KEN 37 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1927 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. Vail & Co,, Printers and Stationers, 170, Farringdou Road. E.C. 150—6/28. SUMMARY OF STATISTICS For the year 1927. Population 1 76,700 Area of Borough in Acres 2,291 Density of Population per Acre 77 Separate Houses or Self-contained Flats Inhabited 33,980 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 5.2 Number of Marriages 1,921 Number of Births 2,657 Birth Rate 15.0 Number of Deaths 2,440 Death Rate 13.3 Infantile Mortality:— Deaths under* 1 year 176 Infantile Death Rate per 1,000 Births 66 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 6 Maternal Death Rate 2.2 Deaths from Phthisis 114 Phthisis Death Rate 0.65 Deaths from all Forms of Tuberculosis 140 Tuberculosis Death Rate 0.80 Deaths from the Zymotic Diseases 63 Zymotic Death Rate 0.36 Product of a 1d. Rate (Gross) £12,172 Rateable Value £2,921,229 Town Hall, Kensington, W.8. June 1st, 1928. 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 1927 upon the state of the Public Health in Kensington, The year under review was satisfactory from the public health standpoint. Although the usual infectious diseases appeared in sporadic form, there was no epidemic of any one of these diseases in the Borough. Indeed, the deaths from the principal zymotic diseases per 1,000 living was the lowest recorded in the history of the Borough. I beg to call particular attention to the tables and information in regard to tuberculosis which appear on pages 54 to 62 of this report. The remarkable decrease in the incidence of and the death rate from tuberculosis which has gone on since the termination of the War must give considerable satisfaction to the members of the Council. To-day, the death rate from this disease is approximately one-half of what it was ten years ago. Tuberculosis was so common in days gone bv that it was known as " the White Man's Scourge "; the gradual removal from our midst of this menace to health and life not only increases the happiness of the people, but effects a considerable economy in the national, local and family budgets. The most interesting steps in public health administration taken during the year were in connection with acute rheumatism in children. On representations made by the Council, the Minister of Health issued regulations making acute rheumatism in children under the age of sixteen years a notifiable infectious disease as from the 1st October, 1927. In order to deal with the cases notified under these regulations, the Council established a Rheumatism Supervisory Centre and full details of the scheme will be found on pages 62 to 66. 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. POPULATION. The population of the Borough as ascertained at the Census in 1921 was 175,859, but for 1927 the Registrar-General has estimated it to be 176,700. 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 176,700 North Kensington 93,109 South Kensington 83,591 Wards. St. Charles 24,385 Golborne 26,453 Norland 22,210 Pembridge 20,061 Holland 18,966 Earl's Court 18,002 Queen's Gate 13,837 Redcliffe 19,966 Brompton 12,820 4 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, 1,921 marriages were registered, representing a rate of 21.7 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 876 Roman Catholic Church 223 Nonconformist Church 37 Jewish Church 12 Register Office 773 Total 1,921 BIRTHS. The number of births registered was 2,657, after correction for inward and outward transfers ; and the birth rate for the Borough was 15.0 per 1,000 population. Distributed according to sex and legitimacy the births were as follow:— Male. Female. Total. Legitimate 1,276 1,181 2,457 Illegitimate 104 96 200 Totals 1,380 1,277 2,657 Table showing the number of births and the birth rates in England and Wales, London Kensington and the various districts in the Borough in 1927, and the rates for the previous five years:— District. 1927. Birth-rates in previous years. No. of Births. Birth-rate. 1926. 1925. 1924. 1923. 1922. England and Wales 654,969 16.7 17.8 18.3 18.8 19.7 20.6 London 73,263 16.1 17.1 18.0 18.7 20.2 21.0 The Borough 2,657 15.0 15.1 15.8 16.2 17.5 17.6 North Kensington 1,851 19.8 18.7 20.6 21.7 22.6 22.9 South Kensington 664 7.9 8.9 8.3 9.2 10.1 9.8 Wards. St. Charles 382 15.6 18.4 18.8 20.5 21.4 23.6 Golborne 629 23.7 21.8 22.2 25.2 26.6 25.5 Norland 509 22.9 21.1 26.0 24.8 24.9 25.7 Pembridge 331 16.5 12.2 14.5 14.9 16.3 15.5 Holland 200 10.5 9.6 8.8 10.8 11.2 11.0 Earl's Court 125 6.9 10.7 8.2 9.9 10.4 10.6 Queen's Gate 79 5.7 7.8 8.5 6.9 6.6 6.9 Redcliffe 163 8.3 9.2 9.2 9.7 12.3 11.0 Brompton 97 7.7 5.9 6.3 7.5 8.7 8.4 Ward unknown 142 ... ... ... ... ... ... 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 1927 the birth rate in each of the two Wards in which the poorest inhabitants of the Borough reside was more than four times as great as the rate for the Ward of Queen's Gate in the South. 5 The decline in the birth rate in Kensington since 1881, which is similar to that taking place throughout the country, is shown in the following table :— Period. Birth-rate per 1.000 population. 1881-1885 26.1 1886-1890 23.5 1891-1895 22.0 1896-1900 21.6 1901-1905 20.4 1906-1910 18.7 1911-1915 19.1 1916-1920 17.2 1921 18.7 1922 17.6 1923 17.5 1924 16.2 1925 15.8 1926 15.1 1927 15.0 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 3,11 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, 2.657 births to Kensington mothers were registered, and of this number 2,549 or 96 per cent. were notified in accordance with the requirements of the Act. The number of stillbirths notified was 56, and the number of births notified as having occurred in Kensington but belonging to other districts was 116. 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 15 1,270 1,285 ,, ,, ,, Parents — 88 88 „ ,, „ Medical Practitioners 19 407 426 „ ,, ,, Other Persons 9 340 349 Births in the Borough 43 2,105 2,148 Notified from Institutions outside the Borough 18 388 401 Totals 56 2,493 2,549 Percentage of Births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907. Year. Percentage. 1923 91 1924 94 1925 99 1926 96 1927 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. 6 DEATHS. The number of deaths registered in the Borough during the year was 2,550, 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 2,550 Deaths of residents in public institutions, etc., beyond the Borough 546 3,096 Deaths of non-residents in public institutions, etc., within the Borough 656 Corrected number of deaths belonging to the Borough 2,440 The corrected number of deaths gives a death-rate of 13.8 per 1,000 living. The following table shows the number of deaths and the death-ratesin England and Wales, London, Kensington and the various districts in the Borough in 1927, and the rates for the previous five years :— District. 1927. Death-rates in previous years. No. of Deaths. Death-rate. 1926. 1925. 1924. 1923. 1922. England and Wales 484,636 12.3 11.6 12.2 12.2 11.6 12.9 London 54,085 11.9 11.4 11.7 12.1 11.2 13.4 The Borough 2,440 13.8 12.8 13.2 13.0 12.3 13.6 North Kensington 1,288 13.8 12.9 13.4 14.0 12.7 14.7 South Kensington 1,120 134 11.8 12.2 11.4 11.2 11.6 Wards. St. Charles 316 12.9 10.7 13.7 12.1 12.3 12.8 Golborne 367 13.8 13.0 12.6 13.4 12.8 15.9 Norland 322 14.5 15.0 14.7 12.5 15.1 17.2 Pembridge 283 14.1 12.8 32.7 13.4 10.3 12.8 Holland 255 13.4 13.5 14.1 12.1 11.4 12.1 Earl's Court 247 13.7 13.1 13.8 14.1 11.4 14.1 Queen's Gate 183 13.2 8.5 9.4 9.2 9.1 8.1 Redcliffe 289 14.5 11.6 12.2 11.3 13.5 12.2 Brompton 146 11.3 11.5 10.1 9.2 9.4 9.7 Ward Unknown 32 ... ... ... ... ... ... 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 1927 13.8 7 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 63 Epidemic Influenza 109 Phthisis 114 Other Tuberculous Diseases 26 Cancer 324 Bronchitis 181 Pneumonia 210 Heart Disease 431 Bright's Disease 61 Puerperal Fever 4 Other Diseases and Accidents of Parturition 2 Premature Birth 29 Accidents 78 Old Age 129 All Other Causes 679 2,440 It will be seen that more than one-third of the deaths, or 936, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 114 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 diarrhoea. The following table shows the zymotic death rate for London and Kensington in each of the last five years. Deaths from Principal Zymotic Diseases per 1,000 persons living. Period. Kensington. London. 1923 0.69 0.60 1924 0.80 0.73 1925 0.46 0.59 1926 0.61 0.63 1927 0.36 0.41 Cancer.—Cancer caused 324 deaths, and of this number 312 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 292 deaths were attributed; sarcoma and epithelioma were the assigned cause of 15 deaths ; 17 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, 1927. Parts Affected. Sex. Total. Male. Female. Buccal Cavity 13 2 15 Stomach, Liver, etc. 41 47 88 Peritoneum, Intestines, Rectum 33 40 73 Female Genital Organs ... 34 34 Breast ... 35 35 Skin 2 2 4 Other and unspecified Organs 46 29 75 Totals 135 189 324 8 The deaths in the several wards, etc., are set out in the following table:— The Borough 324 North Kensington 143 South Kensington 175 Wards. St. Charles 47 Golborne 31 Norland 31 Pembridge 34 Holland 41 Earl's Court 40 Queen's Gate 29 Redcliffe 41 Brompton 24 Ward Unknown 6 Although the number of deaths from this disease was twenty less than in the previous year, there is no doubt that the death rate from cancer is steadily increasing. The number of deaths from this disease occurring in Kensington in each of the past five years is compared in the following table with the deaths occurring in similar periods twenty years ago :— Year. No. of Deaths. Year. No. of Deaths 1903 187 1923 269 1904 174 1924 293 1905 172 1925 315 1906 171 1926 344 1907 201 1927 324 Heart Disease.—Heart disease is still the commonest cause of death, and last year 431 persons died from this complaint, this number being 44 in excess of the figure for 1926. 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, has a great tendency to damage the valves of the heart and thus handicap the patient throughout life, in addition to causing death from heart disease at a comparatively early age. It is with a view to reducing the large amount of heart disease and the invalidity following rheumatic fever and to preventing many of the deaths from heart disease following rheumatic fever that the Council have established their Rheumatism Supervisory Centre at the Princess Louise Kensington Hospital for Children. Table showing the number of deaths in 1927 from certain diseases of public health importance, arranged in four weekly periods. Four Weeks emding Measles. Scarlet Fever. Whooping. Cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhoea and Enteritis. January 29 – – 7 2 42 12 31 49 56 4 February 26 — — 3 3 39 11 19 35 34 1 March 26 — — — 1 9 8 20 15 11 3 April 28 — — 1 — 2 11 20 8 10 3 May 21 — — 1 1 2 4 25 10 6 2 June 18 — — 1 — 2 14 28 3 11 2 July 16 — — — — 1 6 20 4 9 5 August 13 — — — — 1 7 22 6 5 3 Sept. 10 — — — 1 — 5 25 3 5 — October 8 — — — — — 12 23 8 8 9 November 7 — — — — — 5 41 15 15 8 December 3 — — — 1 5 12 26 9 10 2 December 30 1 — 1 2 6 7 24 16 30 — Totals 1 — 14 11 109 114 324 181 210 37 9 Infantile Mortality. During the year 1927, there were 2,657 births and 176 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality rate (deaths of infants under twelve months to each 1,000 births) of 66, which is the lowest rate but one 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 1927, and the infantile death rates for the previous four years. 1927. Infantile Mortality Rates in previous four years, District. No. of Births. No. of Deaths of children under 1 year of age. J Infantile Mortality rate. 1926 1925 1924 1923 England and Wales 654,969 45,346 69 70 75 75 89 London 73,263 4,294 59 64 67 69 60 The Borough 2,657 176 66 60 78 75 70 North Kensington 1,851 135 73 68 83 87 86 South Kensington 664 35 53 51 65 50 37 Wards. St. Charles 382 33 86 55 91 69 85 Golborne 629 46 73 85 77 99 107 Norland 509 32 62 50 99 98 84 Pembridge 331 24 72 88 87 69 42 Holland 200 13 65 81 88 57 51 Earl's Court 125 4 31 41 66 38 11 Queen's Gate 79 2 25 54 25 10 32 Redcliffe 163 13 79 37 48 71 48 Brompton 97 3 31 64 108 51 36 Ward unknown 142 6 – – – – – 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. INFANTILE MORTALITY RATES, 1896-1927. 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 1927 69 59 66 From the above table, it will be seen that whilst the infantile mortality rate in Kensington for 1927 shows an increase on the previous year and is higher than the rate for London, it is still lower than the rate for England and Wales, and that there has been a steady improvement taking place, in recent years. 10 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1927. January 18 February 19 March 18 April 15 May11 June10 July 5 August 8 September 19 October 15 November 19 December 19 CAUSES OF, AND AGES AT. DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1927. Causes of Death. Under 1 week. 1—2 weeks. 2—3 weeks 3—4 weeks. Total 4 weeks. 1—3 months. 3-6 months. 6—9 months 9—12 months. Total Infant Deaths under 1 year. 1. Common Infectious Diseases (Whooping Cough 6) (Diphtheria 1) (Cerebro-spinal Meningitis 1) — — — — — — 4 3 1 8 2. Tuberculosis — — — — — 1 — — 3 4 3. Pneumonia and Bronchitis 1 — 3 2 6 8 9 11 11 45 4, Enteritis — — — — — 7 8 8 4 27 5. Complications of Birth (Injury 6) (Atelectasis 6) 12 — — — 12 — — — — 12 6. Congenital Malformation 3 — — 1 4 1 — — — 5 7. Premature Birth 18 l 1 1 21 3. 1 — — 25 8. Atrophy, Debility and Marasmus 3 2 1 1 7 7 6 2 — 22 9. Other Diseases (Meningitis 3) (Convulsions 10) (Overlying 3) (Other Conditions 12) 5 3 3 — 11 7 3 4 3 28 Totals 42 6 8 5 61 34 31 28 22 176 Death-rate in each age period per 1,000 births 15.8 2.2 3.0 1.9 22.9 12.7 11.6 10.5 8.3 66 Percentage of total infant deaths occurring in each age period 23.8 3.4 4.5 2.8 34.6 19.3 17.6 15.9 12.5 11 It is very pleasing to find 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 clinics 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. ABOVE STANDARD DEATHS. In almost every area there is a number of infant births and deaths occurring in those betterclass homes where it is reasonable to assume that the children receive every care and all requisite medical and nursing assistance. These are called " above standard " cases and, although it is difficult to make certain that none is included under this heading in which the attention of a Woman Health Officer might prove beneficial, they are not generally visited because, in the first place, the Health Officer may not be welcomed and, in the second place, she can occupy her time more profitably in visiting homes in the poorer quarters. In 1927 the "above standard" births numbered 449 and the deaths 18, giving an infantile mortality rate of 40. The 2,108 births and 158 deaths not " above standard " in 1927 give an infantile mortality rate of 75. The causes of death in the " above standard" cases were as follow :— Premature birth 4 Convulsions 2 Congenital heart disease 2 Gastro enteritis 2 Other causes 8 Total 18 The wards to which the children belonged are :— St. Charles 2 Norland 2 Pembridge 5 Holland 1 Queen's Gate 3 Redcliffe 5 Total 18 ILLEGITIMATE INFANT DEATHS. In 1927, 75 per cent. of the births in Kensington were illegitimate and 17.0 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 1927. Total. Legitimate. Illegitimate. Births 2,657 2,457 200 Infant Deaths 176 146 30 Rate per 1,000 births 66 59 150 The following table shows the number of illegitimate births occurring in the Borough during the last five years :— 1923 205 1924 185 1925 198 1926 207 1927 200 12 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 1927 66 150 The illegitimate infant death rate of 150 for 1927 compares very unfavourably indeed with the death rate of 66 for all infants and the death rate of 59 for legitimate infants. Maternal Mortality. In 1927 there were six deaths of Kensington women from diseases or accidents directly connected with child-birth, and this figure represents a death rate of 2.2 mothers per 1,000 births. The rate for London for 1926, the last year for which figures are available, was 3.3, and for England and Wales 4.12. The actual causes of death were :— Puerperal Fever 4 Accidents of Pregnancy and Parturition 2 6 There are ante-natal clinics at the seven Infant Welfare Centres in the Borough ; and an antenatal session is held at the Baby Clinic at No. 92, Tavistock Road, W.ll. In addition, the Queen Charlotte's Hospital Authorities hold a special ante-natal clinic at their Nurses' Home in Ladbroke Grove. In 1927, there were 2,657 births in Kensington and of these 449 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 Schcme. In respect of 1,320 of the 2,208 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 or the Infant Welfare Institutions. The women who gave birth to the remaining 888 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 nearly 60 per cent of the total, but it is 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 still further lowered, more women must be induced to attend the antenatal clinics. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA In Circular No. 834, the Minister of Health has requested that the Report for 1927 shall give a review of the Health Services operating within 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 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. 13 STAFF OF THE COUNCIL'S PUBLIC HEALTH DEPARTMENT. Medical Officers.—In addition to the Medical Officer of Health and the Tuberculosis Officer, who are whole time officers, the Council retain the part-time services of several medical men. Dr. Remington Hobbs, Medical Superintendent of St. Mary Abbots Hospital, acts \as Consultant Gynaecologist in cases of puerperal fever and puerperal pyrexia; Dr. Ronald Carter serves the Council during the Summer months in connection with their scheme for the treatment of zymotic enteritis; and towards the end of the year Dr. Reginald Lightwood, an assistant physician on the staff of the Princess Louise Kensington Hospital for Children, was appointed to take charge of the Rheumatism Supervisory Centre which was opened in November for the purpose of dealing with children notified under the Kensington (Acute Rheumatism) Regulations, 1927. 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. During the early part of the year the Council were still employing two temporary Sanitary Inspectors on 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. In May, one of these temporary Inspectors obtained a permanent post in another Borough and the Council decided that, as the majority of those premises which were suitable to be registered had been placed on the Council's Register of Houses let in Lodgings, the employment of one temporary Inspector would be sufficient to complete the work required. They, therefore, did not fill the vacancy thus created. A summary of the work of the Sanitary Inspectors will be found on pages 22 to 24, 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, the Rag Flock Act, and the Milk (Special Designations) Order. 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 Tuberculosis Dispensary. Health Lecturer.—Mrs. Hayman commenced her duties as Health Lecturer in June, 1926 She 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. Clerical Staff.—In addition to Mr. J. H. Wilson, the Chief Clerk of the Department, there are seven clerks, one of whom is attached to the Tuberculosis Dispensary. Other Staff.—There are :— {a) Five Disinfectors, including a man who acts as engineer. (b) A Mortuary Keeper. (c) Two Sanitary Labourers who assist in drain testing. (d) A Superintendent and Matron of the Medicinal Baths* (e) A Rat Officer. Particulars of the staff, as required by the Ministry of Health Circular No. 359, appear in Table 7. of the Appendix. 14 DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane byexposure to steam under a pressure varying between 15 and 20 lbs. above atmospheric pressure for fifteen minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. above atmospheric pressure for ten minutes in a rotary washing machine. A formalin cupboard is used for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms vacated by persons suffering from infectious disease are disinfected by gaseous formaldehyde, which is generated by the volatilisation of paraform tablets, 20 tablets being used for each 1,000 cubic feet of room space. Verminous rooms are disinfected by the burning of 3 lbs. of sulphur for each 1,000 cubic feet. * SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1927. Nature of Infection. Premises Disinfected. Rooms Disinfected. Disinfections at Wood Lane. No. of Articles Disinfected. Scarlet Fever 257 364 276 4,593 Diphtheria 374 494 355 5,440 Enteric Fever 9 15 70 467 Measles 33 51 2 29 Consumption 118 151 162 1,558 Cancer 60 76 96 941 Vermin 136 206 112 1,023 Other Diseases 273 369 273 2,183 Totals 1,260 1,726 1,346 16,234 * 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 40 tons, 15 cwts., 2 qrs. and 12 lbs. The number of articles disinfected only was 15,729 and the number disinfected and washed, 505. The laundry work for the Medicinal Baths is performed at the Disinfecting Station and this work involved in 1927 the washing of 10,6(56 towels, 405 sheets and 36 other articles. 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 1927 was 25 tons 14 cwts. 2 qrs. 5 lbs. The number of articles disinfected was 6,248 and the number disinfected and washed was 3,713. 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 54. The number of private subscribing library books destroyed was 18; and the number disinfected by formalin and returned to the householders was 14. BACTERIOLOGICAL WORK. During 1927 the Council had an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.I, for the bacteriological examination, at the expense of the Council, of specimens from Kensington cases sent to them by medical practitioners in regard to diphtheria, tuberculosis, typhoid fever, syphilis and other diseases. The examinations in 1927 were as follow :— Disease suspected. No. of examinations. No. of positive results. Diphtheria 1688 196 Diphtheria (Virulence Tests) 16 7 Tuberculosis 218 27 Typhoid Fever (Widal) 7 1 (Faeces) 10 1 Gonorrhoea 4 1 Syphilis 4 2 Dysentery (Water) 3 — 15 In addition to these examinations at the Lister Institute, 499 specimens of sputum were examined at the Tuberculosis Dispensary. Facilities for the examination of cerebro-spinal fluid in suspected cases of cerebro-spinal fever, etc., are available to the Council's Public Health Department through the London County Council's Laboratory and for the examination of suspected foodstuffs and of blood in suspected malaria cases through the Ministry of Health. PUBLIC BATHS AND WASH-HOUSES. There are at the Public Baths, a Men's First Class Swimming Bath with a capacity of 120,000 gallons, a Women's First Class Swimming Bath with a capacity of 45,000 gallons, and a Second Class Men's Bath and Second Class Women's Bath each of which holds 45,000 gallons. The charge for admission to the First Class Baths is 8d.; 3d. is charged fcr admission to the Second Class Baths, children being admitted at half price. There are 13 Men's and 7 Women's First Class Slipper Baths and 34 Men's and 20 Women's Second Class Slipper Baths. The charge for a First Class Warm Slipper Bath is 8d., and for a Second Class, 3d., whilst the charges for a First Class Cold Slipper Bath and for a Second Class Cold Slipper Bath are 4d. and 1½d. 