KEN 2.5 The Royal Borough or Kensington. \ . THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1922 Vail & Co., Printers and Stationers, 170, Farringdon Road, B.C. The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1922 BY JAMES FENTON, M.D., D.P.H. Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. O 3753—400—423. SUMMARY OF STATISTICS For the year 1922. Population 179,100 Area of Borough in Acres 2,290 Density of Population per Acre 77 Separate Houses or Self-contained Flats Inhabited 27,771 Persons per House 6.4 Number of Marriages 1,773 Number of Births 3,152 Birth Rate 17.6 Number of Deaths 2,427 Death Rate 13.6 Infantile Mortality:— Deaths under 1 year 257 Infantile Deaths per 1,000 Births 82 Deaths from Phthisis 139 Phthisis Death Rate 0.78 Deaths from the Zymotic Diseases 1.74 Zymotic Death Rate 0.97 Product of a Id. Rate (Gross) £1 0,349 Town Hall, Kensington, W.S. June 15th, 1923. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. Ladies and Gentlemen,— I have the honour to submit, for your information, my Annual Report upon the state of the Public Health in Kensington, and a record of the administrative work carried out in the Public Health Department for the year 1922, together with the vital statistics of the Borough. A summary of the work done and action taken under the Factory and Workshops Acts is included. The year under review was a satisfactory one from the Public Health standpoint. The death rate was 13.6 per 1,000 living; this compares favourably with the average rate for the Borough for the present century, which is 14.5. The number of deaths of infants under the age of 12 months for every 1,000 births was 82 as against 110 in the previous year. This, with one exception, is the lowest rate recorded in the history of the Borough. Whilst the many steps taken by the Council and various voluntary bodies for the prevention of infant mortality must receive some credit for this decreased rate, it is probable that the favourable climatic conditions throughout the year generally were mainly responsible for the great improvement. The epidemic of scarlet fever which prevailed over a large period of the two preceding years disappeared at the beginning of 1922, and during the year there were only 471 cases as against 870 in 1921. Diphtheria was a little more prevalent than in the preceding year. Ophthalmia neonatorum showed a satisfactory decrease, there being onlv 20 cases as against 33 in 1921 and 53 in 1920. There was an outbreak of measles in the spring months, but the epidemic was not as severe as anticipated. This disease accounted for 58 deaths. The notifications of and deaths from tuberculosis showed, as in recent years, a steady decrease in numbers. The rapid decline in the death rate from this disease during the last ten years is one of the most gratifying happenings in the whole realm of Preventive Medicine. From the administrative point of view, the most important features of the year were :— (1) TAKING OVER BY THE COUNCIL OF THE NORTH KENSINGTON TUBERCULOSIS DISPENSARY. On January 1st, 1922, the Council took over from the North Kensington Voluntary Tuberculosis Dispensary Committee all duties in regard to Dispensary treatment of tuberculosis for persons living in North Kensington* The transfer enabled the Council to combine their work ot Prevention with that of Treatment. These two branches of work are now carried out bv one set of officers. (2) RE-ORGANISATION OF HEALTH VISITING With a view to diminishing the number of officers who may visit any one home and to preventing waste of effort and loss of time in travelling, the Borough has been divided into seven areas in each ot which one Woman Health Officer performs all the work previously undtrtaken by Health Visitors, Lady Sanitary Inspectors and Tuberculosis Nurses. This re-organisation prevents overlapping in home visiting, and enables each Woman Health Officer to become more familiar with the local conditions and to possess a wider and more varied interest in her district. (3) SATISFACTORY PROGRESS OF THE COUNCIL'S SCHEME OF CO-ORDINATION OF MATERNITY AND CHILD WELFARE WORK, The scheme approved by the Council in 1920 for the co-ordination of the large amount of valuable Maternity and Child Welfare work performed by voluntary agencies has proved very satisfactory, and there was no friction at any point during the year. (4) INCREASED ACTIVITY IN REGARD TO HOUSE REPAIRS. With the decline in the cost of labour and material, the Council's Sanitary Inspectors have been able to press more firmly for house repairs and improvements in housing conditions generally, and the effect of the activity of the Council's staff is apparent in certain ot the poor parts of the Borough, where many houses have been reclaimed from the almost uninhabitable condition into which they had drifted during the War period. There is, however, still plenty of work to be done in order to make up the arrears of the War period. The presentation of this Report affords me the opportunity of expressing my appreciation of the sympathetic co-operation in my efforts to discharge the duties of my office which I have received from the Mayor, the Chairmen and Vice-Chairmen of the various Committees and all members of the Council, and of thanking the staff of the Public Health Department for their loyal support throughout the year. 1921 CENSUS STATISTICS. Since the issue of my last Annual Report, the Registrar-General has published Statistics of the Administrative County of London in respect of the population enumerated at the Census taken on 20th June, 1921. In order to form a sound opinion on Public Health and various other problems which will confront the Council from time to time, it will be necessary to refer to these Statistics, and, in these circumstances, it is desirable, for the purpose of easy reference, to submit in this report, a copy of which is supplied to each member of the Council, some of the more important figures concerning Kensington. 4 POPULATION OF THE BOROUGH. Persons. Males. Females. 1901 176,628 69,084 107,544 1911 172,317 66,497 105,820 1921 175,859 67,805 108,054 It will be seen that in the ten years preceding 1921 the population increased by 3,5*42, but, as there was a decrease of 4,311 in the intercensal period 1901-1911, the number of persons in 1921 was actually 769 less than twenty years previously. POPULATION OF LONDON, KENSINGTON AND THE VARIOUS DISTRICTS IN THE BOROUGH AT THE 1921 CENSUS. Area in statute acres. Total Population. Persons per acre. * Residential area in acres. Persons per Residential acre. Persons Males. Females, London 74,850 4,484,523 2,071,579 2,412,944 60 34,883 129 The Borough 2,290 175,859 67,805 108,054 77 1,351 130 N. Kensington 902 92,672 41,251 51,421 103 499 186 S. Kensington 1,388 83,187 26,554 56,633 60 852 97 St. Charles 401 24.268 10,836 13,432 61 140 173 Golborne 113 26,329 12,718 13,611 233 72 366 Norland 195 22,106 9,922 12,184 113 142 156 Pembridge 193 19,969 7,775 12,194 103 145 138 Holland 484 18,874 6,087 12,787 39 283 67 Earl's Court 244 17,912 5,997 11,915 73 163 110 Queen's Gate 173 13,777 4,145 9,632 80 118 117 Redcliffe 271 19,865 6,497 13,368 73 170 117 Brompton 216 12,759 3,828 8,931 59 118 108 The residential area is the toial area less (1) roads, (2) open spaces, and (3) land covered by buildings other than dwellings Table showing the number of Males and Females in the Borough at various age periods, together with the proportion of Females to Males in Kensington and in the County of London in 1921. All Ages Males. Females. Proportion of Females per 100 Males in Kensington, Proportion of Females per 100 Males in the County of London. 67,805 108,054 159 116 0— 4 Years 5,770 5,802 101 98 5—14 „ 11.904 12,290 103 100 15—24 10,568 19,733 187 124 25—34 10,437 19,963 191 130 35—44 9,834 17,385 177 121 45—54 „ 8,788 14,559 165 112 55—64 6,109 9,881 162 115 65 & over 4,395 8,441 192 146 The above table is interesting in that it shows that in Kensington as in London the numbers of males and females under the age of 15 years are approximately the same, whereas over that age the females preponderate considerably, particularly in Kensington. In London there are 116 females to 100 males and in Kensington 159 females to 100 males. This proportion of females to males, which is higher in Kensington than in any other London Borough, has a very important bearing on the vital statistics of the district. 5 Table showing the Marital Conditions of Males and Females in the Borough at various age periods. MALES. Age last birthday. Total. Single. Married. Widowed. Divorced. 0—14 17,674 17,674 - - - 15—44 30,839 15,094 15,410 278 57 45 and over 19,292 2,542 14,659 2,038 53 All Ages 67,805 35,310 30,069 2,316 110 FEMALES. Age last birthday. Total. Single. Mairied. Widowed. Divorced. 0—14 18,092 18,092 15—44 57,081 35,382 19,516 2,049 134 45 and over 32,881 10,891 12,657 9,269 64 All Ages 108,054 64,365 32,173 11,818 198 From the above table it can be calculated that 521 per cent, of the males and 59.5 per cent, of the females are single; that 443 per cent, of the males and 29.8 per cent of the females are married; that 3.4 per cent, of the males and 10.5 per cent. of the females are widowed and that 0.2 per cent, of the males and of the females are divorced. In the County of London 54.7 per cent. of the males and 54.2 per cent, of the females are single, and 41.8 per cent, of the males and 36.4 per cent, of the females are married, whilst 3.5 per cent. of the males and 9.4 per cent. of the females are either widowed or divorced. PRIVATE FAMILIES AND DWELLINGS. — Private Families. Population in Private Families. Structurally Separate Dwellings Occupied. Rooms Occupied. Persons per Room. London 1,120,897 4,243,838 701,035 4,057,271 1.04 Kensington 43,001 158,399 27,806 194,381 0.81 North Kensington 23,639 87,987 12,413 77,061 1.14 South Kensington 19,362 70,412 15,393 117,320 0.60 Wards St. Charles 6,176 23,017 3,626 21,736 1.06 Golborne 6,481 25,998 2,817 15,855 1.64 Norland 5,906 21,391 2,839 18,452 1.16 Pembridge 5,076 17,581 3,131 21,018 0.84 Holland 4,541 17,469 3,861 29,126 0.60 Earl's Court 4.869 15,401 3,535 23,935 0.65 Queen's Gate 2,357 9,738 2,253 17,861 0.54 Kedcliffe 4,985 17,423 3,477 28,047 0.62 Brompton 2,610 10,381 2,267 18,351 0.57 DEFINITIONS OF TERMS USED IN THE ABOVE TABLE. Private Family,—Any person or group of persons in separate occupation of any premises or part of premises is treated as a separate family, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) Institutions, or (ii) Business establishments or boarding-houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings.—A structurally separate dwelling is defined as any room or set of rooms, intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block of flats is a separate unit. A private house which has not been structurally subdivided is similarly a single unit, whether occupied by one family or by several families; thus, a house-let-in-lodgings without being specially adapted for the purpose is one dwelling only. But where a private house has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least three rooms and is more than one quarter ot the whole. The dwellings shown in this Table are those occupied by private families only. Rooms.—The rooms enumerated are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. 6 VITAL STATISTICS FOR THE YEAR 1922 The Royal Borough of Kensington as constituted under the London Government Act, 1899, covers an area of 2,290 acres, and is co-extensive with the Civil Parish and Registration District of the same name. The line of demarcation formed by Holland Park Avenue, High Street, Notting Hill Gate, and the Bayswater Road divides the Borough into approximately equal halves described in previous years and in this Report as North and South Kensington respectively. Each of these areas is co-terminous with the Parliamentary division of the same name. The Borough is further sub-divided into nine wards. North Kensington includes the wards of St. Charles, Golborne, Norland and Pembridge, whilst. South Kensington is made up of the five other wards, namely, Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton. POPULATION. For 1922 the Registrar-General has estimated the population to be 179,100. This seems to me too high a figure. but it has been accepted for the calculation of the various rates in this report. The estimated populations in the different wards of the Borough are shown in the following table :— The Borough 179,100 North Kensington 94,379 South Kensington 84,721 St. Charles 24,715 Golborne 26,814 Norland 22,513 Pembridge 20,337 Holland 19,222 Earl's Court 18,242 Queen's Gate 14,031 Redcliffe 20,232 Bromnton 12,994 In regard to the social status of the population, it may be said that the majority of the inhabitants in North Kensington belong to the poor class, whilst in South Kensington persons of that class constitute only a small proportion of the population. MARRIAGES. During the year 1,773 marriages were registered, representing a rate of 19.8 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 88.2 Roman Catholic Church 188 Nonconformist Churches 31 Jewish Church 3 Register Office 669 Total 1,773 BIRTHS. The number of births registered was 3,152, after correction for inward and outward transfers, and the birth rate for the Borough was 17.6 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,497 1,448 2,945 Illegitimate 102 105 207 Total 1,599 1,558 8,152 7 Table showing the number of births and the birth rates in England and Wales, London, Kensington and the various districts in the Borough in 1922, and the rates for the previous five years:— District. 1922. Birth rates in previous years. No. of Births. Birth·rate. 1921. 1920. 1919. 1918. 1917. England and Wales 780,187 20·6 22·4 25·4 18·5 17·7 17·8 London 94,792 21·0 22·3 26·5 18·2 16·0 17·9 The Borough 3,152 17·6 18·7 24·3 16·1 13·3 14·8 North Kensington 2,160 22·9 25·1 32·8 21·7 17·8 18·5 South Kensington 833 9·8 11·3 13·2 10·3 8·6 9·4 St. Charles 584 23·6 23·8 32·7 21·9 17·8 18·8 Golborne 683 25·5 29·4 38·2 26·6 20·6 21·1 Norland 578 25·7 27·2 35·1 21·9 18·4 19·2 Pembridge 315 15·5 18·6 23·1 14·4 13·6 14·0 Holland 212 110 123 13·9 8·8 7·7 9·8 Earl's Court 193 10·6 14·1 15·0 13·7 13·0 11·9 Queen's Gate 97 6·9 7·5 8·5 8·1 5·9 6·4 Redcliffe 222 11·0 11·4 14·6 11·8 8·7 10·5 Brompton 109 8·4 10·4 12·9 8·1 6·5 7·2 Ward unknown 159 ... ... ... ... ... ... 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 1922 the birth rate for Golborne Ward in the North was nearly four times as great as the rate for the Ward of Queen's Gate in the South. The 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 1921 18·7 1922 17·6 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 50 frequently postponed until the last few days of this period that the records of the ^Registrars of Births do not enable Public Health authorities to gain that early knowledge of the birth of children in their districts which is so essential to the success of the work of Health Visitors. This disadvantage arising from delay in birth registration has been met by the Notification of Births Act, which requires all live births and all still births occurring after the twenty·eighth week of pregnancy to be notified within thirty·six hours to the Medical Officer of Health of the district in which they occur. 8 During the year, 3,152 births to Kensington mothers were registered, and of this number 2,919 or 93 per cent, have been notified in accordance with the requirements of the Act. The number of stillbirths notified was 64. The following table indicates the source of notification and the kinds of births notified. Source of Notification. Number of Births Notified. Still Births. Live Births. Total Births. Number notified by Midwives 34 1784 1,768 „ „ „ Parents — 194 194 „ ,, „ Medical Practitioners 15 478 488 „ „ „ Other Persons 4 173 177 Births in the Borough 58 2,574 2,627 Notified from Institutions outside the Borough 11 345 856 Total 64 2,919 2,983 Although it is 16 years since the Notification of Births Act became law, there is still a good deal of confusion existing in the minds of many people in regard to the two distinct duties of Notification and Registration of births. Many parents believe that the act of Notification to the Medical Officer of Health covers Registration, and vice versa. It is unfortunate that the law requires every birth to be reported to two different Public Officers. Notification to the Medical Officer of Health within 36 hours of birth is of primary importance to the efficiency of a Public Health Department, and cannot be dispensed with; by very slight alteration of the law, it could be made to cover Registration. With such an emendation it would simply be necessary for the Medical Officer of Health to supply the Registrar with a weekly list of births. As the Kensington Registrars and the Medical Officer of Health already exchange weekly lists of births reported to them, in order that each may discover and deal with omissions to notify or register as the case may be, the alteration would decrease rather than increase administrative work and an economy would probably result. In any case, parents would be saved a good deal of trouble and irritation in visiting local Registrars' Offices, which are not always easily found. A greater and still more desirable alteration of the law is the transfer of all duties in connection with registration of births and deaths from the supervision of the Guardians of the Poor to the Local Sanitary Authority. It is well known that the work of the Registrar is not to any material extent, if at all, bound up with the relief of the poor, which is the main function of the Guardians, whereas the work of that official is very closely associated with that of the Public Health Department of a Local Sanitary Authority. For this reason, and for the general convenience of the public, it is desirable that registration of births and deaths should be performed at the Town Hall under the supervision of the Borough Council. DEATHS. The number of deaths registered in the Borough during the year was 2,814, 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 2,814 Deaths of residents in public institutions, etc., beyond the Borough 507 3,321 Deaths of non-residents in public institutions, etc., within the Borough 894 Corrected number of deaths belonging to the Borough 2,427 9 The corrected number of deaths gives a death·rate of 13.6 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 1922, and the rates for the previous five years:— District. 1922. Death·rates in previous years. No. of Deaths. Death rate. 1921. 1920. 1919, 1918. 1917. England and Wales 486,829 12·9 12·1 12·4 13·7 17·6 14·4 London 60,349 13·4 12·4 12·4 13·6 19·2 15·7 The Borough 2,427 13·6 13·8 13·4 15·2 17·8 16·3 North Kensington 1,339 14·7 15·4 14·3 16·6 20·1 18·9 South Kensington 979 11·6 11·2 11·9 13·2 13·8 12·4 Wards. 18·5 16·8 St. Charles 316 12·8 14·6 13·3 15·3 Golborne 426 159 16·7 13·9 17·5 22·2 22·4 Norland 387 17·2 16·6 16·1 17·3 22·7 20·1 Pembridge 260 12·8 13·3 13·9 16·1 17·0 15·2 Holland 233 12·1 11·6 11·4 12·7 13·5 13·7 Earl's Court 258 141 14·6 14·7 15·9 16·2 15·2 Queen's Gate 114 8·1 6·8 9·0 10·5 10·0 8·7 Redcliffe 247 122 12·5 13·6 14·7 15·9 12·8 Brompton 127 9·7 9·1 9·6 10·7 11·9 10·4 Ward Unknown 59 ... ... ... ... ... ... 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 tor the year:- Cause of Death. Number of Deaths. Principal Zymotic (or epidemic) diseases 174 Epidemic Influenza 86 Puerperal Fever 6 Phthisis 139 Other Tuberculous Diseases 30 Cancer 261 Bronchitis 241 Pneumonia 259 Heart Diseases 323 Bright's Disease 82 Diseases and Accidents of Parturition 10 Premature Birth 37 Accidents 50 Old Age 54 All other Causes 675 2,427 It will be seen that considerably more than one·third of the deaths, or 962, were due to disease of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 139 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 ot deaths, the causes of which are very largely preventable. 10 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 four years, cannot be regarded as altogether satisfactory. Deaths from Principal Zymotic Diseases per 1000 persons living Period. Kens'neton, London. 1919 0.87 0.76 1920 0.95 1.00 1921 1.02 0.98 1922 0.97 1.11 Table showing various Causes of Death in 1922, arranged in Four-Weekly Periods. Four Weeks ending Measles. Scarlet Fever. Whooping. Cough Diphtheria Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhoea and Enteritis. January 28 1 3 4 3 51 22 36 52 54 5 February 25 3 1 2 3 23 13 16 31 30 4 March 25 3 — 1 5 3 7 22 19 28 5 April 22 16 4 4 4 10 20 36 £6 5 May 20 27 6 4 1 4 23 19 21 2 June 17 7 — 3 4 — 5 19 4 16 4 July 15 — — 3 1 11 20 7 7 2 August 12 1 1 1 — — 11 21 5 6 2 Sept. 9 — — — 3 — 15 20 5 6 1 October 7 — — 1 1 1 12 18 4 9 1 November 4 1 1 4 2 10 27 12 16 7 December 2 — 1 2 9 23 23 23 6 30 — — — — 1 10 16 24 17 3 Totals 58 6 27 34 86 139 261 241 259 47 INFANTILE MORTALITY. During the year 1922, there were 3,152 births and 257 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality rate (deaths of infants under 12 months to each 1,000 births) of 82. The following table gives the Births and the Infantile Deaths and Death rates for the year 1922 in England and Wales, London, the Borough and the various Wards of the Borough. District No. of Births No. of Deaths of children under 1 year of age. Infantile Mortality rate England and Wales 780,187 60,302 77 London 94,792 7,048 74 The Borough 3,152 257 82 North Kensington 2,160 197 91 South Kensington 833 57 68 St. Charles 584 38 65 Golborne 683 71 104 Norland 578 63 109 Pembridge 315 25 79 Holland 212 19 89 Earl's Court 193 9 47 Queen's Gate 97 5 52 Redcliffe 222 18 81 Brompton 109 6 55 Ward unknown 159 3 — In considering the above and subsequent tables it must be remembered that the deaths of infants at any temporary address (institution or private house) to which the mother went for her confinement, and deaths of infants in institutions to which they were transferred for trealment from the place of birth, are allocated to the district of the usual residence of the mother. 11 Reference to the table below indicates that a high infantile mortality rate in the Borough is not unusual. The table shows only three periods in which the rate for Kensington was smaller than that for England and Wales and a like number when the rate was below that of London. INFANTILE MORTALITY RATES, 1896-1922 Period. England and Wales. London. Kensington. 1896-1900 156 162 176 1901-1905 138 139 144 1906-1910 117 114 120 1911 130 129 135 1912 95 91 92 1913 108 105 111 1914 105 104 95 1915 110 114 119 1916 91 89 85 1917 96 104 130 1918 97 108 97 1919 89 85 102 1920 80 75 81 1921 83 80 110 1922 77 74 82 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1922. January 31 February 20 March 32 April 37 May 21 June 20 July 16 August 6 September 6 October 23 November 26 December 19 It is not uncommon to find the number of deaths in each of the months of August, September and October to be higher than the number in any other month, owing of course to the large number of children carried off by summer diarrhoea, but it is seen from the above table that in the year under review the months of August and September actually had a lower number of infant deaths than any other month of the year. The table serves to demonstrate that the improvement in the infantile death rate in Kensington was to a very large extent due to the Summer being a favourable one from the point of view of infant diarrhoea; in fact, the number of infant deaths from enteritis for the whole year was only 24 as against 87 in the preceding year. 12 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1922. Causes of Death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total 4 weeks. 1—3 months. 3—6 months. 6—9 months. 