100 males and in Kensington 159 females to 100 males. This proportion of females to males, which is higher in Kensington than in any other London Borough, has a very important bearing on the vital statistics of the district. 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. The Borough is peculiar in that there is no one occupation which absorbs a very large proportion of the male workers as is commonly found in many of the industrial areas. MARRIAGES. During the year 1,743 marriages were registered, representing a rate of 19.2 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 783 Roman Catholic Church 201 Nonconformist Churches 22 Jewish Church 14 Register Office 723 Total 1,743 BIRTHS. The number of births registered was 2,717, after correction for inward and outward transfers ; and the birth rate for the Borough was 15T per 1,000 population. Distributed according to sex and legitimacy the births were as follow:— Male. Female. Total. Legitimate 1,271 1,239 2,510 Illegitimate 103 104 207 Totals 1,374 1,343 2,717 Table showing the number of births and the birth rates in England and Wales, London, Kensington and the various districts in the Borough in 1926, and the rates for the previous five years:— 5 District. 1926. Birth-rates in previous years. No. of Births. Birth-rate. 1925. 1924. 1923. 1922. 1921. England and Wales 694,897 17.8 183 18-8 19-7 20-6 22-4 London 78,825 17.1 18-0 18-7 202 210 22-3 The Borough 2,717 15.1 158 16'2 17-5 176 18-7 North Kensington 1,772 18.7 20-6 21-7 22-6 229 25T South Kensington 757 8.9 8-3 92 101 9-8 11-3 Wards. St. Charles 456 18.4 18.8 20.5 21.4 23.6 23.8 Golborne 589 21.8 22.2 25.2 26.6 25.5 29.4 Norland 478 21.1 26.0 24.8 24.9 25.7 27.2 Pembridge 249 12.2 14.5 14.9 16.3 15.5 18.6 Holland 185 9.6 8.8 10.8 11.2 11.0 12.3 Earl's Court 196 10.7 8.2 9.9 10.4 10.6 14.1 Queen's Gate 110 7.8 8.5 6.9 6.6 6.9 7.5 Redcliffe 183 9.2 9.2 9.7 12.3 11.0 11.4 Brompton 78 5.9 6.3 7.5 8.7 8.4 10.4 Ward unknown 188 ... ... ... ... The effects of social status on the birth rate are illustrated by the fact that the rate for South Kensington is usually less than half the rate for North Kensington, whilst in 1926 the birth rate in each of the three most northerly Wards was more than three times as great as the rate for the Ward of Brompton 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 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 1925 15.8 1926 15.1 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, 2,717 births to Kensington mothers were registered, and of this number 2 616 or 96 per cent. were notified in accordance with the requirements of the Act. The number of stillbirths notified was 69. 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 28 1,453 1,481 „ „ „ Parents 1 78 79 „ „ „ Medical Practitioners 12 413 425 „ „ „ Other Persons 16 285 301 Births in the Borough 57 2,229 2,286 Notified from Institutions outside the Borough 12 318 330 Totals 69 2,547 2,616 Percentage of Births in Kensington notified during the past seven years, in accordance with the Notification of Births Act, 1907. Year. Percentage. 1920 90 1921 96 1922 93 1923 91 1924 94 1925 99 1926 96 The importance of securing due compliance with the Notification of Births Act cannot be over-estimated, for the information obtained constitutes the starting point of the work of Health Visitors. DEATHS. The number of deaths registered in the Borough during the year was 2,564, 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 2,564 Deaths of residents in public institutions, etc., beyond the Borough 557 3,121 Deaths of non-residents in public institutions, etc., within the Borough 816 Corrected number of deaths belonging to the Borough 2,305 The corrected number of deaths gives a death-rate of 12 8 per 1,000 living. The following table shows the number of deaths and the death-rates in England and Wales. London, Kensington and the various districts in the Borough in 1926, and the rates for the previous five years:— 7 District. 1926. Death-rates in previous years. No. of Deaths. Death-rate. 1925. 1924. 1923. 1922. 1921. England and Wales 453,795 11.6 12.2 12.2 11.6 12.9 12.1 London 52,431 11.4 11.7 12.1 11.2 13.4 12.4 The Borough 2,305 12.8 13.2 13.0 12.3 13.6 13.8 North Kensington 1,221 12.9 13.4 14.0 12.7 14.7 15.4 South Kensington 1,008 11.8 12.2 11.4 11.2 11.6 11.2 Wards. St. Charles 266 10.7 13.7 12.1 12.3 12.8 14.6 Golborne 352 13.0 12.6 13.4 12.8 15.9 16.7 Norland 340 15.0 14.7 12.5 15.1 17.2 16.6 Pembridge 263 12.8 12.7 13.4 10.3 12.8 13.3 Holland 261 13.5 14.1 12.1 11.4 12.1 11.6 Earl's Court 240 13.1 13.8 14.1 11.4 14.1 14.6 Queen's Gate 120 8.5 9.4 9.2 9.1 8.1 6.8 Redcliffe 237 11.6 12.2 11.3 13.5 12.2 12.5 Brompton 150 11.5 10.1 9.2 9.4 9.7 9.1 Ward Unknown 76 ... ... ... ... ... ... 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 1925 13.2 1926 12.8 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 for the year:- Cause of Death. Number of Deaths. Principal Zymotic (or Epidemic) Diseases 110 Epidemic Influenza 44 Phthisis 130 Other Tuberculous Diseases 30 Cancer 344 Bronchitis 169 Pneumonia 177 Heart Diseases 387 Bright's Disease 43 Puerperal Fever 6 Other Diseases and Accidents of Parturition 3 Premature Birth 22 Accidents 76 Old Age 108 All Other Causes 656 2,305 It will be seen that more than one-third or the deaths, or 863, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 130 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 substantial number of deaths, the causes of which are very largely preventable. 8 The following table shows the zymotic death rate for London and Kensington in each ol the last five years. Period. Deaths from Principal Zymotic Diseases per 1000 persons living. Kensington. London. 1922 0.97 1.11 1923 0.69 0.60 1924 0.80 0.73 1925 0.46 0.59 1926 0.61 0.63 Cancer.—Cancer caused 344 deaths, and of this number 320 occurred in persons over (the age of 45 years. Carcinoma was the form of cancer to which 263 deaths were attributed; sarcoma and epithelioma were the assigned cause of 29 deaths; 52 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, 1926. Parts Affected. Sex. Total. Male. Female. Buccal Cavity 12 2 14 Stomach, Liver, etc. 39 38 77 Peritoneum, Intestines, Rectum 32 50 82 Female Genital Organs ... 39 39 Breast ... 42 42 Skin 1 1 2 Other and unspecified Organs 41 47 88 Totals 125 219 344 The deaths in the several wards, etc., are set out in the following table:— The Borough 344 North Kensington 147 South Kensington 194 Wards. St. Charles 35 Golborne 29 Norland 46 Pembridge 37 Holland 55 Earl's Court 48 Queen's Gate 18 Redcliffe 47 Brompton 26 Ward Unknown 3 Making every allowance for improved diagnostic methods and other factors, there can be no doubt that the death rate from cancer is steadily increasing. The number of deaths from this disease in Kensington in each year from 1902 to 1906 and in each of the last five years is as follows:— Year. No. of Deaths. Year. No. of Deaths 1902 155 1922 261 1903 187 1923 269 1904 174 1924 293 1905 172 1925 315 1906 171 1926 344 These figures reveal the importance of discovering the cause and cure for this disease. With the exception of heart disease, cancer has recently been responsible for more deaths in Kensington than any other malady. Heart Disease.—Heart disease is still the commonest cause of death, and last year 387 persons died from this complaint, this number being 13 in excess of the figure for 1925. It has been estimated that probably about half the deaths from heart disease result from rheumatic fever contracted in the early years of life. This malady, which is common in children,. 9 as a great tendency to damage the valves of the heart and thus handicap the patient throughout fe, in addition to causing death from heart disease at a comparatively early age. Towards the end of the year under review the question as to whether the Council could take any steps to reduce the damage from rheumatic fever was under consideration by the Public Health Committee. Subsequently a Sub-Committee of the Public Health Committee held a conference with representatives of various interested organisations in the Borough. This conference concluded the opinion that rheumatic fever in children under sixteen years of age should be made a notifiable disease, that the Council should establish a supervisory clinic under the control of a skilled physician, that "after care" work should be organised and that the Council should endeavour to arrange for improved treatment of patients suffering from rheumatic fever, both in their homes and at hospitals. Such measures would go a long way towards reducing the amount of heart disease and invalidity following rheumatic fever. Table showing the number of deaths in 1926 from certain diseases of public health importance. arranged in four weekly periods. Four Weeks ending Measles. Scarlet Fever. Whooping. Cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhoea and Enteritis. January 30 7 — — 1 6 13 30 32 17 5 February 27 8 — — 2 6 12 27 20 18 2 March 27 3 1 — 3 3 11 31 18 18 4 April 24 3 1 — — 9 11 14 20 32 2 May 22 1 — — 4 5 6 26 10 12 3 June 19 2 1 1 1 2 5 18 12 7 2 July 17 — — — 2 6 22 4 7 5 August 14 — — 1 2 — 6 27 1 3 7 Sept. 11 — — 1 1 — 10 20 4 9 3 October 9 — 1 — — — 7 26 8 5 5 November 6 — — 1 2 4 18 29 16 18 3 December 4 1 — 1 2 3 19 40 14 14 3 January 1 — — 2 4 4 6 34 10 17 2 Totals 25 4 8 22 44 130 344 169 177 46 Infantile Mortality. During the year 1926, there were 2,717 births and 164 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality rate (death of infants under twelve months to each 1,000 births) of 60, which is by far the lowest rate recorded in the history of the Borough. The following table gives the births and the infantile deaths and death rates in England and Wales, London, Kensington and the various Wards of the Borough for the year 1926, and the infantile death rates for the previous four years. Table 1. 1926. Infantile Mortality Rate in previous four years, District. No. of Births. No. of Deaths of children under 1 year of age. Infantile Mortality rate. 1925 1924 1923 1922 England and Wales 694,897 48,503 70 75 75 69 77 London 78,825 5,008 64 67 69 60 74 The Borough 2,717 164 60 78 75 70 82 North Kensington 1,772 121 68 83 87 86 91 South Kensington 757 41 54 65 50 37 68 Wards. St. Charles 456 25 55 91 69 85 65 Golborne 589 50 85 77 99 107 104 Norland 478 24 50 99 98 84 109 Pembridge 249 22 88 87 69 42 79 Holland 185 15 81 88 57 51 89 Earl's Court 196 8 41 66 38 11 47 Queen's Gate 110 6 54 25 10 32 52 Redcliffe 188 7 37 48 71 48 81 Brompton 78 5 64 108 51 36 55 Ward unknown 188 2 — — — — — 10 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. Table 2. INFANTILE MORTALITY RATES, 1896-1926. Period. England and Wales. London. Kensington. 1896-1900 156 162 176 1901-1905 138 139 144 1906-1910 117 114 120 1911-1915 109 110 110 1916-1920 90 90 96 1921 83 80 110 1922 77 74 82 1923 69 60 70 1924 75 69 75 1925 75 67 78 1926 70 64 60 From the above table, it will be seen that in England and Wales, in London and in Kensington, there has been a steady improvement taking place in recent years, but that improvement has during the past few years been much 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. Indeed, it will be seen that with the exception of the period 1911 to 1915, when the Kensington rate was the same as that for London, and the year 1924, when the Kensington rate was equal to that for England and Wales, there has never been a period when the Kensington figure has not been worse than that for England and Wales and for London until 1926, when the rate for Kensington was four below that for London and ten below that for England and Wales. 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. THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1926. January 18 February 18 March 18 April 14 May 15 June 6 July 19 August 14 September 6 October 8 November 16 December 12 11 Table 3. CAUSES OF, AND AGES AT. DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1926. Causes of Death. Under 1 week. 1—2 2—3 weeks, weeks 3—4 weeks. Total 4 weeks 1—3 3—6 6—9 9—12 months, months, months, months. Total Infant Deaths under 1 year. 1. Common Infectious Diseases (Measles 2) (Whooping Cough 4) (Diphtheria 1) (Cerebro-spinal Meningitis 2) (Encephalitis Lethargica 1) — — — — — 3 2 .2 3 10 2. Tuberculosis... 1 1 1 3 3. Pneumonia and Bronchitis — 1 2 3 8 10 17 8 46 4, Enteritis 8 12 7 3 30 5. Complications of Birth (Injury 6) (Atelectasis 1) 7 — — — 7 — — — — 7 6. Congenital Malformation ... 4 2 — — 6 1 — — — 7 7. Premature Birth 18 3 1 — 22 — — — — 22 8. Atrophy, Debility and Marasmus ... 7 1 — — 8 4 8 — 20 9. Other Diseases (Meningitis 3) (Convulsions 7) (Overlying 3) (Other Conditions 6) 3 1 — — 4 5 4 2 4 19 Totals 39 8 1 2 50 29 37 29 19 164 Death-rate in each age period per 1,000 births 143 2-9 -3 •7 18-4 10-6 13-6 10-6 6-9 60 Percentage of total infant deaths occurring in each age period 23-7 4-9 -6 1-2 305 17-7 22-5 177 11-5 In comparing the above table with that which has appeared in previous reports, it is very interesting to find that the decline in the infantile death rate is largely the result of a decline in the number of deaths in the first month of life. This improvement is an indication that the concentration of effort on ante-natal work in recent years is beginning to tell. Not only are the mothers being advised at ante-natal clinfcs in regard to their own health during and after pregnancy, but they are receiving other instruction which is of great importance to the welfare of the young baby. Through lectures and home visits by experienced workers, the expectant working-class women of North Kensington are gradually acquiring that knowledge in mothercraft which enables them to give the young infant its greatest prospect of life. Of the thirty infant deaths from enteritis, or summer diarrhoea, which took place during the year, twenty-three occurred in tenement houses in North Kensington, three in tenement houses 1'2 in South Kensington, three in private houses and one in a South Kensington mews dwelling. This death in a South Kensington mews was the only one among the 112 children born in this class of dwelling and in this instance it was quite a good clean home; and it breaks a remarkable sequence of four years without an infant death from enteritis in South Kensington mews dwellings. It is most encouraging to note that for the third year in succession there were no infant deaths from enteritis in North Kensington mews dwellings. The Council's policy in recent years of securing a three-weekly removal of manure and their insistence on a higher state of cleanliness in mewsways must have contributed in a marked measure to this satisfactory result. 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 mcdical 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 1926 the "above standard" births numbered 705 and the deaths 25, giving an infantile mortality rate of 35. The 2,012 births and 139 deaths not "above standard" in 1926 give an infantile mortality rate of 69. The causes of death in the " above standard " cases are as follow:— Premature birth 9 Tubercular meningitis 3 Infantile debility 2 Congenital heart disease 2 Gastro enteritis 1 Other causes 8 Total 25 The wards to which the children belonged are:— St. Charles 3 Golborne 1 Norland 2 Pembridge 6 Holland 5 Earl's Court 2 Queen's Gate 3 Redcliffe 1 Brompton 2 Total 25 ILLEGITIMATE INFANT DEATHS. In 1926, 7.6 per cent. of the births in Kensington were illegitimate and 18.9 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 1926. Total. Legitimate. Illegitimate. Births 2,717 2,510 207 Infant Deaths 164 133 31 Rate per 1,000 births 60 53 150 13 The following table shows the number of illegitimate births occurring in the Borough during the last seven years:— 1920 274 1921 308 1922 207 1923 205 1924 185 1925 198 1926 207 The following table compares the total infantile mortality rate for the Borough in recent years with the illegitimate infantile mortality rate:— 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 1925 78 212 1926 60 150 The illegitimate infant death rate of 150 for 1926 compares very unfavourably indeed with the death rate of 60 for all infants and the death rate of 53 of legitimate infants. Indeed, the illegitimate death rate is nearly three times higher than the death rate of legitimate infants. This matter was dealt with very fully in my previous report, and the figures for 1926 emphasize the observations made therein. Maternal Mortality. In 1926 there were nine deaths of Kensington women from diseases or accidents directly connected with child-birth, and this figure represents a death rate of 3.3 mothers per 1,000 births The rate for London for 1925, the last year for which figures are available, was 3.2. The actual causes of death were:— Puerperal Fever 6 Accidents of Pregnancy and Parturition 3 9 There are ante-natal clinics at six of the seven Infant Welfare Centres in the Borough; at the seventh Centre an ante-natal clinic will shortly be established, but at present ante-natal advice is given privately at the infant welfare consultations; and an ante-natal session is held at the Baby Clinic at No. 92, Tavistock Road, W.11. In addition, the Queen Charlotte's Hospital Authorities hold a special ante-natal clinic at their Nurses' Home in Ladbroke Grove. In 1926, there were 2,717 births in Kensington and of these 705 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 1,181 of the 2,012 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 Institutions. The women who gave birth to the remaining 831 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 advice which is now generally recognised to be of the greatest value. It is pleasing to note that the number of expectant working class women receiving ante-natal advice represents more than 50% of the total, but it is still important to secure an even better attendance of expectant mothers and efforts in this direction should be continued. If the maternal mortality rate is to be lowered, more women must be induced to attend the ante-natal clinics. There is remarkable statistical testimony to support this statement. During the last five years there has been only one maternal death following confinement amongst the women who have attended ante-natal clinics in the Borough during pregnancy, whereas there have been fifty-seven deaths amongst those women who have not attended ante-natal clinics. 14 TABLE SHOWING THE BIRTH RATES, DEATH RATES AND INFANTILE MORTALITY RATES IN THE 29 METROPOLITAN CITIES AND BOROUGHS IN 1926. Births per 1000 Population. Deaths per 1000 Population. Infantile Deaths per 1000 Births. 1. Shoreditch 23.3 Lewisham 10.0 Lewisham 40 2. Poplar 21.7 Woolwich 10.1 Woolwich 42 3. Bethnal Green 20.9 Hampstead 10.1 Stoke Newington 49 4. Bermondsey 20.8 Wandsworth 10.4 Lamneth 54 5. Finsbury 20.6 Hackney 10.6 Bermondsey 56 6. Southwark 20.2 Fulham 10.7 Deptford 56 7. Stepney 19.7 Greenwich 10.9 Hampstead 58 8. Islington 18.5 City of London 10.9 Hackney 60 9. Deptford 18.2 Camberwell 11.0 Kensington 61 10. Greenwich 17.8 Stoke Newington 11.0 Battersea 61 11. Battersea 17.3 Deptford 11.1 City of Westminster 62 12. Hackney 17.3 Battersea 11.2 Greenwich 63 13. Lambeth 17.2 City of Westminster 11.2 Camberwell 64 14. Woolwich 16.9 Poplar 11.3 Wandsworth 64 15. St. Pancras 16.8 Hammersmith 11.3 Fulham 65 16. Camberwell 16.6 Lambeth 11.5 Chelsea 65 17. Fulham 16.3 Bethnal Green 11.6 Stepney 65 18. Hammersmith 16.3 Stepney 11.7 Shoreditch 66 19. Stoke Newington 15.6 Holborn 11.7 City of London 66 20. Lewisham 15.5 Bermondsey 11.9 Finsbury 67 21. Paddington 15.4 Shoreditch 11.9 Islington 67 22. Kensington 15.1 Islington 12.0 Hammersmith 67 23. Wandsworth 14.3 St. Pancras 12.2 Poplar 70 24. Chelsea 13.3 Paddington 12.3 Southwark 70 25. St. Marylebone 12.8 Kensington 12.4 Bethnal Green 72 26. Holborn 12.4 Chelsea 12.4 St. Pancras 76 27. Hampstead 12.2 St. Marylebone 12.6 St. Marylebone 82 28, City of Westminster 11.8 Southwark 12.7 Paddington 84 29. City of London 7.9 Finsbury 12.8 Holborn 90 The above figures are taken from the Return of the Registrar General No. 312, Table 11, which shows the provisional birth rate, death rate and infantile mortality rate for the year 1926 based on the population as estimated for the middle of 1925. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. In Circular No. 743, the Minister of Health has requested that the Report for 1926 shall give a review of the Health Services operating withn the area. In the case of a Metropolitan Borough such a review cannot be a complete statement of all the services which are available to the residents, for many seek aid from institutions and organisations beyond the Borough boundaries. For 15 example, large numbers of Kensington patients attend the West London and St. George's Hospitals, many attend those in the central area of London, some actually attend the London Hospital in the East End and the Fever Hospitals in every area of the Metropolis do from time to time accommodate Kensington patients. As it is the Minister's intention that each Medical Officer of Health shall review the services in his area, this report will be limited to an account of those actually within Kensington. STAFF OF THE COUNCIL'S 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 London County Council (General Powers) Acts and, so far as men's factories and workshops are concerned, under the Factory and Workshop 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. The Council employ two Temporary Sanitary Inspectors, who have been engaged during the past four years 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. A summary of the work of the Sanitary Inspectors will be found on pages 24 to 26, columns 1 and 2 at the end of each table representing the work of the temporary officers. In 1925, the Public Health (Meat) Regulations came into operation and the Council appointed a special Officer to carry out the duties required by the regulations. This Officer, who holds the Certificate of the Sanitary Inspectors' Examination Board and the Meat Inspectors' Certificate, also carries out the duties under the Sale of Food and Drugs Acts which, previous to his appointment, were performed by the District Sanitary Inspectors. 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. Health Lecturer.—In February, 1926, Miss Phoebe Goddard commenced her work as Health Lecturer, but relinquished her duties in June, when her place was taken by Mrs. Hayman. Mrs. Hayman is a fully trained hospital nurse. Her office is a part-time one occupying approximately five half-days a week. As the work is experimental in nature, the appointment is regarded as a temporary one. An account of the work done appears on page 77. Clerical Staff.—There are eight clerks in the Public Health Department one of whom is attached to the Tuberculosis Dispensary. Mr. J. H. Wilson was appointed Chief Clerk in 1925. 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. Particulars of ihe staff, as required by the Ministry of Health Circular No. 359, appear in "Table VII. of the Appendix 16 DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane by exposure to steam under a pressure varying between 16 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 3 lbs. of sulphur for each 1,000 cubic feet. *SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1926. Nature of Infection. Premises Disinfected. Rooms Disinfected. Disinfections at Wood Lane. No. of Articles Disinfected. Scarlet Fever 294 379 338 5,714 Diphtheria 410 535 413 6,060 Enteric Fever 45 60 112 1,122 Measles 146 200 19 342 Consumption 152 192 172 1,568 Cancer 64 92 81 1,015 Vermin 179 280 120 1,271 Other Diseases 174 219 220 2,185 Totals 1,464 1,957 1,475 19,277 * 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 43 tons, 9 cwts., 1 qr. and 1 lb. The number of articles disinfected only was 18,722 and the number disinfected and washed, 555. The laundry work for the Medicinal Baths is performed at the Disinfecting Station and this work involved in 1926 the washing of 11,627 towels, 437 sheets and 73 dressing gowns and blankets. The Paddington Authority have 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. As the Paddington Council require certain of the articles to be washed after disinfection, the charge was fixed at 20s. Od. per cwt. of articles dealt with, but there is a proviso in the agreement that the minimum payment per annum is to be £600. The weight of Paddington articles disinfected in 1926 was 22 tons, 19 cwts., 2 qrs. 12 lbs. and 3,380 articles were washed. The Paddington Authority are responsible for the collection of the articles and removal 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. The number of books from the Kensington Public Libraries destroyed during the year by the officers of the Public Health Department was 48. The number of private subscribing library books destroyed was 8; and the number disinfected by formalin and returned to the householders was 12. BACTERIOLOGICAL WORK. The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.1, 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 1926 were as follow:— Disease suspected. No. of examinations. No. of positive results. Diphtheria 1588 246 Tuberculosis 203 42 Typhoid Fever (Widal) 6 1 „ „ (Faeces) 17 4 Gonorrhœa - 8 - Ringworm 1 1 Syphilis 1 - 17 In addition to these examinations at the Lister Institute, 535 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 for admission to the Second Class Baths, children being admitted at half price. During the year, the Council installed special apparatus for the constant filtration and aeration of water in all four swimming baths with a view to securing that the same shall at all times be perfectly clean. The type of plant selected was that made by the Pulsometer Engineering Company, Limited. Practical tests have proved the efficiency of the filtration and aeration plant and bacteriological examinations of the water have shown that even after the baths had been used by numerous bathers the water was as pure as when it was originally drawn from the mains. The plant should amply repay the Council for their capital expenditure by savings on water and fuel. Further tests are to be made during the coming Summer and the results of these will be reported in my next Annual Report. 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 l½d. 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. 1922 245,374 1923 251,069 1924 257,056 1925 265,632 1926 241,349 In the Wash-house or Laundry Department, there were 90 wash-tubs in use in 1926. 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 everv succeeding hour on anv one day. The number of women using the wash-tubs in the last five years is shown in the following table:- Year. Washers. 1922 100,546 1923 110,252 1924 109,502 1925 105,581 1926 106,568 The charge for the use of the washing machines is 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 in 1926 was 11,961. MORTUARY AND CHAPEL OF REST. During the year 67 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of relatives or friends of the deceased 41 At the request of undertakers 2 At the request of Coroner 5 By the police 19 67 In 18 cases, post-mortem examinations were made under the Coroner's warrant. 18 Fifty-seven bodies were deposited in the Chapel of Rest, Avondale Park. This building is of considerable convenience to those poor persons in Notting Dale who live in perhaps one or two rooms and have no satisfactory accommodation for the bodies of dead relatives until the day of the funeral. CLEANSING OF VERMINOUS PERSONS. The cleansing of verminous persons is carried out at the Medicinal Baths, Blechynden Mews, and the record of work done during the year is as follows:— Total Cleansings. Scabies— Adults 78 Schoolchildren189 Children under five years 32 Verminous Conditions— Adults 50 Schoolchildren 3,868 Children under five years 8 Other Conditions— Adults 19 Schoolchildren 140 Children under five years 1 Total 4,385 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 on their visit to the Medicinal Baths, 179 blankets and sheets, 89 articles of night clothing, and 238 other articles have been dealt with. Of the 4,197 school children cleansed at the Medicinal Baths in 1926 only 306 were compulsory cases, the remainder attending voluntarily. The steady improvement in the general cleanliness of school children is most encouraging. At the 3,868 cleansings for verminous conditions in 1926, only 67 children were found to be infested with lice, the remainder showing only eggs of lice on their heads or clothing. THE KENSINGTON POOR LAW AUTHORITY. I am indebted to the Clerk to the Guardians who has kindly provided me with the following particulars in order that I might comply with the request made by the Minister of Health to supply information of the work, etc., done. The Kensington Institution.—This Institution, which is situated in Marloes Road, provides indoor relief for the destitute and infirm. Number of beds for male adults 476 Number of beds for female adults 620 (Accommodation is also available for 18 married couples). Number of adult admissions during the year ended 31st December, 1926 2,458 Average daily number of adult admissions during the year ended 31st December, 1926 6.7 Number of beds for children 66 Types of cases (children) admitted a) Remand children. (b) Children admitted with parents (c) Children for transfer to Schools, etc. Number of children's admissions during the year ended 31st December, 1926 730 Average daily number of children's admissions 2.0 Last ascertained cost per head at the Institution 2s. 11d. per day. 19 St. Mary Abbot's Hospital.—This Institution, which is also situated in Marloes Road, provides medical and surgical treatment for the sick and disabled. Number of beds for male adults 244 Number of beds for female adults 295 Number of adult admissions during the year ended 31st December, 1926 3,621 Average daily number of adult admissions 9.9 Number of beds for children 120 Types of cases (children) admitted All types, except infectious cases which are passed on to the Fever Hospitals. Number of children's admissions during the year ended 31st December, 1926 1,257 Births 328 1,585 Average daily number of children's admissions 4.3 Last ascertained cost per head at St. Mary Abbot's Hospital 5s. 10d per day. Out-door Relief. Number of cases receiving out-door medical treatment during the year ended 31st December, 1926 No. 1 District (West of Lad- broke Grove) 302 No. 2 District (East of Lad- broke Grove) 293 No. 3 District (South of Notting Hill Gate and Holland Park Avenue 37 Total 632 GENERAL HOSPITAL. Although Kensington may be regarded as a central London Borough, it is curious that there is only one General Hospital within the Borough boundary, namely, the Kensington, Fulham and Chelsea General Hospital. There are, however, the West London Hospital, St. Mary's Hospital and St. George's Hospital just outside the Borough. The work performed at the Kensington, Fulham and Chelsea General Hospital for the year 1926 is as follows:— 1.