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. 1923 251,069 1924 257,056 1925 265,632 1926 241,349 1927 249,838 In the Wash-house or Laundry Department, there were 90 wash-tubs in use in 1927. 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 follow :— 2d. for each of the first four hours on any one day. 4d. for the fifth hour on any one day, and 6d. for the sixth and every succeeding hour on any one day The number of women using the wash-tubs in the last five years is shown in the table:— Year. Washers. 1923 110,252 1924 109,502 1925 105,581 1926 106,568 1927 103,657 There are 8 washing machines and the charge for the use of one of these 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 1927 was 17,421. MORTUARY AND CHAPEL OF REST. During the year 100 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of relatives or friends of the deceased 21 At the request of undertakers 4 At the request of Coroner 65 By the police 10 100 In 73 cases, post-mortem examinations were made under the Coroner's warrant. Fifty-two 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 pending the day of the funeral. 16 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 119 Schoolchildren 133 Children under five years 13 Verminous Conditions— Adults 23 Schoolchildren 3,654 Children under five years 5 Other Conditions— Adults 29 Schoolchildren 87 Children under five years 13 Total 4,076 The high pressure steam disinfector at the Medicinal Baths is of great value, and an attempt is 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, 137 blankets and sheets, 75 articles of night clothing, and 168 other articles have been dealt with. Of the 3,874 school children cleansed at the Medicinal Baths in 1927 only 262 were compulsory cases, the remainder attending voluntarily. The steady improvement in the general cleanliness of schoolchildren is most encouraging. At the 3,654 cleansings for verminous conditions in 1927, only 44 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 available for male adults 362 Number of beds available for female adults 434 Number of adult admissions during the year ended 31st December, 1927 1,996 (Elderly Male Casuals, chargeable to the Metropolitan Asylums Board, were also admitted to the Institution during the year, the total number of these admissions amounting to 1,771). Average daily number of adult admissions during the year ended 31st December, 1927 5.4 Average daily number of admissions of Casuals during the year ending 31st December, 1927 4.8 Number of beds available for children 45 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, 1927 639 Average daily number of children's admissions 1.7 Last ascertained cost per head at the Institution 3s. 1.56d. per day. 17 St, Mary Abbots Hospital,—This Institution, which is also situated in Marloes Road, provides medical and surgical treatment for the sick and disabled. Number of beds available for male adults 252 Number of beds available for female adults 296 Number of adult admissions during the year ended 31st December, 1927 (including 137 admissions under the Borough Council Maternity Scheme) 3,577 Average daily number of adult admissions 9.8 Number of beds available for children 119 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, 1927 1,218 Births (including 130 births in the Borough Council Maternity Ward) 306 1,524 Average daily number of children's admissions 4.1 Last ascertained cost per head at St. Mary Abbots Hospital 5s. 10.39d. per day. Out-door Relief. Number of cases receiving out-door medical treatment during the year ended 31st December, 1927 North District (North of Notting Hill Gate and Holland Park Avenue) 689 South District (South of Notting Hill Gate and Holland Park Avenue) 35 Total 724 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 1927 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 14'56 Number of In-Patients at the beginning of year 14 „ „ „ admitted during year 347 „ „ „ at the end of the year 9 Average number of days each Patient was resident 15.32 II.—Out-Patients. (a) Numbers. Total number of new Out-Patients 7,732 Total number of Out-Patient Attendances 24,858 Number of Casualty Patients 1,947 Number of Casualty Attendances 5,841 PRINCESS LOUISE KENSINGTON HOSPITAL FOR CHILDREN. Every effort has been made during the past year to expedite the opening of this new Hospital. Towards the end of 1927, the Out-Patient Department and a ward unit of fifteen beds were completed and on December 6th these were opened for the reception of patients. This marked the completion of the first building contract. When this contract was made, it was intended that the nursing staff should live in houses in the neighbourhood, but early in the Summer of 1927 the Board of Management decided, in the interests of efficiency and economy, to proceed straight away with the building of a second ward block. 18 The advantages to be gained by this step were (a) the nursing and domestic staff could then be housed in temporary quarters on the upper floors of the two blocks and (b) the two ward units on the ground floor would provide from thirty to thirty-six beds instead of fifteen. The erection of this second block commenced in July and will cost £13,000. Great encouragement to the Building Fund Campaign was afforded by the gracious promise that, provided all liabilities are met by May, 1928, their Majesties the King and Queen would perform the formal opening ceremony Their Majesties the King and Queen opened the Hospital on May 21st, 1928. Pending the erection of the new Hospital, out-patient work was carried on at St. Mark's Church Institute, St. Mark's Road, North Kensington, At this institution, from January 1st to December 6th, 1927, 2,896 patients were dealt with and 12,983 attendances recorded. The lack of was acutely felt and many cases which were urgently requiring in-patient treatment were unable to be dealt with at these premises. In spite of these drawbacks, the number of patients attending was 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. The staff engaged at the St. Mark's Road temporary out-patient department was 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 1927 in Kensington TABLE SHOWING NUMBER EXAMINED AND DEFECTS FOUND. Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. Number examined 1062 660 722 840 1088 751 847 817 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. Cases referred for treatment. Cases, Cases referred for treatment. Cases. Cases referred for treat ment. Malnutrition 1 .... 2 .... 1 .... .... .... .... .... 3 3 .... .... .... .... Skin Disease 18 11 9 3 11 4 5 2 13 7 4 1 8 2 3 1 Defective Teeth .... 332 .... 142 .... 175 .... 190 .... 336 .... 181 .... 163 .... 169 Enlarged Tonsils 150 27 105 25 57 12 70 14 169 29 119 19 113 23 119 23 Adenoids 5 3 1 1 .... ... 5 2 11 6 3 2 4 3 1 1 Tonsils & Adenoids 54 47 17 12 9 5 7 7 53 47 20 11 22 15 8 8 Other Nose & Throat 22 7 30 10 20 8 10 4 22 9 22 8 18 5 13 6 Enlarged Glands 249 41 148 25 108 12 107 11 288 48 143 19 152 11 110 11 Eye Disease 36 27 12 6 16 7 9 4 38 26 14 5 18 7 29 14 Defective Vision .... .... .... 47 .... 85 .... 64 .... .... .... 64 .... 102 .... 79 Otorrhoea 22 13 4 1 8 3 9 6 23 9 9 6 11 5 4 4 Other Ear Disease 5 1 2 2 .... ... 3 2 2 1 2 1 .... .... 4 1 Defective Hearing 1 ... 2 .... 3 1 3 1 4 1 5 1 2 1 1 .... Speech Defects 7 .... 5 1 3 .... 6 1 2 .... 1 .... 1 .... 1 .... Heart Defects 41 1 27 ... 29 1 37 1 50 .... 33 3 56 5 34 1 Anaemia 25 4 7 ... 15 3 7 .... 16 1 11 .... 14 3 17 Lung Defects ... 48 7 19 1 4 .... 8 2 55 4 14 .... 12 1 8 1 Nervous System 10 5 6 1 4 1 4 2 4 .... 4 .... 6 2 4 2 Phthisis ... ... .... .... .... .... .... .... 1 .... .... .... .... .... .... .... Other Tubercular Disease ... .... .... .... .... 1 .... .... .... 2 .... .... .... .... .... .... .... Rickets 60 1 20 .... 28 .... 19 .... 36 .... 23 .... 23 .... 8 .... Spinal Deformities .... .... 3 1 4 3 11 10 1 1 2 2 14 12 19 12 Other Deformities 16 5 12 2 18 .... 18 4 8 .... 11 2 28 5 17 1 Other Dfeects 36 7 9 4 16 4 13 5 25 10 18 9 17 7 13 8 Number of children noted for treatment 432 .... 224 .... 280 .... 279 .... 423 .... 282 .... 308 .... 283 19 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 1,062 752 298 12 259 756 47 – 1,038 20 4 1,013 47 2 546 345 171 – – – Girls 1,088 773 303 12 352 699 37 –– 1,043 35 10 1,054 34 – 549 361 178 – – – Age 8. Boys 660 463 182 15 140 481 39 – 654 6 – 623 35 2 380 221 59 367 167 99 Girls 751 518 232 1 165 552 34 – 716 26 9 730 21 – 437 241 73 452 148 124 Age 12 Boys 722 487 225 10 157 530 35 – 708 13 1 691 31 – 461 225 36 428 155 139 Girls 847 518 326 3 155 653 39 – 800 36 11 816 31 – 601 216 30 486 200 154 Age 14 Boys 840 563 272 5 225 594 21 – 832 8 – 811 29 – 587 229 24 568 140 128 Girls 817 557 253 7 251 536 30 – 782 30 5 792 25 – 579 217 21 519 150 133 Total 6,787 4,631 2,091 65 1,704 4,801 282 – 6,573 174 40 6,530 253 4 4,140 2,055 592 2,820 960 777 Kensington percentages 68.2 30.8 1.0 25.1 70.7 4.2 96.8 2.6 0.6 96.2 3.7 0.1 61.0 30.3 8.7 61.9 21.1 17.0 London percentages 58.7 40.2 1.1 20.2 74.8 50 93.5 5.9 0.6 96.6 3.3 0.1 63.0 29.4 7.6 54.2 25.9 19.9 SCHOOL TREATMENT CENTRES. There is in Notting Dale a School Treatment Centre managed by a voluntary committee and the work performed thereat during 1927 is as follows :— New Cases. Total attendances. Eye Cases 584 1,509 Aural Cases 465 1,759 Minor Ailment Cases 2,310 43,269 Dental Cases 1,444 2,566 X-Ray Cases 47 304 A School Treatment Centre has also been established at the Baby Clinic premises in Tavistock Crescent and the record of work for the year 1927 is as follows :— Minor Ailment Cases 3,498 24,256 Dental Cases 1,537 2,618 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 1927 was 2,398 and the number of visits paid, 38,740. 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, 1927 :— Cases. Visits. Maternity Cases 28 296 Miscarriages 40 384 Pneumonia 128 2,260 „ (under 5 years of age) 124 2,248 Ophthalmia Neonatorum and other Inflammations of the Eyes of Newly-born Children 18 387 Influenza 108 1,459 „ (under 5 years of age) 55 332 Zymotic Enteritis 48 437 Tuberculosis 22 804 Measles 2 11 „ (under 5 years of age) 1 4 Whooping Cough 4 51 Erysipelas 1 8 Puerperal Septicaemia 2 44 Pemphigus 9 108 Totals 580 8,833 20 For the splendid services rendered, the Council paid to the Association in 1927 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 56 226 Children under 5 years of age 270 2,345 Totals 326 2,571 Bronchitis 70 436 Ear Discharges 27 237 Minor Ailments 173 1,672 Totals 270 2,345 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 776 confinements, of which 720 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 eight ante-natal clinics at the Infant Welfare Centres and Baby Clinic, 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 1927 is as follows :— Number of individual expectant women who attended the ante-natal sessions 809 Number of Kensington cases 759 Number from other Boroughs 50 Total number of attendances of all ante-natal cases 1,538 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, the Kensington Guardians 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. 21 SUBSCRIPTIONS BY THE BOROUGH COUNCIL TO VOLUNTARY HEALTH ORGANISATIONS DURING 1927. Subscriptions to Hospitals, etc. £ s. d. Cancer Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 Kensington District Nursing Association 5 5 0 Kensington and Fulham General Hospital 10 10 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 26 5 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 Institutic ns. £ s. d. Archer Street Infant Welfare Centre 135 0 0 Bramley Road „ „ (with Kenley Street Branch) 340 0 0 Campden Hill ,, „ 110 0 0 Earl's Court „ „ 185 0 0 Golborne „ „ 210 0 0 Lancaster Road „ „ 310 0 0 Raymede „ 210 0 0 Evelyn Convalescent Cottage Home 16 16 0 Hambledon Cottage Home 8 8 0 St. Mary's Convalescent Home 12 0 0 Kensington Board of Guardians (Maternity Home) 837 16 0 Kensington District Nursing Association 200 0 0 Ladbroke Road Baby Hospital 200 0 0 Mutual Registration of Assistance Society 10 0 0 National League for Health, Maternity and Child Welfare- 8 8 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. 22 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 ] 2 8 4 5 6 7 8 9 10 1 2 Total Complaints Received 230 215 177 349 220 227 190 209 255 199 — — 2/271 Public Health (London) Act, 1891. Complaints received 134 30 138 206 131 224 188 201 255 186 — — 1,693 Houses inspected on complaint 136 30 154 206 144 270 188 214 257 186 — — 2,085 „ after Infectious Disease 104 160 78 106 117 72 49 73 55 32 — — 846 Re-inspections 1041 616 1635 1137 1355 1349 1174 932 2043 1074 — — 11,756 By-Laws vt Houses Let in Lodgings Complaints received 96 185 39 143 89 3 2 8 — 13 — — 578 Houses Inspected on Complaint 96 185 39 143 89 3 2 8 — 13 — — 578 First Annual Inspection (Furnished Houses) 6 — 22 — — 5 — — — — — — 33 Re-inspections ,, ,, 1 3 157 6 — 27 — — — — — — 194 First Annual Inspection (Unfurnished Houses) 96 27 199 88 310 37 71 53 127 18 — — 1,026 Re-inspections „ „ 509 1898 683 1675 1053 468 342 18 6 65 — — 6,717 Housing Act, 1925. Initial Inspections (including preparation or revision of House to House Card) 33 103 136 117 130 54 62 101 76 89 821 417 2,139 Re-inspections 164 174 7 50 59 56 66 — 8 37 293 260 1,174 Underground Living Rooms. Primary Inspections 4 24 3 6 8 7 — — 14 9 687 271 1,033 Re-inspections — 33 — 4 22 52 2 — 9 10 61 73 266 Drainage. House Drains Tested and Inspected 54 121 384 75 134 71 39 46 72 66 188 64 1,314 Inspections of Workshops 8 16 29 42 20 15 66 112 54 70 — — 432 „ Factories 7 20 29 8 10 17 15 23 3 10 — — 142 „ Bakehouses 24 17 44 20 1 1 15 25 70 12 — — 229 „ Ice Cream Premises 11 4 12 28 16 — 4 7 12 20 — — 114 „ other Food Premises 91 65 119 112 188 391 100 68 263 204 — — 1,601 „ Mews 164 108 453 325 191 324 156 402 397 227 — — 2,747 Smoke Observations 110 6 — 4 6 3 1 67 124 165 — — 486 Other Inspections 628 532 476 464 445 421 347 773 305 203 — — 4,594 23 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 10 1 2 Kind of Notices Issued. Public Health (London) Act, 1891. Intimations 172 384 238 574 335 161 83 90 166 138 600 394 3,335 Statutory Notices 48 265 53 180 150 50 31 10 32 30 – – 849 Final 9 72 4 31 40 – 1 – 4 2 – – 163 Summonses issued – 21 – 8 18 5 – – – – – – 52 Housing Act, 1925. Sect. 3 (Repairs) – 7 1 8 3 – 2 – – – – – 21 Sec. 127 (Entry) – 32 4 37 14 – 7 – – – – – 94 Underground Room Habitation – – – 2 – 2 – – 8 9 – 4 25 Removal of Manure 7 19 2 5 9 – – – 29 – – – 71 Smoke Nuisance Notices 3 – – – – – – – – – – – 3 Rent Restrictions Act Certificates – – 2 1 1 – 2 1 – – – – 7 Special Notices included under Public Health (London) Act, 1891, relating to Factories – 6 1 1 – 3 1 1 3 1 – – 17 ,, Workshops 3 4 10 2 6 12 3 8 3 17 – – 69 „ Bakehouses 5 1 – 1 7 – – 1 3 3 – – 21 Other Notices 4 5 – 3 – – – – 2 12 74 75 175 Report of Waste of Water to M. W. B. 13 11 1 8 9 2 – 15 37 5 24 – 125 „ Dangerous Structures to L.C.C. 13 6 1 13 6 1 – – – 15 2 – 57 24 Summary of Works completed under the supervision of the Sanitary Inspectors during the Year- DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Grand Total. 1 2 3 4 5 6 7 8 9 10 House Drains re-constructed 9 12 14 7 19 18 16 6 31 9 141 Defective Drains repaired 25 12 19 14 11 10 10 19 42 39 201 House Drains cleansed 28 31 18 23 25 19 6 29 83 62 324 Water-Closets re-constructed 22 8 46 30 51 17 37 13 77 50 351 „ repaired 136 30 55 12 67 22 14 17 37 59 449 ,, supplied with water – 36 14 19 8 1 6 3 73 98 258 „ new provided 8 4 14 10 9 37 37 15 48 32 214 Soil Pipes ventilated, repaired, &c. 1 9 14 9 14 5 13 21 68 31 185 „ new provided 10 9 12 5 25 11 16 6 74 15 183 Cisterns cleansed 10 9 1 5 55 5 3 7 64 4 163 „ covered 5 9 2 4 41 2 2 1 29 2 97 „ abolished – 2 – 2 – 1 2 1 10 2 20 Taps fixed on rising main 2 2 – 3 4 – 2 3 10 34 60 Yards, areas paved, drained, repaired 80 41 19 33 92 21 2 17 27 35 367 Dustbins provided 91 65 53 63 92 12 11 28 72 39 526 Ashpits abolished 2 9 5 1 12 – 1 1 23 6 60 Accumulations of filth, &c., removed 15 41 8 19 20 16 4 31 21 164 339 Animals removed 4 13 2 3 6 – – 1 8 5 42 Overcrowding abated 18 17 27 9 19 7 1 – 3 – 101 Underground Rooms, illegal occupation discontinued 3 8 6 – 9 1 4 – 11 4 46 Roofs repaired 83 105 14 87 79 25 18 36 85 49 581 Houses provided with water above basement floor 11 2 25 12 29 3 5 1 7 3 98 Dampness in Dwellings remedied 110 51 19 73 57 1 9 23 22 57 422 Closing Orders made under Sect. 11, Housing Act, 1925 – – – – – – – – – – – Closing Orders made under Sect. 18, Housing Act, 1925 – – – 2 – 2 – – – – 4 Closing Orders determined – – – – – – – – – – – Repairs of Houses completed under Sect. 3, Housing Act, 1925 – – 1 5 1 – 2 – – – 9 Infectious Disease Cases removed 94 82 66 62 100 51 40 46 46 10 597 Houses disinfected after Infectious Diseases (including Bedding, Clothing, &c.) 94 118 109 130 142 88 52 91 42 49 915 Rooms in such Houses disinfected after Infectious Disease 94 153 139 154 163 112 64 146 108 57 1190 Houses cleansed under Houses Let in Lodgings By-laws 135 167 53 198 198 50 76 – 11 4 892 Verminous Houses cleansed (including Bedding, Clothing, &c.) 134 42 67 39 36 1 10 12 53 13 407 Verminous Rooms cleansed in such Houses 449 44 73 46 46 2 11 15 68 18 772 Dirty Bedding cleansed 9 14 – 11 47 – 1 3 7 2 94 Dirty Bedding destroyed – 2 – 2 2 – 1 – 2 –1 9 Other Sanitary Works executed 136 200 139 257 142 99 174 38 7 25 1443 25 Summary of Legal Proceedings. Nature of Offence. Number of Summonses heard before the Magistrates. Magistrates' Decisions. Failure to carry out sanitary repairs. 18 Order made for work to be carried out within 14 days in 9 cases, within 21 days in 5 cases, and within 28 days in 2 cases. Summonses withdrawn, work having been carried out, in 2 cases.. Failure to comply with the order made by the Justices requiring the execution of sanitary repairs. 4 Fined £5 in 1 case and £2 in 2 cases. Summonses adjourned sine die, work having been nearly completed, in 1 case. Failure to comply with by-laws for Houses Let in Lodgings. 15 Fined £2 in 3 cases, 30/- in 1 case, £1 in 3 cases, and 10/- in 1 case. Summons adjourned sine die in 1 case, and summonses withdrawn, work having been carried out, in 6 cases. Failure to provide a proper supply of water to the upper storeys. 1 Order made for work to be carried out within 21 days. Failure to abate overcrowding. 9 Fined £2 in 1 case, £1 in 1 case, and 10/in 2 cases. Summonses withdrawn, overcrowding having been discontinued, in 3 cases, and summonses adjourned sine die in 2 cases. Failure to comply with the order made by the Justices to abate overcrowding 1 Fined £1. Permitting overcrowding 3 Fined £2 in 1 case, and summonses adjourned sine die, overcrowding having been discontinued, in 2 cases. Unlawfully removing or carrying through the public streets certain offensive or noxious matter during the hours prohibited for such removal or carriage. 4 Fined £5 and 5/- costs in 1 case, £5 in 2 cases and £2 in 1 case. Unlawfully occupying an underground room as a dwelling. 3 Summons withdrawn, the use of the room as a sleeping place having been discontinued, in each case. Unlawfully occupying an underground room as a dwelling, in respect of which a Closing Order was in force. 2 Fined £1 in 1 case, and summons adjourned sine die in 1 case. Unlawfully permitting an underground room to be occupied as a dwelling. 1 Summons withdrawn, the use of the room as a sleeping place having been discontinued. Unlawfully permitting an underground room to be occupied as a dwelling in respect of which a Closing Order was in force. 1 Summons adjourned sine die. Failure to remove an accumulation of rubbish. 1 Order made for removal within 7 days. 26 In addition to the above, there were issued under the Sale of Food and Drugs Acts 34 summonses, particulars of which are given on pages 41 and 42. SEWERAGE AND DRAINAGE. Every house in the Borough is connected with the water carriage system for the disposal of sewage and, generally speaking, house drainage in Kensington is very satisfactory. At the beginning of the year, the whole of the drainage work was supervised by officers in the Department of the Borough Engineer, except that where notices had been issued under the Public Health Acts the consequent drainage work was supervised by the Sanitary Inspectors in the Public Health Department. In February, the Council considered whether in the interests of convenience to the public and economy some change should be effected and as a result of their deliberations they decided that the following scheme should be put in operation on April 1st:— (i.) The plans of house drainage work resulting from notices issued under the Public Health Acts shall be dealt with by the Department of the Medical Officer of Health and the Sanitary Inspectors, without intervention by the Borough Engineer or his officers, it being understood that the plans of all such work shall ultimately be filed with the similar records now in the Borough Engineer's Department. (ii.) The same course shall be followed with regard to house drainage work undertaken voluntarily by the owners of houses except so far as it may fall within (iii.) below. (iii.) House drainage work in connection with new buildings shall remain with the Borough Engineer. N.B.—The expression " new buildings " is to include the conversion of existing buildings into self-contained flats, and any large reconstructions which the Borough Engineer and the Medical Officer of Health may agree to be more suitable for engineers to deal with than sanitary inspectors. All drainage work on the sewer side of the interceptors will remain with the Borough Engineer. The following table deals with (a) drainage work undertaken voluntarily by owners and supervised by the officers of the Public Health Department from April 1st to December 31st, and (b) all drainage work required by notices served under the Public Health (London) Act, 1891, and carried out under the supervision of the Sanitary Inspectors:— Voluntary work. Work under notice. Plans and applications submitted 140 35 Plans approved by the Council 140 35 Total reconstructions of drainage of premises 41 25 Partial reconstruction of the drainage of premises 51 199 Repair of drainage by the " Economic Method" 16 10 New soil pipes provided 62 121 27 The total number of house drains inspected during the year, including those inspections which may be described as routine and those made on complaint or after infectious disease, totalled 1,314, and in 342 cases notices under the Public Health Act were served for either reconstruction or repairs. In many of these the repairs were slight in nature and the owners were not required to submit plans and applications. In addition to the above drainage work, 214 water closets were provided under notice by the Sanitary Inspectors in order to supplement the accommodation already existing. DUST REMOVAL. House refuse is collected not less than once a week in all districts in the Borough, but more frequent collections are undertaken in certain streets. In 8 main streets where there is congestion of traffic, there is a daily collection which is undertaken before 9 a.m., and in certain other streets or blocks of flats the collection is also daily. In some cases there is a tri-weekly collection and in others a bi-weekly collection. In a number of poorer streets in North Kensington, particularly those where there are many houses let in lodgings, the collection is bi-weekly. 