9—12 months. Total Infant Deaths under 1 year. 1. Common Infectious Diseases (Measles 15) (Whooping Cough 8) (Diphtheria 4) — — — — — — 6 6 15 27 12. Tuberculosis — — — — — — — 1 2 3 3. Pneumonia and Bronchitis 3 4 1 1 9 13 22 16 21 81 4. Enteritis — 1 2 — 3 3 6 9 3 24 5. Syphilis — — — — — 1 — 1 — 2 6. Complications of Birth (Injury 3) (Atelectasis 5) 8 — — — 8 — — — — 8 7. Congenital Malformation 8 8 1 — 17 3 1 1 1 23 8. Premature Birth 32 3 1 — 36 1 — — — 37 9. Atrophy, Debility and Marasmus 12 5 3 2 22 9 2 — — 33 10. Other Diseases (Meningitis 2) (Convulsions 1) (Rickets 1) (Overlaying 1) (Other Conditions 14) 7 2 1 — 10 4 2 2 1 19 Totals 70 23 9 3 105 34 39 36 43 257 Death-rate in each age period per 1,000 births 22 7 3 1 33 11 12 12 14 82 Percentage of total infant deaths occurring in each age period 27 9 4 1 41 13 15 14 17 — DEATHS OF INFANTS UNDER ONE YEAR OF AGE PER 1,000 BIRTHS IN DIFFERENT TYPES OF HOUSES. As pneumonia, bronchitis and enteritis were responsible for a large proportion of the infant deaths in 1922, it will be interesting to see how the rates for these diseases vary in accordance with the types of houses occupied by the families in which the deaths occurred. In the following table, a dwelling occupied by one family only, or which has been converted into self-contained flats or maisonettes, is classed as a "private house." The number of these in the Borough is approximately 19,250, 13 A "tenement house" is one let in lodgings to more than one family without being specially adapted for the purpose. Of the 5,690 houses of this class in the Borough, 2,169 are on the Register of Houses let in Lodgings and, consequently, are subject to the Council's bye-laws. A "mews dwelling" is a premises with generally one to three rooms situated over a stable and coach-house. In the majority of cases in South Kensington and some in North Kensington, the stables and coach-houses have been converted into garages. The occupants of mews dwellings vary in type, some are respectable and careful people, whilst others belong to the most careless and indifferent members of the community. There are 2,091 mews dwellings in the Borough. Deaths of Infants from All Causes Deaths of Infants from Pneumonia and Bronchitis Deaths of Infants from Enteritis Boro. N. Ken. S. Ken. Boro. N. Ken. S. Ken. Boro. N. Ken. S. Ken. Private Houses— Births 790 225 465 790 225 465 790 225 465 Infant Deaths 48 20 28 5 4 1 7 2 5 „ Death Rates 60.7 88.8 60.2 6.3 17.7 2.1 8.8 12.0 10.7 Tenement Houses— Births1,996 1,704 292 1,996 1,704 292 1,996 1,704 292 Infant Deaths 200 173 27 73 66 7 17 14 3 Death Rates 100.2 101.5 92.4 36.6 38.7 24 8.5 8.2 10.2 Mews Dwellings— Births 158 88 70 158 88 70 158 88 70 Infant Deaths 6 6 — 3 3 — — — — Death Rates 36.0 68.3 — 18.9 34.0 — — — — ABOVE STANDARD DEATHS. In almost every area there is a number of infant births and deaths occurring in those betterclass homes where it is reasonable to assume that the children receive every care and all requisite medical and nursing assistance. These are called "above standard" cases and, although it is difficult to make certain that none is included under this heading in which the attention of a Woman Health Officer might prove beneficial, they are not generally visited because, in the first place, the Health Officer may not be welcomed and, in the second place, she can occupy her time more profitably in visiting homes in the poorer quarters. In 1922 the "above standard" births numbered 828 and the deaths 27, giving an infantile mortality rate of 32'6 per 1,000. The 2,324 births and 230 deaths not "above standard" in 1922 give an infantile mortality rate of 99. The causes of death in the "above standard" cases were as follows :— Pneumonia and bronchitis 1 Enteritis 1 Infantile debility 2 Premature birth 15 Congenital malformation 1 Other causes 7 The wards to which the children belonged are :— St- Charles 3 Golborne 1 Norland 4 Pembridge 4 Holland 6 Earl's Court 3 Queen's Gate 1 Redcliffe 4 Brompton 1 ILLEGITIMATE INFANT DEATHS. In 1922, 7 per cent, of the births in Kensington were illegitimate and 11 per cent. of the infant deaths were of children of this class. The following table compares the legitimate and illegitimate births, infant deaths and infantile mortality rates in Kensington for 1922. 14 Total. Legitimate. Illegitimate. Births 3,152 2,945 207 Infant Deaths 257 229 28 Infant Death Rate per 1,000 births 82 78 135 Five infants found dead in regard to whom no particulars of parentage could be obtained' have been classed as legitimate. The following table compares the total infantile mortality rate for the Borough in recent year? with the illegitimate infantile mortality rate:— Year Deaths of all children under 1 year of age per 1,000 births Deaths of illegitimate children under 1 year of age per 1,000 illegitimate births 1910 108 292 1911 135 302 1912 92 357 1913 111 344 1914 95 272 1915 119 346 1916 85 211 1917 130 408 1918 97 256 1919 102 180 1920 81 201 1921 110 217 1922 82 135 Although a good deal of the improvement in the infantile death rate is attributable to the comparative freedom of Kensington from summer diarrhoea during the year, the considerable decrease in the number of births and deaths of illegitimate children has had a very important effect on the rate in question. In 1922 there were 207 illegitimate births as against 308 in 1921, a decrease of over 30 per cent., whereas the total number of births in the Borough showed a decrease of only 4 per cent. In fact, the decrease in the total number of births in the year as compared with 1921 is almost entirely accounted for by the decrease in the number of illegitimate births. Such a result is indeed satisfactory, but what is still more pleasing, is the fact that the deaths of illegitimate infants decreased from 67 in 1921 to 28 in 1922, a drop of 58 per cent. It is scarcely necessary to comment upon the ante-natal and post-natal conditions associated with illegitimate births. In the majority of cases the mothers work almost up to the time of confinement and often resume work as quickly as possible afterwards. Owing to the mother having to earn her living, the child does not generally receive adequate attention, unless it be in an institution. In many cases the child is not wanted. In view of the disabilities imposed by society on unmarried mothers and their children, an even higher death rate might have been expected. For the purpose of allocating births and deaths, the Registrar-General regards the employer's house as the permanent home address of a domestic servant, and as 16 of the 28 illegitimate babies dying were born to single women of this class, it will be seen that the Registrar-General's ruling results in the allocation to Kensington of a number of deaths of children whose mothers probably, do not belong to the Borough. 15 TABLE SHOWING THE BIRTH RATES, DEATH RATES AND INFANTILE MORTALITY RATES IN THE 29 METROPOLITAN CITIES AND BOROUGHS IN 1922. Births per 1000 Population. Deaths per 1000 Population. Infantile Deaths per 1000 Births. 1. Shoreditch 28·1 Hampstead 10·9 Hampstead 54 2. Bermondsey 27·0 Lewisham 11·1 Lewisham 54 3. Poplar 26·9 Wandsworth 11·2 City of Westminster 55 4. Finsbury 25·2 Woolwich 11·5 Greenwich 58 5. Bethnal Green 25·2 Fulham 12·0 Wandsworth 61 6. Southwark 24·6 City of Westminster 12·5 Woolwich 62 7. Stepney 23·9 Hackney 12·7 Chelsea 63 8. Deptford 23·2 Paddington 12·8 Stoke Newington 66 9. Islington 22·7 Holborn 12·8 St. Marylebone 67 10. Battersea 21·7 Greenwich 12·9 Fulham 68 11. Camberwell 215 Chelsea 13·1 Paddington 69 12. St. Pancras 21·4 Battersea 13·1 Battersea 69 13. Hackney 21·2 Hammersmith 13·3 Hammersmith 71 14. Hammersmith 21·0 Camberwell 13·4 Hackney 72 15. Greenwich 21·0 St. Marylebone 13·5 St. Pancras 73 16. Lambeth 20·8 Kensington 13·6 Holborn 74 17. Woolwich 20·8 Stoke Newington 13·6 Deptford 74 18. Fulham 20·3 Lambeth 13·7 Islington 76 19. Paddington 18·8 Islington 13·8 Lambeth 77 20. Lewisham 18·2 Deptford 13·8 Poplar 78 21. Stoke Newington 17·8 City of London 13·9 Camberwell 78 22. Kensington 17·6 Stepney 13·9 Finsbury 79 23. Chelsea 166 Poplar 14·4 Southwark 79 24. Wandsworth 16·6 St. Pancras 14·5 Stepney 80 25. St. Marylebone 16·0 Bethnal Green 15·3 City of London 81 26. Holborn 15·3 Southwark 15·6 Kensington 82 27. Hampstead 14·8 Finsbury 16·2 Bethnal Green 90 28. City of Westminster 13·2 Shoreditch 16·3 Bermondsey 101 29. City of London 10·9 Bermondsey 17·0 Shoreditch 102 THE PREVALENCE OF DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are Compulsorily notifiable 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. 16 Table showing Notifications of Infectious Diseases received in 1922, arranged in Four-Weekly Periods. Four Weeks ending Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Ophthal. mia Neo. natorum. Cerebro. Spinal Fever. Puer. peral Fever. Pneu. monia. Malaria. Encephalitis Lethargica. Total. January 28 60 34 — 5 3 — 1 65 — 1 169 February 25 38 35 — 2 2 — — 26 2 — 105 March 25 22 25 2 2 1 15 — — 67 April 22 29 29 1 4 3 1 — 7 — 1 75 May 20 46 39 — 4 — — I 10 — — 100 June 17 26 55 7 1 3 — I 5 — 2 100 July 15 30 26 2 2 2 — — 5 — — 67 August 12 38 19 — 5 — — — 2 — — 64 Sept. 9 24 32 1 2 3 — I 3 1 — 67 October 7 58 39 — 6 — — 2 10 — — 115 November 4 45 29 3 5 1 1 3 8 — — 95 December 2 20 18 1 3 2 — 1 19 — — 64 30 35 23 1 3 — — — 11 1 — 74 Totals - 471 403 18 44 20 2 10 186 4 4 1,162 Cases of mistaken diagnosis are excluded from the above Table. Small-Pox.—The Metropolis was visited by a sharp outbreak of this disease during the latter period of the year, 70 cases being notified in the County of London. Poplar was the Borough principally affected, 51 cases being notified in that district. The remaining cases were distributed as follows:— Stepney 5 St. Pancras 1 Fulham 2 Bethnal Green 1 Bermondsey 2 Holborn 1 Shoreditch 2 Lambeth 1 South wark 2 Deptford 1 Finsbury 1 I am pleased to state that no case occurred in this Borough. Two suspicious cases were removed to the Metropolitan Asylums Board Hospital for observation, but both were found not to be suffering from the disease. In one case the patient was removed to another hospital as she was found to be suffering from measles. In the other the patient returned home and was then admitted to the St. Mary Abbot's Hospital, where he died. Owing to the difference of opinion amongst medical experts as to the disease from which the patient had been suffering, the Coroner decided to hold an inquest, and came to the conclusion that he died from septicaemia and gastro-enteritis. Scarlet Fever.—The epidemic of scarlet fever which visited London in 1920 and 1921, and which was the largest known in the history of the Metropolitan Asylums Board, disappeared in the first month of the year under review. During the course of 1922 there were 471 cases notified in Kensington. The number of notifications in the three previous vears were 260. 617 and 870. The following table shows the number of cases notified in each four-weekly period during 1922. 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 2051 1744 1377 1357 1366 1183 1270 1128 1029 1342 1243 1192 995 The Borough 65 38 23 29 49 27 30 39 27 60 46 21 37 North Kensington 38 20 13 19 32 15 20 27 22 51 39 15 18 South Kensington 27 18 10 10 17 12 10 12 5 9 7 6 19 Wards. St. Charles 11 7 3 6 7 — 7 10 9 17 6 3 4 Golborne 11 7 3 6 13 12 5 7 10 23 25 2 11 Norland 11 2 3 4 1 2 4 4 1 4 3 5 1 Pembridge 5 4 4 3 11 1 4 6 2 7 5 5 2 Holland 8 3 4 3 5 — 1 3 — 4 2 1 — Earl's Court 6 2 — — 1 1 — 4 3 — 2 — 1 Queen's Gate 3 — — 1 2 2 3 — 1 — 2 2 — Redcliffe 10 9 3 4 7 7 5 4 — 3 1 2 14 Brompton — 4 3 2 2 2 1 1 1 2 — 1 4 Cases of mistaken diagnosis are not excluded lrom the above Table. 17 Of the 471 Kensington cases, 425 were removed to Hospital. The mildness of the disease is reflected in the low death rate; there were only six fatal casss in Kensington during the year, representing a case mortality of 1.27 per cent. The deaths in the three preceding years were 2, 5 and 8. Twenty-seven of the 471 cases of scarlet fever notified were patients in the same family as a person who had, within the previous 28 days, returned from hospital after having been treated for this disease. In addition, two of those developing the disease were members of another family living in the same house as a person who had been discharged from hospital after scarlet fever less than 28 days previously. Cases of this kind are called "return cases," and a very careful investigation was made in each of the 29, with a view to ascertaining the source of infection. Information was obtained that one of the "primary" cases had nasal discharge and that another had aural discharge on leaving the hospital; it is possible that infection was conveyed by the discharge in these two cases, but there was no evidence obtained that the infection had been contracted from patients returning from hospital in the other 27 cases. Seventeen cases notified as suffering from scarlet fever were found, after admission to hospital, not to be suffering Irom any infectious disease at all, with the result that they were returned home. Immediately on receipt of notification at the Town Hall that a person is suffering from scarlet fever, the home is visited by the District Sanitary Inspector for the purpose of investigating the source of infection ; children 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 likelv 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.—Four hundred and three cases were notified during the year, 385 of which were removed to hospital. The cases notified in the three previous vears were 274, 322 and 346. i he following 1 able shows the number ot cases notified in each four-weekly period during 1922:— District. Period No. 1. Period No. 2. Peried No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. f'eriod No. 8 Period No. 9. Period No. 10. Period No. 11 Period No. 12. Period No. 13. London 1382 1361 1185 1048 1085 1101 1169 1128 982 1287 1330 1162 1120 The Borough 36 35 26 29 40 57 26 19 34 41 30 19 23 North Kensington 22 18 18 25 29 45 17 14 26 34 25 12 19 South Kensington 14 17 8 4 11 12 9 5 8 7 5 7 4 Wards. St. Charles 5 5 6 7 6 15 3 5 7 8 4 2 6 Golborne 12 7 2 7 13 21 7 4 14 14 13 6 7 Norland 4 3 5 9 8 6 4 4 2 8 5 3 2 Pembridge 1 3 5 2 2 3 3 1 3 4 3 1 4 Holland 4 11 4 3 4 2 4 — 3 1 1 1 1 Earl's Court 3 3 1 1 1 1 — — 2 1 — 2 2 Queen's Gate 2 2 — — 5 5 4 1 2 3 — 1 — Redcliffe 4 1 — — 1 4 1 3 1 1 3 2 — Brompton 1 — 3 — — — — 1 — 1 1 1 Cases of mistaken diagnosis are not excluded from the above Table. Home visiting, disinfection and school exclusion are carried out on the lines indicated under the paragraph dealing with scarlet fever. The number of Kensington deaths was 34, representing a case of mortality of 8'44 per cent. In the three preceding years the deaths were 16, 24 and 25. Five patients developed diphtheria within 28 days of a member of their family having returned from a fever hospital after having been treated for diphtheria. On investigation it was found that two of the "primary" or returning cases had nasal discharge on leaving the hospital, and it is possible that in these cases the nasal discharge was responsible for the spread of infection. There is no evidence to show how infection was conveyed in the other three cases. Twenty-six notified cases admitted to hospital were found not to be suffering from diphtheria or any other infectious disease. Owing to the degree of accuracy which has now been secured by bacteriologists in the diagnosis of diphtheria, it is customary to take a throat swab for bacteriological examination in all 18 suspicious cases, and for some years past the Council have paid for such examinations performed at the Lister Institute on behalf of Kensington patients. Sterile swabs are obtained from the Town Hall, and, in order to reduce the interval which occurs from the time the doctor takes the swab to the time he obtains the result, arrangements have been made for medical men to leave inoculated swabs at the 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 579 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 89 gave a positive diphtheria result. It is well recognised by the medical profession that the early administration of anti-toxin not only reduces the mortality from diphtheria, but causes the disease to run a milder and shorter course; further, by lessening the duration of the patient's infectivity to others, it reduces the period of occupation of a bed in an isolation hospital. 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 ace unable to pay for a supply. With a view to enabling every medical practitioner to administer subcutaneously an adequate dose of anti-toxin as soon as on clinical evidence he has diagnosed diphtheria in a Kensington resident who is unable to pay for medical services or anti-toxin, the Council during the year revised their scheme for the supply of this preparation and have approved the following arrangements:— (a) On signing the necessary declaration that the patient is unable to pay for specific treatment, a medical man can obtain anti-toxin free of cost from:— (1) Mr. Worsley, Chemist, No. 135, Ladbroke Grove, W. 10. (Anti-toxin can be obtained at this address during the day or night). (2) The Medical Officer of Health, Town Hall, W. 8. During office hours application should be made at the Public Health Department and at other times to Mr. Sutton, an officer of the Department, who lives at No. 1. Hornton Place, Hornton Street, (only a few yards from the Town Hall). (b) On application to Mr. Worsley, or the Medical Officer of Health, a medical man can obtain free of cost the loan of an anti-toxin syringe and portable sterilizer. (The syringe should be sterilized and returned together with the sterilizer immediately after use. It must be clearly understood that the medical practitioner must satisfy himself in regard to the sterilization of the syringe before use and that the Council cannot accept any responsibility whatever in this matter). (c) Medical practitioners administering the Council's anti-toxin to poor persons who cannot afford to pay an adequate fee will, on application to the Medical Officer of Health, be paid a lee of 5s. per patient in respect of the medical assistance rendered by them. Experience has shown that for the purposes of treatment it is seldom safe practice to rely on any dose which is less than 8,000 units, whatever the age of the patient may be. As a means of simplifying the use of the serum for treatment, the Council have decided to stock diphtheria antitoxin only in phials which contain 8,000 units. This amount of anti-toxin is in concentrated form, and a curative dose can be given in one injection with a 10 c.cm. syringe. In addition to making the above arrangements the Council have authorised me to keep a number of phials each containing 500 units of anti-toxin for prophylactic use in the case of persons who have been in close contact with a patient suffering from diphtheria. These prophylactic doses are stocked in the Public Health Department of the Town Hall and also at my private address (No. 9, The Triangle, W. 10. Telephone No. Park 1524). The Council are prepared to pay a fee of 5s. for the administration of a prophylactic dose of their anti-toxin in the case of a patient who is unable to pay for medical assistance, provided that they are satisfied that such administration is desirable in the interests of Public Health. In 1922 the Borough Council supplied 66,000 units of anti-toxin for 19 patients at a cost of £5 10s. Od. During the year the fees claimed by medical practitioners totalled 15s. Enteric Fever—Eighteen cases of this disease were notified, 16 being removed to hospital. The cases notified in the three preceding years were 16, 24 and 22. There were two deaths from this cause against 2, 1 and 3 in the preceding years. Ten of the 18 cases were notified from North Kensington and 8 from South Kensington. In four cases the disease was contracted on the Continent, and in two cases there was a suspicion that fried fish was the vehicle by which contagion had been conveyed. One case was notified as para-typhoid fever. 19 Erysipelas.—Forty-four cases were notified during the year, 18 of which were removed to hospital The cases notified in the three preceding years were 70, 68 and 82. There was only one death from this cause, the deaths in the three previous years being 5, 3 and 1. Puerperal Fever.—Ten cases of this disease were notified, against 11, 9 and 8 in the three preceding years. There were 6 deaths, against 7, 5 and 3 in the three previous years. As the patients contracting this disease are in the child-bearing period of life, a fatal case does not mean only the death of a woman in her prime, but it frequently results in a family of small children being deprived of that maternal care and affection which is so essential to their welfare. Indeed, there is no other disease which is likely to be followed by more disastrous consequences to the family, and when it is realised that puerperal fever is very largely both preventable and curable, it must be admitted that no local authority should rest content until everything has been done in the direction of prevention and treatment. It may be said that treatment is not part of the work of a local authority, but the welfare of the infant population is a very important duty falling to them, and, therefore, the cure of puerperal fever must necessarily call for their careful consideration. It is true that the number of cases notified is small, but this a good reason why an attempt should be made to eradicate the disease. Dr. Hobbs the Medical Superintendent of the St. Mary Abbot s Hospital, has devoted considerable attention to the treatment of this disease, and, judging from papers he has published, he has adopted a method of treatment which is remarkably successful. In fact he is bold enough to say that if puerperal fever patients are admitted to the Hospital in the early stages of their illness, there would be few, if any, deaths from this disease in his Institution. The Borough Council should do everything possible to secure this early admission in order that the Medical Superintendent may have an opportunity of treating his cases with successful results, and also so that this infectious disease may be removed from private homes where it is dealt with by general practitioners and midwives, who are compelled to carry on their ordinary duties at the same time, and may, possibly, convey the infection to other patients. The disease develops insidiously a short time after confinement, and it is often present for several days before the medical attendant or midwife can be quite certain that the septic condition of the patient amounts to puerperal fever. It is because the signs and symptoms in the earlier stages of the disease are uncertain that hospital or surgical treatment is so frequently postponed and notification so often delayed, and it is well known that this postponement offers opportunity for the spread of infection and lessens the prospects of recovery. The medical practitioner cannot always be held responsible, because it is obvious that he cannot be expected to make a definite notification in regard to such a serious condition, unless he is reasonably certain that the disease exists, and, further, he is not anxious to send a patient to hospital with a diagnosis of puerperal fever when, in fact, the ominous signs may disappear and the case turn out to be a simple one within twenty-four hours. I have had several consultations with the Medical Superintendent on this important question with a view to ascertaining whether anything can be done in order to secure earlier admission, and we conclude that it is advisable to make it known— (i) That cases will be accepted at the Hospital on suspicion before the diagnosis is definite, and (ii) That medical men should be informed that, if they do send patients in the earlier stages before the diagnosis is clear, they will not be expected to notify me but can rely on Dr. Hobbs performing this duty in the event of the disease proving to be puerperal fever. In bringing this information to notice, it is important to emphasize that my attitude in regard to notification in these suspicious cases admitted to the Hospital does not apply in cases where the disease is fully developed and the diagnosis clearly established before the patient is sent away for treatment. Cerebro-spinal Fever.—Two cases of this disease occurred in the Norland Ward. Both of them were removed to hospital and one died. The notifications in the three preceding years were 6, 5 and 1. Encephalitis Lethargica.—Four cases of this disease were notified, particulars of which are subjoined:— 1. Female. Aged 42 years. Died in St. Mary Abbot's Hospital on January 3rd. 2. Female. Aged 74 years. Notified April 12th and died at home on April 25th. 3. Male. Aged 43 years. Notified May 26th. Removed to M.A.B. Hospital and recovered. 4. Female. Aged 55 years. Notified June 13th. Removed to a Nursing Home at Putney and died June 14th. Ophthalmia Neonatorum.—This disease, which is an inflammation of the eyes of newly-born infants, is in most cases due to the entrance of gonorrhoeal 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 20 vision may result. In view of the serious consequences of neglect in treatment, ophthalmia neonatorum was made Compulsorily notifiable in 1914. Twenty cases were notified during the year, the numbers in the preceding years being 31, 53 and 33. The Women Health Officers take great pains to obtain the best possible treatment. Every case is visited on the day that notification is received in the Public Health Department and visits are paid daily, if necessary, until the child is cured. Attempts are made to secure the child's and mother's admission to the Metropolitan Asylums Board Ophthalmia Hospital or other suitable institution, and, if these are unsuccessful, arrangements are made for a nurse from the Kensington District Nursing Association, who has been trained in ophthalmia treatment, to visit the home as frequently as is necessary to carry out the nursing instructions of the medical attendant. Care is taken that a medical man is in attendance on every case. Three of the 20 notified infants were born and treated in the St. Mary Abbot's Hospital, 5 were admitted to the Metropolitan Asylums Board Opthalmia Hospital, 2 were treated in the out-patient departments of hospitals and the remaining 10 were attended at home by general medical practitioners. It is the duty of midwives to report all forms of inflammation of the eye, even when the condition is not ophthalmia neonatorum, and these cases, in addition to pure ophthalmia cases, are also dealt with by the Kensington District Nursing Association. In 1922, the ophthalmia neonatorum and inflammation of the eye cases attended by the nurses numbered 38 and the number of home visits paid in connection with these cases was 974. These visits average 26 to each of the 38 patients, and indicate the great amount of trouble taken with this disease. The visits paid by the Council's Women Health Officers are not included in the 974. Quite apart from the intense pain and suffering associated with ophthalmia 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 £150 paid last year to the Kensington District Nursing Association by the Council must be regarded as an economy of the wisest kind. Of the 20 cases notified, the right eye alone was affected in 2 cases, the left eye alone in 2 cases, and both eyes in 16 cases. In every case the disease has been cured without any damage to the sight. Pneumonia and Influenzal Pneumonia—There are many forms of pneumonia, but the only kinds notifiable are acute primary pneumonia and influenzal pneumonia. One hundred and eighty six notifications were received, 92 patients being certified as suffering from acute primary pneumonia and 94 irom influenzal pneumonia. It is clear that many cases escaped notification. The number of deaths from pneumonia during the year was 259. There were 86 deaths certified to be due to influenza, the deaths from this disease in the three preceding years being 151, 46 and 45. The Sanitary Inspectors and, if necessary, the Women Health Officers visited the homes of all notified cases of pneumonia with a view to giving assistance in connection with isolation, disinfection, etc. Under their agreement with the Council, the Kensington District Nursing Association have rendered valuable help in connection with cases of pneumonia. Malaria.