—In-Patients. (a) Number of Beds and In-Patients. Number of Beds available for use 19 Average number of Patients resident daily throughout the year 16 Number of In-Patients in the Hospital at the beginning of year 13 „ „ „ admitted during year 337 „ „ „ in the Hospital at the end of the year 14 Average number of days each Patient was resident 17.75 II.—Out-Patients. (a) Numbers. Total number of new Out-Patients 6,202 Total number of Out-Patient Attendances 26,116 Number of Patients on books at the beginning of the year 410 Number of Casualty Patients 1,823 Number of Casualty Attendances 5,469 CHILDREN'S HOSPITAL. As is now generally known, the movement to provide in the crowded district of North Kensington an efficient hospital for children, with an Out-patient Department which women also could attend, originated from a private conference convened by H.R.H. The Princess Louise, Duchess of Argyll, in Kensington Palace in January, 1924. The old Kensington Dispensary and Children's Hospital in Church Street was housed in outworn insanitary premises and the growth of London had swept the poorer members of the community away northwards. The work begun after the formation, at a public meeting in February, 1924, of a Hospital Re-establishment Committee, with the then Mayor of Kensington, Alderman Archibald J. Allen, at its head, has continued unceasingly, and much progress has been made. In April, 1925, the Committee purchased an excellent site at the corner of St. Quintin Avenue and Wallingford Avenue in North Kensington, and in September of the same year sold the old building, unfit for further use, in Church Street. 20 Every effort to provide the new hospital at an early date has been made. The plans, prepared by the architects as the result of much research and enquiry were finally adopted early in 1926 and building operations commenced on July 26th. A considerable portion of the future building was already distinguishable when H.R.H. The Princess Louise, Duchess of Argyll, laid the Foundation Stone on Tuesday, November 2nd, in the presence of a large number of supporters of the hospital. The out-patient department and a ward unit of fifteen beds will be completed during the present year and it is hoped to open this first portion of the Hospital for patients in September next. Pending the erection of the new hospital, out-patient work has been carried on during 1926, at St. Mark's Church Institute, St. Mark's Road, North Kensington. Here 3,201 patients have been dealt with, both children and women, and 14,671 attendances recorded. The lack of beds has been keenly felt; more than 150 children whose cases were urgent and serious, requiring inpatient treatment, have been unable to be dealt with at these premises. In spite of these drawbacks the number of patients attending has been much higher than during the last few years in Church Street, and has shown a steady increase, thus affording further proof of the need known so well by those who live or work in North Kensington and its neighbourhood, for a properly equipped hospital with accommodation for a large number of patients. At the present time the staff engaged at the St. Mark's Road temporary out-patient department is as follows:— Honorary Medical Officers 5 Resident Medical Officer 1 Dispenser 1 Sister-in-Charge 1 SCHOOL MEDICAL SERVICE. Dr. Menzies, the County Medical Officer, has kindly made it possible for me to give the following particulars of the routine medical examination of elementary school children carried out in 1926 in Kensington. TABLE SHOWING NUMBER EXAMINED AND DEFECTS FOUND. Number examined Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. 1046 511 866 722 987 605 815 763 Defect. Cases. Cases referred for treatment. Cases. Cases referred for treatment. Cases. Cases referred for treatment. Cases. Cases referred for treatment. Cases. Cases referred for treatment. Cases. I Cases referred for treatment. Cases. 1 1 Cases referred for treatment. Cases. 1 Cases referrec for treat ment. Malnutrition 2 ... 2 2 1 1 ... ... 1 ... ... ... 2 1 ... ... Skin Disease 26 17 8 8 13 8 6 5 20 12 6 5 5 2 6 3 Detective Teeth ... 249 ... 128 ... 182 ... 200 ... 246 ... 172 ... 177 ... 178 Enlarged Tonsils 142 37 64 14- 70 15 70 24 171 43 85 14 90 24 105 39 Adenoids 6 2 2 1 3 1 ... 3 2 2 2 5 3 Tonsils & Adenoids 31 26 8 7 14 11 8 8 28 20 15 12 15 11 6 6 Other Nose & Throat 54 16 12 5 22 10 16 6 31 9 15 5 15 4 22 10 Enlarged Glands 159 28 98 8 72 4 72 6 135 23 106 9 78 5 71 7 Eye Disease 41 31 23 11 19 10 11 2 28 20 21 9 15 9 12 4 Defective Vision ... ... ... 51 ... 103 ... 83 ... ... ... 48 ... 103 ... 88 Otorrhoea 15 11 8 5 6 4 13 10 13 8 8 6 13 10 18 11 Other Ear Disease 1 ... 1 1 1 ... 1 ... 3 1 ... 1 1 1 ... Defective Hearing 1 ... 1 .... 2 1 9 2 2 1 1 1 8 4 7 3 Speech Defects 5 ... 5 1 5 2 3 2 2 2 ... ... 1 ... 2 1 Heart Defects 42 1 16 ... 32 2 23 ... 26 ... 23 ... 24 1 39 2 Anaemia 12 ... 18 3 15 1 4 ... 11 1 11 ... 15 1 15 2 Lung Defects 66 9 13 4 15 4 15 6 36 4 15 ... 11 1 10 3 Nervous System 13 1 4 1 7 ... 3 1 5 ... 3 ... 6 1 8 1 Phthisis 1 1 ... ...... 1 1 ... ... ... ... ... ... 1 1 ... ... Other Tubercular Disease 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Rickets 29 1 13 ... 10 ... 7 • • • 19 ... 9 1 3 ... 10 ... Spinal Deformities 2 1 6 4 10 5 11 3 1 ... 6 1 14 6 22 16 Other Deformities 9 2 9 3 18 6 7 1 9 2 8 1 8 4 13 2 Other Defects 17 8 18 8 16 9 11 2 28 19 12 5 21 8 22 7 Number of children noted for treatment 364 214 330 306 335 239 326 322 21 TABLE SHOWING THE CONDITIONS IN REGARD TO CLOTHING, NUTRITION, CLEANLINESS, TEETH AND VISION OF THE CHILDREN EXAMINED. Age Group. Number examined. Clothing and Boots. Nutrition. Cleanliness of Head. Cleanliness of Body Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either eye. Entrants Boys 1,046 794 246 6 267 740 39 — 1,025 21 — 1,025 21 — 579 323 144 — — — Girls 987 808 170 9 256 705 26 — 942 43 2 969 18 — 554 303 130 — — — Age 8. Boys 511 346 153 12 89 399 23 — 501 9 1 479 30 2 269 185 57 248 160 90 Girls 605 468 131 6 136 451 18 — 565 36 4 579 26 — 351 190 64 307 184 100 Age 12 Boys 866 604 234 28 212 635 19 — 855 10 1 826 40 — 579 253 34 497 228 137 Girls 815 578 221 16 139 640 36 — 752 59 4 789 26 — 571 216 28 428 229 156 Age 14 Boys 722 516 181 25 171 538 13 — 710 11 1 696 26 — 453 246 23 441 145 131 Girls 763 607 153 3 185 568 10 — 724 37 2 723 40 — 538 201 24 441 189 129 Total 6,315 4,721 1,489 105 1455 4,676 184 — 6,074 226 15 6,086 227 2 3,894 1,917 504 2,362 1,135 743 Kensington percentages 74.7 23.6 1.7 23.1 74.0 2.9 96.2 3.6 0.2 96.4 3.6 0.0 61.7 30.3 8.0 55.7 26.8 17.5 London percentages 60.2 38.5 1.3 21.4 72.8 5.8 92.5 6.9 0.6 96.0 3.9 0.1 64.2 28.5 7.3 54.7 25.5 19.8 SCHOOL TREATMENT CENTRES. There is in Notting Dale a School Treatment Centre managed by a voluntary committee and the work performed thereat during 1926 is as follows:— New Cases. Total attendances. Eye Cases 650 1,503 Aural Cases 529 2,237 Minor Ailment Cases 2,068 30,677 Dental Cases 1,341 2,433 X-Ray Cases 64 342 A School Treatment Centre has also been established at the Baby Clinic premises in Tavistock Crescent and the record of work for the year 1926 is as follows:— Minor Ailment Cases 3,651 26,674 Dental Cases 1,196 4,363 PROFESSIONAL NURSING IN THE HOME. The Borough is fortunate in having within its boundaries an excellent District Nursing Association which employs a Superintendent and eleven nurses to carry out the nursing of all diseases in the homes of the poor. The number of cases nursed during 1926 was 2 287 and the number of visits paid, 38,964. The following is a table of cases attended and visits paid by nurses of the Kensington District Nursing Association on behalf of the Council from January 1st to December 31st, 1926:— Cases, Visits. Maternity Cases 31 474 Miscarriages 30 292 Pneumonia 293 3,295 Ophthalmia Neonatorum and other Inflammations of the Eyes of Newly-born Children 35 359 Influenza 37 336 Zymotic Enteritis 116 1,245 Tuberculosis 34 987 Measles 60 839 Whooping Cough 2 52 Erysipelas 1 19 Totals 639 7,897 22 For the splendid services rendered, the Council paid to the Association in 1926 a grant of £200. 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. The cases attended and visits paid by the Golborne Home Nurse during the past year are given in the following table:— Cases Attended. Visits Paid. Adults 10 35 Children under 5 years of age 272 2,531 Totals 282 2,566 Bronchitis 34 172 Ear Discharges 34 815 Measles 16 97 Minor Ailments 188 1,447 Totals 272 2,531 MIDWIFERY ARRANGEMENTS. The Borough is well served in this respect. The Queen Charlotte's Hospital Authorities maintain a District Nurses' Home in Ladbroke Grove, North Kensington, and during the year members of the staff thereat conducted 862 confinements, of which 822 were in Kensington homes. The Borough Council maintain a Maternity Home with ten beds and the Guardians also have a ward of ten beds for the confinement of poor women. The number of confinements dealt with by these three organisations, together with those taking place in outlying hospitals, leaves but a comparatively small number to be attended by private doctors and midwives in the homes. In addition to the six ante-natal clinics at the infant welfare centres in the Borough, a similar clinic is maintained by the Queen Charlotte's Hospital authorities at their District Nurses' Home, which is situated a little to the north of Ladbroke Grove Railway Station—a point easily accessible to the majority of North Kensington mothers. The record of work at the Queen Charlotte's Clinic for 1926 is as follows:— Number of individual expectant women who attended the ante-natal sessions 862 Number of Kensington cases 822 Number from other Boroughs 40 Total number of attendances of all ante-natal cases 2,711 The medical work at this ante-natal clinic is performed by the doctors of the Hospital. AMBULANCE FACILITIES. Ambulances for infectious, accident and maternity cases are provided by the Metropolitan Asylums Board and the London County Council, and during the year the service proved efficient OTHER HEALTH SERVICES. There are no fever hospitals within the Borough, but several provided by the Metropolitan Asylums Board are within easy reach. The arrangements for the treatment of tuberculosis and the organisation for maternity and child welfare work are discussed further on in this report. Kensington enjoys a great advantage in possessing a large number of ladies and gentlemen who give freely of their time and money to voluntary bodies interested in the health and welfare of the poorer members of the community. Not only are all the maternity and child welfare institutions in Kensington organised on a voluntary basis, but there are at work in the Borough two branches of the Charity Organisation Society, a branch of the Invalid Children's Aid Association, a branch of the British Red Cross Society, the Kensington Council of Social Service, School Care Committees, a. Tuberculosis Care Committee and a number of other bodies managed and financed on voluntary lines by Kensington residents. The Council have endeavoured with marked success to work in close co-operation with these organisations and the relationship between them has always been a happy one. 23 SUBSCRIPTIONS BY THE BOROUGH COUNCIL TO VOLUNTARY HEALTH ORGANISATIONS DURING 1926. Subscriptions to Hospitals, etc. £ s. d. Brompton Hospital for Consumption 10 10 0 Cancer Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 Kensington District Nursing Association 5 5 0 Kensington and Fulham General Hospital 5 5 0 Kensal Gospel and Medical Mission 5 5 0 National Hospital for Diseases of the Heart 5 5 0 Paddington Green Children's Hospital 5 5 0 Princess Louise Kensington Hospital for Children 13 13 0 St. Mary's Hospital 10 10 0 West London Hospital 10 10 0 Western Ophthalmic Hospital 5 5 0 The sanction of the Ministry of Health is not applied for in respect of these subscriptions and no Government contribution is received. Payments to Maternity and Child Welfare Institutions. £ s. d. Archer Street Infant Welfare Centre 122 0 0 Bramley Road „ „ „ (with Kenley Street Branch) 293 0 0 Campden Hill „ „ „ 97 0 0 Earl's Court „ „ „ 222 0 0 Golborne ,, ,, ,, 272 0 0 Lancaster Road „ „ „ 222 0 0 Raymede „ „ - 222 0 0 Evelyn Convalescent Cottage Home 16 16 0 Hambledon Cottage Home 8 8 0 Hammersmith Borough Council (Maternity Home) 46 13 0 F ulham ,, ,, ( ,, ,,) 16 16 0 Kensington Board of Guardians ( „ „ ) 819 1 8 Kensington District Nursing Association 200 0 0 Ladbroke Road Baby Hospital 200 0 0 Mutual Registration of Assistance Society 10 0 0 Raymede Massage and Electrical Treatment Centre 50 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 £200 to the Kensington District Nursing Assiciation in respect of which the Government contribution is £75. 24 SANITARY CIRCUMSTANCES OF THE AREA. SANITARY INSPECTION. The following table shows a summary of the inspections, etc., carried out by the Male Sanitary Inspectors during the year:— DESCRIPTION OF INSPECTIONS. &c. NUMBER OF DISTRICT Temporary Inspectors Grand Total 1 2 3 4 5 6 7 8 9 10 1 2 Total Complaints Received - 385 236 155 243 267 237 117 158 272 181 20 13 2284 Public Health (London) Act, 1891. Complaints received 196 41 124 153 163 234 107 151 271 165 9 13 1627 Houses inspected on complaint 197 40 129 137 162 269 113 157 271 161 12 16 1664 „ after Infectious Disease 120 164 125 104 123 60 43 65 67 46 3 4 924 Re-inspections 1025 548 1260 1016 1509 1287 925 797 1761 567 — 1 10,696 By-Laws re Houses Let in Lodgings Complaints received 189 195 31 90 104 3 10 7 1 16 11 — 657 Houses Inspected on Complaint 189 195 34 75 70 3 10 7 1 16 10 — 610 First Annual Inspection (Furnished Houses) 12 2 22 12 2 3 — — — — — — 53 Re-inspections „ „ 120 6 302 11 — 94 — — — — — — 533 First Annual Inspection (Unfurnished Houses) 242 320 207 292 231 95 257 86 179 51 — — 1960 Re-inspections „ „ 1111 1690 884 1338 885 993 560 24 191 308 93 — 8077 Housing Act, 1925. Initial Inspections (including preparation or revision of House to House Card) 43 79 109 86 181 37 148 64 220 102 621 478 2168 Re-inspections — 112 52 55 66 67 178 1 5 108 581 1156 2381 Underground Living Rooms. Primary Inspections — 8 6 14 7 16 1 4 9 — 368 167 600 Re-inspections — 34 1 14 21 62 6 1 — — 62 115 316 Drainage. House Drains Tested and Inspected 40 200 151 43 192 18 27 13 69 53 186 178 3175 Inspections of Workshops 12 27 61 51 38 39 84 145 82 141 — — 680 „ Factories 17 33 30 29 15 52 34 35 8 19 — — 272 „ Bakehouses 44 13 46 19 6 1 15 28 61 26 — — 259 „ Ice Cream Premises 22 8 15 39 17 11 5 18 30 18 — — 183 „ other Food Premises 99 84 109 52 194 260 84 83 250 286 — — 1501 ,, Mews 283 200 525 398 128 267 158 443 360 364 — — 3126 Smoke Observations 83 3 — 2 2 — — 42 112 96 — — 340 Other Inspections 425 423 416 376 458 320 319 708 263 367 31 44 4150 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc., found in the various districts during the year:— NUMBER OF DISTRICT Temporary Inspectors. Grand Total 1 2 3 4 5 6 7 8 9 1 2 Kind of Notices Issued. Public Health (London) Act, 1891. Intimations 388 793 254 623 453 202 255 87 262 173 393 349 4232 Statutory Notices 69 228 41 185 171 104 42 27 42 47 52 93 1101 Final 7 99 1 56 52 6 5 2 9 2 20 31 290 Summonses issued 6 12 8 23 17 19 4 1 2 — — — 92 Housing Act, 1925. Sect. 3 (Repairs) 6 5 2 5 6 3 9 — — 1 — — 37 Sec. 127 (Entry) 11 26 2 18 19 6 29 — — 4 — — 115 Underground Room Habitation — 1 1 — 1 — — — 2 2 — — 7 Removal of Manure 4 19 — 1 3 — — — 9 32 — — 68 Smoke Nuisance Notices - 3 — — — — — — — — — — — 3 Rent Restrictions Act Certificates - 1 — 1 3 — 2 3 — — 1 — — 11 Special Notices included under Public Health (London) Act, 1891, relating to Factories — 3 — — 1 — — 1 1 — — — 6 ,, Workshops — 8 — — 10 — — 2 5 — — — 25 „ Bakehouses — 7 — — — — — — — — — — 7 Other Notices 13 7 — 1 — — — — — 3 34 — 55 Report of Wasteof Water to M.W.B. 8 17 — 16 10 15 — 15 31 5 7 3 127 „ Dangerous Structures to L.C.C. 16 17 4 8 7 1 2 1 1 1 2 — 60 26 Summary of Works completed under the supervision of the Sanitary Inspectors during the Year. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Temporary Inspectors Grand Total 1 2 3 4 s 6 7 8 9 1C 1 2 House Drains re-constructed 8 7 4 11 25 3 — 1 7 8 1 1 76 Defective Drains repaired 16 9 19 11 16 6 4 7 13 44 1 — 146 House Drains cleansed 43 47 22 10 23 18 4 39 101 80 1 2 390 Water-Closets re-constructed 42 3 18 15 68 5 18 8 26 22 7 2 234 „ repaired 121 34 52 14 50 19 20 12 44 98 1 11 476 „ supplied with water 10 43 10 26 13 3 12 11 68 98 2 11 307 „ new provided 6 14 6 3 9 19 2 1 19 10 3 8 100 Soil Pipes ventilated, repaired, &c. 5 11 7 31 27 3 2 10 59 10 2 3 170 „ new provided 3 14 3 18 30 6 12 2 44 6 6 1 145 Cisterns cleansed 12 14 6 6 41 6 2 6 83 20 4 9 209 „covered 8 14 6 5 26 — — 3 23 9 3 7 104 „ abolished — 4 — — 2 — 1 1 5 — 1 2 16 Taps fixed on rising main 2 5 6 — — 2 4 3 20 4 — 1 47 Yards, areas paved, drained, repaired 44 33 22 22 76 14 14 11 12 53 70 26 397 Dustbins provided 144 65 68 47 95 26 25 38 106 80 29 39 762 Ashpits abolished 9 5 3 2 21 1 2 2 38 17 9 8 117 Accumulations of filth, &c., removed 27 29 5 7 14 11 2 49 16 36 1 — 197 Animals removed 11 25 4 2 11 2 2 5 3 7 — — 72 Overcrowding abated 5 20 11 6 9 9 3 — — 1 3 3 70 Underground Rooms, illegal occupation discontinued 2 6 4 9 7 5 1 2 6 1 1 — 44 Roofs repaired 115 88 85 61 75 31 29 42 95 77 7 63 768 Houses provided with water above basement floor 7 4 42 15 9 7 5 6 — 4 — 30 134 Dampness in Dwellings remedied 104 99 18 83 50 4 19 21 26 57 20 22 523 Closing Orders made under Sect. 11, Housing Act, 1925 — — — — — 1 — — — — — — 1 Closing Orders made under Sect. 18, Housing Act, 1925 — — 7 9 1 6 1 — — — — — 24 Closing Orders determined — — — — — — — — — — — — — Repairs of Houses completed under Sect. 3, Housing Act, 1925 4 1 2 5 5 — 8 — — 1 — — 26 Infectious Disease Cases removed 113 119 99 100 108 30 35 33 53 22 — 2 714 Houses disinfected after Infectious Diseases (including Bedding, Clothing, &c.) 90 131 148 155 140 53 97 113 64 59 — 2 1052 Rooms in such Houses disinfected after Infectious Disease 90 136 212 169 147 69 123 161 136 92 — 2 1337 Houses cleansed under Houses Let in Lodgings By-laws - 125 175 82 199 130 69 112 10 32 35 109 52 1130 Verminous Houses cleansed (including Bedding, Clothing, &c.) 125 39 74 39 41 4 17 3 32 29 — 14 432 Verminous Rooms cleansed in such Houses 366 39 230 46 — 4 20 18 48 34 — 34 891 Dirty Bedding cleansed 7 13 1 12 29 — 3 3 6 2 — — 76 Dirty Bedding destroyed 1 2 — 4 — — — 1 — — — — 8 Other Sanitary Works executed 110 182 166 200 172 90 169 18 3 173 141 555 1979 27 Summary of Legal Proceedings Nature of Offence. Number of Summonses heard before the Magistrates. Magistrates' Decisions. Failure to carry out sanitary repairs. 36 Order made for work to be carried out within 7 days in 2 cases,within 14 days in 10 cases, within 21 days in 8 cases, and within 28 days in 1 case. Fined £5 and order made for work to be carried out within 14 days in 1 case, fined £5 and order made for work to be carried out within 21 days in 1 case, fined £2 and order made for work to be carried out within 7 days in 2 cases, fined £2 and order made for work to be carried out within 14 days in 1 case, fined £1 and order made for work to be carried out within 14 days in 1 case, and fined £2 in 2 cases Summonses withdrawn work having been carried out in 7 cases. Failure to comply with the order made by the Justices requiring the execution of sanitary repairs. 5 Fined £5 in 2 cases, £2 in 1 case, and £1 in 1 case. Summons withdrawn work having been carried out in 1 case. Failure to comply with by-laws for Houses Let in Lodgings. 10 Fined £2 in 5 cases, 30/- in 1 case, and £1 in 3 cases. Summons adjourned sine die in 1 case. Failure to provide sufficient water closet accommodation. 5 Fined £2 in 1 case and £1 in 1 case. Summonses withdrawn work having been carried out in 3 cases. Failure to provide a proper supply of water to the upper storeys. 7 Order made for work to be carried out within 14 days in 2 cases and within 21 days in 1 case. Summonses withdrawn work having been carried out in 4 cases. Failure to abate overcrowding. 6 Order made for abatement within 1 month in 1 case. Summonses withdrawn, overcrowding having been discontinued, in 2 cases, and summonses adjourned sine die in 3 cases. Failure to remedy dampness. 1 Order made for work to be carried out within 21 days. Failure to comply with Closing Order. 5 Fined £1 in 1 case, and 10s. in I case Order made for compliance within 21 days in 1 case and within 1 month in 2 cases. Failure to provide a sufficient supply of water to premises. 1 Closing Order made to become operative after 14 days. Failure to comply with Magistrate's order to provide a sufficient supply of water to premises. 1 Fined £2. Unlawfully occupying or suffering to be occupied premises in which articles of food intended for the food of man were deposited, such premises having direct inlets to the drain. 2 Fined £2 in 1 case and £1 in 1 case. 28 Summary of Legal Proceedings—continued. Nature of Offence. Number of Summonses heard before the Magistrates. Magistrates' Decisions. Failure to cleanse a foul and offensive room. 1 Order made requiring the abatement of the nuisance within 7 days. Unlawfully occupying an underground room as a dwelling. 2 Fined £2 in 1 case. Summons withdrawn, the use of the room as a sleeping place having been discontinued in 1 case. Unlawfully permitting an underground room to be occupied as a dwelling. 2 Fined £2 in 1 case. Summons withdrawn, the use of the room as a sleeping place having been discontinued in 1 case. Failure to comply with Magistrate's order prohibiting the use of underground room. 1 Summons withdrawn, the room having been vacated. Failure to remove an accumulalation of rubbish. 1 Order made for removal within 7 days. Failure to comply with Magistrate's order to remove an accumulation of rubbish. 1 Fined £1. Allowing a dog to deposit its excrement on the public footway. 3 Fined 10s. in each case. Unlawfully obstructing the execution of a warrant issued to a Sanitary Inspector authorising him to enter premises 1 Fined £5. Failure to pay expenses of work carried out by the Council in default under Section 3 of the Housing Act, 1925. 2 Order made for payment plus 5 per cent. interest in each case. Total 93 In addition to the above, there were issued under the Sale of Food and Drugs Acts 24 summonses, particulars of which are given on pages 43 and 45. SEWERAGE AND DRAINAGE. Every house in the Borough is connected with the water carriage system for the disposal of sewage. House drainage is, generally speaking, quite satisfactory. For example, the two Temporary Inspectors made routine inspections of house drains in 364 cases and of this number it was found necessary to require reconstruction in only two cases and repairs in one case. The number of house drains inspected, including those inspections which may be described as routine in addition to those made on complaint or after infectious disease, totalled 1,175; in 76 cases reconstruction was required and in 146 cases repairs were found to be necessary. During the year, 100 new water-closets were provided under notice by the Sanitary Inspectors in order to supplement the accommodation already existing. DUST REMOVAL. House refuse is collected at least once a week in all districts in the Borough but more frequentr collections are undertaken in certain special areas. 29 The refuse is either disposed of by incineration 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. During the year, the Minister of Transport, on the advice of the London and Home Counties Traffic Advisory Committee and in the exercise of his powers under the London Traffic Act, 1924, made Regulations prescribing the times during which vehicles may be used in certain main streets for collecting house refuse. The Regulations contained the provision that house refuse should not be collected in specified streets between the hours of nine o'clock in the morning and seven o'clock in the evening. In order to comply with the Regulations, the Council decided upon a daily collection in the specified streets and availed themselves of the powers conferred by the by-law made by the London County Council under Section 16 (2) of the Public Health (London) Act, 1891. This by-law provides that "where the local authority determine upon a daily collection of house refuse, they may require the occupiers of premises affected to place their dustbins on the kerb-stone or on the outer edge of the footway or in an easily accessible position on the premises at such hour as the said authority may fix." Notices were served on the occupiers of premises requiring them to place their dust receptacles in the desired position not later than eight o'clock in the morning. During the past year, 762 removable ashbins of galvanised iron have been provided and 117 fixed ashpits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904, as a result of notices served by the Sanitary Inspectors. 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. The problem of securing hygienic conditions in mewsways has been tackled with considerable success during the past three years as a result of close co-operation between the officers in the Public Health Department and the Borough Engineer's Department. The Borough Engineer has undertaken a more extensive surface sweeping of the mewsways with the result that there is a general appearance of tidiness, and no complaints have arisen in regard to decomposing trade and other refuse deposited on the mewsway surfaces. Collections of house refuse are made at least twice weekly in all North Kensington mews. 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 men's and 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. SMOKE ABATEMENT. The Borough contains but few factories or other workplaces where there is a considerable fuel consumption and thus the problem of smoke abatement is not a very large one. Nevertheless, in a Borough which is essentially residential in character, it is very desirable that the nuisance from smoke should be reduced to a minimum, and during the year the Council's Sanitary Inspectors made 340 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health (London) Act, 1891. The only nuisances discovered were in the northern portion of the Borough, in which district it was necessary to serve three notices, which were followed by abatement. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-23. Applications made to the Council in 1926 for certificates under the Acts totalled 15, and 11 certificates were granted. The comparative failure by tenants to attempt to make use of the provisions of the Acts is probably due 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. RAG FLOCK ACT, 1911. Four samples of rag flock were analysed and reported on during the year. They contained 22 20, 15 and 9 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. 30 FOULING OF FOOTPATHS BY DOGS. Towards the end of 1921, the Council succeeded in obtaining the approval of the following by-law for the good rule and government of the Royal Borough:— " No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. " Any person offending against this by-law shall be liable to a penalty not exceeding 40s. " This by-law shall cease to be in force after 31st day of December, 1923, unless a by-law confirming and continuing its provisions has been duly made and come into force before that date." This by-law was made in pursuance of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1889. In 1923 the by-law was sanctioned without limit of time and the Council now have a permanent measure by which they can secure a considerable improvement in the cleanliness of the public footways. The Council have issued leaflets which have been posted in various places in the Borough and delivered by hand to a large number of dog-owners. Attention has been called to the by-law by slips attached to the rate demand notices and the matter has received notice in the local press. Two officers in the Public Health Department make observations and during 1926 they reported three breaches of the by-law to the Public Health Committee. Summonses were taken out, and in each case a fine of 10/- was imposed. The number of convictions under this by-law during the past five years is 10. THE RATS AND MICE (DESTRUCTION) ACT, 1919. A Rat Officer is employed 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:— Number of individual premises visited by the Rat Officer on receipt of complaint 134 Total number of visits paid 1,841 Number of poison baits laid during the year 90,965 „ „ disappeared 85,332 „ ,, removed by the Rat Officer 5,633 Number of premises where concreting of basement floors has been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 24 Number of premises where other repairs have been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 86 Number of sewer defects allowing egress of rats made good 12 Number of Statutory Notices served under the Rats and Mice (Destruction) Act, 1919 6 Number of premises cleared of rats 135 An account of the methods of destruction adopted by the Rat Officer appears in the report for 1923. During the National Rat Week Campaign, held in November, the following special measures were adopted. Sewers.—Five pairs of flushers were placed at the disposal of the Council's Rat Officer to assist him in the laying of baits of barium in the entrances to sewers. In South Kensington 91 entrances were baited daily and in North Kensington 97, the baits disappearing in the majority of cases between the flushers' daily visits. Thirty thousand barium baits in all were laid in the sewer entrances during the week. Wood Lane Depot.—One thousand two hundred barium baits were laid in the metal and other dumps. Railways.