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 past year, 526 removable ashbins of galvanised iron have been provided and 60 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 thirteen public lavatories containing water closets; three are for men only, two for women, two for boys and two for girls, and in four accommodation is provided for both sexes. Part of this accommodation is provided in Avondale Park and the Barlby Road Recreation Ground. In addition, there are eleven urinals for men under the charge of the Council. Free accommodation is provided in the men's and women's lavatories for those who are unable to pay. At eleven railway stations in the Borough there are also conveniences for men and women, and at 75 public houses there are urinals entered from the street and available to the public. The public conveniences for men in the Borough have been regularly inspected throughout the year by the male Sanitary Inspectors, and those for women in the railway stations and elsewhere have 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 486 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. 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 1927 for certificates under the Acts totalled 9, and 7 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. 28 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. 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 the 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 on lamp-posts and 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 1927 they reported nine breaches of the by-law to the Public Health Committee. Summonses were taken out, and fines of £1 in one case and 10/- in eight cases were imposed. The number of convictions under this by-law during the past six years is 19. 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 181 Total number of visits paid 2,730 Number of poison baits laid during the year 95,490 „ „ disappeared 86,910 „ ,, removed by the Rat Officer 8,580 Number of premises where concreting of basement floors has been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 17 Number of premises where other repairs have been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 97 Number of sewer defects allowing egress of rats made good 14 Number of Statutory Notices served under the Rats and Mice (Destruction) Act, 1919 3 Number of premises cleared of rats 54 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.—Six 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 100 entrances were baited daily and in North Kensington 92, 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 and Warwick Road Depots.—Three thousand barium baits were laid in the metal and other dumps at Wood Lane and all disappeared. The Council's depot in Warwick Road was found to be free from rats. 29 Railways.—Working in co-operation with the Council's Rat Officer, the officials of the Metropolitan Railway Company and the Great Western Railway Company heavily baited the railway embankments, permanent way, sheds, dumps, stores and spare ground in and around the Borough. Gas was also successfully used in numbers of rat holes. The coal sidings in Warwick Road were inspected, but no serious complaints were reported. The Great Western Railway Company, who control most of these sidings, supply traps, and these appear to be adequate for the purpose. Wharves.—The Council's wharf in Kensal Road was carefully inspected, but no trace of rats was found. Dogs are kept in the arches where the barges are loaded and apparently keep the place clear of rats. The Council's wharf at Lots Road, Chelsea, was also inspected, and here again no trace of rats was found. The jetty at this wharf was concreted some two years ago, and this would appear to have dealt successfully with the rat problem. 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 seven verminous houses were cleansed during the year by landlords in response to notices served under the powers conferred by the London County Council (Genera/ 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 30 Number of rooms sprayed with Solution " D" 73 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 1012. 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 251, and are inspected and regulated by H.M. Inspectors under the Home Office. The Sanitary Inspectors of the Borough Cou ncil 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 437. The factories at which men were employed numbered 190, It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, drainage of floors, the exhibition of abstracts and certain other matters do not apply to workshops conducted on the system of not employing children, young persons or women. In London, both in factories and workshops, the provision of sanitary conveniences is regulated by Section 38 of the Public Health (London) Act, 1891, the standard adopted being that required by the Sanitary Accommodation Order of 4th February, 1903. The following table shows the various trades and occupations carried on in registered workshops and factories where men are employed :— 30 Trade or Business. Workshops. Factories. Total. Aerated water manufacturers – 2 2 Bakers 61 32 93 Basket makers 1 1 2 Blacksmiths 7 — 7 Blind makers 2 — 2 Boot makers and repairers 63 17 80 Builders 42 11 53 Cabinet makers 13 4 17 Cigarette makers 2 1 3 Coach builders 9 3 12 Coal wharves 2 — 2 Cooked meat dealers 1 2 3 Cycle repairers 6 1 7 Dyers 1 2 3 Electricity generating stations — 4 4 Electric light fitting makers 2 3 5 Firewood choppers 2 2 4 Furriers 5 — 5 Gas works — 2 2 Instrument makers — 3 3 Ironmongers 2 — 2 Ladder makers 1 1 2 Lampshade makers 2 — 2 Laundries 6 17 23 Marine stores 3 — 3 Masons 1 1 2 Metal workers 7 8 15 Motor engineers and garages 34 31 65 Motor spirit dealers 2 — 2 Photographers 2 — 2 Piano makers 1 1 2 Picture frame makers 9 — 9 Pipe makers — 2 2 Printers 3 8 11 Saddlers 3 — 3 Sausage makers 1 6 7 Sign writers 4 — 4 Steam pressers 1 1 2 Sundry businesses 25 14 39 Sweet manufacturers 1 1 2 Tailors 62 2 64 Timber merchants 1 1 2 Trunk makers 4 — 4 Undertakers 10 1 11 Upholsterers 20 1 21 Washing machine manufacturers — 2 2 Watch makers 5 — 5 Wax figure manufacturers 1 1 2 Wheelwrights 7 1 8 Total 437 190 627 31 Factories and Workshops where women are employed.—At the end of the year the registered workshops at which women were employed numbered 575, and the factories numbered 61. The following table shows the various trades and occupations carried on in registered workshops and factories where women are employed:— Trade or Business. Workshops. Factories. Total. Blind makers 3 – 3 Blouse makers 3 — 3 Boot makers and repairers 4 1 5 Corset makers 9 — 9 Dressmakers and ladies' tailors 325 1 326 Dyers 7 1 8 Embroidery workers 4 — 4 Florists 12 — 12 Furriers 17 1 18 Hairdressers 19 — 19 Invisible menders 4 — 4 Jewellers 3 2 5 Knitted goods 2 — 2 Lace workers 3 — 3 Lampshade makers 4 — 4 Laundries 46 46 92 Milliners 51 — 51 Outfitters 9 — 9 Photographers 9 — 9 Picture frame makers 3 1 4 Restaurants 4 — 4 Sundry businesses 18 8 26 Toy makers 2 — 2 Umbrella makers 2 — 2 Upholsterers 10 — 10 Weavers 2 2 Total 575 61 636 Home Work.—Of the 215 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 69 Outworkers in Domestic Workshops 30 Outworkers in their own Homes 116 Total number of Outworkers 215 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 116 home workers on the register is as follows :— Tailoring 49 Dressmaking 32 Bootmaking 12 Drapery 5 Outfitting 4 Woollens 4 Linen working 3 Blouse making 2 Lampshade making 1 Box making 1 Collar making 1 Underwear 1 Ironing 1 116 32 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 142 2. „ Workshop „ 857 3. „ Home Workers' Inspections 160 4. „ Work Place „ 73 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) 267 22 – Workshops (including Workshop Laundries) 1180 70 — Workplaces (other than Outworkers' premises) 184 18 – Total 1631 110 — 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 79 79 – – Want of ventilation 9 9 — — Overcrowding 2 2 – – Want of drainage of floors 6 6 — — Other nuisances 37 35 2 — Sanitary accommodation insufficient 10 10 — — unsuitable or defective 24 24 – — not separate for sexes 8 8 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) – – – – Breach of special sanitary requirements for bakehouses (SS. 97 to 100) – – – – Other Offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) 10 7 3 – Total 181 176 5 — * 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. 33 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 in 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 1927, of the fifteen samples so taken, fourteen were certified as being free from tubercle bacilli; in the remaining sample, animal inoculation revealed the presence of the organism. This sample was taken from a churn of milk at Addison Road Station, consigned from a farm in Berkshire, and in accordance with the procedure laid down in the Act, the facts were communicated to the Medical Officer of Health of that county for ction to be taken. It was subsequently ascertained that four animals at this farm, all of which were " wasters," had been destroyed since the sample had been taken. 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 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 twenty-two 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. In eignteen cases both the original sample obtained from the purveyor and that obtained from the consignor were found to be of genuine composition and the following table gives the details in respect of four cases where the original sample was adulterated and samples taken from the wholesaler were genuine:— Case No. Amount of adulteration in sample taken from the retailer. Result of samples taken from the wholesaler. Action taken. l 11 per cent. of extraneous water and 4 per cent. of the required fat deficient 5 samples all genuine Proceedings. Summons dismissed on warranty defence 2 20.6 per cent. of the required fat deficient 2 samples both genuine Proceedings. Fined £2 and £1 11s. 6d. costs 3 31 per cent. of the required fat deficient 4 samples all genuine Proceedings. Fined £5 and £5 5s. 0d. costs 4 18 per cent. of the required fat deficient 2 samples both genuine Proceedings. Summons dismissed owing to bottle of third part of sample having burst 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. During the past year, however, the Council were concerned in an action in the High Court for the purpose of ascertaining whether a person who sold milk in a closed container in the same condition as he received it was required to be registered as a dairyman under the Order, although the premises from which he sold it were not a dairy. The case is one of very considerable interest. 34 A grocer sold to the Council's Food Inspector a pint of milk in a sealed container. This milk was submitted to the Public Analyst and certified by him to be milk of genuine composition. Proceedings were taken against the grocer for selling milk without being registered as a purveyor of milk and a conviction was recorded. The appeal to the High Court against the conviction failed, it being held that the appellant did carry on the trade of a purveyor of milk and he was thus a dairyman who must be registered. As a result of this decision, the Council decided to enforce registration of all persons selling milk whether in sealed bottles or otherwise. The alterations made in the Council's Register of Dairymen are shown in the following table: — Purveyors of milk in sealed bottles. Dairymen. Dairies and Milkshops. Transfers – 18 18 Added to Register 25 2 2 Vacated and removed from Register – 7 7 Dairymen with premises outside the Borough added to Register – 1 – On Register December, 31st 1926 – 151 151 On Register December 31st, 1927 25 147 146 (+) Increase. (—) Decrease + 25 —4 —5 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. During the course of the detailed inspection of the 151 dairies, it was found necessary to serve twenty-three notices in the years 1926 and 1927 calling for repairs or alterations which were mainly of a minor character; the occupiers complied with these notices without delay in all cases. This detailed inspection was completed during the year and it can now be said that every dairy in Kensington comes up to the high standard of hygiene required under the Milk and Dairies Order, 1926. The total number of inspections of dairies and milkshops during the year was 653. 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 1927 were as follow:— (a) Dealers' licences to use the designation " Certified Milk " 22 (b) Dealers' licences to use the designation " Grade A (Tuberculin Tested) Milk" 20 (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 three of " Pasteurised 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. '* Pasteurised Milk " 100,000 No Standard. 35 The results of the examinations of the nine samples of " Certified Milk " are shown in the following table: — Sample collected on. Bacteria per 1 c,c. Coli per l/10th c.c. 29th April 7,613 nil 16th June 8,746 ,, 15th July 5,053 ,, *15th ., 36,066 ,, *7th September 88,800 present. 23rd „ 7,063 nil. 23rd „ 2,966 ,, 30th November 1,063 ,, 30th ,, 980 ,, *The results of these samples were forwarded to the Minister of Health. The remaining samples proved to be well within the bacteriological standards prescribed by the Order and, indeed, may be classed as very pure milks. Three samples of Pasteurised Milk were examined with the following results: — Sample collected on 2nd November ,, ,, ,, ,, Bacteria per c.c. 323,333 210,000 119,000 These three samples were taken on the same day from three separate churns of milk being delivered to a public institution in the Borough and proceedings were instituted in respect of the first mentioned sample. In addition, the person selling this milk as pasteurised milk did not hold a license from the Borough Council as required by the Regulations, and proceedings were taken against him in respect of this default. In respect of the first summons a penalty of £5 together with £10 10s. 0d. costs, was imposed, whilst in the second there was a penalty of £3. The Public Health (Condensed Milk) Regulations, 1923, and Public Health (Dried Milk) Regulations, 1923.—During the course of the year, the Minister of Health issued two sets of amending Regulations, one in regard to the Condensed Milk Regulations and the other the Dried Milk Regulations. These Regulations come into operation on the 1st September, 1928, except in regard to imported condensed milk in respect of which they operate from 1st May, 1928. The new Regulations are designed to give greater prominence to the words " Unfit for Babies " which are required to appear on the declaration printed on the label, and they further provide that where a tin or other receptacle containing condensed or dried skimmed milk is exposed for sale in a paper or other wrapper, such paper or wrapper must bear the words "Unfit for Babies,'' the letters being not less than one quarter of an inch in height. During the year, three samples of condensed milk were taken and each was found to comply with the Regulations in every respect. No samples of dried milk were taken during this period. Composition of Milk supplied in Kensington.—It is well known that the " limits" of 3 per cent. of fat and 8.5 per cent. of non-fatty solids, which are taken by the Ministry of Agriculture as the primary criteria of genuineness of milk, are figures very much below those found in normal cow's milk. The following may be taken as the average composition of cow's milk :— Water 87.4 per cent. Fat 3 7,, ,, Non-fatty solids 8.9 „ „ Of 289 formal samples of milk taken under the Food and Drugs Act in 1927, 14 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:— 36 Average Composition of Formal Milk Samples taken in 1927. 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 20 3.50 8.71 3.56 8.76 3.0 8.5 February 22 3.78 8.86 3.78 8.86 March 30 3.58 8.79 3.62 8.82 April 20 3.45 8.77 3.50 8.77 May 39 3.51 8.75 3.61 8.75 June 20 3.42 8.80 3.61 8.89 July 28 3.67 8.75 3.72 8.76 August 14 3.84 8.84 3.84 8.84 September 29 3.88 8.94 3.88 8.94 Average Composition, of Normal Cow's Milk. October 20 3.74 8.57 3.86 8.85 November 21 3.89 8.85 3.89 8.35 Percentage of Milk Fat. Percentage of Solids not Fat. December 26 3.85 8.76 3.85 8.76 Average for the Year 289 3.67 8.78 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. 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 one sample taken during the year the presence of artificial colouring matter was detected and proceedings were taken against the vendor. The summons was subsequently withdrawn owing to the death of the defendant. Milk Utensils in Infected Houses.—The practice commenced in 1922 of sending information to milk retailers supplying milk to houses in which cases of infectious disease are being nursed at home was continued throughout the year, and from the date of the receipt of my notification to the date of a later communication stating that the house is free from infection, no milk vessel belonging to a dealer has been allowed to enter the home in question. The procedure seems to meet with general favour and the dealers invariably express their thanks for the information received. Cowsheds.—There are no cowsheds in Kensington. MEAT. Slaughter Houses.—These are licensed annually by the London County Council in the month of October and the five Kensington licences granted in 1926 were renewed in 1927. These premises are kept in a cleanly condition, and from a structural point of view are not open to objection. During the year over 2,000 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. 37 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 two hundred and eighty-two slaughterhouse inspections were made. The following table shows the number of animals slaughtered in the Borough in 1927. Month. Beasts. Animals Slaughtered. Swine. Sheep. January 4 83 33 February — 130 40 March 5 142 — April 3 226 68 May — 103 49 June — 15 57 July — 66 69 August — — 57 September — 103 49 October — 570 80 November — 250 41 December 23 556 119 Total 35 2,244 662 Diseased meat condemned during this period was as follows:— Carcases (including organs) 2 Forequarters 4 Plucks 85 Heads 86 Livers 50 Lungs 74 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 114 butchers' shops within the Borough 112 have been provided with glass fronts, whilst in the two 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 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.—The ice cream 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 fourteen visits to ice cream premises were made by the Inspectors during the year. 38 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-five bakehouses in the Borough, and of this number sixty-two are underground. As a result of two hundred and twenty-nine inspections, which were made during the year, four 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, 1,601 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.) 200 Bacon (lbs.) 42 Beef (spiced) (lbs.) 10 Cheese (lbs.) 20 Cherries (bushels) 200 Eggs (frozen) (lbs.) 88 Fish (stones) 24 Fish (canned) (tins) 367 Fruit (canned) (tins) 174 Meat (lbs) 34 Meat (canned) (tins) 34 Milk (canned) (tins) 328 Sausages (lbs.) 1 Tripe (lbs.) 2 Vegetables (canned) (tins) 50 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 Officer 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. 39 (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 683, of which 35 or 5.1 per cent. were adulterated. Particulars of formal samples collected are as follow :— Nature of Sample. Number Taken. Number Adulterated. Arrowroot 6 ... Brawn 17 ... Butter 35 ... Cakes, Sponge 15 1 Cheese 9 ... Cocoa 8 ... Coffee 12 ... Coffee & Chicory 7 ... Cream 14 ... ,, Preserved 4 4 Dripping 3 ... Fish, Potted 5 ... Fruit, Dried 3 ... Galantine, Chicken and Tongue 1 ... Ham 6 ... Honey 6 ... Lard 15 ... Lemon Cheese or Curd 22 2 Margarine 34 ... Meat, Potted 20 1 Milk 289 14 „ Separated 1 1 „ Sterilised 6 ... Mincemeat 6 ... Mustard 2 ... ,, Compound 1 ... Pepper 3 ... Powder, Baking 3 ... Rice 3 ... Sausages 53 1 Sweets 9 ... Tapioca 3 ... Tea 4 ... Tomato Puree 1 1 Tripe 6 ... Vinegar 45 9 Whisky 6 1 Total 683 35 40 (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. Brawn 3 ... Butter 10 ... " Brinite" 1 ... Cakes, Sponge 6 2 Cheese 6 ... „ Cream 1 ... Coffee 1 ... Cream 6 ... „ Preserved 3 3 Dripping 3 ... Egg Yolk 2 1 Fruit, Dried 5 ... ,, Tinned 10 4 Ginger, Ground 3 ... Ham 6 ... Honey 3 ... Jam, Raspberry 1 ... Jelly, Table 3 ... Lard 3 ... Lemon Cheese or Curd 15 ... Margarine 9 ... Meat, Potted 20 1 „ Preparations 4 ... Milk 122 ... „ Condensed, Full Cream 1 ... ,, „ Machine Skimmed 2 ... „ Sterilized 1 ... Mincemeat 3 ... Peas, Tinned 3 ... Powder, Gregory 3 ... Rennet, Essence of 2 ... Sauce 5 ... Sausages 23 1 Tomato Puree 4 1 Vinegar 21 3 Wines, British 3 1 Total 317 20 41 Summary of the Results of Analysis of the 55 Adulterated Formal and Informal Samples, together with a record of the action taken by the Council. PROCEEDINGS TAKEN UNDER THE SALE OF FOOD AND DRUGS ACTS Article Analysed. Nature and Amount of Adulteration. Action taken. Cakes, Sponge 8.1 grains of boric acid per lb. No action ,, ,, 12.6 ,, ,, ,, Informal sample ,, ,, 11.1 ,, ,, ,, ,, Cream, Preserved 18.5 „ ,, ,, Proceedings. Summons withdrawn „ ,, 16.7 „ ,, ,, Vendor cautioned „ ,, 16.1 „ ,, ,, „ „ ,, 14.1 „ ,, ,, „ „ ,, 17.9 „ ,, ,, Informal sample „ ,, 17.1 „ ,, ,, „ „ ,, 15.2 „ ,, ,, „ Egg Yolk 63.4 ,, „ ,, „ Fruit, Tinned 1 „ tin per lb. „ „ ,, 0.8 ,, „ „ „ ,, 0.8 „ „ „ „ ,, 0.6 „ „ „ Lemon Cheese 0.6 ,, salicylic acid per lb. Proceedings. Summons withdrawn „ ,, 5.5 „ boric „ „ Informal sample „ ,, 4.4 „ ,, ,, „ and 0.2 grains of salicylic acid per lb. „ „ ,, 0.3 grains of salicylic acid per lb. „ ,, Curd 4.9 „ boric „ ,, No action Milk 63 per cent. of extraneous water and artificially coloured. Proceedings. Summons withdrawn owing to death of Vendor „ 11 per cent. of extraneous water and 4 per cent. of required fat deficient Proceedings. Summons dismissed, warranty defence „ 8 per cent. of extraneous water Proceedings. Fined £2 and 10s. 6d. costs „ 31 „ required fat deficient „ „ £5 and £5 5s. costs „ 20.6 „ „ „ „ „ „ £2 and £1 10s. 6d. costs „ 18 „ ,, ,, „ „ Summons withdrawn „ 15 „ ,, ,, „ „ ,, „ 1 3 „ ,, ,, „ „ ,, „ 12 „ ,, ,, „ „ ,, „ II „ ,, ,, „ ,, Fined £3 and £212s. 6d. costs „ 9 „ ,, ,, „ „ Summons withdrawn „ 6 „ ,, ,, „ „ „ dismissed „ 4 „ ,, ,, „ ,, Fined £2 and 10s. 6d. costs „ 2 „ ,, „ ,, No action „ Separated 26 „ „ extraneous water Proceedings. Summons withdrawn owing to death of Vendor Meat, Potted 9.1 grains of boric acid per lb. Vendor cautioned „ ,, 15.6 ,, ,, ,, Informal sample Sausages 15.6 „ ,, ,, Vendor cautioned „ 5.9 „ ,, ,, „ Informal sample Tomato Puree 0.8 „ tin „ No action „ ,, 2.2 ,, ,, „ Informal sample Vinegar 40 per cent. of the required acetic acid deficient Proceedings. Fined £1 and 10s. 6d. costs „ 9 „ ,, ,, „ Fined 10s. and 10s. 6d. costs „ 8 „ ,, ,, „ „ £1 ,, 10s. 6d. „ „ 7.5 „ ,, ,, „ ,, £1 „ 10s. 6d. „ „ 6.5 „ ,, ,, Vendor cautioned „ 5.5 „ ,, ,, „ 42 Article Analysed. Nature and Amount of Adulteration. Action taken. Vinegar 3 per cent. of the required acetic acid deficient Vendor cautioned. „ 2 „ „ „ „ „ 2 „ „ „ „ „ 25 „ „ „ Informal sample „ 8 „ „ „ „ „ 8 „ „ „ „ Whisky 48 degrees under proof Proceedings. Fined £5 and 10s. 6d. costs Wine, British 0.2 grains salicylic acid per pound Informal sample Proceedings taken under the Milk and Dairies (Amendment) Act, 1922. Nature of Offence. Result. Selling pasteurised milk otherwise than in accordance with a licence granted by another authority Fined £5 and £10 10s. costs Selling pasteurised milk without a licence granted by this Council Fined £3. Proceedings taken under the Milk and Dairies Order, 1926. Nature of Offence. Result. Bottling milk otherwise than on registered premises Fined £l. „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ Failing to cover properly or otherwise effectively protect milk from contamination „ „ „ „ „ „ „ „ „ It will be seen that proceedings were taken in thirty-four cases, the fines and costs amounting to £65 Is. 6d. 