—Four 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 Great War. Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a separate section, and one case of continued fever and two cases of polio-myelitis, no notifiable infectious diseases, other than those to which reference has been made, were notified during the year. NON-NOTIFIABLE DISEASES. Measles.—Owing to the appearance of an epidemic in the Spring months of the year, this disease caused 58 deaths. Fortunately, the epidemic, which was not unexpected, was less severe than had been generally anticipated. The deaths in the three preceding years were 14, 23 and 1. Measles ceased to be Compulsorily notifiable in December, 1919, but the Head Teachers of the London County Council schools report to Medical Officers of Health all cases, both of children suffering from measles and of children kept away from school by reason of the disease existing in their homes. In view of the dangerous complications which are liable to follow neglected cases of measles, the Women Health Officers pay a great deal of attention to children suffering from this disease in the poorer quarters of the Borough. Whooping Cough. —There were 27 deaths from this cause, all except one of the children dying being under the age of 5 years. The deaths in the three preceding years were 4, 22 and 22. Cancer.—Cancer caused 261 deaths, and of this number 242 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 198 deaths were attributed; sarcoma 21 and epithelioma were the assigned cause of 21 deaths; 42 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 1922. Parts Affected. Sex. Total. Male. Female. Buccal Cavity, No. 39 12 1 13 Stomach, Liver, etc., No. 40 27 36 63 Peritoneum, Intestines, Rectum, No. 41 25 39 64 Female Genital Organs, No. 42 35 35 Breast, No. 43 38 38 Skin, No. 44 1 1 Other and unspecified Organs, No. 45 33 14 47 Totals 98 163 261 The numbers following the description of the parts affected refer to the classification of causes of death adopted bv 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 261 North Kensington 122 South Kensington 136 St. Charles 33 Golborne 28 Norland 27 Pembridge 34 Holland 31 Earl's Court 35 Queen's Gate 19 Redcliffe 34 Brompton 17 Ward Unknown 3 Whilst the number of deaths from cancer in 1922 was smaller by 18 than in the previous year, it is nevertheless true that the death rate from this disease is steadily increasing throughout the country. In the United Kingdom over 50,000 people die annually from this disease. Various societies and individuals are engaged in research, many working singly and not coordinated with their colleagues, and the time has now arrived when the evidence should be brought together and analysed, no matter how remote the prospects of a cure may appear to be at the present. If the enquiry should make no actual discovery, the public would, at least, know the position of present scientific knowledge in regard to cancer. 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 and who will be available for the nursing of ophthalmia cases. In December, 1920, the grant was increased to £100 per annum, and on March 7th, 1922, it was decided to make the grant £150 for the year 1922. 22 Table of Cases attended and Visits paid by Nurses of the Kensington District Nursing Association from January 1st, 1922, to December 31st, 1922. Cases. Visits. Maternity Cases 45 668 Pneumonia 129 2,274 Ophthalmia Neonatorum and other Inflammations of the Eyes of Newly-born Children 38 974 Influenza 94 1,100 Infantile Diarrhœa 18 250 Tuberculosis 41 996 Diphtheria Suspect 1 3 Measles 40 500 Septicæmia 4 40 Whooping Cough 9 105 Polio-myelitis 1 5 Totals 420 6,915 GRANT TO HOSPITALS, ETC. In addition to the previously mentioned subscription to the Nursing Association, the Council, during the past 12 months, made the following grants:— £. 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 Grants sanctioned by the Minister of Health under the Council's Maternity and Child Welfare Scheme are shown on page 34. TUBERCULOSIS. During the year 252 cases of pulmonary tuberculosis and 87 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. 1921. 1922. The Borough 849 682 564 429 543 432 582 407 374 339 North Kensington 642 516 423 300 406 331 445 294 272 233 South Kensington 186 138 133 127 137 101 137 113 102 106 Wards. St. Charles 146 117 93 75 113 79 104 70 66 48 Golborne 228 176 147 106 124 101 150 88 89 80 Norland 190 162 134 79 102 99 124 93 80 76 Pembridge 78 61 49 40 67 52 67 43 37 29 Holland 37 35 43 31 41 35 36 36 29 28 Earl's Court 51 40 29 40 35 20 31 25 24 24 Queen's Gate 34 17 10 14 20 23 16 15 15 20 Redcliffe 39 31 35 27 23 16 33 25 19 23 Brompton 25 15 16 15 18 7 21 12 15 11 Ward Unknown 21 28 8 2 - - - - - - From this table, it will be seen that notifications of tuberculosis are diminishing in number year by year in all parts of the Borough. 23 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 1921 288 153 87 86 32 18 185 105 1922 252 139 78 87 30 17 169 95 For the first time in the history of the Borough, the deaths from all forms of tuberculosis fell to under one per 1,000 persons living. The rapid improvement in the tuberculosis rates during the last ten years has been most encouraging, and it is to be hoped that it will stimulate both social and official workers to press forward with renewed enthusiasm in the very successful fight against the disease which has caused such a waste of life in the past as to be justly called "The White Scourge." Deaths from Tuberculosis in 1922 Allocated to District of Usual Residence of Patients. Pulmonary Tuberculosis. Other Forms of Tuberculosis The Borough 139 30 North Kensington 95 20 South Kensington 41 10 St. Charles 25 6 Golborne 26 7 Norland 36 4 Pembridge 8 3 Holland 12 2 Earl's Court 13 4 Queen's Gate 4 — Redcliffe 8 3 Brompton 4 1 Ward Unknown 3 — The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary Tuberculosis. Other Forms of Tuberculosis. St. Mary Abbot's Hospital (Kensington Infirmary) 49 6 Patient's Home 52 14 Brompton Hospital 3 — St. Luke's Home 4 — Outlying Hospitals 26 7 Other places outside the Borough 5 3 DISPENSARY TREATMENT OF TUBERCULOSIS. North Dispensary Area. In accordance with their decision of June 28th, 1921, the Council took over from the North Kensington Voluntary Dispensary Committee all duties in regard to the Dispensary treatment of tuberculosis for persons living in the North Dispensary area on January 1st, 1922, and consequently this report covers the first year of work at the North Dispensary under the Council's authority. The features of the scheme were fully set out in my Annual Report for the year 1921 and do not, therefore, call for repetition here, especially as no material alteration has been found desirable. The change over of the Dispensary from a Voluntary Committee to the Royal Borough Council was effected with a minimum of disturbance, owing largely to the support and help I received from Dr. Picard, the Tuberculosis Officer, who was transferred from employment under the Voluntary Committee to the Council's staff on January 1st, 1922. 24 Certain changes in the staffing of the Dispensary were made and the Council's Women Health Officers took over the home visiting and reporting previously done by the Dispensary Nurses of the Voluntary Committee. The Women Health Officers, including the members of the internal staff, have loyally supported the Dispensary, and with the Tuberculosis Officer, have to a great extent been responsible for promoting the efficiency which has been secured. The number of new cases seen at the Dispensary during the year 1922, with the diagnosis made, is shown in the following table:— New Cases. Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 184 175 129 119 607 ("Contacts" included in above) 27 54 63 39 183 New cases with Respiratory Tuberculosis 58 33 3 4 98 (16.1 per cent.) New cases with Non-Respiratory Tuberculosis 5 3 16 17 41 (6.7 „ ) New cases regarded as "Suspects" 35 34 21 21 111 (18.2 „ ) New cases not suffering from Tuberculosis 86 105 89 77 357 (58.8 „ ) The total number of new cases shows a decline on last year, thus continuing the satisfactory diminution generally noticed and referred to in my Annual Report for 1921. It seems justifiable to believe that the fall is associated with the sustained work not only of the Dispensary but also of the medical profession generally, and to the vigorous action of public bodies. The cases went to the Dispensary either on their own account or through the following agencies:—the Public Health Department of the Council, the Guardians, the Ministry of Pensions, the London County Council, Hospitals, School Medical Officers, School Care Committees, the Kensington Dispensary and Children's Hospital, the Invalid Children's Aid Association, the Kensington Council of Social Service, the Infant Welfare Centres, and private practitioners. The large number (128) sent up by private doctors is encouraging, as it is the aim of the Dispensary staff to obtain the support and co-operation of the medical men in the district in all matters relating to tuberculosis. The treatment recommended for the 139 definite cases of tuberculosis was as follows:— Dispensary 49, Sanatorium 44, Hospital 13, Domiciliary 18, the Infirmary 7, transferred to other public authorities 2. In 6, no special treatment was found necessary. The total number of attendances at the Dispensary during the year was 3,951 and the number of systematic physical examinations made was 1,575. Home visits made by the Tuberculosis Officer were 110, and by the Women Health Officers 2,396. The latter does not represent a full years visiting by the Health Officers as they did not begin this work till the month of February. Written reports on patients to public authorities number 1,020 and to private practitioners 209. The former figure is a marked increase on the total for 1921, and the latter is an encouraging rise of 13 per cent. The sputum examinations totalled 552, being 42 more than in 1921. They referred to 425 individual patients in attendance during the year, and of these 119 or 28 per cent. showed tubercle bacilli in the sputum, while in the remaining 306 cases or 72 per cent. no tubercle bacilli were found to be present. Besides routine examinations of old and new cases and the making of recommendations for treatment either at the Dispensary or elsewhere, special efforts have been made to secure the examination of "contacts" of notified cases, and included in the number of new cases seen are 183 of these. Other "contacts" are examined by their own doctors and also by the School Medical Officers, but many escape and it is hoped to secure a larger number of "contact" examinations of cases notified, both by the Dispensary and outside, through a tightening up of the arrangements at present in force. The actual number of "contacts" found to be definitely infected is relatively small, but it is nevertheless of the utmost importance that these few should be discovered. Further, the fact that other cases have been to the Dispensary spreads the knowledge of its existence and purpose and probably increases the readiness of these "contacts" or their friends to make use of it again in the event of suspicious symptoms arising later. There is evidence to show that this does occur by subsequent requests for re-examination in some cases. "Suspect" cases, whether "contacts" or otherwise, are being more actively pursued, and in order to lessen their tendency to cease attendance before a final decision has been made, it has been thought desirable in some cases to put them temporarily on treatment at the Dispensary, thereby promoting their regular attendance, with the consequently increased opportunity of completing the diagnosis. This procedure, to a certain extent, contravenes the principle aimed at by the London 25 County Council of making the local Dispensaries, as far as possible, consultative centres rather than treatment centres, but, on the other hand, any method which increases the supervision of "suspects" or of "contacts" is of special service for the extremely important preventive side of tuberculosis work, a side which must claim more and more attention if the best results are to be obtained. As the housing conditions form such an important element in connection with tuberculosis, the following Table, giving the number of rooms occupied by the families of the definite cases and the number of occupants, is inserted. Number of rooms occupied by the families of definite cases and number of occupants. Rooms. No. of Occupants. 1 2 3 4 5 6 7 8 9 10 11 Cases. 1 5 6 — 1 1 1 2 — — — — 16 2 — 8 7 10 6 4 4 3 3 — — 45 3 — 3 4 2 7 3 2 1 1 — — 21 4 — 1 2 7 2 2 8 2 — — — 24 5 — 1 — 1 1 — — 2 2 — 1 8 6 — — — 1 — 1 — — — 1 — 3 7 — — — 1 — — — — — — — 1 8 — — — — — 1 — — — — — 1 *119 *The total falls short of the total number of cases owing to patients living in boarding houses, private hotels or large private residences not being included. Sleeping arrangements are of great importance and they are often unsatisfactory. The Women Health Officers always enquire into this question and, where possible, desirable alterations are pointed out and urged upon the family. The provision by the Borough Council of beds to be loaned out in certain cases, is of great value in helping to deal with this matter. South Dispensary Area. Under an agreement between the Borough Council and the Brompton Hospital authorities, Dr. Burrell, one of the Visiting Physicians to the Hospital, acts as 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 being devoted to her duties as Secretary of the Chelsea Tuberculosis Dispensary, which is stationed at the Hospital. Chelsea cases are seen on different days and by a different Tubculosis Officer, but in other respects, the Tuberculosis Dispensary arrangements for that Borough are similar to those for South Kensington. Record of work done in 1922. Total (1) New cases 248 (2) New cases with pulmonary tuberculosis 23 (3) New cases suffering from non-pulmonary tuberculosis 14 (4) New cases doubtful 49 (5) Total attendances at the Dispensary 1311 (6) No. of attendances at which systematic physical examinations were made 148 (7) Visits to patients' homes by Tuberculosis Officer 4 (8) Visits to patients' homes by Dispensary Nurses 604 (9) No. of specimens of sputum examined 64 26 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. 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 Health Officers are dealt with. Any "suspects" presenting themselves for examination are dealt with as in the case of those attending at the North Dispensary. 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. The Tuberculosis Officer visits patients at home occasionally, four such visits being paid in 1922. It has been difficult to co-ordinate the work of treatment at a large hospital like Brompton with the preventive work carried out by the Borough Council and in this respect the arrangements in South Kensington have not been as satisfactory as those in the northern area. The Brompton Hospital is a clinical unit established primarily for the treatment of individual patients and has a reputation second to none in the country; but Local Authorities must look at tuberculosis chiefly from a preventive point of view, and it cannot be expected that an institution such as the Brompton Hospital could possibly take a very large share in the preventive aspect of the work associated with this disease. After very careful consideration, the Public Health Committee in the Summer of 1922 came to the conclusion that the task of stamping out tuberculosis in South Kensington suffered from the curative and preventive work being divorced. As the result, of this conclusion, the Council, with the approval of the Ministry of Health and the London County Council, informed the Brompton Hospital Authorities that the present Dispensary arrangement would cease on March 31st, 1923. From April 1st of the present year, the Dispensary Treatment for the whole of Kensington will be centred at No. 119. Ladbroke Grove, the address of the North Kensington Dispensary, and the work of prevention will be carried out by the Council's Officers attached to that institution. MEDICAL CONSULTATIONS AND X-RAY DIAGNOSIS. The Ministry of Health and the County Council have signified their approval of an arrangement by which the Tuberculosis Officer can consult Visiting Specialists at the St. Mary Abbot's Hospital in Marloes Road; they have also approved of Dispensary patients visiting the Hospital for the purpose of X-ray diagnosis in difficult cases. These arrangements were in operation throughout the major portion of 1922. The Board of Guardians, with their Officers, provided every facility to both the Tuberculosis Officer and myself and I desire to express our appreciation of the valuable assistance we have received. DENTAL TREATMENT OF TUBERCULOUS PERSONS. The efficiency of the Dispensary treatment has been much increased by the arrangement made by the Council in 1920 for dental treatment, and it is hoped that a recent increase of the number of hours during which the dentist may be consulted will still further add to the value of the work. The Council's scheme provides for dental treatment, including the provision of dentures, for definite and "suspect" 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 limited to patients recommended by the Medical Officer of Health. The Dental Clinic is established on the Dispensary premises at No. 119, Ladbroke Grove. A Registered Dental Surgeon is employed and is paid by the Council on the basis of work done. The fees paid to the Dentist were slightly increased in respect of dentures on April 1st, 1922, and the scale of fees now being paid is as follows:— (1) Separate extractions. Minimum fee of 2s. 6d. (2) Separate fillings. Minimum fee of 5s. (3) Dentures. From £2 5s. for a part set to £4 for a complete set. No charge for extractions previous to the fitting of dentures. Extractions and fillings are performed for all patients free of charge, while the cost of the provision of dentures, together with the financial position of the persons receiving them, is reported to the Tuberculosis Care Committee who assess and collect payments on behalf of the Council. The work done during the year is shown in the following table:— No. of Dentist's attendances at Dispensary 43 No. of attendances of patients 123 No. of extractions 271 No. of fillings 4 No. of dentures arranged for 18 No. of cases of scalings — Payments to the dentists during the year amounted to £40 12s. 6d. 27 In 7 of the 15 cases for which dentures were provided. the persons were so poor that no assessment was made, and in the other eight cases the assessments totalled £9. Up to the end of the year £6 9s. had been collected by the Tuberculosis Care Committee on behalf of the Council. THE BOROUGH TUBERCULOSIS CARE COMMITTEE. The Interim Tuberculosis Care Committee continued their services up to November 30th, on which date the Borough Tuberculosis Care Committee was definitely constituted in accordance with the proposals brought forward by the Public Health Committee and approved by the Council in July, 1922. The constitution and membership of the Committee are as follows:— (1) Borough Council—Councillor Miss C. Keeling, Chairman of the Public Health Committee, Councillor Miss M. H. Joseph, Councillor Miss M. Drysdale and Miss R. F. Alexander. (2) London County Council—Dr. A. W. Sikes, Divisional Medical Officer, and Miss G. M. S. Paddon, District Organiser of the School Care Committees. (3) Kensington School Care Committees—Miss A. Webster. (4) Kensington Invalid Children's Aid Association—Dr. E. F. Hatton and Miss R. Marwood. (5) Kensington Charity Organisation Society—Mrs. E. Weber and Miss. O. A. Nixon. (6) Brompton Hospital—Miss A. Moses. (7) Kensington Board of Guardians—Councillor Miss A. G. E. Carthew. (8) Kensington District Nursing Association—Miss E. D. Gibbes. (9) Kensington War Pensions Committee—One representative. (10) Kensal House School—Miss C. D. Clay. (11) London Insurance Committee—Dr. H. H. Mills. (12) Ex-officio members—Medical Officer of Health, Tuberculosis Officer for North Kensington, Tuberculosis Officer for South Kensington, and two Women Health Officers. The Committee, at their first meeting, appointed Councillor Miss Carthew as Chairman, Councillor Miss Joseph as Vice-Chairman, and Miss Hargrave, one of the Council's Women Health Officers, as Secretary. The Committee decided to meet fortnightly, on alternate Thursday mornings, at the Town Hall and, in order to ensure that the activities of the Committee shall prove effective, they have framed a set of regulations which are to be observed by the Secretary of the Care Committee and the various persons working in co-operation with that Committee. PREVENTIVE WORK IN RELATION TO TUBERCULOSIS. The treatment of tuberculosis is preventive in so far as it cures the patient and renders him non-infective to others, but, in addition to this method of prevention, the Council undertake various other measures with a view to limiting the spread of this disease. For the sake of brevity, the action taken during the year for the prevention of consumption may be summarised af follows:— 1.—The Number of Visits during the year. Women Health Officers. Total. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Tuberculosis. Pulmonary. First Visits 25 37 22 40 40 40 60 264 Re-Visits 230 260 237 258 39 309 365 1,698 Non-Pulmonary. First Visits 7 5 5 8 3 — 10 38 Re-Visits 76 48 101 86 8 35 42 396 In previous years visits have been paid by the Council's Women Health Officers for the special purpose of taking preventive measures, and other visits have been paid to the same homes by nurses attached to the Dispensary and Brompton Hospital nurses in connection with treatment. In the year 1922, the treatment and preventive visiting in the North Dispensary area were combined, and at each of the visits indicated in the above Table the Health Officer took into her purview the questions of both treatment and prevention. In addition, a certain number of visits were paid by nurses from Brompton Hospital to patients in South Kensington, but these were for the purpose of treatment only. 28 2.—Provision for Home Isolation. Bedsteads and bedding lent — 3.—Disinfection after Death or Removal to Hospital. Cases where beading, etc., was disinfected by steam 109 Number of rooms disinfected 142 4.—Specimens of Sputum from suspects examined bacteriologically by the Lister Institute at the expense of the Council 121 MATERNITY AND CHILD WELFARE. From the point of view of Maternity and Child Welfare work, the year has been a very satisfactory one in many ways; the infantile death rate has fallen considerably; the incidence of ophthalmia neonatorum has decreased as compared with previous years; there was comparatively little summer diarrhoea; and the arrangements made by the Council for the co-ordination of the work of the voluntary agencies engaged on Child Welfare have continued to work smoothly and with efficiency. WOMEN HEALTH OFFICERS. The Maternity and Child Welfare duties allotted to the Women Health Officers are 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 indicate. 2. To visit the homes and make investigations in regard to still-births and infantile deaths. 3. To visit and give advice to parents in cases of ophthalmia, diarrhoea and other diseases causing deaths amongst infants. 4. To visit and report upon all cases of puerperal fever. 