KEN 26 The royal Borough of Kensington. THE ANNUAL REPORT on the HEALTH OF THE BOROUGH FOR THE YEAR 1923 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. SUMMARY OF STATISTICS . For the year 1923. Population 178,500 Area of Borough in Acres 2,290 Density of Population per Acre 77 Separate Houses or Self-contained Flats Inhabited 28,051 Separately occupied tenements in the Borough according to the Census of 1921. (This number represents families or households separately occupying their own rooms in 1921) 43,001 No. of mews dwellings 2,091 Houses intended for one family only, which are now occupied (without having been specially adapted) by two or more families - 5,690 Persons per House 6.4 Number of Marriages 1,773 Number of Births 3,121 Birth Rate 17.5 Number of Deaths 2,196 Death Rate 12.3 Infantile Mortality:— Deaths under 1 year - 218 Infantile Deaths pen 1,000 Births 70 Maternal Mortality:— Deaths of Women from Diseases or Accidents associated with Childbirth 17 Maternal Death Rate 5.4 Deaths from Phthisis 117 Phthisis Death Rate 0.66 Deaths from all Forms of Tuberculosis 152 Tuberculosis Death Rate 0.85 Deaths from the Zymotic Diseases 123 Zymotic Death Rate 0.69 Product of a 1d. Rate (Gross) £10,429 Town Hall, Kensington, W.8. May 20th, 1924. 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 1923, 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 12.3 per 1,000 living. This compares favourably with the averagerate for the Borough for the present century, which is 14.2. Indeed, the rate for 1923 is, with the exception of that of i2T for the year 1910, the lowest recorded in the history of the Borough. The number of deaths of infants under the age of 12 months for every 1,000 births was 70 as against 82 in ]922 and 110 in 1921. This is the lowest figure for infantile mortality which has been reached in Kensington, and is one which must give considerable satisfaction to the Council and the various voluntary bodies interested in the Maternity and Child Welfare movement. The deaths from tuberculosis showed, as in recent years, a steady decrease in number, and the rate of 85 deaths per 100,000 inhabitants for 1923 is the lowest on record. The year was remarkable for the very low incidence of scarlet fever and diphtheria; indeed, there was no outbreak of any infectious disease in the Borough which could be described as epidemic in form. There are two figures which cause anxiety, one is in regard to cancer and the other in regard to maternal mortality. The deaths from cancer number 269, this being the highest figure for any one year in Kensington. The maternal mortality rate (the number of deaths of mothers as a result of diseases or accidents associated with child-birth for every 1,000 births) was 5.4, which is the highest figure recorded in any year of the present century. The question receives special consideration on page 12 of this report. From the administrative point of view, the most important feature of the year has been the great activity in regard to house repairs and improvements in the housing conditions in the poorer parts of the Borough. The condition of the housing accommodation of the working class has received a good deal of attention both inside and outside the Council during the past twelve months and, therefore, I beg to call special attention to a detailed statement showing the enormous volume of housing work which was conducted by the Council in 1923 and the results obtained. The statement appears on pages 70 to 77 of this report. It is appropriate that in presenting this report I should express my appreciation of the full measure of support which has been accorded to me by the Mayor, the Chairmen and Vice-Chairmen of the various Committees, all members of the Council, and the Chief Officers of other Departments, and of thanking the staff of the Public Health Department for their efficient service and loyal co-operation throughout the year. 4 VITAL STATISTICS. 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, Redclifife and Brompton. For 1923 the Registrar-General has estimated the population to be 178,500, and from this figure the populations in the different wards of the Borough have been estimated to be as shown in the following table:— The Borough 178,500 North Kensington 94,063 South Kensington 84,437 Wards. St. Charles 24,632 Golborne 26,724 Norland 22,438 Pern bridge 20,269 Holland 19,158 Earl's Court 18,181 Queen's Gate 13,984 Redcliffe 20,164 Bromoton 12,950 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 19.9 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 855 Roman Catholic Church 208 Nonconformist Churches 42 Jewish Church 8 Register Office 660 Total 1,773 BIRTHS. The number of births registered was 3,121, after correction for inward and outward transfers, and the birth rate for the Borough was 17.5 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,494 1,422 2,916 Illegitimate 101 104 205 Total 1,595 1,526 8,121 Table showing the number of births and the birth rates in England and Wales, London, Kensington and the various districts in the Borough in 1923, and the rates for the previous five years:— 5 District 1923. Birth rates in previous years. No. of Births. Birth-rate. 1922. 1921. 1920. 