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, and the Public Health (Preservatives, etc., in Food) Regulations, dated June 25th, 1927. The effect of the Regulations and the amendments thereof is as follows :— Preservatives.— No person shall manufacture for sale or sell, any article of food which contains any added preservative ; but the following exceptions are provided :— (a) The Regulations shall not apply until January 1st, 1928, in respect of butter, cream, pearl barley 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. (b) 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. (c) 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. 43 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 or benzoic acid 350 600 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 or benzoic acid. 70 120 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) CONTAINS (This coffee extract, etc.) PRESERVATIVE. Il 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 may 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. 44 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. Sale of Food and Drugs Act, 1927.— This Act is designed to give effect to the recommendation of the Departmental Committee on Preservatives and Colouring Matters in Food that "any prohibitions or limitations imposed by Regulation should bind the Courts in proceedings taken under the Sale of Food and Drugs Acts." The Act applies to all Regulations made under the Public Health (Regulations as to Food) Act, 1907, dealing with the composition of, or additions of any ingredient or material to, an article of food. Thus, the standards laid down by the Condensed Milk Regulations and the Dried Milk Regulations, as well as the prohibitions and restrictions in the Preservatives Regulations, will in future be conclusive for the purpose of proceedings under the Sale of Food and Drugs Act, 1875. THE USE OF PRESERVATIVES IN CREAM. The Council have for many years past taken a deep interest in the controversy in regard to the use of preservatives in cream and, now that the Law has finally required cream to be entirely free from preservatives and thus the Council's wishes have been granted, it will be of interest to members of the Council to have before them a history showing the steps which have been taken in arriving at this goal. In 1901, a Departmental Committee appointed by the Government to consider the use of preservatives in food, recommended "that the use of boric acid in cream in an amount not exceeding 0.25% (17.5 grains per pound) be permitted—the amount of such preservative to be notified by a label upon the container.'' The Council of the Royal Borough of Kensington, from time to time, urged the then Local Government Board to give effect—by legislation or otherwise—to the recommendation of the Departmental Committee, and in 1909, in the absence of any action in the direction indicated, the Council notified cream vendors in the Borough that, pending further legislation, they would take proceedings against persons selling cream containing boric acid without making clear disclosure of its presence and also that in cases where such disclosure was made, proceedings would still be taken in cases where the quantitv of boric acid found to be present exceeded 17.5 grains per pound—the equivalent of the limit suggested by the Departmental Committee. In 1912 the Local Government Board issued the original Milk and Cream Regulations which were made under the Public Health (Regulations as to Food) Act, 1907. These were framed in such a manner as to allow of the impression being formed that the addition of boric acid to cream in any amount was permissible providing the receptacle containing the cream bore a certain form of declaratory label. That the addition of boric acid to cream was illegal was clearly proved by the High Court decision in Cullen v. McNair (1906) 72 J.P. 376, which established the fact that the presence of 0.313 per cent., or 21.91 grains per pound, of boric acid rendered the cream injurious to the health of children and invalids, it being held also by the High Court that the limitation of the judgment to children and invalids did not exonerate the vendor, such persons being a substantial part of the community. In the case of Whale v. Bennett (British Food Journal, May to September, 1913), the Justices at the London Quarter Sessions, after hearing a mass of expert evidence, decided that cream containing 0.3157 per cent., or 22.309 grains per pound, of boric acid was injurious to health—there was no suggestion here that children and invalids were the only persons injuriously affected and there was no limitation of the judgment to children and invalids—and that the sale of such article, even when labelled, was an offence under Section 3 of the Sale of Food and Drugs Act, 1875. In this connection it should be borne in mind that, under Section 8 of the Sale of Food and Drugs Act, 1875, where a food is mixed with an ingredient which is injurious to health, disclosure by label is no defence. In 1917 the Local Government Board issued an order amending the Regulations of 1912 by adding to the provision that no preservatives should be added to cream except boric acid, the words "in amount not exceeding 0.4 per cent. (28 grains per pound) " and by requiring the declaratory labels to bear the words "Not suitable for infants or invalids." This Order was, in the view of the Council, misleading, inasmuch as it might be understood by implication to sanction the addition of boric acid to cream up to the amount stated, subject to such amount being declared. 45 The Law and General Purposes Committee were asked to advise upon the position and reported that, viewing the question from a legal standpoint, they were of opinion that the new Order did not limit or affect the provisions of Section 3 of the Sale of Food and Drugs Act, 1875, or the decisions of the Court given thereunder. In the light of this advice the Council decided to adhere to the considered policy laid down by them in 1909 in the matter, and in July, 1917, they issued a general intimation to the cream vendors to that effect. The Sale of Food and Drugs Act, 1927, which came into operation on the 12th April, 1927, provided—inter alia—that where in any regulations made under the Public Health (Regulations as to Food) Act, 1907, the addition of any preservative to an article of food was restricted, the addition of such preservative not exceeding the amount specified by those regulations should not be deemed to render the article injurious to health. It will be seen, therefore, that after the 12th April, 1927, the addition of boric acid not exceeding 0.4 per cent. (28 grains per pound) to cream was not illegal so long as the Milk and Cream Regulations of 1912 and 1917 remained in force, provided that the provisions in respect of labelling were complied with. The result of the Sale of Food and Drugs Act, 1927, was in effect that the Council could not pursue their policy of enforcing the limit of 0.25 per cent (17.5 grains per pound) of boric acid in cream, and indeed, proceedings which had been instituted before the 12th April, 1927, but which were not due to be heard until after that date, in respect of a sample of cream which contained 18.5 grains per pound of boric acid, were withdrawn. This undoubtedly would have been distinctly unfortunate from the Council's point of view had the position as it existed then been continued, but on the 1st January last, when the 1925 Regulations dealing with the prohibition of preservatives in cream came into operation, the Milk and Cream Regulations of 1912 and 1917, under which the limit of 0.4 per cent, was fixed, ceased to operate. It is now quite clear that, as from the 1st January last, cream must be entirely free from preservatives of any kind. Notwithstanding the recommendation of the Departmental Committee in 1901 in regard to cream, and the Milk and Cream Regulations, cream free from preservatives can be supplied in Kensington as is shown in the following table which indicates the extent to which preservatives have been found in samples of cream taken in the Borough since 1908 for analysis under the Sale of Food and Drugs Act, 1875. Year. No. of samples taken for analysis. No. free from preservative. No. containing boric acid Percentage free from preservative. Highest amount of boric acid found in any one sample. Lowest amount of boric acid found in any one sample. Average amount of boric acid found in those samples preserved with this drug. grains per pound. 1908 10 - 10 - 22.30 4.33 12.79 1909 13 5 8 38.4 25.13 5.95 17.01 1910 21 8 13 38.0 37.08 5.95 15.88 1911 26 13 13 50.0 33.83 12.76 19.88 1912 22 11 11 50.0 22.30 6.19 14.93 1913 6 3 3 50.0 33.32 24.29 31.43 1914 16 9 7 56.2 33.09 12.39 19.85 1915 32 12 20 37.5 30.98 2.97 17.28 1916 28 19 9 67.9 24.79 7.56 17.30 1917 — — — — — — — 1918 1 1 — 100.0 — — - 1919 — — — — — - - 1920 — — - - - — - 1921 13 9 4 79.6 25.03 21.32 22.83 1922 — — — — — — — 1923 17 12 5 70.6 19.70 5.55 14.04 1924 14 12 2 85.7 15.80 13.00 14.40 1925 28 17 11 60.7 18.70 10.80 15.10 1926 36 30 6 83.3 19.40 5.90 12.95 1927 27 20 7 74.0 18.50 14.10 16.51 1928 (Jan. 1st to March 1st.) 7 7 100.0 — — — 317 188 129 59.3 37.08 2.97 15.30 46 As the table shows, 59.3 per cent. of the samples of cream taken in Kensington from 1908 to1928 were free from preservatives. Indeed, since 1921, it has been found that in the better classdairies the sale of preserved cream has been discontinued, which fact undoubtedly proves that it is possible to carry on the cream trade without the use of preservatives. It has been the practice for some time past for retailers to obtain their stocks of cream daily instead of bi-weekly or even weekly, as was the previous custom. Since the 1st January last, on which date the Public Health (Preservatives, etc., in Food) Regulations in respect of cream became operative, seven samples of cream have been analysed by the Public Analyst and every one was found to be free from preservatives. Enquiries made of cream retailers have shown that the new Regulations have not resulted in much loss by reason of the cream becoming sour. Indeed, having regard to the process of preparation of cream, which under modern methods is a rapid one, there does not appear to be any justification for taking the retrograde step of again permitting the audition of preservatives to cream, when such cream is intended for consumption in its natural state. I have consulted two large firms of caterers and confectionery makers and, whilst they both agree that it is possible for cream to be sold in shops and restaurants without the use of preservatives, they are by no means certain that hardship and loss will not be experienced in the use of unpreserved cream in the manufacture of such articles of food as pastries, gateaux, eclairs, etc. They point out that cream used in the manufacture of pastries, etc., will sour much more quickly than cream kept in a cool place in a dairy. The cream is usually a day old when used by the confectioner and is subjected to varying temperatures in the vans, shops and so on. One firm mentions that a particular consignment of cream confectionery was made during the night, despatched in the early morning and had to be destroyed at 4 p.m. the same day, owing to the souring of the cream. The other firm stated that there had been a good deal of waste and loss due to souring of cream goods and that at one time they considered the possibility of having to withdraw this type of goods from their market. As a result of further trials, however, they had been able, by reason of employing improved hygienic methods throughout both production and distribution, to carry on the sale so far, but they look forward to the future with some misgivings. These are two large firms and possibly they are in a better position to adopt improved hygienic methods than many smaller firms and, therefore, those smaller firms may be driven to find somesubstitute for cream or may reconstitute cream in a similar way to that in which milk is reconstituted. So far, I am satisfied that in regard to the sale of cream in the ordinary way the Regulations will not create hardship to the trade, but I think further enquiries should be made and a close watch kept on the confectionery trade to see whether the Regulations prove harsh and unreasonable in regard to the use of cream in the manufacture of pastries, gateaux, eclairs, etc. 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 m 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 duriner the year 47 THE PREVENTION OF, AND CONTROL OYER, INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in Kensington:— Acute Encephalitis Lethargica Influenzal Pneumonia. Acute Polio-encephalitis. Malaria. Acute Polio-myelitis. Membranous Croup. Acute Primary Pneumonia. Ophthalmia Neonatorum. Acute Rheumatism Plague. Anthrax. Puerperal Fever. Cerebro-spinal Fever. Puerperal Pyrexia. Cholera. Relapsing Fever. Continued Fever. Scarlatina or Scarlet tever. Diphtheria. Small-pox. Dysentery. Tuberculosis. Erysipelas. Typhoid or Enteric Fever Glanders. Typhus Fever. Hydrophobia. Zymotic Enteritis. Table showing Notifications of certain Infectious Diseases received in 1923-27. Year. Scarlet Fever. Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. †Puerperal Pyrexia Pneumonia. Malaria. Encephalitis Lethargica. p. M'ltis & Polio. Encephalitis. ‡Acute Rheumatism. Cerebro spinal Meningitis. Dysentery. *Enteritis. Total. 1923 205 223 12 67 21 15 † 125 5 3 5 ‡ — — * 681 1924 281 188 29 59 14 5 † 157 3 21 10 ‡ 4 1 40* 813 1925 224 259 25 53 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 1927 251 356 10 59 17 3 44 241 2 5 2 48 5 2 41 1086 Cases of mistaken diagnosis are excluded from the above table. † Puerperal Pyrexia became notifiable on October 1st, 1926. ‡ Acute Rheumatism in children under 16 years of age became notifiable in Kensington on October 1st, 1927, * 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 1927, 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'itls & PolioEnce phalitis. †Acute Rheumatism. Cerebro spinal Meningitis. Dysentery. Enteritis. Total. January 29 10 30 1 2 1 - 6 69 - - - - 1 - 1 121 February 26 15 48 - 4 3 1 5 49 — — — — 1 - — 126 March 26 17 27 1 4 3 — 2 7 — — — — 2 — 1 64 April 23 21 28 — 7 2 — 10 7 — — — — — — — 75 May 21 21 32 - 2 2 1 3 13 - 2 - - — — 6 82 June 18 22 20 1 5 2 1 4 3 — - - — 1 - 2 61 July 16 21 16 4 7 — — 1 5 — 1 — — — — 6 61 August 13 14 12 - 9 — — 2 7 2 - - - - - 9 55 Sept. 10 15 27 1 5 — — 5 2 — 1 - — - - 3 59 October 8 19 37 — 3 — — 1 14 — — — 7 — — 8 89 November 5 35 34 2 4 — — 4 22 — — 1 16 — — 4 122 December 3 17 26 - 3 3 — 1 15 — — — 11 — 2 — 78 December 31 24 19 — 4 1 — — 28 — 1 1 14 ~ - 1 93 Totals 251 356 10 59 17 3 44 241 2 5 2 48 5 2 41 1086 Cases of mistaken diagnosis are excluded from the above Table, † Acute Rheumatism became notifiable on October 1st. 1927. 48 Small Pox.— No case of small pox occurred in the Borough during the year. There were, however, three cases in Hackney, one in Hampstead, one in Poplar, and one in Shoreditch. 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 re-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 264, of which 247 were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1927. District. Period No. 1. Per iod 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 816 739 754 852 945 1082 1148 974 915 1244 1531 1264 1030 The Borough 10 15 18 23 22 24 22 14 16 19 36 21 24 North Kensington 6 11 13 15 18 20 16 12 13 14 29 16 19 South Kensington 4 4 5 8 4 4 6 2 3 5 7 5 5 Wards. St. Charles 2 4 4 4 5 9 4 1 2 2 13 5 5 Golborne — 4 6 3 2 4 10 5 7 8 9 6 6 Norland 3 1 1 5 5 1 1 2 1 3 4 2 6 Pembridge 1 2 2 3 6 6 1 4 3 1 3 3 2 Holland 2 1 — 1 — — 2 1 1 1 — 1 - Earl's Court — — 2 1 - — 1 — — - 2 - 2 Queen's Gate 2 — 2 5 2 2 — — 2 1 2 1 2 Redcliffe — 2 1 — 1 1 1 — — 3 1 3 1 Brompton — 1 — 1 1 1 2 1 — — 2 — - Cases of mistaken diagnosis are not excluded from the above Table Thirteen 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 five 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 no fatal cases during 1927. The deaths in the three preceding years were 1, 2 and 4. In previous years, cases of scarlet fever have occurred in families where a member of the family 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 a very careful investigation is made in each with a view to ascertaining the source of infection. During 1927, however, there has not been a single case of this kind reported. 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.—Three hundred and ninety-two cases were notified during the year, 386 of which were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1927. 49 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 1034 995 969 855 827 837 733 691 709 969 1224 1249 1199 The Borough 32 54 30 32 33 26 19 12 27 38 38 30 21 North Kensington 22 44 22 24 24 21 17 7 21 27 22 19 18 South Kensington 10 10 8 8 9 5 2 5 6 11 16 11 3 Wards. St. Charles 3 11 6 7 5 2 3 - 4 6 10 6 4 Golborne 8 15 11 11 9 5 3 4 9 12 8 5 6 Norland 7 9 2 5 6 10 9 3 7 6 4 4 7 Pembridge 4 9 3 1 4 4 2 2 1 3 — 4 1 Holland 3 2 3 5 1 2 — — 2 8 5 5 2 Earl's Court 2 3 4 2 3 — — 3 1 1 5 3 — Queen's Gate 2 3 1 — — 1 1 1 — 2 3 2 1 Redcliffe 2 2 — 1 5 — 1 1 3 — 1 1 — Brompton 1 — — — — 2 — — — — 2 — — Cases of mistaken diagnosis are not excluded from the above Table. Thirty-six 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 number of Kensington deaths was eleven, representing a case mortality of 3 per cent. In the three preceding years, the deaths were 15, 10 and 22. Ten 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 one instance, the original case was proved to be responsible for three secondary or "return cases"; and in another instance, the original case was responsible for one "return case," who in turn was responsible for two further cases; in the remaining four "return cases" there was no direct evidence that infection was contracted from the primary patients who had returned from hospital. During the year 1,688 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 196 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 1,688 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 diphtheria infection to other persons) or of an avirulent type (incapable of conveying diphtheria infection to other persons), therefore it is necessary to ascertain the particular type of organism present before submitting the patient to prolonged isolation and treatment. In the last four months of the year, twenty-four cases occurred in one of the elementary schools in the Borough. The outbreak commenced on the 20th September when one case was reported. On the 23rd September there were two cases, another on the 26th September and another on the 29th September. Most of these cases were detected by the taking of swabs from all those children in the school whose throats were unhealthy in appearance In view of the repeated discovery of cases by swab examination, it was decided to take swabs from the throats of every child in the school and in this way six cases of mild diphtheria were discovered on the 30th September. One of these six was a child who had entered the school that term for the first time and from the first day the teacher noticed that she seemed to have some difficulty in breathing through her nose. This child was found to have slight nasal discharge and the bacteriological examination showed that she had diphtheria germs in both the nose and throat. Curiously enough, she had been absent from school on those sessions when the previous medical examinations had been made. These six cases were removed to hospital and, although further swabbing was undertaken and careful medical examinations made from time to time, no other cases occurred for a fortnight. It was thus presumed that the child with the "stuffy" nose had been responsible for the outbreak. Four cases occurred towards the end of October and the remainder during November and December. Most of these cases were detected as a result of bacteriological examinations of swabs taken from the throats and were not serious. It is probable that the cases occurring in October, November and December had been contracted from some child who had been infected by the child with the "stuffy" nose, but whose infective condition had remained undetected. Indeed, one of the cases discovered in October or November may have been a previously undetected infective child. This outbreak serves as a very excellent example of the way in which an epidemic can sometimes be cut short and rendered almost free from danger by repeated medical inspections and careful bacteriological examinations. Out of the twenty-four cases, only two or three were seriously 50 ill, but unfortunately one died. The attack of diphtheria in many was so slight that the parents did not even think that the children were ailing. If these infective children had been allowed to remain in school, it is possible that the epidemic might have developed into a serious one giving rise to many severe cases with a number of fatal results. Although these investigations cause a good deal of interference with school routine, there is no doubt that they well repay the labour undertaken. 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.ll, 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 1927, the Borough Council supplied 197,500 units of anti-toxin for 36 patients at a cost of £16 5s. 4d. Home disinfection and school exclusion are carried out as in cases of scarlet fever. Enteric Fever.