5. To investigate applications under the Council's Scheme for the supply of milk free or below cost price. These officers also attend at the Infant Welfare Centres in their respective areas on doctors' consultation days in order to assist in the work and to co-ordinate their efforts with those of the salaried and voluntary workers attached to these institutions. The work performed by the Women Health Officers in 1922 in regard to Maternity and Child Welfare is summarised in the following table:— Description of Work. Health Officers. No. 1 No. 2 No. 3 No. 4 No. 5 No 6 No. 7 Total Visits to Infants under the age of 21 days. (First Visits) 42 363 367 316 299 362 340 2,089 Re-visits to Infants under the age of 12 months 56 639 497 980 1,118 734 790 4,814 Visits to Children between 1 and 5 years 118 950 832 714 1,092 632 523 4,861 Still-birth enquiries 1 6 5 9 8 6 9 44 Visits to Ophthalmia Cases — 1 10 1 1 6 8 27 Return Visits to Ophthalmia Cases — 11 48 9 18 16 28 130 Visits to Measles Cases 39 109 104 85 87 51 83 558 Visits to Whooping Cough Cases 33 11 10 — — 18 8 80 Visits to Puerperal Fever Cases 1 — 2 2 3 1 2 11 Infantile Death Enquiries 12 43 32 21 22 33 40 203 Investigations re Milk Applications 16 99 135 96 32 64 209 651 Ante-natal Visits 13 91 11 16 — 42 49 222 Half-days at Welfare Centres 12 142 141 140 96 82 150 763 Special Visits 285 318 169 232 157 83 151 1395 29 The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of this Report dealing with those subjects, and a complete record of the work performed by each Woman Health Officer during the year appears in Table VII. of the Appendix. INFANT WELFARE CENTRES. There are seven voluntary Infant Welfare Centres in Kensington, and the Borough has been mapped out into a similar number of areas with one Centre in each, an attempt having been made to place each home in the area of that Centre most accessible to the mother. The principal duties of a Welfare Centre are those of an educational institution—providing advice and teaching for the mothers in the care and management of little children with a view to maintaining them in good health. The guidance and teaching is both individual and collective. Individual advice is given at the medical consultations and in the course of home visiting, collective advice being given to mothers by simple class teaching. The following table shows the main items of work performed at each of the Centres curing the year:— Particulars of Work done. Archer Street Bramley Road with Kenley Street branch Campden Hill Earl's Court. Golborne Lancaster Road Raymede Totals 1—No. of births occurring in the area of the Centre suitable for Welfare attention 149 670 142 352 357 312 342 2324 2—No. of sessions at which doctor attended for infant consultations 99 200 91 101 97 92 149 829 3—No. of sessions at which doctor attended for special ante-natal consultations 23 — 12 6* — 21 46 108 4—Total number of individual mothers who attended during the year 424 772 105 98 335 391 390 2515 5—Number of individual mothers who attended ante-natal sessions during the year 60 58 23 51 34 40 99 365 6—Total number of individual children who attended during the year (Old) 223 406 200 224 239 148 307 1747 ,, „ „(New) 213 513 86 159 200 255 290 1716 7—Number seen by doctor at consultations— 1. Ante-natal mothers 98 92 55 139† 107 162 221 874 2. Post-natal mothers 224 484 5 184 259 69 815 2040 3 Children 2446 4567 2003 3145 1983 2245 4223 20612 8—Average number seen by doctor at consultations— 1. Ante-natal mothers 4.2 — 5 11 — 7.7 4.8 — 2. Post-natal mothers 2 2.4 — 2 2.5 .7 5.4 — 3. Children 24.7 22 22 31 20 24.4 28 — 9—Number of individual children weighed during the year 436 919 205 215 439 403 597 3214 10—Total weighings 3076 6569 2022 4126 3881 2946 7837 30457 11—Number of first visits paid by salaried workers to— 1. Expectant mothers 51 186 15 68 20 58 179 577 2. Children 60 14 105 9 — 84 — 272 12—Total number of home visits paid by salaried workers to— 1. Expectant mothers 87 245 67 150 24 142 416 1131 2. Children 2846 1599 1131 1327 787 1258 2941 11889 13—Number of home visits paid to children by voluntary workers — 1. First visits — — — — — 57 — 57 2. Total visits — 252 — 6 104 112 — 474 *Sessions commenced in May, 1922. †Some of these mothers attended infant consultations before ante-natal consultations were commenced. Infant Consultation Sessions are held by medical officers in the afternoons; the sessions begin about 2 p.m. and continue until 4 or 5 p.m. At five of the Centres there are two sessions per week; at Raymede there are three and at Bramley Road three, in addition to the one weekly session at the Branch in Kenley Street. 30 Special Ante-natal Sessions are held in the afternoons at Archer Street, Campden HillEarl's Court, Lancaster Road and Raymede, and at the other two Centres expectant mothers are seen privately on infant consultation days. The Home Visiting figures given in the preceding table do not include visits paid by the Council's Women Health Officers. The numbers, which vary considerably in the different areas, depend to a large extent on the staff available for the purpose. For example, at the Golborne Centre the Sister-in-charge is also Matron of the attached Day Nursery, with the result that she has very little time for visiting. In accordance with the scheme of visiting which has been drawn up by the Advisory Committee and approved by the Council, "first visits" to infants are paid by the Council's Women Health Officers when possible. Other Activities.—Health talks on consultation afternoons or lectures on other afternoons are given at all the Centres, and other activities include treatment of minor 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 all the Infant Welfare Centres provided dental treatment (including the supply of dentures) for expectant and nursing mothers who were unable to pay the fees usually charged by dentists. 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 £5 for a complete set, they were very well made and gave considerable satisfaction. TABLE SHOWING THE AMOUNT OF DENTAL TREATMENT PERFORMED AT THE VARIOUS CENTRES IN 1922. Centre No. of patients. No. of attendances. Extractions. Fillings Dentures Other Treatments. Archer Street 64 240 124 88 24 19 Bramley Road 39 94 161 16 11 11 Campden Hill 4 11 29 — — 1 Earl's Court 119 525 388 122 62 75 Golborne 11 20 10 3 — — Lancaster Road 50 94 120 42 11 4 Raymede 146 583 271 24 25 21 433 1567 1103 295 133 131 TELFORD ROAD BABY CLINIC. This institution acts both as a Treatment Centre and Infant Welfare Centre, but it is not an Infant Welfare Centre in the same sense as the other seven; nevertheless, much valuable work is performed. The following are the records for the year ending December 31st, 1922:— Number of sessions at which doctors attended for infant consultations 151 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 52 Total number of individual mothers who attended during year 224 Total number of individual children who attended during year (Old) 722 ,, ,, ,, (New) 583 Total attendances at Centre of mothers for all purposes (excluding the accompanying of children) 678 Total attendances of children at Centre for all purposes 9,514 Number seen by doctor at consultations:— 1. Ante-natal mothers 312 2. Post-natal mothers 364 3. Children 6,946 Average number seen by doctor at consultations:— 1. Ante-natal mothers 6 2. Post-natal mothers 7 3. Children 46 Number of individual children weighed 1,305 Total weighings 6,946. 31 The Committee of the Telford Road Baby Clinic have recently completed an agreement with the County Council under which a limited number of school children will be treated at the Clinic for certain minor defects and ailments discovered at the School Medical Examinations. In this respect they have met a much-felt want and their decision will enormously enhance the value of the Clinic in North Kensington. There is need of a Centre in North Kensington to which children under school age can be referred for treatment by the doctors at the Infant Welfare Centres and if some satisfactory arrangement could be arrived at so that the Telford Road Clinic could be made to serve purely as a Treatment Centre for infants and school children, the Kensington Child Welfare Scheme would be a splendid example of what could be achieved by voluntary effort. LADBROKE ROAD BABY IN-PATIENT HOSPITAL. This institution, which was opened in 1919, has 19 beds for the treatment of sub-acute and chronic diseases. Records for the year 1922:— Number of infants in residence at commencement of year 16 Number of admissions during the year 98 Number of discharges during the year 90 Number of deaths during the year 7 Number in residence at end of year 17 Average duration of stay in hospital 46 days As in previous years the Council made a grant of £200 to the Authorities of the Hospital towards the maintenance for a further period of twelve months of two beds therein, to be placed at the disposal of the Infant Welfare Centres serving the Borough, the grant to be subject to the same conditions as in 1921, viz: that provision shall be made for the doctors in attendance at the Centres to continue in the hospital, if they so desire, the supervision of the cases recommended by them, and that the Medical Officer of Health shall continue a representative of the Council on the Committee of Management and shall be furnished with the names and addresses of patients admitted from within the Borough, together with the dates of their admission and discharge. Although two beds are reserved for children recommended from the various Kensington Welfare Centres, all the beds are available for children belonging to the Borough. QUEEN CHARLOTTE'S HOSPITAL ANTE-NATAL CLINIC, No. 176, LADBROKE GROVE. This Clinic was opened by the Queen Charlotte's Hospital Authorities in June, 1921, at their District Nurses' Home, which is situated a little north of the Ladbroke Grove Railway Station—a point easily accessible to the majority of North Kensington mothers. During the year 1922, 1,028 individual mothers attended the ante-natal sessions and the total attendances amounted to 1,559. MIDWIFERY ARRANGEMENTS. The number of home confinements attended by the staff of the North Kensington Queen Charlotte's District Nurses' Home during 1922 was 991, a very large majority of these being Kensington cases. Up to the present time no midwifery scheme has been adopted by the Borough Council, although at one period it seemed probable that the Queen Charlotte's Hospital Authorities would establish a Maternity Home in North Kensington and that the Council would contribute towards the cost of maintenance of an agreed number of beds. At the beginning of the year 1922 the private midwife who practised amongst working class mothers in South Kensington, and who had always worked in close co-operation with the Earl's Court Infant Welfare Centre, was obliged to retire owing to ill-heath. The practice was small and it appeared unlikely that another midwife would establish herself in a district where the patients were so few and scattered over such a wide area. In these circumstances the Committee of the Earl's Court Centre decided to employ a midwife and to collect such fees in respect of her services as the patients could pay, in order that the working class mothers in South Kensington should not be without the services of a competent midwife who resided within reasonable distance. The midwife commenced practice on January 23rd, 1922, and up to the end of the year had attended 54 confinements. As was anticipated, the scheme was not at once financially successful, but judging by the increasing number of cases being booked, the Committee of the Earl's Court Centre may look forward with confidence to the year 1923. The Borough Council showed their appreciation of this movement by contributing a sum of £25 towards the deficit which the Centre suffered during the year. 32 DAY NURSERIES. The following table shows a record of children's attendances at the five Day Nurseries in the Borough in the year 1922. Golborne. Kensal Creche (Medical Mission) Lancaster Road. Notting Hill Day Nursery St. Clement's, Treadgold St. Totals 1. Whole day attendances of children under 3 years of age 4376 1789 3286 8510 2749 20710 2. Whole day attendances of children over 3 years of age 1491 325 716 2779 1078 6389 3. Total whole day attendances 5867 2114 4002 11289 3827 27099 4. Charges made for each attendance of a child 10d. 9d. 9d. 8d. 1/- — 5. Half-day attendances of children under 3 years of age — 387 496 — 408 1291 6. Half-day attendances of children over 3 years of age — 157 296 — 184 637 7. Total half-day attendances 544 792 — 592 1928 8. Charges made for each attendance of a child — 5d. 6d. — 8d. — 9. Average daily attendance of children 26 12 21 51 18 — In the Annual Report for 1920 attention was drawn to this branch of Maternity and Child Welfare work, and the opinion was expressed that the future of Day Nurseries required very careful consideration. It is quite true that these institutions are of great value to those mothers who, through force of circumstances, are compelled to go out to work for the support of their families; but there is no doubt that at times Day Nurseries are used for the care of children whose mothers can afford to stay at home but avail themselves of the opportunity of working in factory or shop. It is important, therefore, that particular stress should be laid on the necessity for care in the selection of infants for admission in order to prevent the unnecessary expenditure of public money on children whose mothers go out to work for preference and not out of necessity. HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. A record of work done at the institutions in the Borough in 1922 is shown in the following Table:— 124, Elgin Crescent 2, Upper Phillimore Place Totals 1. No. of expectant or nursing mothers in residence at commencement of year 9 5 14 2. No. admitted during the year 8 27 35 3. No. remaining in residence at the end of the year 7 4 11 4. Average duration of stay before confinement (in days) — 30-50 — 5. Average duration of stay after confinement (in days) 178 80-120 — 6. No. of infants and children under 5 years of age in residence at beginning of year 9 4 13 7. No. admitted during the year 8 21 29 8. No. remaining in residence at end of year 7 — 7 9. Average duration of stay (in days) 178 90-130 — The figures for the Home at No. 124, Elgin Crescent are a record of the work carried out in the first eleven months of the year. At the expiration of that period the Home was closed and the mothers in residence were transferred to the Home at No. 466, Uxbridge Road, W. 12. This address is actually in the Borough of Hammersmith, but the Home is in every other sense a Kensington Institution, controlled by a Kensington Committee, and gives preference to Kensington mothers. 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. 33 STATISTICS FOR THE YEAR ENDED 31st DECEMBER, 1922. No. of Infants in the Institution at the beginning of year 21 No. admitted during the year 106 No. discharged during the year 109 No. in residence at the end of the year 18 Average duration of stay of Infants in the Institution— Malnutrition Cases 67 days Breast Feeding Cases (Infants and Mothers) 24 days No. of Infants receiving out-patient treatment— New Cases 587 Attendances 3,315 No. of Mothers in the Institution at the beginning of the year 9 No. admitted during the year 55 No. discharged during the year 54 No. in at the end of the year 10 Average duration of stay of each mother in the Institution 22 days No. of Mothers receiving out-patient treatment in connection with the re-establishment of breast-milk 195 NATIONAL CHILDREN'S ADOPTION ASSOCIATION HOSTELS. These institutions are situated in the Borough, but their work is national rather than local. Unwanted infants are received from various parts of the country and are cared for until adopted by some reputable person. RECORD OF WORK DONE IN 1922. Tower Cressy, Campden Hill. *Addison House, 38, Holland Villas Road. Number of children in the institution at the commencement of the year 13 4 Number admitted during the year 99 65 Number discharged during the year 94 69 Number in residence at the end of the year 18 — Average duration of stay of each child in the institution 48 days 47 days • This institution was permanently closed on November l5th, 1922. CONVALESCENT HOMES. In May, 1922, the Council discontinued their annual subscription of £10 to the Ashburton Home and in place thereof subscribed for four admission letters to the Evelyn Convalescent Cottage Home at Wargrave, Berks, and two to the Hambledon Cottage Home, Surrey, at a cost of £12 12s. 0d. The subscription of £12 12s. 0d. to the London Mothers' Convalescent Home, Sunningdale, Berks, was continued until December, 1922. In that month the Council were informed that the mothers for whom the letters were intended were unable to pay an extra charge made by the Institution. Further, the maximum age limit on admission of three months in the case of the infant was an obstacle and, on more than one occasion, beds were not available when required. In consequence of these difficulties the letters of admission supplied in respect of the Council's subscription were not fully utilised, and the Council accordingly directed that their subscription of £12 12s. 0d. to the London Mothers' Convalescent Home should be cancelled and that the subscription to the Wargrave Home should be increased by £8 8s. and to the Hambledon Home by £4 4s. The Council can now send each year 8 mothers with infants to the Wargrave Home and 4 mothers with infants to the Hambledon Home. HOME HELPS. No applications for Home Helps under the Council's scheme have been received during the year. HOME NURSING. During the later months of 1922 the Committee of the Golborne Infant Welfare Centre gave careful consideration to the question as to whether anything further could be done in the Golborne Ward to improve the health of the children, and it was resolved to employ a trained nurse on the staff of the Centre to undertake the home nursing of expectant and nursing mothers, and children under five years of age. Home nursing has in the past been conducted in the Golborne Ward, as in every part of the Borough, by the Kensington District Nursing Association, therefore, it was decided to consult the Superintendent of the Nursing Association before any further steps were taken. A Conference, attended by the Hon. Secretary of the Golborne Centre, the Superintendent of the Nursing Association and the Medical Officer of Health, drew up a scheme of work under which the nursing staffs of the three authorities namely (1) the Borough Council (2) the Kensington District Nursing Association and (3) the Golborne Infant Welfare Centre, work in close co-operation. Overlapping is avoided, arrangements having been made for only one nurse to be in attendance at any one house. The Golborne Centre Nurse commenced duty on November 24th, 1922, and up to the end of the year she had paid 123 nursing visits. Details of the work performed by the Kensington District Nursing Association appear on page 22. 34 SUPPLY OF EXTRA NOURISHMENT TO MOTHERS AND CHILDREN. The distribution of extra nourishment to mothers and children is part of the Council's Maternity and Child Welfare Scheme, but at the suggestion of the Ministry of Health the record of the work done is given under the "Food Supply" section of this report and will be found on page 42. GRANTS TO MATERNITY AND CHILD WELFARE INSTITUTIONS PAID BY THE BOROUGH COUNCIL FOR THE YEAR 1922 The Archer Street Infant Welfare Centre £ s. d. 100 0 0 The Bramley Road „ „ „ (with Kenley Street Branch) 225 0 0 The Campden Hill ,, „ ,, 75 0 0 The Earl's Court ,, ,, ,, 100 0 0 The Golborne „ „ „ 150 0 0 The Lancaster Road „ „ ,, 150 0 0 The Raymede „ „ „ 150 0 0 Evelyn Convalescent Cottage Home 8 8 0 Hambledon Cottage Home 4 4 0 The London Mothers' Convalescent Home 12 12 0 The Ladbroke Road Baby Hospital 200 0 0 The Kensington District Nursing Association 150 0 0 These grants have been sanctioned by the Minister of Health, with the result that 50 per cent. will be refunded to the Council by the Government in all except the last mentioned, in respect of which the Government's contribution is £50. THE WORK OF THE ADVISORY COMMITTEE TO THE MATERNITY AND CHILD WELFARE COMMITTEE. This Committee was formally constituted by the Council in 1920, and is composed of two representatives appointed by each of the seven Infant Welfare Centres with two appointed by the Telford Road Baby Clinic. Mrs. H. T. Carnegie, for the second year in succession, acted as Chairman. In November, on re-election of the Committee by the Council, Lady Davison was appointed Chairman and Lady Maurice Vice-Chairman for the ensuing year. The primary object of the Advisory Committee was to secure the co-ordination of the work of the various Welfare Centres and Baby Clinic and co-operation between these voluntary organisations and the Borough Council. There is no doubt that the formation of the Advisory Committee was the first sound step towards real co-operative progress, and the existence of this body has been fully justified by the successful manner in which difficult problems have been solved, and by the enthusiastic way in which the various institutions work under its guidance. During the year under review much valuable work has been accomplished. A scheme of record keeping was worked out with much care, and, after being put into operation in Kensington, was largely adopted by the Ministry of Health for use throughout England and Wales. The high infantile death rate of the Borough, as shown in the statistics published in the Annual Report for 1921, received very careful consideration, and a special sub-committee was appointed to investigate the subject from the point of view of the Infant Welfare Centres. As a result of their investigations and deliberations, a series of recommendations were forwarded to the Council's Maternity and Child Welfare Committee; these dealt mainly with insanitary houses and the collection of house refuse in the poorer quarters of the Borough. In addition, a deputation waited on the Kensington Board of Guardians to call attention to certain details of administration which, in the opinion of the Advisory Committee, would influence mothers to seek earlier admission to the St. Mary Abbot's Hospital for their sick children, so that they might receive in the early stages of illness that skilled medical and nursing attention which would certainly reduce the number of infant deaths in the Borough. Recommendations on many questions concerning child welfare have been forwarded to the Maternity and Child Welfare Committee, and in addition a large amount of work dealing with the routine administration of the Infant Welfare Centres was carried out during the year. FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are regulated by Section 8 of the London County Council (General Powers) Act, 1908. Premises where milk is sold are required to be kept in accordance with the Dairies, Cowsheds and Milkshops Order, 1885, and the Regulations made thereunder by the Council. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Proceedings in cases of adulteration are instituted under the Sale of Food and Drugs Acts. Milk Supply.—The Dairies, Cowsheds and Milkshops Order, 1885, requires the Council to keep a Register of persons from time to time carrying on the trade of dairymen or purveyors of milk and provides that a person may not carry on the trade unless he is registered. Under Section 5 of the London County Council (General Powers) Act, 1908, the Council are authorised to remove from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose. 35 In November, 1920, the Council resolved that the presence upon any premises of such articles as (1) paraffin, (2) loose pickles, (3) vinegar (except in sealed bottles), (4) fish, (5) meat of all forms (except when in sealed tins or glass), (6) fruit, (7) vegetables, (8) coals or coke, and (9) wood (except in bundles, provided the same be not kept in the milk store), would constitute a source of contamination rendering the said premises unsuitable for the sale of milk, and the registration of persons entitled to carry on the trade of a purveyor of milk in Kensington has been subject to the resolution being complied with. Section 2 of the Milk and Dairies (Amendment) Act, 1922, empowers the Council to refuse to enter any person's name on the Register or to remove his name from that Register, if they are satisfied that the public health is or is likely to be endangered by any act or default of his in relation to the quality, storage or distribution of milk. During the year 1922, 22 applications for registration were received from persons who proposed to sell milk, and with one exception these were granted. The alterations made in the Register of Milk Purveyors in 1922 are summarised in the following table:— Class of Premises Milkshops. General Stores. Restaurants. Totals. Transferred 11 3 0 14 Vacated and removed from Register 2 0 0 2 Premises added to Register 6 1 0 7 On Register December 31st, 1921 112 19 32 163 On Register December 31st, 1922 116 20 32 168 Increase+ Decrease— +4 +1 +0 +5 — It will be seen that at the end of the year the Register, kept by the Council, and revised from time to time in accordance with the requirements of the Milkshops Order, contained the names of 168 persons carrying on the trade of purveyors of milk on premises within the Borough. The inspections of dairies and milkshops made during the year numbered 808, and notices were served requiring the remedy of defects which were found on 3 of the premises visited. Milk (England and Wales) Order, 1921.—Under this Order, which continued in force until the end of the year, the Minister of Health granted licences for the sale of "Grade A" milk or "Grade A (Certified)" milk in respect of 14 shops in the Borough, these being additional to the 28 premises licensed in 1921. Milk (Special Designations) Order, 1922.—The Minister, in exercise of the powers conferred upon him by Section 3 of the Milk and Dairies (Amendment) Act, 1922, issued in December last this Order, which prescribes the conditions subject to which licences may be granted for the sale of milk as "Certified," " Grade A (Tuberculin Tested)," "Grade.A," or "Pasteurised." Licences may be granted to two classes of persons, namely:— (1) Those who sell milk either by wholesale or retail; and (2) "Producers," i.e., persons owning or having control of herds from which milk is sold. Under the Order the Council are authorised to grant licences to persons other than a producer to sell milk under any of the special designations above mentioned. Every licence granted will be valid for a period ending on the 31st day of December in the year in respect of which it is granted. The Order lays down a schedule of fees to be paid by applicants for licences. Addition of Colouring Matter, etc., to Milk.— Section 4 of the Milk and Dairies (Amendment) Act, 1922, prohibits the addition of any colouring matter or water, or reconstituted milk, or skimmed or separated milk, to milk intended for sale. This Section enables the Council to deal with cases in which additions are made for fraudulent purposes, but in which difficulty is experienced in proving that the mixture is sold as milk. Milk Utensils in Infected Homes.