1919. 1918. England and Wales 758,386 19.7 20.6 22.4 25.4 18.5 17.7 London 91,662 20.2 21.0 22.3 26.5 18.2 16.0 The Borough 3,121 17.5 17.6 18.7 24.3 16.1 13.3 North Kensington 2,127 22.6 22.9 25.1 32.8 21.7 17.8 South Kensington 85.6 10.1 9.8 11.3 13.2 10.3 8.6 Wards. St. Charles 526 21.4 23.6 23.8 32.7 21.9 17.8 Golborne 711 26.6 25.5 29.4 38.2 26.6 20.6 Norland 559 24.9 25.7 27.2 35.1 21.9 18.4 Pembridge 331 16.3 15.5 18.6 23.1 14.4 13.6 Holland 214 11.2 11.0 12.3 13.9 8.8 7.7 Earl's Court 189 10.4 10.6 14.1 15.0 13.7 13.0 Queen's Gate 93 6.6 6.9 7.5 8.5 8.1 5.9 Redcliffe 248 12.3 11.0 11.4 14.6 11.8 8.7 Brompton 112 8.7 8.4 10.4 12.9 8.1 6.5 Ward unknown 138 ... ... ... ... ... ... 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 1923 the birth rate for Golborne Ward in the North was 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. Birth-rate per 1.000 population. 1881-1885 26.1 1886-1890 23.5 1891-1895 22.0 1896-1900 21.6 1901-1905 20.4 1906-1910 18.7 1911-1915 19.1 1916-1920 17.2 1921 18.7 1922 17.6 1923 17.5 Notification of Births Act, 1907.—Parents are allowed a period of six weeks within which to register the birth of a child, but the fulfilment of this duty is so frequently postponed until the last few days of this period that the records of the Registrars of Births do not enable Public Health authorities to gain that early knowledge of the birth of children in their districts which is so essential to the success of the work of Health Visitors. This disadvantage arising from delay in birth registration has been met by the Notification of Births Act, which requires all live births and all still births occurring after the twenty-eighth week of pregnancy to be notified within thirty-six hours to the Medical Officer of Health of the district in which they occur. During the year, 3,121 births to Kensington mothers were registered, and of this number 2,837 or 91 per cent, have been notified in accordance with the requirements of the Act. The number of stillbirths notified was 89. The following table indicates the source of notification and the kinds of births notified. 6 Source of Notification. Number of Births Notified. Still Births. Live B.rths. Total Births. Number notified by Midwives 44 1654 1,698 „ „ „ Parents — 115 115 „ ,, „ Medical Practitioners 17 450 467 ,, „ Other Persons 11 240 251 Births in the Borough 72 2,469 2,581 Notified from Institutions outside the Borough 17 878 895 Total 89 2,887 2,926 DEATHS. The number of deaths registered in the Borough during the year was 2,551, 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 2,551 Deaths of residents in public institutions, etc., beyond the Borough 484 3,035 Deaths of non-residents in public institutions, etc., within the Borough 839 Corrected number of deaths belonging to the Borough 2,196 The corrected number of deaths gives a death-rate of 12 3 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 1923, and the rates for the previous five years:— District. 1923. Death-rates in previous years. No. of Deaths. Death-rate. 1922. 1921. 1920. 1919. 1918. England and Wales 444,869 11.6 12.9 12.1 12.4 13.7 17.6 London 50,743 11.2 18.4 12.4 12.4 13.6 19.2 The Borough 2,196 12.3 13.6 13.8 13.4 15.2 17.8 North Kensington 1,193 12.7 14.7 15.4 14.3 16.6 20.1 South Kensington Wards. 919 11.2 11.6 11.2 11.9 13.2 13.8 St. Charles ... 304 12.3 12.8 14.6 13.3 15.3 18.5 Golborne 342 12.8 15.9 16.7 13.9 17.5 22.2 Norland 338 15.1 17.2 16.6 16.1 17.3 22.7 Pembridge 209 10.3 12.8 13.3 13.9 16.1 17.0 Holland 219 11.4 12.1 11.6 11.4 12.7 13.5 Earl's Court ... 208 11.4 14.1 14.6 14.7 15.9 16.2 Queen's Gate... 127 9.1 8.1 6.8 9.0 10.5 10.0 Redcliffe 273 13.5 12.2 12.5 13.6 14.7 15.9 Brompton 122 9.4 9.7 9.1 9.6 10.7 11.9 Ward Unknown 54 ... ... ... ... ... ... 7 Table showing Kensington death-rates since 1896:— Death-rate per 1,000 living. Period. 1896-1900 16.4 1901-1905 144 1906-1910 13.8 1911-1915 14.3 1916-1920 15.6 1921 13.8 1922 13.6 1923 12.3 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 123 Epidemic Influenza 46 Puerperal Fever 7 Phthisis 117 Other Tuberculous Diseases 35 Cancer 269 Bronchitis 171 Pneumonia 217 Heart Diseases 292 Bright's Disease 50 Diseases and Accidents of Parturition 10 Premature Birth 29 Accidents 60 Old Age 79 All Other Causes 691 2,196 It will be seen that more than one-third of the deaths, or 797, were due to disease of the heart or the organs of respiration. Phthisis, an infectious or preventable disease, caused 117 deaths. The diseases described in the above list as the "principal zymotic diseases" are small-pox, measles, scarlet fever, diphtheria, whooping-cough, enteric fever (including fever not otherwise defined) and diarrhœa; together they were responsible for a very substantial number of deaths, the causes of which are very largely preventable. 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 will be of interest. Deaths from Principal Zymotic Diseases per 1000 persons living Period. Kensington. London. 