KEN 24 The Royal Borough of Kensington. THE ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH ON THE HEALTH OF THE BOROUGH, 1920. Ordered by the Council to be Printed. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. KEN 24 THE ANNUAL REPORT ON THE Health, Sanitary Condition, &c., OF The Royal Borough of Kensington FOR THE YEAR 1920 BY JAMES FENTON, M.D., D.P.H. Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. O 3590-300-6.21. SUMMARY OF STATISTICS For the yean 1920. Population (Estimated for Birth Rate calculation) 165,496 „ ( „ Death Rate „ 164,1 77 Area of Borough in Acres 2,291 Density of Population per Acre 72 Separate Houses or Self-contained Flats Inhabited 26,025 Persons per House 6.4 Number of Marriages 2,111 Number of Births 4,020 Birth Rate 24.3 Number of Deaths 2,193 Death Rate 13.4 Infantile Mortality:— Deaths under 1 year 325 Infantile Deaths per 1,000 Births 81 Deaths from Phthisis 135 Phthisis Death Rate 0.82 Deaths from the Zymotic Diseases 156 Zymotic Death Rate 0.95 Product of a 1d. Rate £10,379 (Gross) Town Hall, Kensington, W.S. 21 st June, 1921. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Ladies and Gentlemen,— I have the honour to submit my Annual Report for the year 1920, which contains an account of the sanitary state of the Borough and a summary of the action taken for the prevention of disease. The chief features in regard to the Public Health in the Borough during the year were:— (1) The epidemic of a mild type of scarlet fever in the latter half of the year, the outbreak in the Metropolis being the most extensive in the history of the Metropolitan Asyiums Board. (2) The large number of ophthalmia neonatorum cases notified, together with the excellent results following treatment under the scheme adopted by the Council. (3) The unusual occurrence of a rate of infantile mortality higher in South Kensington than in the northern half of the Borough. The most important administrative steps taken by the Council in regard to matters of Public Health during the year were:— (1) The decision to erect a Cleansing Station, to be known hereafter as the " Medicinal Baths.'' (2) The establishment of an Advisory Committee to the Maternity and Child Welfare Committee to assist the Council in co-ordinating the work of the numerous voluntary bodies engaged on child welfare work in the Borough. (3) The provision of dental treatment for tuberculosis patients under Dispensary treatment. (4) The organisation of a scheme for the supply of milk to necessitous mothers and infants. In view of the transfer of the North Kensington Tuberculosis Dispensary to the Council at the close of the present year, arrangements in regard to taking over the control and management of the Dispensary as a Municipal Institution will have to be considered at an early date, therefore I have thought it advisable to give a detailed account of the work of this institution for the guidance of members of the Council. The presentation of this report affords me the opportunity of expressing 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 and all members of the Council, and of thanking the staff of the Public Health Department for their efficient service and loyal co-operation in my first year of office in the Royal Borough. VITAL STATISTICS. The Metropolitan 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. The Borough is further subdivided into nine wards. South Kensington includes the wards of Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton, and is co-extensive with the South Kensington Parliamentary Division. North Kensington, containing the wards of St. Charles, Golborne, Norland and Pembridge, is not co-terminous with the Parliamentary Division of the same name, in that it extends northwards to include an area of 100 acres with a population of 3,500 persons which is still allotted, for parliamentary purposes only, to Chelsea. 4 POPULATION. To meet the altered constitution of the population caused by the War, the Registrar-General has estimated the population of Kensington in 1920 as 165,496 for the purpose of calculating the birth rate, and as 164,177 for the calculation of the death rates. Table showing the estimated populations in the various wards of the Borough at the middle of 1920:- District. Population. For Death Rate Calculation. For Birth Rate Calculation. The Borough 164,177 165,496 North Kensington 83,940 84,613 South Kensington 80,237 80,883 St. Charles 21,663 21,837 Golborne 24,360 24,555 Norland 20,186 20,348 Pembridge 17,731 17,873 Holland 19,306 19,461 Earl's Court 16,786 16,920 Queen's Gate 13,610 13,720 Redcliffe 18,199 18,345 Brompton 12,336 12,437 In regard to the social status of the population, it may be said that the majority of the inhabitants of North Kensington belong to the poor classes, whilst in South Kensington persons of the poor classes constitute only a small proportion of the population. MARRIAGES. During the year 2,111 marriages were registered, representing a rate of 25.1 per 1000 of the population. The place of marriage is set out in the following table:— Church of England 1,090 Roman Catholic Church 256 Nonconformist Churches 31 Jewish Church 16 Register Office 718 Total 2,111 BIRTHS. The number of births registered was 4,020, after correction for inward and outward transfers, and the birth rate for the Borough was 24 3 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,890 1,856 3,746 Illegitimate 139 135 274 Total 2,029 1,991 4,020 Table showing the number of births and the birth rates in England and Wales, London, Kensington and the various districts in the Borough in 1920 and the rates for the previous five years:— 5 District. 1920. Birth rates in previous years. No. of Births. Birth-rate. 1919. 1918. 1917. 1916. 1915. England and Wales 957,994 25.4 18.5 17.7 17.8 21.6 22.0 London 123,043 26.5 18.2 16.0 17.9 23.0 22.6 The Borough 4,020 24.3 16.1 13.3 14.8 18.3 18.0 North Kensington 2,778 32.8 21.7 17.8 18.5 24.7 24.8 South Kensington 1,070 13.2 10.3 8.6 9.4 10.7 10.8 St. Charles 715 32.7 21.9 17.8 18.8 26.0 24.7 Golborne 937 38.2 26.6 20.6 21.1 28.8 29.3 Norland 714 35.1 21.9 18.4 19.2 25.4 26.9 Pembridge 412 23.1 14.4 13.6 14.0 16.7 16.5 Holland 271 13.9 8.8 7.7 9.8 11.8 10.7 Earl's Court 254 15.0 13.7 13.0 11.9 12.9 12.9 Queen's Gate 117 8.5 8.1 5.9 6.4 6.5 8.5 Redcliffe 267 14.6 11.8 8.7 10.5 11.8 11.4 Brompton 161 12.9 8.1 6.5 7.2 8.8 9.7 Ward unknown 172 ... ... ... ... ... ... The effects of social status on the birth rate are illustrated by the fact that the rate for South Kensington usually is less than half the rate for North Kensington, whilst in 1920 the birth rate for Golborne Ward in the North was more than four times as great as the rate for the Ward of Queen's Gate in the South. To a certain extent, however, this wide discrepancy is due to differences in the numbers of married women of child-bearing age in the districts compared. For many years past the steadily decreasing birth rate throughout the country has given rise to great anxiety. During the last two years of the War the birth rate for Kensington was actuallv lower than the death rate. The birth rates in Kensington since 1881 are shown in the following table:— Period. Annual birth-rate per 1,000 population. 1881-1885 26.1 1886-1890 23.5 1891-1895 22.0 1896-1900 21.6 1901-1910 20.0 1911 18.7 1912 19.3 1913 19.4 1914 18.4 1915 18.0 1916 18.3 1917 14.8 1918 13.3 1919 16.1 1920 24.3 It was expected that there would be a marked increase following the termination of the War and sufficient time has now elapsed to enable this to be measured. This increase reached its highest point in March, 1920, and during the first quarter of 1920 the birth-rate was astonishingly high. There were in England and Wales, 126,162 more births than in the first quarter of 1919. It was the highest number recorded in any quarter since the establishment of civil registration. The natural increase in population (excess of births over deaths) in Kensington in the first three months of 1920 was four times greater than that which occurred in the whole of the preceding year. It was not thought probable that such a high rate would continue; indeed there has been a steady fall in the rate since the first quarter of the year under review and it has now resumed its pre-War level. Notification of Births Act, 1907.—Parents are allowed a period of six weeks within which to register the birth of a child, but the fulfilment of this duty is so frequently postponed until the last few days of this period that the records of the Registrars of Births do not enable Public Health authorities to gain that early knowledge of the birth of children in their districts which is so essential to the success of the work of Health Visitors. This disadvantage arising from delay in birth registration has been met by the Notification of Births Act, which requires all live 6 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. The information supplied under this Act constitutes the starting point of the work of Health Visitors. During the year, 4,020 births to Kensington mothers were registered, and of this number 3,606, or 90 per cent. have been notified in accordance with the requirements of the Act. The number of stillbirths notified was 143. 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. Notified by Midwives 69 2,283 2,352 ,, ,, Parents 7 238 245 „ „ Medical Practitioners 25 515 570 „ ,, Other Persons 27 243 270 Births in the Borough 128 3,309 3,437 Notified from Institutions outside the Borough 15 297 312 Total 143 3,606 3,749 DEATHS. The number of deaths registered in the Borough during the year was 2,436, 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 2,436 Deaths of residents in public institutions, etc., beyond the Borough 510 2,946 Deaths of non-residents in public institutions, etc., within the Borough 753 Corrected number of deaths belonging to the Borough 2,193 The corrected number of deaths gives a death-rate of 13.4 per 1,000 living. Table showing the number of deaths and the death-rates in England and Wales, London, Kensington and the various districts in the Borough in 1920 and the rates for the previous five years:— District. 1920. Death-rates in previous years. No. of Deaths. Death-rate. 1919. 1918. 1917. 1916. 1915. England and Wales 466,213 12.4 13.7 17.6 14.4 14.0 15.7 London 58,178 12.4 13.6 19.2 15.7 14.3 16.8 The Borough 2,193 13.4 15.2 17.8 16.3 15.4 15.5 North Kensington 1,197 14.3 16.6 20.1 18.9 17.3 18.6 South Kensington 957 11.9 13.2 13.8 12.4 11.8 11.2 St. Charles 288 13.3 15.3 18.5 16.8 15.8 16.6 Golborne 339 13.9 17.5 22.2 22.4 18.7 20.5 Norland 324 16.1 17.3 22.7 20.1 18.7 22.1 Pembridge 246 13.9 16.1 17.0 15.2 15.6 14.7 Holland 221 11.4 12.7 13.5 13.7 12.7 12.2 Earl's Court 246 14.7 15.9 16.2 15.2 13.6 12.9 Queen's Gate 123 9.0 10.5 10.0 8.7 7.8 8.3 Redcliffe 248 13.6 14.7 15.9 12.8 14.5 11.6 Brompton 119 9.6 10.7 11.9 10.4 8.6 9.7 Ward Unknown 39 ... ... ... ... ... ... 7 Table showing Kensington death-rates in quinquennial periods 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 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) 156 Epidemic Influenza 46 Puerperal Fever 5 Phthisis 135 Other Tuberculous Diseases 44 Cancer 238 Bronchitis 162 Pneumonia 192 Heart Diseases 280 Bright's Disease 78 Diseases and Accidents of Parturition 6 Premature Birth 58 Accidents 61 Old Age 61 All other Causes 671 2,193 It will be seen that more than one-third of the deaths, or 769, were due to disease of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 135 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; together they were responsible for a very substantial number of deaths, the causes of which are very largely preventable. As the zymotic death rate is, with certain reservations, accepted as a test of the sanitary state of the district in which it prevails, the following table showing the rates for London and Kensington in the last three years, may be regarded as not altogether unsatisfactory. Deaths from Principal Zymotic Diseases per 1000 persons living. Period. Kensington. London. 1918 0.81 1.45 1919 0.87 0.76 1920 0.95 1.00 Table showing various Causes of Death in 1920, arranged in Four-Weekly Periods. Four Weeks ending Measles. Scarlet Fever. Whooping- Cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhœa and Enteritis. January 31 3 — 3 4 4 14 18 23 20 2 February 28 2 — 10 2 5 10 16 18 21 3 March 27 1 1 3 3 11 11 17 21 22 5 April 24 8 1 1 4 9 10 6 10 23 4 May 22 3 — — 3 2 14 21 6 15 7 June 19 3 3 — 1 4 7 12 6 9 7 July 17 2 — 1 — 2 7 21 4 10 3 August 14 1 — 1 2 1 6 21 7 8 6 Sept. 11 — 2 — 2 — 12 22 8 5 8 October 9 — — — — — 12 24 5 8 10 November 6 — — — — 1 12 18 2 3 9 December 4 — — — 1 2 13 21 24 19 11 January 1, 1921 — — 3 2 5 7 21 28 29 6 Totals 23 5 22 24 46 135 238 162 192 81 8 INFANTILE MORTALITY. The deaths among infants under the age of one year numbered 325, the infantile mortality rate being 81. By expressing the number of deaths in proportion to the number of births, the influence of age distribution is eliminated and a reliable standard is afforded for measuring the comparative mortality in different districts. The following table shows a decline in the Kensington infantile death rate from 172 in the quinquennium 1896-1900 to 81 in the present year:— DEATHS UNDER ONE YEAR PER 1,000 BIRTHS. Period. Kensington. London. England and Wales. 1896-1900 172 162 156 1901-1905 144 139 138 1906-1910 120 114 117 1911 135 129 130 1912 92 91 95 1913 111 105 109 1914 95 104 105 1915 119 114 110 1916 85 89 91 1917 130 104 97 1918 97 108 97 1919 102 85 89 1920 81 75 80 Although it is true that other factors have favoured a low mortality, there can be no doubt that the unprecedented fall in the number of deaths has been very largely due to the excellent work of the infant welfare centres and the Health Visitors. In the Metropolis, whilst the general death rate has fallen steadily since 1870, the mortality amongst the infantile population, in spite of notable sanitary reforms, remained stationary until the year 1900. From this onwards, as the table shows, the infant death rate has continued to fall. The difference between the infantile death rates recorded in the various districts of the Borough is very marked, as will be seen from the following table giving the number of deaths in children under one year of age, and the infantile death rate in the Borough and the various Wards thereof during 1920, together with the infantile mortality rates for the previous five years. District. 1920. Deaths per 1,000 Births. No. of Deaths. Deaths per 1,000 Births. 1919. 1918. 1917. 1916. 1915. The Borough 325 81 102 97 130 85 119 North Kensington 222 80 113 111 150 95 136 South Kensington 97 91 76 68 88 67 78 St. Charles 46 64 99 79 124 97 144 Golborne 72 77 112 132 179 86 132 Norland 68 95 122 115 156 122 165 Pembridge 36 88 128 110 121 66 76 Holland 29 107 169 76 87 78 106 Earl's Court 27 106 52 48 107 50 80 Queen's Gate 14 119 45 118 66 79 66 Redcliffe 19 71 56 71 82 60 64 Brompton 8 50 50 47 88 82 66 Unknown Ward 6 ... ... ... ... ... ... The infantile death rate in North Kensington is generally much higher than in South Kensington, but in the year under review there has been a very gratifying improvement in the northern wards, whilst the rate in the south is much higher than usual. It is true that the Council's Health Visitors and the workers at the Infant Welfare Centres perform much more work in the north than in the south of the Borough, but the decrease in the infantile death rate in North Kensington is too marked to justify the credit being given entirely to these lady workers. During the larger portion of the year there was ample work at good wages for the working classes, and this fact is reflected in the improved rate. There is, however, another factor which influenced the rates for the year. The infantile mortality rate is the number of deaths in the year of children under twelve months of age to every 1,000 children born in the year, and the unusually large number of children born in 1920 taken in conjunction with the comparatively small number of children born in 1919 and still under twelve months of age on January 1st, 1920, is a factor of importance in determining the low rate by reason of the fact that the comparatively small number of 1919 children under twelve months of age in the early part of 1920 would not, normally, die in numbers proportionate to the enormous increase in the number of births in 1920 and, consequently, there would result a reduction in the infantile 9 death rate for the year. This explanation will be made more clear by a simple example. Assuming that ten children, born towards the end of 1919, died in 1920 before reaching the age of twelve months, their deaths would give an infantile death rate of ten for the year 1920 if there were 1,000 births in the latter year, whereas they would give a rate of only five if 2,000 children were born in 1920. As there were 4,020 births in 1920 compared with 2,653 in 1919, it will be seen that the improvement in North Kensington for 1920 must be regarded to some extent as apparent rather than real. As regards the high rates for Holland, Earl's Court and Queen's Gate wards, it must be remembered that a few deaths more or less have a marked effect on the mortality figures owing to the small number of births occurring. The rates for these wards do, however, warrant close examination and the causes of death are shown in the following table:— Holland. Earl's Court, Queen's Gate. Common Infectious Diseases 3 0 3 Diarrhoea (including Enteritis) 6 5 0 Premature Birth 7 6 4 Congenital Defects (including Injury at Birth and Atelectasis) 2 4 3 Wasting and Debility 3 4 2 Bronchitis and Pneumonia 5 3 0 Other causes 3 5 2 29 27 14 CAUSES OF HIGH INFANTILE MORTALITY. The principal causes of high infantile mortality are to be sought in the conditions which accompany poverty. Lack of food, both for mother and child, improper food, crowding of persons in rooms, want of air, uncleanly homes, neglect, deliberate or inevitable, and ignorance of the simple rules of health are perhaps the conditions which chiefly affect the health of infants in the homes of the poor. To pay rent for the minimum of cubic space, to live on insufficient food, and to supplement the weekly income by sending their wives out to work, are the means by which numbers of casual labourers keep themselves and their large families from the work-house. If the mother be obliged to go out to work, the neglect described as inevitable must follow. There are then certain injurious influences, the direct outcome of poverty, which the Infant Welfare Centres and the Council's Health Visitors can do but little to alleviate. On the other hand, in giving advice as to feeding, cleanliness and the necessity of fresh air, especially to the teachable mothers of first babies, an immense amount of good can be and is effected by the workers at the Welfare Centres and the Health Visitors. The chief diseases which were registered as the immediate causes of death in 1920 and the two preceding years are summarised in the following list:— Causes of Death. Number of Deaths. 1918. 1919. 1920. Common Infectious Diseases 10 5 20 Diarrhœa (including Enteritis) 36 71 64 Premature Birth 29 41 58 Congenital Defects (including Injury at Birth and Atelectasis) 9 11 26 Wasting and Debility 41 26 36 Tuberculous Diseases 1 6 7 Syphilis 5 3 7 Bronchitis and Pneumonia 62 63 69 Overlaying — 6 3 Other causes 31 38 35 224 270 325 BIRTHS AND DEATHS OF ILLEGITIMATE CHILDREN. During the year the births of 274 children were registered as illegitimate, and of this number 55 died. The death rate expressed as the number of deaths per 1000 illegitimate births thus amounted to 201 as compared with an infantile death rate of 81 in the infant population as a whole. In view of the disabilities imposed by society on these unfortunate children and their mothers, an even higher death rate might have been expected. For a certain number of illegitimate children 10 satisfactory provision is made by rescue workers; but for the majority the Council's Health Visitors are unable to obtain such assistance other than that granted by the Poor Law Authorities, which would be necessary to bring about a material reduction in the illegitimate death rate. TABLE SHOWING THE BIRTH RATES, DEATH RATES AND INFANTILE MORTALITY RATES IN THE 29 METROPOLITAN CITIES AND BOROUGHS IN 1920. Births per 1000 Population. Deaths per 1000 Population. Infantile Deaths per 1000 Births. 1. Shoreditch 36.6 Hampstead 9.0 Hampstead 48 2. Poplar 34.2 Wandsworth 10.0 Chelsea 52 3. Bethnal Green 33.7 Woolwich 10.4 Woolwich 60 4. Finsbury 31.9 Lewisham 10.8 Wandsworth 62 5. Southwark 31.8 Paddington 11.1 Holborn 64 6. Bermondsey 31.8 Hammersmith 11.2 Lewisham 65 7. Stepney 31.2 Fulham 11.3 St. Marylebone 65 8. Deptford 28.3 Camberwell 11.5 Hammersmith 65 9. Islington 28.2 City of Westminster 11.6 Lambeth 67 10. Battersea 28.1 Chelsea 11.9 Camberwell 70 11. Lambeth 27.8 Greenwich 11.9 City of London 71 12. Fulham 27.2 Deptford 12.0 Islington 71 13. Hackney 26.6 St. Pancras 12.3 City of Westminster 71 14. Camberwell 26.5 Battersea 12.3 Greenwich 72 15. Greenwich 25.9 St. Marylebone 12.5 St. Pancras 72 16. St. Pancras 25.4 Hackney 12.6 Fulham 74 17. Woolwich 24.7 Stoke Newington 12.8 Finsbury 76 18. Hammersmith 24.5 Bermondsey 13.0 Paddington 78 19. Kensington 24.3 Lambeth 13.0 Deptford 79 20. Stoke Newington 23.1 City of London 13.3 Stoke Newington 80 21. Lewisham 23.1 Islington 13.3 Kensington 81 22. Paddington 22.8 Kensington 13.4 Hackney 81 23. Chelsea 22.2 Stepney 14.4 Poplar 82 24. St. Marylebone 21.6 Southwark 14.4 Battersea 82 25. Holborn 20.8 Finsbury 14.5 Bermondsey 84 26. Wandsworth 20.8 Poplar 14.6 Southwark 86 27. Hampstead 17.1 Bethnal Green 14.7 Stepney 87 28. City of Westminster 16.2 Holborn 14.9 Shoreditch 91 29. City of London 12.6 Shoreditch 15.4 Bethnal Green 95 THE PREVALENCE OF DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsorily nolifiable in Kensington:— Small-pox. Acute Poliomyelitis. Cholera. Glanders. Diphtheria. Anthrax. Membranous Croup. Hydrophobia. Erysipelas. Tuberculosis. Scarlatina or Scarlet Fever. Influenzal Pneumonia. Typhus Fever. Acute Primary Pneumonia. Typhoid or Enteric Fever. Trench Fever. Relapsing Fever. Malaria. Continued Fever. Dysentery. Puerperal Fever. Plague. Ophthalmia Neonatorum. Acute Encephalitis Lethargica. Cerebro-Spinal Fever. Acute Polio-Encephalitis. 11 Table showing Notifications of Infectious Diseases received in 1920, arranged in Four-Weekly Periods. Four Weeks ending Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Cerebrospinal Fever. Puer. peral Pever. Continued Fever. Pneumonia. Malaria. Dysentery. Encephalitis Le. thargica. PolioMyelitis. Total. January 31 28 35 — 9 5 1 2 29 1 1 — — 111 February 28 24 33 2 5 4 1 1 — 26 2 1 — — 99 March 27 44 38 3 4 1 — 1 — 30 4 — — — 125 April 24 24 37 1 8 4 1 — — 13 — — — — 88 May 22 41 33 3 5 5 — — — 9 — — 1 — 97 June 19 22 20 2 6 9 — 1 — 7 1 — 1 — 69 July 17 32 23 6 3 5 1 — — 8 3 — — — 81 August 14 54 14 — 3 6 — 2 — 6 1 — — — 86 Sept. 11 35 15 1 4 5 — 1 — — — 1 1 1 64 October 9 64 23 1 4 1 — — — 1 — — — 1 95 November 6 86 25 1 7 2 — 1 1 4 — — — — 127 December 4 84 19 1 6 5 — — — 9 — 1 — — 125 Jan. 1, 1921 79 24 3 4 1 1 — — 5 — — 2 — 119 Totals 617 339 24 68 53 5 9 1 147 12 4 5 2 1,286 Cases of mistaken diagnosis are excluded from the above Table. Scarlet Fever.—During the year the Metropolitan Borough Councils and the Metropolitan Asylums Board were called upon to deal with the biggest epidemic of scarlet fever known in the history of the Board. The disease became prevalent in the month of July, and a few days subsequent to the re-opening of the elementary schools after the summer holidays a very rapid rise took place and continued throughout the Metropolis until the 23rd November, when there were no fewer than 5,664 scarlet fever patients in the Board's hospitals. During this outbreak of scarlet fever there was a large number of diphtheria cases notified, with the result that on November 23rd there were 8,669 patients in the Metropolitan Asylums Board Hospitals, or 1,511 more than the highest number previously recorded. There were 617 cases of scarlet fever notified in Kensington in 1920. The number of notifications in the three previous years was 158, 234 and 260. The following table shows the number of cases notified in each four-weekly period during the year, and indicates those parts of the Borough most affected by the epidemic. TABLE SHOWING THE INCIDENCE OF SCARLET FEVER IN THE THIRTEEN FOUR-WEEKLY PERIODS OF 1920. 