— Ten cases of this disease were notified, 5 being removed to hospital and 2 to nursing homes. The cases notified in the three preceding years were 29, 29 and 30. There were no deaths from this cause against 3, 3 and 2 in the preceding years. Eight of the cases were notified from the southern division of the Borough and 2 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 fact 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 have not the very good water supply and sanitary arrangements which are enjoyed by residents in London generally. Six of the cases were notified as paratyphoid fever. Erysipelas.— Fifty-nine cases were notified during the year, 20 of which were removed to hospital. There were 4 deaths from this cause, the deaths in the three preceding years being 1, 5 and 5. Ophthalmia Neonatorum.— The following table gives particulars of ophthalmia cases notified in 1927 and the results of treatment. Case No. Cases. Vision unimpaired. Vision impaired. Total Blindness. Deaths. Notified. Treated. At home. In hospital. 1. Jan. 13 - Yes Yes - - _ 2. Feb. 2 — „ „ — — — 3. „ 13 - „ „ — — — 4. „ 16 — „ „ — — — 5. Mar. 13 Yes - „ — — — 6. „ 17 „ - „ — — — 7. „ 21 „ - „ — — — 8. Apr. 17 „ - „ — — — 9. „ 20 „ - „ — — — 10. „ 26 „ - „ — — — 11. May 4 „ - „ — — — 12. June 4 „ - „ — — — 13. July 7 - Yes „ — — — 14. Nov. 7 - „ „ — — — 15. „ 26 - „ „ — — — 16. Dec. 12 Yes — „ — — — 17. Nov. 11 - Yes „ - - Yes, from another cause. 51 It will be seen that all the cases except one occurring in 1927 recovered without any injury to sight. In the case which proved fatal the cause of death was in no way associated with ophthalmia neonatorum. Since the year 1921 there has occurred only one case with any impairment of vision. 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 1927, the ophthalmia neonatorum and inflammation of the eye cases attended by the nurses numbered 18 and the number of home visits paid in connection with these cases was 387. These visits average 21 to each of the 18 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 387. Puerperal Fever.—The incidence of this disease has been light during the past year. Three cases only were notified and two of them were removed to hospital for treatment; all three cases recovered. The Registrar-General reported the deaths from this disease of four women in hospitals outside the Borough. During the year 1926, the Minister of Health issued the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, and these were reported upon in my Annual Report for that year, together with particulars of the Council's scheme for dealing with cases of puerperal fever and puerperal pyrexia. Puerperal Pyrexia.—Forty-four cases of puerperal pyrexia were notified during the year. Two occurred in nursing homes and twenty in hospitals, to which institutions the patients had been removed previous to their confinements; ten were removed to hospitals after the confinements had taken place in the patients' homes; and the remainder received satisfactory treatment in their own homes. Two cases only developed into puerperal fever; one was transferred from one hospital in which the patient had been confined to another hospital where the case proved fatal some days afterwards; and in the other case the patient went to her mother's address in Fulham to be confined and from there was removed to one of the Metropolitan Asylums Board's hospitals where she died. Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia, but the only kinds notifiable are acute primary pneumonia and influenzal pneumonia. Two hundred and fortyone notifications were received, 151 patients being certified as suffering from acute primary pneumonia and 90 from influenzal pneumonia. It is clear that many cases escaped notification. The number of deaths from pneumonia during the year was 210, and 109 deaths were certified to be due to influenza. Malaria.—Two cases of this disease were notified, and investigation revealed that both patients had contracted the disease abroad, one in Uganda and the other in India. 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. Since 1924, the incidence has happily declined. 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 Engand and Wales, 225 in London, and 10 in Kensington. In 1927, there were 1,587 cases in England and Wales, 146 in London and 6 in Kensington. One of the six cases notified in the Borough was 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. F. 69 23rd April. Recovered, Physical condition poor. Still under doctor. 2. F. 43 25th „ Recovered, but in asylum. 3. M. 12 4th July. Recovered completely. 4 F. 25 2nd September. Died. 5. F. 42 30th November. Recovered completely. 52 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 1927, two cases of polio-myelitis were notified to the Public Health Department and the following table gives details:— No. Sex. Age. Date of Notification. Result. 1 F. 113/4 16th October. Recovered. Muscular weakness in arms and legs. 2 M. 28 15th December. Died. Cerebro Spinal Meningitis.—There were five cases of this disease notified during the year Particulars are subjoined:— No. Sex. Age. Date of Notification. Result. 1 F. 11/2 14th January. Died. 2 M. 4 1st February. Recovered completely. 3 M. 4 mos. 3rd March. Died. 4 M. 18 23rd „ Recovered completely. 5 F. 29 11th June. Recovered completely Zymotic Enteritis or Summer Diarrhœa.—The Borough Council's scheme for control and treatment has now been in operation for four years—the first year, namely, 1924, from 1st July to 30th September, and in 1925, 1926 and 1927 from the 1st June to 30th September—and it has not been found necessary to alter the arrangements under the scheme which were described in my Annual Report for the year 1925. 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 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. During the year 1927, only forty-one cases of enteritis were notified and of these twenty were removed to hospital. Dr. Carter visited twenty-one cases in their homes and paid fifty-four visits. The District Nurses attended forty-eight cases, and paid 437 visits. It is a splendid testimony to Dr. Carter to be able to record that no case attended by him since the commencement of the Council's scheme in 1924 has proved fatal. The following is a report by Dr. Carter giving particulars of cases of enteritis dealt with during the year under review:— Zymotic Enteritis, 1927. Last year was peculiarly cool and wet and consequently there was not much of this illness among infants and children. The Borough Council's scheme, however, has been of great use in bringing to light several cases of wrong feeding. I saw twenty-one individual cases of enteritis and paid fifty-four visits. The majority of these suffered from acute dyspepsia with vomiting and diarrhoea. These symptoms quickly subsided when treatment was commenced within twenty-four hours after onset. I did not send any cases into hospital myself, but I had the opportunity of seeing several acute cases sent to St. Mary Abbot's Hospital by other doctors. Amongst these were two cases from the same family in which the Flexner bacillus was isolated; these being cases of true dysentery and as they were considered to be too infective to keep in the wards at St. Mary Abbot's Hospital, they were sent to one of the Metropolitan Asylum Board's Hospitals. The several cases admitted to the hospital had usually been ill for about a week before admission. Dr. Fenton has continued to accept notifications of all cases of diarrhoea and vomiting. It is impossible to draw a line clinically between an infective and non-infective type. A child may die from the loss of water from the body without having any rise of temperature, particularly if the infant is below normal weight before the onset of the disease. 53 The Council's scheme continues to have a good educational effect in the Borough. The Superintendent of the Kensington District Nursing Association, Miss Eales, tells me that the nurses find no difficulty in carrying out the treatment in the patients' homes, and the doctors in the neighbourhood are glad to make use of the nurses' services. I have heard no complaint in connection with the treatment. The local medical practitioners can have their orders carried out by nurses, who report to the doctors on the general progress of the case. I think the Borough Council are very fortunate in having Miss Eales to supervise this part of the work. Kensington District Nursing Association. The number of cases nursed during the year was forty-eight and no deaths occurred amongst these children whilst the nurses were in attendance. During the last four years, only two deaths have occurred amongst two hundred and thirty-five cases nursed by the Association. Examination of Health Visitors' Notes. The number of cases notified was forty-one. Of these twenty-six were under one year and fifteen were one year and over. The number of families in which the patient was the only case was thirty-eight. Two families had more than one case. The notes were very carefully recorded. I gave a list to the Health Visitors of some of the cases which have been discharged from St. Mary Abbots Hospital, and they visited these and reported upon them. Several have been referred to the Infant Welfare Centres where they have continued under the supervision of the physician and their weights have been recorded. In this manner it has been possible to follow up the cases and to see the results of treatment. Food on which children were fed before illness. Mixed diet 16 cases Cow's milk 9 cases Breast only 5 cases Condensed milk 4 cases Breast and dried milk 3 cases Condensed and cow's milk 1 case Breast and condensed milk 1 case Breast and cow's milk 1 case Proprietory food 1 case "Mixed diet" means gravy and bread or potatoes with a milk pudding at the mid-day meal; the other meals usually consist of cow's milk. These children invariably are one year old and over. Dysentery.—Two cases of this disease were notified during the year. The patients were sisters aged five and two years respectively. The children were admitted to St. Mary Abbots Hospital with enteritis and upon bacteriological examination being made Flexner dysentery bacilli were found. These cases were transferred to one of the Metropolitan Asylum Board's Hospitals, but after they had been there for a fortnight another bacteriological examination showed that no bacillus associated with dysentery could be isolated, and the patients were therefore discharged. An aunt of these children arrived from Cairo a month before the date of onset of the disease and, although she had been in direct contact with them on various occasions, it was impossible to trace the infection to her. There was one death from this disease. The case was not notified in this Borough, as the patient had been an inmate of a mental hospital in the country since 1922, and, therefore, could not have contracted the disease in Kensington. Owing to the fact that the man's original permanent place of residence was in this Borough, the Registrar-General allocated the death to Kensington. Other Notifiable Diseases.—With the exception of tuberculosis and acute rheumatism, which are dealt with in separate sections, 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 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 under consideration. In 1926, 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 met and as an outcome of their deliberations, the following scheme for the reception of cases of scarlet fever and measles into the Board's Hospitals was recomended:— (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 imminent the Board should inform the Medical Officers of Health and accept cases only upon their recommendation. 54 (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. (/) 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. The Metropolitan Asylums Board adopted the scheme and last year the approval of the Ministry of Health was obtained, but as there was no measles epidemic during the year, it was not necessary to put it into operation. The Women Health Officers visited 75 cases and 39 were admitted to hospital. There was only one death from measles in Kensington in 1927. Whooping Cough.—There were fourteen deaths from this cause. The deaths in the three preceding years were 20, 18 and 8. The Women Health Officers paid 57 visits to cases of this disease during the year. The number of cases admitted to hospital was 38. TUBERCULOSIS. During the year 178 cases of pulmonary tuberculosis and 74 cases of non-pulmonary tuberculosis were notified. The following table shows the number or cases of both forms of the disease notified in the Borough and the several Wards therein during each year since 1919. District. Years. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. The Borough 582 407 374 339 403 314 292 317 252 North Kensington 445 294 272 233 267 228 207 227 166 South Kensington 137 113 102 106 136 86 85 90 86 Wards. St. Charles 104 70 66 48 61 45 52 50 39 Golborne 150 88 89 80 86 65 56 69 53 Norland 124 93 80 76 85 75 67 59 44 Pembridge 67 43 37 29 35 43 32 49 30 Holland 36 36 29 28 26 30 27 20 11 Earl's Court 21 25 24 24 28 13 18 25 25 Queen's Gate 16 15 15 20 22 17 13 15 10 Redcliffe 33 25 19 23 41 15 18 22 25 Brompton 21 12 15 11 19 11 9 8 15 From the above table it will be seen that the steady decrease in the number of cases of tuberculosis notified, which has been commented upon in previous Reports, continued during 1927. In the year under review the number of cases reported was the smallest since compulsory notification was first established in 1912. The gratifying decrease in the incidence of the disease is particularly noticeable in the St. Charles, Golborne and Norland Wards; this is not surprising in view of the very large amount of time and attention devoted to the welfare of the people in these three Wards, both by the Borough Council and other bodies interested in the health of the people. 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 1927 140 (2) No. of persons dying unnotified or notified at death 38 (3) No. notified within one month before death 18 (4) No. notified within three months before death (excluding those under heading 3) 19 (5) No. notified within six months before death (excluding those under headings 3 and 4) 13 55 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 — — — 2 2 1—5 — — 7 4 — — 3 4 5—10 1 2 12 10 — 1 2 2 10—15 1 5 4 10 2 1 — 3 15—20 5 13 3 4 5 7 4 1 20—25 11 14 2 6 8 8 — 2 25—35 23 29 4 5 12 10 — — 35—45 ??? 9 — 1 15 4 — — 45—55 12 12 — — 12 5 — — 55—65 17 3 — — 18 3 — — 65 and upwards — 3 — 1 — 3 1 — Totals 88 90 33 41 72 42 12 14 †Primary notifications of 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. The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1919, 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. 1919 489 169 107 93 38 24 207 131 1920 293 135 82 114 44 27 179 109 1921 288 153 87 86 32 18 185 105 1922 252 139 78 87 30 17 169 95 1923 280 117 66 123 35 19 152 85 1924 236 120 67 78 29 16 149 83 1925 235 134 75 57 25 14 159 89 1926 248 130 72 69 30 17 160 89 1927 178 114 65 74 26 15 140 80 It has already been stated that the number of cases of tuberculosis notified in 1927 was the smallest on record, and the above table shows a satisfactory decline in the number of deaths from this disease. Indeed, the number of deaths and the death rate from tuberculosis are the lowest recorded in Kensington. These statistics must give considerable satisfaction to members of the Borough Council and to all those voluntary workers who have so ably supported the Local Authority on the Tuberculosis Care Committee and in other ways in the campaign against this disease. Tuberculosis is a preventable disease and with a continuance of the present enthusiastic efforts by many interested workers there is no reason why the malady should not become even much less common than it is to-day. Deaths from Tuberculosis in 1927 Allocated to District of Usual Residence of Patients. Pulmonary Tuberculosis. Other Forms of Tuberculosis. The Borough 114 26 North Kensington 82 24 South Kensington 32 2 Wards. St. Charles 17 2 Golborne 27 10 Norland 22 6 Pembridge 16 6 Holland 7 1 Earl's Court 8 — Queen's Gate 4 — Redcliffe 6 — Brompton 7 1 56 The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary Tuberculosis. Non-Pulmonary Tuberculosis. Patient's Home 48 6 St. Mary Abbots Hospital 39 11 Brompton Hospital 4 — St. Luke's Home 1 — Baby Clinic Hospital — 2 Outlying Hospitals 17 5 Other places outside the Borough 5 2 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. During the year no case occurred which required the attention of the Council under these Regulations. THE COUNCIL'S SCHEME FOR THE PREVENTION AND TREATMENT OF TUBERCULOSIS. The Staff 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 officers give whole-time service to tuberculosis work. 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 six 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 15 yrs. Total. Males. Females. Males. Females. Examined for first time 161 319 215 184 879 New cases with Respiratory Tuberculosis 48 43 1 4 96 (10.9 per cent.) New cases with Non-Respiratory Tuberculosis 1 5 14 9 29 ( 3.3 „ ) New cases regarded as "Suspects" 23 36 10 9 78 ( 8.9 „ ) New cases not suffering from Tuberculosis 89 235 190 162 676 (76.9 „ ) This table shows a decrease in the number of respiratory cases as compared with the year 1926 and a slight increase in the number of non-respiratory cases. 57 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 31 left on the Dispensary books at the end of 1926, making a total of 109. The subsequent disposal of these 109 was as follows:— Diagnosed subsequently as suffering from respiratory tuberculosis 4 Diagnosed subsequently as suffering from non-respiratory tuberculosis 3 Discharged finally as non-tubercular 79 Discharged as having ceased attendance 9 Died (malignant disease) 1 Remaining on books on 31st December, 1927 13 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, Clergy and private practitioners. The treatment recommended for the cases diagnosed at the Dispensary as suffering from tuberculosis, which numbered 132 (pulmonary 100 and 32 non-pulmonary), was as follows:—Sanatoria, 36; Domiciliary, 24; St. Mary Abbots Hospital, 23; Dispensary, 30; Hospitals, 5; Kensal House School, 2; Convalescence, 2. No special treatment was required in 10 cases beyond general advice and instruction to report at the Dispensary if necessary. The total number of attendances by patients at the Dispensary was 2,927 and 1,653 systematic examinations were made. The number of visits paid by the Tuberculosis Officer was 109, of which 26 were consultations at home with the doctor in charge of the case. Written reports on cases to Public Authorities numbered 1,201 and to doctors 415. The total number of sputum examinations was 499 (including 72 specimens sent up by doctors) from 425 individual cases. One hundred and thirty-four specimens showed tubercle bacilli to be present and 365 gave negative results. Of the 100 new cases with respiratory tuberculosis there were 74 with tubercle bacilli in the sputum. Records. The following table shows the number of cases of tuberculosis on the Register of Notifications on 1st January, 1927, 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, 1927. Pulmonary. Non-Pulmonary. Males Females Males Females No. of cases on the Register of Notifications on 1st January 1,140 1,218 547 545 No. of cases notified for the first time during the year 88 90 33 41 No. of cases brought to notice otherwise than by notification 15 9 8 4 No. of cases removed from the Register during the year on account of having:— (a) been cured 69 74 24 22 (b) removed from district 40 25 5 8 (c) died 75 48 9 11 (d) been inaccurately diagnosed 2 1 — 1 No, of cases remaining on the Register on 31st December 1,057 1,169 550 548 The number of patients on the Dispensary Register on December 31st, 1927, was 859, whilst at the beginning of the year they numbered 1,253. This considerable reduction was brought about by a thorough overhauling of the register and the removal therefrom of those cases that had not attended for several years, as well as those who have been cured, removed from the district, died, or been lost sight of and proved untraceable over a minimum period of two years. 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. 58 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 Abbots Hospital. The Kensington Board of Guardians provide at St. Mary Abbots 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 St. Mary Abbots 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 Abbots 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 Abbots 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. 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 Abbots Hospital and send Dispensary patients to that institution for the purpose of X-ray diagnosis have remained in operation throughout the year. Light Treatment. Negotiations between the Public Health Committee of the Council and the Victoria Hospital for Children, Tite Street, Chelsea, for the treatment of suitable patients residing in the southern portion of the Borough by artificial light, and with the Kensington Branch of the British Red Cross Society for the treatment of patients from any part of the Borough, were concluded satisfactorily in 1927. Up to the present time only a few tuberculous patients have received treatment under this scheme and it is too early for me to make a statement as to the extent of the benefit derived from exposure to the artificial sunlight. 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 two at a total cost to the Council of £29 5s. 0d. Co-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, or are sent for institutional or convalescent 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 231 cases referred to the Dispensary by private practitioners during 1927 as compared with 205 in 1926. 59 Home Visiting The number of home visits paid in 1927 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 18 17 22 20 29 39 21 166 Re-Visits 219 333 242 231 68 198 303 1,574 N on- pulmonary. First Visits 4 10 14 14 8 1 15 66 Re-Visits 64 120 164 130 30 1 35 544 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. The following table giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1927 by the Tuberculosis Officer, and the number of occupants, ascertained by the Women Health Officers on their visits to the homes, is inserted to show the difficulties experienced in securing home isolation in many cases:— No. of Occupants 1 2 3 4 5 6 7 8 9 10 Rooms 1 8 10 2 1 — — — — — — =21 cases „ 2 — 4 10 11 5 7 3 1 1 1 =43 „ „ 3 — 2 7 7 2 4 3 2 1 — =28 „ „ 4 — — 1 1 4 1 1 1 — — = 9 „ „ 5 — — 1 1 3 1 1 — — — = 7 „ ,, 6 — — — 2 — — — 1 — — = 3 „ 111 cases This total falls 21 short of the total number of cases owing to patients living in boarding houses, private hotels or large private residences not being included. 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 109 "suspect" cases. Of these, 4 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 13 still on the books at the end of the year. The remaining 79 were finally discharged as non-tubercular. 