1920 0.95 1.00 1921 1.02 0.98 1922 0.97 1..11 1923 0.69 0.60 Table showing various Causes of Death in 1923, arranged in Four-Weekly Periods. Four Weeks ending Measles. Scarlet Fever. Whooping. Cougb Diphtheria Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhœa and Enteritis. January 27 - - - 2 3 6 20 23 25 3 February 24 — — 1 2 3 12 23 10 21 2 March 24 -- 1 4 1 5 10 23 17 23 3 April 21 1 1 3 2 7 7 20 11 24 5 May 19 3 — 5 - 4 10 19 8 12 6 June 16 - - 3 - 3 12 19 12 12 3 July 14 1 -- 1 2 - 10 19 8 8 1 August 11 — — 3 - 1 10 26 5 3 7 Sept. 8 — — 2 - — 3 16 7 7 9 October 6 1 — - 1 3 11 25 17 14 November 8 — — - 1 4 8 23 16 11 5 December 1 1 — — 2 5 8 21 19 24 7 ,, 29 8 — 1 1 8 11 15 28 28 2 Totals 15 2 28 14 46 117 269 171 217 67 8 INFANTILE MORTALITY. During the year 1923, there were 3,121 births and 218 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 70. The following table gives the births and the infantile deaths and death rates for the year 1923 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 758,386 52,362 69 London 91,662 5,541 60 The Borough 3,121 218 70 North Kensington 2,127 182 86 South Kensington 856 32 37 St. Charles 526 45 85 Golborne 711 76 107 Norland 559 47 84 Pembridge 331 14 42 Holland 214 11 51 Earl's Court 189 2 11 Queen's Gate 93 3 32 Redcliffe 248 12 48 Brompton 112 4 36 Ward unknown 138 4 — In considering the above and subsequent tables it must be remembered that the deaths of infants at any temporary address (institution or private house) to which the mother went for her confinement, and deaths of infants in institutions to which they were transferred for treatment from the place of birth, are allocated to the district of the usual residence of the mother. 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, 1896-1923 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 1923 69 60 70 Although the Kensington infantile mortality rate for 1923 is higher than that for London as a whole and slightly above the figure for England and Wales, it is the lowest rate recorded in the history of the Borough. The great reduction in the infant death rate in recent years is most encouraging, and it is to be hoped that it will stimulate both voluntary and official workers to press forward with renewed enthusiasm in a campaign which has been associated with such marked success. 9 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1923. January 22 February 22 March 21 April 21 May 18 June 7 July 12 August 17 September 30 October 13 November 15 December 20 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1923. 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 nonths 9—12 'months. Total Infant Deaths under 1 year. 1. Common Infectious Diseases (Measles 3) (Whooping Cough 13) (Diphtheria 1) — — — — — 1 6 5 5 17 2. Tuberculosis - - - - - - 2 — 2 4 3. Pneumonia and Bronchitis — 2 2 1 5 12 16 12 13 58 4. Enteritis — — — 1 1 6 18 16 5 46 5. Syphilis - - - - - - 4 2 1 7 6. Complications of Birth (Injury 3) (Atelectasis 4) 7 - — ~ 7 - - -- - 7 7. Congenital Malformation 3 - - - 3 3 1 1 - 8 8. Premature Birth 22 3 — 1 26 2 1 — — 29 9. Atrophy, Debility and Marasmus 8 3 — — 11 4 7 — — 22 10. Other Diseases (Meningitis 2) (Convulsions 1) (Gastritis 1) (Overlaying 3) (Other Conditions 13) 5 2 2 1 10 3 4 3 — 20 Totals 45 10 4 4 63 31 59 39 26 218 Death-rate in each age period per 1,000 births 14 3 1 1 20 10 19 12 9 70 Percentage of total infant deaths occurring in each age period 21 5 2 2 30 14 27 17 12 10 It will be seen that 46, or '21 per cent., of the '218 infant deaths were due to enteritis. As there has been no obligation on doctors or parents to report cases of this complaint, it has happened only by chance that children suffering from the disease have been discovered by officers of the Public Health Department; indeed, the first information obtained in many cases is on the receipt of a copy of the death certificate from the Registrar of Deaths. The Council have recently obtained an Order under the Public Health (London) Act, 1891, which makes zymotic enteritis or infectious diarrhoea in children under the age of 5 years a notifiable infectious disease. After this Order comes into operation in the Summer of 1924, many casts of the disease will be brought to the notice of the Medical Officer of Health at an early stage of illness with the result that a Woman Health Officer can visit the home to arrange for such nursing and other assistance as may be required. It is hoped that the notification of this disease will enable certain forms of treatment to be adopted in poor homes which will help to relieve suffering and to reduce the mortality from enteritis. 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 approximately half of the infant deaths in 1923, it will be interesting to see how the rates for these diseases vary in accordance with the types of houses occupied by the families in which the deaths occurred. In the following table, a dwelling occupied by one family only, or which has been converted into self-contained flats or maisonettes, is classed as a "private house." The number of these in the Borough is approximately 19,250. A "tenement house" is one let in lodgings to more than one family without being specially adapted for the purpose. Of the 5,690 houses of this class in the Borough, 2,428 are on the Register of Houses let in Lodgings and, consequently, are subject to the Council's by-laws. A "mews dwelling" is a habitation with generally one to three rooms situated over