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 1264 1176 1081 962 963 902 1171 1184 1675 2907 3753 3336 2363 The Borough 28 25 45 27 42 23 33 56 40 68 88 88 81 North Kensington 16 17 34 20 25 15 25 42 33 42 59 68 42 South Kensington 12 8 11 7 17 8 8 14 7 26 29 20 39 Wards. St. Charles 4 6 6 7 6 4 5 13 7 13 16 24 15 Golborne 7 2 5 6 4 1 7 11 15 11 24 25 10 Norland 3 8 6 2 11 6 10 12 10 14 14 13 10 Pembridge 2 1 17 5 4 4 3 6 1 4 5 6 7 Holland 9 1 6 2 3 3 3 6 5 15 3 4 4 Earl's Court 1 2 3 1 7 4 3 7 — 4 11 2 7 Queen's Gate 1 1 — 2 — — — — — 5 7 6 6 Redcliffe 1 4 2 — 7 1 2 — 2 1 8 6 16 Brompton — — — 2 — — — 1 1 — 2 6 Cases of mistaken diagnosis are not excluded from the above Table. During the epidemic the Metropolitan Asylums Board were able to remove the vast majority of patients to hospital at once but, at the busiest times, a little delay did take place in moving some of the cases. Of the 617 Kensington cases, 538 were removed to hospital and no case the Board were asked to receive was refused admission. Although the epidemic was extensive, the cases were generally mild in character and the extent of the outbreak was very largely due to this characteristic. The children affected were, in some cases, so slightly indisposed that they were not kept in bed; they were not always kept away from school and frequently there was no thought of calling in a doctor. These mild cases are just 12 as dangerous as severe ones from the point of view of spread of infection; probably they are even more dangerous because the absence of marked indisposition results in the patients moving about in public amongst other peopie who are thus exposed to risk. When a patient is severely ill with scarlet fever he is confined to bed, the doctor is called in, the disease is diagnosed and isolation is enforced at an early stage of the illness. In many cases the parents thought their children were suffering from colds, and it was not until the appearance of desquamation that the true nature of the illness was made clear. I saw a number of cases which had not been detected and of these two were children who had attended school regularly for a period of three weeks during which they had gone through the acute stages of scarlet fever and had become convalescent. The mildness of the epidemic is reflected in the low death rate from the disease; there were only five deaths in Kensington during the whole year from scarlet fever, representing a case mortality of 0.81 per cent. The deaths in the three preceding years being 3, 7 and 2. The five deaths in 1920 occurred before the end of August and, from September 1st to December 31st, during the height of the epidemic, there was not one Kensington death due to scarlet fever. Twenty 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. Immediately on receipt of a notification at the Town Hall, the home is visited by the District Sanitary Inspector for the purpose of investigating the source of infection; children are excluded from school 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 his 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.—With the outbreak of scarlet fever in epidemic form there was an increase in the number of diphtheria cases throughout the Metropolis, but it cannot be said that there was an epidemic of this disease. Three hundred and thirty-nine cases were notified during the year, 322 of which were removed to hospital. The cases notified in the three previous years were 146, 163 and 274. A pamphlet of advice is left with the parents after a case has been notified and, on discharge from hospital or on becoming free from infection if the patient is nursed at home, a school child is excluded from school for a further period of fourteen days. Home disinfection is carried out as in the case of scarlet fever. The number of Kensington deaths was 24, representing a case mortality of 7.08 per cent. In the three preceding years the deaths were 9, 11 and 16. Nineteen notified cases admitted to hospital were returned as not suffering from diphtheria or any other infectious disease. In marked contrast to the mild wave of scarlet fever being experienced in the country, diphtheria of a severe type is presenting itself at the present time and, therefore, it is most important to secure an early diagnosis in order that appropriate treatment can be commenced without delay, particularly in view of the fact that the later in the course of the illness suitable treatment begins the more likely is the result to prove fatal. Owing to the degree of accuracy which has now been secured by bacteriologists in the diagnosis of diphtheria, it is customary to take a that swab for bacteriological examination in all suspicious cases, and for some years past the Council have undertaken to pay for such examinations performed at the Lister Institute on behalf of Kensington patients. Sterile swabs are obtained from the Town Hall, and until last Spring local medical practitioners, after inoculating these swabs from patients' throats, sent them by post to the Lister Institute, where they arrived on the following day. The swabs were then incubated, and the results of examination, which were determined on the second day after the throats had been swabbed, were communicated by the Lister Institute to the doctors by telephone or letter. It will be seen that there was always a delay of thirty-six to forty-eight hours or more before a medical man obtained information as to the result of the swab examination, and in a disease like diphtheria, where an early diagnosis is of such importance, this was serious. In order to reduce the interval which occurred from the time the doctor took the swab to the time he obtained the result, arrangements were made during the year for medical men to leave inoculated swabs at the North Kensington Tuberculosis Dispensary, 119, Ladbroke Grove, before 3.30 p.m., or at the Town Hall, before 4 p.m., on any day (Saturdays, Sundays and Bank Holidays excepted). Swabs so left are collected by one of the Council's messengers, who delivers them at the Lister Institute before 5 p.m. on the same day, and the results are telephoned to the doctors on the following morning. On Saturdays, Sundays and Bank Holidays medical men can send swabs direct to the Lister Institute before 5 p.m. and obtain an equally speedy result. This scheme enables medical men to learn the result of the swab examination 24 or more hours before the answer could be obtained under the old arrangement, and it has proved of inestimable value to doctors and their patients. During the year 366 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 88 gave a positive diphtheria result. 13 Under the Anti-Toxin Order, 1910, local authorities are empowered to supply diphtheria anti-toxin to medical men for administration to those of their patients who are unable to pay for the supply. This Order enables the doctors, without cost to themselves, to administer anti-toxin to poor patients before they are admitted to hospital, with the result that they stand an enhanced prospect of recovery. In 1920 the Borough Council supplied 178,000 units of anti-toxin for 43 patients at a cost of £18 6s. Practitioners are offered a fee of five shillings for administering anti-toxin to poor persons who cannot pay for medical assistance, and during the year the fees paid totalled £2. Enteric Fever.—Twenty-four cases of this disease were notified, 13 being removed to hospital. The cases notified in the three preceding years were 20, 11 and 16. There was only one death from this cause against 5, 1 and 2 in the three preceding years. All except three of the twenty-four cases were notified from the southern division of the Borough. This heavier incidence in South Kensington is not usual with other infectious diseases, and it is probably accounted for by the fact that water supplies and sanitary arrangements in London generally are very good and that most persons contracting typhoid fever are infected outside the Metropolis. It will be admitted that the residents in the southern portion of the Borough leave the London area more frequently than those in the north and, consequently, are more exposed to infection by reason of the fact that many outside London districts do not enjoy the same sanitary efficiency. Of the cases notified from the south of the Borough, three had recently returned home from the Continent, and in five others there was a history of the patients having been out of London quite recently, together with some evidence that the infection had been contracted whilst they were so absent from home. A study of typhoid fever over the last 40 years reveals the remarkable way in which the disease appears to be gradually disappearing from this country. A very steady decrease in the number of notified cases has taken place during the period in which the water carriage system of sewage disposal has been extensively installed throughout the country. Erysipelas.—Sixty-eight cases were notified during the year, 25 of which were removed to hospital. The cases notified in the three preceding years were 69, 48 and 79. There was only one death from this cause, the deaths in the three previous years being 5, 5 and 3. Continued Fever.—One case of this disease was notified, and was treated at home. Puerperal Fever.—Nine cases of this disease were notified, against 2, 4 and 11 in the three preceding years. There were 5 deaths, against 1, 0 and 7 in the three previous years. Cerebrospinal Fever.—Five cases of this disease were notified, particulars of which are appended:— 1. Female. Aged 6 years. Attacked January 14th—treated at home and recovered. 2. Male. Aged 4 years. Attacked January 24th—removed to hospital and recovered with slight paralysis. 3. Male. Aged 6 weeks. Attacked April 1st and died April 3rd. 4. Male. Aged 7 months. Attacked June 28th—removed to hospital—a bacteriological examination was made with a positive result—returned home nearly blind. 5. Female. Aged 1½ years. Attacked December 13th—was removed to hospital, and recovered. The notifications in the three preceding years were 17, 14 and 6, and the deaths 10, 6 and 1. Encephalitis Letliargica.—Five cases of this disease were notified, particulars of which are subjoined:— 1. Female. Aged 46 years. Attacked May 3rd. The family having removed from the Borough, the ultimate result of the case cannot be ascertained. 2. Male. Aged 42 years. Attacked May 26th, and died June 14th. 3. Male. Aged 31 years. Attacked November 8th. This patient was treated at home and ultimately made a good recovery. 4. Female. Aged 37 years. Attacked December 5th, and was removed to St. Mary's Hospital, where she died on December 20th. 5. Male. Aged 17 years. Attacked December 12th, and was removed to the western Hospital, where he recovered. After careful enquiry it was found that there was no connection between these five cases, but it should be mentioned that in February, 1921, a case was notified from the block of flats from which case No. 4 was removed in December. Case No. 4 was a maid in one flat, and the patient notified in February was a lady occupying another close by. Very thorough investigation revealed the fact that the only possible place of contact would be in the electric lift, and the evidence obtained indicated that it would be most unlikely that these two persons would ever be in the lift at the same time. At present this disease is making its appearance all over the world—a fact which has been noted by the Committee of the Office International d'Hygiene Publique, Paris, 1920, whose statements regarding the malady include the following:— In France 321 cases have been reported, the deaths being about 30 per cent. In Denmark, 58 cases have occurred since July, 1919. 14 The question of the disease has been referred to by delegates from Portugal, Poland, Morocco, Belgium, Spain and Algeria. In Italy, over 4,000 cases, resulting in 1,018 deaths, have been reported. It has also made its appearance in various parts of the United States, and in September, 1918, in New York. In this country, encephalitis lethargica was made a notifiable disease in 1918, and Medical Officers of Health of Metropolitan Boroughs make careful enquiries into all notified cases occurring in their respective areas. The facts ascertained are forwarded by each Borough Medical Officer to the County Medical Offier, who circulates the information thus obtained regarding each London case to every Borough Medical Officer. In this way Health Officials are acquiring a considerable amount of knowledge concerning this obscure disease, and it is hoped that the cause and methods for the prevention of the possible spread of infection may be discovered in the near future. So far 1 have not heard of two cases occurring in any one house in the Metropolitan area, and the only outbreak in this country in which a number of cases occurred in a single institution was at Derby in 1918. Fortunately, the disease, which is formidable, and has a case mortality usually estimated at 30 to 40 per cent., does not apparently, in ordinary circumstances, spread from case to case. Evidence, however, accumulates both at home and abroad of the possibility of groups of cases being due to a common source of infection. In view of the uncertainty existing in regard to the cause of encephalitis lethargica, when a case occurs in this Borough, arrangements are made for the disinfection of the premises, the isolation of the patient, and the observance of the usual precautions taken in regard to other infectious diseases, in order that no possible spread of infection can be attributed to any omission on the part of the Council's Public Health Staff. Poliomyelitis.—Two cases of this disease were notified during the year, viz., a female, aged 24 years, who became ill on August 16th, was removed to Kensington Infirmary, and died on August 24th. The second case was that of a male, aged 8 years, who was attacked on September 21st, and recovered. Ophthalmia Neonatorum.—Fifty-three cases of this disease were notified during the year, the numbers in the preceding three years being 19, 28 and 31. Ophthalmia neonatorum, or inflammation of the eyes of newly born infants, is in most cases due to the entrance of gonorrhœal infection into the eyes during the process of birth. It, however, sometimes results from the entrance of other forms of disease germs at the time of birth, and infection may also occur at any time afterwards if disease bacteria are brought into contact with the child's eyes by the unclean fingers of the mother or nurse. In neglected cases ulcers may form on the outer membrane of the eye, and partial or complete loss of vision may result. In view of the serious consequences of neglect in treatment, ophthalmia neonatorum was made compulsorily notifiable in 1914. During 1920 the Council evinced considerable interest in this disease, and it appears desirable to review the statistics for the year. London. No. of ophthalmia neonatorum cases notified during 1920 1,187 No. of births registered during 1920 123,043 Percentage of ophthalmia cases to births 0.97 Kensington. No. of ophthalmia neonatorum cases notified during 1920 53 No. of births registered during 1920 4,020 Percentage of ophthalmia cases to births l.32 It will be seen that the percentage of ophthalmia cases to children born is higher in the Borough than in London generally but, although this suggests that the disease is more prevalent in this Borough than elsewhere, it is possible that Kensington midwives may be more thorough than others in regard to the notification of cases to the Medical Officer of Health. It is, however, not safe to rest content in this belief, which could not be supported without an exhaustive enquiry, and, consequently, efforts must not be relaxed until the disease is much less common amongst the newly born. Of the 53 cases notified in Kensington there were 2 at which a doctor and a midwife were both in attendance at birth ; in 19 cases a doctor was in attendance without the assistance of a midwife, and in the remaining 32 a midwife only was present. There was only one doctor who had more than one case in his practice during the year, and he notified two. The first occurred on the 2nd February and the second on the 29th April, and the interval of three months does not suggest that there was any connection between the two. There were seven midwives who had more than one case, and particulars are shown in the following table, the dates under each heading indicating those on which the midwife in question notified a case of ophthalmia to the Medical Officer of Health :— Midwife A. B. C. D. E. F. G. Jan. 9th Feb. 24th Apr. 16th May 12th Feb. 7th Jan. 3rd May 26th „ 26th Sept. 4th June 5th Aug. 9th Mar. 2nd May 27th June 26th Apr. 5th ,, 7th ,, 12th June 29th July 1st „ 23rd July 27th Aug. 9th June 19th Aug. 6th ,, 20th July 26th ,, 15th Oct. 1st Aug. 18th 15 It will be seen that in the practices of midwives C, D, E and F two cases occurred so close together in point of time that the possibility of the midwife having conveyed the infection from one case to the other cannot be precluded, although, of course, these particulars do not in any way prove such a suggestion. In fairness to women engaged in maternity practice, it must be pointed out that the large number of midwives with two or more cases compared with the fact that only one doctor had two cases does not necessarily indicate that the midwives are not so careful as the doctors in regard to the preventive measures which can be taken against this disease. The number of medical men attending confinements in the Borough is so large that the 53 ophthalmia cases distributed amongst them would not give one per doctor, whereas the number of women engaged in maternity practice is small in comparison and several of them must of necessity have two or more of the 53 cases on their lists. Every one of the 53 notified cases has been finally reported as cured without any appreciable loss of vision. The very gratifying results of treatment are largely due to the excellent arrangement which the Borough Council have entered into with the Kensington District Nursing Association, under which the nurses of the latter authority carry out treatment at patients' homes prescribed by any doctor, when requested to do so by the Medical Officer of Health. No less than 48 of the 53 cases were attended by the Kensington District Nursing Association's nurses and 8 were admitted to some hospital or the Kensington Infirmary immediately the disease developed or after they had received some attention by the Association's nurses. Quite apart from the intense pain and suffering associated with this disease and the possible tragedy to the child of blindness for life, there is the economic side to be considered. The charges on rates and taxes for the education and maintenance of one blind person throughout life must represent an enormous sum and, in view of the fact that more than 30 per cent. of the children in blind institutions have lost their sight as a result of ophthalmia neonatorum, the grant of £100 per annum to the Kensington District Nursing Association by the Council must be regarded as an economy of the wisest kind. There was one case of ophthalmia in the month of August in regard to which no notification was received and, when the facts came to my knowledge in December, it was found that the sight of one eye was completely lost and that of the other seriously damaged. The Council instituted proceedings against the medical practitioner for having failed to notify this case and he was fined £5 and one guinea costs. At the hearing before the Magistrates, the Town Clerk made it clear that it was not suggested that the doctor's treatment of the case was in any way at fault but that proceedings had been instituted with a view to securing more efficient notification of this and other notifiable diseases. Pneumonia.—One hundred and forty-seven cases of this disease were notified, 124 being certified to be suffering with primary pneumonia and 23 with influenzal pneumonia. Malaria. —Twelve cases of this disease were notified, and investigation revealed that each patient had been a soldier who had contracted the disease whilst abroad during the recent War. Dysentery.—Four cases of this disease were notified. Particulars of each case are as follows:— 1. Male. Aged 63. Contracted bacilliary dysentery on War service in the Near East. Has died since notification. 2. Male. Aged 32. Contracted amoebic dysentery in India during the War. Now well, and engaged in motor-car trade. 3. Male. Age 31. Contracted amoebic dysentery on War service in Mesopotamia. Has died since notification. 4. Female. Aged 3. Bacteriologist failed to find amoebae, cysts or bacilli of dysentery, but the case was notified on clinical evidence. The child has now left the Borough. Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no notifiable infectious diseases, other than those referred to, were notified during the year. ANTHRAX FROM SHAVING BRUSHES. When it became known, early in 1920, that the occurrence in London of cases of anthrax in man had been traced to the use of contaminated shaving brushes imported from Japan, the Kensington Sanitary Inspectors visited all retail establishments in the Borough where shaving brushes are sold, and seized several hundred of Japanese origin. The Chief Sanitary Inspector personally conveyed the brushes back to the wholesale dealers from whom they had been bought, and gave a warning in regard to the danger persons incurred in using them. On the occasion of the last visit to the wholesale shops, his suspicions were aroused that these returned articles were being sold at low prices to street hawkers and. in view of this, a number of brushes subsequently collected in Kensington were retained in the Public Health Office. The facts were brought to the notice of the Council, and I was authorised (1) to destroy the brushes collected and also any suspicious brushes which may be collected in the future and (2) to issue certificates of destruction to the retail owners, on which these tradesmen can claim compensation, at the rate of wholesale prices, from the Borough Treasurer. This seems to be the only safe measure to adopt. The importation of Japanese shaving brushes has been prohibited by an Order in Council issued in 1920. 16 NON-NOTIFIABLE DISEASES. Measles.—This disease was the cause of 23 deaths, 20 of which were of children under the age of 5 years. The deaths in the three preceding years were 101, 14 and 14. Measles ceased to be compulsorily notifiable in January, 1920, 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. Whooping-Cough—There were 22 deaths from this cause, all children dying being under the age of 5 years. The deaths in the three preceding years were 12, 36 and 4. Influenza.—There were 46 deaths from this disease, the deaths in the three preceding years being 51, 336 and 151. Cancer.—Cancer caused 238 deaths, and of this number 215 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 174 deaths were attributed; sarcoma and epithelioma were the assigned cause of 9 deaths each; 46 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 1920. Parts Affected. Sex. Total. Male. Female. Buccal Cavity, No. 39 8 1 9 Stomach, Liver, etc., No. 40 34 27 61 Peritoneum, Intestines, Rectum, No. 41 17 40 57 Female Genital Organs, No. 42 ... 21 21 Breast, No. 43 1 38 39 Skin, No. 44 3 3 6 Other and unspecified Organs, No. 45 24 21 45 Totals ... 87 151 238 The numbers following the description of the parts affected refer tc the classification of causes of death adopted by the Registrar-General for use in England and Wales. The deaths in the several wards, etc., are set out in the following Table:— The Borough 238 North Kensington 106 South Kensington 131 Ward Unknown 1 St. Charles 24 Golborne 26 Norland 31 Pembridge 25 Holland 23 Earl's Court 35 Queen's Gate 17 Redcliffe 37 Brompton 19 HOME NURSING BY THE KENSINGTON DISTRICT NURSING ASSOCIATION. In July, 1917, the Council made a grant of £50 per annum to the Kensington District Nursing Association, in return for which the Association agreed to undertake, when requested by the Medical Officer of Health, the nursing of measles, German measles, whooping-cough, ophthalmia, summer diarrhoea, tuberculosis or any other disease for which nursing assistance is required, and to retain on their staff a nurse who is a qualified midwife who will be available for the nursing of ophthalmia cases. In December last the grant was increased to £100 per annum. Table of Cases attended and Visits paid by the Nurses of the Kensington District Nursing Association from October 30th, 1919, to October 30th, 1920. Cases. Visits Paid. Monthly Nursing 56 646 Pneumonia 82 1,483 Ophthalmia Neonatorum 48 1,592 Influenza - 18 137 Infantile Diarrhœa 17 138 17  Cases. Visits Paid. Tuberculosis 33 2,071 Diphtheria Suspects 2 5 Measles 9 199 Typhoid Fever 2 78 Septicæmia 1 37 Whooping-Cough 4 44 Erysipelas 2 20 Total 274 6,450 GRANTS TO HOSPITALS, ETC. In addition to the previously mentioned grant to the Nursing Association, the Council, during the year, gave the following subscriptions:— £ s. d. West London Hospital 10 10 0 Kensington and Fulham General Hospital 5 5 0 St. Mary's Hospital 10 10 0 Paddington Green Children's Hospital 5 5 0 Kensington Dispensary and Children's Hospital 5 5 0 Kensal Gospel and Medical Mission 5 5 0 Chelsea Hospital for Women 5 5 0 Brompton Hospital for Consumption 10 10 0 Kensington District Nursing Association 5 5 0 London Mothers Convalescent Home 12 12 0 Shaftesbury Society (Ashburton Home) 10 0 0 Western Ophthalmic Hospital 5 5 0 Ladbroke Road Baby In-patient Hospital 200 0 0 TUBERCULOSIS. During the year 293 cases of pulmonary tuberculosis and 114 cases of non-pulmonary tuberculosis were notified. The following Table shows the number of cases of both forms of the disease notified in the Borough and the several Wards therein during each year since 1913. District. Years. 