—During the year it came to my notice that milk purveyors continued to supply milk in their own vessels to householders in cases where patients suffering from notifiable infectious diseases were being nursed at home. These vessels often remained in the house for 24 hours, and were frequently returned unwashed to the purveyor. I communicated with retailers in Kensington, and all agreed to refuse to leave their milk vessels at infected houses and to insist on delivering the milk into vessels provided by the customer. I have, therefore, now adopted the practice of sending information to retailers supplying milk to houses in which cases of infectious disease are being nursed at home, and from the date of the receipt of my notification to the date of a later communication stating that the house is free from infection, no milk vessel belonging to the dealer is allowed to enter the home in question. 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 in 1920, 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 185 premises were shown in the Register of places within the Borough where ice cream is prepared or sold, fourteen having been removed during the year. 36 The trade is mainly regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice cream are also required to notify the occurrence of infectious disease among their employees or persons living on their premises. The Act further provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice cream has been obtained. Two hundred and twenty-five visits to ice cream premises have been made by the inspectors during the year. The powers under the Public Health (London) Act, 1891, and the London County Council (General Powers) Act, 1902 and 1908, enable the Council to exercise efficient control where the vendors and premises are known, but, inasmuch as ice cream may be made under unsatisfactory conditions on premises other than those where it is stored, a system of compulsory registration of premises where the commodity is manufactured, stored or sold and of itinerant vendors of ice cream, should be introduced. In addition, byelaws are needed to secure the sale of ice cream from street barrows being conducted under clean conditions. Bakehouses.—There are 93 bakehouses in the Borough, and of this number 69 are underground. As a result of 308 inspections, which were made during the year, 14 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 284. Other Places Where Food is Prepared.—In addition to the above-mentioned food premises, places in the Borough where food is prepared for or exposed for sale are entered in a Register under the date on which they were finally inspected and found to comply with the requirements of the County Council (General Powers) Act, 1908. The following Table shows the number of such premises on the Register at the end of the years 1921 and 1922, 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, 1921 288 178 111 39 55 103 16 790 No. added 7 10 1 1 0 0 1 20 Removed 0 0 0 0 0 1 0 1 On Register Dec. 31st, 1922 295 188 112 40 55 102 17 809 The inspections of the above premises during the year numbered 1,004, 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 2 Drains defective 2 Refuse deposited 1 Want of cleanliness 23 Defective ashpit accommodation 8 Other detects 25 Total number of defects found 61 Food Sold from Street Stalls.—Street trading is carried on in various parts of the Borough, out particularly in Portobello Road, and the foodstuffs sold from the street stalls are inspected 37 frequently by the Council's Sanitary Inspectors. These officers find that on the whole the foodstuffs are of good quality and wholesome. There is, however, no means of knowing where the food is stored at night and on Sundays. Street traders should be registered and Bye-laws giving wide powers are needed in order to safeguard public health. Registration would enable the storage places to be inspected. Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— Skate (stone) 14½ Plaice (stone) 2 Liver (lbs.) 12 Haddock (box) 1 Cods Roe (box) 1 Plums (baskets) 100 Apples (boxes) 36 SALE OF FOOD AND DRUGS ACTS. Each of the ten Sanitary Inspectors is appointed an Inspector under the above Acts, and is instructed to take samples in any place in the Borough which is not within his own sanitary district. The samples procured are of two kinds, namely, formal and informal. (a) Formal Samples.—These are samples which are taken strictly in conformity with the requirements of the Sale of Food and Drugs Act, 1875, and during the year the Inspectors collected 685, of which 33 or (4.7 per cent) were adulterated. Particulars of formal samples collected are as follows:— Nature of Sample. Number Taken. Number Adulterated. Milk 278 3 Butter 74 ... Margarine 30 ... Cheese 26 ... Soft Cheese 2 ... Dutch Cheese 2 ... Arrowroot 12 ... Fish Paste 11 3 Sweets 18 ... Medical Prescription 6 ... Calomel Ointment 5 1 Meat Paste 21 2 Whisky 4 ... Epsom Salts 3 ... Tincture of Iodine 3 ... Gregory Powder 2 ... Carbonate of Magnesia 2 ... Magnesia 5 2 Rum 3 ... Gin 9 1 Rice 11 1 Vinegar 34 5 Sausages 20 7 Brawn 14 2 Black Pepper 2 ... ... Lard 3 ... Tartaric Acid 1 ... Tea 12 ... Cocoa 20 ... Flour 8 ... Coffee 20 ... Boric Acid Ointment 5 ... Mustard Mixture 1 ... Mustard 3 ... Coffee and Chicory Mixture 2 ... Separated Milk 1 ... ... Mincemeat 6 1 Tinned and Preserved Peas 6 5 Total 685 33 38 (b) Informal samples.—These are taken without compliance with the strict formalities of the Food and Drugs Act and serve to show the conditions obtaining without disclosing to the vendor the fact that samples are being taken for analysis. Particulars of informal samples collected are as follows:— Nature of Sample. Number Taken. Number Adulterated. Milk 105 4 Butter 26 • • • Margarine 15 • • • Fish Paste 8 . . . Sweets 1 • • • Meat Paste 10 1 Tincture of Iodine 6 • • • Dried Milk 14 • • • Magnesia 5 2 Rum 2 ... Gin 4 2 Rice 1 • • • Vinegar 7 1 Sausages 3 • • • Brawn 3 2 Cornflour 6 ... Black Pepper 1 • • • Tartaric Acid 1 ... Cyder 1 • • • Cayenne Pepper 1 • • • Flour 4 ... Coffee 2 • • • Boric Acid Ointment 3 • • • Mustard Mixture 5 ... Mustard 3 ... British Wine 3 2 Lime Juice 2 ... Shredded Beef Suet 1 • • • Concentrated Ginger Wine 1 • • • Corned Beef 1 ... Total 240 14 No legal proceedings can be taken in respect of an informal sample, but, when adulteration is discovered, formal samples are obtained immediately and necessary action taken. In the fourteen samples of dried milk the percentage of milk fat present varied from 24.6 to 28.5 Summary of the Results of Analysis of the 47 Adulterated Formal and Informal Samples, together with a record of the action taken by the Council. Article Analysed. Nature and Amount of Adulteration. Action taken. Brawn 12.145 grains of Boric Acid per pound Vendor cautioned Brawn 10.857 grains Boric Acid per pound Informal sample Brawn 9.604 grains Boric Acid per pound Informal sample Brawn 6.069 grains Boric Acid per pound Vendor cautioned British Wine 0.875 grains of Salicylic Acid per pint Informal sample British Wine 0.70 grains of Salicylic Acid per pint Informal sample Calomel Ointment 42 per cent. required Calomel deficient Vendor cautioned Fish Paste 13.636 grains Boric Acid per pound Vendor cautioned 39 Article Analysed. Nature and Amount of Adulteration. Action taken. Fish Paste 12.516 grains Boric Acid per pound Vendor cautioned Fish Paste 10.01 grains Boric Acid per pound Vendor cautioned Gin 54.05 degrees under proof Informal sample Gin 47.68 degrees under proof Informal sample Gin 47.2 degrees under proof No action. Declaration exhibited by vendor Magnesia 100 per cent. Magnesium Carbonate Vendor cautioned Magnesia 100 per cent. Magnesium Carbonate Vendor cautioned Magnesia 90 per cent. Magnesium Carbonate Informal sample Magnesia 45 per cent. Magnesium Carbonate Informal sample Meat Paste 4.33 grains of Boric Acid per pound Vendor cautioned Meat Paste 9.716 grains of Boric Acid per pound Vendor cautioned Meat Paste 8.351 grains of Boric Acid per pound Informal sample Milk 4.7 per cent. extraneous water Proceedings dismissed. Warranty defence Milk 3.6 per cent. extraneous water Informal sample Milk 2.0 per cent. extraneous water Informal sample Milk 3.0 per cent. extraneous water Vendor cautioned Milk 2.2 per cent. extraneous water Vendor cautioned Milk 2.0 per cent. extraneous water Informal sample Milk 3.6 per cent. extraneous water Informal sample Mincemeat 5.268 grains of Boric Acid per pound Vendor cautioned Preserved Peas 1.449 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Preserved Peas 1.311 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Preserved Peas 0.828 grains of Crystallised Sulphate of Copper per pound Vendor cautioned Rice 5.6 grains extraneous mineral matter per pound Vendor cautioned Sausages 11.529 grains of Boric Acid per pound Vendor cautioned Sausages 8.351 grains of Boric Acid per pound Vendor cautioned Sausages 7.511 grains of Boric Acid per pound Vendor cautioned Sausages 20.825 grains of Boric Acid per pound Proceedings. Fined £2 and 10s. 6d. costs Sausages 14.504 grains of Boric Acid per pound Vendor cautioned Sausages 12.516 grains of Boric Acid per pound Vendor cautioned Sausages 9.912 grains of Boric Acid per pound Vendor cautioned Tinned Peas 1.380 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Tinned Peas 1.518 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and £1 l1s. 6d. costs Proceedings. Fined 10s. and 10s. 6d. costs Vinegar 7.5 per cent. of Acetic Acid deficient Vinegar 3.0 per cent. of Acetic Acid deficient Vendor cautioned Vinegar 3.0 per cent. of Acetic Acid deficient Informal sample Vinegar 2.0 per cent. of Acetic Acid deficient Vendor cautioned Vinegar 300 per cent. of Acetic Acid deficient Proceedings. Fined £1 and 10s. 6d. costs Vinegar 2.5 per cent. of Acetic Acid deficient Vendor cautioned It will be seen that proceedings were taken in eight cases, the fines and costs amounting to £23 4s. 6d. 40 COMPOSITION OF MILK SUPPLIED IN KENSINGTON. It is well known that the "limits" of 3 per cent. of fat and 8.5 per cent. of non-fatty solids, which are taken by the Ministry of Agriculture as the primary criteria of genuineness of milk, are figures very much below those found in normal cow's milk. Dr. Crowther, in a paper read before the National Milk Conference held at the Guildhall in October, 1922, gave the following as the average composition of cow's milk:— Water 87.4 per cent. Fat 3.7 „ „ Non-fatty solids 8.9 „ „ Of 278 formal samples of milk taken under the Food and Drugs Act in Kensington in 1922, only 3 were certified by the Public Analyst as adulterated, i.e., containing less than 3 per cent. fat or 8.5 non-fatty solids. These particulars, however, do not give any indication of the general quality of the milk supplied in Kensington, therefore, it will be interesting to note the average composition of the milk samples taken in the Borough during the year. These figures are given in the following table:— Average Composition of Milk Samples taken in 1922. Months. Number of Samples Taken. Average Composition of all Samples Submitted, Genuine and Adulterated. Average Composition of Genuine Samples. Ministry of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat, Percentage of Solids not Fat. January 12 3.60 8.81 3.60 8.81 3.0 8.5 February 42 3.72 8.87 3.72 8.87 March 10 3.48 8.83 3.50 8.92 April 48 3.68 8.77 3.68 8.77 May 24 3.95 8.89 3.95 8.89 June — No samples taken. July 48 3.56 8.78 3.57 8.80 August 13 3.66 8.83 3.66 8.83 September 11 3.54 8.85 3.54 8.85 Dr. Crowther's Figures of Average Composition. October 37 3.75 8.90 3.75 8.90 November 12 4.09 9.01 4.09 9.01 Percentage of Milk Fats. Percentage of Solids not Fat. December 21 3.72 8.85 3.72 8.85 Averages for the Year 278 3.70 8.85 3.71 8.86 3.7 8.9 From this table it will be seen that the fat in the milk supplied in Kensington was up to the average figure reported to the National Milk Conference and that the amount of the non-fatty solids was practically equal to the average quoted at that Conference. It is interesting to note that the average fat content of Kensington samples exceeded the Ministry of Agriculture standard by over 20 per cent. or, in other words, the samples would have been returned as genuine by the Public Analyst even though 20 per cent of the fat might have been removed by a fraudulent vendor. The table shows that the average fat and non-fatty solid content for each month of the year is well above the legal standard and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content of about 3 per cent. Cream Regulations.—The Public Health (Milk and Cream) Regulations, 1912, made by Local Government Board in pursuance of the powers conferred by Section 1 of the Public Health (Regulations as to Food) Act, 1907, came into force on October 1st, 1912. They prohibit absolutely the presence of any kind of preservative in milk or in cream containing less than 35 per cent. of milk fat, and the addition of any thickening substance of any kind except sugar to cream. In the case of cream containing 35 per cent. of fat or more, the effect of the Regulations is to permit the addition of boric acid, borax or hydrogen peroxide, provided the cream so preserved is sold in vessels bearing a label with a printed declaration of the percentage of borax or peroxide which has been used. The addition of any other kind of preservative is prohibited. These Regulations were amended by the Public Health (Milk and Cream) Regulations, 1917, so as to limit the boric acid and borax which may be added to cream containing 35 per cent. or more of fat, to an amount not exceeding 0.4 per cent. by weight of the cream. These amending Regulations also provide that the declaratory label must state that the cream is not suitable for infants or invalids. On the grounds that the addition of preservatives in any quantity to cream is unnecessary, the Council have taken no action under these Regulations. 41 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. In February, 1922, a deputation from the Kensington Chamber of Commerce, which waited on the Public Health Committee, called attention to the fact that whdst the Council's attitude is sound in Law, the trader in Kensington, who is required to comply with the provisions of the Sale of Food and Drugs Acts, is placed in an unfair position, compared with traders in adjoining boroughs, where the sale of cream is governed by the Regulations of 1912 and 1917. The Council in April, 1922, concluded that the present position is most unsatisfactory whether regarded from the point of view of the Local Authority responsible for the administration of the Sale of Food and Drugs Acts, the trader, or the consumer, and they accordingly addressed a communication to the Minister of Health urging him to institute forthwith the enquiry promised by the President of the Local Government Board in 1917, in order that the Ministry might be able to lay down a clear and definite pronouncement as regards the use of preservatives in cream which, whilst being fair to the trader, should be consistent with the provisions of the Sale of Food and Drugs Acts and protective to the health of the community. A copy of the communication addressed to the Minister of Health was forwarded to the Kensington Chamber of Commerce in order that they might, if they thought fit, make similar representations. Also, communications were addressed to each of the other Metropolitan Borough Councils inviting them to support the action taken by the Council. Margarine and Butter Substitutes.—Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts:— Lipton, Ltd. 210, Portobello Road. „„145,Brompton Road. E.C. Nicholls19,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. Pearks, Ltd. 76, Golborne Road. Sale of Food Order, 1921.—This Order placed upon Local Authorities certain duties in regard to— (1) the sale of bread and tea by weight. (2) the labelling of imported produce, (3) the composition of jam and marmalade, dripping, margarine, and other edible fats. The provisions of that part of the Order dealing with the sale of bread and tea by weight are administered by the London County Council, but the Borough Council are required to enforce the remaining sections of the Order. Since this Order was published an Amending Order has been issued, which cancels certain sections of the original, with the result that the only part now to be enforced by the Borough Council is that which relates to the labelling of imported produce (lard excepted). A further Amending Order, dated September 1st, 1922, removes bacon and ham from the list of imported foods which must not be exposed for sale by retail unless they bear a label containing the words "Imported" in letters easily readable by customers. Under the Expiring Laws Act, 1922, Parts 1 and 3 (as now altered), together with the relative clause of Part 6 of the Sale of Food Order, 1921, are continued in force until December 31st, 1923. FOOD POISONING. In November last, about 120 mistresses and girls attending a private school sat down to a lunch which consisted of rissoles, potatoes, currant roll and rice pudding. Between tea-time and bedtime on the same day 30 of the 120 fell ill with acute enteritis, the attacks varied in intensity, but fortunately all the patients made a satisfactory recovery in a very short time. An exhaustive enquiry was made and samples of the rissoles, on which suspicion fell, were forwarded to the Government Bacteriological Laboratory, but no definite source of infection was discovered. The general cleanliness of the school premises, including the kitchen, larder, kitchen utensils, etc., left nothing to be desired, and the premises from which the various articles of food were purchased were all very clean and satisfactory. All members of the school staff and also the shopkeepers who had been in contact with the food were in good health and there was no reason to suspect that any one of them was the cause of the trouble. 42 This outbreak was not of course one of botulism, but it is desirable to point out here that in the event of any case of botulism occurring in Kensington, medical practitioners will be able to obtain a supply of antitoxin for use in this disease from the Ministry of Health, Whitehall, direct, or by application through the Medical Officer of Health. The immediate use of this antitoxin is of paramount importance and the lapse of a few hours between the appearance of the symptoms and the use of the antitoxin may make all the difference between its successful and unsuccessful application. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. In May, 1920, the Council adopted a scheme for the distribution of milk to expectant and nursing mothers and infants under the age of five years, which was described in detail in my Annual Report for that year. In March, 1921, the Minister of Health required that local authorities must obtain his sanction, under the Maternity and Child Welfare Act, 1918, to schemes for the supply of milk to expectant and nursing mothers and infants. The Minister laid down the conditions under which his sanction would be given and, as these were practically identical with those which governed the Kensington scheme, it was only necessary to make slight modifications in order to obtain the necessary approval. In view of the great care in administration which has been exercised by the Council's Milk Sub-Committee, the effort of the Minister of Health to secure a similarly reasonable administration throughout the Country was welcomed. On December 13th, 1921, the Minister issued circular No. 267, in which he stated that he was not satisfied that the milk being supplied by local authorities was always consumed by the persons for whom it was intended, and that he was of opinion that the provision of meals to be consumed by expectant and nursing mothers on premises, or under arrangements, controlled by local authorities, would be of greater physiological value than the supply of milk given under existing conditions. He further stated that the supply of fresh or dried milk should only be given to infants up to .12 months of age not being nursed by their mothers. In view of the Minister's Circular, the Council reconsidered their scheme for the supply of nourishment to expectant and nursing mothers, and arrangements were made with the Golborne, Raymede, and Lancaster Road Infant Welfare Centres to supply dinners at a cost to the Council of 6d. per meal. This revision was approved by the Minister. During the year 1922 there were 348 grants of milk made by the Council's Milk SubCommittee. One hundred and thirty-nine of the grants were in response to new applications, and the remaining 209 were renewals of grant. Thirty-six applications for dinners were granted; 23 of these were new applications, and 13 renewals. Particulars of Fresh Milk supplied under the Council's Scheme. No. of pints of Milk granted. Price per pint paid by Recipients. Estimated Cost to Council. £ s. d. 8,192 Free 119 17 7 926 2d. 8 10 11 9,118 — 128 8 6 Particulars of Dried Milk supplied free or below Cost Price tinder the Council's Scheme. No. of packets of Milk granted. Price per lb. packet paid by Recipients. Estimated Cost to Council. £ s. d. 132 Free 11 14 8 8 1s. 0d. 0 9 0 4 0s. 10d. 0 3 6 36 0s. 6d. 2 17 0 180 — 15 4 2 43 Particulars of Dried Milk supplied at Cost Price under the Council's Scheme. Name of Welfare Centre at which the dried milk was distributed No. of 1lb. packets sold. Value of milk sold. £ s. d. Golborne 128 12 2 0 Raymede 2,005 185 18 4 Bramley Road 1,148 98 5 6 Lancaster Road 766 68 2 5 Archer Street 1,660 155 13 7 Earl's Court 5 0 6 11 — 5,712 520 8 9 Particulars of Dinners supplied under the Council's Scheme. No. of Dinners granted. Price per Dinner paid by Recipients. Cost to Council. £ s. d. 540 Free 13 10 0 180 2d. 3 0 0 16 10 0 The Mutual Registration of Assistance Society (a branch of the Charity Organisation Society) have been of considerable help to the Council's Milk Sub-Committee in providing information of the assistance being given by other bodies to applicants for milk at a reduced price or free of cost, and the Council acknowledge the value of the work by making an annual grant of £10 to the Society. The Council's Milk Sub-Committee work in close co-operation with the Board of Guardians and a scheme has been formulated whereby milk and dinners recommended by the Milk SubCommittee are supplied by the Board to certain nursing mothers who are already in receipt of Poor Law relief. This scheme obviates the undesirable practice of a person being granted a somewhat similar form of relief by two different authorities. The dried milk and dinners supplied during the year by the Board of Guardians under this scheme are shown below:— No. of packets of Dried Milk supplied. Cost to the Board of Guardians. No. of Dinners supplied. Cost to the Board of Guardians. 227 £21 15 6 203 £5 1 6 NOTE.— The figures for fresh milk supplied by the Guardians after recommendation by the Milk [Sub-Committee cannot be given separately. FACTORIES AND WORKSHOPS. Section 132 of the Factory and Workshop Act, 1901, requires the Medical Officer of Health of every District Council to report specifically on the workshops and workplaces in his district, and to send a copy of his annual report to the Secretary of State. The total number of workshops on the Council's register is 1,383. Workshops where men only are employed are placed under the supervision of the Sanitary Inspector in whose district they are situated; workshops where women are employed are inspected by the Women Health Officers, who also visit the premises of home-workers and inspect the sanitary conveniences reserved for women in railway stations and other public places in Kensington. The factories in the Borough number 289, 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. The Ministry of Health (Factories and Workshops) Order, 1921, transfers, from the Secretary of State to the Minister of Health, the powers and duties under Sections 61, 97, 98, 99, 100, 109 and 110 of the Factory and Workshops Act, 1901. Section 61 provides that the occupier of a factory or workshop shall not knowingly allow a woman or girl to be employed therein within four weeks after she has given birth to a child. This Section is extended to laundries by Section 103 of the Act. In his circular letter No. 235, the Minister of Health has expressed the hope that the Council will assist occupiers of factories, workshops and laundries in observing the provisions of this Section, so far as they are in a position to do so. 44 Sections 97 and 98 lay down regulations regarding sanitary conditions in bakehouses and provide for penalties in the case of a bakehouse unfit for use as such; Section 99 provides for the periodical cleansing of the walls and ceilings of bakehouses; Section 100 restricts the use as sleeping places of rooms adjoining bakehouses. Under Section 102 of the Act, the Sanitary Inspectors have, for many years, carried out, as regards retail bakehouses, the duties imposed under these four Sections, but, with regard to factory bakehouses, although the Council's officers have made inspections from time to time, any prosecutions which may have been found necessary have hitherto been undertaken by the Factory Inspector. In accordance, however, with the suggestion contained in the circular letter above mentioned, the Council have directed that those duties of their officers in the Public Health Department hitherto performed only in respect of retail bakehouses shall be extended to all bakehouses in the Borough. Sections 109 and 110 provide for the supervision of home work in houses where there is notifiable infectious disease. Officers in the Public Health Department have enforced these two Sections for many years past and the. powers and duties of the Council are not affected by the transfer to the Minister of jurisdiction in regard to these Sections. MEN'S WORKSHOPS. At the end of the year, the registered workshops at which men alone were employed numbered 939. The factories at which men alone were employed numbered 232. 