—Companies whose lines are within the boundaries of the Borough were requested to co-operate in baiting and in every case expressed their willingness to do so. One company successfully used gas in a number of rat holes. Cinemas.—By special arrangements with the proprietors of several cinemas in the Borough, lantern-slides were shown at all performances during Rat Week informing the public that advice and assistance in connection with rat extermination can be obtained on application to the Public Health Department. VERMINOUS PREMISES CLEANSED. Four hundred and thirty-two verminous houses were cleansed during the year by landlords in response to notices served under the powers conferred by the London County Council (General Powers) Act, 1922. The Council's Rat Officer, in addition to his duties under the Rats and Mice (Destruction) Act, carries out disinfection of verminous premises in certain cases. The following is a summary of his activities in this direction: — Number of premises visited 101 Number of rooms sprayed with Solution "D" 129 31 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 995. 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 homeworkers and inspect the sanitary conveniences reserved for women in railway stations and other public places in Kensington. The factories in the Borough number 247, and are inspected and Tegulated 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. Factories and Workshops where men are employed.—At the end of the year, the registered workshops at which men were employed numbered 421. The factories at which men were employed numbered 187, 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 bv the Sanitarv Accommodation Order of 4th Februarv. 1903. The following table shows the various trades and occupations carried on in registered workshops and factories where men are employed:— Trade or Business. Workshops. Factories. Total. Aerated water manufacturers – 2 2 Bakers 58 31 89 Basket makers 1 1 2 Bath crystal maker 1 – 1 Billiard table maker 1 – 1 Biscuit maker – 1 1 Blacksmiths 7 – 7 Blind makers 2 – 2 Boot makers and repairers 60 17 77 Box maker 1 – 1 Brush maker – 1 1 Builders 41 11 52 Cabinet makers 13 4 17 Carpet repairer 1 – 1 Chaff cutter – 1 1 Chiropodist 1 – 1 Cigarette makers 2 1 3 Coach builders 9 3 12 Coal wharves 2 – 2 Composition ivory worker – 1 1 Cooked meat dealers 1 2 3 Cycle repairers 5 1 6 Dairy – 1 1 Dyers 1 2 3 Electricity generating stations – 4 4 Electric light fitting makers 2 3 5 Electric sweeping machine maker – 1 1 Enamel maker 1 – 1 Eyelet hole maker – 1 1 Firewood choppers 2 2 4 Fried fish shop – 1 1 Furniture depository 3 – 1 Furriers 5 – 5 Gas fittings store 1 – 1 Gas works – 2 2 Hairdresser 1 – 1 Instrument makers – 2 2 Ironmongers 2 – 2 Ladder makers 1 1 2 Lampshade makers 2 – 2 Laundries 6 17 23 Manufacturing chemist 1 – 1 Marine stores 3 – 3 Masons 1 1 2 Metalworkers 7 8 15 32 Trade or Business. Workshops. Factories. . Motor engineers and garages 33 31 64 Motor spirit dealers 2 – 2 Organ builder 1 – 1 Oxy-acetylene welder – 1 1 Perfume manufacturer 1 – 1 Photographers 2 – 2 Photographic supplies manufacturer l – 1 Piano makers l 1 2 Picture frame makers 9 – 9 Pipe maker – 2 2 Plumber 1 – 1 Pottery warehouse 1 – 1 Printers 2 8 10 Rubber dealer 1 – 1 Rusk manufacturer – 1 1 Saddlers 3 – 3 Sausage makers 1 6 7 Sewing machine mechanic 1 – 1 Sign writers 4 – 4 Starch maker – 1 1 Steam pressers 1 1 2 Sundry businesses 4 1 5 Sweet manufacturers 1 1 2 Tailors 59 2 61 Timber merchant – 1 1 Trunk makers 4 – 4 Undertakers 10 1 11 Upholsterers 20 1 21 Washing machine manufacturers – 2 2 Waste paper merchant 1 – 1 Watch makers 5 – 5 Wax figure manufacturers 1 1 2 Wheelwrights 7 1 8 Wine and spirit dealer 1 – 1 Wireless worker – 1 1 Total 421 187 608 Factories and Workshops where women are employed.— The number of workshops and factories at which female labour was employed at the end of 1926 was 635,'.187 in North Kensington and 448 in South Kensington. The number of persons employed varies with the period of the year, being, of course, greatest during the "season." 33 The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. Workshops. Factories. Total. Blind makers 3 – 3 Blouse makers 3 – 3 Bookbinder 1 – 1 Boot makers and repairers 4 1 5 Cabinet maker – 1 1 Cardboard-box maker 1 – 1 Carpet maker 1 – 1 Chemist 1 – 1 Cigarette maker 1 – 1 Corset makers 9 – 9 Draper 1 – 1 Dressmakers and ladies' tailors 332 1 333 Dyers and cleaners 7 1 8 Embroidery workers 4 – 4 Eyelet-hole maker – 1 1 Fancy hand-bag maker 1 – 1 Florists 12 – 12 Furriers 18 1 19 Hairdressers 19 – 19 Hemstitcher – 1 1 Invisible menders 4 – 4 Jewellers 3 2 5 Knitted goods 1 – 1 Lace workers 4 – 4 Lampshade makers 3 – 3 Laundries 46 46 92 Machinist 1 – 1 Milliners 43 – 43 Non-inflammable composition manufacturer – 1 1 Outfitters 9 – 9 Pastry cook 1 – 1 Photographers 9 – 9 Pictorial advertisements 1 – 1 Picture frame makers 3 1 4 Pipe maker – 1 1 Powderpuff maker 1 – 1 Printer – 1 1 Restaurants 4 – 4 Scarf maker 1 – 1 Shirtmaker 1 – 1 Surgical supplies – 1 1 Stationery packer 1 – 1 Sweet makers 1 – 1 Toilet requisites 1 – 1 Toy makers 2 – 2 Typist 1 – 1 Umbrella makers 2 – 2 Upholsterers 10 – 10 Weaver 2 – 2 Wig maker 1 – 1 Wire brush maker – 1 1 Total 574 61 635 Home Work.— Of the 228 outworkers registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshop 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 74 Outworkers in Domestic Workshops 35 Outworkers in their own Homes 119 Total number of Outworkers 228 34 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 119 home workers on the register is as follows:— Tailoring 55 Dressmaking 26 Bootmaking 13 Drapery 7 Blouse making 4 Lampshade making 3 Outfitting 3 Linen working 2 Box making 1 Collar making 1 Furrier 1 Millinery 1 Underwear 1 Ironing 1 119 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 Workshop Acts, so far as it is capable of being expressed in this form:— 1. No. of Factory Inspections 146 2. „ Workshop „ 773 3. „ Home Workers' Inspections 154 4. „ Work Place „ 80 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. I.—Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 518 12 – Workshops (including Workshop Laundries) 1315 73 – Workplaces (other than Outworkers' premises) 108 10 – Total 1941 95 – 35 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 123 120 – – Want of ventilation 6 6 – – Overcrowding 4 4 – – Want of drainage of floors 4 4 – – Other nuisances 47 47 – – Sanitary accommodation insufficient 15 15 – – unsuitable or defective 31 30 – – not separate for sexes 9 9 – – Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) 1 1 – – Breach of special sanitary requirements for bakehouses (SS. 97 to 100) – – _ – Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) 1 1 – – Total 241 237 – – * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. FOOD SUPPLY. MILK SUPPLY. Milk and Dairies (Consolidation) Act, 1915.—This Act, the operation of which was postponed owing to War conditions, came into force on September 1st, 1925. It has for its main object the prevention of the sale of tuberculous milk. Under this Act County Councils and County Borough Councils may make an order which will prohibit the sale of infected milk in any area. In this connection it should be pointed out that the Minister of Agriculture and Fisheries has made a Tuberculosis Order which came into operation on September 1st, 1925. This Order provides for the slaughter of bovine animals infected with certain specified forms of tuberculosis and for the payment of compensation in respect of animals so slaughtered. It will be the duty of the local authority, when in the exercise of their powers under the Act they discover the presence in a herd of an animal to which the Order applies, to cause it to be slaughtered in pursuance of the Order. When this Act came into operation the Council decided that a number of samples of milk should be taken each year for the purpose of examination for the presence of tubercle bacilli. In the year 1926, twelve samples were taken and in no case were the organisms detected. If a sample were found to contain tubercle bacilli, the County Council or the County Borough Council exercising authority in the area from which the milk came, would be notified in order that steps might be taken under this Act and the Tuberculosis Order to prevent milk from the infected cow or cows being used further for human consumption. The Act enlarges the powers of officers of local authorities to take samples of milk for chemical examination, and such samples may, under the Act, be taken at any time before the milk is delivered to the consumer. Perhaps the most important change of the law effected as far as Kensington is concerned is in connection with the third schedule which amends the provisions of the Sale of Food and Drugs Acts with regard to the warranty defence. When the purveyor proposes to plead such a defence he must give notice to the local authority so that a sample from a corresponding milking can be taken in the course of transit or delivery to the purveyor; and if the owner of the cows so requests, a further sample must be taken at the dairy at which the cows 36 are kept. Unless notice is given within 60 hours of the sample being taken the warranty defence cannot be used. This defence will also not be available where the sample in respect of which proceedings are taken is a mixture of milk obtained from more than one seller or consignor. Power is also given to the local authority of the district in which the first sample was taken, instead of or in addition to taking proceedings against the purveyor, to proceed against the seller or consignor. In nineteen instances where the Council's Food Inspector had obtained a sample of milk from a purveyor a request was submitted that a further sample should be taken in the course of delivery from a corresponding consignment, and in every case both the original sample obtained from the purveyor and that obtained from the consignor were found to be of genuine composition. Milk and Dairies Order, 1926.—The Milk and Dairies (Consolidation) Act, 1915, grants power to the Minister of Health to make a Milk and Dairies Order with regard to various matters, such as the registration of dairies, the addition of colouring matter, the sale of certified milk, etc., and in pursuance of this power, the Minister made a Milk and Dairies Order in 1926. This Order, which came into operation on October 1st, 1926, revoked the Dairies, Cowsheds and Milkshops Order, 1885, which had been in force during the year up to that date. The main provisions of the rescinded Order and Regulations are incorporated in the new Order, but modified in accordance with the development of modern hygienic knowledge so as to lay greater stress on the cleanliness in all operations connected with the production and handling of milk than upon the structure of buildings. The most important of the entirely new provisions of the Order relate to the health and inspection of cattle, the handling, conveyance and distribution of milk and the prevention of the spread of infectious disease through the milk supply. The new Order requires the Council to keep two registers, namely, one for premises wherein milk is sold or deposited for sale, and one for the names of owners or occupiers of these premises. 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 compliance with the resolution. Milk and Dairies (Amendment) Act, 1922.—Section 2 of this Act empowers the Council to refuse to enter any person's name on the Register of Dairies, 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. Register of Retail Dairies and Milkshops.—The Milk and Dairies (Consolidation) Act, 1915, and the Milk and Dairies Order, 1926, make it clear that a shop wherein milk is not supplied otherwise than in the properly closed and unopened receptacles in which it was delivered to the shop does not come within the definition of a dairy. Furthermore, a shop where milk is sold for consumption on the premises only is not included in this definition. The new definition has made it necessary to revise the Council's Register of Dairies and the alterations made during the year are shown in the following table. Milkshops. Restaurants. Totals. Transfers 8 – 8 Vacated and removed from Register 1 – 1 Removed from Register under the Milk & Dairies (Amendment) Act, 1922 1 – 1 Removed from Register as not being dairies defined by the Milk and Dairies Order, 1926 – 34 34 Premises added to Register 5 – 5 On Register December 31st, 1925 148 34 182 On Register December, 31st 1926 151 – 151 (+) Increase. (—) Decrease + 3 –34 –31 In one case where there had been several convictions under the Sale of Food and Drugs Acts in respect of adulteration, the Council decided to remove the dairyman's name from the Register. 37 The dairyman appealed against the Council's decision to a Court of Summary Jurisdiction, but the appeal was dismissed. A relative, who had been connected with the business for some years, then submitted an application for registration, but as the Council were not satisfied that he was more than a nominee of the former dairyman, registration was refused. An appeal against this decision was made to a Court of Summary Jurisdiction and, after several adjournments, the Magistrate referred the case back to the Council with directions to register the applicant on the following conditions: (a) that a dissolution of partnership between the two persons be executed, (b) that the former dairyman give an undertaking not to carry on the trade of dairyman or purveyor of milk within the Borough for a period of five years and (c) that the former dairyman vacate the premises. The Council, acting upon these directions, registered the relation. Register of Wholesale Dairies.—The Milk and Dairies (Amendment) Act, 1922, requires the Council to keep a separate Register of wholesale dairies. This Register contained one name at the beginning of the year and no alteration has been required. Inspection of Dairies and Milkshops.—The Milk and Dairies Order, 1926, requires a higher standard of hygiene in connection with milkshops and the distribution of milk than existed under previous legislation and, in order to secure the improvements required as smoothly as possible, the Council directed that a routine inspection of twelve dairies should be made every month and notices served with a view to bringing these premises up to the standard required by the new Order. From October to the end of the year thirty-six dairies were inspected in this routine manner and it was found that eighteen complied in every respect with the requirements of the Order. In the remaining eighteen, minor defects only were found, in respect of which statutory notices were served ; these notices were complied with in every case. The total number of inspections of dairies and milkshops during the year was 636 and such sanitary defects as were found were remedied. Milk (Special Designations) Order, 1923.—Under the Order the Council are authorised to grant . licences to persons other than a producer to sell milk under special designations. 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 1926 were as follow:— (a) Dealers' licences to use the designation "Certified Milk" 30 (b) Dealers' licences to use the designation "Grade A (Tuberculin Tested) Milk" 19 (c) Dealers' licences to use the designation "Pasteurised Milk" 27 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 to set up a pasteurising establishment within the Borough. During the year, nine samples of "Certified Milk" and two of "Grade A (Tuberculin Tested) Milk" were taken for the purpose of ascertaining whether they complied with the bacteriological standards laid down in the Milk (Special Designations) Order, which are as follow:— Special Class of Milk. Maximum number of bacteria permitted per c.c. Standard for bacillus coli. "Certified Milk" 30,000 Must not be found in onetenth c.c. "Grade A. (Tuberculin Tested) Milk" 200,000 Must not be found in one- hundredth c.c. The results of the examinations are shown in the following tables:— Sample collected on Producer. ''Certified Milk." Bacteria per 1 c.c. Coli per l/10th c.c. 28th January Viscount Elveden 1,726 Nil. 9th March Viscount Elveden 7,533 Nil. 9th March G. V. Baxendale 21,196 Nil. 27th May Express Dairy Co 2,743 Nil. 8th June G. V. Baxendale 3,766 Nil. 29th July Viscount Elveden 2,666 Nil. 29th July Viscount Elveden 6,700 Nil. 29th July Express Dairy Co 1,833 Nil. 28th December G. V. Baxendale 5,633 Nil. "Grade A. (Tuberculin Tested) Milk." 9th March B. Davis & Son 10,466 Nil. 8th Tune G. & C. King 16,300 Nil. It will be seen that all samples of designated milk proved to be well within the bacteriological standards prescribed by the Order, and, indeed, may be classed as very pure milks. 38 The Public Health (Condensed Milk) Regulations, 1923, and Public Health (Dried Milk) Regulations, 1923.—Twelve samples of condensed milk and six of dried milk were taken during the year and each was found to comply with the Regulations in every respect. 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. Fat3.7 „ „ Non-fatty solids 8.9 „ „ Of 286 formal samples of milk taken under the Food and Drugs Act in 1926, 16 were certified by the Public Analyst as adulterated, i.e., containing less than 3 per cent. of fat or 8.5 per cent. 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 1926. 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 Januuary 35 3.53 8.80 3.66 8.88 3.0 8.5 February 38 3.56 8.68 3.59 8.80 March 13 3.49 8.76 3.57 8.75 April 24 3.57 8.84 3.61 8.83 May 18 3.40 8.82 3.40 8.82 June 20 3.58 8.87 3.53 8.87 July 27 3.42 8.67 3.53 8.75 August 11 3.70 8.76 3.70 8.76 September 36 3.78 8.80 3.78 8.80 Average Composition, of Normal Cow's Milk. October 19 3.98 8.92 4.03 8.92 November 28 3.83 8.90 3.83 8.90 December 15 3.84 8.84 3.96 8.82 Percentage of Percentage of Milk Fat. Solids not Fat. Average for the Year 3.64 8.79 3.73 8.82 3.7 8.9 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. Addition of Colouring Matter to Milk.— section 4 of the Milk and Dairies (Amendment) Act, 1922, prohibits the addition of any colouring matter, or water, or re-constituted, or skimmed or separated milk, to milk intended for sale. This section enables the Council to deal 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. In two samples taken during the year the presence of artificial colouring matter was detected, and upon proceedings being taken the Magistrates imposed a fine of £5 and 10s. 6d. costs in each case. Milk Utensils in Infected Houses.— he 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 then thanks for the information received. Cowsheds.— There are no cowsheds in Kensington. 39 MEAT. Slaughter Houses.— These are licensed annually by the London County Council in the month of October and the five Kensington licences granted in 1925 were renewed in 1926. These premises are kept in a cleanly condition, and from a structural point of view are not open to objection. During the year over 1,000 pigs were killed in the slaughterhouse in Walmer Road and the licence in respect of the premises was renewed by the London County Council in October, subject to the same conditions as in the previous year, namely, that the premises be not used for the purpose of slaughtering on more than twenty 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 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. By-laws prescribing humane slaughtering came into operation in London during 1924, and approved methods have been adopted at each of the slaughterhouses in the Borough. The Council's Food Inspector makes frequent inspections to satisfy himself that these humane methods of slaughtering are applied satisfactorily. Public Health (Meat) Regulations, 1924.—These Regulations provide that no person may slaughter any animal without first giving verbal or written notice to the Council of his intention. Upon receipt of such notice, the Council's Food Inspector attends during the slaughtering process whether by day or night, and examines all carcases immediately afterwards. During the year three hundred and twenty-six slaughterhouse inspections were made. The following table shows the number of animals slaughtered in the Borough in 1926. Month. Beasts. Animals Slaughtered. Swine. Sheep. January 8 174 44 February 4 148 53 March 2 56 64 April – 8 41 May 4 13 129 June 2 – 102 July 2 – 72 August – 21 33 September – 184 95 October – 335 90 November – 163 80 December 10 190 124 Total 32 1,292 927 Diseased meat condemned during this period was as follows:— Carcases (including organs) 4 Forequarters 1 Hindquarters 2 Plucks 32 Heads 41 Livers 63 Lungs 117 The Regulations prescribe for the protection of meat from contamination by dirt and flies in shops, on stalls and during transit. The administration of this requirement has been rendered somewhat difficult owing to the various interpretations which could be placed upon the Regulations dealing with this matter. The Ministry of Health issued a Circular in 1925, which stated that the provision of glass fronts to butchers' shops in all cases was not contemplated, and that the precautions which it would be reasonable to require under the Regulations must depend on the circumstances of individual cases. Speaking generally, the Council have every reason to feel satisfied with the way in which butchers have responded to the demands made upon them. Of the 124 butchers' shops within the Borough 120 have been provided with glass fronts, whilst in the four shops remaining precautions have been taken which would probably satisfy the Magistrates that the Regulations have been adequately observed; at the present time there is not one shop in the Borough where the Council could, with any prospect of success, issue a summons for non-compliance with the Regulations. It should, however, be pointed out that in many cases the glass fronts are kept open at times of the day when trade does not require this. It is significant that in the better-class areas in the Borough it is usual for the windows to be kept closed at all times, probably because traders recognise that the customers in their areas appreciate the necessity of care being taken to keep meat free from contamination. With the advance of public opinion on the question of clean food, it is hoped 40 that the officers of the Public Health Department will be able to persuade all butchers to keep their shop windows closed much more than is the case at the present time. The precautions taken by those traders who retail meat from street stalls are not adequate. Ice Cream.—At the end of the year, one hundred and sixty-nine premises were shown in the Register of places within the Borough where ice cream is prepared or sold, two 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. One hundred and eighty-three visits to ice cream premises were made by the Inspectors during the year. The powers under the Public Health (London) Act, 1891, and the London County Council (General Powers) Acts, 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, by-laws are needed to secure the sale of ice cream from street barrows being conducted under clean conditions. Bakehouses.—There are eighty-six bakehouses in the Borough, and of this number sixty-two are underground. As a result of two hundred and fifty-nine inspections, which were made during the year, seven notices were served for the cleansing of walls and ceilings. Other Places Where Food is Prepared.—In addition to the above-mentioned premises, other places in the Borough where food is prepared or exposed for sale are required to be kept in accordance with the provisions of the London County Council (General Powers) Act, 1908. There were, in addition to inspections of dairies, ice cream premises, etc., mentioned above, 1,501 inspections of premises where food is prepared or exposed for sale. Unsound Food.—Under the provisions of Section 47 of the Public Health (London) Act, 1891, any persons having in their possession food intended for sale which is diseased or unsound, or unfit for human consumption, may surrender it to the Council for destruction as trade refuse. The unsound food surrendered and destroyed during the year is shown in the following list:— Apples (lbs.) 750 Cheese (lbs.) 75 Fish (stones) 26 Fish (canned) (tins) 82 Fruit (canned) (tins) 350 Game and Poultry (brace) 10 Meat (canned) (tins) 91 Milk (condensed) (tins) 79 Vegetables (canned) (tins) 176 In no instance was any unsound food seized under the Public Health (London) Act by the Council's Food Inspector. Sale of Food and Drugs Acts.—The Council's Food Inspector is the Inspector appointed under these Acts and he is instructed to take samples in any place within the Borough. The samples procured are of two kinds, namely, formal and informal. 41 (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 Food Inspector collected 686, of which 52 or 7.5 per cent. were adulterated. Particulars of formal samples collected are as follow:— Nature of Sample. Number Taken. Number Adulterated. Arrowroot 6 ... Asparagus, Tinned 1 1 Butter 37 ... Cakes, Sponge 12 ... Cheese 18 ... Cocoa 11 ... Coffee 15 ... Coffee & Chicory 4 ... Cream 22 1 „ Preserved 5 5 Dripping 6 ... Fish, Potted 4 1 Gin 1 ... Honey 12 ... Lard 6 ... Lemon Cheese or Curd 1 ... Margarine 35 ... Meat, Potted 29 ... Milk 286 16 „ Condensed 6 ... Mincemeat 6 ... Mustard 2 ... „ Compound 4 ... Pepper 6 ... Powder, Baking 1 ... Rice 21 1 Rum 2 ... Sago 3 ... Sausages 48 21 Semolina 2 ... Sulphur, Milk of 6 ... Sweets 15 ... Tea 6 ... Vinegar 39 5 Whisky 4 1 Prescriptions, Medical 4 ... Total 686 52 42 (b) 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. Almonds, Ground 1 ... Apples 1 ... Asparagus, Tinned 4 1 Butter 11 ... Cakes, Sponge 9 ... Cheese 9 ... Catsup, Tomato 1 ... Cocoa 3 ... Coffee and Chicory 1 ... Cream 9 ... Fish, Potted 1 ... Ginger Beer 1 ... Honey 10 ... Lard 3 ... Lemon Cheese or Curd 5 1 Lemon Essence 1 ... Lemonade, Crystals 1 ... Margarine 10 ... Meat, Potted 12 ... Milk 126 8 „ Condensed 6 ... „ Dried 6 ... Mustard 2 ... „ Compound 1 ... Oysters 2 1 Peas, Dried 2 ... „ Split 3 ... „ Tinned 3 ... Powder, Baking 2 ... Rennet, Essence of 1 1 Rice 6 1 Salt, Table 1 ... Sauce 4 ... Sausages 23 9 Soup, Ox tail 1 ... Tea 1 ... Tomatoes, Tinned 1 ... Vinegar 20 5 Whisky 6 ... Wines "British" 3 ... Total 313 27 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. 43 Summary of the Results of Analysis of the 77 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. Asparagus, tinned 1.9 grains of tin per lb. Informal sample „ „ 1.3 „ „ „ No action Cream 5.9 „ boric acid per lb. ,, „ preserved 19.4 ,, „ „ Vendor cautioned „ „ 16.4 ,, ,, ,, ,, „ „ 14.8 ,, ,, ,, ,, „ „ 12.2 ,, ,, ,, No action „ „ 9 ,, ,, ,, ,, ,, ,, Fish, potted 9 ,, ,, ,, ,, ,, ,, Milk 4.2 per cent. of extraneous water Proceedings. Fined £1 and 10s. 6d. costs „ 2.3 ,, ,, ,, No action „ 2 ,, ,, ,, ,, „ 1.5 ,, ,, ,, ,, „ 50.8 ,, ,, ,, Proceedings. Fined £50 and 10s 6d. costs „ 17 „ the required fat deficient „ „ £5 and £1 1s. 0d. costs „ 14 ,, ,, ,, ,, ,, ,, ,, ,, „ 7 ,, ,, ,, „ Summons withdrawn „ 6.5 „ extraneous water „ Fined £3 and £1 1s. 0d. costs „ 6 ,, ,, ,, ,, ,, ,, ,, ,, „ 6 ,, the required fat deficient „ „ 10s. and 10s. 6d. costs „ 3 „ extraneous water No action „ 13 „ the required fat deficient Proceedings. Fined £2 and 10s. 6d. costs „ 32 ,, ,, ,, „ „ £5 and 10s. 6d. costs „ 2 ,, ,, ,, No action „ 42 ,, ,, ,, Informal sample „ 2 „ extraneous water ,, „ 29 „ the required fat deficient ,, „ 14 extraneous water ,, „ 8 „ the required fat deficient ,, „ 8 ,, ,, ,, ,, „ 2 ,, ,, ,, ,, „ 8.7 „ extraneous water ,, Oysters 0.69 grains of copper sulphate per lb. ,, Rennet, essence of 87.3 „ boric acid per lb. ,, Rice 14 „ extraneous mineral matter per pound ,, „ 12.6 ,, ,, ,, Vendor cautioned Sausages 32.5 „ boric acid per lb. Proceedings. Fined £10 and 10s. 6d. costs „ 19.3 ,, ,, ,, „ „ £5 and 10s. 6d. costs „ 21.4 „ ,, „ „ „ £3 and £2 2s. 0d. costs „ 7 „ „ „ Vendor cautioned „ 16.3 ,, ,, ,, ,, „ 15.1 ,, ,, ,, ,, „ 11.9 ,, ,, ,, ,, „ 15.3 „ ,, ,, ,, „ 14.9 „ „ „ ,, „ 14.8 ,, ,, ,, ,, „ 14.6 „ „ „ ,, „ „ 12.8 ,, „ ,, ,, 44 Article Analysed. Nature and Amount of Adulteration. Action taken. Sausages 12.3 grains of boric acid per lb. Vendor cautioned „ 15.4 „ „ „ „ „ 15.2 „ „ „ „ „ 14.9 „ „ „ „ „ 14.5 „ „ „ „ „ 12.6 „ „ „ „ „ 14.9 „ „ „ „ „ 14.6 „ „ „ „ „ 5.6 „ „ „ No action „ 16.7 „ „ „ Informal sample „ 16.1 „ „ „ „ „ 14.8 „ „ „ „ „ 5.9 ,, ,, ,, „ „ 17.1 „ „ „ „ „ 14.9 „ „ „ „ „ 13.3 „ „ „ „ „ 15.2 „ „ „ „ „ 13 „ „ „ „ Vinegar 14.5 per cent. of the required acetic acid deficient Proceedings. Fined £2 and 10s. 6d. costs „ 5.5 „ „ „ Vendor cautioned „ 8 „ „ „ „ „ 5.5 „ „ 3 „ „ „ No action „ 31 „ „ „ Informal sample „ 1 „ „ „ „ „ 22 „ „ „ „ „ 5.5 „ „ „ „ „ 1 „ „ „ „ Whisky 39.21 degrees under proof Proceedings. Fined £5 and 10s. 6d. costs Proceedings under the Milk and Dairies (Amendment) Act, 1922. Nature of Offence. Result. Selling graded milk without a licence Fined 10s. The addition of colouring matter to milk intended for sale ,, £5 and 10s. 6d. costs. „ „ „ „ „ „ „ „ „ „ Proceedings under the Milk and Dairies Order, 1926. Nature of Offence. Result. Bottling milk otherwise than on registered premises Fined £1. „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ Failing to cover properly or otherwise effectively protect milk from contamination „ £2. 45 Proceedings under the Dairies, Cowsheds and Milk shops Order, 1885. Nature of Offence. Result. Carrying on the trade of purveyor of milk without being registered Conviction, 10s. costs. „ „ „ „ „ „ Fined £2 and £5 5s. costs. It will be seen that proceedings were taken in twenty-four cases, the fines and costs amounting to £134 16s. 6d. Cream Regulations.—The Public Health (Milk and Cream Regulations), 1912, made by the Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907, came into force on October 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 boric acid, 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 which will cease to operate when the cream clauses of the Public Health (Preservatives, etc., in Food) Regulations, 1925, come into force on the 1st January, 1928. The Public Health (Preservatives, etc., in Food) Regulations, 1925.