1913. 1914. 1915. 1916. 1917. 1918. 1919. 1920. The Borough 849 682 564 429 543 432 582 407 North Kensington 642 516 423 300 406 331 445 294 South Kensington 186 138 133 127 137 101 137 113 Ward Unknown 21 28 8 2 – – – – Wards. St. Charles 146 117 93 75 113 79 104 70 Golborne 228 176 147 106 124 101 150 88 Norland 190 162 134 79 102 99 124 93 Pembridge 78 61 49 40 67 52 67 43 Holland 37 35 43 31 41 35 36 36 Earl's Court 51 40 29 40 35 20 31 25 Queen's Gate 34 17 10 14 20 23 16 15 Redcliffe 39 31 35 27 23 16 33 25 Brompton 25 15 16 15 18 7 21 12 From this table, it will be seen that notifications of tuberculosis are diminishing in number year by year. In the opinion of the two Tuberculosis Officers and the Council's Women Sanitary Inspectors, this decreasing number of notifications is due to the fact that the disease is becoming less prevalent. There is, however, one important point to be considered before this view can be accepted, and that is whether the medical practitioners are notifying the cases as regularly as they did in pre-War years. I am of the opinion that, in some cases, medical practitioners are not strictly complying with their obligations in regard to notification under the Tuberculosis Regulations, and I propose, at an early date, to circularise local medical men drawing attention to the importance of their strict compliance with these Regulations and of their utilising freely the services of the Tuberculosis Officers in order to arrive at a diagnosis as early as possible in difficult or doubtful cases. 18 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1913, together with the number of deaths and death-rates in each year. The Year. Pulmonary Tuberculosis. Other Forms of Tuberculosis. Tuberculosis (all forms). No. of Notifications. No. of Deaths. Deaths per 100,000 persons living. No. of Notifications. No. of Deaths. Deaths per 100,000 persons living. No. of Deaths. Deaths per 100,000 persons living. 1913 628 189 111 221 51 30 240 140 1914 501 189 110 181 78 45 267 156 1915 402 183 107 162 77 45 260 152 1916 300 186 122 129 54 35 240 157 1917 445 178 117 98 66 43 244 161 1918 336 203 131 96 47 30 250 161 1919 489 169 107 93 38 24 207 131 1920 293 135 82 114 44 27 179 109 Deaths from Tuberculosis in Wards, 1920. Pulmonary Tuberculosis. Other Forms of Tuberculosis. The Borough 135 44 North Kensington 85 29 South Kensington 48 14 Ward Unknown 2 1 St. Charles 25 3 Golborne 18 11 Norland 27 9 Pembridge 15 6 Holland 17 3 Earl's Court 8 2 Queen's Gate 2 3 Redcliffe 12 4 Brompton 9 2 The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary Tuberculosis. Other Forms of Tuberculosis. Kensington Infirmary 34 13 Patient's Home 63 14 Brompton Hospital 1 1 St. Luke's Home 3 0 Outlying Hospitals 23 13 Other Deaths beyond the Borough 11 3 PREVENTIVE WORK IN RELATION TO TUBERCULOSIS. For the purpose of making inquiries, offering assistance and giving advice, 348 first visits and 420 re-visits were paid by the Women Sanitary Inspectors to the homes of the tuberculous persons who have been notified to the Public Health Department. For the sake of brevity, the action taken during the year for the prevention of consumption may be summarised in tabular form as follows:— I.—The Number of Visits paid during the year. a. First visits after notification 348 b. Subsequent visits 420 Total visits paid during the year 768 II.—Provision for Home Treatment. Bedsteads and bedding lent 3 III.—Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam 185 Number of rooms disinfected 214 IV.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 80 At the first visit a printed card of advice is left, and the particulars as to the history, home surroundings and treatment obtained are subsequently entered on the case sheets containing the 19 notes of every patient notified. Second visits are paid with the object of obtaining for patients the treatment they require, and of seeing that the advice given is carried out. A number of sputum cups are distributed at the North Tuberculosis Dispensary, and others are taken to the homes of consumptive patients by the Women Inspectors. For the purpose of preventing the spread of infection in families, additional bedsteads with bedding are provided by the Council free of charge, and lent to those who need them on the advice of the Tuberculosis Officer. At the end of the vear 15 of the Council's beds were in use. Two beas have been on loan since 1912. „ „ „ „ 1914. Four „ „ „ 1915. One bed has been „ 1916. „ „ „ 1917. „ „ „ „ 1918. Three beds have been „ 1919. One bed has been „ 1920. In two of the three cases where beds were lent during 1920 they were returned on the patient's removal to Sanatorium. DISPENSARY TREATMENT OF TUBERCULOSIS. The Borough Council have no treatment machinery of their own but they have arranged with the Kensington Tuberculosis Dispensary Committee to carry out Dispensary Treatment for those persons residing in that portion of the Borough north of the Kensington High Street, and with the Brompton Hospital authorities for those Kensington persons residing south of this street. The North Kensington Tuberculosis Dispensary. This is a voluntary unit controlled by a Committee with the following constitution:— J. M. Rendel, Esq. (Chairman). Miss Alexander. Dr. Ethel Bentham. Miss Rachel Alexander. Miss A. S. Hayne Dr. James Fenton. Dr. A. J. Rice-Oxley. H. W. Simpkinson, Esq., C.B. Miss M. J. Wilde. C. S. Weir, Esq. Miss M. Drysdale (Hon. Sec.) Staff. Tuberculosis Officer A. W. K. Picard, M.D. Tuberculosis Nurse Miss V Hartwell (Hosp. trained) Miss A. Oliver. ( „ „ ) Assistant Secretary and Dispenser Miss Haycock. Caretaker H. Lake. Honorary Secretary Miss M. Drysdale. Record of Work done in 1920. Insured. Uninsured. Total. (1) New cases 171 434 605 (2) New cases with pulmonary tuberculosis 78 41 119 (3) New cases suffering from non-pulmonary tuberculosis 12 33 45 (4) New cases doubtful 46 117 163 (5) Total attendances at Dispensary 1,425 3,231 4,656 (6) No. of attendances at which systematic physical examinations were made 508 986 1,494 (7) Visits to patients' homes by Tuberculosis Officer 47 187 234 (8) Visits to patients' homes by Dispensary nurses 887 2,480 3,367 (9) No. of written reports on individual patients 490 121 611 (10) No. of specimens of sputum examined 249 114 363 Income and Expenditure (extracted from Annual Report for 1919). £ s. d. £ s. d. To rent, rates and taxes 130 8 10 By donations and subscriptions 334 6 11 „ drugs and chemicals 182 17 3 „ donation in the form of rent not claimed 75 0 0 „ salaries and wages 1,025 16 4 „ other expenses 413 2 6 „ grant from Central Fund for 1919 400 0 0 „ receipts from Kensington Borough Council 638 0 0 „ patients' payments 39 0 10 „ other payments 63 8 4 1,549 16 1 „deficit 202 8 10 £1,752 4 11 £1,752 4 11 20 Description of the Dispensary Routine. Primary Examination and Diagnosis of New Cases. A. Notified cases and others known io have Tuberculosis.—The Tuberculosis Officer examines every patient carefully in order to ascertain the type and extent of the disease, and in many cases repeated observations are made in order to determine the most suitable line of treatment. In some cases it is possible for the Tuberculosis Officer to form a definite opinion immediately after the first examination or in the course of a few days, but in others a period of observation may be necessary, particularly in regard to ascertaining the line of treatment most likely to be successful. This period varies considerably, but it does not generally extend beyond one month. It should be mentioned that the absence of those aids to diagnosis which are provided by X-rays considerably diminishes the efficiency of the Dispensary. B. Suspects.—Suspects are persons in whom there is some reason to believe that active tuberculosis may be present. They come to the notice of the Dispensary staff in the following ways:— (a) "Contacts" * who are not in the best of health. (b) Cases referred to Dispensary by School Medical Officers, Welfare Medical Officers, the Medical Officer of Health and general practitioners for examination and expert opinion. (c) Cases referred on suspicion by voluntary workers attached to various organisations interested in Public Health. (d) Patients attending on their own initiative or recommended by friends. A person coming under any of these headings is regarded as a "suspect" from the moment he first attends the Dispensary until a definite diagnosis is made. If clear signs be found it is possible to make a diagnosis of active tuberculosis almost immediately; but, as a rule, suspects are generally in a low state of health but do not show any definite signs of disease, and consequently it may take several months of observation before a final opinion can be formed. Frequently in the case of children it may be necessary to have other conditions, such as enlarged tonsils and adenoids, removed before a diagnosis can be made. A very difficult case may require observation over a period of six months, but, generally speaking, the diagnosis is settled within one to three months. C. Contacts.—When the Tuberculosis Officer diagnoses pulmonary tuberculosis in a patient referred to him by a private medical practitioner, he asks the doctor if he would like the contacts of the case to be examined at the Dispensary. If such examinations be desired, the Tuberculosis Officer instructs one of the Dispensary nurses to arrange appointments. When patients other than those sent by medical practitioners are found to be suffering from pulmonary tuberculosis the Dispensary nurses receive similar instructions forthwith. On receiving her instructions the nurse visits the home to explain to the contacts, or their parents, the importance of an early examination by an expert, and she endeavours to induce them to attend the Dispensary, offering each a definite appointment at a time convenient to both the contact and the Tuberculosis Officer. Failure to keep the appointment is followed by a second visit to the home, when a second appointment is offered, and, if necessary, a third visit is paid in order to offer a third appointment. On attending the Dispensary the contact is carefully examined and necessary observations are made, as in the case of suspects, until a definite opinion can be formed as to whether the person is tubercular or not. Action taken when a definite opinion has been formed by the Tuberculosis Officer.—Patients examined on behalf of general practitioners are referred back to their own doctors, the Tuberculosis Officer sending any necessary report. In some cases a consultation follows, at which the line of treatment (Dispensary, Residential or Domiciliary) is determined. War Pensions cases return to their own medical men, and any necessary report is sent to the War Pensions Committee. Definite cases of tuberculosis in insured persons are reported to the Insurance Committee, together with a recommendation as to whether the treatment should be Dispensary, Residential or Domiciliary. Contacts, suspects and others not sent by medical men, and found to be tubercular, are advised to secure appropriate treatment, but if this cannot be obtained satisfactorily they are treated at the Dispensary. Those found to be non-tubercular are informed accordingly, and any appropriate advice is given; in many cases the patient is advised to attend again in six or twelve months' time in order that the Tuberculosis Officer may note that his condition is satisfactory. Treatment.—During the War there was a large number of attendances at the Dispensary made by persons who simply visited the institution periodically in order to obtain a bottle of medicine or a tin of cod-liver oil and malt. The results looked very satisfactory in the annual reports, but it should be remembered that if the Tuberculosis Officer be largely occupied in "handing out" cod-liver oil he is prevented from fulfilling his proper functions as an expert. This view is recognised by the Dispensary Committee, with the result that straightforward cases not requiring specialised treatment are referred, where possible, to private doctors, and (* A "contact" is a person living close in association with a notified case of pulmonary tuberculosis.) 21 treatment at the Dispensary is being more and more confined to those cases requiring expert treatment and to those straightforward cases for whom other satisfactory arrangements cannot be made. The new line of action has a tendency to diminish the popularity of the institution with certain patients; nevertheless the Dispensary is carrying out its true functions more genuinely than in the past, and the amount of work to be done on these new lines is sufficient to occupy fully the present staff. If more routine treatment be desired an additional Tuberculosis Officer must be appointed. Home Visiting.—When a patient attends the Dispensary for any reason whatever his home address is placed on the visiting list of the Dispensary nurses and removed from that of the Borough Council's Women Sanitary Inspectors, and all responsibility for home visiting in regard to that particular case is undertaken in future by the Dispensary nurses. The Tuberculosis Officer gives instructions as to frequency of visits in certain cases but in others the nurses visit as often as circumstances permit. There is no rule that cases must be visited at certain intervals and the nurses arrange their visits in the light of their knowledge of home conditions. The number of sessions per week on which the Tuberculosis Officer sees patients has been increased recently and, as the nurses wait upon him at the Dispensary sessions, the time left available for home visiting is reduced. The periodical visiting of every tubercular case on the Dispensary list, whether in regular attendance or not, is essential. Following up of patients ceasing attendance without satisfactory reason.—Some patients pass away to the care of other institutions or come under the treatment of a private doctor, others are discharged on requiring no further attention, but there must be, in connection with every dispensary, a large number who discontinue attendance without any satisfactory reason being known to the officers. The records at the Dispensary are so kept that it is possible to ascertain whether any patient has failed to keep his appointment. These failures are "followed up" at the earliest opportunity by a visit to the home at which the nurse tries to persuade the patient to re-continue attendance and offers him another appointment with the Tuberculosis Officer. In the event of the patient still failing to attend the Dispensary, further home visits may be paid, but there is no rule for the guidance of the nurses and the extent of the "following up" is left to their own discretion. South Kensington Tuberculosis Dispensary. Under an agreement between the Borough Council and the Bromption Hospital authorities, Dr. Burrell, one of the Visiting Physicians to the Hospital, is appointed Tuberculosis Officer for South Kensington and all patients residing in that portion of the Borough south of Kensington High Street who are referred to the Tuberculosis Officer under the Tuberculosis Scheme are dealt with by him. He sees the patients at 2.30 p.m. on Mondays and Thursdays of each week, a certain portion of the out-patient department being reserved for South Kensington Dispensary purposes on these two afternoons. One of the Assistant Lady Almoners is appointed Secretary to the South Kensington Dispensary and devotes roughly one third of her time to the work of preparing records, interviewing patients and visiting homes; the remaining two thirds of her time are devoted to her duties as Secretary of the Chelsea Dispensary, which is stationed at the Hospital. Chelsea cases are seen on different days and by a different Tuberculosis Officer, but in other respects, the Tuberculosis Dispensary arrangements for that Borough are similar to those for South Kensington. Record of Work done in 1920. Insured Non-Insured Total (1) New cases 54 98 152 (2) New cases with pulmonary tuberculosis 20 4 24 (3) New cases suffering from non-pulmonary tuberculosis 4 5 9 (4) New cases doubtful 18 28 46 (5) Total attendances at Dispensary 503 969 1,472 (6) No. of attendances at which systematic physical examinations were made 121 215 336 (7) Visits to patients' homes by Tuberculosis Officer 2 0 2 (8) Visits to patients' homes by Dispensary Nurses 144 204 348 (9) No. of written reports on individual patients 62 12 74 (10) No. of specimens of sputum examined 43 17 60 This Dispensary is part of a large hospital which is essentially a treatment unit. Most patients attend with the object of securing treatment and after a positive diagnosis is made, the cases, if resident in South Kensington and otherwise suitable, are treated on days allotted to Dispensary work, unless they have been referred by a medical practitioner for diagnosis only. If residential treatment be needed, the patient is admitted to the wards of the Hospital or sent to the Sanatorium at Frimley, which is a branch of Brompton Hospital. In-patient treatment of insured patients must be approved by the Insurance Committee and that of non-insured by the London County Council before these authorities accept financial 22 responsibility, but, as the Tuberculosis Officer can admit cases into beds under his charge, there is little delay in securing admission in suitable cases. Certain cases are recommended for Domiciliary Treatment but these are not numerous due to the fact that many of the patients are domestic servants who leave South Kensington for their own homes when a diagnosis of tuberculosis is established. Owing to the small number of cases and the comparatively large staff available for the work, there is little risk of the Dispensary arrangements becoming clogged by routine treatment of ordinary cases. An X-ray expert, a throat specialist, a bacteriologist and other physicians are always available or consultative purposes and nothing is wanting in regard to the diagnostic and curative aspect of the work. There has not been any definite attempt to examine contacts, and only those presenting themselves on the suggestion of the Assistant Lady Almoner and the Council's Women Sanitary Inspectors are dealt with. The Tuberculosis Officer is, however, anxious to examine the contacts of all notified cases in the South Kensington area and, in fact, he does not wish to regard himself as a hospital physician in regard to South Kensington cases, but desires to become an Assistant (Tuberculosis) Medical Officer of Health for the district. If more time be required, he is prepared to give it, but there is a limit to the time available in the case of a consulting physician, and if that be exceeded he is willing to arrange for a house physician to deal with surplus contacts. Any suspects presenting themselves or referred for examination are dealt with as in the case of those attending at the North Dispensary. Home Visiting.—The Assistant Lady Almoner and nurses on the Hospital staff visit the homes of patients on the Dispensary books; the nurses also perform actual nursing duties in the homes when necessary. There is, however, no definite system of visiting every Dispensary case at stated intervals and this question requires consideration. The Tuberculosis Officer visits patients at home occasionally, but hopes to arrange for more visits to be paid by a Hospital house physician. Following up of patients ceasing attendance without satisfactory reason.—There is little difficulty in securing regular attendance owing, no doubt, to the national reputation of this institution and the fact that patients can secure both in-patient and out-patient treatment; nevertheless, some persons become tired of any treatment. Records of appointments given and attendances made are kept by the Assistant Lady Almoner and those patients failing to attend on the appointed day are visited by this worker. There is, however, no definite routine in the "following up" of cases, but the Borough Council's Women Sanitary Inspectors have always found that efforts are made to secure continuous attendance of definitely tubercular cases and suspects. There is an unofficial arrangement whereby the Assistant Almoner notifies to the Public Health Department those patients who cannot be induced to continue attendance. It works satisfactorily and should be placed on an official basis. THE KENSINGTON INTERIM TUBERCULOSIS CARE COMMITTEE. An Interim Tuberculosis Care Committee for the Borough was established in 1917. The members are ladies and gentlemen interested in health matters, together with certain officials engaged on work more or less associated with the welfare of tuberculous persons. The Committee meet at the North Kensington Dispensarv on alternate Thursdays in order to receive reports in regard to all new cases at both Dispensaries. It is the duty of the Committee to investigate home and social circumstances of patients, to consider reports by the Medical Officer of Health, the Tuberculosis Officer and other medical practitioners and to make recommendations for residential treatment when necessary. The Committee undertake certain arrangements in connection with the admission of patients to sanatoria and endeavour to make satisfactory arrangements for their reception at home after discharge and for proper after care. DENTAL TREATMENT OF TUBERCULOUS PERSONS. During the year, the Council approved of a scheme for the provision of dental treatment, including dentures, for definite and suspicious cases of tuberculosis under Dispensary treatment in all cases in which the same is necessary for the efficient treatment of patients likely to make satisfactory recoveries. The treatment is to be limited to patients recommended by the Medical Officer of Health. By arrangement with the Kensington Dispensary Committee, the dental clinic has been established on the premises occupied by this body at 119, Ladbroke Grove, and work commenced early in 1921. The Dispensary Committee have agreed to allow their Tuberculosis Officer to give anaesthetics when requested by the dentist, and the Council will pay £25 per annum for these services. 23 A registered dental surgeon has been appointed, and he will be paid by the Council on the basis of work done, the scale of fees being as follows:— (1) Separate extractions. Minimum fee of 2s. 6d. (2) Separate fillings. Minimum fee of 5s. (3) Dentures. £2 each or £3 10s. for a complete set. No charge for extractions previous to dentures. Extractions and fillings will be performed for uninsured persons free of charge, whist the cost of the provision of dentures, together with the financial position of the uninsured persons receiving them, will be reported to the Kensington Interim Tuberculosis Care Committee who will assess and collect payments on behalf of the Council. Originally it was proposed that insured persons should be treated free of charge on the condition that the Insurance Committee would pay the full cost but, on ascertaining that the financial position of this Committee did not enable them to make any contributions towards the cost of such dental treatment, the Council decided that the scheme should remain in abeyance in so far as it related to the insured. On receiving an assurance from the central authorities at a later stage that the Ministry of Health would contribute 50 per cent. and the London County Council 25 per cent. towards the Council's net approved expenditure on dental treatment of both the uninsured and the insured, it was agreed to undertake the dental treatment of the latter on and after May 1st, l921. on the same conditions as those laid down for the treatment of the former. FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are regulated by Section 8 of the London County Council (General Powers) Act, 1908. Premises where milk is sold are required to be kept in accordance with the Dairies, Cowsheds and Milkshops Order, 1885, and the Regulations made thereunder by the Council. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Proceedings in cases of adulteration are instituted under the Sale of Food and Drugs Acts. Milk Supply.—At the end of the year the Register kept by the Council and revised from time to time in accordance with the requirements of the Milkshops Order, 1885, contained the names of 178 persons carrying on the trade of purveyors of milk on premises within the Borough. Under Section 5 of the London County Council (General Powers) Act, 1908, the Council are authorised to remove from or refuse to enter upon the Register the name of any person proposing to sell milk on premises which are for any reason unsuitable for the purpose. In April, 1909, the Council resolved that the presence upon any premises of such articles as paraffin, loose pickles, fish, fresh meat, fruit, vegetables and coals would constitute a source of contamination rendering the premises unsuitable for the sale of milk, and the registration of persons entitled to carry on the trade ot a purveyor of milk in Kensington has been subject to the resolution being complied with. On November 16th, 1920, the Council amended the list of articles not to be sold in milk shops, so as to include (1) all forms of meat (except when in sealed tins or glass), (2) vinegar (except in sealed bottles) and (3) coke and wood (except in bundles, provided the same be not kept in the milk store). As a result of the amendment, the list of prohibited articles is almost identical with those adopted by the Paddington and Hammersmith Borough Councils, with the result that administration is simplified. During the year 10 applications for registration were received from persons who proposed to sell milk, and in each case the application was granted. The alterations made in the Register of Milk Purveyors during the year 1920 are summarised in the following table:— THE REGISTER OF MILK PURVEYORS. Class of Premises. Milkshops. General Stores. Restaurants. Totals. Transferred 3 4 0 7 Vacated and removed from Register 1 1 0 2 Premises added to Register 2 1 0 3 On Register December 31st, 1919 117 28 32 177 On Register December 31st, 1920 118 28 32 178 Increase + Decrease — +1 ± 0 ± 0 +1 The inspections of dairies and milkshops made during the year numbered 937, and notices were served requiring the remedy of defects which were found on 9 of the premises visited. 24 Cowsheds.—For some years past the only milk produced within the Borough came from a small cowshed in Walmer Road where about 10 cows were kept. The cowkeeper discontinued his business at these premises during the year, and now, for the first time, as far as is known, there is no milk being produced in Kensington. Ice Cream.-At the end of the year 195 premises were shown in the Register of places within the Borough where ice cream is prepared or sold, five having been added during the year. The trade is regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice cream are also required to notify the occurrence of infectious disease 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. Forty-two visits to ice cream premises have been made by inspectors during the year. Bakehouses.-There are 95 bakehouses in the Borough, and of this number 69 are underground. As a result of 535 inspections which were made during the year, 10 notices were served for the cleansing of walls and ceilings. Slaughter Houses.-The six slaughter houses in the Borough were again licensed in October by the London County Council. They are kept in a cleanly state, and from a structural point of view are not open to objection. During the year a considerable number of pigs were killed in the slaughter house in Walmer Road, and the license was renewed by the London County Council in October on condition that the premises be not used for the purpose of slaughtering on more than 20 Sundays in the year, that slaughtering on Sundays be carried out in the forenoon only, that the licensee do inform the Council of the Royal Borough of Kensington on the previous day when he intends to slaughter animals on a Sunday, and that on week-days cattle be slaughtered only between the hours of 8 a.m. and 8 p.m. in the months of May, June, July, August and September, and between the hours of 8 a.m. and 6 p.m. during the remainder of the year. The slaughter house inspections for the year numbered 391. Other Places Where Food is Prepared.-In addition to the above-mentioned food premises, places in the Borough where food is prepared or sold are entered in a Register under the date on which they were finally inspected and found to comply with the requirements of the County Council (General Powers) Act, 1908. The following Table shows the number of such premises on the Register at the end of the years 1919 and 1920, together with the number added to or removed from the Register during the twelve months to which the report relates:- Provision Dealers. Restaurants. Butchers. Fried Fish. Fishmongers. Greengrocers. Others. Total. On Register Dec. 31st. 1919 283 171 96 34 50 102 15 751 No. added 5 2 0 3 4 0 0 14 Removed 0 0 1 2 0 0 0 3 On Register Dec. 31st, 1920 288 173 95 35 54 102 15 762 The inspections of the above premises during the year numbered 1,097, and resulted in the discovery of the following defects which were remedied after the service of notices:- Defects found. Number of Defects. W.C. defective 4 Drains defective 1 Refuse deposited 2 Want of cleanliness 19 Defective ashpit accommodation 10 Other defects 15 Total number of defects found 51 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— Bacon (lbs.) 169 Beef(lbs.)22 Beef (tins) 30 Butter (lbs.) 19¼ 25 Cheese (lbs.) 23 Cocoa Nuts 162 Cows (tuberculosis) 2 Dates(box) 1 Fish(lbs.) 183 Gooseberries (bushel)½ Herrings (barrel) 1 Herrings (box) 1 Mackerel (case) 1 Milk (tins) 421 Oranges (boxes) 170 Ox Tongue (jars) 2 Periwinkles (shell-fish) (sack) 2 Pigs' Carcases, etc. (tuberculosis) 6 Pigs' Offal (tuberculosis) 10 Pork Pies 6 Poultry 2 Rabbits 60 Salmon (whole) 10 Sardines (tins) 10 Sausages (lbs.) 4 SALE OF FOOD AND DRUGS ACTS. Each of the ten Sanitary Inspectors is appointed as an inspector under the above Acts, and is instructed to take samples in any place in the Borough which is not within his own sanitary district. During the year the Inspectors collected 745 samples, of which 27 (or 3.6 per cent.) were adulterated The samples collected were as follows:— Nature of Sample. Number Taken. Number Adulterated. Milk 301 8 Sausages 52 5 Vinegar 51 3 Sweets 24 ... Butter 50 ... Pepper 36 ... Coffee 33 2 Cocoa 30 ... Fish Paste 12 ... Tea 20 ... Wood Vinegar 3 ... Meat Paste 13 ... Boric Acid 1 ... Cocoa Mixture 1 ... Coffee and Chicory 1 ... Cornflour 12 ... Tapioca 12 ... Mustard Mixture 8 ... Mustard 5 4 Sausage 2 2 Coffee Mixture 1 ... Cheese 12 ... Dried Milk 8 ... Ham and Tongue Paste 1 ... Separated Milk 1 ... Borax 12 ... Baking Powder 12 ... Milk of Sulphur 11 ... Camphorated Oil 8 1 Bloater Paste 3 ... Chicken and Ham Paste 3 1 Salmon and Shrimp Paste 2 1 Veal and Ham Paste 1 ... Pheasant Paste 1 ... Crab Paste 1 ... Precipitated Sulphur 1 ... Total 745 27 26 Summary of the Results of Analysis of the 27 Adulterated Samples, together with a record of the action taken by the Council. Article Analysed. Nature and Amount of Adulteration. Action taken. Milk 19.76 per cent. extraneous water Proceedings. Fined £10 and 10s. 6d. costs Milk 146 per cent. of the required fat deficient Proceedings. Fined £3 and 10s. 6d. costs Milk 10.0 per cent. of the required fat deficient Proceedings dismissed. Warranty defence Milk 6.3 per cent. extraneous water No action on account of high percentage of fat Milk 4 48 per cent. extraneous water Vendor cautioned Coffee 25 per cent. of chicory Vendor cautioned Sausages 10.78 grains of Boric Acid per pound Vendor cautioned Vinegar 8.5 per cent. extraneous water Proceedings. Fined £5 and 10s. 6d. costs Vinegar 7.0 per cent. extraneous water Proceedings. Fined £5 and 10s. 6d. costs Milk 8.2 per cent. extraneous water Proceedings. Fined £10 and 15s. 6d. costs Coffee 20 per cent. Chicory Vendor cautioned owing to conditions of sale Sausages 8.351 grains Boric Acid per pound Vendor cautioned Mustard 23 per cent. Wheat Flour Proceedings. Fined £5 and 10s. 6d. costs Mustard 20 per cent. Wheat Flour No action owing to conditions of sale Mustard 18 per cent. Wheat Flour No action owing to conditions of sale Mustard 3 per cent. Wheat Flour No action Sausage 9 604 grains Boric Acid per pound Vendor cautioned Sausage 8'673grains Boric Acid per pound Vendor cautioned Milk 3.5 per cent. extraneous water Vendor cautioned Vinegar 3.5 per cent. extraneous water Vendor cautioned Sausages 917 grains Boric Acid per pound Vendor cautioned Milk 11.0 per cent. extraneous water Proceedings dismissed. Warranty defence Sausages 18.718 grains Boric Acid per pound Proceedings. Fined £10 and 10s. 6d. costs Sausages 8'351 grains Boric Acid per pound Vendor cautioned Chicken and Ham Paste 10.437 grains Boric Acid per pound Vendor cautioned Salmon and Shrimp Paste 9 604 grains Boric Acid per pound Vendor cautioned Camphorated Oil 1.5 per cent. of required Camphor deficient Vendor cautioned It will be seen that proceedings were taken in nine cases, the fines and costs amounting to £51 18s. 6d. Margarine and Butter Substitutes.—Under Section 9 of the Margarine Act. 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Act:— Lipton, Ltd. .... 210, Portobello Road. „ „ 145, Brompton Road. E. C. Nicholls 19, Church Street. Pearks, Ltd. 165, Portobello Road. Maypole Dairy Co., Ltd. 196, Portobello Road. Home and Colonial Stores, Ltd. 136, Portobello Road. „ „ „ 20, Chepstow Mansions. „ „ „ 71, Notting Hill Gate. „ „ „ 171, Earl's Court Road. „ „ „ 98, Golborne Road. Cream Regulations.—The Public Health (Milk and Cream) Regulations, 1912, made by the Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907, came into force on October 1st, 1912. They prohibit absolutely the presence of any kind of preservative in milk or in cream containing less than 35 per cent. of milk fat, and the addition of any thickening substance of any kind except sugar to cream. In the case of cream containing 35 per cent. of fat or more, the effect of the Regulation is to permit the addition of boric acid, borax or hydrogen peroxide, provided the cream so preserved is sold in vessels bearing a label with a printed declaration of the percentage of borax or peroxide which has been used. The addition of any other kind of preservative is prohibited. 27 These Regulations were amended by the Public Health (Milk and Cream) Regulations, 1917, so as to limit the boric acid and borax which may be added to cream containing 35 per cent. or more of fat, to an amount not exceeding 0.4 per cent. by weight of the cream. These amending Regulations also provide that the declaratory label must state that the cream is not suitable for infants or invalids. On the grounds that the addition of preservatives in any quantity to cream is unnecessary, the Council have taken no action under these Regulations. In all cases of milk and cream samples submitted to the Public Analyst, an examination for preservatives is made, and if any be found, the Public Health Committee consider the question of instituting proceedings under the Food and Drugs Act, even though in the case of borax or boric acid in cream the amount found be less than that allowed by the amending Regulations. Food Stalls..—In certain streets in the Borough, but particularly in Portobello Road and Golborne Road, a considerable trade is carried on in food which is sold from costermongers barrows and from stalls. The barrows and stalls are regularly inspected in the daytime and occasional visits are paid on Saturday nights. Generally speaking, no fault can be found with either the quality or the freshness of foodstuffs sold by street traders; but there is, of course, no means of ascertaining where the food is stored at nights and on Sundays. It is important that street traders should be registered and that by-laws, giving wide powers to local authorities, should be made, with a view to safeguarding the public health. Food Poisoning.—On October 9th, a resident in South Kensington died shortly after admission to Hospital, and at the post-mortem examination it was ascertained that death was due to food poisoning. The circumstances surrounding the case were carefully investigated by the Westminster Coroner, the Ministry of Health and Officers of the Kensington and Chelsea Public Health Departments, and, as a result, it was generally concluded that the article responsible for the poisoning was a portion of imported ox kidney purchased from a shop in the Borough of Chelsea, situated in close contiguity to Kensington. A quarter of a pound of kidney was purchased on October 7th, and was taken by deceased at his evening meal on the same day. The illness commenced on the following morning and the man died within 36 hours of the onset of the illness. On visiting the butcher's shop after the facts came to light, the Chelsea Health Officers ascertained that the whole consignment of ox kidney had been sold. As it was possible that Kensington residents in the neighbourhood may have made purchases from the consignment, a communication was addressed to various Kensington doctors practising in the neighbourhood of the butcher's shop, but in no case was evidence obtained that any patient was suffering from symptoms which could be attributed to food poisoning. SUPPLY OF MILK FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. On May 4th, 1920, the Council adopted a scheme, since approved by the Minister of Health, for the distribution of milk to expectant and nursing mothers and infants under the age of five years. Those in necessitatis circumstances are the only persons for whom a supply cf milk at less than cost price can be granted—with this restriction in operation all expenditure incurred by the Council is eligible for the Government 50 per cent. grant. The following is an outline of the scheme:— Supply of Fresh Milk Free or at Less Than Cost Price. 1. Unless there be exceptional circumstances, no application is considered when the family income exceeds the following scale:— £ s. d. 1 parent 1 10 0 2 parents 1 15 0 2 „ 1 child 2 5 0 2 „ 2 children 2 15 0 2 „ 3 3 5 0 2 „ 4 3 15 0 2 „ 5 „ 4 0 0 2 ,, 6 ,, 4 5 0 and 5s. for each additional child. 2. Application must be made on a special form, the information required must be given completely and accurately and the form must be signed by the father (if he be dead or living away from home the mother's signature will be accepted). 3. (a) When the mother or child is in attendance at a Welfare Centre, the application form is handed to the Superintendent of the Institution, who certifies that the family is in need of assistance to obtain additional milk. The application is endorsed by the Medical Officer of the Welfare Centre and forwarded to the Medical Officer of Health. (b) Applications made within 10 days after confinement are endorsed by the Midwife and forwarded direct to the Medical Officer of Health. (c) Mothers not known at and unable to attend a Welfare Centre communicate with the Borough Health Visitors, who assist in making the application. 28 4. Apparently suitable cases are submitted weekly or fortnightly to the Milk Sub-Committee (Councillor Miss Hayne, Chairman, with Councillor Miss Keeling, J.P., and Mrs. Jarrett). 5. Where the Sub-Committee have decided to make a grant, the Medical Officer of Health issues to the dairyman an order stating the quantity of milk to be supplied daily, the price to be paid by the mother, and the number of weeks for which the supply is authorised. 6. A copy of the order is given to the mother, and if a renewal of a grant of milk be needed, she fills in the particulars on the reverse side of the form, and returns it seven days before the current order expires. 7. In cases of emergency, the Medical Officer of Health issues orders immediately, and reports action taken at the next Milk Sub-Committee meeting. Supply of Dried Milk. 1. The Medical Officer of Health arranges for dried milk to be supplied to Infant Welfare Centres on receipt of a requisition from the Superintendent. The manufacturers' accounts are paid by the Borough Council. 2. On the recommendation of the Medical Officer of a Welfare Centre, the Superintendent may sell not more than two packets of dried milk weekly at wholesale cost price to regular attenders at the institution who are unable to pay the ordinary retail price. 3. If dried milk be required at less than cost price, application must be made in the manner prescribed for fresh milk. 4. When the Milk Sub-Committee have decided to make a grant, coupons are issued to the mother, who is enabled to obtain dried milk from a Welfare Centre by presenting them to the Superintendent and paying the price stated thereon. Each coupon bears the mother's name and is available for one packet of milk only. Coupons are not transferable. 5. Each packet of dried milk sold is recorded in a "Sales of Dried Milk" book kept at the Welfare Centre. The record shows the date of sale, name of purchaser and price paid. 6. At the end of each quarter, the Superintendent of the Welfare Centre submits to the Medical Officer of Health a statement giving (a) Stock of dried milk in hand at beginning of quarter. (b) New supplies received during the quarter. (c) Quantity sold during the quarter. (d) Stock in hand at end of quarter. The cash and coupons received during the quarter are forwarded with the statement and the Superintendent is responsible for any deficiency. The quantity of milk supplied does not ordinarily exceed a pint (or the equivalent in dried milk) per day per person eligible, and the milk is only given at less than cost price when the Medical Officer of Health is satisfied that a supply is essential on the grounds of health. Particulars of income are verified in every instance where this is possible. The usual method adopted is that of applying for information to the employer, but written consent is obtained before this course is followed. A Health Visitor visits the home before a grant is made and makes re-visits during the period of grant. The avoidance of overlapping receives very considerable attention. Every grant or renewal of grant issued is reported to the Mutual Registration of Assistance Society, who supply the Council with details of all assistance given by bodies co-operating with the Society. In consideration of the help given, the Council recently recommended the payment of an annual subscription of £10 to this voluntary body. Co-operation with all relief-granting bodies, whether official or voluntary, is as complete as possible. The usual period of grant is one month, and an application for renewal at the end of that period is considered by the Sub-Committee as in the case of a new application. Particulars of Fresh Milk Granted During 1920. Number of new applications granted, 317. Number of renewal applications granted, 541. No. of pints of Milk granted. Price per pint paid by Recipients. Cost to Council. £ s. d. 13,331 Free 274 8 4 33,826 2d. 435 17 9 210 3d. 1 3 8 84 4d. 0 14 0 47,451 — 712 3 9 29 Particulars of Dried Milk Granted Under the Council's Scheme During 1920. Name of Welfare Centre. Date of commencement of Council's Scheme. No. of 1-lb. packets sold at cost price. Value of dried milk sold at cost price. No. of 1-lb. packets sold below cost price or granted free. Estimated deficit to be borne by Council in connection with the grant of dried milk below cost price or free. £ s. d. £ s. d. Golborne July 14th, 1920 227 25 5 8 - Raymede July 24th, 1920 640 70 14 0 8 0 10 8 Lancaster Road Aug. 18th, 1920 340 37 1 2 29 2 9 8 Bramley Road Oct. 26th, 1920 129 15 1 0 6 0 8 0 1336 148 1 10 43 3 8 4 FACTORIES AND WORKSHOPS. Section 132 of the Factory and Workshop Act, 1901, requires the Medical Officer of Health of every District Council to report specifically on the workshops and workplaces in his district, and to send a copy of his annual report to the Secretary of State. The total number of workshops on the Council's register is 1,548. 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 Sanitary Inspectors, who also visit the premises of home-workers and inspect the sanitary conveniences reserved for women in railway stations and other public places in Kensington. The factories in the Borough number 256, and are inspected and regulated by H.M. Inspectors under the Home Office. The Sanitary Inspectors of the Borough Council are, however, required to ensure the provision of suitable and sufficient sanitary conveniences in factories as well as in workshops. MEN'S WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 974. The factories at which men alone were employed numbered 193. 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 alone are employed:— Trade or Business. Workshops. Factories. Total. Aerated water manufacturer — 4 4 Baker 77 18 95 Basket maker 4 — 4 Blacksmith 36 1 37 Boot maker 172 7 179 Builder 110 7 117 Cabinet maker and joiner 55 2 57 Carver and gilder 10 — 10 Coach builder 33 3 36 Cycle maker 16 — 16 Electric generating works — 12 12 Firewood manufacturer 13 4 17 French polisher 2 — 2 Marble mason 6 4 10 Printer 4 22 26 Saddler 20 — 20 Tailor 118 — 118 Trunk maker 20 — 20 Umbrella maker 5 — 5 Undertaker 10 — 10 Upholsterer 32 2 34 Watch maker 49 2 51 Wig maker 15 — 15 Sausage maker — 16 16 Sundry businesses 167 89 256 Total 974 193 1,167 30 WOMEN'S WORKSHOPS. The number of workshops and factories at which female labour was employed at the end of 1920 was 637, being 234 in North Kensington and 403 in South Kensington. The number of persons employed varies with the period of the year, being, of course, greatest during the " season"—it averages 8,000. The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. Factories. Workshops. Total. Art Needlework — 2 2 Blind maker — 2 2 Blouse maker — 7 7 Boot header — 1 1 Boot closer — 2 2 Button maker — 1 1 Cabinet maker 1 — 1 Cardboard box maker — 2 2 Chemists — 1 1 Cinema film maker 1 — 1 Colour printer 1 — 1 Corset maker 1 7 8 Dressmaker and ladies' tailor 3 271 274 Dyer and Cleaner 4 — 4 Eyelet-bole finisher 1 — 1 Florist — 14 14 Furrier 1 12 13 Glove maker 1 — 1 Hosier — 1 1 Invisible mending — 1 1 Jeweller 2 — 2 Knitting 1 — 1 Lace worker — 4 4 Lacquer worker — 1 1 Lampshade maker — 1 1 Laundry 41 63 104 Machinist — 1 1 Mantle maker — 5 5 Milliner — 42 42 Motor car repairer — 1 1 Outfitter 2 17 19 Photographer — 13 13 Pictorial advertisements — 1 1 Pipe maker 1 — 1 Printer 1 — 1 Shirt maker — 1 1 Tailor 1 60 61 Typist — 1 1 Toy maker — 3 3 Umbrella maker — 2 2 Upholsterer — 14 14 Weaving — 2 2 Wire brush maker — 1 1 Wig maker — 17 17 Total 63 574 637 Routine inspections of the workshops shown on the above list were carried out during the year, and complaints from His Majesty's Inspectors or anonymous sources received immediate attention. Ventilation.—Additional means of ventilation were provided in six of the workrooms visited. Whilst a very marked improvement in the ventilation of workshops has taken place, it is still necessarv to serve notices in cases where premises become newly occupied as workshops. Overcrowding.—Employers are provided by the Council with cards showing the maximum number of workers allowed in each workroom and cases where the number is deliberately exceeded are now of rare occurrence. Cleanliness.—Thirty-four workrooms were cleansed and whitewashed after notice and twentysix other sanitary defects were dealt with. Sanitary Conveniences.—During the year defects in twenty-four sanitary conveniences in factories or workshops were found and remedied. 