60 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 790 contacts traced by the Dispensary Service in 1927. Of these, 437 were examined one or more times by the Tuberculosis Officer, 145 were examined by their own doctors or had been recently examined at school, while 208 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. These examinations are not included in the above totals. 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 been continued. The Dentist who had carried out this work on behalf of the Council since October, 1924, resigned on the 20th July, and, as the Public Health Committee had entered upon the Summer vacation, temporary arrangements were made for the treatment of those patients who were in need of urgent attention at the Hammersmith Dispensary of the British Dental Hospital. On the 27th September the Council appointed Mr. A. Dreaper, L.D.S. (R.C.S.), as Dental Officer. The work done at the Dispensary during the year is shown in the following table:- Dentist's attendances at the Dispensary 36 Number of individual patients treated 25 Patients attendances 68 Number of fillings 4 Number of extractions 72 Number of dentures arranged for 8 In addition to the above, four patients received treatment at the Hammersmith Dispensary of the British Dental Hospital. Three of these were supplied with dentures and necessary extractions were made in the fourth case. Artificial Pneumothorax Treatment. During the year the Council undertook to pay for artificial pneumothorax treatment in two cases and the payments amounted to £16 5s. 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 include 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. 1923 39 638 1924 35 575 1925 36 614 1926 34 987 1927 22 804 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. 61 The following are particulars of the nourishment granted during 1927:— Number of patients assisted 8 Number of pints of milk granted. 159 Number of eggs granted. 159 Estimated cost to the Council of nourishment granted during the year £4 2s. 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 Miss M. Drysdale and Councillor Miss A. S. 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 M. G. C. Crombie 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 E. D. 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. (12) British Red Cross Society—Mrs. Burne, M.B.E., and Mrs Burchell. (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. 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. In the Autumn the Tuberculosis Care Committee appointed a Sub-Committee to consider the establishment in the Borough of a handicrafts class for tuberculous patients whose disability prevents them from performing full-time work. Largely as a result of the help of Miss Ruth Alexander in offering the use of a room rent free at "The Quest," the Sub-Committee succeeded in putting a scheme into operation and the class was opened in December. An expert teacher is instructing a class of men and women for two hours weekly in basket making. Attendances of patients at the class vary from 6 to 8, but it is hoped to increase the numbers gradually. 62 The results obtained so far are encouraging; but the refusal of the Ministry of Health to sanction the making of grants from Borough funds in aid of such schemes has rendered it imperative for the Tuberculosis Care Committee to make efforts to raise funds from voluntary sources to meet the cost of materials, tools, heating, lighting and the salary of the teacher. At the end of a full year's work I hope to report more fully upon the result of this experiment in occupational therapy. 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 eighteen patients to whom bedsteads and bedding are being loaned. In twelve of these the assistance was given for the first time during the past twelve months, the articles issued being as follow:— Bedsteads 9 Mattresses 11 Bolsters 10 Pillows 10 Pillow-slips 18 Sheets 33 Blankets 25 Quilts 9 Mattress Covers 3 The total stock of bedding, etc., on loan on December 31st, 1927, was:— Bedsteads 11 Mattresses 11 Bolsters 11 Pillows 13 Pillow slips 20 Sheets 35 Blankets 27 Quilts 11 Bed-cushions 3 Mattress Covers 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 162 Number of rooms disinfected 151 Bacteriological Examinations. Specimens of Sputum submitted by Medical Practitioners for bacteriological examination at the Lister Institute at the expense of the Council 218 Specimens examined by the Tuberculosis Officer:— In respect of Dispensary patients 427 Sent up by Medical Practitioners 72 Sputum Flasks. These are supplied to patients who are infectious, and advice is given in regard to the disposal' of sputum. ACUTE RHEUMATISM (RHEUMATIC FEVER) IN CHILDREN In 1926 and 1927, the Borough Council gave considerable attention to the question of acute rheumatism and, as a result of representations made by them to the Ministry of Health, an Order was introduced making acute rheumatism in children compulsorily notifiable in Kensington from October 1st, 1927, for an experimental period of three years. The only other area in this country where compulsory notification has been applied to acute rheumatism is in the neighbouring Borough of Paddington. The Council of that Borough have introduced notification in order to provide information to Dr. Reginald Miller, a physician at Paddington Green Children's Hospital, of cases in the Borough so that he can, with voluntary workers, arrange to undertake supervision and treatment of sufferers from this disease. The Kensington Borough Council, however, have introduced a municipal scheme which includes investigation into and control of the environmental factors concerned in the causation of acute rheumatism and the supervision of children affected by this disease. The scheme is very largely experimental in nature, but it is hoped that the researches to be undertaken will prove fruitful and supply information which will enable an effective attack to be made against this increasingly serious disease. 63 As the scheme came into operation during the year under review and as it is the first of its kind to be introduced in this country by a local authority, it may be well to give a somewhat full outline. Notification. Under the Kensington (Acute Rheumatism) Regulations, 1927, dated July 30th, 1927, made by the Minister of Health, acute rheumatism, as defined in these Regulations,* was made a notifiable disease for a period of three years from the 1st October, 1927. The Regulations provide that "the Medical Officer of Health, or a person acting under the instructions of the Medical Officer of Health, shall make such enquiries and take such steps as are necessary or desirable for investigating the source of disease, for removing conditions harmful to the patient and arranging for the treatment of the patient. The Local Authority may establish a centre to be called the Rheumatism Supervisory Centre and mav make such other arrangements as they deem necessary or desirable for the supervision, after-care and treatment of cases of acute rheumatism in the district.'' Before sanctioning these Regulations, the Ministry required to be satisfied that:— (a) efficient machinery existed for investigating the cases notified, (b) there was accommodation for institutional treatment, and (c) the Local Authority was well organised in regard to health administration and had good housing records. Rheumatism Supervisory Centre. After conferring with the authorities of the Princess Louise Kensington Hospital for Children, it was arranged that:— (a) the Rheumatism Supervisory Centre should be at the new Children's Hospital, and (b) a physician or assistant physician on the honorary staff of the Hospital should be appointed as physician-in-charge of the Centre and consulting physician to the Royal Borough of Kensington for cases of acute rheumatism. The Rheumatism Supervisory Centre was opened in October, 1927, and Dr. Reginald C. Lightwood, an assistant physician on the staff of the Children's Hospital, was appointed physician-in-charge of the scheme. Hospital Accommodation for Rheumatic Children. By arrangement with the Poor Law Authorities of Kensington, the physician-in-charge of the Rheumatism Supervisory Centre was appointed as visiting physician for acute rheumatism at St. Mary Abbots Hospital (Kensington Infirmary). The Poor Law Authorities agreed to provide sufficient in-patient accommodation for the rheumatic children coming under the Scheme. Convalescent Accommodation for Rheumatic Children. An annual grant is being made by the Council of the Royal Borough to assist in the provision of accommodation for convalescent rheumatic children in suitable recovery homes. Control of the Scheme. The Scheme is under the control of the physician-in-charge of the Rheumatism Supervisory Centre, who acts under the authority of the Medical Officer of Health. In this way a unified control is obtained. Details of the Scheme. The Medical Officer of Health and the physician-in-charge of the Rheumatism Supervisory Centre drew up the following experimental plan for the organisation of the work of the Centre:— (1) On the receipt of a notification, a Health Visitor, acting under the instructions of the Medical Officer of Health, visits the home of the patient and fills in appropriate information on a card which is reproduced in miniature below:— *The expression "acute rheumatism" means the following conditions, occurring separately or together in a child under the age of sixteen years. (a) Rheumatic pains or arthritis, if accompanied by a rise of temperature; (b) Rheumatic chorea; (c) Rheumatic carditis. This definition is similar to the one used in the Paddington Notification Regulations. 64 THE ROYAL BOROUGH OF KENSINGTON. ACUTE RHEUMATISM ENQUIRY CARD. Name Address No. Age years months Sex Date of notification Dr. Date of onset School attended Places where patient has lived in last five years (in chronological order) No. of rooms occupied by family No. of families in house Position of rooms: basement, first, second, third floor Evidence of dampness Is there a damp course? Is there any evidence of this being defective? Is there any dampness in the rooms occupied by the patient's family? How many feet does the dampness spread up the walls in the rooms occupied by the patient's family? Is the dampness present all the year round or in Winter only? If patient lives in basement, is the floor of wood, concrete or stone? Is there ventilation under the floor? Lighting of rooms Good Fair Poor Ventilation of rooms Good Fair Poor Cleanliness of rooms Good Fair Poor Verminous Cleanliness of clothing Good Fair Poor Verminous Family Occupation of father Occupation of mother Brothers—how many? Ages Sisters—how many? Ages How many children sleep in the same room as the patient? Have any persons sleeping in same room shown any signs of rheumatism, chorea, tonsillitis, growing pains? No. of children in house not sleeping in same room as the patient? Have any of these shown any signs of rheumatism, chorea, tonsillitis, growing pains? Health Record Other Father Mother Brothers Sisters Relations Acute rheumatism Chorea Tonsillitis Growing pains Tuberculosis Has the patient had scarlet fever? If so, give date Have the patient's tonsils been operated on? If so, give date Has the patient been in hospital for acute rheumatism or been under previous medical attention for it? Is the patient confined to bed or able to go out? Is the patient attending school? Is the patient receiving regular medical attention now? Is the doctor willing that patient should attend Rheumatism Supervisory Centre? If the patient has attended the Rheumatism Supervisory Centre, indicate date of first attendance Remarks Signature SUBSEQUENT HOME VISITS. VISITS BY HEALTH VISITOR. Date Remarks Initials 65 Every effort is made to persuade the parents to take the child to the Centre for examination. In cases where the patient is too ill to go, but in which the private medical practitioner desires his opinion, the rheumatism expert arranges to visit the patient's home and to consult the private practitioner there. (2) Cases of rheumatism, or cases of suspected rheumatism, coming to the notice of any of the following persons or bodies, are recommended to attend the Centre, even though they are not notified or not notifiable: the Medical Officer of Health or his staff (Health Visitors, etc.), the physician-in-charge of the Centre, the Invalid Children's Aid Association, the Charity Organisation Societv, the Infant Welfare Centres, the staff of the Children's Hospital, and the School Medical Service. Such cases are either notified at the Centre, or, if not notifiable, a card similar to that used for notified cases and shown above is filled up by the vountary worker who visits the home. (3) The Council have appointed a Rheumatism Sub-Committee to undertake the vision of the scheme. This Sub-Committee is composed of Miss Keeling (Chairman of the Public Health Committee), Miss O. A. Nixon (Secretary of the North Kensington Branch of the Charity Organisation Societv), Miss M. G. Crombie (Secretary of the Kensington Branch of the Invalid Children's Aid Association), Miss Webster (Representative of the School Care Committee), and the Medical Officer of Health. Miss Crombie acts as Secretary of this Committee. The work of the Centre is performed by the physician-in-charge, Dr. Lightwood, and by Dr. Davies, a medical assistant. The first home visit of all notified cases is paid by the Council's Health Visitor in charge of the district in which the patient lives. These ladies are trained hospital nurses and qualified Sanitary Inspectors, and at this visit they fill up the enquiry card outlined above. The Invalid Children's Aid Association gives considerable assistance through their Kensington Secretary and voluntary workers attached to that organisation. In particular, Miss Kahn and Miss Dudley Baxter have identified themselves with the scheme and performed invaluable duties in connection with home visiting, preparation of record cards and assisting generally under the direction of Miss Crombie. (4) The policy of the Centre is outlined in the following leaflet, which has been circulated to the medical practitioners in the Borough:— RHEUMATISM SUPERVISORY CENTRE (For the supervision of children suffering from rheumatism, chorea and rheumatic heart disease). The Centre is intended to meet the need shown by rheumatic cases for careful supervision during periods of apparent quiescence to prevent the development of heart disease. The plan adopted is to supervise the care cf the children when apparently well by periodical examinations, and to instruct the parents to consult their usual practitioner or hospital should fresh symptoms of rheumatism supervene. Treatment at the Centre itself is given only in urgent cases. Whilst it is not the policy of the Centre to treat ordinary cases of rheumatism but rather to supervise sufferers from this condition during their periods of apparently normal health, patients may be accepted for treatment in cases where their medical practitioner (if any) has expressed a desire that treatment should be carried out at the Centre. In this way it is hoped that the Centre will form a useful link between medical practitioners, the School Medical Service and the hospitals, for the benefit of the patients. Further, instruction is given to parents in the care of rheumatic children; and investigations into the causation of rheumatism are being made. The Centre is under the direction of one of the Honorary Assistant Physicians to the Hospital, and has behind it all the scientific resources of the Hospital. Beds are set apart at St. Mary Abbots Hospital and certain of the Metropolitan Asylums Board hospitals for rheumatic cases requiring in-patient treatment. (5) Sessions are held once a week, the patients being seen by appointment. Clinical records are kept at the Centre on appropriate record cards. (6) St. Mary Abbots Hospital. Cases requiring in-patient treatment, whether seen at the Centre or in consultation with practitioners, are drafted to St. Mary Abbots Hospital, where they are under the carc of the rheumatism expert and are seen at weekly intervals. They are seen daily by the Resident Medical Officer acting under his instructions. (7) Other Institutional Treatment. All cases requiring convalescent treatment are recommended for such to the Metropolitan Asylums Board, or convalescence is arranged through voluntary channels. Beds will be available later at the Princess Louise Hospital for rheumatic children requiring such treatment as operations on the ear and throat. (8) The clinical material arising is being investigated as follows:— (a) Environmental factors. Damp housing. Locality. School conditions. Social position. Family incidence. 66 (b) Clinical factors. Effect of tonsillectomy, partial or complete. Dental caries. Effect of institutional treatment. Observations of some physical signs found in rheumatism, e.g., sinus arrhythmia, extra systolies, altered cardiac sounds, etc. Record of work performed in 1927. A few days prior to October 1st, a copy of the Kensington (Acute Rheumatism) Regulations and details in regard to notification were supplied to all medical practitioners in the Borough, and from October 1st to the end of the year the number of notifications received was 48. The Rheumatism Supervisory Centre commenced work at the Children's Hospital temporary quarters in St. Mark's Road on the 29th October and was transferred to the new Princess Louise Kensington Hospital for Children on the 3rd December. Up to the end of the year nine sessions had been held, the number of new patients presenting themselves was 26, the total number of attendances at the Centre being 56. The Health Visitors made investigations at the homes of 43 of the 48 notified cases. In view of the short time the scheme has been in operation, it is advisable to reserve observations in regard to the work and the conclusions to be drawn therefrom until a later date. 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. (c) The subsidisation of the voluntary infant welfare institutions. (d) The provision of "home helps." (e) The provision of hospital accommodation for infants. (f) The provision of convalescent home accommodation for mothers and infants. (g) The provision of home nursing for sick mothers and infants. (h) The supply of milk and meals free or at a reduced price to necessitous mothers and infants. (i) The provision of a maternity home. (j) Arrangements for the treatment of ophthalmia neonatorum and zymotic enteritis. (k) The 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 1927 in regard to Maternity and Child Welfare is summarised in the following table:— 67 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) 17 277 323 281 230 332 399 1,859 Re-visits to Infants under the age of 12 months 127 667 606 813 907 746 978 4,844 Visits to Children between I and 5 years 283 1,600 967 1,492 1,164 1,088 810 7,404 Still-birth Enquiries 3 8 2 4 2 3 1 23 Visits to Ophthalmia Cases 3 2 4 3 3 3 8 26 Return Visits to Ophthalmia Cases 8 2 — 7 9 5 28 59 Visits to Measles Cases 10 2 5 3 15 4 36 75 Visits to Whooping Cough Cases 1 11 20 14 1 — 10 57 Visits to Puerperal Fever Cases 3 — 5 — 3 1 1 13 Visits to Puerperal Pyrexia Cases 6 5 9 6 7 7 15 55 Visits to Enteritis Cases 2 7 7 30 — 5 9 60 Infantile Death Enquiries 13 17 15 16 14 20 39 134 Investigations re Milk Applications 24 51 77 57 7 106 141 463 Ante-natal Visits 49 112 74 22 55 96 138 546 Half-days at Welfare Centres 22 100 152 143 90 116 148 771 Special Visits 934 154 313 159 228 267 360 2,415 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 eacii Woman Health Officer during the year appears in Table 5 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. 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 1927 is shown in the following table:— 68 Particulars of Work done. Archer Street. Bramley Road with Kenley Street Branch. Campden Hill. Earl's Court. Golborne. Lancaster Road. Raymede. Totals 1—No. of births occurring in the area of the Centre suitable for Welfare attention 138 595 127 232 277 359 258 1986 2—No. of sessions at which doctor attended for infant consultations 95 202 90 100 98 132 135 852 3—No. of sessions at which doctor attended for special ante-natal consultations 23 30 11 11 14 22 34 145 4—Total number of individual mothers who attended during the year 397 621 115 107 509 693 512 2954 5—Number of individual mothers who attended ante-natal sessions during the year 50 92 34 87 56 81 61 461 6—Total number of individual children who attended during the year (Old) 196 395 98 181 370 386 297 1923 ,, ,, ,,(New) 230 421 91 185 305 353 231 1816 7—Total attendances at Centre of mothers for all purposes. (Excluding the accompanying of children and for the purpose of buying dried milk or other article) 803 2366 628 2288 2217 4663 3761 16726 8—Total attendances at Centre of children for all purposes 3492 7258 2952 4522 6276 8114 8307 40721 9—Total attendances at dinners (Included in Nos. 7 and 8 above)— 1. Mothers — — — — 730 2498 — 3228 2. Children — — — — — 1806 — 1806 10 —Total attendances at doctors' consultations— 1. Ante-natal mothers 147 266 72 172 117 245 162 1381 2. Post-natal mothers 183 394 45 546 651 320 400 2939 3. Children 2864 5548 1914 3719 3469 3785 4043 25342 11--Average attendances at doctors' consultations— 1. Ante-natal mothers 6 13 6 15 8 11 5 64 2. Post-natal mothers 2 1 — 5 6 2 3 19 3. Children 30 27 21 37 35 28 29 207 12—Number of individual children weighed during the year 426 813 188 352 675 739 518 3711 13—Total weighings 3429 6982 1855 4337 5812 6238 7455 36108 14—Number of first visits paid by salaried workers to— 1. Expectant mothers 32 70 12 12 95 82 123 426 2. Children 17 31 123 17 — — — 188 15—Total number of home visits paid by salaried workers to— 1. Expectant mothers 96 135 32 55 253 166 292 1029 2. Children 1626 1311 737 2012 4298 1604 2505 14093 16—Number of home visits paid to children by voluntary workers — 1. First visits — — — — — — — — 2. Total visits — 123 — 92 — — — 215 One interesting observation on the above table is in regard to 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 21 to 37. 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 and Lancaster Road Centres three sessions per week; and at Bramley Road there are three in addition to the weekly session at the Branch in Kenley Street. The Centres are in every case fortunate in having very able and keen medical officers who show considerable interest in their work. Ante-Natal Clinics.—Special ante-natal clinics are held at every Centre, and during the past year 145 sessions were held. 69 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 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. 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 also held weekly. 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, and five small lock-up shops adjoining the Nursing Association premises, and have decided to erect upon the site an Infant Welfare Centre, which will be situated on the ground floor, and five flats. The plans of the new premises have received the approval of the Ministry of Health and the London County Council, and the work of demolition of the old premises has commenced. It is hoped that the new Infant Welfare Centre will be opened during the course of the present year. The Bramley Road Infant Welfare Centre Committee are appointing a special committee to take over the Centre and it will be conducted in a similar manner to the other voluntary Welfare Centres in the Borough. The Borough Council are financiallv responsible for the erection of the premises and the Committee of the Centre will pay an annual rent to the Council for their use. C\mpden 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. 