—These Regulations were made on August 4th, 1925, and have been amended by the Public Health (Preservatives, etc., in Food) Amendment Regulations, dated December 10th, 1926. The effect of the Regulations and the amendment thereof is as follows:— Preservatives.—No person shall manufacture for sale or sell after January 1st, 1927, any article of food which contains any added preservative ; but the following exceptions are provided:— (a) The Regulations shall not apply until July 1st, 1927, in respect of bacon, ham, egg yolk and articles of food containing preservatives necessarily introduced by the use in their preparation of preserved margarine. (b) The Regulations shall not apply until January 1st, 1928, in respect of butter, cream and articles of food containing preservative necessarily introduced by the use in their preparation of preserved bacon, preserved ham, preserved egg yolk or preserved cream. (c) The Regulations shall not apply until July 1st, 1928, in respect of articles of food taining preservative necessarily introduced by the use in their preparation of preserved butter. (d) In regard to the foods mentioned in the first column of the following table, there will be no offence under the Regulations in respect of the presence of either sulphur dioxide or benzoic acid provided that the preservative is not present in a proportion greater than that indicated in the third column below. 46 Food. Preservative. Parts per Million. 1. Sausages and sausage meat containing raw meat, cereals and condiments Sulphur dioxide 450 2. Fruit and fruit pulp (not dried) for conversion into jam or crystallised glace or cured fruit as defined in items 6 and 7: (a) Cherries „ „ 3,000 (b) Strawberries and raspberries „ „ 2,000 (c) Other fruit „ „ 1,500 3. Dried fruit: (a) Apricots, peaches, nectarines, apples and pears „ „ 2,000 (b) Raisins and sultanas „ „ 750 4. Unfermented grape juice and non-alcoholic wine made from such grape juice if labelled in accordance with the rules contained in the Second Schedule to these Regulations Benzoic acid 2,000 5. Other non-alcoholic wines, cordials and fruit juices, sweetened or unsweetened Either sulphur dioxide 350 or benzoic acid 600 6. Jam (including marmalade and fruit jelly prepared in the way in which jam is prepared) Sulphur dioxide 40 7. Crystallised glace or cured fruit (including candied peel) „ „ 100 7a.Fruit and fruit pulp, not otherwise specified in this Schedule „ „ 350 8. Sugar (including solid glucose) „ „ 70 9. Corn syrup (liquid glucose) „ „ 450 10. Gelatine „ „ 1,000 11. Beer „ „ 70 12. Cider „ „ 200 13. Alcoholic wines „ „ 450 14. Sweetened mineral waters Either sulphur dioxide 70 or benzoic acid. 120 15. Brewed ginger beer Benzoic acid 120 16. Coffee extract „ „ 450 17. Pickles and sauces made from fruit or vegetables „ „ 250 If sulphur dioxide or benzoic acid is added to sausages, sausage meat, coffee extract, pickles, sauces, and (where the proportion of benzoic acid exceeds 600 parts per million) grape juice and wine, there must be a printed declaration attached to the foodstuff which must be in the following form:— (These sausages or) (This coffee extract, etc.) contain(s) PRESERVATIVE. If any dealer sells a preservative for use by traders, the product must bear a label on which is a printed declaration in the following form:— THIS PRESERVATIVE CONTAINS (a) PER CENT OF SULPHUR DIOXIDE (OR BENZOIC ACID). At "(a)" the exact percentage must be inserted. Colouring Matters.— From January 1st, 1927, no person shall manufacture for sale or sell any article of food which contains any of the following colouring matters: (a) compounds of any of the following metals :—antimony, arsenic, cadium, chromium, copper, mercury, lead, zinc; (b) gamboge ; (c) coal tar colours, such as picric acid, Victoria yellow, Manchester yellow, aurantia, aurine 47 The addition of thickening substance to cream is prohibited. A thickening substance is defined as sucrate of lime, gelatine, starch paste or any other substance, which when added to cream is capable of increasing its viscosity but does not include cane or beet sugar. The penalty for an offence under the Regulations is a fine not exceeding £100, and in the case of a continuing offence a further penalty not exceeding £50 for every day during which the offence continues. These Regulations are generally in accordance with the views which have been put forward by the Council for many years past, and there is good reason to be satisfied with them, for they prohibit the addition of those preservatives which the Council have endeavoured to exclude from foodstuffs in this Borough, and they sanction the use of only two preservatives, namely, sulphur dioxide and benzoic acid, which may be regarded as harmless in the quantities prescribed and in regard to which the Council have never seen fit to take proceedings. The Council have for a large number of years required a much higher standard in regard to the absence of preservative in foods than has been usual in other districts ; therefore, the position of Kensington traders under these Regulations will be by no means so difficult as that of shopkeepers in other areas. Indeed, the administration of the Regulations during the early part of 1927 has not revealed many difficulties and, generally speaking, the requirements have been complied with in a satisfactory manner. 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. „ „ 145, Brompton 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.—No infringements of the Order were noted during the year. Food Poisoning.—No instance of food poisoning was brought to my notice during the year. THE PREYENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in Kensington:— Acute Encephalitis Lethargica Acute Polio-encephalitis. Acute Polio-myelitis. Acute Primary Pneumonia. Anthrax. Cerebro-spinal Fever. Cholera. Continued Fever. Diphtheria. Dysentery. Erysipelas. Glanders. Hydrophobia. Influenzal Pneumonia. Malaria. Membranous Croup. Ophthalmia Neonatorum. Plague. Puerperal Fever. Puerperal Pyrexia. Relapsing Fever. Scarlatina or Scarlet Fever. Small-pox. Trench Fever. Tuberculosis. Typhoid or Enteric Fever. Typhus Fever. Zymotic Enteritis. 48 Table showing Notifications of certain Infectious Diseases received in 1922-26. Year. Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Puer¬. peral Fever. Puerperal Pyrexia. Pneumonia. Malaria. Encephalitis Lethargica. P. M'uis & Encephalitis. Smalpox. cerebro spinal Meningitis. Dysentery. itis. Total. 1922 471 403 18 44 20 10 † 186 4 4 2 – 2 – * 1164 1923 205 223 12 67 21 15 † 125 5 3 5 – – – * 681 1924 281 188 29 59 14 5 † 157 3 21 10 1 4 1 40* 813 1925 224 259 25 58 14 5 † 138 2 12 1 – 8 1 122 864 1926 264 391 28 69 15 9 11 145 2 5 4 – 2 – 97 1042 Cases of mistaken diagnosis are excluded from the above table. † Puerperal Pyrexia became notifiable on October 1st, 1926. *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 Cases of Infectious Diseases occurring in 1926, arranged in Four-Weekly Periods. ]Four Weeks ending Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Puerperal Pyrexia.† Pneumonia. Malaria. Encephalitis Lethargica. P. M'itis & PolioEnce phalitis. Smallpox. Cerebro spinal Meningitis. Dysentery. Enteritis. Total.  January 30 14 24 – 7 2 – – 8 – 1 – – 1 – 3 60 February 27 17 32 2 8 2 – – 10 – 1 1 – – – 3 76 March 27 10 33 2 4 – – – 8 – – – – 1 – 1 59 April 24 18 31 6 6 – – – 24 – – – – – – – 85 May 22 18 33 – 11 1 1 – 17 – 1 – – – – 1 83 June 19 28 27 4 8 1 – – 12 1 – – – – – 17 93 July 17 33 27 6 5 2 – – 15 – 2 – – – – 11 101 August 14 27 23 2 3 1 2 – 6 – – 1 – – – 18 83 Sept. 11 11 20 3 6 – – – 4 – – – – – – 9 56 October 9 25 24 2 8 4 2 1 9 – – – – – – 30 106 November 6 14 27 1 4 1 2 4 11 – – 1 – – –– 4 69 December 4 21 34 – 3 1 – 4 11 – – – – – – – 74 January 1 25 56 – 1 – 2 2 10 1 – – – – – – 97 Totals 264 391 28 69 15 9 †11 145 2 5 4 – 2 – 97 1042 Cases of mistaken diagnosis are excluded from the above Table, † Puerperal Pyrexia became notifiable on October 1st, 1926. Small Pox.— No case of small pox occurred in the Borough during the year. There were, however, two cases in St. Marylebone, one in Lambeth, one in Islington, and one in St. Pancras. A. number of persons who had been in contact with cases of small pox in various parts of the country or on board ship came into the Borough during the period in which they might possibly have been incubating the disease. In every case these contacts were visited at once and urged to be vaccinated if this precautionary measure had not already been adopted. Daily visits were continued to these persons until the extreme possible period of incubation had expired. The object of the visits is to secure prompt isolation before the patient becomes infectious in the event of any suspicious illness developing. Scarlet Fever.— The number of cases notified during the year was 298, of which 27??? were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1926. 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 969 1005 927 903 981 958 1035 741 701 1001 1122 1125 894 The Borough 14 18 16 18 20 31 33 34 14 32 14 21 33 North Kensington 10 11 11 10 16 21 24 28 10 24 9 19 21 South Kensington 4 7 5 8 4 10 9 6 4 8 5 2 12 Wards. St. Charles 2 3 2 1 6 3 6 1 4 6 2 11 9 Golborne 6 5 8 6 6 9 6 15 2 3 4 – 7 Norland 2 2 1 – 2 7 12 11 2 13 2 3 4 Pembridge – 1 – 3 2 2 – 1 2 2 1 5 1 Holland 1 3 2 2 1 2 4 3 1 1 – 1 4 Earl's Court 1 1 2 2 – 2 1 2 2 1 1 – 3 Queen's Gate – 1 1 – 1 – – 1 – 2 1 1 – Redcliffe 1 2 – 2 1 6 3 – 1 2 3 – 4 Brompton 1 – – 2 1 – 1 – – 2 – – 1 Cases of mistaken diagnosis are not excluded from the above Table. 49 Thirty-four cases notified as suffering from scarlet fever were found, after admission to hospital, not to be suffering from any infectious disease at all, with the result that they were returned home. During the past four years, the Borough has been comparatively free from scarlet fever and at no time in this period has the disease existed in what might be described as epidemic form. The mildness of the disease is reflected by the fact that there were only four fatal cases during 1926. The deaths in the three preceding years were 2, 1 and 2. Seven of the 298 cases of scarlet fever were patients in the same family as the person who had within the previous twenty-eight days returned from a fever hospital after having been treated for this disease. Cases of this kind are called "return cases" and very careful investigation was made in each of the seven with a view to ascertaining the source of infection. A boy left hospital on the 23rd December, and on the following day developed a nasal discharge. He spent two or three days at Christmas with friends at Hammersmith. Before the end of the year his sister and his nurse developed scarlet fever and three of the children in the house at Hammersmith in which he had stayed for Christmas developed this disease. All were removed to hospital. The boy himself was sent back to hospital on the 29th December, and no further cases developed. This boy accounted for two of the seven Kensington return cases. The three Hammersmith ones are not included in the seven because they occurred outside the Borough. In the remaining five Kensington return cases there was no evidence that the disease had been contracted from the patient who had just returned from hospital. Immediately on receipt of notification at the Town Hall that a person is suffering from scarlet fever, the home is visited by the District Sanitary Inspector for the purpose of investigating the source of infection, children in the house are excluded from school for 7 days and a pamphlet is left at the home advising that a doctor should be called in if any other member of the family becomes unwell, suffers from a sore throat or develops a rash. Disinfection of the home and any articles likely to be infected is carried out on the day following the admission of the patient to hospital, or in the case of a patient nursed at home, on the receipt of a medical certificate that he is free from infection. A child of school age is not allowed to resume school attendance until a fortnight has elapsed since discharge from hospital or, in the case of a child nursed at home, a fortnight after the doctor's certificate of freedom from infection has been received. Diphtheria.—Four hundred and thirty cases were notified during the year, 422 of which were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1926. 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 1216 1276 1208 1136 1017 877 901 830 723 1054 1239 1135 1037 The Borough 24 34 33 31 41 32 31 23 23 24 32 41 61 North Kensington 22 21 25 25 28 23 26 20 22 20 28 36 40 South Kensington 2 13 8 6 13 9 5 3 1 4 4 5 21 Wards. St. Charles 5 4 9 7 10 6 4 1 4 5 6 5 9 Golborne 8 6 7 8 10 6 5 8 13 13 14 13 15 Norland 5 7 8 3 3 6 14 11 5 2 7 17 13 Pembridge 4 4 1 7 5 5 3 – – – 1 1 3 Holland – – – 1 3 2 – – – 1 1 1 5 Earl's Court – 3 1 1 3 2 1 2 – 1 1 2 5 Queen's Gate – 4 1 – 1 – 2 1 – – 1 2 10 Redcliffe 2 4 3 3 3 5 2 – – 2 1 – 1 Brompton – 2 3 1 3 – – – 1 – – – – Cases of mistaken diagnosis are not excluded from the above Table. Thirty-nine cases notified as suffering from diphtheria were found after admission to hospital not to be suffering from any infectious disease at all, with the result that they were returned home. The disease appeared in epidemic form towards the end of the year, but the majority of cases notified were of a mild type. The number of Kensington deaths was twenty-two, representing a case mortality of 5.1%. In the three preceding years, the deaths were 14, 15 and 10. Seven patients developed diphtheria within twenty-eight days of a member of the household returning from a fever hospital after having been treated for this disease. In each of two instances 50 the original case was proved to be responsible for two secondary or "return cases." In the remaining three return cases there was no direct evidence that the infection had been contracted from persons returning from hospital. During the year 1,588 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 246 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 or by myself. These swabs are included in the 1,588 referred to above. In a number of cases germs of diphtheria were discovered; but germs so found in apparently healthy throats or noses may be of a virulent type (capable of conveying dipthheria 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. Several persons at a public institution contracted diphtheria and as the circumstances pointed to the fact that the infection came from someone in that building, a number of inmates were swabbed. In one of these diphtheria germs of a virulent type were found and, following isolation, no further cases developed. At another institution several cases of diphtheria occurred and, after swabbing the throats of other inmates, it was discovered that one had virulent germs of diphtheria in his throat. He was removed to hospital, and no further cases developed. At a boys' home four cases of diphtheria occurred within the space of three days. Following the removal of these cases to hospital, all the boys in the home were carefully examined and swabs were taken in about twelve doubtful cases. Three of these proved to be positive for diphtheria. The patients were removed to hospital, and no further cases occurred. These cases demonstrate that careful investigations for the source of infection do from time to time well repay the labour undertaken, for they enable persons in an infective condition who are quite innocent of the fact to be isolated. Doubtless many a localised outbreak can be terminated in this way. Under the Anti-toxin Order, 1910, the Council are empowered to supply diphtheria antitoxin 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.11, 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 1926, the Borough Council supplied 268,500 units of anti-toxin for 80 patients at a cost of £18 18s. Od. Home disinfection and school exclusion are carried out as in cases of scarlet fever. The Schick Test and Immunisation. Individuals may be divided into two classes—those who are naturally immune to diphtheria infection and those who are susceptible. It invariably happens in an outbreak of diphtheria that a number of cases occur, some perhaps of a fatal nature, before the infecting agent or carrier can be discovered. We have, however, at our disposal the means by which all susceptible individuals can be protected against infectious carriers. By means of inoculation, somewhat similar in nature to vaccination against smallpox, natural anti-toxin can be made to develop in susceptible individuals. This natural anti-toxin creates immunity to diphtheria, which lasts for many years and perhaps during lifetime. In order to tell whether an individual is susceptible, and requires this method of immunisation, a test is employed. This is called the Schick test, and it is performed on the skin of the forearm, a trace of diphtheria toxin being injected under the skin. If the individual is susceptible, a small circular red wheal arises round the site of injection in the course of a few days. The absence of any such reaction in the skin denotes that the person is naturally immune and, therefore, does not require to be immunised. The test is also used to tell whether the immunising injections have proved -effective, and a susceptible individual having received three immunising doses should give a negative result to the Schick test, say at the end of three months. This would prove that he is immune or protected. If the test proves positive it is evident that the three immunising injections are insufficient to create immunity in the particular case, and it will be necessary to repeat the series of 51 injections. In a few rare instances three and even four series of injections have been necessary before the person developed immunity to diphtheria as indicated by the Schick test. This may be compared with the inspection of vaccinations; unless a vaccination is inspected about the eighth or ninth day, there is no proof that the vaccination has been successful. This method of testing and immunisation was put into practice in New York by Park in 1913, and since then some 50,000 school children have been treated in that City. It is noteworthy that 90 per cent. of those have remained immune to diphtheria after seven years. In this country the Ministry of Health have carried out extensive tests, and have introduced this form of immunisation into fourteen residential schools. The Medical Officers of the Ministry have tested 4,528 children, and have immunised 1,400. Among the former there were 265 cases of diphtheria before immunisation but during the year following this treatment, there were only two cases. In Edinburgh some 4,000 school children have been treated by the Sanitary Authority, and the method has been widely practised in the fever hospitals of Manchester and Birmingham. In the Metropolitan Borough of Holborn, since 1922, immunisation work has been carried out for children under school age attending the Maternity and Child Welfare Centre; the number tested was 642, of which 460 were positive, and 172 were negative or immune; ten did not attend for the test to be inspected. The Royal Borough Council have intimated to medical men in Kensington that they are prepared to provide apparatus and materials for the application of the Schick test in institutions, schools, boarding-houses, etc., but throughout the year no requests were received for this form of assistance. At the time of writing, the nursing staff at St. Mary Abbot's Hospital are being tested and immunised against diphtheria, and there is no doubt that the time is now ripe for making this preventive measure more readily available for the child population. Consideration should be given as to whether it might be carried out at Maternity and Child Welfare Centres, as children under the age of five years are the most susceptible to diphtheria, and are those most likely to die from it. Enteric Fever.—Thirty cases of this disease were notified, 16 being removed to hospital and 5 to nursing homes. The cases notified in the three preceding years were 12, 29 and 29. There were two deaths from this cause against 2, 3 and 3 in the preceding years. Two of the notified cases were afterwards certified not to be suffering from enteric fever or any other notifiable disease. Of the remaining 28 cases, 16 were notified from the southern division of the Borough and 12 came from North Kensington. This heavier incidence in South Kensington is not usual with other infectious diseases, and it is probably accounted for by the facts that the water supply and sanitary arrangements in London generally are very good and that a large number of 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 seven cases there was evidence that the disease had been contracted abroad; in one case the infection was contracted in Ireland and in another case in Scotland Five patients had paid visits to places in the country a short time prior to the date of attack. The remaining fourteen had not been out of London for some time before the illness; amongst these there was a history of having partaken of fried fish in one case and of watercress in two cases shortly before the date of onset. Four of the cases were notified as paratyphoid fever. Erysipelas.—Sixty-nine cases were notified during the year, 25 of which were removed to hospital. There were 5 deaths from this cause, the deaths in the three preceding years being 4, 1 and 5. Ophthalmia Neonatorum.—The following table gives particulars of ophthalmia cases notified in 1926 and the results of treatment. ]Case No. Age of child on receipt of notification. Eyes affected. Where treated. Result of treatment.  1. 6 days Left Hospital Recovered. No injury to sight. 2. 6 „ Both „ „ „ „ 3. 18 „ Right „ „ „ „ 4. 13 „ Both Home „ „ „ 5. 6 weeks Both Hospital „ „ „ 6. 5 days Both Nursing Home „ „ „ 7. 12 „ Right Maternity Home „ „ „ 8. 3 „ Both Home „ „ „ 9. 1 month Left „ „ „ „ 10. 3 weeks Right „ „ „ „ 11. 3 days Both Hospital „ „ „ 12. 2 weeks Right „ i„ „ „ 13. 7 days Both Home „ „ „ 14. 3 weeks Left Hospital „ „ „ 15. 16 days Left Home „ „ „ 52 It will be seen that all the cases occurring in 1926 recovered without any injury to sight. In fact, since the year 1921 there has occurred only one case where there has been any impairment of vision. This case was reported upon in my Annual Report for the year 1925, and now there is a marked opacity in the left eye, but the sight of the right eye is saved. These very gratifying results are largely due to the efforts made by the Council's Health Officers to secure hospital treatment, and to the excellent arrangements which the Borough Council have entered into with the Kensington District Nursing Association for the home treatment. 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 1926, the ophthalmia neonatorum and inflammation of the eye cases attended by the nurses numbered 35 and the number of home visits paid in connection with these cases was 359. These visits average 10 to each of the 35 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 359. Puerperal Fever.—The incidence of this disease has been light during the past year, nine cases only being notified. Eight were admitted to hospital, and the remaining case was admitted to a nursing home. There were 6 deaths from this disease during the year. 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. Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926.— During the year, the Minister of Health issued Regulations relating to the notification of puerperal fever and puerperal pyrexia, which came into operation on October 1st. These Regulations prescribe the form in which medical practitioners are required to notify oases of puerperal fever and, in addition, they provide for the notification of all cases of puerperal pyrexia. Puerperal pyrexia is defined as any febrile condition (other than puerperal fever which is required to be notified under the Infectious Disease (Notification) Acts) occurring in a woman within twenty-one days after childbirth or miscarriage in which a temperature of 100.4° Fahrenheit has been sustained during a period of twenty-four hours or has recurred during that period. The Council are required to enforce and execute the Regulations, and must cause to be sent to all medical practitioners resident or practising within the Borough notice of the duties imposed upon them. The Council must provide each doctor with a supply of notification forms. The Medical Officer of Health must forward a copy of every notification to the County Medical Officer within twenty-four hours of receipt and to the Metropolitan Asylums Board within twelve hours. A medical practitioner is entitled to a fee of 2s. 6d. in respect of the notification of a case occurring in his private practice and to a fee of 1s. if the case occurs in his practice as medical •officer of a public body or institution. Puerperal fever has been notifiable throughout the country since the Infectious Disease (Notification) Extension Act, 1899, came into force. Experience has shown, however, that for a variety of reasons notification of this disease has been far from complete, with the result that not only are the statistics relating to the disease inaccurate and misleading (particularly as regards incidence and fatality rate), but measures for the prevention and effective treatment of the condition have been seriously hampered. In this connection, it should be pointed out that since 1902 maternal mortality has not declined proportionately in the same degree as the death rates from all causes of women at reproductive ages, as the general death rate for all persons at all ages, or as the infant mortality rate for children under one year of age. In fact, the child-bearing mother is not sharing equally with the rest of the population in the improved public health. Maternal deaths are due principally to puerperal infection. The main reason for the comparative failure to notify is to be found in the fact that puerperal fever is ill-defined and is not a specific disease comparable with scarlet fever or diphtheria. There is frequently, therefore, a genuine doubt as to the correct diagnosis. The term moreover bears a connotation which may be thought to imply some slur upon the patient or medical attendant, and this may possibly act as a deterrent to notification of a doubtful case. In any event, it is certain that many cases are not notified at all and that severe cases are often notified only when it is too late for effective action to be taken. It is in view of these circumstances that the Minister has found it necessary to modify the existing arrangements for the notification of puerperal fever by jequiring the prompt notification of this morbid process as soon as symptoms suggestive of septic 53 infection become manifest, in order that adequate nursing and treatment can be ensured and the spread of infection to others prevented. Whilst prescribing new forms for the notification of cases of puerperal fever, the Regulations also require the notification of cases of puerperal pyrexia in addition to the present notification of puerperal fever. Thus there is an obligation upon medical practitioners to notify all cases of pyrexia arising during the puerperal period irrespective of the cause to which the fever may be attributed. These requirements will lead to an increase in the number of notifications and many cases so reported will be relatively trivial in degree, but the great importance of securing adequate treatment in the early stages of puerperal infection outweighs any objection to the notification of a certain amount of minor illness. If the more complete notification is to have practical value, it should be supplemented by the provision, when necessary, of facilities for assistance in diagnosis and for the treatment of patients who are not able to secure adequate treatment for themselves. In Circular No. 722, dated August 9th, 1926, the Minister of Health points out that Maternity and Child Welfare Authorities are empowered, with his sanction, to make provision for (a) institutional treatment, (b) special treatment of women suffering from puerperal pyrexia, (c) skilled nursing, and (d) consultation with an obstetric specialist. The Minister points out that these Authorities and their Medical Officers of Health should do all that is possible to meet the requests of medical practitioners for special assistance for women suffering from puerperal pyrexia which is, or is likely to be, serious in character, in order that maternal mortality and morbidity from this cause may be so far as possible prevented. (a) Institutional Treatment.—As pointed out in the Ministry of Health Circular No. 622, dated September 14th, 1925, arrangements have been made by the Metropolitan Asylums Board whereby cases of puerperal fever are received at three of their hospitals, namely, the Eastern Hospital, the North-Western Hospital, and the South-Western Hospital. Special wards are set aside for these cases and special medical and nursing staffs are provided. The Board have also, with the approval of the Minister of Health, appointed an obstetric consultant at these three institutions. (b) Special Treatment of Women Suffering from Puerperal Pyrexia.—The Kensington Board of Guardians have arranged for puerperal pyrexia cases to be admitted to the St. Mary Abbot's Hospital on the order of Dr. Hobbs, the Medical Superintendent, and thus the delay and inconvenience of making an application to the Relieving Officer is saved. Dr. Hobbs has devoted considerable attention to the treatment of this disease and, judging from papers he has published, he has adopted a method of treatment which is remarkably successful. From October 1st, 1926, onwards, the Metropolitan Asylums Board admit to their hospitals cases of puerperal pyrexia in the same manner as they admit cases of puerperal fever, and therefore, the arrangements made by the Metropolitan Asylums Board and the Guardians provide all that is necessary in Kensington in the way of special treatment. (c) Skilled Nursing.—By an agreement between the Council and the Kensington District Nursing Association, the nurses of the latter body undertake, when requested by the Medical Officer of Health, the nursing of any disease for which skilled nursing is necessary, and their services can be and have been requisitioned for cases of puerperal fever and puerperal pyrexia. The nurses are skilled and doctors appreciate very much the splendid assistance they can obtain from these trained women. Indeed, it would be impossible at the present time to improve upon the arrangements for nursing in the homes of the poor which now exist in the Borough. (d) Consultation with an Obstetric Specialist.