31 HOME WORK. Of the 320 outworkers registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshops Act, 1901, others work in domestic workshops, whilst the remainder are the genuine "Home Workers" engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The number of outworkers belonging to each of these three classes is shown in the following Table Outworkers in Workshops or Factories 58 Outworkers in Domestic Workshops 60 Outworkers in their own Homes 202 Total number of Outworkers 320 The factories and workshops referred to in the above list are included in the Tables which shows the trades carried on in the factories and workshops on the Council's register. The nature of the work given out to the home workers in the 202 homes on the register is as follows:— Tailoring 69 Dressmaking 48 Bootmaking 26 Outfitting 24 Ironing 20 Shirtmaking 3 Millinery 3 Embroidery 2 Artificial flowers 1 Feather worker 1 Hosier 1 Knitting 1 Lace mending 1 Tie maker 1 Upholstery 1 202 Infectious Disease.—Infectious disease occurred in three premises where home work was carried on. In no instance was it found necessary to stop the work as the infected persons were immediately removed to hospital and disinfection carried out. The appended Table summarises the work for the year of the Women Sanitary Inspectors under the Factory and Workshops' Acts, so far as it is capable of being expressed in this form:— 1. Factory Inspections, No. of 70 2. Workshop „ „ 889 3. Home Workers Inspections, No. of 338 4. Work Place „ „ 61 5. Sanitary Defects Remedied. (a) Additional means of ventilation provided 6 (b) Rooms cleansed and whitewashed 34 (c) Miscellaneous defects remedied 26 (d) Sanitary conveniences, defects remedied 24 „ „ insufficient 1 „ ,, not separate for sexes 1 6. Written Intimations issued 35 7. Statutory Notices issued 4 Home Office Tables. The following tables are supplied by request of the Secretary of State and contain a summary of the inspections made and the defects found and remedied in workshops and factories within the Borough, where men, women, young persons or children are employed. In Table IV. the chief classes of workshops are set forth. Table V. shows the number of cases in which action was taken in matters referred to the Council by H.M Inspectors. 32 Factories, Workshops, Workplaces and Homework. I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 195 10 — Workshops (including Workshop Laundries) 1,938 44 — Workplaces (other than Outworkers' premises included in Table 3 of this Section of the Report) 61 4 — Total 2,194 58 — II.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Heaith Acts:—* Want of cleanliness 38 38 — — Want of ventilation 6 6 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 33 33 — — Sanitary accommodation insufficient 4 4 — — unsuitable or defective 31 31 — — not separate for sexes 3 3 — — Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 14 ]4 — — Other Offences — — — — (Excluding offences relating to outwork which are included in Table 3 of this Section of the Report.) Total 129 129 — — • Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 33 III. Home Work. NATURE OF WORK. OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES. SECTIONS 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. Prosecutions. Instances. Notices served. Prosecutions Instances. Orders made (s. 110). Prosecutions (Sections 109, 110). Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. Failing to send lists. Outworkers. Lists. Outworkers. Lists. Contractors. Work men. Contractors. Workmen. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel— making, &c. 82 77 796 7 ... 42 51 ... ... ... ... 2 ... ... cleaning and washing 14 12 6 1 ... 1 4 ... ... ... ... ... 1 ... ... Household linen 2 ... 8 ... ... ... ... ... ... ... ... ... ... ... ... Lace, lace curtains and nets 2 5 12 ... ... ... ... ... ... ... ... ... ... ... ... Curtains and furniture hangings ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Furniture and upholstery 4 4 10 ... ... ... 1 ... ... ... ... ... ... ... ... Electro-plate 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... File making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brass and brass articles ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Fur pulling ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cables and chains ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Anchors and grapnels ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cart gear ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Locks, latches and keys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Umbrellas, &c. 2 12 ... ... ... ... ... ... ... ... ... ... ... ... ... Artificial flowers ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Nets, other than wire nets ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Tents ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Sacks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Racquet and tennis balls ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Paper, &c., boxes, paper bags ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Brush making ... ... ... •... ... ... ... ... ... ... ... ... ... ... ... Pea picking ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Feather sorting ... ... ... ... ... ... ... ... ... ... ... ... ... ... Carding, &c., of buttons, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Stuffed toys ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Basket making ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Chocolates and sweetmeats ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cosaques, Christmas crackers Christmas stockings, &c. ... ... ... ... ... ... ... ... ... ... ... ... ... ... Textile weaving ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total 108 113 832 8 ... 43 56 ... ... ... ... 3 ... ... 34 IV.—Registered Workshops. Workshops on the Register (s. 131) at the end of the Year. Number. Important classes of workshops, such as workshop bakehouses, may be enumerated here. ' Dressmakers and Ladies' Tailors 271 Workshop Laundries 63 Workshop Bakehouses 77 Other Workshops 1.137 Total number of workshops on Register 1,548 V.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) 5 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Notified by H.M. Inspectors 37 Reports (of action taken) sent to H.M. Inspectors 34 Other — Underground Bakehouses (s. 101):— Certificate granted during the year — In use at the end of the year 69 MATERNITY AND CHILD WELFARE. Under modern conditions, child bearing makes great claims upon the mother even under the most favourable circumstances. Strength and vitality are sacrificed to a large extent, and even at times life itself. Furthermore, owing mainly to ignorance of the simple rules of health on the part of young mothers, enormous numbers of crippling defects are found in school children, and the rate of infantile mortality is still very high. Loss of maternal and infant life and health must be prevented by every possible means, and the country has at last realised the utmost importance of adequate provision being made for the welfare of both mother and child. Since the passing of the Notification of Births Act, 1907, Health Visitors and voluntary workers have been engaged in increasing numbers on the systematic supervision of the health of expectant and nursing mothers, and of babies and little children until they are old enough to attend school and come automatically under the care of the School Medical Officer. During the same period a very satisfactory and steady decrease in the rate of infantile mortality has occurred. This decrease is shown in the Table on page 8, and whilst there are many factors to account for it, not the least important is the magnificent work carried out by Health Visitors appointed by local authorities and those voluntary workers who have established and maintained Infant Welfare Centres and similar institutions. HEALTH VISITORS. During the year under review there were four Health Visitors employed by the Council. Each had an area allotted to her, and her duties were as follows:— 1. To visit the homes of all newly-born children amongst the working classes within 21 days after birth, and subsequently as circumstances indicated. 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, diarrhoea and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever and tuberculosis in children. 5. To investigate applications under the Council's Scheme for the supply of milk free or below cost price. 35 These officers also attended at several of the Infant Welfare Centres in their respective areas on the doctors' consultation days, in order to assist in the work and to co-ordinate their efforts with those of the voluntary workers attached to these institutions. The work performed by the Health visitors in 1920 is summarised in the followingTable. Description of Work. Districts. No. 1. No. 2. No. 3. No. 4. Total. Visits to Infants under the age of 21 days. (First Visits) 887 846 994 466 3,193 Re-visits to Infants under the age of 12 months 672 1,094 1,219 995 3,980 Visits to Children between 1 and 5 years 75 608 112 134 929 Still-birth enquiries 24 9 10 — 43 Visits to Ophthalmia Cases 21 20 25 6 72 Return Visits to Ophthalmia Cases 61 67 72 29 229 Visits to Tuberculosis Cases 20 5 9 — 34 Visits to Puerperal Fever Cases 5 1 — 1 7 Infantile Death Enquiries 22 68 27 10 127 Investigations re Milk Applications 142 65 127 15 349 Ante-natal Visits 27 48 2 — 77 Special Visits 542 419 465 142 1,568 Totals 2,498 3,250 3,062 1,798 10,608 INFANT WELFARE CENTRES. An Infant Welfare Centre is primarily an educational institution providing advice and teaching for the mothers in the care and management of infants and little children, with a view to maintaining them in good health. Its essential function is to supervise the healthy child rather than to treat the sick, although the incidental treatment of simple ailments may be included in its scope. The guidance and teaching is both individual and collective. Individual advice is given at the consultations and in the course of home visiting; collective advice is given by means of simple class teaching. These three branches (consultations, home visiting and class teaching) are essential to the proper conduct of an Infant Welfare Centre, although other activities may be included if circumstances permit. Teaching of this description is just as important as instruction now being given to children in elementary schools. It is as necessary to have a healthy nation as a wise one, and the present curriculum at an elementary school does not and cannot include all that instruction on mothercraft which is needed to secure health for the future manhood of the country. The Borough has been mapped out into seven areas with one Welfare Centre situated in each, an attempt having been made to place each home in the area of that Centre most accessible to the mother. The following Table shows the main items of work performed at each of the Centres during the year. Archer Street Bramley Road with Kenley Street extension Campden Hill Earl's Court, Warwick Road Gol. borne Lancaster Road Raymede Totals 1—No. of births occurring in the area of the Centre and notified by the Medical Officer of Health to the Welfare Secretary as suitable for Welfare attention 184 888 144 329 441 464 516 2966 2—No. of sessions at which doctors attended for infant consultations 99 149 93 99 98 90 99 727 3—No. of sessions at which doctors attended for special ante-natal consultations 44 — 12 — — 8 52 116 4—No. of individual children under 5 years of age who attended for the first time 293 624 111 209 285 276 261 2059 5—Total No. of children's attendances at infant consultations. (Only those counted at which the child saw the doctor)... 2303 3276 2041 2132 1338 2437 2816 16343 6—No. of individual expectant mothers who attended for the first time 92 33 16 42 12 21 131 347 7—Total No. of expectant mothers' attendances for ante-natal consultations. (Only those counted at which the mother saw the doctor) 277 83 44 166 22 56 337 985 8—No. of home visits paid by Welfare Sisters 5738 2161 1621 3459 727 1131 3339 18176 9 —No. of home visits paid by voluntary workers — 467 — — 903 — 495 1865 36 Infant Consultation Sessions are held by medical officers in the afternoons; they commence about 2 p.m. and continue until 4 or 5 p.m. At all Centres there are two sessions per week, the number at Bramley Road being large owing to the fact that in addition to the two weekly sessions at Bramley Road Centre itself, there is one weekly session at the Branch in Kenley Street. Special Ante-natal Sessions are held in the afternoons at Archer Street, Campden Hill, Lancaster Road and Raymede and at the other three Centres expectant mothers are seen privately on infant consultation days. Daring the year, only 347 women attended the ante-natal consultations, paying 985 visits, but these figures include 152 attendances at Raymede by nursing mothers who visited the doctor for special advice on "ante-natal" days. Many expectant mothers attended for dinners, lectures, etc., but the figures relate to medical consultations only. At first sight, the numbers appear disappointing, but it must be remembered that ante-natal work at Welfare Centres is a new departure and is not yet known to all the expectant mothers. Owing to a natural shyness on the part of many young women expecting their first child, they do not readily attend the Centres at present, but their reluctance will gradually disappear when they realise that all the ante-natal consultations are held by lady doctors. Midwives are encouraged to send their poor class mothers to the nearest Welfare Centres for at least one examination and arrangements have been made for the doctor to return the patient with a written report for the midwive's guidance. The Home Visiting figures given in the preceding table do not include any paid by the Borough Health Visitors. The numbers, which vary considerably in the different areas, depend to a large extent on the staff available for the purpose. For example, at Golborne and Lancaster Road Centres the Sisterin-charge is also Matron of the attached Day Nursery and in each case she has very little time for visiting. Other Activities. Health talks on consultation afternoons or lectures on other afternoons are given at all the Centres, and other activities include minor treatment of simple ailments, sewing classes, cooking classes, the provision of free or cheap dinners for mothers and children, baths for mothers, thrift clubs, etc. Dried milk, supplied under the Council's scheme, is distributed from the Centres. Dental Treatment. The importance of good teeth both to the mother and her child cannot be over estimated and there is no doubt that the national physique and happiness are dependent to a considerable extent on efficient dental treatment at reasonable charges. During the year, five of the Infant Welfare Centres provided dental treatment (including the supply of dentures) for expectant and nursing mothers who were unable to pay the ordinary dentists' fees for the treatment they needed. Each Welfare Centre endeavoured to make the scheme of dental treatment practically selfsupporting by charging such fees as the mothers could pay and by obtaining the dentures at a very low rate. Although the dentures were generally not more than £4 to £b for a complete set, they were usually very well made and gave considerable satisfaction. TABLE SHEWING THE AMOUNT OF DENTAL TREATMENT PERFORMED AT THE VARIOUS CENTRES IN 1920. Centre. No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other Treatments. Campden Hill and Archer Street 77 164 152 80 6 20 Bramley Road 55 167 263 24 28 — Lancaster Road 26 66 92 10 7 6 Golborne 15 32 20 2 3 5 Raymede 201 575 195 12 27 20 374 1004 722 128 71 51 TELFORD ROAD CLINIC. This institution acts both as a Treatment Centre and an 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 by this unit. The following are records for the year ending December 31st, 1920:— 1. No. of sessions at which doctors attended for infant consultations 150 2. Number of sessions at which doctors attended for special ante and natal consultations 50 3. No. of individual children under 5 years who attended for the first time 711 4. Total number of children's attendances at infant consultations. (Only those counted at which the child saw the doctor.) 6805 5. Number of individual expectant and nursing mothers who attended for the first time 163 6. Total number of expectant mothers attendances for consultations. (Only those counted at which the mother saw the doctor.) 795 37 Collective instruction by lectures is not undertaken at Telford Road. Also, there is little home visiting; in fact, no area is allotted to this unit, therefore any visiting carried out would be in the district of one or other of the seven Welfare Centres. There is need of a treatment centre in Kensington. If the Telford Road authorities were to discontinue the use of the existing institution as an Infant Welfare Centre for healthy babies and a scheme were arranged under which infants from Welfare Centres requiring treatment could be referred, when suitable, to Telford Road and returned to their respective Welfare Centres on completion of treatment, the Kensington Child Welfare scheme would be a splendid example of what can be done by voluntary effort. LADBROKE ROAD BABY IN-PATIENT HOSPITAL. This institution, which was opened in 1919, has 17 beds for the treatment of sub-acute and chronic diseases. Two beds are reserved for children recommended from the various Kensington Infant Welfare Centres, but all the beds are available for children belonging to the Borough. Records for the year 1920:— Number in residence at commencement of year 11 Number of admissions during the year 63 Number of discharges during the year 57 Number of deaths during the year 5 Number in residence at end of year 12 Average duration of stay in hospital 13 weeks DAY NURSERIES. At the commencement of 1920 there were seven Day Nurseries in the Borough, but the Raymede Nursery closed towards the end of the year owing to the lack of funds. The following Table shows a record of attendances for the year:— Golborne. Kensal Creche (Medical Mission) Lancaster Road. Netting Hill Day Nursery St. Clement's, Treadgold St. St. Luke's Fulham Road Totals 1. Whole day attendances of children under 3 years of age 4924 2389 3446 8988 3110 3192 26049 2. Whole day attendances of children over 3 years of age 2348 882 432 1947 609 835 7053 3. Total whole day attendances 7272 3271 3878 10935 3719 4027 33102 4. Charges made for each attendance of a child 1/- 9d. 1 /- 8d. 11- 1/- — 5. Half-day attendances of children under 3 years of age — 162 — — 663 — 825 6. Half-day attendances of children over 3 years of age — 85 — 138 — 223 7. Total half-day attendances — 247 — — 801 — 1048 8. Charges made for each attendance of a child — 5d. — — 6d. — — 9. Average daily attendance of children 32 14 14 51 18 18 147 Owing to the closure of the Raymede Day Nursery and the dissolution of the Committee, it is impossible to obtain figures for the portion of the year during which the Nursery was open. The value of Day Nurseries was unquestionable during the War, when it was of supreme national importance that women should take the place of men in the industries of the country, but now that we have returned to days of peace, a mother with young children should find her daily occupation at home. It is true that many mothers, owing to sickness or death of their husbands, or other circumstances, are compelled to go out to work, and to these women Day Nurseries are of great value; there is, however, a great danger of these institutions being used for the care of children whose mothers can afford to stay at home but will avail themselves of an opportunity of working in factory or workshop. In the selection of infants for admission to these Institutions, very great care should be taken to prevent the unnecessary expenditure of money supplied by voluntary effort and Government grant on children whose mothers go out to work for preference and not out of necessity. The future of Day Nurseries requires very careful consideration, for it is open to question whether it would not be better and even more economical to spend money on keeping necessitous, widowed and deserted mothers at home with their children, rather than on the support of Day Nurseries. 38 HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. There are three of these institutions in the Borough, and a record of work done in 1920 is shown in the following Table. 124, Elgin Crescent 65, Lancaster Road 2, Upper Phillimore Place Totals 1. No. of expectant or nursing mothers in residence at commencement of year 8 7 7 22 2. No. admitted during the year 14 19 32 65 3. No. remaining in residence at the end of the year 9 6 6 21 4. Average duration of stay before confinement (in days) — — 30-60 — 5. Average duration of stay after confinement (in days) — 30 100-130 — 6. No. of infants and children under 5 years of age in residence at beginning of year 8 8 2 18 7. No. admitted during the year 14 19 16 49 8. No. remaining in residence at end of year 8 12 2 22 9. Average duration of stay (in days) 137 135 180-240 — THE MOTHERCRAFT TRAINING SOCIETY, 29-31, TREBOVIR ROAD. This institution receives patients from all parts of the country and does not provide for Kensington cases any more than for those from other districts; therefore, although situated in the Royal Borough, it cannot be regarded as a Kensington institution in the same sense as the other units dealt with in this report. Besides giving treatment to children and advice to mothers, particularly in regard to dietetic errors, the institution is a teaching centre for practical training in Child Welfare. The courses of instruction are intended for general hospital nurses, maternity nurses and welfare workers. NATIONAL CHILDREN'S ADOPTION ASSOCIATION, CAMPDEN HILL. This institution is situated in the Borough, but it is a national rather than a local institution. Unwanted infants are received from various parts of the country and they are cared for until adopted by some reputable person. CONVALESCENT HOMES. The Borough Council contribute to the London Mother's Convalescent Home, Sunningdale, Berks, £12 12s. per annum for which they are entitled to send six mothers to the institution for a fortnight's holiday each year. A sum of ten pounds per annum is given to the Ashburton Homes, Addiscombe, Surrey, which enables six Kensington cases to be admitted into the institution for a fortnight each year. During 1920 six cases were sent to each Home. HOME HELPS. No applications for Home Helps under the Council's scheme have been received during the year. HOME NURSING. This subject is dealt with under "The Prevalence of Disease" on page 16. CO-ORDINATION OF MATERNITY AND CHILD WELFARE WORK. The high rate of infantile mortality and the serious effects in later years of disease neglected in infancy have not only led to the establishment of numerous infant welfare institutions throughout the country during the last 15 years, but have also resulted in Parliament placing on the Statute Book the important Maternity and Child Welfare Act, 1918. This Act gives very wide powers in regard to the health of young children and their mothers to local authorities and imposes on them the duty of appointing a Maternity and Child Welfare Committee to which all matters relating to the welfare of mothers and infants must be referred. The Kensington Maternity and Child Welfare Committee was appointed by the Council under the Act in 1918 and immediately took over the control of the work of the Health Visitors, the administration of the distribution of milk to mothers and young children and other duties relating to maternity and child welfare. In addition, the Committee have reviewed the work of the large number of recently established voluntary child welfare bodies which Kensington is fortunate in possessing. The first Infant Welfare Centre in Kensington was opened in 1907, and since that year six similar institutions, seven Day Nurseries, a Baby Clinic and two Baby In-patient Hospitals have been established in the Borough. Other institutions, such as homes for unmarried mothers and their children, hospitals, dispensaries, etc., are also engaged, partly or wholly, in work relating to the welfare of mothers and infants. These institutions are maintained by the isolated efforts of more than twenty independent and voluntary bodies, most of which were formed with the one object of improving the health of the infant population of the Borough. 