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 occupation's carried on in registered workshops and factories where men alone are employed:— Trade or Business. Workshops. Factories. Total. Aerated water manufacturer — 4 4 Baker 63 31 94 Basket maker 4 — 4 Blacksmith 35 1 36 Boot maker 165 10 175 Builder 112 9 121 Cabinet maker and joiner 48 4 52 Carver and gilder 10 — 10 Coach builder 33 3 36 Cycle maker 15 — 15 Electric generating works — 12 12 Firewood manufacturer 13 3 16 French polisher 2 — 2 Marble mason 6 4 10 Printer 4 22 26 Saddler 19 — 19 Tailor 115 — 115 Trunk maker 20 — 20 Umbrella maker 5 — 5 Undertaker 9 — 9 Upholsterer 32 4 36 Watch maker 44 3 47 Wig maker 14 — 14 Sausage maker — 18 18 Sundry businesses 171 104 275 Total 939 232 1,171 WOMEN'S WORKSHOPS. The number of workshops and factories at which female labour was employed at the end of 1922 was 501, 202 in North Kensington and 299 in South Kensington. The number of persons employed varies with the period of the year, being, of course, greatest during the "season"—it averages 7,000. 45 The businesses carried on at the registered premises are set out in the subjoined list:— Trade or Business. Workshops. Factories. Total. Art needlework 3 — 3 Blind maker 2 — 2 Blouse maker 1 — 1 Boot maker and repairer 1 — 1 Boot closer 1 — 1 Button maker — 1 1 Cabinet maker — 1 1 Cardboard box maker 1 — 1 Chemist 1 — 1 Cigarette maker 1 — 1 Corset maker 7 1 8 Dressmaker and ladies' tailor 194 — 94 Dyer and cleaner 21 3 24 Florist 12 — 112 Furrier 16 1 17 Glove maker — 1 1 Hairdresser 5 — 5 Hair-dye manufacturer 1 — 1 Invisible mending 1 — 1 Jeweller 1 1 2 Lace worker 5 — 5 Lampshade maker 1 — 1 Laundry 27 20 47 Machinist 28 24 52 Milliner 39 — 39 Motor car maker — 1 1 Non-inflammable composition manufacturer — 1 1 Outfitter 5 — 5 Photographer 7 — 7 Pictorial advertisements 1 1 2 Pipe maker — 1 1 Powderpuff maker 1 — 1 Shirt maker 1 — 1 Tailor 43 — 43 Toilet requisites 1 — 1 Typist 1 — 1 Toy maker 1 — 1 Umbrella maker 2 — 2 Upholsterer 8 — 8 Weaving 2 — 2 Wire brush maker 1 — 1 Wig maker 1 — 1 Total 444 57 501 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 one of the workrooms visited, Whilst a very marked improvement in the ventilation of workshops has taken place, it is still necessary 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—Eight workrooms were cleansed and whitewashed after notice and one other sanitary defect was dealt with. Sanitary Conveniences.—During the year one defective sanitary convenience in a workshop was found and remedied. HOME WORK. Of the 260 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. 46 The number of outworkers belonging to each of these three classes is shown in the following Table:— Outworkers in Workshops or Factories 46 Outworkers in Domestic Workshops 40 Outworkers in their own Homes 174 Total number of Outworkers 260 The factories and workshops referred to in the above list are included in the Tables which show the trades carried on in the factories and workshops on the Council's register. The nature of the work given out to the 174 home workers on the register is as follows:— Tailoring 87 Dressmaking 55 Bootmaking 16 Outfitting 4 Shirtmaking 2 Millinery 5 Embroidery 1 Furrier 4 174 No cases of infectious disease were reported during the year from premises where home work was carried on. The appended Table summarises the work for the year of the Women Health Officers under the Factory and Workshops' Acts, so far as it is capable of being expressed in this form:— 1. No. of Factory Inspections 57 2. „ Workshop „ 583 3. „ Home Workers Inspections 334 4. „ Work Place „ 49 5. Sanitary Defects Remedied. (a) Additional means of ventilation provided 1 (b) Rooms cleansed and whitewashed 8 (c) Miscellaneous defects remedied 1 (d) Sanitary conveniences, defects remedied 1 „ „ insufficient — „ „ not separate for sexes — 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. Factories, Workshops, Workplaces and Homework. I.—Inspection. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 215 4 — Workshops (including Workshop Laundries) 927 27 — Workplaces (other than Outworkers' premises included in Table 3 of this Section of the Report) 49 — — Total 1191 31 — 47 II.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 28 28 — — Want of ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 26 26 — — Sanitary accommodation insufficient 3 3 — — unsuitable or defective 3 3 — — not separate for sexes 1 1 — — Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements tor bakehouses (SS. 97 to 100) 17 17 — - Other Offences (Excluding offences relating to outwork which are included in Table 3 of this Section of the Report.) - - - - Total 79 79 — - * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. 48 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. Lists. Outworkers. Lists. Outworkers. (1) Contractors Work men. Contractors. Workmen. (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) Wearing apparel— making, &c. 20 23 309 10 - 28 26 - - - - - - - - cleaning and washing 3 15 1 1 — 1 6 — — — — — — — — Household linen 3 22 5 — — — — — — — - — — — — Lace, lace curtains and nets 2 5 1 — — — — — - — — — — — — Furniture and upholstery 1 — — 1 — 2 — — — — — — — — — Electric-plate 1 1 2 — — — — — — — — — — — — Umbrellas, etc. 1 3 3 — — — — — — — — — — — — Total 31 69 321 12 — 31 32 - — — — — — — - 49 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 194 Workshop Laundries 27 Workshop Bakehouses 63 Other Workshops 1,099 Total number of workshops on Register 1,383 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) — 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 19 Reports (of action taken) sent to H.M. Inspectors 19 Other — Underground Bakehouses (s. 101):— Certificate granted during the year - In use at the end of the year 69 50 ADMINISTRATION. In addition to the record of work under each of the preceding headings of this report, it will be useful to submit a summary of certain of the main branches of Public Health administration. STAFF OF PUBLIC HEALTH DEPARTMENT. Medical Officers.—In 1921, the Medical Officer of Health was appointed Administrative Tuberculosis Officer under the Council's scheme for the prevention and treatment of tuberculosis, and the Tuberculosis Officers at the North and South Kensington Dispensaries were appointed Assistant Medical Officers of Health for the purpose of the Tuberculosis Regulations. Male Sanitary Inspectors.—The staff in 1922 consisted of one Chief Sanitary Inspector and ten district Inspectors. The Chief Sanitary Inspector undertook the supervision of the work of the district Sanitary Inspectors and assisted the Medical Officer of Health in special inquiries. Unfortunately, Mr. G. M. Pettit, who has held the position of Chief Sanitary Inspector in the Borough with distinction for 24 years, was absent owing to illness for the last eight months of the year. The Council have acceded to Mr. Pettit's desire to retire from office on the 31st March, 1923, and have passed a resolution expressing their appreciation of the valuable work he has performed in the Borough during his long service. The vacancy created will not be filled. 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 Workshops Act, 1901. During the year Inspector T. W. Forbes left the service of the Council and Inspector H. J. Green was appointed to take his place. A summary of the work of the Inspectors will be found in Tables VI and VIa of the Appendix. Women Health Officers—There are nine ladies appointed as Women Health Officers. Seven are engaged in the work of visiting mothers of the poorer classes and advising them in the care and management of their infants, in visiting cases of ophthalmia in newly-born infants and in assisting with the work of the seven Infant Welfare Centres. They also devote a portion of their time to the inspection of factories and workshops where women are employed, and in visiting cases of measles, whooping cough and consumption. Two Women Health Officers (Miss Hargrave and Miss Haycock) are employed on in-door work at the Dispensary. During the year Miss N. T. F. de Chaumont, on medical advice, tendered her resignation. Miss de Chaumont was one of the first ladies in the Country to hold the office of Sanitary Inspector under a Local Authority, having held this position in Kensington since 1896. She performed splendid pioneer work during the whole of her long and faithful service. The vacancy created by Miss de Chaumont's resignation was filled by the appointment of Miss E. M. Law. Dispensary Staff.—On January 1st, the date on which the Council assumed control of the Tuberculosis Dispensary, there were added to the staff of the Public Health Department (1) Dr. Picard, the Tuberculosis Officer for North Kensington, (2) Miss Haycock, a trained nurse and dispenser, previously engaged at the Dispensary and (3) the caretaker of that institution and his wife. Two of the nurses engaged by the Voluntary Dispensary Committee resigned at the end of 1921. When the Council took over the Dispensary, the duties of one of these nurses were distributed amongst the Council's Women Health Officers, and Miss Hargrave, Women Health Officer of the Bramley Road area, was transferred to the Dispensary to perform the duties hitherto carried out by the other nurse. When the Borough Tuberculosis Care Committee was constituted, in November, 1922, Miss Hargrave received the additional appointment of Secretary to the Committee. Mrs. Neve was appointed by the Council to take the place of Miss Hargrave in the Bramley Road area. Clerical Staff.—There are five clerks and a shorthand-typist. Other Staff.—There are:— (a) 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 Medicinal Baths. (e) A man employed as a Rat Officer. Particulars of the staff as required by the Ministry of Health Circular No. 359, dated 10th January, 1923, appear in Table 9 of the Appendix. 51 Legal proceedings were instituted in 75 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, etc. Date. Name and Address of Defendant. Offence. Result Jan. 17th T. Cawley, Observatory Lodge, Observatory Gardens. Failure to carry out sanitary repairs at 7, Observatory Gardens. Order made for work to be carried out within one month. Feb. 7th F. Parsons, 24, York Villas, Brighton. Failure to carry out sanitary repairs at 18, Campden Street. Summons withdrawn, work having been carried out. „ 14 Mrs. Hawkins, 55, Alexander Road, Hornsey. Failure to carry out sanitary repairs and breach of lodging house by-laws at 7, Wornington Road. Order made for work to be carried out within 21 days. „ „ Preece's Riding School and Motor Garage Co. Ltd., 248-250, Fulham Road. Failure to repair the wood paving of covered yard at 248, Fulham Road and the approach from Fulham Road. Order made for work to be carried out within 3 months. „ „ E. W. Bowes, 78, Walmer Road. Failure to carry out sanitary repairs and to comply with by-laws for houses let in lodgings at 39, Golborne Gardens. Order made for work to be carried out within 21 days. „ 21st T. M. Studd, 27, Chardos Road, Cricklewood. Failure to carry out sanitary repairs' at 11, Upper Addison Gardens. Order made for work to be carried cut within 14 days. Mar. 7th J. Carter, 286, Goldhawk Road. Failure to carry out sanitary repairs at 15a, Stratford Road. Order made for work to be carried out within 14 days. „ 21st E. V. Doggett, 175, Cornwall Road. Failure to carry out sanitary repairs at 127, Wornington Road. Fined £5 and order made for work to be carried out within 7 days. May 2nd C. Sturley, 41, Archer Street. Failure to carry out sanitary repairs at 124, Portobello Road. Summons withdrawn, work having been carried out. June 20th C. Rassell, 80, Earls Court Road. Failure to provide an efficient supply of water to premises at 7, Shaftesbury Cottages. Summons withdrawn, work having been carried out. „ „ Do. Failure to provide an efficient supply of water and to carry out sanitary repairs at 6, Shaftesbury Cottages. Summons withdrawn, work having been carried out. „ „ Miss A. M. Ellis, Turret House, Bexley Heath. Failure to carry out sanitary repairs at 19, Uxbridge Street. Order made for work to be carried out within 21 days. „ „ D. G. Kendon, 5, Church Street. Failure to carry out sanitary repairs at 37, Dartmoor Street. Order made for work to be carried out within 14 days. „ „ Mrs. C. Wagner, 12, North Common Road, Ealing. Failure to carry out sanitary repairs at 375, Portobello Road. Order made for work. to be carried out within 14 days. 52 Date. Name and Address of Defendant. Offence. Result. June 20th Barnsbury Estates, Ltd. 381, Camden Road. Failure to carry out sanitary repairs at Nos. 2, 5, 8, 23, 25, 26, 27, 28, 29, 30, 31, & 32 Bolton Road. Order made for work to be carried out within 3 months. „ Do. Failure to comply with by-laws for houses let in lodgings at same addresses. Adjourned sine die. July 18th T. Crosson, 38, Sidney Road, Richmond. Failure to carry out sanitary repairs at 46, Sirdar Road. Order made for work to be carried out within 28 days. „ Do. Failure to comply with by-laws for houses let in lodgings at same address. Adjourned sine die. Oct. 3rd Barnsbury Estates, Ltd. 381, Camden Road. Failure to comply with by-laws for houses let in lodgings at Nos. 2, 5, 8, 23, 25, 26, 27, 28, 29, 30, 31 & 32, Bolton Road. Fined £5 in the case of each house, £60 in all. 17th E. Banks, 189, Albany Street, Regent's Park. Unlawfully carrying on the trade of a dairyman without being registered. Fined 40s. „ J. Walker, 24, Farmer Street. Do. Summons dismissed. Nov, 7th T. Crosson, 38, Sidney Road, Richmond. Failure to comply with the Magistrate's order in regard to to 46, Sirdar Road. Fined £3. „ Do. Failure to comply with bylaws for houses let in lodgings at 46, Sirdar Road. Fined £2. „ F. J. Bryant, 42, Coram Street. Failure to carry out sanitary repairs at 57, Southam Street. Order made for work to be carried out within 21 days. „ Mrs. H. Halbury, 22, Prince of Wales Road, Kentish Town. Unlawfully selling milk from vehicle without her name inscribed thereon. Summons dismissed. Dec. 5th Barnsbury Estates, Ltd., 381, Camden Road. Failure to comply with the Magstrate'sorders to carry out sanitary repairs at Nos. 2, 5, 8, 23, 25, 26, 27, 29, 30, 31 and 32, Bolton Road. Summonses adjourned sine die. „ F. W. Sprules, 11, Silvester Mews. Failure to carry out sanitary repairs at 1, Boundary Mews. Order made for work to be carried out within 14 days. 19th F. J. Bryant, 42, Coram Street. Failure to comply with by-laws for houses let in lodgings at 57, Southam Street. Fined £5. „ S. E. Musk, 4, Defoe Road, Tooting. Failure to carry out sanitary repairs at 36, Wornington Road. Order made for work to be carried out within 21 days. In addition to the above, there were issued under the Food and Drugs Acts 8 summonses, particulars of which are given on pages 38 and 39. 53 DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane by exposure to steam under a pressure varying between 15 and '20 lbs. above atmospheric pressure for fifteen minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. above atmospheric pressure for ten minutes in a rotary washing machine. A formalin cupboard is used for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms vacated by persons suffering from infectious disease are disinfected by gaseous formaldehyde, which is generated by the volatilisation of paraform tablets, 20 tablets being used for each 1,000 cubic feet of room space. Verminous rooms are disinfected by the burning of 1 lb. of sulphur for each 1,000 cubic feet. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1922. Nature of Infection. Premises Disinfected. Rooms Disinfected. Disinfections at Wood Lane. No. of Articles Disinfected. Scarlet Fever 497 646 514 8,091 Diphtheria 368 451 371 5,280 Enteric Fever 15 16 14 274 Measles 62 99 3 199 Consumption 116 142 109 1,131 Vermin 228 284 133 1,254 Other Diseases 191 229 220 2,618 Total 1,477 1,867 1,364 18,847 The total weight of the bedding, clothing, &c., disinfected was 47 tons, 1 cwt. and 6 lbs. The number of articles disinfected was 17,846 and the number disinfected and washed, 1,001. In addition, the laundry work for the Medicinal Baths was performed at the Disinfecting Station; the number of articles washed was: Towels, 10,199; Sheets, 518; and Dressing Gowns and Blankets, 279. Whilst the Hammersmith Borough Council's disinfecting apparatus was undergoing overhaul and repair in the Summer, infected articles from that Borough were dealt with at the Kensington Disinfecting Station. A cheque of 7s. 6d. for services rendered was paid into the Council's funds by the Hammersmith Authority. DISINFECTION OF LIBRARY BOOKS. In view of the difficulty of securing efficient disinfection of books, the Libraries Committee authorise the Medical Officer of Health to destroy all Public Library volumes removed from infected houses, this gives Kensington borrowers complete protection from infection from the Council's books. Books from private subscribing libraries found in infected houses are dealt with as follows : (a) Books which have not been exposed to infection.—Disinfected by formalin vapour and returned to the subscriber. (b) Books which are believed to be infected.—A notification is sent to the Librarian. The householder is informed that the books will not be accepted at the Library and that they can be disinfected by formalin or destroyed at his option ; he is advised that destruction is the only really safe method of dealing with the books but that this will only be carried out on the understanding that the Council will not pay compensation. VERMINOUS ROOMS CLEANSED BY LANDLORDS. Eight hundred and forty-two verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council (General Powers) Acts, 1904 and 1922. DUST REMOVAL. House refuse is collected once a week in most areas in the Borough but more frequent collections are undertaken in certain special areas. The refuse is either disposed of by cremation in the Council's destructor at Wood Lane or removed by barge from the wharves in Kensal Road and Lots Road. 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, 662 new movable ash-bins of galvanised iron have been provided during the year, and 110 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. 54 REFUSE REMOVAL FROM MEWS. In view of the unsatisfactory arrangements made for the storage of house refuse, trade refuse and manure in certain mewsways in North Kensington, which are not used exclusively for any one purpose, but which contain a number of dwellings, stables and costermongers' stores, the Council have installed in 21 mewsways a number of common dustbins, somewhat similar to the street sandbins, each of which serves eight or nine mews dwellings. This arrangement effects a great sanitary improvement. The owners contribute towards the cost of the bins, which have been made specially for the purpose. DRAINAGE WORK. Drainage work in connection with new buildings is carried out under the supervision of the Borough Engineer, who also supervises the construction of drains on existing premises where the work is undertaken by the owner on his own initiative. The reconstruction of drains found to be defective by the Sanitary Inspectors is carried out under their supervision, plans of any proposed alteration being submitted in the first instance to the Borough Engineer and then handed on to the Public Health Department. During the year 48 house drains have been reconstructed under notices served by the Sanitary Inspectors. PUBLIC CONVENIENCES. The Council provide six public lavatories containing water-closets; two are for men only, and in four accommodation is provided for both sexes. In addition there are 12 urinals for men under the charge of the Council. In the women's lavatories there is free accommodation for those who are unable to pay. There are also conveniences for women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the Women Health Officers. BACTERIOLOGICAL WORK. The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.I, for the bacteriological examination, at the expense of the Council, of specimens from Kensington cases sent to them through medical practitioners in regard to diphtheria, tuberculosis, typhoid fever, syphilis and other diseases. The examinations in 1922. were as follows:— Disease suspected. No. of examinations. No. of positive results. Diphtheria 579 89 Tuberculosis 121 31 Typhoid Fever 13 — Goncrrhœa 2 — Dysentery 1 — Food Poisoning 1 — In addition to these examinations at the Lister Institute, 616 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 suspected foodstuffs and of blood in suspected malaria cases 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 1922 and in the three preceding years by washers and bathers:— Year. Washers. Bathers. 1919 82,002 259,200 1920 88,207 319,991 1921 103,546 292,464 1922 100,480 245,374 MORTUARY AND CHAPEL OF REST. During the year 93 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of relatives or friends of the deceased 49 At the request of undertakers 19 By the Police 25 93 55 In 82 cases, post-mortem examinations were made under the Coroner's warrant. Sixty-one bodies were deposited in the Chapel of Rest, Avondale Park. On July 28th a communication was received from the Kensington Council of Social Service complaining that dead bodies are kept too long in the homes of poor and overcrowded families and asking the Borough Council to consider the matter with a view to taking such action as will ensure that the existing mortuaries are more used. The matter was considered by the Public Health Committee and a letter was sent to the Clerk of the Guardians;— (1) Stating that there is ample accommodation at the Council's mortuaries for bodies of persons who die at the St. Mary Abbot's Hospital and that these mortuaries can be used for their reception ; (2) Suggesting that the Guardians should ask their officers to encourage removal of bodies to the Council's mortuaries, rather than to the homes of the poor ; and (3) Asking the Guardians to expedite as far as possible the sending of information to the Medical Officer of Health in respect of persons who die at St. Mary Abbot's Hospital and whose bodies are to be removed to the homes of relatives. 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. The applications made to the Council for certificates in 1920 totalled 10 and the number granted was 2. The figures for 1921 was 12 applications and 21 certificates granted and for 1922 19 applications and 9 certificate granted. This comparative failure by tenants to attempt to make use of this provision of the Act is probably mainly due to the fact that many houses in a defective state of 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. 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 advantages granted them by the Act. CLEANSING OF VERMINOUS PERSONS ACT, 1897. The record of work done at the Medicinal Baths during the year is as follows:— Total Cleansing. SCABIES- Adults 187 Schoolchildren 336 Children under five years 81 VERMINOUS CONDITIONS— Adults 33 Schoolchildren 2,819 Children under five years 5 OTHER CONDITIONS— Adults 6 Schoolchildren 2 Children under five years 6 Total 3,775 In 1920 an agreement was entered into with the London County Council, which provides for the use of the Medicinal Baths by the County Council for the cleansing of children attending elementary schools in and around Kensington. Under this agreement the County Council guarantee to the Borough Council a minimum payment of £450 per annum for a period of five years. Technically, in accordance with the provisions of the Children Act, 1908, children sent from the elementary schools are cleansed by the School Nurse in the employ of the London County Council, who attends at the Station for the purpose, and is responsible to her employers for the effective use of the apparatus provided. In practice, the actual work of bathing and disinfecting garments is executed by the Borough Council's servants under the supervision of the School Nurse 56 A further agreement in regard to the cleansing of verminous inmates of common lodging houses was made with the County Council in 1920, in which the Borough Council have agreed to cleanse verminous inmates from Kensington common lodging houses free of charge and to bath those sent by the London County Council officers from common lodging houses in neighbouring boroughs at a rate of a 1/- per bath. The cleansing of Kensington persons not sent by officers of the County Council is performed free of charge by the Superintendent and his wife under the direction of the Medical Officer of Health. Arrangements have been made with the Councils of the neighbouring Boroughs of Hammersmith and Fulham for the cleansing of residents (other than school children and lodginghouse cases) of those Boroughs at the Medicinal Baths, on the recommendation and under the responsibility of the Medical Officers of Health of the Boroughs in which the persons reside. The Councils of these two Boroughs have agreed to pay 1s. per bath and to indemnify the Council of the Royal Borough against any claim which a Hammersmith or Fulham person may bring, in respect of any treatment given at the Medicinal Baths. The methods adopted for the cleansing of verminous persons and for the treatment of scabies (itch) were described in detail in my two previous reports. The installation of a very efficient steam disinfector at the Medicinal Baths is proving of great value, and an attempt is being made to disinfect as much clothing and bed linen as possible during the personal cleansings, in order to obviate, as far as possible, re-infection of persons cleansed on return to their homes. FOULING OF FOOTPATHS BY DOGS. A by-law made in pursuance of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the Local Government Act, 1899, making it an offence to allow a dog on a lead to deposit its excrement upon the public footway, has been in operation in the Borough since December, 1921. The Council have issued a pamphlet which has been posted in various places in the Borough and delivered by hand to a very large number of Kensington dog owners. The matter has alsoreceived notice in the local press. There is no doubt that the condition of the foot pavements has improved considerably since this by-law has been in operation. Two officers of the Council's Public Health staff make observations and during 1922 they reported two breaches of this by-law to the Public Health Committee. In each case a warning was issued. 