a stable and coach-house. In the majority of cases in South Kensington and some in North Kensington, the stables and coach-houses have been converted into garages. The occupants of mews dwellings vary in type, some are respectable and careful people, whilst others belong to the most careless and indifferent members of the community. There are 2,091 mews dwellings in the Borough. Deaths of Infants from All Causes Deaths of Infants from Pneumonia and Bronchitis Deaths of Infants from Enteritis Boro. N. Ken. S. Ken Boro. N. Ken. S. Ken. Boro. N. Ken. S. Ken. Private Houses— Births 735 345 390 735 345 390 735 345 390 Infant Deaths 33 20 13 2 2 — 8 3 5 „ Death Rates 45 58 33 3 6 — 11 9 13 Tenement Houses— Births 2,048 1,711 337 2,048 1,711 337 2,048 1,711 337 Infant Deaths 169 151 18 54 54 — 36 34 2 Death Rates 82 88 53 26 31 — 17 20 6 Mews Dwellings— Births 140 59 81 140 59 81 140 59 81 Infant Deaths 16 14 2 2 1 2 2 — Death Rates 114 237 24 14 17 12 14 34 — The table shows clearly the high death rates in tenement and mews dwellings as compared with private houses, and it will be noted that the death rate of infants in mews dwellings in North Kensington is more than twice as great as any other rate shown in the table. Before any conclusions are arrived at as to the effect of housing conditions upon the infant death rate, consideration must be given to the fact that negligent, careless, ignorant and povertystricken parents generally drift into the worst type of tenement houses and mews dwellings. The year 1923 is the third in succession in which there has not been an infant death from enteritis in a South Kensington mews dwelling. There are very few horses kept in the South Kensington mews, with the result that there is practically no storage of manure on which flies can breed, and this is probably the reason for the absence of enteritis deaths in the mews dwellings in that half of the Borough. 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 11 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 1923 the "above standard" births numbered 618 and the deaths 22, giving an infantile mortality rate of 35 6. The 2,503 births and 196 deaths not " above standard " in 1923 give an infantile mortality rate of 78. The causes of death in the "above standard" cases were as follows:— Pneumonia and bronchitis 3 Enteritis 3 Infantile debility 3 Premature birth 7 Congenital malformation 1 Other causes 5 The wards to which the children belonged are:— St. Charles 4 Golborne 2 Norland 1 Pembridge 7 Holland 3 Earl's Court — Queen's Gate 1 Redcliffe 2 Brompton 2 ILLEGITIMATE INFANT DEATHS. In 1923, 6.6 per cent, of the births in Kensington were illegitimate and 12 per cent, of the infant deaths were of children of this class. The following table compares the legitimate and illegitimate births, mtant deaths and inf mortality rates in Kensington for 1923. Total. Legitimate. Illegitimate. Births 3,121 2,916 205 Infant Deaths 218 192 26 Rate per 1,000 births 70 66 127 One infant found dead in regard to whom no particulars of parentage could be obtained has been classed as legitimate. The following table compares the total infantile mortality rate for the Borough in recent years with the illegitimate infantile mortality rate:— Year Deaths of all children under 1 year of age per 1,000 births Deaths of illegitimate children under 1 year of age per 1,000 illegitimate births 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 1923 70 127 12 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, and the remarkable decrease in the rate which has taken place in recent years, as shown in the last column of the above table, is very gratifying. For a certain number of illegitimate children satisfactory provision is made by rescue workers but for the majority, the Council's Women Health Officers are unable to obtain such assistance other than that granted by the poor law authorities, which would be necessary to bring about a further material reduction in the illegitimate infant death rate. 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 11 of the 26 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. Maternal Mortality. In 1923 there were 17 deaths of Kensington women from diseases or accidents directly connected with child-birth, and this figure represents a death rate of 5.4 mothers per 1,000 births. The rate for England and Wales in 1922, the last year for which figures are available, was 3.58. The general death rate in England and Wales has been reduced by one-third, and the infant mortality rate has been halved since the beginning of the century, but the maternal mortality rate is little lower than it was twenty years ago. The rate for 1902 was 4 47 against the rate of 3'58 for 1922. The position in Kensington is even less satisfactory as a result of an increase in the maternal mortality rate which has taken place in recent years; in 1921 it was 3.9, in 1922 it increased to 5, and for 1923 it has reached the high figure of 5.4. Of the 17 women who lost their lives in connection with child-birth in 1923, three belonged to South Kensington and the remainder to North Kensington. Eleven died in the St. Mary Abbot's Hospital to which institution they had been admitted for confinement