—Since 1922, Dr. Hobbs has acquired a high reputation in connection with the treatment of puerperal pyrexia which extends beyond the boundaries of this country. The practitioners in Kensington generally have been very much interested in his work, and have welcomed very heartily the opportunity of being able to consult him in any difficult case. Dr. Hobbs is a whole-time officer of the Kensington Guardians and the Board have allowed him to act as a consultant to medical practitioners in Kensington when assistance is required in difficult cases of puerperal pyrexia. A remuneration of £50 per annum is paid for the services of Dr. Hobbs in this respect. The appointment of Dr. Hobbs as obstetric consultant, together with the other facilities already available, has provided the doctors of Kensington with every reasonable measure for securing the effective treatment of puerperal fever and puerperal pyrexia. Puerperal Pyrexia.—Eleven cases of puerperal pyrexia were notified, nine of which were removed to hospital. One case only developed into puerperal fever; this patient received prompt surgical treatment in St. Mary Abbot's Hospital and made a good recovery. 54 Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia, but the onlykinds notifiable are acute primary pneumonia and influenzal pneumonia. One hundred and fortyfive notifications were received, 107 patients being certified as suffering from acute primary pneumonia and 38 from influenzal pneumonia. It is clear that many cases escaped notification. The number of deaths from pneumonia during the year was 177, and 44 deaths were certified to be due to influenza. Malaria.—Two cases of this disease were notified, and investigation revealed that one patient had been a soldier who had contracted the disease whilst on foreign service ; the other patient was a girl of fourteen years who was under treatment in hospital for epilepsy and had been artificially infected with malaria parasites. Encephalitis Lethargica.—This disease, commonly known as "sleepy sickness," was prevalent throughout the country in the year 1924, the number of cases notified in that year in England and Wales being 5,063, in London 620, and in Kensington 21. During the year 1925, the number of cases diminished considerably, the figures for England and Wales being 2,670, for London 302, and for Kensington 15. In the year 1926 there was a still further reduction, 2,267 cases being notified in England and Wales, 225 in London and 10 in Kensington. Five of the ten cases notified in the Borough were found after admission to hospital not to be suffering from encephalitis lethargica or any other notifiable disease ; thus, the number of Kensington cases was reduced to five. The following table gives details of the five definite cases:— No. Sex. Age. Date of Notification. Result. 1. M. 48 3rd February. Recovered, but suffers from loss of memory. 2. F. 68 5th Recovered completely. 3. F. 3 8th May. Died. 4 F. 5 3rd July. Recovered, but remains delicate. 5. M. 2 mos. 12th July. Died. 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 they 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. In 1926, four cases of poho-myelitis were notified to the Public Health Department and the following table gives details:— No. Sex Age. Date of Notification. Result. 1 F. 8 mos; 6th February. Recovered. Slightly nervous, but otherwise quite well. 2 F. 9 mos. 6th August. Now in Queen Mary's Hospital, Carshalton. Paralysed in both legs. 3 M. 18 21st September. Partially recovered. Progressing satisfactorily. 4 M. 23rd October. Paralysed in right shoulder. Attending University College Hospital. Cerebro Spinal Meningitis.—There were four cases of this disease notified during the year. Two of the four cases after admission to hospital were certified not to be suffering from cerebro spinal meningitis or any other notifiable disease. Particulars of the remaining two are subjoined :— No. Sex- Age. Date of Notification. Result. 1 F. 5 mos. 15th January. Died. •2 F. 3½ 9th March. Recovered. 55 Zymotic Enteritis or Summer Diarrhoea.—This disease may be described briefly as an acute inflammation of the lining membrane of the intestines which is infectious or contagious and which is apt to appear in epidemic form during the Summer months, particularly amongst infants. Causation.—Although the etiology of zymotic enteritis or Summer diarrhoea is still obscure in several respects, many facts are known about its predisposing and exciting causes. The principal predisposing causes are three in number.— (1) High Mean Atmospheric Temperature.—When, in a town, the temperature of the air is constantly above 60F., the mortality from the disease is generally high. It has also been observed that the death rate does not become high until the mean temperature of the earth, taken at a point four feet from the surface, has attained 56°F. The hotter and drier the Summer, the greater will be the infant mortality from diarrhoea. (2) Early Age.—The disease is one of childhood, occurring almost exclusively during the first two years of life. (3) A weakened and deranged condition of the lining membrane of the stomach and intestines.—Babies on the breast are affected less frequently than those who are hand-fed ; those who are badly nourished and those whose digestive organs are irritated by improper feeding are especially liable to be infected and to suffer severely. The exciting cause is a multiplication of micro-organisms in the alimentary canal. In the causation of this disease it has hitherto been held that there is not a specific microorganism, as there is in tuberculosis, but that any one or more of a large class of germs may produce the symptoms. These bacteria multiply enormously, and their products act as severe general poisons as well as local irritants to the lining membrane of the digestive tract. In the great majority of cases the germs are introduced along with cow's milk. Milk is a congenial medium for them to grow in, and they multiply and flourish in it both inside and outside the child's alimentary canal. Symptoms.—The disease may be met with in the extremely acute form, called " holera infantum" because of the close resemblance which its symptoms present to those of real cholera, or in the less severe variety which resembles a severe attack of dyspeptic diarrhoea and vomiting. The cases which are met with in Kensington and throughout the country are mostly of the latter type. The patient is in the majority of cases a hand-fed baby, sometimes he seems in good health when the severe symptoms commence. Very often, however, he has been suffering for some time from digestive disturbance, so that the diarrhoea and vomiting appear as an exacerbation of a chronic or sub-acute attack. Before the vomiting and purging begin, the patient is restless and distressed, and his temperature is raised. After a few hours of discomfort, the child vomits, first undigested food, and later watery mucus tinged with bile. Any fluid given to allay thirst is at once returned, and soon the diarrhoea commences. At first, ordinary motions are passed. The motions succeed one another rapidly; their yellow colour changes to pale green, grey, or brown, and they are very offensive. There may be ten, twenty, or more motions in the twenty-four hours. The child loses flesh very rapidly, his eyes sink in, and he is exhausted by the repeated purging and vomiting. Treatment and Prevention.—Under suitable treatment, the diarrhoea and vomiting gradually cease, and the child is convalescent after a week or less. If the case is neglected, or the attack a severe one, it may prove fatal in a very short time. It will be convenient to mention here that the milder cases of this disease are difficult to distinguish from simple diarrhoea or enteritis and the physician sometimes finds it impossible to make a distinction. As mentioned before, there is not one specific micro-organism responsible for zymotic enteritis, but any one of a number may produce it; therefore it is impossible to secure a diagnosis by bacteriological examination as in the case of such diseases as typhoid fever, diphtheria, tuberculosis and so on. In these circumstances, the available statistics in regard to zymotic eureritis require to be read with great care, for it is undoubted that many cases of zymotic enteritis are classified as simple non-infective enteritis or gastro-enteritis whilst, on the other hand, many of these simple cases of enteritis are classified as belonging to the infective or zymotic form. Subsequent tables in th:s report, showing the names which have been used by medical men in bringing cases of enteritis to my notice, serve to demonstrate the difficulty which they experience in deciding on the correct name to give to cases of enteritis in children. 56 The time has now arrived when the nomenclature of enteritis should be considered by the medical profession as a whole, and until this is done it will be very difficult to deal with zymotic enteritis statistically in a satisfactory manner. The death rates of children under two years of age per thousand births from enteritis and diarrhoea (these terms are not defined, but undoubtedly the majority of the deaths are due to zymotic enteritis or Summer diarrhoea) in Kensington, London and England and Wales during the past six years are shown in the following table:— Year Kensington London England 1921 35.2 21.3 15.5 1922 9.8 7.1 6.2 1923 15. 1 10.2 7.7 1924 6.4 8.4 7.3 1925 10.9 10.6 8.4 1926 13.2 11.8 8.7 It is not practicable to give comparative statistics for Kensington and other parts of the country for earlier years ; but the following table shows the number of deaths of infants under one year of age in Kensington in each year since 1900, together with the number due to enteritis and diarrhoea and the percentage of the total due to these complaints. (The deaths include those from'all forms of enteritis, but undoubtedly the majority are due to the zymotic type). KENSINGTON. Year No. of deaths of infants under one year of age No. dueto enteritis and diarrhœa Percentage due to enteritis and diarrhœa 1900 641 80 12.5 1901 581 91 15.6 1902 505 58 11.4 1903 510 75 14.7 1904 503 109 21.6 1905 498 65 13.0 1906 452 92 20.3 1907 433 21 4.8 1908 420 64 15.2 1909 379 50 13.2 1910 345 28 8.1 1911 435 123 28.2 1912 305 32 10.4 1913 371 62 16.7 1914 298 47 15.7 1915 365 50 13.7 1916 258 32 12.4 1917 309 48 15.5 1918 224 36 16.0 1919 270 71 26.3 1920 325 64 19.6 1921 363 87 23.9 1922 257 24 9.3 1923 218 44 20.1 1924 219 18 7.1 1925 223 22 9.8 1926 164 30 18.3 It will be seen that a very considerable percentage of the infantile deaths are due to enteritis and diarrhoea. In the year 1924, zymotic enteritis received the careful consideration of the Council and it was concluded that further progress could be made in preventive work if 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. As this knowledge can best be obtained by notification, 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 in Kensington on July 1st, 1924. (It is notifiable in seven other Boroughs in London). With better knowledge it is possible to take effective steps with regard to prevention and treatment of the disease, and for this purpose the Council put a scheme into operation on the date the disease became notifiable. 57 The preventive work under the scheme is carried out by the staff of the Public Health Department, assisted by the voluntary and paid workers at the Infant Welfare Centres. For the purposes of treatment, Dr. Carter is appointed to render medical assistance when required during the Summer months and an arrangement has been made with the Kensington District Nursing Association under which the services of the nurses can be requisitioned for home nursing at any time of the year. (Full details in regard to the scheme have appeared in my last two Annual Reports). The cases dealt with during the year 1924 are as follow:— Year No. of Notifications Cases treated by Dr. Carter No. of deaths amongst Dr Carter's cases Cases nursed by. District Nurses No, of visits paid by District Nurses No. of de-ths amongst District Nurses' cases 1924 40 *31 Nil. *34 267 Nil. These figures are satisfactory, but the Summer of 1924 was wet and cold with the result that there were few cases of zymotic enteritis. It will be clear, therefore, that at the end of 1924, it was not possible to form any sound opinion as to the value of the Council's scheme. The fieures for 1925 are as follow :— Year No. of Notifications Cases treated by Dr. Carter No. of deaths amongst Dr. Carter's cases Cases nursed by District Nurses No. of visits paid by District N urses No, of deaths amongst District N arses' cases 1925 122 *45 Nil. *58 588 l * All cases treated by Dr. Carter are nursed by the District Nurses, who, in addition, attend cases under the care of other doctors. The District Nurses do not undertake home nursing unless a doctor is in attendance. The year 1925 was very different from the previous one from a climatic point of view. The months of May and June were fine and hot; indeed, rarely has this country enjoyed two more perfect Summer months. But such months favour the spread of zymotic enteritis and, therefore, there was ample opportunity for the scheme to be thoroughly tried out. It is satisfactory to be able to record that not one of the cases attended by Dr. Carter throughout the two years proved fatal, and there was only one fatal case amongst those nursed by the District Nnrsinc Association durint? that time. The following tables give particulars for 1926. TABLE No. 1. Notifications of cases of Enteritis received in 1926 (Children under 5 years). Four Weeks ending Zymotic Enteritis Epidemic Diarrhoea Acute Enteritis Diarrhœa and Vomiting GastroEnteritis Infantile Enteritis Infantile Diarrhœa Enteritis Chronic Diarrhoea Diarrhœa Total January 30th 2 — — — — — — — — — 2 February 27th 1 — — — — — — — — 2 3 March 27th 1 — — — — — — — — — 1 April 24th — — — — — — — — — — — May 22nd — — — — — — 1 — — — 1 June 19th 9 — — — 1 1 1 — 1 1 11 July 17th 7 1 — — — 4 — 1 — 1 14 August 14th 6 10 — 2 — — — — — — 18 September 11th 4 2 — 1 — — — — — 2 9 October 9th 10 3 2 1 2 — — 9 1 3 31 November 6th 4 — — — — — — — — — 4 December 4th — — — — — — — — — — — January 1st — — — — — — — — — — — Totals 44 16 2 4 3 5 2 10 2 9 97 58 In view of the fact that the Council's scheme of treatment is just as useful in the ordinary enteritis as in the zymotic variety and that the staff available could cope with the work, I resolved to accept all notifications received, and imagine that it will be wise to follow a similar course in future years until further research makes it possible to separate the zymotic from the other forms. TABLE No. 2. Deaths from Enteritis in 1926 (Children under 5 years). Four Weeks ending Zymotic Enteritis Enteritis (Infective) Acute Enteritis GastroEnttritis Enteritis Asthenia anil Enteritis bronchitis and Enteritis Total January 30th 1 — — 3 — — — 4 February 27th — — — 2 — — — 2 March 27th — — — . 4 — — — 4 April 24th — — — — — — — — May 22nd — — — 1 — — 1 2 June 19th — — — 2 — — — 2 July 17th — — — 4 — 1 — 5 August 14th 1 — 1 2 1 — 1 6 September 11th — - — 1 1 — — 2 October 9th 1 1 — — 1 — — 3 November 6th 3 1 — 1 — — — 5 December 4th 1 — — 1 — — 1 3 January 1st — — — 1 — — — 1 Totals 7 2 1 22 3 1 3 39 Thirty of the 39 deaths occurred in children under the age of one year. TABLE No. 3. Details of Cases dealt with by Dr. Carter. Four Weeks ending No. of Notifications of all forms No. referred to Dr. Carter No. ol visits by Dr. Carter No. treated by Dr. Carter throughout illness No. sent by Dr. Carter to hospital No. of deaths of patients treated by Dr. Carter January 30th 2 2 — — — — February 27 3 3 — — — — March 27th 1 1 — — — — April 24th — — — — — — May 22nd 1 1 — — — — June 19th 14 14 12 5 — — July 17th 14 14 15 8 — — August 14th 18 18 12 5 — — September 11 9 9 11 4 — — October 9th 31 31 66 10 — — November 6 4 4 — — — — December 4th — — — — — — January 1st — — — — — — Total 97 97 116 32 Nil. Nil. *Dr. Carter is retained to treat cases during the months of June, July. August and September only. 59 TABLE No. 4. Details of Cases dealt with by the District Nurses. Four Weeks ending No. of cases referred to District Nurses. No.of cases visited by District Nurses. No. of visits paid by District Nurses. Mo. of cases treated by District Nurses throughout. No. of cases treated by District Nurses sent to hospital. No.of deaths of cases treated by District Nurses. Jan. 30th 2 5 45 5 — 1 Feb. 27th 3 2 19 2 — — March 27th 1 3 23 2 1 — April 24th — — — — — — May 22nd 1 1 18 1 — — June 19th 14 14 197 14 — — July 17th 14 22 257 22 — — Aug. 14th 18 15 227 15 — — Sept. 11th 9 13 157 12 1 — Oct. 9th 31 33 194 28 1 — Nov. 6th 4 6 94 10 — — Dec. 4th — 2 14 2 — — Jan. 1st — — — — — — Total 97 116 1,245 113 3 1 The following is a report by Dr. Carter, giving particulars of the cases of enteritis dealt with under the Council's scheme during the year under review:— Zymotic Enteritis—1926. The Borough Council's scheme has now been in operation for three years—the first year, namely, 1924, from 1st July to 30th September, and in 1925 and 1926 from 1st June to 30th September—and I have not found it necessary to alter the first plan of treatment, which I described in my report for the year 1925. There has been no interference with the work of the general practitioners in the neighbourhood. I am glad to say that several doctors are making use of the scheme and have requested the District Nurses to carry out the treatment prescribed in the Council's scheme. This extremely gratifying because one of the chief aims of the Public Health Department is to be of assistance to the doctors in the neighbourhood. Not a single complaint has reached me with regard to the practical working of the Council's scheme. I think the success attained is largely due to the enthusiasm of the staff of the Kensington District Nursing Association. Miss Eales tells me that the nurses think it a pleasure to work the scheme because the results are so good, also it gives the nurses and the mothers a feeling of confidence. Some of the Council's Health Visitors have informed me that the scheme has had a distinct educational influence on the mothers and they have been heard discussing what to do when the child is suddenly attacked with vomiting and diarrhoea. The mothers also realise the importance of keeping a child without food for twenty-four hours. This I consider is a great step forward in the prevention of the disease, as many of these mothers do not come to the Welfare Centres and probably never intend to come. I have learned from the Kensington District Nursing Association that many of the cases have been notified within twenty-four hours of the commencement of the attack; consequently they have received treatment at the earliest possible moment. The results have, therefore, been good. Many of the cases were mild in type, but in former years many of these mild cases developed into acute enteritis, so that it is never safe to predict that a case which is mild at first will remain so. I consider that this third year of trial conclusively proves that early treatment is the best preventive measure to adopt. 60 Feeding. The result of giving Malted Milk as a temporary measure has been excellent The child's strength is, in the majority of cases, well maintained, as it receives more nourishment in this manner than if it were given simply albumin water. Malted Milk has to be given five days or a week until dyspeptic symptoms have subsided. Great care is necessary in returning to a normal diet. I have not seen any cases of relapse this year, nevertheless, it is sometimes impossible to return to ordinary cow's milk. Examination of Health Visitor's Notes. The number of cases notified was ninety-seven. Of these cases fifty-eight were under the age of one year and thirty-nine were one year and over. The number of families in which the patient was the only case was ninety-three. In two instances two cases occurred in one family. Two children developed the disease twice in the year and in two cases two patients were notified from one house but not in the same family. The number of healthy children attacked Was sixty-two. Children who were under the average weight for their age and suffering from chronic digestive disturbances numbered thirty-five. The majority of the notes were carefully recorded and will form a valuable aid in years to come in elucidating certain public health problems. Kensington District Nursing Association. The number of cases nursed during the year was one hundred and sixteen. The nurses were asked to attend nineteen cases which had not been notified by the local doctors and this fact accounts for the larger number of cases seen by them. Only one death occurred amongst the children visited by the nurses. During the last three years, only two deaths have occurred amongst one hundred and eighty-seven cases nursed by the Association's nurses. I think this is a very good result. The deaths from all forms of enteritis in the Borough were thirty-nine. We must remember that zymotic enteritis has not appeared in epidemic form since 1921, so that we cannot hope always to get such brilliant results. Food on which children were fed. Mixed diet 39 cases Breast only 19 „ Cow's milk 18 „ Nestle's Condensed 9 „ Glaxo 2 „ Breast and Nestle's 1 case Ambrosia 1 „ Almata 1 „ Allenbury's 1 „ Cow and Gate 1 „ Unknown 5 cases "Mixed diet" means gravy or bread and potatoes with a milk pudding at mid-day meal; the other meals usually consist of cow's milk. These children are invariably one year old and over. No cases were sent by me to hospital during the year I do not intend to give the public the idea that I have discovered some new cure for zymotic enteritis, I have only applied our present day knowledge in formulating a scheme which is mainly preventive rather than curative and which I think can usefully be added to the Public Health Service. (Signed) Ronald Carter. The information given will, I think, lead the Council to the conclusion that as a result of close co-operation all round, their scheme has proved satisfactory. During the month of July, the Lancaster Road Fathers' Council, in conjunction with 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." The fathers, accompanied by a cart loaded with practical exhibits, traversed many streets in North Kensington giving lectures to groups of people who gathered round on the best way of dealing, from the point of view of health, with the fly nuisance. They also made a house-to-house distribution of pamphlets dealing with the matter. Typhus Fever.—One case of this disease was notified during the year. The patient was a boy aged six years. He was removed to hospital, extensive disinfection was carried out and every 61 precaution taken to prevent the spread of infection. After four days, however, the Metropolitan Asylums Board notified the Public Health Department that the child was not suffering from typhus fever or any other notifiable disease. 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 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. Four hundred and nineteen visits to cases of measles were paid by these officers during the year. The number of cases admitted to hospital was 102. This disease caused 25 deaths during the year. The destructive nature of measles as compared with scarlet fever is well shown by an examination of their respective death rates during the years 1911 to 1925. Of every million people living during that period, 251 died annually from measles and 42 from scarlet fever. Of cases of measles treated in the Metropolitan Asylums Board's Hospitals during the same period, numbering 28,266, the case mortality was 10.6 per cent., whereas for scarlet fever, numbering 194,975 cases, it was only 1.5 per cent. In view of the high mortality of this disease compared with scarlet fever, the general policy pursued in most districts in the country in giving priority of admission to isolation hospitals to cases of scarlet fever is a matter which has been considered both by the Metropolitan Asylums Board and the Metropolitan Medical Officers of Health. In April, 1926, a conference took place between representatives of the Ministry of Health, the London County Council, the Metropolitan Branch of the Society of Medical Officers of Health, and the Metropolitan Asylums Board, and as the outcome of their deliberations, the following recommendations were made:— (a) That the Board should allocate from time to time a number of beds for measles and a number for scarlet fever, such allocation to be altered by the Board as circumstances demand. (b) That cases of scarlet fever and measles be admitted on doctors' certificates as now, without reference to the Medical Officer of Health. (c) That when shortage of beds for scarlet fever or measles is imminen the Board should inform the Medical Officers of Health and accept cases only upon their recommendation, (d) That during such shortage of beds applications for admission from general practitioners should be referred to the Medical Officers of Health for recommendation. (e) That the selection of cases for admission should be based on type of home rather than type of case. (f) That cases of measles in tenement houses where there are no facilities for home nursing or in houses connected with shops or where a member of the family is employed in the handling of food, should be given priority over cases of scarlet fever in single family houses where isolation is possible. In October, 1926, the Metropolitan Asylums Board agreed to the alterations and arrangements for the admission to the Board's Infectious Hospitals of cases of scarlet fever and measles on the lines set forth in the recommendations of the conference, and representations were made to the Ministry of Health for their sanction. If the approval of the Ministry is obtained, the scheme will be put into operation and it is earnestly hoped that it will be the means of making a large reduction in the high mortality rate from measles amongst children. Whooping Cough.—There were 8 deaths from this cause. The deaths in the three preceding years were 23, 20 and 18. The Women Health Officers paid 138 visits to cases of this disease during the year. The number of cases admitted to hospital was 34. 52 TUBERCULOSIS. During the year 248 cases of pulmonary tuberculosis and 69 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 1919. District. 1919. 1920. 1921. Years. 1924. 1925. 1926 1922. 1923. The Borough 582 407 374 339 403 314 292 317 North Kensington 445 294 272 233 267 228 207 227 South Kensington 137 113 102 106 136 86 85 90 Wards. St. Charles 104 70 66 48 61 45 52 50 Golborne 150 88 89 80 86 65 56 69 Norland 124 93 80 76 85 75 67 59 Pembridge 67 43 37 29 35 43 32 49 Holland 36 36 29 28 26 30 27 20 Earl's Court 21 25 24 24 28 13 18 25 Queen's Gate 16 15 15 20 22 17 13 15 Redcliffe 33 25 19 23 41 15 18 22 Brompton 21 12 15 11 19 .11 9 8 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 1926 160 (2) No. of persons dying unnotified or notified at death 36 (3) No. notified within one month before death 22 (4) No. notified within three months before death (excluding those under heading 3) 15 (5) No. notified within six months before death (excluding those under headings 3 and 4) 11 The following summary shows the age and sex distribution of the cases notified and the deaths from this disease during the year:— Age Periods. Years; New Cases† Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F M. F. M. F. M. F. 0—1 — 1 1 1 — 1 1 1 1—5 — 1 8 9 — 6 8 6—10 5 4 9 12 _ 2 1 1 10—15 2 — 3 5 1 — — 2 15—20 7 20 1 3 5 8 - 1 20—25 18 19 1 6 10 5 — — 25—35 26 27 2 1 12 14 - 3 35—45 31 25 — 4 17 15 2 — 45—55 22 15 1 _ 9 8 2 — 55—65 8 10 2 _ 9 10 1 — 65 and upwards 4 3 — — 4 — — 1 Totals 123 125 28 41 67 63 13 17 †Primary notifications or persons notified during life to be suffering from tuberculosis. 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. 63 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1917, together with the number of deaths and death-rates in each year. 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. 