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. A Fathers' Council was established at this Centre during the latter part of the year. 70 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 at the beginning of the year were seen privately at these consultations, but special ante-natal sessions were commenced in May. 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 ot expectant and nursing mothers and sick infants. There is an average daily attendance of 36 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 23. 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. Three Infant consultations and one antenatal session are held each week. 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. During the past year, a Children's Massage, Medical Gymnastics and Electrical Treatment Clinic was conducted on the premises of this Centre, but the work has now been transferred to the Princess Louise Kensington Hospital for Children. Details of the work conducted at this Clinic will be found on page 72. 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 1927 Centre No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other Treatments. Archer Street 74 209 208 39 13 33 Bramley Road 68 169 66 26 7 15 Campden Hill — — — — — — Earl's Court 101 196 180 60 14 28 Golborne 29 79 37 3 5 — Lancaster Road 127 430 148 33 25 115 Raymede 269 671 312 6 34 2 Totals 668 1754 951 167 98 264 71 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, 1927:— Number of sessions at which doctors attended for infant consultations 151 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 50 Total number of individual mothers who attended during year 259 Total number of individual children who attended during year (Old) 844 ,, ,, ,, (New) 683 Total attendances at Centre of mothers for all purposes (excluding the accompanying of children) 1020 Total attendances of children at Centre for all purposes 15,871 Number seen by doctor at consultations:— 1. Ante-natal mothers 350 2. Post-natal mothers 550 3. Children 6,946 Average number seen by doctor at consultations:— 1. Ante-natal mothers 7 2. Post-natal mothers 11 3. Children 46 Number of individual children weighed 1,527 Total weighings 6,946 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 1927:— Number of infants in residence at commencement of year 18 Number of admissions during the year 120 Number of discharges during the year 113 Number of deaths during the year 12 Number in residence at end of year 13 Average duration of stay in hospital 45 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 1926, 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 and Hospital 173 new cases involving 4,544 treatments and making an average of about 86 attendances weekly. The number of treatments showed only a slight increase over the numbers for the year 1926 (4,363) as, for the past 2 years, the whole available time of the Department has been taken up. 72 The original Mercury Vapour Lamp in use in the Hospital since October, 1924, has been replaced by a more modern type of the same kind, while the more recent Lamp in use at the Clinic is the larger pattern of Mercury Vapour Lamp. As well as the two Mercury Vapour Lamps there are two small radiant heat Lamps and one long-ray Red Lamp in use. In practically all cases massage and rhythmic exercises are carried out along with the Light treatment and in certain cases definite remedial exercises are necessary. Electrical treatment has also been much more used during the past year. Much has been done during the year from the educational side with suitable posters and photographs with the result that there is definite appreciation on the part of the mothers of the value of sunlight, both artificial and real. Further, the necessity of suitable clothing and proper footgear is brought to the notice of the mothers during the time of dressing and undressing the children. Most of the children treated suffered from rickets, bronchitis, undernourishment, tuberculous adenitis, and general debility following wasting diseases, like measles and whooping-cough, while some cases of Skin disease and old-standing impetiginous sores had local treatment with beneficial results. For the different groups it was found that different dosage, varying length of time under treatment, and other changes, were necessary to get the best results. Most of the children throughout the course of treatment become more lively and active, and with excitable and nervous children the dosage is kept low. Special care is taken with new cases to get the children happy when treatment is begun and to avoid their being frightened in any way. The result of this has been that most of the children are contented, and enjoy being in the Light Room. The usual course of treatment occupies about 3 months with exposures twice a week, then an interval of 4 to 6 weeks, and frequently a second course of 3 months. During the year more children have been sent from the Welfare Centres for treatment and reports of their progress are sent at intervals to the Centres. THE RAYMEDE MASSAGE AND ELECTRICAL TREATMENT CLINIC No. 240, LADBROKE GROVE. This Clinic 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. My last Annual Report stated that when the Princess Louise Kensington Hospital for Children opened, the question would arise as to continuing the work at this Clinic. As anticipated, the Clinic was closed at the beginning of 1928, and the work transferred to the Hospital. The services rendered by the Clinic have been very valuable and there is no doubt that it has met a serious need in North Kensington, but it is hoped that the transfer of the work to the Hospital will result in a considerable increase in the number of patients receiving massage treatment. The treatment was carried out by four ladies, all of whom held the Certificate of the Chartered Society of Massage and Medical Gymnastics and a Medical Officer attended on the first Friday in each Month. A record of the work done in 1927 is shown in the following table:— No. of cases attending at beginning of year (Over 5 years of age) 31 ,, „ „ „ ,, (Under 5 years of age) 19 New cases treated during year (Over 5 years of age) 36 „ „ „ (Under 5 years of age) 12 Total cases treated during year 98 No. discharged during year 36 No. transferred to Hospitals for treatment 3 No. of treatments given 2839 No. of non-Kensington cases treated 5 No. of self-discharged cases 18 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 Abbots 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. 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. 73 Statement of Work done, &c. 1924. Oct. 1st to Dec. 31st. 1925. 1926. 1927. No. of applications for admission 36 112 135 143 No. of applications accepted 35 111 134 137 No. of applications withdrawn after acceptance 2 5 4 10 No. of women confined during the year 13 108 123 126 The gross cost of the scheme to the Council during the year was £837 16s. 0d. The assessments made in respect of patients whose applications were submitted during the year amounted to £414 6s. 0d. Payments made by patients totalled £346 10s. 6d. DAY NURSERIES. The following table shows a record of children's attendances at the four Day Nurseries in the Borough in the year 1927. Golborne. Lancaster Road. Notting Hill Day Nursery St. Clement's, Tread gold St. Totals 1. Whole day attendances of children under 3 years of age 5447 9875 2338 2336 19996 2. Whole day attendances of children over 3 years of age 2717 505 3281 857 7360 3. Total whole day attendances 8164 4792 12619 3193 28768 4. Charges made for each attendance of a child l0d. 9d. 8d. 1 /- — 5. Half-day attendances of children under 3 years of age — — — 375 375 6. Half-day attendances of children over 3 years of age — — — 146 146 7. Total half-day attendances — — — 521 521 8. Charges made for each attendance of a child — — — 6d. — 9. Average daily attendance of children 36 23 56 22 — HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. A record of work done in 1927 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 6 15 No. admitted during the year 6 19 25 No. remaining in residence at the end of the year 10 7 17 Average duration of stay before confinement (in days) — 46 — Average duration of stay after confinement (in days) 298 120 — Infants. No. in residence at beginning of year 9 3 12 No. admitted during the year 6 12 18 No. remaining in residence at end of year 10 2 12 Average duration of stay (in days) 298 120 — 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 74 RECORD OF WORK DONE IN 1927. Number of children in the institution at the commencement of the year. 7 Number admitted during the year 157 Number discharged during the year 142 Number in residence at the end of the year 22 Average duration of stay of each child in the institution 31 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 1927. Number of children in the institution at the commencement of the year 22 Number admitted during the year 44 Number discharged during the year 46 Number in residence at the end of the year 20 Average duration of stay of each child in the institution 6 months CONVALESCENT HOMES. In 1927, the Borough Council paid subscriptions of £16 16s. 0d. to the Evelvn Convalescent Cottage Home, Wargrave, Berkshire, £8 8s. 0d. to the Hambledon Cottage Home, Surrey, and £12 0s. 0d. to St. Mary's Convalescent Home, Birchington-on-Sea, Kent. During the Summer months, ten mothers with their babies and four mothers without babies were sent to the Evelyn and Hambledon Homes for a fortnight's holiday and, in the month of December, one mother with her baby was sent to the St. Mary's Home. It was only at the end of the year that the Council decided to subscribe to the latter institution and the letters were not received until towards the end of December. HOME HELPS. Seven applications were received during the year for the provision of a Home Help under the Council's Scheme. The assistance requested was granted in four cases for a period of fourteen days each and in two cases for a period of twenty-eight days each. The remaining application was not granted. The gross cost of the scheme to the Council during the year was £12. 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. 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 during the year under review:— No. of persons lectured to 12,026 No. of lectures given 793 No. of visits paid to Centres 306 No. of special visits 134 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. Controversial points are avoided as much as possible. The Maternity and Child Welfare lectures are based on the Council's booklet "Advice to Mothers." Kensington was 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. 75 SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The Council's scheme for the supply of milk to expectant and nursing mothers and infants under the age of five years, and the supply of dinners to expectant and nursing mothers has been described in detail in previous reports, and no modification has been required during the past twelve months. In the year 1927 there were 531 grants of milk made by the Council's Milk Sub-Committee. One hundred and forty-three of the grants were in response to new applications, and the remaining 388 were renewals of grant. Eighteen applications for dinners were granted; 2 of these were new applications, and 16 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. 13,982 Free £ s. d. 192 3 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. 140 Free £ s. d. 10 10 0 Particulars of Dried Milk supplied at Cost Price under the Council's Scheme. Name of Welfare Centre at which the dried milk was distributed. No. of lib. packets sold. Value of milk sold. £ s. d. Archer Street 1,848 133 18 0 Bramley Road 979 73 8 6 Golborne 571 42 16 6 Lancaster Road 4,305 322 17 6 Raymede 1,433 107 9 6 — 9,136 680 10 0 Particulars of Dinners supplied under the Council's Scheme. No. of Dinners granted. Price per Dinner paid by Recipients. Estimated Cost to Council. 350 Free £ s. d. 8 15 0 The Mutual Registration of Assistance Society (a branch of the Charity Organisation Society) have been of considerable help to the Council's Milk Sub-Committee in providing information of the assistance being given by other bodies to applicants for milk at a reduced price or free of cost, and the Council acknowledge the value of the work by making an annual grant of £10 to the Society. 76 The Council's Milk Sub-Committee work in close co-operation with the Board of Guardians and a scheme has been formulated whereby milk and dinners recommended by the Milk SubCommittee are supplied by the Board to certain nursing mothers who are already in receipt of Poor Law relief. This scheme obviates the undesirable practice of a person being granted a somewhat similar form of relief by two different authorities. The dried milk and dinners supplied during the year by the Board of Guardians under this scheme are shown below:— No. of packets of Dried Milk supplied. Cost to the Board of Guardians. No. of Dinners supplied Cost to the Board of Guardians. 22 £1 13 0 332 £8 6 0 NOTE.—The figures for fresh milk supplied by the Guardians after recommendation by the Milk Sub-Committee 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 January, 1927, 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. During the year, many matters of importance occupied the attention of the Advisory Committee, and it is to the wise counsel of this body 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 21,422, 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 885 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 520. 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 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, 77 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 1927 the number was reduced to 50. These 50 are situated in the following parts of the Borough: — Norland Ward 22 St. Charles Ward 9 Pembridge Ward 9 Golborne Ward 10 50 The average rent of a furnished room is 7s. per week including the use of such furniture as the owner provides. There are in the Borough about 13,000 basements used for dwelling purposes. The number of these dwellings with ceilings at or below the street level is approximately 640, 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. In 1927 there were 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 1927. 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 In the early part of 1928 the Common Lodging House at No. 194, Kensal Road was sold and is at present empty and for sale as a dwelling house. BY-LAWS FOR HOUSES LET IN LODGINGS. There came into operation in 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 are 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. 78 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 until all houses registered have been visited. REGISTER OF HOUSES LET IN LODGINGS. Registration of houses let in lodgings commenced in this Borough in 1886. When the Counciladopted their present housing policy in 1923, the number of houses on the Register was 2,169, and by the end of 1927 this number had increased to 3,608. In March, 1926, the Public Health Committee decided that housing records should be kept on 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 is now possible for the Committee 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 several thousand houses which have been inspected in a routine manner in recent years. The work will continue until there is a card in respect of every house in Kensington and the Council will then be in possession of extremely valuable housing records. The work of registration was practically completed during 1926, and in 1927 the Council's temporary inspectors were engaged in a routine inspection of all registered houses with a view to bringing the information up to date. In this way, 1,238 houses were carefully inspected by the temporary inspectors in 1927; cards were made out and the necessary notices served in respect of defects found. One hundred and seventy-five houses were removed from the Register, as their occupation was such as to render them no longer registerable; and thirteen houses were added to the Register. ACCOMMODATION PROVIDED BY COUNCIL. The Council are the owners of 120 houses and flats which they built prior to the War in Kenley Street, Hesketh Place and Runcorn Place, abutting upon Avondale Park. The new housing accommodation provided by the Council since the termination of the War is as follows: — Cottages 54 Flats and tenements 263 Flats and maisonettes provided by conversion of large houses 102 419 The approximate expenditure incurred in connection with the provision of the 419 flats, tenements and cottages has been as follows: — Acquisition and conversion of houses in Powis Square, Colville Terrace, Elgin Crescent, Ladbroke Grove, Bassett Road and Adair Road, into 102 flats and maisonettes 84,371 Avondale Park Gardens and Mary Place Scheme— Provision of 32 cottages, including cost of site and road and sewer works 42,060 St. Quintin Estate Scheme— Cost of land, fencing, &c 14,447 Construction of roads and sewers 15,205 Buildings 125,133 Threshers Place Scheme— 14 flats (estimated) 9,300 St. James's Place Scheme— 38 flats (estimated) 20,000 No. 33, Sirdar Road— 4 tenements 666 Nos. 54 and 56, Sirdar Road— 12 tenements 6,463 Nos. 34 and 36, Bosworth Road— 12 tenements 6,031 £323,676 In addition to the above the Council have recently purchased the properties known as Windsor House, Kenley Street, and Nos. 22-30, Sirdar Road, which were in an unsatisfactory condition; and plans have been approved for the demolition of the buildings and for the erection of an Infant Welfare Centre and five flats on the site. The cost of the new buildings will be upwards of £5,000. Some years ago the Council acquired, under the provisions of the Housing Acts, the freehold interest in a number of premises in Hesketh Place, Notting Dale, and they have recently decided to take steps to obtain the surrender of the leases of the premises. 79 The Borough Council have made special arrangements with the London County Council by which ninety-nine Kensington families will be placed in improved housing accommodation on the County Council's Wormholt Estate adjacent to North Kensington, and have agreed to pay the sum of £7 per house per annum for a period of twenty years in respect of this accommodation. The majority of these houses are now occupied. It may be mentioned further that the London County Council, in connection with their large housing estates, allocate fifty per cent. of the accommodation to applicants nominated by the Borough Councils and reserve the remaining fifty per cent. for applicants on their own general list. It has been ascertained from the County Council that about 150 families comprising 755 persons nominated by the Borough Council have been given houses on the County Council estates and that the number of Kensington families from their general list who have been allotted improved accommodation is 663, representing about 2,652 persons. SUMMARY. The housing accommodation provided by the Council together with that provided by the County Council and occupied by Kensington families may be summarised as follows: — Pre-War. Number of persons accommodated. Houses and Flats in Kenley Street, Hesketh Place and Runcorn Place, abutting upon Avondale Park 540 Post-War. Buildings above referred to at— 1,902 Avondale Park Gardens and Mary Flac.e St. Quintin Estate Thresher's Place St. James's Place Sirdar Road Bos worth Road Flats and maisonettes provided by conversion of large houses 357 Houses on Wormholt Estate 545 On other Estates of L.C.C 755 4,099 Add number of Kensington persons accommodated on the County Council's various estates from their general list 2,652 6,751 In the estimates for each year since 1924-5, the Council have provided a sum of £10,000 for the purpose of buying and reconditioning dilapidated property. ACCOMMODATION PROVIDED BY HOUSING ASSOCIATIONS. The number of houses and flats acquired during the year by the Wilsham Trust Company, the Improved Tenements Association, the Kensington Housing Trust and similar bodies was 55 ; these have been or will be altered so as to provide satisfactory accommodation for about 165 families. The accommodation in North Kensington now owned and managed by housing associations ls 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 or selfcontained flats. Families. Wilsham Trust Company 124 49 49 186 222 358 Improved Tenements Association 42 16 62 209 120 275 Kensington Housing Trust 14 4 23 82 41 106 Others — 9 30 100 39 109 80 These dwellings, together with the Council's properties in Kenley Street, Hesketh Place, Runcorn Place, Sirdar Road, St. James's Place and Bosworth Road, are managed on the Octavia Hill system by a group of women house property managers. MEASURES TAKEN TO DEAL WITH INSTANCES OF OVERCROWDING AND INDECENT OCCUPATION DISCOVERED. Whilst there are no "slum areas" in the Borough it cannot be denied that overcrowding exists, and unfortunately in some cases instances of indecent occupation are discovered. It must be remembered that Kensington is a central residential area of the Metropolis and there is a constant influx of people desiring to live near the centre. It is inevitable, therefore, that instances of overcrowding must be discovered and, indeed, will occur for all time. For a large number of the people wishing to live near the centre of London the rents are high ; and the money which would secure a whole house in the suburbs will enable a man to obtain only one or two rooms in London for the accommodation of himself and his family. It is gratifying, however, to record that cases of overcrowding and indecent occupation discovered by the Council's officers are generally remedied without recourse to legal proceedings. The following table shows the number of cases of overcrowding and indecent occupation detected in the last three years and the effectiveness of the action taken can be deduced therefrom: Overcrowding:— 1925 1926 1927 Intimation Notices served 75 103 88 Statutory Notices served where the Intimation Notice was not complied with 60 38 28 Summonses issued 8 6 9 Indecent Occupation: — Intimation Notices served 40 79 92 Statutory Notices served where the Intimation Notice was not complied with 21 12 2 Summonses issued 1 — — As only 23 summonses were eventually issued in 266 cases of overcrowding, and only one summons in regard to 211 cases of indecent occupation in the three years, it will be seen that 453 families were able to improve their accommodation without the Council having to resort to extreme measuies. 