or other treatment, two died in Queen Charlotte's Hospital, two at home, one at a mental hospital outside the Borough and one in a nursing home. The actual causes of death were:— Accidents of Pregnancy 8 Puerperal Haemorrhage 1 Puerperal Fever 7 Puerperal Embolism 1 17 These 17 deaths represent a serious and largely preventable loss of life at the time of its highest capacity and in its most fruitful effort. But these deaths do not tell the whole story of avoidable suffering, for an unknown number of mothers are permanently injured or invalided in the process of child-birth, which should be a physiological and normal act. Dr. Campbell, of the Ministry of Health, speaking of the high maternity mortality rate in England and Wales, says:— "This is a situation which must necessarily cause grave concern to all interested in the wellbeing of women and little children. It scarcely seems necessary to enlarge upon the serious effect of a high maternal mortality rate upon tne health and welfare of many hundreds of families every year, with certain exceptions the women concerned are in the prime of life and are actively engaged in fulfilling the most important duty of bearing and rearing children for the nation. Most of them might in the ordinary course of events look forward to many years of health and usefulness. The unexpected loss of the mother is a tragedy to the family. It is not infrequently associated with the death of the infant for whom the maternal life has been sacrificed, and is often followed by the impaired health and nutrition of the remaining children. Further, the fact that the mortality returns reveal only part of the total damage and disability, and that an incalculable amount of unreported and often untreated injury and ill-health result from pregnancy and labour, has many times been pointed out. It is this burden of avoidable suffering which we seek to relieve scarcely less than to save lives which need not be lost." This question has received considerable attention in Kensington during the past twelve months. There is a sufficient number of Infant Welfare Centres in the Borough, at each of which facilities for ante-natal examination and advice are available. Six centres have special ante-natal sessions where advice is given by experts, and at the seventh expectant mothers are advised privately on infant consultation days. These ante-natal clinics are not used as fully as they should be, and the problem before us now is to secure a better attendance of expectant mothers. Queen Charlotte's Hospital authorities hold a special ante-natal clinic at their Nurses' Home in Ladbroke Grove, which can be attended by any poor expectant woman irrespective of whether her confinement is to be conducted by the Queen Charlotte's nurses or by a private midwife. In 1923, there were 3,121 births in Kensington, and of these 618 may be said to have occurred in families which are regarded as "above standard" financially, and do not come within the scope of the Council's Maternity and Child Welfare scheme. 13 In respect of 1,277 of the 2,503 births in families regarded as coming within the scope of the Council's scheme, the expectant mothers received ante-natal advice at the special clinics held at the Queen Charlotte's Nurses Home and the Infant Welfare Centres. The women who gave birth to the remaining 1,226 children may have received professional attention by private medical men or at Hospitals, but it is probable that the majority did not secure for themselves the advantages of that skilled ante-natal advice which is now generally recognised to be of the greatest value. All those voluntary and official workers engaged in the operation of the Council's Maternity and Child Welfare scheme are endeavouring to reduce the percentage of expectant mothers in the Borough who do not receive skilled ante-natal care, and the paramount importance of making a great effort in this direction becomes very clear as the result of an enquiry made by Officers of the Public Health Department into the circumstances associated with the 17 maternal deaths in 1923 and the 16 similar deaths in 1922. Not one of the 17 women who died in 1923 was known to have received ante-natal advice at clinics or hospitals or from private doctors; and not one of the 16 women who died in 1922 had attended the ante-natal clinics at the Queen Charlotte's Nurses Home or the Infant Welfare Centres, but in one case it is possible that ante natal advice was received at a hospital outside the Borough, This statistical testimony to the efficacy of skilled ante-natal attention is sufficiently striking to call for notice in this report, but it must be at once pointed out that the figures are much too small and the period over which the enquiry has been made is too short to allow definite opinions to be stated. The figures are, however, the only ones available for Kensington and, even though it be frankly admitted that it is a coincidence that not one of the 33 mothers who died had been to a Kensington ante-natal clinic, and that attendance at a clinic might not have prevented certain of the complications which proved fatal, the facts must prove a great encouragement to the large band of Maternity and Child Welfare