39 In view of the large number of these voluntary institutions now at work in the Borough, the Maternity and Child Welfare Committee have concluded that there is no occasion to establish municipal institutions, such as those set up in other areas under the Maternity and Child Welfare Act; but there has been increasing recognition of the fact that the Council, as the body primarily responsible for the public health (including child welfare) in the Borough, should endeavour to secure co-operation between the voluntary institutions themselves and co-ordination of the voluntary work with that of the Council in order to prevent overlapping and to guide the growth of the new movement. During the early part of 1920, the Maternity and Child Welfare Committee gave careful consideration to this matter and concluded that, in the first place, there should be a co-ordinated scheme in regard to the work of the Infant Welfare Centres. With this end in view they appointed a Sub-Committee to confer with a Kensington Conjoint Committee of Infant Welfare Centres. The meeting was held at the Town Hall on July 26th, when the following resolution was passed unanimously:— "That this Conference agrees to the principle of the formation of an Advisory Committee, "consisting of two representatives from each School for Mothers (Infant Welfare "Centre) and the Telford Road Clinic, such Advisory Committee to take the place "of the Joint Committee of Infant Welfare Centres and also of the Standing Sub"Committee of the Borough Council's Maternity and Child Welfare Committee, and "the duties of the Advisory Committee to be modelled on the lines laid down in the "report of the Medical Officer of Health." The resolution was approved by the Council who invited the Committee of each of the seven Infant Welfare Centres and the Telford Road Baby Clinic to nominate two of their members to serve on the Advisory Committee. On receipt of the names of those nominated, the Council formally appointed the Advisory Committee on November 16th and assigned to them the following duties:— 1. Advisory. To advise the Maternity and Child Welfare Committee of the Borough Council on all matters relating to maternity and child weltare work, and particularly on the following questions:— (a) The organisation of a complete and co-ordinated scheme of work with regard to infant welfare centres, home visiting, dentistry, ante-natal consultations, treatment, etc., for the whole Borough. (b) Changes in administration which experience may from time to time suggest. (c) The area of activity of each welfare centre. (d) The organisation of a uniform system of keeping records, etc., by the welfare centres. (e) Applications for grant from infant welfare centres. 2. Supervisory. (a) To supervise and co-ordinate the working of that part of any scheme (approved by the Borough Council where such approval is necessary) which devolves upon the voluntary bodies. (b) To act in a supervisory capacity in regard to any centralised voluntary service such as dentistry, ante-natal work, etc., which may be established. (c) To act as the channel through which annual reports, applications for grant to voluntary bodies, etc., are sent to the Maternity and Child Welfare Committee of the Borough Council. (d) To consider all such voluntary bodies reports, applications, etc., and to make suggestions to the welfare centres in regard to any matters arising therefrom. (e) To arrange tables of statistics, etc., and to obtain from each welfare centre the necessary information for the compilation of the same. (/) To frame regulations dealing with the keeping of records, etc., by the infant welfare centres, and to secure the observance of such regulations. 3. Executive. (а) With the approval of the Borough Council and the Ministry of Health this Advisory Committee shall have power to perform such executive functions as may be authorised by the Borough Council. (б) To carry out on behalf of the voluntary bodies, such duties as they may request the Committee to perform. The initial formal meeting of the Advisory Committee was held on November 30th, 1920, when Mrs. Carnegie, of the Bramley Road Centre, was appointed Chairman. The first business to receive their attention was the question of home visiting, which branch of work was more in need of co-ordination than any other. In the past there has been very considerable overlapping owing to the absence of co-operation between the Council's Health Visitors and the visitors working from the Centres, both sets of workers having been in the habit of visiting the same homes. Following the Maternity and Child Welfare Committee's adoption of the recommendations of the Advisory Committee, the Council have appointed one additional Health Visitor, making, with the two Women Sanitary Inspectors, seven Women Health Officers on the staff of the Public Health Department. One of these ladies is attached to each of the seven centres and is responsible for 40 the arrangements in connection with home visiting. She attends the centre each morning and confers with the workers thereat in regard to the work of the day so as to prevent any waste of effort. Her records are kept at the Centre in order to be available for reference on doctor's consultation days. The arrangements which were put into operation on January 1st, 1921, have proved to be satisfactory and add considerably to the efficiency of the work being carried out. The Advisory Committee have been engaged on other questions but most of their recommendations have been submitted during the year 1921, and will be considered in the next annual report on the health of the Borough. DISTRIBUTION OF MILK TO MOTHERS AND CHILDREN. The administration of the distribution of milk to mothers and children is part of the Council' Maternity and Child Welfare Scheme, but at the suggestion of the Ministry of Health the record of the work done is given under the "Food Supply" section of this report and will be found on page 27. ANNUAL GRANTS TO MATERNITY AND CHILD WELFARE INSTITUTIONS PAID BY THE BOROUGH COUNCIL. £ s. d. The Ladbroke Road Baby Hospital 200 0 0 The Kensington District Nursing Association 100 0 0 The London Mothers Convalescent Home 12 12 0 The Ashburton Home 10 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. The Council have decided to distribute an amount not exceeding £1,000 to the Infant Welfare Centres during 1921 and this proposal has received the approval of the Minister of Health. ADMINISTRATION. In addition to the record under each of the preceding headings of this report, it will be useful to submit a separate summary of certain of the main branches of Public Health administration. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officer of Health.—Dr. Sandilands relinquished his appointment as Medical Officer of Health in December, 1919, on leaving to take up his duties as Executive Health Officer for Bombay, and I had the honour of being selected to be his successor on January 13th, commencing duty on February 18th, 1920. Male Sanitary Inspectors.—The normal staff is one Chief Sanitary Inspector and ten district Inspectors. The Chief Sanitary Inspector undertakes the supervision of the work of the district Sanitary Inspectors and assists the Medical Officer of Health in special inquiries. For the purposes of sanitary inspection the Borough is divided into ten districts, one of which is allotted to each of the ten male Sanitary Inspectors, who carry out duties under the Public Health Act, the Housing Acts, 1890-1919, the Sale of Food and Drugs Acts, the Rag Flock Act, 1911, the London County Council General Powers Acts and, so far as men's factories and workshops are concerned, under the Factory and Workshop Act, 1901. Mr. James Steward, who had completed over 25 years faithful service as one of the Council's district Sanitary Inspectors, died after a very short illness on 24th September, 1920. The vacancy caused by his death and the vacancy arising from the death of Mr. A. E. Friend, who died in 1916, have been filled by the appointment of Mr. John McDermid and Mr. T. W. Forbes. A summary of the work of the Inspectors will be found in Table VI. of the Appendix. Women Sanitary Inspectors.—There are two women Sanitary Inspectors whose duties consist in the inspection of factories and workshops where women are employed, and in visiting cases of measles, whooping-cough and consumption. Miss Bennett resigned owing to ill-health in June, 1920, and in view of the re-organisation of the work of the Council's Women Health Officers, the vacancy caused by her resignation was not filled until the beginning of 1921. A record of the work of these two officers appears under various headings in this report. Health Visitors—The work of the four Health Visitors consists in visiting mothers of the poorer classes and advising them in the care and management of their infants, in visiting cases of ophthalmia in newly born infants, and in assisting with the work at five of the Infant Welfare Centres. The visits made by these officers are detailed in the section on "Maternity and Child Welfare." Clerical Staff.—There are five clerks and a shorthand-typist. Other Staff.—There are:— (а) Four disinfectors, including a man who acts as engineer. (b) A Mortuary Keeper. (c) A sanitary labourer who assists in drain testing. (d) A Superintendent and Matron of the Cleansing Station and (e) A man employed as a Rat Officer. 41 LEGAL PROCEEDINGS. Legal proceedings were instituted in 17 cases, particulars of which are summarised in the following list:— Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Local Management Act and Housing, Town Planning, etc., Act, 1909. Date. Name and Address of Defendant. Offence. Result. April 6th E. W. Bowes, 20, Kensal Road Failure to carry out sanitary repairs at 65, Kensal Road Order made for works to be carried out within 14 days. „ Do. Failure to carry out sanitary repairs at 196, Kensal Road Fined £5 and order made for work to be carried out within 28 days April 20th - Messrs. Rogers, Chapman and Thomas, 78, Gloucester Road Failure to carry out sanitary repairs at 5, Eardley Crescent Order to execute work within 21 days „ Do. Failure to carry out sanitary repairs at 56, Eardley Crescent Summons withdrawn, the work having been executed „ G. Harrison, 5, Newstead Road Failure to carry out sanitary repairs at 105, Oxford Gardens Order to execute work within 21 days May 4th T. Crosson, 38, Sidney Road, Richmond Failure to carry out sanitary repairs at 46, 48, 54 and 56, Sirdar Road (four summonses) Order to execute work within 8 weeks May 18th E. W. Bowes, 53, Mall Road, Hammersmith For altering a portion of the soilpipe at 10, Maxilla Gardens, contrary to Bye-laws of the L.C.C., Sect. 202 of the Metropolis Management Act, 1855 Fined 40s. „ Do. For fitting or fixing apparatus in connection with w.c. at 10, Maxilla Gardens without giving notice contrary to the provisions of Bye-law 14 of the L.C.C. under Sec. 39 of the Public Health (London), Act, 1891 Fined 40s. „ Messrs. Dimmer and Courthorpe, 43, Knightsbridge Failure to construct new w.c.'s at 6, Bina Gardens Order to execute work within 14 days „ Mrs. A. Pilbrow, 24, Hyde Park Square Failure to carry out sanitary repairs at 47, Mary Place Order to execute work within 14 days July 6th A. E. Maidwell, 2, Glynde Mews For unlawfully carrying on the trade of a dairyman without being registered Fined 20s. and 5s. costs „ Mrs. A. Pilbrow, 24, Hyde Park Square Failure to comply with the Order made on the 18th May to carry out certain sanitary repairs at 47, Mary Place Fined 5s. per day for 24 days (£6 in all) Dec. 7th F. C. Mander, 145, Uxbridge Road Failure to carry out sanitary repairs at 2, Wornington Mews Order to execute work within 14 days, and ordered to pay 5s. costs „ W. J. Waldron, 29a, Redcliffe Gardens Failure to carry out sanitary repairs at 15, Finboro ugh Road Summons withdrawn, the work having been carried out 42 In addition to the above, there were issued under the Food and Drugs Acts, nine summonses, particulars of which are given on page 26. DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane by exposure to superheated 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. Public Library books removed from houses after infectious disease are destroyed by burning, the cost of books dealt with in this manner in 1920 being approximately £26. 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 1 lb. of sulphur for each 1,000 cubic feet. Summary of Work carried out by the Disinfecting Staff during 1920. Nature of Infection Premises Disinfected Rooms Disinfected Disinfections at Wood Lane No. of Articles Disinfected Scarlet Fever 574 651 598 8,417 Diphtheria 328 344 302 3,823 Enteric Fever 20 27 23 363 Measles 105 159 5 50 Consumption 185 214 66 656 Vermin 35 37 49 513 Other Diseases 147 173 244 2,303 Total 1,394 1,605 1,278 16,125 The total weight of the bedding, clothing, &c., disinfected was 44 tons, 11 cwts. 1 qr. and 26 lbs. The number of articles disinfected only was 14,666 and the number disinfected and washed 1,459. In addition, the laundry work for the Cleansing Station was performed at the Disinfecting Station; the number of articles washed were:—Towels 7,580, sheets 369 and dressing gowns and blankets 275. VERMINOUS ROOMS CLEANSED BY LANDLORDS. Three hundred and ninety-three verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council (General Powers) Act, 1904. DUST REMOVAL. House refuse is collected once a week and is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharf in Kensal Road. The period of seven days is the maximum period during which the Council are permitted by the Public Health (London) Act, 1891, to allow refuse to accumulate on premises within their district. Trade refuse is removed by the Council on payment of a fee in accordance with the provisions of Section 33 of the same Act. Fish offal and other offensive trade products, which could be removed on application as trade refuse, are for the most part removed and sold by the persons to whom this class of refuse belongs. In compliance with notices served by the Sanitary Inspectors, 335 new movable ash-bins of galvanised iron have been provided during the year, and 17 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. DRAINAGE WORK. All drainage work in connection with new buildings is carried out under the supervision of the Borough Engineer, who also supervises the construction of drains on existing premises where the work is undertaken by the owner on his own initiative. The reconstruction of drains found to be defective by the Sanitary Inspectors, is carried out under their supervision, plans of any proposed alteration being submitted in the first instance to the Borough Engineer and then handed on to the Public Health Department. During the year 54 house drains have been reconstructed under notices served by the Sanitary Inspectors. PUBLIC CONVENIENCES. The Council provide six public lavatories containing water-closets; two are for men only, and in four accommodation is provided for both sexes. In addition there are 12 urinals for men under the charge of the Council. In the women's la.vatories there is free accommodation for those who are unable to pay. There are also conveniences for women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the "Women Sanitary Inspectors. 43 BACTERIOLOGICAL WORK. The Borough Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.1, for the bacteriological examination, at the expense of the Council, of specimens from Kensington cases sent to them through medical practitioners in regard to diphtheria, tuberculosis, typhoid fever, syphilis and other diseases. The examinations in 1920 were as follows:— Disease examined for. No. of examinations. No. giving positive results. Diphtheria 366 88 Tuberculosis 80 23 Typhoid Fever 6 2 Syphilis 1 1 In addition to these examinations at the Lister Institute, 423 specimens of sputum were examined at the Tuberculosis Dispensaries. 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 blood in suspected malaria through the Ministry of Health. PUBLIC BATHS AND WASH-HOUSES. The subjoined particulars set forth the use made of the Public Baths and Wash-houses during 1920 and in the three preceding years by washers and bathers:— Year. Washers. Bathers. 1917 77,888 162,579 1918 80,089 162,970 1919 82,002 259,200 1920 88,207 319,991 It is satisfactory to be able to report that the number of bathers is now approximately double the number in pre-war years, whilst the figures of washers show an increase of more than 10,000 over those recorded 10 years ago. MORTUARY AND CHAPEL OF REST. During the year 239 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of the relatives or friends of the deceased 67 At the request of undertakers 18 By order of the Coroner 135 By the Police 19 Total 239 In 111 cases, post-mortem examinations were made under the Coroner's warrant. Thirty-one bodies were deposited in the Chapel of Rest, Avondale Park. VENEREAL DISEASE. During the year representations from the Societies established for the purpose of assisting in the prevention of venereal disease were considered by the Council and they decided that, whilst it was obviously the duty of the Council to assist in any scheme tending to promote a higher standard of morality, they were not prepared to associate themselves with the propaganda of any particular society formed to deal with the subject. BUSINESSES OF RAG AND BONE DEALERS. In October, the Council considered the expediency of the making of by-laws for regulating the businesses of rag and bone dealers and they resolved to ask the London County Council to obtain confirmation of by-laws for regulating such businesses and to consider also the wisdom of declaring the business of a rag and bone dealer to be an " offensive trade." EXPOSURE OF ARTICLES OF FOOD FOR SALE IN PUBLIC STREETS. The Council have passed a resolution in favour of legislation conferring on the County Council power to make regulations or by-laws with regard to the exposure in the streets of articles of food for sale, such by-laws to provide that they shall be enforced by the Borough Council. FOULING OF PAVEMENTS BY DOGS. Considerable attention has been given by the Public Health Committee during the year to the nuisance and danger to health caused by the excreta of dogs on the footway. The Council have on more than one occasion in previous years endeavoured, without success to obtain the sanction of the late Local Government Board and the Home Office to a by-law dealing with this subject and, therefore, it was decided that a communication should be addressed to the holders of dog licences in the Borough calling their attention to the nuisance and urging them, in the interests of public health, to lead their dogs on the leash to the roadway or gutter. 44 As the London County Council, in spite of several representations, refused to give to the officers of the Borough Council access to the Register of Dog Licence Holders, the Minister of Health has again been asked to sanction a by-law in regard to this nuisance. The Council have made it clear that power is required, not to control the habits of dogs when running free, which is impossible, but to penalise those persons adopting the common and objectionable practice of allowing dogs on the leash to foul the footpath when it would be quite easy to lead them to the gutter. The Minister has offered to consider any by-law submitted by the Council and at present the framing of a suitable Clause is under consideration by the Law and General Purposes Committee. RAG FLOCK ACT, 1911. Four samples of rag flock were analysed and reported on during the year. They contained 20, 15, 10 and 7.5 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACT, 1920. Under Section 2 of this Act, a tenant is entitled at any time, not being less than three months after the date of an increase of rent permitted by the Act, to apply to the County Court for an Order suspending such increase, on the ground that the house is not in all respects reasonably fit for human habitation or is otherwise not in a reasonable state of repair. Before he can succeed the tenant must satisfy the Court by the production of a certificate of the sanitary authority or otherwise that his application is well founded. When this Act was under consideration by the Council in September last, it was anticipated that the Public Health Department would be inundated with applications, but to the end of the year the number received totalled 10 and the number of certificates granted was 2. Up to the time of writing this report (June, 1921) the applications are not more numerous than in 1920. This failure by tenants to attempt to make use of this provision of the Act is probably due mainly to the fact that many houses in defective repair come under the notice of the Sanitary Inspectors, who put the Public Health Acts into operation and thus save the tenants the necessity of appealing to the County Court. It would appear that the Act will be of more use to tenants in areas where the sanitary administration is inclined to be lax. There are, of course, cases where the rents have not been increased to the full extent permitted owing to the defective condition of the houses, whilst in other cases owners of houses in good repair have not availed themselves of the opportunities granted to them by the Act. CUSTOM AND INLAND REVENUE ACTS. Under these Acts, 27 certificates were issued by the Medical Officer of Health during the year in respect of 27 flats in 10 houses (one being a common lodging house) containing 27 separate dwellings. CLEANSING OF VERMINOUS PERSONS ACT, 1897. At the end of 1913, the Council took over for use as a Station for the cleansing of verminous persons the Casual Wards in Mary Place. In the receiving room there were three baths on the ground floor which were suitable for the bathing of verminous persons, and the Council installed in the adjoining room a machine for the disinfestation of clothing by steam at a temperature of 100 degrees Centigrade. The Station was staffed by a married couple who resided on the premises. The husband was responsible for the working of the disinfector and the bathing of adult males, and his wife undertook the bathing of the females and children. At times of pressure a temporary female assistant was employed. The Casual Wards occupied part of the site selected for the Council's Mary Place housing scheme, and in order to allow the contractors to proceed with the erection of the new houses, the Cleansing Station was closed and demolished in August. Table showing the work done since the opening of the Cleansing Station. Year. School Children Cleansed. Adults Cleansed. No. of Baths Given. 1914 788 32 1,897 1915 502 390 1,641 1916 1,223 155 3,134 1917 1,889 131 5,109 1918 1,351 178 4,709 1919 1,815 72 4,888 1920 (Jan. to Aug. only) 2,140 56 6,020 There was an enormous increase of work in 1920; in seven months considerably more work was done than in any preceding twelve months. The increase was mainly due to two factors, namely, (1) the return to civil life of a large number of the County Council school doctors and school nurses, which enabled more frequent and more complete examinations to be undertaken for verminous conditions, and (2) the unusually large number of cases of scabies (itch), which disease was undoubtedly disseminated by infected soldiers who had returned home from foreign service. 