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 supression 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 repression in sewers vested in the County Council. The Borough Council are also required to observe the requirements of the Act in respect of any land of which they are the occupiers. The Borough Council may, within their own area, give instructions by public notice as to the most efficient methods that can be adopted both individually and collectively with a view to the destruction of rats and mice. Also, in the event of the occupier failing to take necessary action, the Council may serve notice requiring him to take steps for the purpose of destroying rats and mice and of preventing his land or premises becoming infested, or, after 24 hours' notice, they may enter the premises, carry out the work and recover any reasonable expenses from him. The Council have delegated their powers under the Act to the Public Health Committe, and each Sanitary Inspector makes inspections in his district for the purpose of detecting rat-infested premises and reports to the Medical Officer of Health cases in which the occupiers are not taking all practical steps to destroy the rats or to prevent their premises becoming infested. A Rat Officer is employed at a wage of £4 per week to assist in the work of rat destruction under the supervision of the Sanitary Inspectors. He has carried out good work during the year as is evidenced by the following table:— Number of visits to Premises 2,098 „ individual Premises visited 288 „ Premises cleared of rats 164 „ Poison Baits laid 21,110 „ „ disappeared 18,820 „ „ removed by Rat Officer 2,290 57 Barium Carbonate and Extract of Squills have been the poisons in general use. 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. An account of the methods of work adopted by the Rat Officer appears in the report for 1920. During the National Rat Week—November 6th to November 11th-the Borough Engineer kindly placed at my disposal the gang of flushers for the purpose of laying poison baits in sewers. The baits were placed in the side entrances to the sewers, which are generally connected with the sewers by galleries and are about ten feet distant therefrom. As the galleries fall about four feet from the entrance level to the sewer level, it will be seen that the bait was well above the general level of the water. Five thousand baits were laid at one hundred and sixty-one entrances, and all disappeared. HOUSING OF THE WORKING CLASSES. NEW HOUSING ACCOMMODATION. 1. Provided by the Council. 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 were 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 ot the Council, purchased, in the northern half of the Borough, 19 houses which were converted, during the year 1920, into 102 flats or maisonettes. The flats are all occupied and provide accommodation for about 400 persons. The cost of acquisition and conversion into flats was £83,415 and the total annual rentals (exclusive of rates and taxes) amount to £5,934. (b) Mary Place Scheme. This scheme, comprising a group of 32 cottages known as Avondale Park Gardens, was completed in 1922 at a cost, for land, building, etc. of £35,750. Each of these cottages consists of two living rooms and three bedrooms and the total rentals received amount to £1,275 per annum (exclusive of rates and taxes). These 32 cottages provide accommodation for about 250 persons. (c) St. Quintin Estate Scheme. The land originally acquired measured nine acres, the price paid being £13,500 or £1,500 per acre. The lay-out of the land was approved by the Ministry of Health and provided for the erection of 208 cottages and maisonettes. The first and second sections, comprising 8 cottages and 76 flats, have been completed and all the premises are occupied. Each cottage consists of a living room, kitchen, scullery and four bedrooms and is let at an exclusive sum of 18s. per week. Of the flats, 32 contain a living room, kitchen and three bedrooms and each is rented at a sum of 14s. per week, exclusive of rates, etc.; the remaining 44 flats consist of living room, kitchen and two bedrooms, and each is let at an exclusive rental of 1ls. per week. The cost of erecting these 8 cottages and 76 flats was £58,100 and accommodation has been found for about 400 persons. In view of the fact that there was little likelihood of the remaining land being built upon or otherwise dealt with within the period prescribed by the Housing (Assisted Scheme) Regulations, 1919, namely, three years from the passing of the Housing, Town Planning, etc., Act, 1919, the Council, during the course of 1922, placed themselves in communication with the Ministry of Health and received a reply in which it was stated that it was the Ministry's wish that the Council should dispose of the surplus land. The Housing Committee have strongly urged on the Minister of Health that he should consent to the Council proceeding with a further section of the St. Quintin Scheme, which would embrace the erection of 38 maisonettes and 5 cottages, and it was pointed out that if building operations were resumed, it would be a means of providing work for a number of unemployed men resident in the Borough, but the Minister has not altered his decision. Looking to the fact that the Minister of Health in the first place urged the Council to purchase land for the erection of houses and to proceed with the construction of roads and sewers, and also approved of the lay out, the above decision is much to be regretted. 58 2. Provided by Private Enterprise. With the exception of five houses, four in the northern part of the Borough and one in the south, the only new housing accommodation provided in the Borough since the war other than by the Council, is that in connection with Dr. Schuster's housing programme in the Notting Dale Area. A commencement was made by Dr. Schuster in 1914 when 11 cottages in Mary Place were erected. The War intervening, nothing more was attempted until 1920, when a further 4 cottages were built in Threshers Place. The work has continued steadily, 9 flats in Walmer Road, Princes Road and Threshers Place and 2 cottages in Tobin Street were completed in 1921, and during last year, 2 flats in Threshers Place and 2 flats in Tobin Street were completed and 4 houses in Kenley Street, at the corner of Sirdar Road, were converted into 10 flats. At the time of writing this report, the erection of 1 cottage and 2 sets of flats in Tobin Street and 1 cottage in Threshers Place, is in hand. EXISTING HOUSING ACCOMMODATION. 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 3/5 to 4/9 2 62 7/4 to 9/9 3 32 10/2 to 11/2 Totals 120 3/5 to 11/2 The above tenements are all within the Borough. COMMON LODGING HOUSES. The Common Lodging Houses in the Borough number 9 and contain accommodation for 463 persons. Ward Name of Keeper Address of Common Lodging House No. of Lodgers for which licensed in 1921. Male Female Total Golborne Madden, James 194, Kensal Road 75 - 75 Norland Rusha, Alfred 18 & 20, Bangor Street — 69 69 ,, Woodhouse, Jane E. 10, Crescent Street — 25 25 ,, Hankins, John Wm. 28 & 30, do. 54 — 54 ,, Woodhouse, Jane E. 40, do. — 25 25 ,, Rusha, Alfred 25 & 27, do. — 57 57 ,, Davis, Sagel 66, St. Ann's Road 66 — 66 ,, Rusha, Alfred 34 & 36, Sirdar Road — 53 53 ,, Davies, Henry A. (Dr. Barnardo's Home) 12, Penzance Place - 39 39 Totals 195 268 463 It will be seen that there are only three common lodging houses for men in the Borough, one of these being in the Golborne Ward and the other two in the Notting Dale district of the Norland Ward. Dr. Barnardo's Home for Women is licensed annually as a common lodging house, but it does not come within the strict definition of one and would not be registered if Dr. Barnardo's Association did not voluntarily submit an application each year. This Home is intended primarily for absolutely destitute mothers with young children, but old women are accepted. The lodgers are not asked to make any payment. The doors are opened about 8 p.m.; the lodgers then receive supper and retire for the night; they must leave the premises early next morning. The institution is clean throughout and I can well imagine the feeling of comfort that weary mothers must experience when they sit down to eat their evening meal from a scrupulously clean plain wooden table in a brightly lighted room with a good fire burning. Of the other 5 common lodging houses for women, one is situated in Sirdar Road, one in Bangor Street and three in Crescent Street. Curiously enough, these houses are within a stone's throw of one another and are located in the Notting Dale Area of the Norland Ward. In each of three of these institutions for women, two adjoining dwellings have been converted into a common lodging house, and in each of the other two, one dwelling is being used for the 59 purpose of a common lodging house. The total number of ordinary dwelling houses taken up by these five common lodging houses is eight. The houses are the ordinary basement type commonly found in that district, and were originally built as single family houses; they are ill-adapted for their present use, and they make probably the poorest kind of common lodging house in London. Perhaps the worst feature is the fact that the basement is used as a common kitchen in three cases. Apart from common lodging houses maintained by the Church Army and other philanthropic bodies, the women's common lodging houses in Kensington are the cheapest in London—the charge per woman per night, for bed and the use of the kitchen and cooking utensils being 8d. It will be seen that they provide accommodation for the poorest of those unfortunate creatures who have drifted to a common lodging house life. It is difficult to avoid the conclusion that the presence of these women, 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. HOUSES LET IN LODGINGS. It is beyond dispute that one of the most difficult housing problems in Kensington is the sanitary control of houses let in lodgings. There are in the Borough to-day over 5,000 houses let in lodgings and occupied by the working classes without having been specially adapted for the purpose. These houses are not small, usually they have eight or nine large living rooms and, in addition to the basement, there are a ground floor, first floor and second floor, with perhaps only one W.C., and one water tap, both in the basement; and as there are no sinks upstairs, in addition to the carrying of clean water up, dirty water has to be carried down. These houses were originally intended for one family, but it is not uncommon now to find them occupied by 2, 3, 4, 5, or perhaps even 7 or 8 families. It is impossible to estimate the population living in these tenement houses, but, at a low estimate, it is certainly not less than 60,000. Conditions arising from the War, including the high cost of repairs and labour, have resulted in considerable deterioration of this class of property and the question of control becomes one of great importance. Further, the houses let in lodgings problem in Kensington is one which will probably grow in magnitude because the Borough contains a large number of single family houses for which there is every year less demand owing to domestic and other economic difficulties. In some parts of the Borough, these large houses are being converted into high-class flats and maisonettes, but in those parts bordering on the tenement house district, there is a tendency for houses vacated by single families to be let off in lodgings to several families, without being specially adapted for the purpose. The Council have certain powers under various Acts of Parliament and they also have by-laws, but these are not sufficient for their purpose and Parliament has recognised this in the Housing Act of 1919. Section 26 of this Act provides that by-laws for this class of property shall be made by the London County Council and that such by-laws so made shall be observed and enforced by each Metropolitan Borough Council. The County Council submitted draft by-laws to the Minister of Health and. after certain alterations, the Minister returned them to the County Council with an intimation that he was prepared to approve them as amended. This is now over two years ago, but the County Council have not yet re-submitted the by-laws for the Minister's final approval. In view of the urgent need of the by-laws for the prevention of further deterioration of Kensington houses, a deputation from the Borough Council waited on the County Council's Public Health Committee in February of this year to ask that the by-laws should receive immediate consideration. The number of houses let in lodgings on the Council's register at the end of the year was 2,169. The effect of registration is to render the premises subject to the requirements of the Council's By-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 during 1922 numbered 7,051. The owners of twenty-two lodging houses were summoned for breaches of the lodging house by-laws, or for failure to carry out sanitary works required by the Council. Particulars relating to the defects found and the notices served are to be found in Table VIa of the Appendix. Houses Let in Furnished Rooms.—Of the 2,169 lodging houses on the Council's Register, 95 were in 1922 let in furnished rooms, the average rent charged being at the rate of 7/- per week per room. 60 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 12 Golborne Ward 16 Other Wards 0 95 IMPROVEMENT OF EXISTING HOUSING ACCOMMODATION. During the year 1922 very active measures were taken by the staff of the Public Health Department with a view to securing remedies for the many housing defects which had arisen as a result of the unavoidable curtailment of repair work in the years of the War. The steps taken were very successful and many houses were reclaimed from their almost uninhabitable condition. The ten Inspectors visited 6,975 houses, and of these 234 were subjected to a detailed survey under the Housing (Inspection of District) Regulations, 1910. Two thousand, nine hundred and seventy-one of the houses visited were found not to be in all respects reasonably fit for human habitation. In many cases the defects were of a simple nature and easily remedied, but in an unusually large number the repair works required were extensive in character. In 118 cases the necessary repairs were carried out without the issue of notices, but in 2,845 notices under the Public Health Acts were served. Some indication of the successful results of the Inspectors' efforts, supported as they were by the Public Health Committee and the Council, may be gathered from the fact that in no fewer than 2,797 houses the defects found were remedied during the year or in the early part of 1923. It is true that this report shows that it was found necessary to issue 75 summonses in respect of non-compliance with the Council's notices, but it should be pointed out that no fewer than 48 were in connection with certain houses in Bolton Road, in regard to which the Council have had, and are still experiencing, difficulty in securing habitable conditions. An indication of the improvements effected may be gathered from the following short extract taken from the returns of work submitted by the Inspectors:— No. of water closets reconstructed or repaired 625 No. of new water closets provided 48 No. of cisterns cleaned or covered 266 No. of yards and areas paved or repaired 306 No. of new dustbins provided 662 No. of old ashpits abolished 110 No. of roofs repaired 639 No. of houses provided with water above the basement floor 53 No. of dwellings in which dampness was remedied 244 No. of houses let in lodgings cleansed, under the Council's By-laws 578 Section 28 of the Housing, Town Planning, etc., Act, 1919, has not been applied extensively by the Council, but since this Section came into operation, notices have been served under it in 80 cases. In 30 of these the notices have been fully complied with ; and at the time of writing (June, 1923) the work is nearing completion in 3 cases, and has been partially carried out by the owners in 7 cases. In 2 cases of default by the owner the necessary repairs have been undertaken by the Council, who are now recovering their expenses from the rentals received from the repaired properties. In several cases the work is about to be carried out by the Council, and in others, the notices were not served until a few weeks ago. In certain cases there has been total failure to comply with the notices on the part of the Owner, but owing to technical difficulties in connection with these, it has been thought wise to have recourse to the Public Health (London) Act and the By-laws thereunder to secure the execution of the works originally embodied in the Section 28 notices. HOUSING STATISTICS FOR 1922 (MINISTRY OF HEALTH TABLE). 1. Estimated population 179,100 2. General death-rate 13.6 3. Death-rate from tuberculosis 0.95 4. Infantile mortality rate 82 5. No. of dwelling houses of all classes:— (a) Separately occupied tenements in the Borough according to the Census of 1921. (This number represents families or households separately occupying their own rooms in 1921) 43,001 61 (b) Occupied houses in the Borough in 1922. (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 27,771 6. No. of working class dwelling houses:— (a) With three or less bedrooms 896 (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 in 1922:— (a) Total— Flats 54 Houses 4 (b) As part of a municipal housing scheme— Flats 40 Houses 4 8. Total number of dwelling houses inspected by Sanitary Inspectors for housing defects (under Public Health or Housing Acts) 6,975 9. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 234 10. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 0 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 2,971 12. No. of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 118 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 during 1922 requiring repairs 8 2. Number of dwelling houses which were rendered fit during the year:— (a) By owners 7 (b) By Local Authority in default of owners 0 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 2,845 2. Number of dwelling houses in which defects were remedied during the year or in the early part of 1923— (a) By owners 2,797 (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. 62 APPENDIX. TABLE I. Vital Statistics of Whole District during 1922 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 1917 ‡ 168,919 B 151,535 1) 2,201 2,378 14.8 3,280 21.6 1,329 523 309 130 2,474 16.3 1918 ‡ 173,463 B 154,814 D 2,220 2,308 13.3 3,735 24.1 1,508 524 224 97 2,751 17.8 1919 ‡164,470 B 157,886 D 2,281 2,653 16.1 3,429 18.3 1,454 438 270 102 2,413 15.2 1920 ‡65,496 B 164,177 D 3,997 4,020 24.3 2,436 14.8 753 510 325 81 2,193 13.4 1921 175,859 (Census) 3,159 3,288 18.7 2,656 15.1 727 496 363 110 2,425 13.8 1922 †79,100 2,993 3,152 17.6 2,814 15.7 894 507 257 82 2,427 13.6 * 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 1921. Area of District in acres (exclusive of area Total population at all ages 175,859 covered by water) 2290 Total families or separate occupiers 43,001 63 TABLE II. Cases of Infectious Disease notified during the Year, 1922. Notifiable Disease Number of Cases Notified. Total Cases Notified in each Ward. Total Cases Removed to Hospital. At all Ages. At Ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 5. 5 to 15. 15 to 25. 25 to 45. 45 to 65. 65 and upwards. Small-Pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cholera ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Plague ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria (including Membranous croup) 403 20 139 153 44 40 7 ... 73 124 63 39 39 16 23 18 8 385 Erysipelas 44 1 4 4 8 10 15 2 7 12 5 3 4 5 5 2 1 18 Scarlet fever 471 8 119 262 49 26 7 ... 84 127 42 55 38 20 15 70 25 425 Typhus fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 18 ... ... 9 4 4 1 ... ... 2 6 2 2 1 4 1 ... 16 Continued fever 1 ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Puerperal fever 10 ... ... ... 1 9 ... ... 3 1 1 2 1 1 1 ... ... 9 Encephalitis Lethargica 4 • •• ... ... ... 2 1 1 . .. ... 2 ... 1 ... ... 1 ... 3 Cerebro-Spinal Meningitis 2 ... 1 ... 1 ... ... ... ... ... 2 ... ... ... ... ... ... 2 Poliomyelitis 2 ... 2 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 2 Pulmonary Tuberculosis 252 ... ... 13 47 120 63 9 38 50 48 26 24 19 17 21 9 142 Other forms of Tuberculosis 87 4 11 52 11 3 6 ... 10 30 28 3 4 5 3 2 2 28 Ophthalmia Neonatorum 20 20 • • • ... ... ... ... ... 6 2 7 2 ,.. ... ... ... 3 8 Primary Pneumonia 92 2 15 12 8 31 13 11 11 17 18 21 4 4 9 5 3 37 Influenzal Pneumonia 94 8 19 6 3 25 24 9 17 29 23 8 8 3 2 7 2 19 Malaria 4 ... ... ... ... 3 1 ... ... 1 1 ... ... ... ... ... 2 ... Totals 1504 63 310 511 176 273 139 32 250 395 247 162 115 74 79 127 55 1094 64 TABLE III. Causes of, and Ages at, Death during the Year 1922. 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 2,427 257 101 82 58 80 248 597 1004 Enteric Fever 2 ... ... ... 1 ... 1 ... ... Small-pox • •• ... ... ... ... ... ... ... ... Measles 58 15 21 18 4 ... ... ... ... Scarlet Fever 6 ... 1 1 3 ... 1 ... ... Whooping-Cough 27 8 12 6 1 ... ... ... ... Diphtheria 34 4 6 19 3 1 ... 1 ... Influenza 86 ... 1 1 ... 1 15 31 37 Encephalitis Lethargica 3 ... .. . ... ... ... 1 1 1 Meningitis 11 2 ... ... 3 2 3 1 ... Tuberculosis of Respiratory System 139 ... ... ... 4 30 45 50 10 Other tuberculous diseases 30 8 4 4 6 3 4 5 1 Cancer, Malignant disease 261 ... ... ... ... 2 17 136 106 Rheumatic Fever 2 ... ... ... 2 ... ... ... Diabetes 20 ... ... ... ... 2 2 5 11 Cerebral Hœmorrbage, etc. 93 4 ... ... . . . ... 4 22 63 Heart Disease 302 ... ... ... 1 6 19 81 195 Arterio-sclerosis 122 ... ... ... ... ... 1 20 101 Bronchitis 241 16 2 2 1 2 10 45 163 Pneumonia (all forms) 259 65 40 29 5 6 26 24 64 Other respiratory diseases 35 1 ... ... 1 ... 5 15 13 Ulcer of Stomach or Duodenum 9 ... ... ... ... 1 1 3 4 Diarrhœa, etc. 47 24 7 1 1 ... 2 4 8 Appendicitis and Typhlitis 16 ... ... ... 3 3 3 5 2 Cirrhosis of Liver 10 ... ... ... ... ... 2 7 1 Acute and Chronic Nephritis 84 1 ... ... 2 2 7 27 45 Puerperal Sepsis 6 ... ... ... ... ... 6 ... ... Other accidents and diseases of Pregnancy and Parturition 10 ... ... ... ... 1 9 ... ... Congenital Debility and Malformation, Premature Birth 96 93 1 ... 1 1 ... ... ... Suicide 82 ... ... ... ... 4 10 14 4 Other deaths from violence 53 ... 2 ... 8 4 11 13 15 Other Defined Diseases 333 21 4 1 8 9 43 87 160 Causes ill-defined or unknown ... ... ... ... ... ... ... ... ... 65 TABLE IV. INFANT MORTALITY DURING THE YEAR 1922. 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 70 23 9 3 105 34 39 36 43 257 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox ... ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 13 15 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 4 3 1 8 Diphtheria and Croup ... ... ... ... ... ... 2 1 1 4 Erysipelas ... ... ... ... ... ... ... ... ... ... Tuberculous Meningitis ... ... ... ... ... ... ... 1 2 3 Abdominal Tuberculosis ... ... ... ... ... ... ... ... ... ... Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... 1 ... ... 1 2 Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... ... ... ... ... ... ... ... 1 1 Bronchitis 1 ... ... ... 1 6 5 2 2 16 Pneumonia (all forms) 2 4 1 1 8 7 17 14 19 65 Diarrhœa ... ... ... ... ... ... ... 2 ... 2 Enteritis ... 1 2 ... 3 3 6 7 3 22 Gastritis ... ... ... ... ... ... ... ... ... ... Syphilis ... ... ... ... ... 1 ... 1 ... 2 Rickets ... ... ... ... ... ... ... 1 ... 1 Suffocation, overlaying ... ... ... ... ... ... ... 1 ... 1 Injury at birth 3 ... ... ... 3 ... ... ... ... 3 Atelectasis 5 ... ... ... 5 ... ... ... ... 5 Congenital Malformation 8 8 1 ... 17 3 1 1 1 23 Premature Birth 32 3 1 ... 36 1 ... ... ... 37 Atrophy, Debility, and Marasmus 12 5 3 2 22 9 2 ... ... 33 Other causes 6 2 1 ... 9 3 2 ... ... 14 70 23 9 3 105 34 39 36 43 257 legitimate, 2,945. legitimate infants, 229. Nett Births in the year Nett Deaths in the year of illegitimate, 207. illegitimate infants, 28. 66 TABLE V. Causes of Death at different periods of life in the Year 1922. 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 2 ... 2 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... ... ... ... ... 2 2 Measles 6 58 38 20 10 5 14 7 11 7 35 19 54 3 1 ... ... ... ... ... ... ... ... 3 1 4 Scarlet Fever 7 6 3 3 ... ... 1 ... ... 1 1 1 2 2 1 ... ... ... 1 ... ... ... ... 2 2 4 Whooping-Cough 8 27 9 18 3 5 3 9 3 3 9 17 26 ... 1 ... ... ... ... ... ... ... ... ... 1 1 Diphtheria 9A 34 17 17 3 1 2 4 9 10 14 15 29 1 2 1 ... ... ... 1 ... ... ... 3 2 5 Influenza 10 86 30 56 ... ... ... 1 ... 1 ... 2 2 ... ... ... 1 6 9 14 17 10 27 30 51 84 Dysentery 14 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 4 4 Erysipelas 18 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Parotitis 19 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Pyæmia, Septicæmia 20 7 l 6 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 3 ... 2 ... ... 1 6 7 • Actinomycosis 25 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Pulmonary Tuberculosis 28 A B 139 72 67 ... ... ... ... ... ... ... ... ... 3 1 14 16 21 24 30 20 4 6 72 67 139 Acute Miliary Tuberculosis 29B 3 ... 3 ... ... ... ... ... 1 ... 1 1 ... 1 ... 1 ... ... ... ... ... ... ... 2 2 Tuberculous Meningitis 30 12 4 8 1 2 1 3 1 2 3 7 10 1 1 ... ... ... ... ... ... ... ... 