workers in the Borough. The midwifery service in Kensington is satisfactory, The poor in North Kensington are adequately provided for by the well-trained staff of midwives attached to the Queen Charlotte's Hospital Nurses' Home in Ladbroke Grove. Difficult cases found by these midwives are sent immediately to the hospital for in-patient treatment. Ac there is such an excellent organisation available for the poorest women in North Kensington, the midwives engaged in private practice in the Borough are able to deal with all the mothers who can afford the usual fees. The private midwives are generally satisfactory, and I have no evidence that there is any unqualfied woman in the Borough carrying on a midwifery practice. Owing to unsatisfactory housing conditions, particularly in tenement dwellings where there are very limited facilities for home nursing, there are many cases in which it is particularly desirable that the woman should be removed from home for her confinement, and it is to be hoped that the scheme recently introduced for making use of a ward at the St. Mary Abbot's Hospital as a Kensington Maternity Home will mature, and prove successful in assisting to reduce the maternal death rate in Kensington. TABLE SHOWING THE BIRTH RATES, DEATH RATES AND INFANTILE MORTALITY RATES IN THE 29 METROPOLITAN CITIES AND BOROUGHS IN 1923. Births per 1000 Population. Deaths per 1000 Population. Infantile Deaths per 1000 Births. 1. Shoreditch 27.1 Woolwich 9.9 Hampstead 42 2. Poplar 25.8 Wandsworth 10.1 Woolwich 43 3. Bermondsey 25.0 Hampstead 10.3 Lewisham 45 4. Bethnal Green 24.4 Lewisham 10.3 City of Westminster 46 5. Southwark 24.4 Fulham 10.5 Stoke Newington 48 6. Finsbury 24.1 City of Westminster 105 Battersea 48 7. Stepney 23.5 Stoke Newington 10.6 Wandsworth 52 8. Islington 21.4 Hackney 10.6 Chelsea 55 9. Deptford 21.3 Battersea 10.7 Camberwell 56 10. Camberwell 21.0 Hammersmith 10.8 Hackney 53 11. Greenwich 20.8 Greenwich 10.8 Lambeth 58 12. St. Pancras 20.6 Deptford 10.9 Deptford 58 13. Lambeth 20.4 Camberwell 11.0 Poplar 59 14. Battersea 20.4 Poplar 11.2 Finsbury 60 15. Hammersmith 20.2 Bethnal Green 11.3 Greenwich 62 16. Woolwich 20.2 Lambeth 11.4 Stepney 63 17. Hackney 19.7 St. Marylebone 11.5 St. Pancras 63 18. Fulham 19.6 Paddington 11.5 Hammersmith 63 19. Lewisham 18.7 City of London Stepney 11.5 Fulham 63 20. Stoke Newington 18.3 11.6 Islington 66 21. Paddington 18.1 Islington 11.6 Paddington 68 22. Kensington 17.5 St. Pancras 12.0 St. Marylebone 68 23. Wandsworth 16.4 Holborn 12.1 Southwark 68 24. Chelsea 15.9 Chelsea 12.1 Bethnal Green 69 25. St. Marylebone 15.8 Bermondsey 12.1 Kensington 70 26. Hampstead 14.3 Kensington 12.3 Bermondsey 73 27. Holborn 13.9 Southwark 12.8 Holborn 76 28. City of Westminster 12.4 Shoreditch 12.9 Shoreditch 80 29. City of London 8.3 Finsbury 13.1 City of London 81 14 THE PREVALENCE OF DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in Kensington:— small-pox. Cholera. Diphtheria. Membranous Croup. Erysipelas. Scarlatina or Scarlet Fever. Typhus Fever. Typhoid or Enteric Fever. Relapsing Fever. Continued Fever. Puerperal Fever. Ophthalmia Neonatorum. Cerebro-Spinal Fever. Acute Poliomyelitis. Glanders. Anthrax. Hydrophobia. Tuberculosis. Influenzal Pneumonia. Acute Primary Pneumonia. Trench Fever. Malaria. Dysentery. Plague. Acute Encephalitis Lethargica. Acute Polio-Encephalitis. Table showing Notifications of Infectious Diseases received in 1923, arranged in Four-Weekly Periods. Four Weeks ending Scarlet Fever Diphtheria. Enteric Fever. Erysipelas. Ophthalmia Neonatorum. Puerperal Fever. Pneumonia. Malaria. Encepha. litis Lethargica. P. M'etis & PolioEnce phalitis. Total. January 27 26 14 - 7 1 7 - 1 56 February 24 30 26 - 5 2 — 8 - — — 72 March 24 19 23 — 3 4 3 4 - 1 — 57 April 21 17 20 - 3 1 1 16 1 1 1 62 May 19 12 21 — 2 — 1 14 - — — 50 June 16 10 15 2 3 2 1 15 1 - — 49 July 14 10 18 1 6 2 2 6 1 — — 46 August 11 10 13 5 2 - 7 - - - 37 Sept. 8 10 7 2 3 1 1 3 2 - 1 30 October 6 12 12 4 5 1 3 7 — — — 44 November 3 19 22 — 5 1 1 13 — - — 61 December 1 16 25 — 12 1 1 13 — - 2 70 29 14 7 1 8 3 1 12 — - 1 47 Totals - 205 223 12 67 21 15 125 5 3 5 681 Cases of mistaken diagnosis are excluded from the above Table. Small-Pox.—Only 11 cases of this disease were notified in the Metropolis during the year. The Boroughs affected were:— Greenwich 4 Hackney 1 Baltersea 1 Camberwell 1 Paddington 1 Lewisham 1 Finsbury 1 City of Westminster 1 A lady who arrived in London from Spain on the 4th August, 1923, and who developed a modified form of smallpox on 13th August, whilst staying at a hotel, appears to have been the original source of infection in six of the cases which occurred in London, and in a similar number which occurred in districts surrounding London. This lady thought she was suffering from influenza, and did not call in a doctor. She left the hotel on the 19th August, and went to live with her sister in a district adjoining Kensington. An enquiry into the history of several cases which cropped up in various parts of London and the Home Counties showed that each patient had been in more or less direct contact with this lady during the period she was supposed to have been suffering from influenza. A careful search was made for the lady's whereabouts and, after some difficulty, she was discovered on September 10th. She was found to be recovering from smallpox and was removed to hospital. On the following day I received information that the lady had been shopping in various establishments in Kensington on the day that her disease was diagnosed, and also a few days previously. As full information as possible of her visits to Kensington was obtained, and immediate steps were taken in regard to vaccination of those with whom she had been in contact. About 2,000 persons in Kensington who were possible contacts were vaccinated. 