1917 445 178 117 98 66 43 244 160 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 95 192 280 117 66 123 35 19 152 85 1924 236 120 67 78 29 16 149 83 1925 235 134 75 57 25 14 159 89 1926 248 130 72 69 30 17 160 89 Deaths from Tuberculosis in 1926 Allocated to District of Usual Residence of Patients. Pulmonary Tuberculosis. Other Forms of Tuberculosis. The Borough 130 30 North Kensington 93 17 South Kensington 36 13 Wards. St. Charles 19 4 Golborne 31 4 Norland 22 2 Pembridge 21 7 Holland 5 2 Earl's Court 12 4 Queen's Gate 6 2 Redcliffe 9 3 Brompton 4 2 Ward Unknown 1 — The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Patient's Home 54 5 St. Mary Abbot's Hospital 47 10 Brompton Hospital 2 — St. Luke's Home 3 — Outlying Hospitals 20 14 Other places outside the Borough 4 1 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These Regulations were introduced with a view to:— (1) preventing persons suffering from respiratory tuberculosis entering upon an occupation involving the handling of milk; and (2) enabling local authorities, in proper cases and with suitable safeguards, to require persons engaged in such occupation to discontinue their work when found to be suffering from the disease in an infective stage. There was one case during the year in which a milk roundsman developed tuberculosis but he was removed from his post by his employers without intervention on the part of the Council. No other case occurred during the year which required the attention of the Council under these Regulations. THE COUNCIL'S SCHEME FOR THE PREVENTION AND TREATMENT OF TUBERCULOSIS. The Stall Engaged on Tuberculosis Work. The staff at the Dispensary consists of a Tuberculosis Officer; two indoor nurses, one of whom acts as Secretary to the Tuberculosis Care Committee and the other as a Dispenser; a Clerk and a Caretaker. These give whole-time service to tuberculosis work. 64 In 1920, the Borough was divided into seven areas for the purpose of home visiting in connection with Maternity and Child Welfare work and a Woman Health Officer was allocated to each of these districts. When the Council assumed full control of tuberculosis work in the Borough arrangements were made for the home visiting of tuberculous patients to be undertaken by these Women Health Officers in their respective areas. These Officers visit the Tuberculosis Dispensary daily for the purpose of obtaining information as to visits necessary to be paid, and they confer weekly with the Tuberculosis Officer, when they report to him in regard to the home visits paid in the previous week. Approximately three-sixteenths of the time of these seven Women Health Officers is devoted to tuberculosis work. Dispensary Diagnosis and Treatment. The adequacy of the scheme adopted by the Council in 1922 for the prevention and treatment of tuberculosis is evidenced by the fact that after four years of work no material alterations or additions have been required. The number of new cases seen at the Dispensary during the year, with the original diagnoses made, is shown in the following table :— New Cases. Adults. Children under IS yrs. Total. Males, Females. Males. Females. Examined for first time 205 339 201 196 941 New cases with Respiratory Tuberculosis 68 65 5 3 141 (14.9 per cent.) New cases with Non-Respiratory Tuberculosis 1 6 7 9 23 ( 2.4 „ ) New cases regarded as "Suspects" 26 40 21 12 99 (10.5 „ ) New cases not suffering from Tuberculosis 110 228 168 172 678 (72.0 „ ) This table is not strictly comparable with similar ones given in my reports for previous years owing to the altered definition of contact cases (included above in each separate total). This altered method of expression was prescribed in a Memorandum issued by the Ministry of Health at the end of the year 1925. There was, however, an increase in the number of respiratory cases and a decrease in the number of non-respiratory cases. The "suspect" cases shown above include all cases not diagnosed in the first instance as either definitely tuberculous or non-tuberculous; to these must be added 45 left on the Dispensary books at the end of 1925, making a total of 144. The subsequent disposal of these was as follow :— Diagnosed subsequently as suffering from respiratory tuberculosis 8 Diagnosed subsequently as suffering from non-respiratory tuberculosis 3 Discharged finally as non-tubercular 92 Discharged finally as having ceased attendance 10 Remaining on books on 31st December, 1926 31 Cases came to the Dispensary of their own accord or were sent up through one of the following agencies : the Public Health Department of the Council, the Ministry of Pensions, Hospitals, School Medical Officers, the Kensington Board of Guardians, the Invalid Children's Aid Association, the Charity Organisation Society and private practitioners. The treatment recommended for the cases diagnosed at the Dispensary as suffering from tuberculosis, which numbered 175 (149 pulmonary and 26 non-pulmonary), was as follows:— Sanatoria, 56; Domiciliary, 40; St. Mary Abbot's Hospital, 18 ; Dispensary, 36; Hospitals, 16; Kensal House School, 3; Convalescence, 1. No special treatment was required in 5 cases beyond general advice and instruction to report at the Dispensary if necessary. The total number of attendances by patients at the Dispensary was 3,517 and 1,915 systematic physical examinations were made. The number of home visits by the Tuberculosis Officer was 113, of which 15 were consultations with the doctor in charge of the case. Written reports on cases to Public Authorities numbered 1,266 and to doctors, 375. The total number of sputum examinations was 496 (including 38 specimens sent up by doctors) fron 416 individual cases. One hundred and forty-two specimens showed tubercle bacilli to be 65 present and 354 gave negative results. Of the 140 new cases with respiratory tuberculosis there were 91 showing tubercle bacilli present (65 per cent.) and 49 had a negative sputum (35 per cent.). These figures show a slight improvement on last year's results, when 69.6 per cent. of the new cases had a positive sputum. There were also made during the year three examinations of discharge from the ears of patients, all of which were found to contain tubercle bacilli, also two examinations of pus extracted from neck glands, one giving a positive result and the other a negative one. Records. The following table shows the number of cases of tuberculosis on the Register of Notifications on 1st January, 1926, the number of cases removed from the Register on account of their having been cured or having removed from the district or having died, the number of cases added to the Register during the year and the number of cases remaining thereon on 31st December, 1926. Pulmonary. Non-Pulmonary. Males Females Males Females No. of cases on the Register of Notifications on 1st January 1,178 1,238 535 526 No. of cases removed from the Register during the year on account of having:— (a) been cured 38 40 8 11 (b) removed from the district 54 41 4 6 (c)died 77 72 9 16 No. of cases added to the Register during the year 131 133 33 52 No. of cases remaining on the Register on 31st December 1,140 1,218 547 545 The number of patients on the Dispensary Register on 31st December, 1926, was 1,253, whilst at the beginning of the year they numbered 1,303. Residential Institutional Treatment. Under the scheme for the treatment of tuberculosis in London, the London County Council provide all the beds required for residential institutional treatment except those available in Poor Law Infirmaries. When the Tuberculosis Officer is of the opinion that a patient should be admitted to a sanatorium, appropriate recommendations are forwarded to the County Medical Officer of Health, who, in due course, informs the patient, the Tuberculosis Officer and the Borough Tuberculosis Care Committee of the sanatorium where a bed is available and the date on which the patient should present himself for admission. St. Mary Abbot's Hospital. The Kensington Board of Guardians provide at St. Mary Abbot's Hospital a ward containing 26 beds for male patients and a ward of 22 beds for female patients who are suffering from respiratory tuberculosis. The latter ward has a good verandah with awnings where, whenever possible, patients receive open air treatment. The beds are used for (1) emergency cases requiring immediate institutional treatment whether or not sanatorium treatment is subsequently to be provided, (2 advanced cases where the home conditions do not permit of proper isolation and (3) patients who are not able to obtain adequate nursing attention at home. No special provision is made at the hospital for non-respiratory cases but these are admitted to the surgical wards when necessary. Dr. Picard, the Tuberculosis Officer, has continued to act as Visiting Medical Officer to StMary 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 other sources have been transferred by him after due observation to various sanatoria provided by the London County Council. 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. 66 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. Light Treatment. The Public Health Committee of the Council have given close consideration during the year to the question of the provision of artificial light treatment at or in connection with the Tuberculosis Dispensary. Negotiations have been entered into with the Victoria Hospital for Children, Tite Street, Chelsea, for the treatment of suitable patients residing in the southern portion of the Borough, and with the Kensington Branch of the British Red Cross Society for the treatment of patients from any part of the Borough. At the end of the period under review these negotiation0s had not been completed and the work of treating patients by this means had not started. The Council have continued to accept financial responsibility for "Finsen light" treatment applied to suitable cases of lupus and surgical tuberculosis at the London Hospital. The usual charge for this treatment is 5s. per exposure. The number of cases treated during the year under review was three at a total cost to the Council of £25. One of these patients is still undergoing treatment. Cc-operation with Medical Practitioners and other Bodies and Institutions. The Tuberculosis Dispensary is used fairly extensively as a consultation and treatment centre by School Medical Inspectors and the Medical Officers of School Treatment Centres. Reports are sent by the Tuberculosis Officer to the Divisional Medical Officer of the London County Council in regard to all school children who are contacts of notified respiratory cases, whether attending the Dispensary or not, thus enabling the School Medical Inspectors to keep under observation those children who, although found to be unaffected by tuberculosis at the time of the primary examination," are exposed to infection in their homes. Those children who are found to be suffering from or are suspected of having contracted the disease continue to attend the Tuberculosis Dispensary for further observation and treatment. An all important factor in the treatment of tuberculosis is early diagnosis and with this in mind every endeavour has been made during the past few years to encourage medical practitioners to avail themselves of the services of the Tuberculosis Officer in a consultative capacity. The number of reports upon patients sent to medical practitioners has increased year by year. There were 205 cases referred to the Dispensary by private practitioners during 1926 as compared with 104 in 1924 and 172 in 1925. These figures pay testimony to the growth of the favour in which the Tuberculosis Dispensary is held by the local medical men. Home Visiting The number of home visits paid in 1926 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 20 24 36 25 39 48 50 242 Re-Visits 211 263 209 231 83 270 352 1,619 Non-Pulmonary. First Visits 2 8 12 5 14 1 2 44 Re-Visits 58 62 130 140 20 5 24 439 Housing conditions form an important element in regard to tuberculosis, and home visits are valuable in this connection. The sleeping 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. 67 The following table giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1926 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 l 2 3 4 5 6 7 9 9 10 11 Rooms 1 12 7 11 5 4 1 — — — — — =40 cases ,,2 — 8 17 9 10 5 5 1 — 1 — =56 „ „ 3 — 5 6 9 7 10 4 3 — — — =44 „ ,,4 — 1 _ 4 5 2 — 1 2 — — 1 =15 „ ,,5 — — — 2 2 6 — 2 —v— — — =12 „ „6 — — — 1 1 — — — — — — = 2 „ 169 cases This total falls 6 short of the total number of cases owing to patients living in boarding houses, private hotels or large private residences not being included. The Following-up of Patients in Cases of Doubtful Diagnosis. Patients often do not realise the importance of allowing the Tuberculosis Officer to complete his diagnosis. When a "suspect" has failed to keep an appointment, he is visited at home by a Woman Health Officer, who gives him a definite appointment with the Tuberculosis Officer at the Dispensary so that he will not be kept waiting. If he fails to keep this appointment, second and third visits are paid for the same purpose, when, if of no avail, the case is dropped for the time being. During the year there were 144 "suspect" cases. Of these, 8 were finally discovered to be suffering from respiratory and 3 from non-respiratory tuberculosis. The number who ceased attendance or who were lost sight of before the completion of diagnosis was 10, and there were 31 still on the books at the end of the year. The remaining 92 were finally discharged as non-tubercular. Arrangements for Securing the Examination and Systematic Supervision of Home Contacts. Special efforts are made to secure the examination of all "home contacts" of notified cases. Every " home contact " is visited at the home at least three times if necessary by the Health Officer with a view to inducing him to attend the Dispensary. Perhaps one of the most encouraging features of the work is the steady rise in the number of "home contacts " examined year by year in relation to the number of cases notified. There were 707 contacts traced by the Dispensary Service in 1926. Of these, 363 were examined one or more times by the Tuberculosis Officer, 105 were examined by their own doctors or had been recently examined at school, while 239 refused examination. The endeavour to secure a second examination of the " home contacts " of infectious cases after approximately one year's interval, especially young adult cases whose age renders them more vulnerable, has been continued and the number of these examinations, apart from the 363 contacts mentioned above, was 142. Any cases the least suspicious or with a bad family history are further supervised. Dental Treatment of Tuberculous Persons. The scheme for the dental treatment of tuberculous persons upon the Dispensary premises, which was instituted in the year 1920, has continued to work uninterruptedly during 1926. The Dentist has made regular weekly attendances at the Dispensary and his efforts and those of the staff of the Dispensary have resulted in a slight all-round increase in the amount of dental work carried out. The work done during the year is shown in the following table :— Dentist's attendances at the Dispensary 49 Number of individual patients treated 47 Patient's attendances 107 Number of fillings 5 Isfumber of extractions 115 Number of dentures arranged for 14 Repairs executed 5 Number of scalings 3 68 Artificial Pneumothorax Treatment. During the year the Council undertook to pay for artificial pneumothorax treatment in two cases and payments to Brompton Hospital amounted to £\2 1s. 6d. Home Nursing. The arrangements made by the Council for nursing in the homes of the poor to be carried out by the Kensington District Nursing Association provides for the home nursing of tuberculosis. The Association is represented upon the Tuberculosis Care Committee and in this manner provision is made for co-operation between the two bodies. The cases of tuberculosis attended and the visits paid by the Nurses of the Association during the past five years are shown in the following table:— Year. Cases. Visits. 1922 41 996 1923 39 638 1924 35 575 1925 36 614 1926 34 987 The nurses carry out their work splendidly and are very much appreciated by the poor. 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. In the administration of this assistance the principle that temporary assistance only shall be given is followed. The assistance given is generally one pint of milk and one new-laid egg daily and usually covers a period of one month, the patients having to make an application for the renewal of the grant if desired. The following are particulars of the nourishment granted during 1926 :— Number of patients assisted 5 Number of renewals of grants issued 2 Number of pints of milk granted. Number of eggs granted. 80 80 Estimated cost to the Council of nourishment granted during the year £1 19s. 0d. Arrangements for "Care" and "After-Care." In July, 1922, the Council approved a proposal for the constitution of a Borough Tuberculosis Care Committee, and this Committee, which commenced its activities in December of that year, undertook the whole of the "care" and "after-care" work in the Borough. The constitution and membership of the Committee during the past year were as follow :— (1) Borough Council—Councillor Mr. J. T. Saunders, Chairman of the Public Health Committee, Councillor Miss Drysdale and Councillor Miss Hayne. (2) London County Council—Dr. A. W. Sikes, Divisional Medical Officer and Miss G. M. S. Paddon, District Organiser of School Care Committees. (3) Kensington School Care Committees—Miss A. Webster. (4) Kensington Invalid Children's Aid Association—Miss Burton and Miss M. H. Joseph. (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—Lady Mellor. (8) Kensington District Nursing Association—Miss Gibbes. (9) Kensal House School—Miss C. D. Clay. (10) London Insurance Committee—Dr. H. H. Mills. (11) Panel Committee for the County of London—Dr. A. K. Barrett and Dr. A. S. Herbert. (12) British Red Cross Society—Mrs. Burne M.B.E., and Miss Forbes. (13) British Red Cross Society (Emergency Help Committee)—Miss C. Keeling, J.P. (14) United Services Fund—Miss M. Pickton. (15) Ex-officio members—The Medical Officer of Health, Tuberculosis Officer and two Women Health Officers. The Committee have met fortnightly during the year, and the attendance of members has been well maintained. Every new case of tuberculosis coming to notice is allocated for social welfare purposes to a member of the Committee, whose duty it is to report as necessary in regard to those patients for the supervision of whom she has accepted responsibility. 69 The visiting of adult cases is undertaken on behalf of the Committee by the Charity Organisation Society through their representatives on the Committee, whilst a similar arrangement exists with the Invalid Children's Aid Association in regard to children. In order to secure that no case shall escape routine visitation, a scheme has been evolved whereby the appropriate care worker is required to submit to the Tuberculosis Care Committee at six-monthly intervals reports upon all cases which have been referred to her for supervision. The Committee undertake the work of making assessments for contributions in respect of hospital or sanatorium treatment and dental treatment, and they also deal with applications for grants of nourishment. Arrangements for Finding Employment. The difficulties of a Care Committee in securing work for persons whose physical capacity is limited will be readily appreciated, but every effort is made in this matter. In some instances the intervention of the Tuberculosis Care Committee has resulted in employers holding open the positions of men about to undergo sanatorium treatment. Provision of Shelters at the Homes of Patients. The Council are prepared to loan shelters and they keep several in readiness at their Wood Lane Depot but, at the present time, none is in use. Provision of Bedding for Home Isolation. At the present time there are nine patients to whom bedsteads and bedding are being loaned. In four of these the assistance was given for the first time during the past twelve months, the articles issued being as follow :— Bedsteads 2 Mattresses 2 Bolsters 2 Pillows 3 Pillow-slips 8 Sheets 11 Blankets 8 Quilts 4 The total stock of bedding, etc., on loan on December 31st, 1926, was :— Bedsteads 7 Mattresses 6 Bolsters 4 Pillows 8 Pillowslips 14 Sheets 20 Blankets 14 Quilts 7 Bed-cushions 3 Disinfection after Death or Removal to Hospital. In all cases after death from tuberculosis the Council offer disinfection. This offer is also extended when patients enter hospitals or sanatoria and when they change their residence. Disinfection is also carried out upon request by the Tuberculosis Officer or private practitioners. The following table shows the number of disinfections carried out during the year :— Cases where bedding, etc., were disinfected by steam 172 Number of rooms disinfected 192 Bacteriological Examinations. Specimens of Sputum submitted by Medical Practitioners for bacteriological examination at the Lister Institute at the expense of the Council ... 203 Specimens examined by the Tuberculosis Officer :— In respect of Dispensary patients 496 Sent up by Medical Practitioners 39 Sputum Flasks. These are supplied to patients who are infectious, and advice is given in regard to the disposal of sputum. MATERNITY AND CHILD WELFARE. The Borough Council's Scheme of Maternity and Child Welfare work includes the following amongst other activities :— (a) 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. (r;) The subsidisation of the voluntary infant welfare institutions. (d) The provision of "home helps." 70 (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 subsidisation of a massage and electrical treatment centre for cases of infantile paralysis, etc. (I) Addresses on health and the prevention of disease by a Health Lecturer. (m) The distribution of pamphlets and booklets giving advice on various matters concerning the welfare of mothers and infants. WOMEN HEALTH OFFICERS. The principal Maternity and Child Welfare duties allotted to the Council's 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 and puerperal pyrexia. 5. To investigate applications under the Council's Scheme for the supply of milk and meals free or below cost price. 6. To arrange for the admission of women to the maternity home and women and children to Convalescent Homes, etc. 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 voluntary and salaried workers attached to these institutions. The work performed by the Women Health Officers in 1926 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) 6 301 313 269 274 288 339 1,790 Re-visits to Infants under the age of 12 months 124 649 582 792 984 493 896 4.520 Visits to Children between 1 and 5 years 430 1,022 1,053 1,445 972 1,158 592 6,672 Still-birth Enquiries 2 14 5 5 5 2 7 40 Visits to Ophthalmia Cases 1 2 1 1 4 4 4 17 Return Visits to Ophthalmia Cases 1 8 4 7 7 2 23 52 Visits to Measles Cases 114 5 109 35 92 6 58 419 Visits to Whooping Cough Cases 4 25 28 66 — 4 11 138 Visits to Puerperal Fever Cases 2 — 1 3 1 3 1 11 Visits to Puerperal Pyrexia Cases — 1 4 — 2 2 — 9 Visits to Enteritis Cases l 44 47 14 5 17 27 155 Infantile Death Enquiries 15 23 12 14 21 25 30 140 Investigations re Milk Applications 38 58 118 80 9 125 166 594 Ante-natal Visits 62 63 67 25 67 96 110 490 Half-days at Welfare Centres - 25 92 169 133 99 136 148 802 Special Visits 847 235 305 226 243 260 288 2,404 The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of this report dealing with those subjects, and a complete record of the work performed by each Woman Health Officer during the year appears in Table V. of the Appendix. 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. 71 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 work done at the Infant Welfare Centres during the year 1926 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. Ravmede. Totals. 1—No. of births occurring in the area of the Centre suitable for Welfare attention 106 593 135 281 341 316 240 2032 2—No. of sessions at which doctor attended for infant consultations 94 200 96 101 97 134 98 820 3—No. of sessions at which doctor attended for special ante-natal consultations 24 25 11 13 – 21 24 118 4—Total number of individual mothers who attended during the year 363 666 67 212 492 702 238 2740 5—Number of individual mothers who attended ante-natal sessions during the year 49 69 27 77 40 42 55 359 6—Total number of individual children who attended during the year ... (Old) 156 363 92 194 303 414 462 1984 .. " (New) 219 402 90 160 348 296 193 1698 7—Total attendances at Centra of mothers for all purposes. (Excluding the accompanying of children and for the purpose of buying dried milk or other article) 712 1775 730 744 2164 3812 2557 12494 8—Total attendances at Centre of children for all purposes 3482 6657 1936 3320 5770 8259 7031 36455 9—Total attendances at dinners (Included in Nos. 7 and 8 above)— ]. Mothers 930 2019 2949 2. Children – 2195 2195 10—Total attendances at doctors' consultations— 1. Ante-natal mothers 144 167 78 171 79 271 159 1069 2. Post-natal mothers 171 367 9 219 429 176 271 1642 3 Children 2595 4908 1899 2859 2793 4037 3073 22194 11- -Average attendances at doctors' consultations— 1. Ante-natal mothers 6 7 7 13 – 1 6 — 2. Post-natal mothers 2 2 2 4 13 3 3. Children 27 25 20 28 23 30 31 12—Number of individual children weighed during the year 375 764 182 194 651 680 655 3501 13—Total weighings 2931 6380 1916 3193 4856 6326 6225 31827 14—Number of first visits paid by salaried workers 1. Expectant mothers 18 94 34 10 88 83 112 439 2. Children 15 16 139 12 — — — 182 15—Total number of home visits paid by salaried workers to— 1. Expectant mothers 93 161 65 22 216 120 228 905 2. Children 1725 1306 863 1736 4115 1401 2173 13319 16—Number of home visits paid to children by vnlnntarv workers — 1. First visits – – – – – – 2. Total visits – 182 – – – – – 182 Une interesting observation on the above table is the number of children seen at each doctor's consultation. It is generally recognised that a doctor cannot satisfactorily deal with more than 26 to 30 children at one session and it will be seen in item No. 11 that the average numbers dealt with varied from 20 to 31. 72 General Observations on the Work of the Infant Welfare Centres. Infant Consultation Sessions are held by medical officers in all Centres in the afternoons from 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 Raymede Centre there are two weekly sessions and one fortnightly; at Lancaster Road Centre 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. Ante-Natal Clinics.—Special ante-natal clinics are held at every Centre but Goiborne, and during the past year 118 sessions were held. At the Goiborne Centre, expectant mothers have been seen privately on Infant Consultation days, but in the near future an ante-natal clinic will be established at this institution. The work of ante-natal consultations must grow as it becomes better known, and, in view of the excellent arrangements made by the Voluntary Committees, it is to be hoped that more expectant mothers will take full advantage of them, and thus remove as far as possible all danger of disease and accident in their confinements. Home Visiting.-—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 Health 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. Education in Health.—School medical inspections and Maternity and Child Welfare work have revealed that large numbers of children are suffering from preventable ailments and defects which are likely to impair their development and which are in a large degree attributable to' insufficient knowledge of the simple rules of health on the part of mothers. It is this lack of knowledge which the Infant Welfare Centres are especially designed to meet. For some years past, lectures have been given to mothers by Women Health Officers and Welfare Sisters but these ladies are not appointed as lecturers and, owing to the rush of work on consultation days, they have experienced difficulty in finding suitable opportunities for addressing groups of mothers. In order to meet this difficulty the Council in the early part of the year appointed on their staff a Woman Health Lecturer, whose work is described on page 77. Details Concerning Individual Centres. Archer Street Infant Welfare Centre. This Centre serves the southern part of the Pembridge Ward. Infant consultations are held by the Medical Officer on two afternoons in each week and ante-natal and dental clinics are each held twice monthly. Baths are provided for the mothers. In addition to these activities there are Boot, Clothing, Blanket, Maternity and Denture Clubs connected with the institution. A voluntary masseuse also attends at this Centre and massage treatment is provided free of charge. 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. There is a Maternity Club and Dental Savings Bank. The Infant Welfare work at Kenley Street cannot properly be developed to meet the needs of Notting Dale owing to inadequate accommodation. With a view to removing this bar to progress, the Council have purchased a house and shop next door to the Nursing Association premises, and during the year the Maternity and Child Welfare Committee have conferred with the Committees of the Bfamley Road Centre and the Nursing Association as to how the house and shop might best be used. The question is still under consideration. 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. Massage treatment is provided at this centre, the Masseuse giving her services voluntarily. 73 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 fortnightly, and ante-natal clinics once monthly This Centre also has a Maternity Club. 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. Infant consultations are held twice weekly; expectant mothers have been seen privately at these consultations, but special ante-natal sessions will be commenced during 1927. 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 29 children at the Day Nursery attached to this Centre 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 and children. Dental treatment is provided at the Centre. 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. The daily number of infants received in the Day Nursery attached to this Centre averages 21. Raymede Infant Welfare Centre This Centre serves parts of the St. Charles and Golborne Wards, and is one of the largest institutions of its kind in Kensington. The corner house, in which the Centre is established, is particularly well adapted for the work to be carried out. Five Infant consultations and one antenatal session are held each fortnight. A dental clinic is attached to the Centre. Sewing Classes are held weekly. Various clubs for the benefit of mothers are organised. There is a Mothers' Council which does excellent work and a Fathers' Council has been established. Those who have joined are exceptionally keen and have been of assistance to the institution. The objects of the Fathers' Council are identical with those of the Lancaster Road Fathers' Council, with whom they work in unison and harmony. A Children's Massage, Medical Gymnastics, and Electrical Treatment Centre is conducted on the premises at this Centre, but it is managed by a separate Committee. Dental Treatment.—All the Centres provide dental treatment. Each Welfare Centre endeavours, as far as possible, to make the scheme of dental treatment 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 1926. Centre No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other Treatments. Archer Street 101 329 215 88 17 15 Bramley Road 62 163 212 27 10 12 Campden Hill 6 35 67 1 5 12 Earl's Court 62 140 44 64 17 81 Golborne 31 89 52 — 1 — Lancaster Road 125 356 425 33 13 163 Raymede 272 752 332 12 29 4 Totals 659 1864 1347 225 92 287 74 THE BABY CLINIC, No. 92, TAVISTOCK ROAD. 