1 1 2 Tuberculosis of Peritoneum, &c. 31AB 6 2 4 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 3 ... ... 2 4 6 Tuberculosis of Spinal Column 32 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... 1 Tuberculosis of Joints 33 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 2 Tuberculosis of other Organs 34 4 3 l ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... ... ... ... ... 3 1 4 Disseminated Tuberculosis 35 2 1 l ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 Rickets 36 1 ... l ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 37 10 3 7 ... 2 ... 1 ... ... ... 3 3 ... ... 1 ... 1 1 1 3 ... ... 3 4 7 Cancer 89-45 261 98 163 ... ... ... ... ... ... ... ... ... ... ... 1 1 4 13 52 84 41 65 98 163 261 Other Tumours 46 8 ... 8 ... ... ... ... ... ... ... ... ... ... l ... ... ... ... ... 2 ... 3 ... 8 8 Rheumatic Fever 47 2 1 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... 1 1 2 Chronic Rheumatism, &c 48ABC 7 5 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 1 5 2 7 Diabetes 50 20 9 11 ... ... ... ... ... ... ... ... ... ... ... 1 1 2 ... 1 4 5 6 9 11 20 Exophthalmic Goitre 51 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 2 2 Leucocythæmia, &c. 53AB 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 1 4 2 6 Anæmia Chlorosis 54 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 3 2 3 4 7 11 Alcoholism 56 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Total for General Diseases 726 307 419 18 16 21 25 24 25 63 66 123 13 13 19 22 38 60 107 145 67 113 244 353 597 67 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 Five Years. Total M F M F M F M F M F Total M F M F M F M F M F M F Total Brought forward 726 307 419 18 16 21 25 24 25 63 66 129 13 13 19 22 38 60 107 145 67 113 244 353 597 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 8 4 4 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... 2 1 1 ... 1 4 4 8 Meningitis 61BC 11 4 7 ... 2 ... ... ... ... ... 2 2 1 2 1 1 1 2 1 ... ... ... 4 5 9 Locomotor Ataxy 6'2 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 4 ... 4 Other Diseases of the Spinal Cord 63AB 16 8 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 3 3 5 3 8 8 16 Cerebral Hæmorrhage, Apoplexy 64 AE 93 35 58 2 2 ... ... ... ... 2 ... 4 ... ... ... ... 3 1 11 11 19 44 33 56 89 Softening of Brain 65 6 1 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 1 2 1 5 6 Paralysis without specified cause 66AC 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 2 3 General Paralysis of the Insane 67 10 8 2 . . . ... ... ... ... ... ... ... ... ... ... ... ... 3 1 5 1 ... ... 8 2 10 Other forms of Mental Alienation 68 4 ... 4 . . . ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 4 4 Epilepsy 69 5 2 3 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 1 ... 2 3 5 Infantile Convulsions under 5 years 71AB 3 2 1 2 ... ... 1 ... ... 2 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Neuritis 73 2 1 1 • •• ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... ... 1 1 2 Other Diseases of the Nervous System 74 AD 12 6 6 1 ... ... ... ... ... 1 ... 1 ... ... 1 ... 1 ... 2 5 1 1 5 6 11 Mastoid Disease 76 A 2 ... 2 ... ... ... ... ... ... . . . ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Other Diseases of the Ears 76B 4 1 3 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 1 ... ... 1 ... 1 1 2 3 Total for Diseases of the Nervous System, and of the Organs of Special Sense 183 77 106 5 5 ... 1 ... ... 5 6 11 3 4 3 2 9 13 28 25 29 56 72 100 172 III.—DISEASES OF THE CIRCULATORY SYSTEM. Pericarditis 77 1 1 . . . ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Acute Endocarditis 78AC 12 6 6 ... . . . ... ... ... ... ... ... ... 1 1 ... ... 2 ... 3 4 ... 1 6 6 19, Valvular Disease 79A 125 55 70 ... ... ... ... ... ... ... ... ... 1 ... 4 2 6 4 18 23 26 41 55 70 125 Fatty Degeneration of the Heart 79B 33 15 18 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 3 7 8 5 7 15 18 33 Other Organic Diseases of the Heart 79C 144 53 91 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 14 11 37 79 53 91 144 Angina Pectoris 80 8 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 3 2 5 3 8 Carried forward 1232 519 713 23 21 21 26 24 25 68 72 140 18 18 27 26 61 81 178 217 167 299 451 641 1092 68 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 1232 519 713 23 21 21 26 24 25 68 72 140 18 18 27 26 61 81 178 217 167 299 451 641 1092 DISEASES OF THE CIRCULATORY SYSTEM—continued. Arterial Sclerosis, &c. 81AC 122 60 62 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 13 7 47 54 60 62 122 Cerebral Embolism and Thrombosis 82A 18 4 14 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 4 12 4 14 18 Other Embolism and Thrombosis 82B 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 2 1 3 Diseases of the Lymphatic System 84AB 1 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Other Diseases of the Circulatory System 85AC 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Total for Diseases of the Circulatory System 168 203 265 ... ... 1 ... ... ... 1 ... 1 2 1 5 3 15 9 56 55 124 197 202 265 467 IV.—DISEASES OF THE RESPIRATORY SYSTEM. Diseases of the Larynx 87AC 2 1 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 Myxœdema 88 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Bronchitis 89 & 90 241 109 132 8 8 2 ... 1 1 11 9 20 ... 1 ... 2 8 2 29 16 61 102 98 123 221 Broncho-pneumonia 91 170 89 81 38 22 17 19 13 11 68 52 120 3 ... 1 1 2 1 5 5 10 22 21 29 50 Lobar-pneumonia 92A 42 21 21 ... ... 1 1 ... ... 1 1 2 ... 2 2 1 9 6 4 6 5 5 20 20 40 Pneumonia (type not stated) 92B 47 19 28 2 3 1 1 3 2 6 6 12 ... ... ... 1 3 5 4 ... 6 16 13 22 35 Empyema 93A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 1 2 Other Pleurisy 93 B 5 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 3 1 ... 2 3 5 Pulmonary Congestion, &c. 94AD 9 3 6 ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 ... ... 1 5 3 6 9 Gangrene of the Lung 95 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Asthma 96 9 7 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 2 2 ... 7 2 9 Emphysema 97 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Fibroid Disease of Lung 98A 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 2 1 3 Total for Diseases of the Respiratory System 535 257 278 49 33 21 21 17 14 87 68 155 4 3 3 5 25 16 51 33 87 153 170 210 380 Carried forward 1912 844 1068 72 54 43 47 41 39 156 140 296 22 21 30 32 87 98 242 258 307 519 688 928 1616 69 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 1912 844 1068 72 51 43 47 41 39 156 140 296 22 21 30 32 87 98 242 258 307 519 688 928 1616 V.—DISEASES OF THE DIGESTIVE SYSTEM. Diseases of Mouth and Aunexa 99 1 ... 1 ... ... ... ... ... 1 ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Oesophagus 101 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Perforating Ulcer of Stomach 102 9 6 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 2 1 3 1 6 3 9 Inflammation of Stomach 103A 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 2 ... 2 2 4 Other Diseases of the Stomach 103B 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Diarrhœa and Enteritis 104 & 105AB 47 28 19 16 8 4 3 1 ... 21 11 32 ... 1 ... ... 1 1 4 ... 2 6 7 8 15 Appendicitis 108 16 6 10 ... ... ... ... ... ... ... ... ... 1 2 2 1 2 1 1 4 ... 2 6 10 16 Hernia 109A 10 6 4 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... 1 1 4 3 5 4 9 Intestinal Obstruction 109B 13 4 9 ... 1 ... ... ... ... ... 1 1 ... ... ... ... 2 1 2 1 ... 6 4 8 12 Other Diseases of the Intestines 110 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 2 Icterus Gravis 111 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Cirrhosis of the Liver, &c. 113AC 10 6 4 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 4 3 1 ... 6 4 10 Biliary Calculi 114 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 2 1 3 4 Other Diseases of the Liver 115 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 1 2 Diseases of the Spleen 116 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Peritonitis (cause unstated) 117 4 2 2 1 ... ... ... ... ... 1 ... 1 ... ... ... ... 1 2 ... ... ... ... 1 2 3 Other Diseases of Digestive System 118 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 3 ... 3 Total for Diseases of the Digestive System 129 68 61 18 9 4 3 1 1 23 13 36 1 3 3 1 8 7 19 14 14 23 45 48 93 VI.—NON-VENEREAL DISEASES OF THE GENITO URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 2 1 1 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 1 Bright's Disease, &c. 120AB 82 37 45 ... ... ... ... ... ... ... ... ... ... 2 1 1 3 4 11 15 22 23 37 45 82 Other Diseases of the Kidney 122AD 4 3 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 3 1 4 Calculi of the Urinary Passages 123 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Diseases of the Bladder 124 8 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 ... 5 ... 8 ... 8 Diseases of the Urethra 125AB 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Diseases of the Prostate 126 10 10 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 10 ... 10 ... 10 Ovarian Cyst (Tumour) 131 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of Female Genital Organs 132 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Total for non Venereal Diseases of the Genito-Urinary System and Annexa 111 61 50 1 ... ... ... ... ... 1 ... 1 ... 2 2 1 4 5 13 16 41 26 60 50 110 Carried forward 2152 973 1179 91 63 47 50 42 40 180 153 333 23 26 35 34 99 110 274 288 362 568 793 1026 1819 70 TABLE V.—continued. CAUSES OF DEATH. Classification No. TotalsAll 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 2152 973 1179 91 63 47 50 42 40 180 158 333 23 26 35 34 99 110 274 288 362 568 793 1026 1819 VII.—THE PU EBP URAL STATE. Puerperal Haemorrhage 135 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Other Accidents of Childbirth 136 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 4 ... ... ... ... ... 5 5 Puerperal Fever 137 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 6 6 Puerperal Convulsions 188C 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... 3 3 Total for Diseases of the Puerperal State 16 ... 16 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 15 ... ... ... ... ... 16 16 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142A 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Other Gangrene 142D 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Carbuncle 143 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Phlegmon, Acute Abscess 144AB 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Diseases of the Integumentary System 145 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 ... 1 3 4 Total for Diseases of the Skin and of the Cellular Tissue 8 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 3 2 ... 5 3 8 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION 146 .7 6 3 3 ... ... ... 1 ... ... ... 1 1 ... ... 1 ... ... 1 2 1 ... ... 3 2 5 X.—MALFORMATIONS. Congenital Malformation 150AD 26 17 9 14 9 1 ... ... ... 15 9 24 1 ... 1 ... ... ... ... ... ... ... 2 ... 2 XI.—DISEASES OF EARLY INFANCY. Premature Birth 151A 37 24 13 24 13 ... ... ... ... 24 13 37 ... ... ... ... ... ... ... ... ... ... ... ... ... Infautile Atrophy, Debility and Marasmus 151B 33 22 11 22 11 ... ... ... ... 22 11 33 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 1510 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diseases of Umbilicus 152A 1 1 ... 1 ... ... ... ... ... 1 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 5 3 2 3 2 ... ... ... ... 3 2 5 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 3 ... 8 ... 3 ... ... ... ... ... 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 80 51 29 51 29 ... ... ... ... 51 29 80 ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 2288 1049 1239 156 101 48 51 42 40 246 192 438 24 26 37 35 101 126 277 292 364 568 803 1047 1850 71 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 2288 1049 1239 156 101 48 51 42 40 246 192 438 24 26 37 35 101 126 277 292 364 568 803 1047 1850 XII.—OLD AGE. Old Age 154AB 54 15 39 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 14 39 15 39 54 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. Suicide by Poison 155 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Suicide by Asphyxia 156 10 7 3 ... ... ... ... ... ... ... ... ... ... ... 1 1 4 1 2 1 ... ... 7 3 10 Suicide by Hanging 157 8 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 2 1 3 Suicide by Drowning 158 4 8 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 1 ... 3 1 4 Suicide by Firearms 159 2 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... ... 1 1 2 Suicide by Cutting or Piercing Instruments 160 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 ... 4 ... 4 Suicide by Jumping from High Place 161 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 2 1 ... ... 3 3 6 Suicide by Crushing 162 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 ... 2 Other Acute Poisonings 165 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Conflagration 166 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Burns 167 8 4 4 ... ... ... 1 ... ... 1 1 2 1 ... ... 1 ... 1 1 ... 1 1 3 3 6 Absorption of Deleterious Gases (Overlain, &c.) 168 6 4 2 ... ... ... ... ... ... ... ... ... 1 ... 1 ... 2 1 ... 1 ... ... 4 2 6 Accidental Drowning 169 2 2 ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... ... ... ... ... 2 ... 2 Injury by Fall 172 9 6 3 ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 ... 1 2 2 1 6 3 9 Injury by Machines 174 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Injury by other Crushing (vehicles, railways, &c.) 175 22 18 4 ... ... ... ... ... ... ... ... ... 4 ... 1 ... 2 ... 6 2 5 2 18 4 22 Starvation 177 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 ... 1 Homicide 184 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Total for Affections produced by External Causes 85 60 25 ... ... 1 1 ... ... 1 1 2 8 ... 6 2 13 8 18 9 14 5 59 24 83 Grand Totals 2427 1124 1303 156 101 49 52 42 40 247 193 440 32 26 43 37 114 134 296 301 392 612 877 1110 1987 72 TABLE VI. Summary of Inspections, &c., done by the Male Sanitary Inspectors during the year 1922. DESCRIPTION OF WORK, &c NUMBER OF DISTRICT Grand Total 1 2 3 4 5 6 7 8 9 10 Complaints received 355 244 148 262 238 226 147 182 274 258 2334 Public Health (London) Act, 1891. Houses inspected on complaint - 236 109 154 255 238 269 107 206 278 252 2104 ,, after Infectious Disease 174 169 106 120 133 90 66 100 98 55 1111 Primary Routine House Inspections - 16 52 92 - 82 300 150 142 834 Re-inspections - 1098 584 1139 1093 1319 1235 635 939 1298 1039 10379 Bye-Laws re Houses Let in Lodgings Complaints received First Inspections during each 115 121 28 10 — — 21 1 3 8 307 month (Furnished Houses) 26 9 342 40 — 55 33 — — 1 506 Re-inspections „ „ 30 4 548 40 — 107 7 — — 2 738 First Inspections during each month (Unfurnished Houses) - 415 621 98 116 162 152 127 79 365 51 2186 Re-inspections „ „ 548 598 150 286 425 672 310 71 37 217 3314 Housing Acts, 1890-1919. Initial Inspections 17 88 34 28 4 2 9 21 — 31 234 Re-inspections — 53 17 5 82 141 14 — 1 26 339 Underground Living Rooms. Primary Inspections 1 1 4 7 — — — — 3 6 22 Re-inspections - - — — — — - — 2 5 7 Drainage. House Drains Tested and Inspected 15 124 47 30 10 23 32 29 61 23 394 Re-inspections 13 209 21 6 35 — 16 6 22 11 339 Inspections of Workshops 2 17 31 9 12 15 29 126 74 29 344 „ Factories 5 12 20 24 1 — 11 68 8 9 158 „ Bakehouses 29 18 29 67 33 12 25 13 55 27 308 ,, Slaughterhouses - 1 27 216 — — 22 8 1 — 9 284 „ Dairies, Cowsheds and Milkshops - 89 34 55 113 85 140 46 99 84 63 808 „ Ice Cream Premises 21 19 16 22 5 2 8 2 11 17 123 „ other Food Premises 163 136 94 88 54 72 50 33 155 159 1004 ,, Mews 551 183 589 201 366 263 68 445 819 317 3802 Smoke Observations 146 7 — 4 11 — 16 138 44 176 542 Other Inspections 672 566 365 485 436 341 133 430 212 313 3953 Food and Drugs Acts, &c. Samples taken (formal & informal) 125 125 88 88 125 125 — 125 124 — 925 Notices Issued. Public Health (London) Act, 1891. Intimations 342 381 233 343 197 169 184 102 311 127 2389 Statutory Notices 67 96 51 60 36 31 43 23 59 46 512 Final 12 35 10 29 13 12 9 4 5 9 138 Summonses issued 2 3 3 — 3 27 5 3 1 — 47 Houses Let in Lodgings. Statutory Notices 72 97 46 56 55 29 30 7 39 25 456 Summonses issued — 2 1 — 1 24 — — — — 28 Housing Acts, 1890 1919. Sect. 30, 1909 — 9 — 14 — 10 — — — — 33 Sect. 17, 1909 - - - - - - - - - - - Sec. 28, 1919 — 3 4 3 — 8 — — — — 18 Underground Room Habitation 1 — 3 1 1 —* 1 1 2 1 11 Removal of Manure 10 3 — 5 4 1 — — 2 4 29 Smoke Nuisance Orders 2 - - - - - - - - - 2 Rent Restrictions Act Certificates 1 1 — — 4 — 1 1 — 1 9 Special Notices included under Public Health (London) Act, 1891, relating to Factories 2 2 4 ,, Workshops — 1 — — — 2 2 — 6 2 13 „ Bakehouses 1 1 2 Other Notices 3 5 1 1 — 1 11 — 1 9 ' 32 Report of Waste of Water to M. W. B. 6 15 6 8 — 5 13 3 24 10 90 „ Dangerous Structures to L.C.C. 5 13 7 17 — — 11 — — 6 59 73 TABLE VIA. Summary of Works completed by the Sanitary Inspectors during the Year 1922. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Grand Total 1 2 3 4 5 6 7 8 9 10 House Drains re-constructed 3 13 - 3 3 3 4 1 14 4 48 Defective Drains repaired 10 30 14 2 2 9 18 12 26 34 157 House Drains cleansed 56 78 15 14 30 12 17 16 119 62 19 Water-closets reconstructed, repaired, &c 169 93 66 60 83 26 12 20 31 65 625 Water-closets supplied with water 31 5 11 42 71 4 4 7 116 60 351 Water-closets, new, provided - — 7 — 2 4 5 1 23 6 48 Soil-pipes ventilated, repaired, &c. 4 10 4 5 4 1 1 5 61 7 102 Soil-pipes, new, provided 6 9 - 6 8 4 1 3 12 2 51 Cisterns cleaned, covered, &c. 19 72 22 15 2 8 9 7 103 9 266 Yards, Areas paved, drained, repaired 51 90 29 25 19 6 14 8 27 37 306 Dustbins provided 134 95 47 51 40 42 42 30 137 44 662 Ashpits abolished 21 32 10 9 5 2 4 2 4 21 110 Accumulations of filth, &c., removed 23 57 6 8 9 3 12 26 27 58 229 Animals removed 3 16 1 5 3 5 1 2 - 36 Overcrowding abated 1 3 3 — 1 1 1 1 2 - 13 Underground Rooms, illegal occupation discontinued 1 _ 3 1 1 - 1 1 2 1 11 Roofs repaired 94 87 56 25 70 31 31 44 156 45 639 Houses provided with water above basement floor 5 20 2 8 1 10 - - 5 2 53 Dampness in Dwellings remedied 47 23 26 12 35 2 31 15 22 31 244 Houses closed under Sect. 17, Housing Act, 1909 - - - - - - - - - - - Repairs of Houses completed under Sect. 28, Housing Act,1919 1 2 — — 3 — 1 — — — 7 Infectious Disease Cases removed 148 141 64 90 100 52 42 60 69 35 801 Houses Disinfected after Infectious Diseases (including Bedding, Clothing, &c.) 144 142 65 84 104 52 44 43 66 42 786 Rooms in such Houses, disinfected after Infectious Disease 149 170 68 88 107 76 75 68 129 53 983 Houses cleansed under Houses Let in Lodgings By-laws 73 149 45 63 82 18 37 24 63 24 578 Verminous Houses cleansed (including Bedding, Clothing, &c 112 134 84 80 12 15 14 1 9 25 486 Verminous Rooms cleansed in such Houses 227 176 201 131 12 14 25 1 24 31 842 Dirty Bedding cleansed 6 3 10 22 1 — 3 - 3 2 50 Dirty Bedding destroyed 1 - 1 39 2 — — - 1 1 45 Other Sanitary Works executed 39 322 190 162 189 72 68 26 79 163 1,310 74 TABLE VII. The Work of the Women Health Officers for the Year 1922. HEALTH OFFICERS Total 1 2 3 4 5 6 7 Child Welfare— First Visits to Infants 42 363 367 316 299 362 340 2,089 Return Visits to Infants 56 639 497 980 1,118 734 790 4,814 Visits to Children between 1 and 5 years 118 950 832 714 1,092 632 523 4,861 Stillbirth Enquiries 1 6 5 9 8 6 9 44 Visits to Ophthalmia cases — 1 10 1 1 6 8 27 Return Visits to Ophthalmia cases — 11 48 9 18 16 28 130 Visits to Measles cases 39 109 104 85 87 51 83 558 Visit to Whooping Cough cases 33 11 10 — — 18 8 80 Visits to Puerperal Fever cases 1 — 2 2 3 1 2 11 Infantile Death Enquiries 12 43 32 21 22 33 40 203 Milk Investigations 16 99 135 96 32 64 209 651 Ante-Natal Visits 13 91 11 16 - 42 49 222 Half-days at Welfares 12 142 141 140 96 82 150 763 Special Visits 285 318 169 232 157 83 151 1,395 Tuberculosis— Pulmonary.—First Visits 25 37 22 40 40 40 60 264 Re-Visits 230 260 237 258 39 309 365 1,698 Non-Pulmonary—First Visits 7 5 5 8 3 — 10 38 Re-Visits 76 48 101 86 8 35 42 396 Factories and Workshops Act. Inspections of Factories 13 3 13 21 — 5 2 57 Inspections of Workshops 268 5 24 61 119 33 73 583 Inspections of Outworkers' Premises 117 — 25 55 — 100 37 334 Inspections of other Workplaces 35 — — — 1 10 3 49 Total Visits 1,399 3,141 2,790 3,150 3,143 2,662 2,982 19,267 Notices issued under the Public Health Act— Intimation Notices 6 — — 3 — 2 3 14 Statutory Notices 2 — — — — — — 2 Final Notices - - - - - - - - Summonses — — — — — — — — 75 TABLE VIII. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1921. 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 there Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Success fully Vaccinated. Column 11. Column V. Dead, Unvaccinated. Postponement by Medical Certificate. Removed to other Districts and notified to Vaccination Officers of the Districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Total Number of Certificates of Successful Vaccination received during the Calendar Year, 1922. Insusceptible of Vaccination. Certificate of Conscientious Objection. 1921. 1 2 3 4 6 7 8 9 10 1st January to 31st Dec. North 2,344 1,458 4 501 130 26 61 160 4 3,277 South 957 673 1 118 45 12 31 72 5 Total 3,301 2,131 5 619 175 38 92 232 9 76 TABLE IX. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1922. (as required by Ministry of Health Circular 359). Year of Appointment Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., D.P.H. 1920 Assistant Medical Officers of Health and Tuberculosis Officers. A. W. K. Picard, M.D. 1922 L. S. T. Burrell, M.D., M.A. 1922 Clerical Staff. Edward R. Hill (Chief Clerk) 1888 Horace A. Hillam 1891 James H. Wilson 1902 William Gascoyne 1919 John C. Minter 1917 Miss M. A. Carter 1922 Sanitary Inspectors. *George M. Pettit (Chief Inspector) 1891 *Henry Dawes 1893 *Nelson Males 1897 *Charles G. Sexton 1898 *Thomas Cutting 1900 *James R. Bagshaw 1901 *Edward J. Bennett 1901 *George W. McQuinn 1901 *Joseph H. Fowles 1902 †John McDermid 1920 †Hubert J. Green 1922 Women Health Officers. Miss E. Mackay 1909 Miss F. C. Hargrave 1910 ‡†*Miss E. Dixon 1917 Mrs. E. E. Buck 1918 ‡†*Miss W. H. E. Whitbread 1920 †*Mrs. V. A. Ross 1921 ‡† Mrs. H. R. Neve 1922 ‡*Miss E. M. Law 1922 Miss A. E. Haycock 1922 Mortuary Keeper. William Sutton 1907 Disinfecting Staff. Albert Nunn (Chief Disinfector) 1906 William Cambridge 1906 Frank Chillcott 1906 George H. I. Harris 1914 Medicinal Baths Staff. William C. Webber (Superintendent) 1913 Mrs. R. Webber (Matron) 1913 Rat Officer. George Bridge 1920 Drain Testing Assistant. William Clancy 1903 *Certificate of the Royal Sanitary Institute. Examination Board. †Certificate of the London Sanitary Inspectors ‡Certified Midwife. All the Women Health Officers have undergone 3 years General Hospital Training and have secured the certificate of general nursing proficiency Exchequer grants equal to half the salary paid are received by the Council in respect of the Medical Officers, the Sanitary Inspectors, the Women Health Officers and the Lady Clerk. INDEX. PAGE Administration 50 Advisory Committee to the Maternity and Child Welfare Committee — Work of the 34 Annual Grants to Child Welfare Institutions 34 Bacteriological Work 54 Bakehouses 36 Births 6 Birth Rates, Death Rates, and Infantile Mortality Rates in 29 Metropolitan Cities and Boroughs (Table) 15 Cancer 20 Census Statistics, 1921 3 Cerebro-Spinal Fever 19 Chapel of Rest 54 Cleansing of Verminous Persons Act, 1897 55 Common Lodging Houses 58 Convalescent Homes 33 Council's Housing Programme 57 Cowsheds 35 Cream Regulations 40 Day Nurseries 32 Deaths 8 „ Causes of (Tables) 9, 10 and 64 „ Causes of at age periods, Table V. (Appendix) 66-71 Diphtheria 17 Disinfection 53 Dispensary Treatment of Tuberculosis 23 Dogs, Fouling of Pavement by 56 Drainage Work 54 Dried Milk, Supply of. 42 Dust Removal 53 Encephalitis Lethargica 19 Enteric Fever 18 Erysipelas 19 Factories and Workshops 43 Food Poisoning 41 Food Supply 34 Grants to Hospitals 22 Health Visitors, Duties and Work of 50 Home Nursing by Kensington District Nursing Association 21 Home Office Tables (Factory and Workshop) 46-49 Homes for Deserted, Widowed or Unmarried Mothers and their Children 32 Home Work 45 Houses, Let in Lodgings 59 Housing of the Working Classes 57 Housing Statistics for 1922 60 Ice Cream 35 Illegitimate Children, Births and Deaths of 13 Increase of Rent and Mortgage Interest (Restrictions Act), 1920 55 PAGE Infantile Mortality 10 „ „ during the year (Table IV. Appendix) 65 Infant Welfare Centres 29 Infectious Disease, Cases notified during the year (Table II. Appendix) 63 Influenzal Pneumonia 20 Ladbroke Road Hospital 31 Legal Proceedings 51 Malaria 20 Margarine and Butter Substitutes 41 Marriages 6 Maternity and Child Welfare 28 Measles 20 Men's Workshops 44 Midwifery Arrangements 31 Milk Supply 34 Milk Supply for Expectant and Nursing Mothers 42 Mortuary 54 Mothercraft Training Society 32 National Children's Adoption Association Hostels 33 Notification of Births Act, 1907 7 Notifiable Infectious Diseases 15 Ophthalmia Neonatorum 19 Pneumonia 20 Population 6 Prevalence of Disease 15 Public Baths and Washhouses 54 Public Conveniences 54 Public Health Department Staff 50 and 76 Puerperal Fever 19 Rag Flock Act, 1911 55 Rats and Mice (Destruction) Act, 1919 56 Refuse Removal from Mews 54 Sale of Food and Drugs Acts 37 Sanitary Inspectors (Male), Summary of Work done during the Year (Tables VI. and VIA.) Appendix 72-73 Scarlet Fever 16 Slaughter-houses 36 Small-Pox 16 Statistics, Summary of 2 Telford Road Clinic 30 Tuberculosis 22 Unsound Food 37 Vaccination Officer—Return for 1921 (Table VII.) Appendix 75 Verminous Rooms Cleansed 53 Vital Statistics 6 „ „ for whole District, 1921, and previous years (Table I.) Appendix 62 Whooping Cough 20 Women's Workshops 44