15 One of the cases in regard to which this lady was the probable original source of infection paid frequent visits to one of the Council's Depots right up to the time of his illness. This information was obtained immediately after the case was diagnosed, and a number of contacts in the Council's service at the Depot were vaccinated forthwith. No case of smallpox occurred in the Borough. Scarlet Fever.—There was a greatly diminished incidence of this disease during 1923, only 205 cases being notified against 617, 870 and 471 in the three preceding years. Since 1900, there have been only two years in which the number of notifications was less than in the year 1923. The following table shows the number of cases notified in each tour-weekly period during 1923. 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 935 838 851 663 710 699 719 520 542 939 991 928 783 The Borough 27 34 21 19 12 11 11 10 10 12 19 17 14 North Kensington 19 10 32 12 4 6 6 9 7 4 14 12 12 South Kensington Wards 8 24 9 7 8 5 5 1 3 8 5 5 2 St. Charles 5 2 5 4 1 5 - 1 1 2 4 — 2 'Golborne 10 6 5 5 1 1 3 3 1 1 5 7 — Norland 2 1 2 2 2 — 2 3 2 1 1 3 3 Pembridge 2 1 — 1 — — 1 2 3 — 4 2 7 Holland — 3 3 3 3 5 2 — — 1 — — — Earl's Court 1 — — 1 2 — — 2 2 — — — Queen's Gate 2 — 2 1 2 — 1 — — 1 — 1 — Redcliffe 3 16 3 2 1 — 1 1 1 2 2 3 1 Brompton 2 5 1 — — — 1 — — 2 3 1 1 Cases of mistaken diagnosis are not excluded from the above Table. Of the 205 Kensington cases, 197 were removed to Hospital. The mildness of the disease is reflected in the low death rate; there were only two fatal cases in Kensington during the year, representing a case mortality of 1.00 per cent. The deaths in the three preceding years were 5, 8 and 6. Eight of the 205 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 10 with a view to ascertaining the source of infection, but no satisfactory clue could be obtained. Thirteen cases notified as suffering from scarlet fever were found, after admission to hospital, not to be suffering from any infectious disease at all, with the result that they were returned home. 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 likely to be infected is carried out on the day following the admission of the patient to hospital, nr 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.—Two hundred and twenty-three cases were notified during the year, 216 of which were removed to hospital. The cases notified in the three previous years were 322, 346 and 403. The number of notifications received during the year was smaller than in any other year since the termination of the War. The following table shows the number of cases notified in each four-weekly period during 1923:- 16 District. Period No. 1. Period No. 2. Period No. 3 Period No. 4. Period No. 5. Period No. 6. Pe> iod NO. 7. Period No. 8 Period No 9 Period No. 10. Period No 11 Period Period No 12. No. 13. London 1136 1112 956 851 790 710 685 597 539 705 801 722 783 The Borough 19 29 23 25 23 17 20 15 8 11 22 27 9 North Kensington 14 20 14 16 16 15 13 12 8 9 18 22 7 South Kensington Wards. 5 9 9 9 7 2 7 3 2 4 5 2 St. Charles 1 9 3 3 4 3 2 3 4 4 3 3 4 Golborne 6 4 7 8 5 10 5 8 1 2 8 13 — Norland 3 4 1 2 3 1 5 1 3 2 6 4 3 Pembridge 4 3 3 3 4 1 1 — 1 1 2 - Holland 2 3 4 5 — 1 1 1 — — 1 1 - Earl's Court — 2 1 1 2 - 1 1 — — — 2 - Queen's Gate 1 1 — — 1 1 1 — — 1 1 — 2 Redcliffe 2 2 1 3 1 — 4 — — 1 1 2 — Brompton 1 3 - 3 - 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 in the paragraphs dealing with scarlet fever. The number of Kensington deaths was 14, representing a case of mortality of 6.9 per cent. In the three preceding years the deaths were 24, 25 and 34. Two 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 one of the "primary" or returning cases had nasal discharge on leaving the hospital, and it is possible that in this case the nasal discharge was responsible for the spread of infection. There is no evidence to show how infection was conveyed in the other case. 