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, 1926:— Number of sessions at wh'ch 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 209 Total number of individual children who attended during year (Old) 922 „ „ (New) 725 Total attendances at Centre of mothers for all purposes (excluding the accompanying of children) 880 Total attendances of children at Centre for all purposes 14,990 Number seen by doctor at consultations :— 1. Ante-natal mothers 171 2. Post-natal mothers 502 3. Children 6,692 Average number seen by doctor at consultations :— 1. Ante-natal mothers 5 2. Post-natal mothers 11 3. Children 45 Number of individual children weighed 1,647 Total weighings 6,692 Collective instruction by lectures is undertaken at Tavistock Road, by the Council's Health Lecturer, but there is little home visting. 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 20 beds for the treatment of sub-acute and chronic diseases. Records for the year 1926 :— Number of infants in residence at commencement of year 16 Number of admissions during the year 120 Number of discharges during the year 107 Number of deaths during the year 11 Number in residence at end of year 18 Average duration of stay in hospital 39 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 1925, 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. ARTIFICIAL SUNLIGHT TREATMENT. (The Baby Clinic and Hospital). Dr. W. A. Hislop, one of the Medical Officers of the Hospital, has kindly supplied me with the following report in regard to Light Treatment. Artificial Sunlight Treatment in the Baby Clinic and Hospital. During the past year there have been treated in the Light Department of the Baby Clinic 630 children, involving 4,363 treatments, and making an average of about 80 attendances weekly. This is a considerable increase over the previous year, and the whole of the available working time of the Department is taken up. In fact, there has been for some time a waiting list. Most of the parents bring their children with regularity, and show great interest in the treatment and progress of the children. 75 Nearly all the cases have massage and exercises as well as light treatment, and it is striking how the very young children can be induced, with patience and careful handling, to do the necessary exercises satisfactorily. The association of massage and exercises with the ultra-violet ray exposures is a definite improvement, and more rapid progress is observed. The parents see the children at their exercises, and in some cases they are being carried out at home with benefit. It is now no longer necessary to persuade parents to allow their children to have artificial sunlight treatment. Indeed, in many cases it is asked for. An increasing number of children are sent from the Welfare Centres for treatment, and reports of their progress are sent from time to time to the centres. During the treatment the children are happy and contented, and of the two great difficulties, the first—the initial wearing of goggles to protect the eyes—is largely overcome by tact in application and care to avoid any hurry; the second—the difficulty of some of the mothers to find time to leave their households—is at present in part surmounted by the careful arrangement of days and hours to suit them. It is obvious that the next difficulty will be the need of more time and space to deal with the increasing number of children who come for treatment. With the lamp in the Baby Hospital there have been treated 47 in-patients, involving 784 treatments in the year. As a rule these have been the more severe cases of rickets, general debility and anaemia. Here also we find the light treatment of great benefit in supplementing the general treatment of the Hospital. THE RAYMEDE MASSAGE AND ELECTRICAL TREATMENT CENTRE No. 240, LADBROKE GROVE. This Centre was opened in the early part of 1922 for the purpose of giving massage, electrical and gymnastic treatment to poor children whose parents cannot afford to pay for private treatment, or are unable, owing to financial and other reasons, to take the children to a hospital. The days and hours of attendance are : Mondays, Wednesdays and Fridays from 2 to 5 p.m., and the treatment is carried out by four ladies, all of whom hold the Certificate of the Chartered Society of Massage and Medical Gymnastics. There is also a Medical- Officer attached to the Centre who attends on the first Friday in each month. A record of the work done in 1926 is shown in the following table :— No. of cases attending at beginning of year (Over 5 years of age) 23 „ „ „ „ „ (Under 5 years of age) 10 New cases treated during year (Over 5 years of age) 64 „ „ „ (Under 5 years of age) 36 Total cases treated during year 133 No. discharged during year 45 No. transferred to Hospitals for treatment 4 No. of cases attending at end of year (Over 5 years of age) 31 „ „ „ „ „ „ „ „ (Under 5 years of age) 19 No. of treatments given 2632 No. of non-Kensington cases treated 5 No. of self-discharged cases 34 Cases Treated. Scoliosis 38 Fractures 6 Round Shoulders and Kypholor- Spastic Paraplegia 4 dosis 26 Genu Valgum 4 Rickets 16 Flat Foot 3 Paralysis 11 Asthenia 3 Debility 9 Other Diseases 13 The work carried out is very valuable and there is no doubt that the Raymede Massage Centre is meeting a serious need in North Kensington. There is no institution in that part of the Borough where poor persons can obtain this special form of treatment except the Archer Street and Campden Hill Infant Welfare Centres, where a limited amount of massage is performed. When the new Princess Louise Kensington Hospital for Children is opened the question will then arise as to continuing the work at this Centre, but for the present this institution is worthy of support. KENSINGTON MATERNITY HOME. The Kensington Maternity Home was opened in 1924 and consists of a detached ward of ten beds in the southern portion of the grounds of St. Mary Abbot's Hospital. The Home is available for married women of all classes whose home conditions are not suitable for their confinement and who cannot afford to pay the fees charged in private nursing homes. 76 The medical and nursing personnel, the food and other necessities are supplied by the Guardians. For services, etc. rendered, the Borough Council pay 5s. per day for each maternity case admitted and they also pay the cost of any additional medical or nursing staff which the Guardians find it necessary to employ. Statement of Work done, &c. 1924. Oct. 1st to Dec. 31st 1925. 1926. No. of applications for admission 36 112 135 No. of applications accepted 35 111 134 No. of applications withdrawn 2 5 4 No. of women confined during the year 13 108 123 Cleansing ana reaecoration operations during the month, of September necessitated the closing of the Maternity Home for a period of tivo weeks. As no other suitable accommodation at St Mary Abbot's Hospital was available for the reception of maternity cases, arrangements were made with the Hammersmith and Fulham Borough Councils for the admission to the Maternity Homes maintained by those two authorities of those women whose confinements were expected during the period of the closure. Three cases admitted to the Hammersmith ancLiwo in the Fulham Maternity Homes are included in this figure. The gross cost of the scheme to the Council during the year was £853 15s. 8d., including the sum of £34 14s. Od., paid to the Hammersmith and Fulham Borough Councils. The assessments made in respect of patients whose applications were submitted during the year amounted to £369 17s. Od. Payments made by patients totalled £336 8s. 6d. DAY NURSERIES. The following table shows a record of children's attendances at the four Day Nurseries in the Borough in the year 1926. Golborne. Lancaster Road. Notting Hill Day Nursery St. Clement's, Treadgold St. Totals 1. Whole day attendances of children under 3 years of age 4331 3331 8952 3156 19770 2. Whole day attendances of children over 3 2192 1566 2910 662 7330 3. Total whole day attendances 6523 4897 11862 3818 27100 4. Charges made for each attendance of a child lOd. 9d. 8d. 1/- — 5. Half-day attendances of children under 3 years of age — 194 — 451 645 6. Half-day attendances of children over 3 years of age — 155 108 263 7. Total half-day attendances — 349 — 559 908 8. Charges made for each attendance of a child — 6d. — 8d. — 9. Average daily attendance of children 29 21 51 22 — HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. A record of work done in 1926 is shown in the following table :— 466, Uxbridge Road. 2, Upper Phillimore Place. Totals. Expectant and Nursing Mothers. No. in residence at commencement of year 9 4 13 No. admitted during the year 12 26 38 No. remaining in residence at the end of the year 10 6 16 Average duration of stay before confinement (in days) 74 Average duration of stay after confinement (in days) 730 86 — Infants. No. in residence at beginning of year 10 3 13 No. admitted during the year 12 14 26 No. remaining in residence at end of year 10 2 12 Average duration of stay (in days) 730 86 — 77 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 1926 Number of children in the institution at the commencement of the year 19 Number admitted during the year 121 Number discharged during the year 113 Number in residence at the end of the year 27 Average duration of stay of each child in the institution - 38 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 1926 Number of children in the institution at the commencement of the year 14 Number admitted during the year 46 Number discharged during the year 43 Number in residence at the end of the year 19 Average duration of slay of each child in the institution 6 months CONVALESCENT HOMES. In 1926, the Borough Council paid subscriptions of £16 16s. Od. to the Evelyn Convalescent Cottage Home, Wargrave, Berkshire, and £8 8s. Od. to the Hambledon Cottage Home, Surrey. During the Summer months, ten mothers with their babies and four mothers without babies were sent to one or other of these Convalescent Homes for a fortnight's holiday. HOME HELPS. One application was received during the year for the provision of a Home Help under the Council's Scheme. The assistance requested was granted for a period of fourteen days at a cost to the Council of £1 10s. Od. HEALTH LECTURER. A new feature in connection with Maternity and Child Welfare work was introduced by the Borough Council during the year 1926 by the appointment of a part-time Woman Health Lecturer. She started her duties in February and at the commencement her work was mainly in connection with the organisation of the Maternity and Child Welfare Exhibition which was held in the Argyll Hall in March. Subsequently, she paid visits to all the Infant Welfare Centres and several clubs for women and girls, where she lectured to those in attendance. The following is a summary of her work :— Welfare Institutions visited 34 Other institutions visited 4 Number of lectures given 38 Special visits 60 In May, owing to private affairs, the Lecturer relinquished her office and the Council appointed another lady who commenced duty on September 6th. This lady gives addresses in the afternoons at the Infant Welfare Centres and the Baby Clinic, and lectures in the evenings at women's and girls' clubs, etc. Nearly all the latter institutions have been eager to reserve definite dates for further lectures. The following statistics show the work done by this officer from September 6th to December 31st, 1926 :— No. of Visits to Infant Welfare Institutions. No. of Visits to other Institutions, Clubs, &c. No. of special visits to homes. No. of lectures given. No. of persons lectured to. 82 41 19 101 3,006 At some of the infant Welfare Centres, the Health Lecturer found it difficult to obtain an audience for a set lecture, so she commenced a series of informal talks to small groups of mothers. The mothers themselves graatly appreciate this method of receiving instruction and many who will not attend a formal lecture have been interested and communicative during the few minutes 78 the Health Lecturer has spent with them. The great aim has been to awaken the interest of the mothers and to encourage them to ask questions, not only about their babies, but also in connection with themselves, older children, home management, cooking, etc. The Maternity and Child Welfare lectures are based on the Council's booklet " Advice to Mothers." Kensington is the first local authority to appoint a Municipal Health Lecturer; her work is thoroughly appreciated by the Committees of the Infant Welfare Institutions and other bodies, and the number of applications made for her services shows that she fills an important place in the Public Health Service. The promotion of knowledge on hygiene amongst the poor will give better and more lasting results than can be obtained in an endeavour to force them to observe Acts of Parliament on health which they do not fully comprehend. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS ANt> 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 1926 there were 563 grants of milk made by the Council's Milk Sub-Committee. One hundred and seventy-four of the grants were in response to new applications, and the remaining 389 were renewals of grant. Seventeen applications for dinners were granted; 6 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. £ s. d. 13,314 Free 184 5 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. £ s. d. 161 Free 12 1 6 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 lib. packets sold. Value of milk sold. £ s. d. Archer Street - 1,463 103 9 0 Bramie)' Road 1,121 84 1 6 Golborne 160 12 n 0 Lancaster Road 2,932 219 17 0 Raymede 894 63 9 0 — 6,570 482 16 6 Particulars of Dinners supplied under the Council's Scheme. No. of Dinners granted. Price per Dinner paid by Recipients. Estimated Cost to Council. £ s. d. 330 Free 8 5 0 79 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 Guaidians. 23 £1 14 0 155 £3 17 6 NOTE.—The figures for fresh milk supplied by the Guardians after recommendation by the Milk Sub-Committ e cannot be given separately. 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 Baby Clinic. On the re-election of the Committee in November, the membership was as follows:— Centre. Representatives. Archer Street Infant Welfare Centre Mrs. Hillis and Miss Ramsden Bramley Road „ „ „ Mrs. Carnegie and Mrs. Graham Campbell Campden Hill „ „ „ Mrs. Nisbet and Mrs. Ware Earl's Court „ „ „ Lady Trustram Eve and Mrs. Truscott Golborne „ ,, ,, Mrs. Swan and Miss Fraser Lancaster Road „ „ „ Mrs. Burne and Mrs. Webb Raymede „ „ „ Mrs. Fox and Mrs. Sedgwick The Baby Clinic „ „ „ Lady Maurice and Dr. Bentham Mrs. Carnegie was again appointed Chairman and Mrs. Burne Vice-Chairman. For convenience of administration, it has been decided that the Advisory Committee will hold office each year in future from January 1st to December 31st instead of from November 1st to October 31st. In March, the Committee organised a second Maternity and Child Welfare Exhibition, the first having been held in 1924. In order to enable as many of the poorer mothers of North Kensington as possible to visit the Exhibition, it was decided to hold it at the Argyll Hall, Lancaster Road, and to keep it open for three days. The Council kindly placed the Hall at the disposal of the Advisory Committee free of charge. The "Archer Street" Centre displayed the work of their Dental Clinic, "Bramley Road," "Campden Hill," "Lancaster Road" and "Raymede," the weighing of babies and doctors consultations. In addition, "Lancaster Road" provided a very interesting collection of exhibits dealing with hygiene. "Golborne" provided a fully equipped Day Nursery, and "Earl's Court" exhibited garments for children. The Kensington District Nursing Association, the Raymede Massage Clinic, King's College for Women, the Institute of Hygiene, and the Lancaster Road Fathers' Council provided very interesting exhibits. The Gas Light and Coke Company showed their "Anti-Smoke Exhibition," the United Dairies Limited illustrated "The Necessity for a Pure and Clean Milk," and Messrs. Gibbs, Limited (The Ivory Castle League), besides exhibiting, kindly lent cinematograph films which proved a great attraction to the younger folk. About four thousand persons visited the Exhibition. Nine competitions for fathers and mothers of children attending the various Centres were arranged and these proved very popular, nearly six hundred entries being received. 80 The Mayor and Mayoress visited the Exhibition. Mrs. Dudley Baxter presented the prizes to each successful competitor and also gave each one a certificate personally signed by herself. The Exhibition proved a conspicuous success and it is certain that much good Maternity and Child Welfare educational work was carried out. During the year, the Advisory Committee prepared the programme of work for the Council's Health Lecturer; they laid down a carefully considered policy for adoption by the Infant Welfare Centres in regard to Birth Control; and carried out other advisory and supervisory duties of great value. It is to the wise counsel of the Advisory Committee that the smooth and harmonious working of the Council's Maternity and Child Welfare Scheme must be mainly attributed. HOUSING ACCOMMODATION EXISTING IN THE BOROUGH. The number of private dwellings, self-contained maisonettes, mansion-flats, residential hotels and boarding-houses in the Borough is approximately 21,200, and they are situated chiefly in South Kensington and the Pembridge Ward of North Kensington. They are occupied by the higher social and professional and semi-professional classes and present little difficulty to the officers of the Public Health Department. There are 866 houses of the cottage type, that is, with three or less bedrooms. These cottages are distributed fairly evenly over all parts of the Borough and generally provide satisfactory accommodation for single families. The number of tenements in block buildings in various parts of the Borough occupied by the working classes is approximately 470. As these are generally of fairly recent construction, they are mostly satisfactory from the sanitary point of view. There are 2,091 mews-dwellings in the Borough and the following table shows the number situated in North and South Kensington, with the number of rooms they contain: — North Kensington South Kensington The Borough Number with 2 rooms 163 208 371 ,, ,, 3 ,, 311 753 1,064 ,, ,, 4 ,, 188 374 562 ,, ,, 5 ,, 23 71 94 In recent years the general condition of mews-dwellings in the Borough has been very much improved and the Council have paid a good deal of attention to the cleanliness of the mewsways. In certain of the mewsways occupied by the poorest classes, the stable accommodation is used for storage purposes by costermongers, and difficulties arise owing to the careless manner in which these street traders dispose of their unsound food-stuffs. The activities of the Council, however, in regard to this problem have done much to secure better conditions in North Kensington mewsways. There are in the Borough approximately 5,690 houses let in lodgings and occupied by the working classes without having been specially adapted for the purpose. These houses are satisfactory from the point of view of structural and architectural planning, and except for the fact that they have in the majority of cases no bathroom, they would be regarded as providing satisfactory accommodation as single-family houses. They are large, with a basement, ground floor, first floor, second floor, and sometimes a third floor and fourth floor. There are two rooms on each floor and generally a slip room on one or two floors. With the exception of the slip rooms, the rooms are of good dimensions. Difficulties arise, however, owing to these houses, which were originally intended for one family, having been let to three, four, five or six families. Houses let in furnished rooms 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 1926 the number was reduced to 53. reduced to 53. These 53 are situated in the following parts of the Borough: — Norland Ward 22 St. Charles Ward 10 Pembridge Ward 9 Golborne Ward 12 53 The average rent of a furnished room is 7s. per week including the use of such furniture as the owner provides. 81 There are in the Borough 13,095 basements used for dwelling purposes. The number of these dwellings with ceilings at or below the street level is approximately 648, the number in which the width of the front area does not exceed three feet is 1,233, and the number in which the width of the front area exceeds three feet and does not exceed four feet is 2,087. There are in the Borough seven common lodging houses, particulars of which appear in the following table: — Ward. Name of Keeper. Address of Common Lodging House. No. of Lodgers for which licensed in 1926. Male. Female. Total. Golborne Madden, John 194, Kensal Road 66 — 66 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, do. — 25 25 ,, Rusha, Alfred 25 & 27, do. — 57 57 ,, Davis, Sagle 66, St. Ann's Road 66 66 Totals - 186 176 362 Two houses, Nos. 34 and 36, Sirdar Road, which constituted one common lodging house with accommodation for 45 women, were purchased by the Improved Tenements Association in 1926, and are now being converted into tenement houses. This common lodging house was unquestionably the most unsatisfactory in the Borough and one of the poorest in London; and its acquisition by the Improved Tenements Association constituted a valuable public health improvement in the Notting Dale area. BY-LAWS FOR HOUSES LET IN LODGINGS. There came into operation on March 5th, 1926, a new series of by-laws for houses let in lodgings, which rescinded those which had been in force for many years previously. They are a distinct advance on the old code and will be of much value to the Council in securing even better results than those noted in recent years. The clauses of the new by-laws under which the Council can require considerable structural alterations so as to provide more satisfactory lavatory and washing accommodation and accommodation for the storage, preparation and cooking of food, do not come into operation until six months after the Rent and Mortgage Interest (Restrictions) Acts and continuing enactments thereof cease to be in force. The new by-laws have made a very important amendment in the definition of a " house let in lodgings." Hitherto, any house which was occupied by members of more than one family of the working classes came within the scope of the by-laws, but under the new code a house will not be regarded as let in lodgings if the tenant resides in the premises and not more than two persons in addition to the tenant and his family lodge therein. In other words, a tenant renting the whole house can accept two lodgers without the dwelling becoming subject to the by-laws. Further, the Minister of Health, in his Certificate of Confirmation of the by-laws, added a rider that they should not apply to any house in which the tenant resides and not more than one family is lodged. This Certificate of Confirmation by the Minister excludes from the category of a house let in lodgings a dwelling which has been let wholly to one tenant who has sublet one or more rooms to not more than one family. This exception does not apply to a house in which the owner lets part to one family and part to another. The effect of the altered definition of "house let in lodgings" and the qualification to that definition added by the Minister is that approximately five hundred houses will have to be removed from the Council's Register of houses let in lodgings. This estimate is a rough one, for it is impossible to give accurate figures without paying a visit to all houses registered. The definition of "owner" in the new by-laws is the same as that of "landlord" in the old code with the important proviso that where the premises are let without the consent in writing or connivance of the owner so as to bring them within the scope of the by-laws, the tenant responsible for the sub-letting will be required to carry out the obligations of the owner thereunder. The Public Health Committee have in the past received from owners a large number of objections to registration and to the execution of works under the by-laws, which have been based on the ground that the tenant has sublet without the owner's consent and that such tenant and not the owner is the person benefiting by the subletting. The Council have not hitherto possessed the power to enforce the tenant to carrv out certain repairs in such circumstances, but when the owner is now able to prove that he has not consented to or connived at the subletting, he will be relieved of responsibilities under the by-laws. 82 Register of Houses Let in Lodgings. When the new by-laws came into operation it became necessary to consider what alterations, if any, were needed in the work of the Public Health Department. Registration of houses let in lodgings commenced in this Borough in 1886. By 1890, there were 1,800 houses on the Register. In 1923, when the Council adopted their present housing policy, the number registered had reached 2,169, and, at the time of the introduction of the new by-laws in March, 1926, it was 3,651. In March, 1926, the Register comprised eleven books and, apart from the houses which were added in the previous three years, the information was very much out of date and probably inaccurate in many details. In respect of about half of the houses on the Register the original entries were made more than thirty-five years ago. It was obvious that this Register needed revision. Further, it has been found that books are not very suitable for the purpose of recording information regarding houses, particularly as this information is constantly changing and consequently requires alteration from time to time. The Public Health Committee decided, therefore, that it would be cheaper and more satisfactory to keep housing records on the card index system. On the adoption of the card index system, blue cards were introduced for houses let in lodgings and white cards for other houses. This system has effected a great improvement in the work of the Public Health Department and it will in future be possible for the Council to learn at a moment's notice full details as to the size of rooms, ventilation, water supply, drainage and all the material points in regard to the many thousands of houses which have been inspected in a routine fashion in recent years. All houses let in lodgings are now being re-registered under the new system and the old, outof-date information which had to be relied upon in the past is gradually being replaced. At the commencement of 1926 there were on the old Register 3,614 houses. The number of new houses registered during the year was 265. The number of houses removed from the Register during the year was 109. At the end of the year the number on the Register was 3,770, and 581 of these had been transferred from the old Register to the card index register, leaving 3,189 to be reviewed and transferred to the new register or removed as not coming within the definition of a house let in lodgings. ACCOMMODATION PROVIDED BY THE COUNCIL. The Borough Council built before the War 120 tenements in the Notting Dale area. Since the War they have provided, through the Housing Committee, 55 cottages and 178 flats, and have converted 19 large houses into 102 maisonettes. The cost of the housing work undertaken by the Housing Committee in the provision of these 335 separate houses, cottages or maisonettes, has been £279,010 16s. 5d. Five cottages and 30 flats were completed during the year. A piece of land in Tobin Street and Thresher's Place on which there were some old and dilapidated cottages was secured during the year and a commencement was made in the erection of 14 flats on the cleared site. The estimated cost is £11,800. In the past few years the Public Health Committee, on behalf of the Council, have acquired two derelict houses in Bosworth Road, which have been converted into 12 flats, four houses in Sirdar Road which have also been converted into 12 flats, and one house in Sirdar Road which has been put into a satisfactory state of repair and is now occupied by four families. They have acquired a block of 18 dilapidated flats in Virginia Place, together with a piece of vacant land adjoining, and during 1926 they erected on this vacant land one block of flats which provides 12 two-roomed and 7 three-roomed tenements.. At the time of writing (April, 1926), the old block is being demolished with a view to the erection of a new block on the cleared site. During the year the Council purchased one house in Kenley Street, but it has not yet been decided whether it shall be used for increasing housing accommodation or as an Infant Welfare Centre. ACCOMMODATION PROVIDED BY HOUSING ASSOCIATIONS. The number of houses acquired during the year by the Wilsham Housing Trust, the Improved Tenements Association and similar bodies was 28; these have been or will be altered so as to provide satisfactory accommodation for 68 families. 