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 obtained in the three years have been as follow: Number of Council Houses let by Town Clerk and reported to the Medical Officer of Health 59 Number of instances in which the rooms vacated by the 59 tenants have been let to Kensington families whose previous accommodation was unsatisfactory or overcrowded 42 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 and 1927 with the following results: — . Number of County Council houses let and reported to the Medical Officer of Health 120 Number of instances in which the rooms vacated by the 120 tenants have been let to Kensington families whose previous accommodation was unsatisfactory or overcrowded 48 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. Each of the ten District Sanitary Inspectors attempts to make a routine inspection of ten houses each month and the number of these inspections in 1927 was 850. In addition to this routine work, special efforts have been made in recent years and those for 1927 may be described briefly under the following headings: — 81 (1) Improvements in Houses Let in Lodgings secured during the year by the Permanent and porary Sanitary Inspectors. At the time of making their detailed inspections, the two Temporary Sanitary Inspectors prepared a list of all defects found and improvements required, and issued Intimation Notices calling for the necessary repairs and alterations. The details in regard to each house were reported at the fortnightly meetings specially held for this purpose by the Public Health Committee, who gave directions for the issue of Statutory Notices in necessary cases with a view to bringing the houses up to the highest reasonable standard of habitability attainable under present legislation. The drains were tested in every case and notices served in respect of defects found. The Temporary Sanitary Inspectors paid 1,781 visits to 1,238 houses let in lodgings and served 994 Intimation Notices. For many years past, the District Sanitary Inspectors have endeavoured to visit every registered house in the Borough at least once a year but, owing to the increase in the number of houses on the register and the volume of other work, it has been found impossible to make an inspection of all registered houses during a period of twelve months. In the year 1927, the number of registered houses inspected was 963, and the number of visits paid to these houses was 8,359. (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, 375 during 1926, and 127 were inspected in a routine manner in 1927. Sixty-nine Intimation Notices under the Public Health Act were served in respect of the 127 dwellings inspected, Although there are 2,091 mews dwellings in the Borough, the routine inspections may be considered to 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. (3) Closing Orders. One thousand and thirty-three underground rooms were submitted to routine inspection and 50 of these were reported to the Public Health Committee as not complying with the Council's Regulations. Forty-six were made to comply after Informal Notices had been served and in 4 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 1927 under Section 3 of the 1925 Act are as follow: — (1) Number of houses in respect of which notices have been served 21 (2) Number of houses in which repairs were carried out by the owner 6 (3) Number of houses in which the Council carried out the work in default of the owner 4 The total cost to the Council in carrying out repairs under Section 3 in 1927 was £543, and this, added to the expenditure incurred in connection with this class of work since the commencement of 1923, gives a total of £1,763. The amount repaid to the Council is £823, and the remaining sum with interest at five per cent., is being recovered. HOUSING STATISTICS FOR 1927. 1.—Unfit Dwelling-houses. Inspection— (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,707 (2) Number of dwelling houses which were inspected and recorded under the Housing Consolidated Regulations, 1925 2,139 82 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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 3,650 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 294 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 2l (2) Number of dwelling houses which were rendered fit:— (a) By owners 6 (b) By Local Authority in default of owners 4 (The remaining 11 are being dealt with in 1928.) (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 3,335 (2) Number of dwelling houses in which defects were remedied:— (а) By owners 3,209 (б) 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 Nil Underground Rooms 50 (2) (a) Number of dwelling houses in respect of which Closing Orders were made Nil (b) Number of underground rooms in respect of which Closing Orders were made 4 (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 (5) 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 follow:— Houses cleansed 1299 House drains re-constructed 141 Defective drains repaired 201 House drains cleansed 324 Water closets re-constructed, repaired, &c., 800 „ „ supplied with water 258 „ „ new provided 214 Soil-pipes ventilated, repaired, &c., 185 „ new provided 183 Cisterns cleaned, covered, &c., 280 Yards, areas paved, drained, repaired 367 Dustbins provided 526 Ashpits abolished 60 Accumulations of filth, &c., removed 339 Animals removed 42 Overcrowding abated 101 Underground rooms, illegal occupation discontinued 46 83 Roofs repaired 581 Houses provided with water above basement floor 98 Dampness in dwellings remedied 422 Other important repairs 1443 I have the honour to be, My Lords, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 84 APPENDIX. TABLE I. Vital Statistics of Whole District for 1927 and previous Years. Year Population estimated to Middle of each Year. Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District Uncorrected Number. Nett. of Nonresidents registered in the District. of Residentsnot 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 1922 179,100 2,998 8,152 17.6 2,814 15.7 894 507 257 b2 2,427 13.6 1928 178,500 3,042 3,121 17.5 2,551 14.3 839 484 218 70 2,196 12.3 1924 178.700 2,591 2,908 16.2 2,759 15.5 880 453 219 75 2,332 13.0 1925 ‡179,600 B 179,400 D 2,494 2,846 15.8 2,830 15.7 980 468 223 78 2,368 13.2 1926 ‡180,000 B 179,800 D 2,405 2,717 15.1 2,564 14.2 816 557 104 60 2,305 12.8 1927 176,700B 176,500D 2,270 2,657 15.0 2 550 14.4 656 546 176 66 2,440 13.8 * 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 1021. Area of District in acres (exclusive of area covered by water) 2,291 Total population at all ages 175,859 Total families or separate occupiers 48,001 85 TABLE II. Cases of Infectious Disease notified during the Year, 1927. 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 2 ... 2 ... ... ... ... ... ... 2 ... ... ... ... ... ... ... 2 Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 392 9 102 210 37 30 3 1 62 104 81 41 39 21 23 15 6 386 Erysipelas 59 2 2 2 8 13 22 10 14 9 9 10 4 4 2 3 4 20 Scarlet fever 264 4 81 180 31 15 3 ... 62 71 33 35 12 7 21 14 9 247 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 10 1 ... 1 2 6 ... ... 2 ... ... 1 1 1 2 2 1 5 Continued fever ... ... ... .... — ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 3 ... ... ... 1 2 ... ... 1 ... 2 ... ... ... ... ... ... 2 ‡ Puerperal pyrexia 44 ... ... ... 16 28 ... ... 9 8 7 7 3 2 2 5 1 32 Encephalitis Lethargica 6 ... ... 1 ... 4 ... 1 1 3 ... ... 1 ... ... 1 ... 6 Cerebro-spinal meningitis 5 1 8 ... ... 1 ... ... 1 2 1 ... ... 1 ... ... ... 5 Polio-myelitis and Polio-encephalitis 2 ... ... 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... 1 Pulmonary Tuberculosis 178 ... ... 9 43 79 44 3 25 35 31 23 6 20 8 18 12 144 Other forms of Tuberculosis 74 1 11 36 15 10 ... 1 14 18 13 7 5 5 2 7 3 33 Ophthalmia Neonatorum 17 17 ... ... ... ... ... ... 1 2 6 3 1 ... 2 1 1 9 Primary Pneumonia 151 7 34 31 15 26 27 11 18 68 28 12 7 5 8 6 4 82 Influenzal Pneumonia 90 7 9 4 8 30 19 13 13 30 20 4 5 3 7 5 3 37 Malaria 2 ... ... ... ... 1 1 ... 1 ... ... 1 ... ... ... ... ... ... *Enteritis 41 24 17 ... ... ... ... ... 6 19 15 ... 1 ... ... ... ... 20 † Acute Rheumatism 48 ... 2 42 4 ... ... ... 13 6 22 3 3 ... ... 1 ... 11 Totals 1388 73 263 467 180 246 119 40 243 377 263 147 88 70 78 78 44 1042 ‡ Notifiable since October 1st, 1926. * Notifiable only in children under the age of 5 years. † „ „ „ „ „ 16 years since October 1st, 1927. Cases of mistaken diagnosis are not excluded from the above table TABLE III. Causes of Death at Different Periods of Life in 1927. 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 upward ALL CAUSES M. 1,107 91 24 23 19 50 97 367 228 208 F. 1,333 85 21 17 24 33 109 323 278 443 Enteric Fever M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Small-pox M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Measles M. 1 ... ... 1 ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Scarlet Fever M. ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... Whooping-Cough M. 9 3 2 4 ... ... ... ... ... ... F. 5 3 1 1 ... ... ... ... ... ... Diphtheria M. 4 ... ... 4 ... ... ... ... ... ... F. 7 1 1 2 2 ... ... 1 ... ... Influenza M. 32 ... 1 ... ... ... 6 12 6 7 F. 77 1 1 ... ... 1 9 20 23 22 Encephalitis Lethargica M. 2 ... ... ... ... 2 ... ... ... ... F. 2 ... ... ... ... 1 1 ... ... ... Meningococcal meningitis M. 1 1 ... ... ... ... ... ... ... ... F. 2 ... 1 ... ... ... 1 • • ... ... Tuberculosis of Kespiratory System M. 72 ... ... ... 2 12 25 33 ... ... F. 42 ... ... ... 2 15 14 8 2 1 Other tuberculous diseases M. 12 2 ... 3 1 5 ... ... 1 ... F. 14 2 2 1 5 3 ... l ... ... Cancer, Malignant disease M. 135 ... ... ... ... ... 6 54 52 23 F, 189 ... ... ... 1 1 4 93 52 38 .Rheumatic Fever M. 2 ... ... ... 1 ... ... 1 ... ... F, 4 ... ... ... 1 ... 1 1 ... 1 Diabetes M, 8 ... ... ... ... ... 1 3 3 1 F. 17 ... ... ... ... ... 1 3 4 9 Cerebral Hæmorrhage, etc. M, 36 ... ... ... ... 1 ... 13 13 9 F, 74 ... ... ... ... ... 7 18 21 28 Heart Disease M, 175 ... ... ... ... 1 9 65 45 55 F, 256 ... ... ... 2 3 17 59 75 100 Arterio-sclerosis M. 51 ... ... ... ... ... ... 18 17 16 F, 53 ... ... ... ... ... ... 8 15 30 Bronchitis M, 90 5 1 ... 1 ... 1 25 27 30 F, 91 4 2 ... ... ... 1 16 24 44 Pneumonia (all forms) M. 110 19 16 5 ... 3 7 35 16 9 F, 100 17 9 6 4 1 4 13 19 27 Other respiratory diseases M. 25 2 ... 2 1 1 2 8 4 5 F, 16 ... ... 1 ... 1 1 4 1 8 Ulcer of Stomach or Duodenum M. 17 ... ... .. ... 1 2 10 2 2 F. 5 ... ... ... ... ... ... 1 2 2 Diarrhoea, etc. M. 15 13 ... ... ... ... 1 1 ... ... F, 22 14 2 ... ... ... 1 ... 1 3 Appendicitis and Typhlitis M, 7 ... ... ... 1 ... 2 3 1 ... F. 18 ... ... ... ... ... 3 5 ... 5 Cirrhosis of Liver M, 12 ... ... ... ... ... 1 9 1 1 F, 6 ... ... ... ... ... 4 2 ... Acute and Chronic Nephritis M, 35 ... ... 1 ... 2 5 13 11 3 F, 25 ... ... ... 1 ... 6 7 4 7 Puerperal Sepsis M. ... ... ... ... ... ... ... ... ... ... F. 4 ... ... ... ... 1 3 ... ... ... Other accidents and diseases of Pregnancy and Parturition M. ... ... ... ... ... ... ... ... ... ... F, 2 ... ... ... ... ... 2 ... ... ... Congenital Debility and tion, Premature Birth M, 31 30 ... ... 1 1 ... ... ... ... F, 31 31 ... ... ... ... ... ... ... Suicide M, 19 ... ... ... ... 2 8 7 1 1 F, 16 ... ... ... ... 2 9 4 1 ... Other deaths from violence M, 36 3 2 1 3 7 6 10 2 2 F, 40 2 ... 2 2 2 5 7 7 13 Other Defined Diseases M. 169 13 2 2 9 12 14 47 26 44 F. 220 10 2 3 4 2 19 50 25 105 Causes ill-defined or unknown M. 1 ... ... ... ... ... 1 ... ... ... F. ... ... ... ... ... ... ... ... ... ... 86 87 TABLE IV. INFANT MORTALITY DURING THE YEAR 1927. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. Under 1 week. 1-2 Weeks. 2-3 Weeks. 3-4 Weeks. Total under 4 Weeks. 1-3 Months. 3-6 Months. 6-9 Months. 9-12 Months. Total Deaths under One Year. All Causes. Certified 39 6 7 4 56 28 26 23 21 154 Uncertified 3 ... 1 1 5 6 5 5 1 22 Measles ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 3 3 ... 6 Diphtheria ... ... ... ... ... ... ... ... 1 1 Influenza ... 1 ... ... 1 ... ... ... ... 1 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis ... ... ... ... ... ... 1 ... ... 1 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... 1 ... ... 3 4 Bronchitis ... ... 3 ... 3 2 2 2 2 11 Pneumonia ... ... 1 1 3 6 7 9 9 34 Other respiratory diseases ... ... ... ... ... ... ... ... ... ... Diarrhoea, etc. ... ... ... ... ... 7 8 8 4 27 Congenital debility 3 2 1 1 7 7 6 2 ... 22 Malformation 3 ... ... 1 4 1 ... ... ... 5 Premature Birth 18 1 1 1 21 3 1 ... ... 25 Other deaths from violence 1 ... 1 ... 2 ... 1 1 1 5 Other defined diseases 16 2 1 1 20 7 2 3 2 34 42 6 8 5 61 34 31 28 22 176 Nett Births in the year of legitimate, 2,457. illegitimate, 200. Nett Deaths in the year of legitimate infants, 146. illegitimate infants, 30. 88 TABLE V. The Work of the Women Health Officers for the Year 1927. HEALTH OFFICERS Total. 1 2 3 4 5 6 7 Child Welfare- First Visits to Infants 17 277 323 281 230 332 399 1,859 Return Visits to Infants 127 667 606 813 997 746 978 4,844 Visits to Children between 1 and 5 years 283 1,600 967 1,492 1,164 1,088 810 7.404 Stillbirth Enquiries 3 8 2 4 2 3 1 23 Visits to Ophthalmia cases 3 2 4 3 3 3 8 26 Return Visits to Ophthalmia cases 8 2 — 7 9 5 28 59 Visits to Measles cases 10 2 5 3 15 4 36 75 Visits to Whooping Cough cases 1 11 20 14 1 — 10 57 Visits to Puerperal Fever cases 3 — 5 — 3 1 1 13 Visits to Puerperal Pyrexia cases 6 5 9 6 7 7 15 55 Visits to Enteritis cases 2 7 7 30 — 5 9 60 Infantile Death Enquiries 13 17 15 16 14 20 39 134 Milk Investigations 24 51 77 57 7 106 141 463 Ante-Natal Visits 49 112 74 22 55 96 138 546 Half-days at Welfare Centres 22 100 152 143 90 116 148 771 Special Visits 934 154 313 159 228 267 360 2,415 Tuberculosis— Pulmonary.—First Visits 18 17 22 20 29 39 21 166 Re-Visits 219 313 242 231 68 198 303 1,574 Non-Pulmonary—First Visits 4 10 14 14 8 1 15 66 Re-Visits 64 120 164 130 30 1 35 544 Rheumatism— First visits to cases notified 3 2 18 7 1 4 8 43 Factories and Workshops Act. Inspections of Factories 24 43 62 4 2 2 5 142 Inspections of Workshops 480 30 43 8 256 17 23 857 Inspections of Outworkers' Premises 32 2 18 24 18 38 28 160 Inspections of other Workplaces 18 1 — — 5 1 8 33 Total Visits 2,367 3,553 3,162 3,488 3,152 3,100 3,567 22,389 Notices issued under the Public Health Act— Intimation Notices — — 2 — — 1 — 3 Statutory Notices — — — — — — — — Final Notices — — — — — — — — Summonses — — — — — — — — 89 TABLE VI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1926. DATE. Registration Sub-Districts comprised in Vaccination Officer's District. Number of Births returned in Birth List Sheets. Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), viz,: Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I, Successfully 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, 1927. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1926 1 2 3 4 6 7 8 9 10 1st January to 31st Dec. North 1,502 1,026 5 262 58 23 52 61 15 - 1,881 South 907 619 9 96 42 21 50 59 11 Total 2,409 1,645 14 358 100 44 102 120 26 90 TABLE VII. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1927. (as required by Ministry of Health Circular 359). Year of Appointment Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A. W. K. Picard, M.D. 1922 Consultant Medical Officers (Part time). H. Ronald Carter, M.D. (Treatment of Zymotic Enteritis) 1924 Remington Hobbs, M.D., (Consultant Gynaecologist) 1926 Reginald C. Lightwood, M.D., M.R.C.P., D.P.H., (Rheumatism Supervisory Clinic) 1927 Clerical Staff. James H. Wilson (Chief Clerk) 1900 William Gascoyne 1919 John C. Minter 1917 John S. Russell 1923 Denis C. Page 1925 Donald J. Hunt 1924 John S. Wheeler 1924 Arthur L. Vague 1927 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 †ohn McDermid 1920 ¶† Henry W. Walters (Food Inspector) 1925 ¶† Cecil R. Webb 1925 ¶† Redmond J. McCarthy ... 1926 ¶† Ernest L. Peddie 1927 Women Health Officers. Miss E. Mackay 1909 Miss F. C. Hargrave 1910 ‡†* Miss E. Dixon 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 K. M. Roe 1926 Health Lecturer. Mrs. M. Hayman 1926 Mortuary Keeper. William Sutton 1907 Disinfecting Staff. Aibert Nunn (Chief Disinfector) 1906 William Cambridge 1906 Frank Chillcott 1906 George H. I. Harris 1914 William Taylor 1926 Medicinal Baths Stajf). H. S. Hutchinson (Superintendent) ... 1926 Mrs. R. Webber (Matron) 1913 Rat Officer. Walter E. Weedon 1926 Drain Testing A ssistants. William Clancy 1903 Charles H. Coombs 1927 * Certificate of the Royal Sanitary Institute. †Certificate of the London Sanitary Inspectors Examination Board. ‡ Certified Midwife. ¶Certificate for Meat and other Foods. 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 all the Medical Officers, (with the exception of Dr. Lightwood),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) 5 Birth Rate, Decline in (Table) 5 Births, Wards and Rates (Table) 4 Cancer 7 Causes of Death 7 Deaths 6 Deaths from Certain Diseases (Table) 8 Deaths, Wards and Rates (Table) 6 Heart Disease 8 Infantile Mortality— 9 Deaths, Above Standard 11 Deaths, Causes of (Table) 10 Deaths each month (Table) 10 Deaths in Wards (Table) 9 Illegitimate Births, Last 5 years (Table) 11 Illegitimate Infant Deaths 11 Infantile Mortality Rates (Table) 9 Marriages 4 Maternal Mortality 12 Notification of Births Act, 1907 5 Population 8 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 12 Ambulance Facilities 20 Bacteriological Work 14 Chapel of Rest 15 Cleansing of Verminous Persons 16 Disinfection, Rooms, Bedding, &c 14 ,, Library Books 14 Health Lecturer 13 Home Nursing, Golborne Infant Welfare Centre 20 Kensington and Fulham General Hospital 17 Kensington District Nursing Association 21 Kensington Institution 16 Male Sanitary Inspectors 13 Medical Officers 13 Medicinal Baths 16 Midwifery Arrangements 90 Mortuary 15 Nursing, Professional, in the home 19 Other Health Services 20 Out-Door Relief 17 Poor Law Authority 16 Princess Louise Hospital for Children 17 Public Baths and Washhouses 15 St. Mary Abbots Hospital 17 School Medical Service 18 School Treatment Centres 19 Staff, Clerical 13 PAGE Staff, Other 13 Subscriptions to Hospitals and Voluntary Health Organisations 21 Women Health Officers 13 SANITARY CIRCUMSTANCES AND ADMINISTRATION 22 Dust Removal 27 Factories and Workshops— 29 Defects Found (Table) 32 Home Office Tables 32 Home Work 31 Inspections (Table) 32 Men's Workshops 29 Outworkers (Table) 31 Women's Workshops 31 Fouling of Footpaths by Dogs 28 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923 27 Public Conveniences 27 Rag Flock Act, 1911 28 Rats and Mice (Destruction) Act, 1919 28 Refuse Removal from Mews 27 Sanitary Inspection— 22 Inspections made (Table) 22 Legal Proceedings 25 Notices issued (Table) 23 Works completed (Table) 24 Sewerage and Drainage 26 Smoke Abatement 27 Verminous Premises cleansed 29 INSPECTION AND SUPERVISION OF FOOD 33 Bakehouses 38 Cowsheds 36 Dairies and Milkshops, Inspection of 34 Food Poisoning 46 Food Supply 33 Ice Cream 37 Margarine and Butter Substitutes 46 Meat 86 Milk, Addition of colouring matter to 36 Milk and Dairies (Amendment) Act, 1922 (Proceedings under) 42 Milk and Dairies (Consolidation) Act, 1915 33 Milk and Dairies Order, 1926 (Proceedings under) 42 Milk (Special Designations) Order, 1928 34 Milk supplied in Kensington, Composition of 85 „ Supply 83 „ Utensils in Infected Houses 36 Other Places where Food is prepared 38 INDEX—continued. PAGE Preservatives in Cream, Use of 44 Public Health (Condensed Milk) Regu. lations, 1928 35 Public Health (Dried Milk) Regulations, 1928 85 „ ,, (Meat) Regulations, 1924 37 ,, „ (Preservatives in Food) Regulations, 1925 42 Register of Retail Dairies and Milkshops 33 „ ,, Wholesale Dairies 34 Sale of Food and Drugs Act, 1927 44 Sale of Food and Drugs Acts 38 ,, ,, (Proceedings taken under) 41 „ ,, Order, 1921 46 Samples, Formal (Table) 39 Samples, Informal (Table) 40 Slaughter-houses 36 Unsound Food 38 PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. 47 Cerebro Spinal Meningitis 52 Diphtheria 48 Dysentery 53 Encephalitis Lethargica 51 Enteric Fever 50 Erysipelas 50 Infectious Cases in Four-Weekly Periods (Table) 47 Malaria 51 Measles 53 Non-Notifiable Diseases 53 Notifiable Infectious Diseases 47 Notifications of Infectious Disease (Table) 47 Ophthalmia Neonatorum 50 Pneumonia and Influenzal Pneumonia 51 Polio-Myelitis and Polio-Encephalitis 52 Puerperal Fever 51 „ Pyrexia 51 Scarlet Fever 48 Small-Pox 48 Whooping Cough 54 Zymotic Enteritis 52 TUBERCULOSIS. 54 Artificial Pneumothorax Treatment 60 Bacteriological Examinations 62 Bedding for Home Isolation, Provision of 62 Care and After-Care, Arrangements for 61 Co-operation with Medical Practitioners, other Bodies and Institutions 58 Council's Scheme for Prevention and Treatment 56 Deaths in Wards (Table) 54 Dental Treatment 60 Disinfection 62 Dispensary Diagnosis and Treatment 56 PAGE Employment, Arrangements for finding 61 Extra Nourishment, Supply of 60 Home Contacts, Examination and Supervision of 60 Home Nursing 60 „ Visiting 59 Light Treatment 58 Medical Consultations 58 Notifications, Age & Sex distribution 55 Notifications, Deaths and Death Rates since 1919 (Table) 55 Notifications in Wards since 1919 (Table) 54 Primary Notifications (Table) 56 Public Health (Prevention of Tuberculosis) Regulations, 1925 56 Records 57 Residential Institutional Treatment 57 St. Mary Abbots Hospital 58 Shelters 62 Sputum Flasks 62 X-ray Diagnosis 58 ACUTE RHEUMATISM. Convalescent Accommodation 63 Hospital „ 63 Notification 63 Work performed, Record of 66 Scheme, Details of 63 Supervisory Centre 63 MATERNITY AND CHILD WELFARE. 66 Advisory Committee 76 Ante-Natal Clinics G8 Artificial Sunlight Treatment 71 Baby Clinic 71 ,, Hospital 71 Convalescent Homes 74 Creagh Nursery Training School 74 Day Nurseries 73 Dental Treatment 70 Details of individual Infant Welfare Centres 69 Extra Nourishment, Supply of 75 General Observations on Infant Welfare Centres 68 Health Lecturer 74 Home Helps 74 Homes for Deserted, Widowed or Unmarried Mothers and their Children 73 Home Visiting 69 Infant Consultations 68 Infant Welfare Centres— 67 Archer Street 69 Bramley Road 69 Campden Hill 69 Earl's Court 69 Golborne 70 Lancaster Road 70 Raymede 70 Maternity Home 72 IN D EX—continued. PAGE National Children's Adoption Association Hostel 73 Raymede Massage and Electrical Treatment Centre 72 Women Health Officers 66 Work done at Infant Welfare Centres in 1925 (Table) 68 HOUSING. 76 Closing Orders, Underground Rooms 81 Common Lodging Houses 77 Habitability of Houses, Steps taken to secure and maintain a higher standard of 80 Houses Let in Furnished Rooms 77 „ „ ,, Lodgings (By-laws for) 77 Housing Accommodation existing in Borough 76 „ ,, provided by Council 78 ,, ,, provided by Housing Associations 79 ,, Statistics 81 Improvements Secured (Table) 82 indecent Occupation, Measures taken to deal with 80 PAGE Mews Dwellings 81 Overcrowding, Measures taken to deal with 80 Registration of Houses Let in Lodgings 78 Work under Section 3 of the Housing Act, 1925 81 APPENDIX. 84 Causes of Death at Different Periods of Life in 1927 (Table III) 86 Infantile Mortality during 1927 (Table IV) 87 Infectious Disease, Cases notified during 1927 (Table II) 85 Staff of Public Health Department (Table VII) 90 Vaccination Officer's Return for 1926 (Table VI) 89 Vital Statistics for 1927 and previous years (Table I) 84 Work of Women Health Officers for 1927 (Table V) 88