45 In view of the impending closure of the Cleansing Station, the Council, in the early part of the year, gave careful consideration to the steps it would be necessary to take in order to continue the excellent work which was being performed at the Mary Place Station. It was finally resolved to erect a Cleansing Station, to be hereafter called the Medicinal Baths, on the site, owned by the Council, in Blechynden Mews, adjoining the Public Baths and Washhouses. The plans provide for:— (1) Waiting-room with office enclosure and lavatory accommodation. (2) Hair washing room. (3) Three bath rooms with dressing rooms adjoining. (4) Two chambers containing disinfecting apparatus whereby clothing will be disinfected by superheated steam at a pressure of 15 lbs. per square inch above atmospheric pressure. Hot water and steam will be supplied from the Public Baths. This arrangement will effect a great economy, for the small amount required at the Medicinal Baths will make but comparatively little difference in the amount of hot water and steam prepared daily at the Public Baths and Washhouses. Following the Council's decision, a new agreement has been entered into with the London County Council, which provides for the use of the Medicinal Baths by the latter body for the cleansing of children attending elementary schools in and around Kensington. Under this agreement the County Council will pay 1s. in respect of each bath given to a school child (whether resident in Kensington or not) and a minimum payment at the rate of ±'450 per annum is guaranteed for five years. This agreement follows the lines of one made between the County Council and the Borough Council in 1917 and which expired in 1920, but the guaranteed minimum of £450 per annum for five years is new, the Borough Council insisting on this guarantee being given before commencing the erection of the new building. Technically, in accordance with the provision of the Children Act, 1908, children sent from the elementary schools are cleansed by the School Nurse in the employ of the London County Council, who attends at the Station for the purpose, and is responsible to her employers for the effective use of the apparatus provided. In practice, the actual work of bathing and. disinfecting garments is executed by the Borough Council's servants under the supervision of the School Nurse. A further agreement in regard to the cleansing of verminous inmates of common lodging houses has been made with the County Council on the lines of the old agreement which expired recently. The Borough Council have agreed to cleanse verminous inmates from Kensington common lodging houses free of charge and to bath those sent by the London County Council Officers from common lodging houses in neighbouring boroughs at a rate of 1/- per bath. The cleansing of Kensington persons not sent by officers of the County Council will be performed free of charge by the Superintendent and his wife under the direction of the Medical Officer of Health. Persons non-resident in Kensington, other than those mentioned in the two agreements with the County Council, will not be dealt with unless the Councils of the areas in which they reside undertake to pay an adequate sum for the services rendered. The Medical Officer of Health will be responsible to the Council for the general supervision of the Medicinal Baths. The work of building is progressing satisfactorily and it is hoped that the Baths will be ready for use in July of the present year. During the interregnum, from August 7th to the date of the opening of the Medicinal Baths, the Marylebone Borough Council, through their Medical Officer of Health, have kindly consented to cleanse any bad cases of scabies sent from Kensington. Owing to the great distance, not much use has been made of this offer, and a record of the number of baths given to Kensington cases has not been kept. THE RATS AND MICE (DESTRUCTION) ACT, 1919. This Act, which became operative on January 1st, 1920, involves local authorities and occupiers of premises in additional responsibilities in connection with the suppression of rats. The first section of the Act reads as follows:— "Any person who shall fail to take such steps as may from time to time be necessary "and reasonably practicable for the destruction of rats and mice on or in any land of "which he is the occupier, or for preventing such land from becoming infested with " rats or mice, shall be liable on summary conviction to a fine not exceeding five " pounds, or, where he has been served with a notice under this Act requiring him to " take such steps, not exceeding twenty pounds." In the Borough, the Borough Council are the authority required to execute and enforce this Act; but the London County Council are responsible for rat suppression in sewers vested in the County Council. The Borough Council are also required to observe the requirements of the Act in respect of any land of which they are the occupiers. The Borough Council may, within their own area, give instructions by public notice as to the most efficient methods that can be adopted both individually and collectively with a view to the destruction of rats and mice. Also, in the event of the occupier failing to take necessary action, the Council may serve notice requiring him to take steps for the purpose of destroying rats and mice and of preventing his land or premises becoming infested, or, after 24 hours' notice, they may enter the premises, carry out the work and recover any reasonable expenses from him. 46 The Council have delegated their powers under the Act to the Public Health Committee, and each Sanitary Inspector has been directed to make inspections in his district for the purpose of detecting rat-infested premises and also to report to the Medical Officer of Health cases in which the occupiers are not taking all practical steps to destroy the rats and to prevent their premises becoming infested. In the earlier months of the year the Council employed a part-time Rat Officer, who was paid at the rate of 5/- for each complaint dealt with. This arrangement, which proved to be unsatisfactory, was terminated on May 5th, 1920, and a man was employed as a Rat Officer at a wage of £4 per week to assist in the work of rat destruction under the supervision of the Sanitary Inspectors. Inspections made by the Sanitary Inspectors in connection with rat destruction are included in the record of houses inspected in Table VI. of the Appendix, and notices for repair of drains, floors, etc., to prevent ingress of rats are issued under the Public Health Act and are included in the record of "Notices Issued" also in Table VI. On receiving a complaint of trouble from rats, or on discovery of rat-infested premises, the Inspector usually offers the occupier the assistance of the Rat Officer, and this offer is so willingly accepted and the advice given is so readily followed, that the Public Health Committee have on only one occasion found it necessary to issue a notice as prescribed by the Act. The Rat Officer prepares poison baits which he lays in suitable places, and the following, table shows the number of visits paid, baits laid, etc., from July to the end of the year. No. of premises visited by the Rat Officer for the first time 132 No. of premises where evidence of rats was found 119 Total number of visits to rat-infested premises 1,034 No. of poison baits laid 18,275 No. of poison baits found by Rat Officer to have disappeared within 2 or 3 days 14,220 No. of poison baits not having disappeared in 2 or 3 days, and therefore removed by Rat Officer 2,018 No. of poison baits laid in sewers (where no re-inspection was made) 2,037 (The records of work done by the part-time Rat Expert in the earlier months of the year are too unreliable to be worth summarising). Barium Carbonate has been the poison in general use, but in a few cases Extract of Squills has been tried. Each bait contains sufficient poison to kill one rat, and is made up to about the size of a lump of sugar by adding meal, flour, fat and other ingredients known to be attractive to rodent vermin. Rats which have consumed Barium Carbonate suffer from intense thirst before death and generally leave the premises in search ot water, with the result that they die in drains or sewers or out of doors. As it is very unusual to find a rat poisoned with Barium Carbonate inside premises, Rat Officers commonly reckon the number of rats killed as being equal to the number of poison baits found to have disappeared. This, however, is too liberal an estimate for, doubtless, a hungry rat will eat several baits before feeling ill effects, especially as the poison itself is tasteless. It is perhaps safe to state that the rats killed equal 25 per cent. in number of the baits which have disappeared, and with this low estimate it can be assumed that the laying of baits in Kensington from July to December has accounted for not less than 3,000 rats. The expenditure by the Council on this work has, undoubtedly, been a sound investment for the ratepayers, even if judged from the baiting work alone. A rat eats food to the value of about one penny per day and, in estimating the value of the work to the ratepayers, it must be remembered that not only have rats large appetites, but it is common for householders to throw away remainders of quantities of food which may have been attacked but not entirely consumed by rats. It must be borne in mind that rats do considerable damage to the structure ot buildings and may also convey disease. At each visit for the purpose of laying baits, the Rat Officer makes a careful record of the numbers laid and the position of each. The premises are re-inspected in two or three days' time, when all baits still in position are removed, counted and recorded in the office register. Rats do not eat stale baits when they can obtain fresh food, but there is a more important reason for the removal of baits. From time to time there occurs amongst man and animals illness for which no cause can be ascribed, and there is no doubt that there are many people who would be prepared to attribute the blame for such illness to rat poison in the event of there being any evidence that baits had been left at the premises, even if they had been laid some years previously. The Rat Officer's register will always be available to rebut such charges. The Rat Officer does not lay baits in places to which young children or poultry have access, but there have been several instances where cats have died as a result of eating the baits. Occupiers are always impressed with the fact that the baits are poisonous and are warned against laying any themselves in exposed places. The laying and removing of baits and the giving of advice occupies a good deal of the Rat Officer's time but the simple poisoning of Rats would be of little practical value unless the means of ingress to premises were dealt with, therefore this Officer supplements the work of the Sanitary Inspectors in searching for rat inlets and also helps them in inducing occupiers to concrete rat holes, basement floors, etc. In addition to searching for holes in walls and floors in infested premises, a careful examination is made for the discovery of defective drains and sewers, it being a well established fact that these defects are the cause of most of the worst cases of rat infestation in urban districts. 47 HOUSING OF THE WORKING CLASSES. The preparation of this report has been delayed purposely in order that the question of housing accommodation in the Borough might be reviewed in the light of the knowledge gained from the 1921 Census figures. Unfortunately, owing to the coal strike, it was found necessary to postpone the taking of the Census until June, with the result that the figures relating to population, number of houses, etc., will not be available sufficiently early to enable the report to be issued within a reasonable time after the close of the year to which it relates. I have decided, therefore, to submit at present only a few known facts relating to the housing problem and to leave a complete survey (including a consideration of the general housing conditions in the district, the extent of the shortage of houses, the extent of overcrowding, the fitness of existing houses, etc.) to be submitted in a future special report. When up to date and accurate figures of population, houses, etc. are available, more valuable conclusions can be drawn than would be possible at the present moment, when the Census figures of 10 years ago are the most recent reliable data on which to work. LODGINGS PROVIDED BY THE COUNCIL. The number of tenements for the working classes provided, prior to the War, by the Council, under the Housing Acts, is shown in the following Table:— Rooms in Tenement. Number of Tenements. Rent per Week. 1 26 3/1 to 4/7 2 62 7/- to 9/- 3 32 9/- to 10/6 Totals 120 3/1 to 10/6 The above tenements are all within the Borough. HOUSES LET IN LODGINGS. The number of houses let in lodgings on the Council's register at the end of the year was 2,067. The effect of registration is to render the premises subject to the requirements of the Council's Bye-Laws made under Section 94 of the Public Health (London) Act, 1891, as extended by Section 16 of the Housing, Town Planning, etc. Act, 1909. The inspections and re-inspections of the registered lodging houses in the Borough numbered 4,921. Notices requiring the remedy of defects found were served in 429 instances, and 21 cases of overcrowding were abated. The owners of four lodging houses were summoned for breaches of the lodging house bye-laws, or failure to carry out sanitary works required by the Inspectors. Houses Let in Furnished Rooms.—Of the 2,067 lodging houses on the Council's Register, 101 were in 1920 let in furnished rooms, the average rent charged being at the rate of 7/- per week per room. The following figures show the number of houses let in furnished rooms in the different parts of the Borough. Norland Ward 63 St. Charles Ward 4 Pembridge Ward 18 Golborne Ward 16 Other Wards 0 101 These houses constitute the most unsatisfactory and undesirable form of housing accommodation and it is therefore very pleasing to note that the number of dwellings of this type in the Borough is gradually diminishing. In 1912 there were 187, no less than 103 being in the Notting Dale area. The total number of inspections of these houses in 1920 was 975. COMMON LODGING HOUSES. The Common Lodging Houses in the Borough number 13, and contain accommodation for 467 persons. From the following Table it will be seen that all but one of these houses are situated in the Norland Ward:— 48 Ward Name of Keeper Address of Common Lodging House No. of Lodgers for which licensed in 1920. Male Female Total Golborne Madden, James 194, Kensal Road 75 — 75 Norland Rusha, Alfied 18, Bangor Street — 24 24 „ do. 20, do. — 45 45 „ Hankins, John Wm. 10, Crescent Street — 25 25 „ do. 28, do. 54 — 54 „ do. 30, do. „ Woodhouse, Jane E. 40, do. — 25 25 „ Rusha, Alfred 25, do. — 57 57 „ do. 27, do. „ Davis, Sagel 66, St. Ann's Road 66 — 66 „ Rusha, Alfred 34, Sirdar Road — 53 53 „ do. 36, do. „ Davies, Henry A. 12, Penzance Place — 43 43 Totals 195 272 467 In five streets in the Notting Dale area there are seven houses capable of receiving 272 single women and two houses licensed to accommodate 120 single men. It is difficult to avoid the conclusion that the presence of this population of 392 persons, who for the most part come from the lowest ranks of society, must necessarily constitute an effective bar to the progress of social reform in the neighbourhood where the common lodging houses are situated. The inspection of common lodging houses is carried out by the inspectors of the London County Council, who exercise effective control under a system of annual licensing. If a house is not kept in conformity with the by-laws, the renewal of the license can be refused, and in this way the necessity for resorting to the cumbersome procedure of prosecution for each offence as it arises is avoided. The adoption of a similar system of annual licensing would materially strengthen the hands of the Sanitary Inspectors in dealing with the houses let in furnished lodgings, and special powers for the control of such houses are needed. THE COUNCIL'S HOUSING PROGRAMME. The provision of additional housing accommodation under the Housing, Town Planning, etc., Act, 1919, and amending Acts has been delegated by the Council to a Special Housing Committee, which Committee have been given all the powers possessed by the Council in regard to the preparation and execution of housing schemes except the power to borrow money or make a rate. After considering a report submitted by the Medical Officer of Health in 1919, which indicated that 314 houses would be required in the next three years to meet the needs of the Borough, the Special Housing Committee prepared three schemes which have been approved by the Council and the Ministry of Health. The following are particulars in regard to each scheme:— (a) Scheme for the Purchase and Conversion into Flats of Large Houses. The Ministry of Health, acting as agents of the Council, have purchased, in the northern half of the Borough, 19 houses and His Majesty's Office of Works, also acting as agents of the Council, have converted these into 102 flats or maisonettes. The conversions were completed during the year and all the flats have been assigned to the Council and are now occupied. Details are given in the following Table:— Property. Estimated Expenditure. No. of Flats or Maisonettes Provided. Estimated Annual Rental. Acquisition. Conversion. Total. £ s. d. £ £ s. d. £ 20a, Adair Road 759 17 1 4,265 5,024 17 1 6 307 47, Bassett Road 1,022 18 6 3,600 4,622 18 6 5 *425 85, Ladbroke Grove 3,899 15 10 15,715 19,614 15 10 5 *410 65, Elgin Crescent 5 *482 67, „ „ 5 *410 69, „ „ 3 *240 25, Colville Terrace 365 4 10 40,520 48,211 19 10 5 380 3, 4, 5, 8, 9, 10, 11, 12, 15, 16, 23 and 24, Powis Square 7,326 15 0 68 4,550 Totals 13,374 11 3 64,100 77,474 11 3 102 7,204 * Exclusive of rates, etc. All others are inclusive. 49 (b) Mary Place Scheme. This scheme provides for the erection of 32 cottages, each having two living rooms and three bedrooms. Twenty-two cottages are in course of erection by the contractor and will be ready for occupation in the Summer of 1921; tenders for the remaining ten will be invited shortly. (c) St. Quintin Estate Scheme. The scheme provides for the erection of 18 cottages and 190 flats. Four cottages, each containing 2 living rooms and 4 bedrooms; 14 flats, each containing 1 living room and 3 bedrooms; and 22 flats, each containing 1 living room and 2 bedrooms, are in course of erection, but tenders have not yet been invited for the others. It is somewhat doubtful whether the Council will be in a position to complete the whole of this scheme or any very considerable portion thereof by the month of July, 1922, which, as the law now stands, is the date fixed for the termination of the period in which schemes must be completed if they are to rank for Government subsidy. The question of the position of the Council in regard to this scheme is at the present time receiving consideration. DR. SCHUSTER'S HOUSING SCHEME IN THE NOTTING DALE AREA. The only housing accommodation being provided in the Borough, in addition to that under the Council's three schemes, is in connection with Dr. Schuster's housing programme in the Notting Dale area. The work commenced in 1914 with the erection of eleven cottages in Mary Place. The War prevented further progress until 1920, when four cottages in Thresher's Place were completed. At the end of the year, the erection of five flats was in progress. Sixteen cottages are to be built in Tobin Street at an early date. HOUSING STATISTICS FOR 1920 (MINISTRY OF HEALTH TABLE). 1. Estimated population 165,496 2. General death-rate 13.4 3. Death-rate from tuberculosis 1.09 4. Infantile mortality rate 81 5. No. of dwelling houses of all classes:— (a) Separately occupied tenements in the Borough according to the Census of 1911. (This number represents families or households separately occupying their own rooms in 1911) 38,118 (b) Occupied houses in the Borough in 1920. (The figures are obtained from the Rate Collector's returns, in which a house let in lodgings or occupied by members of more than one family is reckoned as a single house. Computed on this basis, the number in 1911 was 27,507) 26,025 6. No. of working class dwelling houses:— (а) With three or less bedrooms 775 (b) No. of tenements in block buildings 464 (c) No. of mews dwellings 2,091 (d) Houses intended for one family only, which are now occupied (without having been specially adapted) by two or more families 5,690 7. No. of new working class houses erected:— (а) Cottages erected by private enterprise 4 (b) Flats or maisonettes provided by Council 102 (c) Houses or flats in course of erection 67 8. Total number of dwelling houses inspected by Sanitary Inspectors for housing defects (under Public Health or Housing Acts) 6,258 9. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 74 10. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 9 11. 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 2,162 12. Number of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 20 50 Action under Statutory Powers. A.— Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919. 1. Number of dwelling houses in respect of which Notices were served requiring repairs 12 2. Number of dwelling houses which were rendered fit during the year:— (a) By owners 1 (b) By Local Authority in default of owners 1 3. Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close 0 B.— Proceedings under Public Health Acts. 1. Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 2,139 2. Number of dwelling houses in which defects were remedied during the year or in the early part of 1921— (a) By owners 2,139 (b) By Local Authority in default of owners 0 C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning etc., Act, 1909 0 I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 51 APPENDIX. TABLE I. Vital Statistics of Whole District during 1920 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 1915 † 155,795 2,917 2,969 19.7 3,100 19.9 942 493 365 119 2,636 16.9 1916 ‡ 165,535 B 2,861 3,027 18.3 3,183 20.9 1,275 429 258 85 2,337 15.4 152,114 D 1917 168,919 2,201 2,378 14.8 3,280 21.6 1,329 523 309 130 2,474 16.3 151,535 D 1918 ‡ 173,463 B 2,220 2,308 13.3 3,735 24.1 1,508 524 224 97 2,751 17.8 154,814 D 1919 ‡ 164,470 B 2,281 2,653 16.1 3,429 18.3 1,454 438 270 102 2,413 15.2 157,886 D 1920 165,496 B 3,997 4,020 24.3 2,436 14.8 753 510 325 81 2,193 13.4 164,177 D * Rates calculated per 1,000 of estimated population. † Civil Population as estimated by the Registrar-General, and upon which the rates in the year are based. ‡ B. Population as estimated by the Registrar-General for the calculation of Birth rate. D. ,, ,, „ „ „ „ „ Death rate. At Census of 1911. Area of District in acres (exclusive of area covered by water) 2291 Total population at all ages 172,317 Total families or separate occupiers 38,118 52 TABLE II. Cases of Infectious Disease notified during the Year, 1920. 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. Golbome. Norland. Pembridge. Holland. Earl's Court. 1 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 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 339 6 78 183 38 28 5 1 61 74 61 55 22 18 15 22 11 322 Erysipelas 68 2 ... 9 7 18 27 5 11 16 12 10 6 4 6 2 1 25 Scarlet fever 617 5 84 413 60 48 7 ... 121 119 110 64 62 55 24 51 11 538 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 24 ... ... 4 9 9 2 ... 2 ... ... 1 5 3 1 5 7 13 Continued fever 1 ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... ... ... ... Puerperal fever 9 ... ... ... ... 9 ... ... 2 ... 4 ... 1 ... ... 1 1 5 Encephalitis Lethargica 5 ... ... ... 1 3 1 ... ... ... 1 ... 2 ... ... 1 1 2 Cerebro-Spinal Meningitis 5 2 1 ... 1 ... 1 ... ... 1 ... ... 1 2 ... 1 ... 4 Poliomyelitis 2 ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... 2 1 Pulmonary Tuberculosis 293 ... 7 26 56 134 59 11 51 54 65 35 29 24 11 16 8 129 Other forms of Tuberculosis 114 3 11 70 12 11 6 1 19 34 28 8 7 1 4 9 4 39 Ophthalmia Neonatorum 53 53 ... . ... ... ... ... 14 12 11 9 2 2 3 ... ... 8 Primary Pneumonia 124 8 36 14 20 24 17 5 24 27 25 21 12 6 1 6 2 75 Influenzal Pneumonia 23 1 2 2 3 11 2 2 2 2 4 7 3 1 1 1 2 6 Malaria 12 ... ... ... 2 10 ... ... 1 6 2 ... 1 ... 2 ... ... 3 Dysentery 4 ... 1 ... ... 2 1 ... ... ... 2 ... 1 1 ... ... ... ... Totals 1693 80 220 722 210 307 129 25 308 346 325 210 154 117 68 115 50 1170 53 TABLE III. Causes of, and Ages at, Death during the Year 1920. Causes of Death Nett Deaths at the subjoined ages of" Residents " whether occurring within or without the District. All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 and upwards. All causes Certified 2,193 325 57 50 57 96 245 496 867 Uncertified — — — — — — — — — Enteric Fever l ... ... ... ... ... ... l ... Small-pox ... ... ... ... ... ... ... ... ... Measles 23 5 10 5 2 1 ... ... ... Scarlet Fever 5 ... l 2 1 ... 1 ... ... Whooping-Cough 22 15 5 2 ... ... ... ... ... Diphtheria, and Croup 24 ... 1 10 12 ... ... l ... Influenza 46 3 1 3 1 3 12 10 13 Erysipelas 1 . . . ... ... ... 1 ... ... ... Phthisis (Pulmonary Tuberculosis) 135 ... 1 ... 3 31 51 37 12 Tuberculous Meningitis 14 3 2 1 5 ... 2 ... 1 Other tuberculous diseases 30 4 1 1 1 7 5 8 3 Cancer, Malignant disease 238 ... ... ... 2 ... 21 112 103 Rheumatic Fever 6 ... ... ... 4 ... ... ... 2 Meningitis 12 4 2 ... 2 3 1 ... Organic Heart Disease 280 ... ... ... 2 5 22 78 173 Bronchitis 162 16 3 1 ... ... 8 33 101 Pneumonia (all forms) 192 53 17 11 7 8 19 23 54 Other diseases of Respiratory Organs 23 1 ... ... ... 1 4 7 10 Diarrhoea and Enteritis 81 64 5 1 ... 1 3 2 5 Appendicitis and Typhlitis 7 ... ... ... ... 1 2 2 2 Cirrhosis of Liver 10 ... ... ... ... ... ... 8 2 Alcoholism 2 ... ... ... ... ... ... ... 2 Nephritis and Bright's Disease 78 ... ... ... ... 3 5 32 38 Puerperal Fever 5 ... ... ... ... ... 5 ... ... Other accidents and diseases of Pregnancy and Parturition 6 ... ... ... ... 2 4 ... ... Congenital Debility and Malformation including Premature Birth 117 112 1 2 ... 2 ... ... ... Violent Deaths, excluding Suicide 61 10 1 4 5 10 8 11 12 Suicide 20 ... ... ... ... 