83 The accommodation in North Kensington now owned and managed by housing associations is shown in the following table: — SingleFamily Houses. Selfcontained Flats. Tenement Houses Let in Lodgings. Totals. No. of Houses. No. of Families accommodated in Tenement Houses. Houses. Families. Wilsham Housing Trust 123 49 49 186 221 358 Improved Tenements Association 43 16 57 209 116 268 Others 2 — 28 79 30 109 These dwellings, together with the Council's properties in Kenley Street, Hesketh Place, Runcorn Place, Sirdar Road, Virginia Place and Bosworth Road, are managed on the Octavia Hill system by a group of women house property managers. A SUMMARY OF THE STEPS TAKEN IN 1926 TO INCREASE HOUSING ACCOMMODATION. The new accommodation provided in the Borough during 1926 by the Council has furnished homes for approximatly 180 persons. The additional housing accommodation provided in 1926 by private enterprise has found homes for approximately 200 persons. It is estimated that approximately 82 large single-family houses have been converted by private persons or companies into self-contained maisonettes and thus accommodation for 82 families has been converted into accommodation for 265 families, an increase for 183 families or 902. persons. The Council during the year entered into an agreement with the London County Council wherebv 99 houses on the new County Council Wormholt Estate will be reserved for Kensington families nominated by the Borough Council. The amount payable by the Borough Council for this special allocation is £1 per house per annum for a period of 20 years. It is not expected that these houses will be ready for occupation before the end of 1927. In addition, the Housing Department of the London County Council have accepted 21 Kensington families as tenants of houses on various County Council Estates, with the result that approximately 100 persons have left the Borough, thus reducing the housing shortage in Kensington. MEASURES TAKEN TO DEAL WITH INSTANCES OF OVERCROWDING AND INDECENT OCCUPATION DISCOVERED. In Kensington at the 1921 Census there were 194,381 rooms occupied by 158,399 persons in private families, with the result that there was a proportion of more than one room per person. In the more thickly populated northern half of the Borough, there were 77,061 rooms for 87,987 persons, or only 114 persons per room. Even in the most congested part of the Borough, namely, Golborne Ward, there were 15,855 rooms for 25,998 persons, giving a proportion of 1.64 persons per room. From these figures it is clear that if the population of the Borough could be evenly distributed, there would be no over-crowding in Kensington; indeed, there would be ample accommodation for all. But this evidence does not allow the argument to be advanced that there is no overcrowding problem, for it is obvious that it is quite impossible to pool all the housing accommodation in the Borough and distribute the population evenly. The proportion of rooms to persons does, however, lend support to the opinion that many cases of overcrowding could be ameliorated if the tenants took steps to improve the conditions under which they live. Recognising that the difficulty of finding housing accommodation has become less than in previous years, the Public Health Committee in 1925 commenced to deal more actively with instances of overcrowding discovered, mainlv with a view to inducing heads of overcrowded families to make a search for more suitable accommodation. Many of the worst cases of overcrowding and indecent occupation in recent years have been discovered in families where the sons and daughters have left school and are at work earning good money. These families can often well afford verymuch better and more satisfactory accommodation. Both in 1925 and 1926, the Sanitary Inspectors served Intimation Notices for overcrowding in every case where a house let in lodgings, whether registered or not, did not provide each person; 84 with 300 cubic feet of air space in every room used for sleeping purposes only or 400 cubic feet in every room used for both sleeping and living purposes (in the case of a child under ten years of age the figures are 150 and 200 cubic feet respectively). In addition, the Inspectors served Intimation Notices where members of the two sexes over twelve years of age occupied one sleeping room in a registered tenement house, except where they were living together as man and wife. The Notices served bv the Inspectors were reported fortnightly to the Public Health Committee who authorised the issue of Statutory Notices and Summonses in cases where the Intimation Notices had not been complied with. This policy has had the effect of making many people find more satisfactory accommodation either in or outside the Borough. The following figures show the extent of action taken in the two years and the results obtained: — Overcrowding— 1925. 1926. Service of Intimation Notices 75 103 Service of Statutory Notices where the Intimation Notice was not complied with 60 38 Summonses issued 10 6 Indecent Occupation— Service of Intimation Notices 40 79 Service of Statutory Notices where the Intimation Notice was not complied with 21 12 Summonses issued 1 0 As only 10 summonses were eventually issued in 1925 and 6 in 1926 in 178 cases of overcrowding, and only one summons in the two years in regard to 119 cases of indecent occupation, it will be seen that 104 families in 1925 and 176 families in 1926 were able to improve their accommodation without the Council having to resort to extreme measures. At the commencement of 1925 another step was adopted for the purpose of relieving cases of overcrowding. The Public Health and Special Housing Committees arranged that immediately a new house provided by the Council had been let, the Town Clerk should supply me with information as to the name and address of the future tenant. This information has enabled officers of the Public Health Department to know several weeks in advance of rooms which would become vacant, with the result that they have been able to approach the owners of these rooms and urge that they might be let to Kensington families known to be living under overcrowded conditions. The results have been as follow: — 1925. 1926. Number of Council Houses let by Town Clerk and reported to the Medical Officer of Health 33 23 Number of instances in which the rooms vacated by the 56 tenants have been let to Kensington families whose previous accommodation was unsatisfactory or overcrowded 24 18 In 1925, the Housing Department of the London County Council commenced to send me information of all Kensington persons accepted as tenants for County Council houses in order that a similar procedure could be adopted in regard to rooms vacated by tenants leaving the Borough for such houses. This practice was continued during 1926, with the following results: — 1925. 1926. Number of County Council houses let and reported to the Medical Officer of Health 41 30 Number of instances in which the rooms vacated by the 62 tenants have been let to Kensington families whose previous accommodation was unsatisfactory or overcrowded 21 12 STEPS TAKEN BY THE COUNCIL TO SECURE AND MAINTAIN A HIGHER STANDARD OF HABITABILITY IN HOUSES. Every house in the Borough is inspected in routine fashion after a case of infectious disease has been reported therefrom and on receipt of a complaint. The permanent Sanitary Inspectors attempt to make a routine inspection of ten houses each month and the number of these inspections in 1926 was 1,069. In addition to this routine work, special efforts have been made in recent years and those for 1926 may be described briefly under the following headings: — (1) Improvements in Houses Let in Lodgings secured during the year by the Permanent and Temporary Sanitary Inspectors. 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 85 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 Temporary Sanitary Inspectors paid 2,929 visits to houses let in lodgings and served 742 Intimation Notices, 145 Statutory Notices and 51 Final Notices. The ten District Sanitary Inspectors attempt to visit every registered house in their districts at least once a year with a view to keeping them up to standard. (2) Improvements in Mews Dwellings. During the year the ten District Sanitary Inspectors have continued the work commenced in 1925 of inspecting and bringing up to standard the mews dwellings in the Borough. Six hundred and four had been dealt with by them during 1925 and 375 were inspected in a routine manner in 1926. One hundred and sixty-one Intimation Notices under the Public Health Act were served in respect of the 375 dwellings inspected. Although there are 2,091 mews dwellings in the Borough, the routine work of inspecting these will shortly be completed as far as is necessary, for most of the mews dwellings remaining uninspected are in South Kensington and are in a satisfactory condition or have in recent years been converted into private houses which are let at good rentals to people of the professional and semi-professional classes and do not call for the same detailed inspection as is needed in the case of those mews dwellings occupied by the poorer classes. '(3) Closing Orders. One house was closed during 1926 subsequent to the service of a Notice by the Council under Section 3 of the Housing Act, 1925. This house has now been made fit for habitation. Six hundred underground rooms were submitted to routine inspection and 44 of these were reported to the Public Health Committee as not complying with the Council's Regulations. Twenty were made to comply after an informal Notice had been served and in 24 cases Closing Orders were issued. None of these Closing Orders was determined during the year. '(4) Work under Section 3 of the Housing Act, 1925. Section 28 of the 1919 Act (now repealed) provided that if the owner of a house suitable for the working classes failed to keep it in all respects reasonably fit for habitation, the Council could require him to execute such works as were necessary. The owner could appeal, and might, in certain circumstances, close the house; but if he neither exercised his rights nor carried out the repairs, the Council could do the work and recover the cost thereof with interest. Section 28 has been replaced by Section 3 of the Housing Act, 1925, which, in addition to giving powers similar to those under Section 28, grants to the Council the powers and remedies of a mortgagee under the Conveyancing Acts, 1881-1922, for the purpose of recovering their • expenses. The new Section also defines the appeals of which an 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 are able to feel much more secure in availing themselves of the powers granted. Particulars of action taken in 1926 under Section 3 of the 1925 Act are as follow: — (1) Number of houses in respect of which notices have been served 37 (2) Number of houses in which repairs were carried out by the owner 21 (3) Number of houses in which the Council carried out the work in default of the owner 5 The total cost to the Council in carrying out repairs under Section 3 in 1926 was £325, and this, added to the expenditure incurred in connection with this class of work since the commencement of 1923, gives a total of £1,220. The amount repaid to the Council is £677, and the remaining sum of £543, with interest at five per cent., is being recovered. housing statistics for 1926. 1.—Unfit Dwelling-houses. Inspection— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,769 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,168 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 (4) Number of dwelling houses (exclusive of those referred to under the preceding heading) found not to be in all respects reasonably fit for human habitation 4,536 sa 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 267 3.—Action under Statutory Powers. A.—Proceedings under Section 3 of the Housing, Act, 1925. (1) Number of dwelling houses in respect of which Notices were served requiring repairs 37 (2) Number of dwelling houses which were rendered fit:— (a) By owners 21 (b) By Local Authoritv in default of owners 5 (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 4,332 (2) Number of dwelling houses in which defects were remedied:— (a) By owners 4,157 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 11, 14, 15 and 18 of the Housing Act, 1925. (1) Number of representations made with a view to the making of Closing Orders— Dwelling-houses 1 Underground Rooms 44 (2) (a) Number of dwelling houses in respect of which Closing Orders were made 1 (b) Number of underground rooms in respect of which Closing Orders were made 24 (3) (a) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (b) Number of underground rooms in respect of which Closing Orders were determined, the rooms having been rendered fit Nil (4) Number of dwelling houses in respect of which Demolition Orders were made Nil (S) Number of dwelling houses demolished in pursuance of Demolition Orders Nil The principal improvements secured in carrying out the work indicated in the above table are as follows:— Houses cleansed 2021 House drains re-constructed 76 Defective drains repaired 146 House drains cleansed 390 Water closets re-constructed, repaired, &c., 710 „ „ supplied with water 307 , „ new provided - 100 Soil-pipes ventilated, repaired, &c., 170 „ new provided 145 Cisterns cleaned, covered, &c., - 329 Yards, areas paved, drained, repaired - 397 Dustbins provided 762 Ashpits abolished 117 Accumulations of filth, &c., removed 197 Animals removed 72 Overcrowding abated after service of Notice 97 Underground rooms, illegal occupation discontinued - 44 Roofs repaired 768 Houses provided with water above basement floor 134 Dampness in dwellings remedied 523 Other important repairs 1979 87 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 quarters ot the Borough. In considering the work which lies ahead, there is one important point to be remembered in regard to tenement houses, particularly those occupied by many families, and in which almost every room is used for living and sleeping purposes. As soon as repair and cleansing works have been completed deterioration sets in again. When, therefore, the owners have spent considerable sums of money in carrying out the requirements of the Council in these houses, it is desirable that the Sanitary Inspectors should pay visits as frequently as possible in order to ensure, as far as is in their power, that the efforts of the owners are not neutralised by the neglect and carelessness of indifferent 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, My Lords, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 88 APPENDIX. TABLE I. Vital Statistics of Whole District for 1926 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 Member. 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 1921 175,859 8,159 8,288 18.7 2,656 15.1 727 496 368 110 2,425 13.8 1922 179,100 2,998 8,152 17.6 2,814 15.7 891 507 257 82 2,427 13.6 1923 178,500 8,042 3,121 17.5 2.551 14.8 839 484 218 70 2,196 12.3 1924 178.700 2,591 2,908 16.2 2,759 15.5 880 453 219 75 2,S32 13.0 1925 ‡179,600 B 179,400 D 2,494 2,846 15.8 2,830 15.7 930 468 223 78 2,368 13.2 1926 ‡180.000 B 179,800 D 2,405 2,717 15.1 2,564 14.2 816 557 164 60 2,805 12.8 * 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 1921. Area of District in acres (exclusive of area covered by wator) 2,291 Total population at all ages 175,859 Total families or separate occupiers 43,001 89 TABLE II. Cases of Infectious Disease notified during the Year, 1926. 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Dysentery ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... •• ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 430 4 121 209 43 42 7 4 73 125 102 33 15 22 23 28 9 422 Erysipelas 69 1 3 5 5 16 34 5 19 19 6 6 3 5 4 5 2 25 Scarlet fever 298 2 102 145 26 16 7 ... 55 75 62 20 26 15 13 25 7 276 Typhus fever 1 ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... 1 Enteric fever 30 ... 1 8 5 13 2 1 ... 1 9 3 3 2 7 3 2 21 Continued fever ... ... ... ... .... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 9 ... ... ... 3 6 ... ... ... 3 1 1 2 ... 1 1 ... 8 ‡Puerperal pyrexia Encephalitis 11 ... ... ... 6 5 ... ... 4 1 3 1 ... ... 1 1 ... 9 Lethargica 10 1 1 1 2 2 2 1 1 1 3 2 ... ... 2 ... 1 9 Cerebro-spinal meningitis 4 2 2 ... ... ... ... ... ... 1 3 ... ... ... ... ... ... 2 Polio-myelitis and Polio-encephalitis 4 2 ... 1 1 ... ... ... ... ... 1 1 1 1 ... ... ... 4 Pulmonary Tuberculosis 248 1 1 11 64 109 55 7 40 50 46 41 15 21 12 15 8 146 Other forms of Tuberculosis 69 2 17 29 11 7 3 ... 10 19 13 8 5 4 3 7 • •• 38 Ophthalmia Neonatorum 15 15 • • • ... • •• ... ... ... 1 1 1 4 1 2 1 4 • •• 8 Primary Pneumonia 107 3 25 31 12 18 10 8 15 47 25 13 1 1 2 1 2 42 Influenzal Pneumonia 38 3 5 3 4 8 8 7 4 22 5 3 1 ... 1 1 1 11 Malaria 2 ... ... 1 ... ... ... 1 ... ... 1 ... ... ... ... 1 ... 1 *Enteritis 97 56 41 ... ... ... ... ... 9 38 41 3 1 2 2 ... 1 32 Totals 1442 92 319 445 182 242 128 34 232 403 322 139 74 75 72 92 33 1056 ‡ Notifiable since October lit, 1926. * Notifiable only in children under the age of 5 years. 90 TABLE III. Causes of Death at Different Periods of Life in 1926. Causes of Death Sex. 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 under 75 years. 75 and upwards ALL CAUSES M. 1,056 101 35 22 24 39 89 811 235 199 F. 1,219 63 33 33 21 85 130 805 266 363 Enteric Fever M. 1 ... ... ... ... ... ... 1 ... ... F. 1 ... ... ... ... ... 1 ... ... ... Small-pox M. • •• ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Measles M. 14 1 9 2 2 ... ... ... ... ... F. 11 I 4 4 1 ... ... 1 ... ... Scarlet Fever M. 4 ... 2 1 1 ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Whooping-Cough M. 3 1 1 1 ... ... ... ... ... ... F. 5 3 2 ... ... ... ... ... ... ... Diphtheria M. 10 l 1 3 5 ... ... ... ... ... F. 12 ... 1 4 4 1 1 ... 1 ... Influenza M. 19 l ... ... ... 1 1 5 3 8 F. 25 l 1 ... ... ... 1 3 8 11 Encephalitis Lethargica M. 3 l ... ... ... ... ... 1 1 ... F. 2 ... ... 1 ... ... 1 ... ... ... Meningococcal meningitis M. 1 l ... ... ... ... ... ... ... F. 8 2 ... 1 ... ... ... ... ... ... Tuberculosis of Respiratory System M. 67 ... ... ... 1 16 29 18 8 1 F. 63 1 ... ... 2 13 29 18 ... ... Other tuberculous diseases M. 13 1 3 8 1 ... 2 3 ... ... F. 17 1 3 5 8 1 3 ... ... 1 Cancer, Malignant disease M. 125 ... ... ... ... ... 3 64 43 15 F. 219 ... ... ... ... 1 19 98 60 40 Rheumatic Fever M. 1 ... ... ... ... ... ... 1 ... ... F, 3 ... ... ... 2 l ... ... ... Diabetes M. 11 ... ... ... ... 1 2 4 ... 4 F. 17 ... ... ... ... ... 4 6 6 1 Cerebral Haemorrhage, etc. M. 49 ... ... ... ... ... 1 20 15 13 F. 71 ... ... ... ... .... ... 16 24 31 Heart Disease M. 163 ... ... ... ... 3 9 45 54 52 F. 224 ... ... ... 2 5 9 44 57 107 Arterio-sclerosis M. 45 ... ... ... ... ... 1 12 20 12 F. 42 ... ... ... ... ... ... 4 14 24 Bronchitis M, 85 7 1 ... ... ... 4 27 23 23 F, 84 8 2 1 ... .... 2 11 23 42 Pneumonia (all forms) M. 87 22 10 11 1 8 5 17 10 3 F. 90 14 11 8 2 2 8 9 14 22 Other respiratory diseases M. 17 ... ... ... ... ... 1 10 5 1 F. 28 1 1 ... ... 1 3 9 5 3 Ulcer of Stomach or Duodenum M. 19 ... ... ... ... ... 7 9 1 2 F. 8 ... ... ... ... ... 2 6 ... ... Diarrhœa, etc. M. 23 15 3 ... 1 ... ... 3 ... 1 F. 23 15 4 2 ... 2 ... ... ... ... Appendicitis and Typhlitis M. 8 ... ... ... 1 1 3 ... 1 2 F. 10 ... ... 2 ... ... 1 2 3 2 Cirrhosis of Liver M. 8 ... ... ... ... ... 1 4 2 1 F. 8 ... ... ... ... ... 3 5 ... ... Acute and Chronic Nephritis M. 23 ... ... ... ... 2 ... 7 5 9 F. 23 ... ... ... ... ... 4 7 5 7 Puerperal Sepsis M. ... ... ... ... ... ... ... ... ... ... F. 6 ... ... ... ... 2 4 ... ... ... Other accidents and diseases of Pregnancy and Parturition M. ... ... ... ... ... ... ... ... ... ... F. 3 ... ... ... ... ... 3 ... ... ... Congenital Debility and Malformation, Premature Birth M, 38 36 ... ... 1 1 ... ... ... ... F. 13 13 ... ... ... ... ... ... ... ... Suicide M. 15 ... ... ... ... ... 4 9 ... 2 F. 13 ... ... ... 2 4 6 1 ... Other deaths from violence M. 40 3 3 ... 7 6 4 9 7 1 F. 36 2 1 2 1 2 7 9 3 9 Other Defined Diseases M. 164 11 2 2 3 6 12 42 42 44 F. 189 6 3 2 4 2 19 53 42 58 Causes ill-defined or unknown M. • •• ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... 91 TABLE IV. INFANT MORTALITY DURING THE YEAR 1926. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. otal Deaths under One Year. All Causes. Certified 30 8 2 40 28 35 28 17 148 Uncertified 9 ... 1 ... 10 1 2 1 2 16 Measles ... ... ... ... ... ... ... ... 2 2 Whooping-cough ... ... ... ... ... 2 1 1 ... 4 Diphtheria ... ... ... ... ... 1 ... 1 Influenza ... ... ... ... ... 1 1 ... 2 Encephalitis Lethargica ... ... ... ... ... 1 ... ... ... 1 Meningococcal Meningitis ... ... ... ... ... ... 1 2 3 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases ... ... ... ... ... ... 1 1 ... 2 Bronchitis ... 1 ... 1 2 1 3 4 ... 10 Pneumonia ... ... ... 1 1 7 7 13 8 36 Other respiratory diseases ... ... ... ... ... 1 ... ... ... 1 Diarrhoea, etc. ... ... ... ... ... 8 12 7 3 30 Congenital debility 7 1 ... ... 8 4 8 ... ... 20 Malformation 4 2 ... ... 6 1 ... ... ... 7 Premature Birth 18 3 ... ... 22 ... ... ... ... 22 Other deaths from violence 3 1 ... ... 4 1 ... ... ... 5 Other defined diseases 7 ... ... ... 7 3 2 2 3 17 39 8 1 2 50 29 37 29 19 164 Nett Births in the year legitimate, 2,510. illegitimate, 207. Nett Deaths in the year of legitimate infants, 188. illegitimate infants, 81. 92 TABLE V. The Work of the Women Health Officers for the Year 1926. HEALTH OFFICERS Total. 1 2 3 4 5 6 7 Child Welfare— First Visits to Infants 6 301 313 269 274 288 339 1,790 Return Visits to Infants 124 649 582 792 984 493 896 4,520 Visits to Children between 1 and 5 years 430 1,022 1,053 1,445 972 1,158 592 6,672 Stillbirth Enquiries 2 14 5 5 5 2 7 40 Visits to Ophthalmia cases 1 2 1 1 4 4 4 17 Return Visits to Ophthalmia cases 1 8 4 7 7 2 23 52 Visits to Measles cases 114 5 109 35 92 6 | 58 419 Visits to Whooping Cough cases 4 25 28 66 — 4 : 11 138 Visits to Puerperal Fever cases 2 — 1 3 1 3 1 11 Visits to Puerperal Pypexia cases — 1 4 — 2 2 — 9 Visits to Enteritis cases 1 44 47 14 5 17 27 155 Infantile Death Enquiries 15 23 12 14 21 25 30 140 Milk Investigations 38 58 118 80 9 125 166 594 Ante-Natal Visits 62 63 67 25 67 96 110 490 Half-days at Welfare Centres 25 92 169 133 99 136 148 802 Special Visits 847 235 305 226 243 260 288 2,404 Tuberculosis— Pulmonary.—First Visits 20 24 36 25 39 48 50 242 Re-Visits 211 263 209 231 83 270 352 1,619 Non-Pulmonary—First Visits 2 8 12 5 14 1 2 44 Re-Visits 58 62 130 140 20 5 24 439 Factories and Workshops Act. Inspections of Factories 20 50 62 4 1 1 8 146 Inspections of Workshops 360 25 49 11 189 19 80 733 Inspections of Outworkers' Premises 23 3 19 31 9 24 45 154 Inspections of other Workplaces 2 — — — 1 6 6 15 Total Visits 2,368 2,977 3,335 3,562 3,141 2,995 3,207 21,645 Notices issued under the Public Health Act— Intimation Notices 2 — 5 4 — 2 1 14 Statutory Notices — — — — — — — — Final Notices — — — — — — — — Summonses — — — — — — — — 93 TABLE Vl. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1925. date. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered iu 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 1. 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, 1926. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1925 1 2 3 4 6 7 8 9 10 1st January to 31st Dec. North 1,640 1,113 5 297 76 19 48 72 10 1,908 South 857 657 4 92 35 11 17 37 4 Total 2,497 1,770 9 389 111 30 65 109 14 94 TABLE VII. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1926. (as required by Ministry of Health Circular 359). Medical Officer of Health and Administrative Tuberculosis Officer. Year of Appoint meat James Fenton, M.D., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A. W. K. Picard, M.D. 1922 Clerical Staff. James H. Wilson (Chief Clerk) 1902 William Gascoyne 1919 Horace A. Hillam 1891 John C. Minter 1917 John S. Russell 192a Denis C. Page 1925 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 *Edward J. Bennett 1901 *George W. McQuinn 1901 *Joseph H. Fowles 1902 †John McDermid 1920 ¶*†Hubert }. Green 1922 ¶†Henry W. Walters (Food Inspector) 1925 ¶†Cecil R. Webb 1925 ¶†tRedmond J. McCarthy 1926 †George W. Herrick 1926 Women Health Officers. Miss E. Mackay 1909 Miss F. C. Hargrave 1910 ‡†*Miss E. Dixpn 1917 Mrs. E. E. Buck 1918 ‡†*Miss W. H. E. Whitbread 1920 †*Mrs. V. A. Ross 1921 ‡†*Miss E. M. Law 1922 Miss A. E. Haycock 1922 ‡Miss E. M. Roe 1926 Health Lecturer. Mrs. M. Hayman 1926 Mortuary Keeper. William Sutton 1907 Disinfecting Staff. Albert Nunn (Chief Disinfector) 1906 William Cambridge 1906 Frank Chillcott 1906 George H. I. Harris 1914 William Taylor 1926 Medicinal Baths Staff. Maurice M. Beveridge (Superintendent) 1926 Mrs. R. Webber (Matron) 1913 Rat Officer. Walter E. Weedon 1926 Drain Testing Assistant. William Clancy 1903 * Certificate of the Royal Sanitary Institute, t Certificate of the London Sanitary Inspectors Examination Board. ¶ Certificate for Meat and other Foods. ‡ 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, the Health Lecturer and Mr. Russell. INDEX. PAGE SUMMARY OF STATISTICS 2 INTRODUCTION 8 VITAL STATISTICS, 3 Births 4 Births Notified (Table) 6 Birth Rates, Death Rates, and Infantile Mortality Rates in 29 Metropolitan Cities and Boroughs (Table) 14 Birth Rate, Decline in (Table) 5 Births, Wards and Rates (Table) 5 Cancer 8 Causes of Death 7 Deaths 6 Deaths from Certain Diseases (Table) 9 Deaths, Wards and Rates (Table) 7 Heart Disease 8 Infantile Mortality— 9 Deaths, Above Standard 12 Deaths, Causes of (Table) 11 Deaths each month (Table) 10 Deaths in Wards (Table) 9 Illegitimate Births, Last 7 years (Table) 13 Illegitimate Infant Deaths 12 Infantile Mortality Rates (Table) 10 Marriages 4 Maternal Mortality 13 Notification of Births Act, 1907 5 Population 4 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 14 Ambulance Facilities 22 Bacteriological Work 16 Chapel of Rest 17 Children's Hospital 19 Cleansing of Verminous Persons 18 Disinfection, Rooms, Bedding, &c. 16 „ Library Books 16 Health Lecturer 15 Home Nursing, Golborne Infant Welfare Centre 22 Kensington and Fulham General Hospital 19 Kensington District Nursing Association 21 Kensington Institution 18 Male Sanitary Inspectors 15 Medical Officers 15 Medicinal Baths 18 Midwifery Arrangements 22 Mortuary 17 Nursing, Professional, in the home 21 Other Health Services 22 Out-Door Relief 19 Poor Law Authority 18 Public Baths and Washhouses 17 St. Mary Abbot's Hospital 19 School Medical Service 20 School Treatment Centres 21 Staff, Clerical 15 PAGE Staff, Other 15 Subscriptions to Voluntary Health Organisations 28 Women Health Officers 15 SANITARY CIRCUMSTANCES AND ADMINISTRATION 24 Dust Removal 28 Factories and Workshops— 31 Defects Fouud (Table) 35 Home Office Tables 34 Home Work 38 Inspections (Table) 34 Men's Workshops 31 Outworkers (Table) 33 Women's Workshops 32 Fouling of Footpaths by Dogs 30 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1928 29 Public Conveniences 29 Rag Flock Act, 1911 29 Rats and Mice (Destruction) Act, 1919 30 Refuse Removal from Mews 29 Sanitary Inspection— 24 Inspections made (Table) 24 Legal Proceedings 27 Notices issued (Table) 25 Works completed (Table) 26 Sewage and Drainage 28 Smoke Abatement 29 Verminous Premises cleansed 30 INSPECTION AND SUPERVISION OF FOOD 35 Analyses, Results of 43 Bakehouses 40 Cowsheds 38 Cream Regulations. 45 Dailies and Milkshops, Inspection of 37 Dairies, Cowsheds and Milkshops Order, 1885 (Proceedings undtr) 45 Food Poisoning 47 Food Supply 35 Ice Cream 40 Margarine and Butter Substitutes 47 Meat 39 Milk, Addition of colouring matter to 38 Milk and Dairies (Amendment) Act, 1922 36 ,, ,, ,, ,, ,, ,, (Proceedings under) 44 Milk and Dairies (Consolidation) Act, 1915 85 „ „ Order, 1926 36 „ „ „ „ (Proceedings under) 44 Milk (Special Designations) Order, 1923 37 Milk supplied in Kensington, Composition of 38 „ Supply 35 „ Utensils in Infected Houses 38 Other Places where Food is prepared 40 INDEX—continued. PAGE Public Health (Condensed Milk) Regulations, 1928 38 Public Health (Dried Milk) Regulations, 1928 88 „ „ (Meat) Regulations, 1924 39 ., „ (Preservatives in Food) Regulations, 1925 45 Register of Retail Dairies and Milkshops 36 „ „ Wholesale Dairies 37 Sale of Food and Drugs Acts 40 „ „ Order, 1921 47 Samples, Formal (Table) 41 Samples, Informal (Table) 42 Slaughter-houses 39 Unsound Food 40 PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. 47 Cerebro Spinal Meningitis 54 Diphtheria 49 Encephalitis Lethargica 54 Enteric Fever 51 Erysipelas 51 Infectious Cases in Four-Weekly Periods (Table) 48 Malaria 54 Measles 61 Non-Notifiable Diseases 61 Notifiable Infectious Diseases 47 Notifications of Infectious Disease (Table) 48 Ophthalmia Neonatorum 51 Pneumonia and Influenzal Pneumonia 54 Polio-Myelitis and Polio-Encephalitis 54 Puerperal Fever 52 „ Pyrexia 58 Scarlet Fever 48 Schick Test and Immunisation 50 Small-Pox 48 Typhus Fever 60 Whooping Cough 61 Zymotic Enteritis 55 TUBERCULOSIS. 62 Artificial Pneumothorax Treatment 68 Bacteriological Examinations 69 Bedding for Home Isolation, Provision of 69 Care and After-Care, Arrangements for 68 Co-operation with Medical Practitioners, other Bodies and Institutions 66 Council's Scheme for Prevention and Treatment 68 Deaths in Wards (Table) 68 Dental Treatment 67 Disinfection 69 Dispensary Diagnosis and Treatment 64 PACE Employment, Arrangements for finding 69 Extra Nourishment, Supply of 68 Home Contacts, Examination and Supervision of. 67 Home Nursing 68 „ Visiting 66 Light Treatment 66 Medical Consultations 66 Notifications, Age & Sex distribution 62 Notifications, Deaths and Death Rates since 1917 (Table) 63 Notifications in Wards since 1919 (Table) 62 Primary Notification-; (Table) 64 Public Health (Prevention of Tuberculosis) Regulations, 1925 63 Records 65 Residential Institutional Treatment 65 St. Mary Abbot's Hospital 65 Shelters 69 Sputum Flasks 69 X-ray Diagnosis 66 MATERNITY AND CHILD WELFARE. 69 Advisory Committee 79 Ante-Natal Clinics 72 Artificial Sunlight Treatment 74 Baby Clinic 74 „ Hospital 74 Convalescent Homes 77 Creagh Nursery Training School 77 Day Nurseries 76 Dental Treatment 73 Details of individual Infant Welfare Centres 72 Education in Health 72 Extra Nourishment, Supply of 78 General Observations on Infant Welfare Centres 72. Health Lecturer 77 Home Helps 77 Homes for Deserted, Widowed or Unmarried Mothers and their Children 76 Home Visiting 72 Infant Consultations 72 Infant Welfare Centres— 70 Archer Street 72 Bramley Road 72. Campden Hill 72 Earl's Court 73 Golborne 73 Lancaster Road 73 Raymede 73 Maternity Home 75 National Children's Adoption Association Hostel 77 Raymede Massage and Electrical Treatment Centre 75 Women Health Officers 70 Work done at Infant Welfare Centres in 1925 (Table) 71 INDEX—continued. PAGE HOUSING. 80 Closing Orders, Underground Rooms 85 Closing Orders, Houses unfit for habitation 85 Common Lodging Houses 81 Habitability of Houses, Steps taken to secure and maintain a higher standard of 84 Houses, Cottage Type 80 Houses Let in Furnished Rooms 80 „ „ ,, Lodgings (By-laws for) 81 Housing Accommodation existing in Borough 80 „ „ provided by Council 82 „ ,, provided by Housing Associations 82 ,, „ Steps taken to increase 88 „ Statistics (Table) 85 Improvements Secured (Table) 86 Indecent Occupation, Measures taken to deal with 83 Mews Dwellings 85 PAGE Overcrowding, Measures taken to deal with 83 Registration of Houses Let in Lodgings 82 Work under Section 8 of the Housing Act, 1925 85 APPENDIX. 88 Causes of Death at Different Periods of Life in 1926 (Table III) 90 Infantile Mortality during 1926 (Table IV) 91 Infectious Disease, Cases notified during 1926 (Table II) 89 Staff of Public Health Department (Table VII) 94 Vaccination Officer's Return for 1925 (Table VI) 98 Vital Statistics for 1926 and previous years (Table I) 88 Work of Women Health Officers for 1926 (Table V) 92 JR2/68