4 9 6 1 Other Defined Diseases 587 34 6 7 10 13 61 123 333 Diseases ill-defined or unknown 5 1 ... ... ... ... 2 2 2,193 325 57 50 57 96 245 496 867 54 TABLE IV. INFANT MORTALITY DURING THE YEAR 1920. 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 83 10 11 7 1ll 68 56 57 33 325 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... 1 ... 3 1 5 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough .... ... ... ... ... 1 2 7 5 15 Diphtheria and Croup ... ... ... ... ... ... ... ... ... ... Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... 1 2 ... 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... 1 1 Other Tuberculous Diseases... ... ... ... ... ... ... ... 1 2 3 Meningitis (not Tuberculous) ... ... ... ... ... 2 ... 2 ... 4 Convulsions 3 3 ... ... 6 ... 1 1 1 9 Laryngitis ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... 1 ... 1 7 3 4 1 16 Pneumonia (all forms) ... 2 1 1 4 12 12 12 13 53 Diarrhœa ... ... ... ... ... 1 2 2 1 6 Enteritis 2 ... 1 1 4 14 20 16 4 58 Gastritis ... ... ... ... ... ... ... 1 ... 1 Syphilis ... ... 1 ... 1 3 2 1 ... 7 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying 2 ... ... ... 2 1 ... ... ... 3 Injury at birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformation 5 2 2 ... 9 6 1 1 1 18 Premature Birth 44 2 2 1 49 6 1 2 ... 58 Atrophy, Debility, and Marasmus 11 1 2 4 18 12 5 1 ... 36 Other causes 8 ... 1 ... 9 2 6 1 3 21 83 10 11 7 111 68 56 57 33 325 Nett Births in the year legitimate, 3,746. illegitimate, 274. Nett Deaths in the year of ilegitimate infants, 270. (illegitimate infants, 65. 55 TABLE V. Causes of Death at different periods of life in the Year 1920. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 years and upwards. Totals— Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total I. GENERAL DISEASES. Enteric Fever 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Measles 6 23 16 7 4 1 10 ... 1 4 15 5 20 1 1 ... 1 ... ... ... ... ... ... 1 2 3 Scarlet Fever 7 5 4 1 ... ... 1 ... 2 ... 3 ... 3 1 ... ... ... ... 1 ... ... ... ... l 1 2 Whooping-Cough 8 22 12 10 9 6 2 3 1 1 12 10 22 ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 9A 24 11 13 ... ... ... 1 6 4 6 5 11 5 7 ... ... ... ... ... 1 ... ... 5 8 13 Influenza 10 46 20 26 2 1 1 ... 2 1 5 2 7 1 ... 1 2 5 7 5 5 3 10 15 24 39 Dysentery 14 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... ... 2 1 3 Erysipelas 18 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Pyaemia, Septicaemia 20 3 2 1 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 ... 2 1 3 Pulmonary Tuberculosis 28AB 135 65 70 ... ... ... 1 ... ... ... 1 1 1 2 14 17 19 32 21 13 7 5 65 69 134 Acute Miliary Tuberculosis 29B 5 5 ... ... ... 1 ... ... ... 1 ... 1 ... ... 2 ... ... ... 2 ... ... ... 4 ... 4 Tuberculous Meningitis 30 14 9 5 1 2 2 ... 1 ... 4 2 6 4 1 ... ... ... 2 ... ... 1 ... 5 3 8 Tuberculosis of Peritoneum, &c. 31AB 7 3 4 2 ... ... ... ... 1 2 1 3 ... ... ... 1 1 1 ... 1 ... 1 3 4 Tuberculosis of Spinal Column 32 5 1 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 ... 1 ... 1 1 4 5 Tuberculosis of Joints 33 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ] ... ... ... 1 1 Tuberculosis of other Organs 34 9 6 3 2 ... ... ... ... ... 2 ... 2 ... ... 1 2 ... ... 3 ... ... 1 4 3 7 Disseminated Tuberculosis 35 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... 1 1 2 3 Syphilis 37 8 4 4 3 3 ... ... ... ... 3 3 6 ... ... ... ... ... ... ... 1 1 ... 1 1 2 Ophthalmia Neonatorum 38C 2 ... 2 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 ... ... ... ... ... 1 1 Cancer 39-45 238 87 151 ... ... ... ... ... ... ... ... ... 2 ... ... ... 5 16 41 71 39 64 87 151 238 Other Tumours 46 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Rheumatic Fever 47 6 1 5 ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... 1 1 1 5 6 Chronic Rheumatism, &c. 48AB 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 Diabetes 50 18 6 12 ... ... ... ... ... ... ... ... ... 1 ... ... l ... 1 2 4 3 6 6 12 18 Leucocythæmia, &c. 53AB 2 1 1 ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Anaemia Chlorosis 54 15 5 10 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 7 2 1 5 10 15 Other General Diseases 55 2 ... 2 ... 2 ... ... ... ... ... 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Alcoholism 56 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Cocaine Poisoning 57AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Total for General Diseases 604 265 339 23 16 17 5 14 11 54 32 86 17 15 19 27 34 65 80 108 61 92 211 307 518 56 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Uder 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards Totals— Above Five Years. Tolal M F M F M F M f M F Total M F M F M F M F M F M F Total Brought forward 604 265 339 23 16 17 5 14 11 54 32 86 17 15 19 27 34 65 80 108 61 92 211 307 518 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 4 3 1 ... ... ... ... ... ... ... ... ... 2 ... ... ... 1 1 ... ... ... ... 3 1 4 Meningitis 61BC 12 4 8 2 ... ... 2 ... ... 2 4 6 1 ... ... 3 1 ... ... ... ... ... 2 4 6 Locomotor Ataxy 62 4 3 1 ... ... ... ... • • • ... ... ... ... ... ... ... ... ... 1 2 ... 1 ... 3 1 4 Other Diseases of the Spinal Cord 63AB 12 6 6 ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 3 4 6 6 12 Cerebral Hæmorrhage, Apoplexy 64AE 84 37 47 ... ... ... ... 2 ... 2 ... 2 ... ... ... ... 1 2 12 13 22 32 35 47 82 Softening of Brain 65 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 1 1 2 Paralysis without specified cause 66AC 8 2 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 5 2 6 8 General Paralysis of the Insane 67 16 12 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 6 3 6 1 ... ... 12 4 16 Other forms of Mental Alienation 68 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 2 ... ... ... 5 5 Epilepsy 69 6 2 4 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 1 ... 2 4 6 Infantile Convulsions under 5 years 71AB 13 7 6 5 4 2 1 ... 1 7 6 13 ... ... ... ... ... ... ... ... ... ... ... ... ... Neuritis 73 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Other Diseases of the Nervous System 74AD 7 3 4 ... ... ... ... ... ... ... ... ... ... 1 1 1 1 ... ... 2 1 ... 3 4 7 Diseases of the Eyes and Annexa 75 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Mastoid Disease 76A 1 ... 1 ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Ears 76B 2 2 .. ... ... ... ... ... ... ... ... ... ... ... ... ... l ... 1 ... ... ... 2 ... 2 Total for Diseases of the Nervous System, and of the Organs of Special Sense 179 85 94 7 7 2 3 2 1 11 11 22 4 2 2 5 14 12 24 23 30 41 74 83 167 III.—DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 .. ... ... 1 1 Acute Endocarditis 78AC 9 3 6 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 3 2 1 ... ... 3 6 9 Valvular Disease 79 A 146 63 83 ... ... ... ... ... ... ... ... ... ... 2 4 1 9 9 20 21 30 50 63 83 146 Fatty Degeneration of the Heart 79B 28 10 18 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 5 7 5 9 10 18 28 Other Organic Diseases of the Heart- 79C 106 46 60 ... ... ... ... ... ... ... ... ... ... ... .. 1 1 13 12 32 47 46 60 106 Angina Pectoris 80 8 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 2 3 4 4 8 Carried forward 1081 476 605 30 23 19 8 16 12 65 43 108 21 20 25 34 59 92 146 174 160 242 411 562 973 57 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages Under 1 year. 1 and under 2 years. 2 and under 5 years Totals— Under 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above 5 Years Total M F M F M F M F M F Total M F M F M F M F M F M F Brought forward 1081 476 605 30 23 19 8 16 12 65 43 108 21 20 25 34 59 92 146 174 160 242 411 562 973 DISEASES OF THE CIRCULATORY SYSTEM—continued. Arterial Sclerosis, &c. 81AC 125 60 65 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 13 5 44 60 60 65 125 Cerebral Embolism and Thrombosis 82A 23 6 17 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 3 4 14 6 17 23 Other Embolism and Thrombosis 82B 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 3 4 Diseases of the Veins 83AD 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 4 4 Diseases of the Lymphatic System 84AB 2 2 ... ... ... ... ... 1 ... 1 ... 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Oilier Diseases of the Circulatory System 85AC 2 ... 2 ... ... ... ... • •• ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Total for Diseases of the Circulatory System 458 195 263 ... ... ... ... 1 ... 1 ... 1 ... 3 4 2 15 15 58 54 117 189 194 263 457 IV.—DISEASES OF THE RESPIRATORY SYSTEM. Diseases of the Larynx 87AC 4 ... 4 ... ... ... 1 ... 1 ... 2 2 ... 1 ... ... ... ... ... ... ... 1 ... 2 2 Myxedema 88 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Bronchitis 89 & 90 162 70 92 9 7 1 2 ... 1 10 10 20 ... ... ... ... 5 3 22 11 33 68 60 82 142 Broncho-pneumonia 91 112 62 50 30 19 8 7 2 3 40 29 69 2 2 1 ... ... 1 4 3 15 15 22 21 43 Lobar-pneumonia 92A 45 27 18 1 ... ... ... 2 1 3 1 4 1 ... 4 1 5 7 8 4 6 5 24 17 41 Pneumonia (type not stated) 92B 35 20 15 2 1 2 ... ... 3 4 4 8 1 1 ... 2 4 2 4 ... 7 6 16 11 27 Empyema 93A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 1 2 Other Pleurisy 93B 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 2 2 3 5 Pulmonary Congestion, &c. 94AD 4 3 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 ... 1 ... 1 ... 3 ... 3 Gangrene of the Lung 95 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Asthma 96 7 4 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 3 1 1 1 4 3 7 Emphysema 97 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Fibroid Disease of Lung 98A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 1 2 Other Diseases of the Respiratory System 98B 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Total for Diseases of the Respiratory System 382 191 191 42 28 11 10 4 9 57 47 104 4 4 5 4 17 14 42 21 66 101 134 144 278 V.—DISEASES OF THE DIGESTIVE SYSTEM. Diseases of the Pharynx, Tonsillitis 100AC 3 2 1 ... ... 1 ... ... ... 1 ... 1 ... ... ... 1 ... ... 1 ... ... ... 1 1 2 Diseases of the Œsophagus 101 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... .... ... ... 1 ... ... ... 1 ... 1 Carried forward 1627 739 888 72 51 31 18 21 21 124 90 214 25 24 30 39 80 106 206 206 274 423 615 798 1413 58 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Age. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1627 739 888 72 51 31 18 21 21 124 90 214 25 24 30 39 80 106 206 206 274 423 615 798 1413 DISEASES OF THE DIGESTIVE SYST KM—continued. Perforating Ulcer of Stomach 102 10 3 7 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 ... 1 1 3 3 7 10 Inflammation of Stomach 103A 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 2 2 4 Other Diseases of the Stomach 103B 3 1 2 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 1 1 2 Diarrhœa and Enteritis 104 & 105AB 81 46 35 36 28 2 3 1 ... 39 31 70 ... ... 1 ... 2 1 1 l 3 2 7 4 11 Appendicitis 108 7 4 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 1 1 1 1 4 3 7 Hernia 109A 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 2 2 3 3 6 Intestinal Obstruction 109 B 11 4 7 3 ... ... ... ... ... 3 ... 3 ... ... ... 1 1 1 ... 2 ... 3 1 7 8 Other Diseases of the Intestines 110 2 1 1 ... 1 ... ... 1 ... 1 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Ictcrus Gravis 111 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 1 Cirrhosis of the Liver, &c. 118AC 10 5 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 4 1 1 5 5 10 Biliary Calculi 114 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of the Liver 115 5 ... 5 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 3 ... 1 ... ... ... 5 5 Peritonitis (cause unstated) 117 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 Other Diseases of the Digestive System 118AB 2 1 1 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Total for Diseases of the Digestive System 149 73 76 39 30 4 3 2 ... 45 33 78 ... 1 2 4 6 10 10 11 10 17 28 43 71 VI.—NON-VENEREAL DISEASES OF THE GENITO URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Bright's Disease, &c. 120 A B 76 36 40 ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 11 20 20 18 36 40 76 Other Diseases of the Kidney 122AD 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 ... 6 6 Diseases of the Bladder 124 12 9 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 8 2 9 3 12 Diseases of the Urethra 125 AB 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Diseases of the Prostate 126 9 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 7 ... 9 ... 9 Uterine Haemorrhage (non-puerperal) 128 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Uterine Tumour 129 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Other Diseases of the Uterus 130AB 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Ovarian Cyst (Tumour) 131 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 3 3 Other Diseases of the Female Genital Organs 132AB 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... ... ... ... ... 3 3 Total for non Yenereal Diseases of the Genito-Urinary System and Annexa 118 58 60 ... ... ... ... ... ... ... ... ... ... ... 2 2 4 10 17 24 35 24 58 60 118 Carried forward 1890 867 1023 111 81 34 21 23 21 168 123 291 25 25 34 44 90 126 231 211 319 464 699 900 1599 59 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and under 65 years. 65 years and upwards. Totals— Above 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 1890 867 1023 111 81 84 21 23 21 168 123 291 25 25 34 44 90 126 231 241 319 464 699 900 1599 VII.—THE PUERPERAL STATE. Accidents of Pregnancy 134AB 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Accidents of Childbirth 136 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Puerperal Fever 137 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... 5 5 Puerperal Convulsions 138C 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... 3 3 Phlegmasia Dolens and Embolism 139AB ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of the Puerperal State 11 ... 11 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 9 ... ... ... ... ... 11 11 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142A 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Gangrene of Mouth 142B 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 2 2 Carbuncle 143 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 Phlegmon, Acute Abscess 144AB 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 2 1 3 Diseases of the Integumentary System 145AD 7 2 5 1 1 ... ... ... ... 1 1 2 ... ... ... ... ... ... ... ... 1 4 1 4 5 Total for Diseases of the Skin and of the Cellular Tissue 16 6 10 1 1 ... ... ... ... 1 l 2 ... 1 ... ... ... 1 1 1 4 6 5 9 14 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION 146-7 4 3 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 2 1 ... ... 3 1 4 X.—MALFORMATIONS. Congenital Malformation 150AD 22 14 8 12 6 ... 1 1 ... 13 7 20 ... ... 1 1 ... ... ... ... ... ... 1 1 2 XI.—DISEASES OF EARLY INFANCY. Premature Birth 151A 58 33 25 33 25 ... ... ... ... 33 25 58 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility and Marasmus 151B 36 17 19 17 18 ... ... ... 1 17 19 36 ... ... ... ... ... ... ... ... ... ... ... ... ... Want of Breast Milk 151E 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 5 4 1 4 1 ... ... ... ... 4 1 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Lack of Care 153 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 103 56 47 56 46 ... ... ... 1 56 47 103 ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 2046 946 1100 180 134 34 22 24 22 238 178 416 26 26 35 47 90 136 234 243 323 470 708 922 1630 60 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals— All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. Totals— Under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years 45 and under 65 years. 65 years and upwards. TotalsAbove 5 years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 2046 946 1100 180 134 34 22 24 22 238 178 416 26 26 35 47 90 136 234 243 323 470 708 922 1630 XII.—OLD AGE. Old Age 154AB 61 27 34 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 27 34 27 34 61 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 155 4 1 3 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 1 ... ... 1 3 4 Suicide by Asphyxia 156 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... ... ... 3 3 Suicide by Drowning 158 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 ... ... 2 2 4 Suicide by Firearms 159 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... ... ... ... 2 2 4 Suicide by Cutting or Piercing Instruments 160 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 ... 3 Suicide by Jumping from High Place 161 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Suicide by Crushing 162 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Poisoning by Food 164 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 Burns 167 9 1 8 ... ... 1 ... ... 4 1 4 5 ... ... ... ... ... ... ... 1 ... 3 ... 4 4 Absorption of Deleterious Gases (Overlain, &c.) 168 11 7 4 5 2 ... ... ... ... 5 2 7 ... ... ... ... 1 ... ... 2 1 ... 2 2 4 Accidental Drowning 169 3 3 ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... ... ... 3 ... 3 Injury by Fall 172 11 8 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 ... 4 2 8 3 11 Injury by Machines 174 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 2 ... 2 Injury by other Crushing (vehicles, railways, &c.) 175 14 8 6 ... ... ... ... ... ... ... ... ... 2 1 4 3 1 ... 1 2 ... ... 8 6 14 Homicide 184 4 1 3 1 ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 1 ... 1 ... ... ... 3 3 Fractures (cause not specified) 185 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Violence 186 5 3 2 1 1 ... ... ... ... 1 1 2 ... ... ... ... ... 1 2 ... ... ... 2 1 3 Total for Affections produced by External Causes 81 42 39 7 3 1 ... ... 4 8 7 15 4 1 7 7 9 8 7 10 7 6 34 32 66 XIV.-ILL-DEFINED CAUSES. Heart Failure 189A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 Other Ill defined Causes 189BCD 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cause not specified 189F 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 ... 2 Total for Ill-defined Causes 5 4 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 1 2 ... ... ... 3 1 4 Grand Totals 2193 1019 1174 188 137 35 22 24 26 247 185 432 30 27 42 54 100 145 243 253 357 510 772 989 1761 61 TABLE VI. Summary of the Work done by the Male Sanitary Inspectors during the Year 1920. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Grand Total. 1 2 3 4 5 6 7 8 9 Complaints received 284 107 134 157 50 94 294 285 126 1,531 House to House Inspections 10 20 127 59 186 19 121 283 135 960 Houses Inspected on Complaint 608 533 331 418 519 537 473 512 291 4,222 Re-inspections of Houses 1,302 851 1,147 1,422 1,382 1,262 761 1,019 895 10,041 Inspections of Lodging Houses (unfurnished) 547 922 323 419 697 75 657 53 253 3,946 Inspection of Lodging Houses (furnished) 28 — 780 87 — 80 — — — 975 Houses cleansed, &c. 111 267 166 122 81 13 157 51 53 1,021 Verminous Rooms cleansed 112 90 105 52 15 1 13 1 4 393 Dirty Bedding cleansed 3 30 — — — — — — — 33 „ „ destroyed 1 3 — — — — — — — 4 Overcrowding abated 1 19 — — — — — 1 — 21 Underground Rooms, illegal occupation discontinued — 1 — — — — 3 — — 4 House Drains re-constructed 9 23 2 4 5 1 4 6 — 54 Defective Drains repaired 32 68 15 6 — 13 22 17 12 185 House Drains cleansed 23 111 15 10 27 23 28 25 28 290 Water-closets constructed, repaired, &c. 157 64 44 65 61 27 83 22 37 560 Water-closets supplied with water 3 116 11 41 66 4 70 8 23 342 Water-closets new, provided 3 16 2 1 4 — 9 1 2 38 Soil-pipes ventilated, repaired, &c. 7 37 3 3 1 3 3 5 10 72 Soil-pipes new, provided 11 4 1 5 1 — 4 — 1 27 Cisterns cleansed, covered, &c. 26 81 11 12 6 4 6 5 6 157 Yards, Areas paved, drained, repaired 35 18 2 3 6 3 36 10 .10 123 Dustbins provided 112 71 25 34 16 16 16 26 19 335 Ashpits abolished 3 1 — 3 — — 7 3 — 17 Accumulations of filth, &c., removed 12 18 7 3 2 6 85 14 16 163 Animals removed 8 7 2 — 8 — 11 — 10 46 Other Sanitary Works executed 45 546 100 51 90 29 266 48 99 1,274 Workshops, &c., Inspections of 7 30 48 63 28 38 45 88 167 514 Factories, Inspections of 1 12 10 37 — — 14 30 21 125 Bakehouses, Inspections of 62 73 58 102 27 53 61 39 60 535 Slaughter Houses, Inspections — 29 209 1 — 6 145 1 — 391 „ „ Notices — — — — — — — — — — Dairies. &c., Inspections 121 67 98 178 155 110 55 68 85 937 „ Notices — — — — — — — — — — Ice Cream Vendors, premises, Inspections 5 19 14 4 — — — — — 42 Ice Cream Vendors, premises, Notices — — — — — — — — — — Other Places where Food is prepared, Inspections of 173 176 158 159 74 51 127 56 123 1,097 Smoke Observations 76 44 — — 1 — 44 79 38 282 Nuisances from smoke observed — — — — — — — — — — Mews, Inspections of 776 552 604 363 536 480 350 591 821 5,073 Other Inspections 187 219 51 188 33 89 72 210 192 1,241 Notices issued Written Intimations 289 264 177 268 158 147 134 150 123 1,710 Statutory 48 59 39 62 21 32 34 31 38 364 Lodging House 76 106 50 73 32 16 48 4 24 429 Removal of Manure — 3 — — — — 1 — 3 7 Sanitary Works completed 714 1,591 511 415 389 143 823 243 330 5,159 Legal Proceedings—Number of Summonses Issued 4 2 6 — — — — — 5 17 62 TABLE VII. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1919. DATE. Registration Sub-Districts comprised in Vaccination Officers 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. Success fully Vaccinated. Column II. Column V. Dead, Unvaccinated. Postponement by Medical Certificate. Removed to other Districts and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Total Number of Certificates of Successful Vaccination received during the Calendar Year, 1920. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1919. 1 2 3 4 6 7 8 9 10 1st January to 31st Dec. North 1,038 672 1 165 76 8 23 93 2,305 Central 591 377 2 101 40 5 7 59 South 813 528 3 101 55 3 48 75 Total 2,442 1,577 6 367 171 16 78 227 INDEX. PAGE Administration 40 Annual Grants to Child Welfare Institutions 40 Anthrax from Shaving Brushes 15 Bacteriological Work 43 Bakehouses 24 Births 4 Birth Rates, Death Rates, and Infantile Mortality Rates in 29 Metropolitan Cities and Boroughs (Table) ... 10 Cancer 16 Cerebro-Spinal Fever 13 Chapel of Rest 43 Cleansing of Verminous Persons Act, 1897 44 Common Lodging Houses 47 Continued Fever 13 Convalescent Homes 38 Co-ordination of Maternity and Child Welfare Work 38 Council's Housing Programme 48 Cowsheds 24 Cream Regulations 26 Customs and Inland Revenue Acts 44 Day Nurseries 37 Deaths 6 „ Causes of (Tables) 7 and 53 „ Causes of at age periods, Table V. (Appendix) 55-60 Diphtheria 12 Disinfection 42 Dogs, Fouling of Pavement by 43 Drainage Work 42 Dried Milk, Supply of 28 Dust Removal 42 Dysentery 15 Encephalitis Lethargica 13 Enteric Fever 13 Erysipelas 13 Factories and Workshops 29 Food Poisoning 27 Food Stalls 27 Food Supply 23 Grants to Hospitals 17 Health Visitors, Duties and Work of 34-35 Home Nursing by Kensington District Nursing Association 16 Home Office Tables (Factory and Workshop) 32-34 Homes for Deserted, Widowed or Unmarried Mothers and their Children 38 Home Work 31 Houses, Let in Lodgings 47 Housing of the Working Classes 47 Housing Statistics for 1920 49 Ice Cream 24 Illegitimate Children, Births and Deaths of 9 Increase of Rent and Mortgage Interest (Restrictions Act), 1920 44 PAGE Infantile Mortality 8 „ „ Causes of High 9 „ „ during the year (Table IV. Appendix) 54 Infant Welfare Centres 35 Infectious Disease, Cases notified during the year (Table II. Appendix) 52 Influenza 16 Ladbroke Road Hospital 37 Legal Proceedings 41 Malaria 15 Margarine and Butter Substitutes 26 Marriages 4 Maternity and Child Welfare 34 Measles 16 Men's Workshops 29 Milk Supply 23 Milk Supply for Expectant and Nursing Mothers 27 Mortuary 43 Mothercraft Training Society 38 Notification of Births Act, 1907 5 Notifiable Infectious Diseases 10 Ophthalmia Neonatorum 14 Pneumonia 15 Poliomyelitis 14 Population 4 Prevalence of Disease 10 Public Baths and Washhouses 43 Public Conveniences 42 Public Health Department Staff 40 Public Streets, Exposure of Food for Sale in 43 Puerperal Fever 13 Rag and Bone Dealer, Business of 43 Rag Flock Act, 1911 44 Rats and Mice (Destruction) Act, 1919 45 Sale of Food and Drugs Acts 25 Sanitary Inspectors (Male), Summary of Work done during the Year (Table VI.) Appendix 61 Scarlet Fever 11 Slaughter-houses 24 Statistics, Summary of 2 Telford Road Clinic 36 Tuberculosis 17 Unsound Food 24 Vaccination Officer—Return for 1919 (Table VII.) Appendix 62 Venereal Disease 43 Verminous Rooms Cleansed 42 Vital Statistics 3 ,, ,, for whole District, 1920, and previous years (Table I.) Appendix 51 Whooping Cough 16 Women's Workshops 30