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 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. During the year 559 throat swabs were examined at the Lister Institute at the expense of the Council, and of these 79 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 for administration to patients who are too poor to pay, and on signing the necessary declaration that the patient cannot afford specific treatment, a medical man can obtain a free supply from Mr. Worsley, Chemist, at No. 135, Ladbroke Grove, W. 10, or from the Public Health Department at the Town Hall. The anti-toxin is obtainable at all hours of the day and night from Mr. Worsley's premises, and during office hours from the Town Hall. When the Town Hall is closed, applications for anti-toxin can be made to Mr. Sutton, an Officer of the Department, who lives at No. 1, Hornton Place, Hornton Street, (only a few yards from the Town Hall). The Council loan syringes with portable sterilizers to doctors for the purpose of administering the anti-toxin. Medical men administering the Council's anti-toxin to poor persons are, on application to the Medical Officer of Health, paid a fee of 5s. per patient treated. In 1923, the Borough Council supplied 178,500 units of anti-toxin for 52 patients at a cost of £13 8s. 10d. No fees were claimed by medical practitioners in respect of the administration of anti-toxin during the year. 17 Enteric Fever.—Twelve cases of this disease were notified, 9 being removed to hospital. The cases notified in the three preceding years were 24, 22 and 18. There were two deaths from this cause, against 1, 3 and 2 in the preceding years. Six of the 12 cases were notified from North Kensington and 6 from South Kensington. In one case the disease was contracted on the Continent, and in three others the patients had paid visits to country places just prior to the date of attack. Six of the cases were notified as para-typhoid fever. Erysipelas.—Sixty-seven cases were notified during the year, 32 of which were removed to hospital. The cases notified in the three preceding years were 68, 82 and 44. There were four deaths from this cause, the deaths in the three previous years being 3, 1 and 1. Puerperal Fever.—Fifteen cases of this disease were not ified, against 9,8 and 10 in the three preceding years. There were 7 deaths, against 5, 3 and 6 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. On notification of a case of this disease, the Health Officers immediately pay a visit to the home, and endeavour in every case where practicable to secure removal to hospital. This step is taken because it is more satisfactory to carry out any necessary surgical treatment in a hospital, and also because it is not desirable that district midwives and nurses, who may be called upon to attend other confinements, should nurse a case of puerperal fever which is an infectious disease. Of the 15 cases notified, 5 were removed to St. Mary Abbot's Hospital, 5 to the Western Metropolitan Asylums Board Hospital, 2 were treated in nursing homes, and 3 remained for treatment in their own homes. There were 5 deaths at St. Mary Abbot's Hospital, none at the Western Hospital, one in a nursing home, and 1 in her own home. Encephalitis Lethargica.—Three cases of this disease were notified, particulars of which are subjoined:— 1. Female. Aged 40 years. Notified January 25th. Recovered. 2. Female. Aged 10½ years. Notified March 21st. Recovered. 3. Male. Aged 42 years. Notified March 26th. Died July 15th. Ophthalmia Neonatorum. —This disease, which is an inflammation of the eyes of newly-born infants, is in most cases due to the entrance of gonorrhœal infection into the eyes during the process of birth. It, however, sometimes results from the entrance of other forms of disease germs at the time of birth, and infection may also occur at any time afterwards if disease bacteria are brought into contact with the child's eyes by the unclean fingers of the mother or nurse. In neglected cases ulcers may form on the outer membrane of the eye, and partial or complete loss of vision may result. In view of the serious consequences of neglect in treatment, ophthalmia neonatorum was made compulsorily notifiable in 1914. Twenty-one cases were notified during the year, the numbers in the preceding years being 53, 33 and 20. The Women Health Officers take great pains to obtain the best possible treatment. Every case is visited on the day that notification is received in the Public Health Department and visits are paid daily, if necessary, until the child is cured. Attempts are made to secure the child's and mother's admission to hospital and, if these are unsuccessful, arrangements are made for a nurse from the Kensington District Nursing Association, who has been trained in ophthalmia treatment, to visit the home as frequently as is necessary to carry out the nursing instructions of the medical attendant. Care is taken that a medical man is in attendance on every case. Three of the 21 notified infants were born and treated in the St. Mary Abbot's Hospital, 12 were admitted to the Metropolitan Asylums Board Ophthalmia Hospital, 4 were treated in the out-patient departments of hospitals and the remaining 2 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 1923, the ophthalmia neonatorum and inflammation of the eye cases attended by the nurses numbered 61 and the number of home visits paid in connection with these cases was 1,131. These visits average 19 to each of the 61 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 1,131. Of the 21 cases notified, the right eye alone was affected in 2 cases, the left eye alone in 2 cases, and both eyes in 17 cases. In one case the child died of another complaint whilst being treated for ophthalmia, and in every other case the disease has been cured without any damage to sight. There was a similarly splendid record in 1922. In 1921, 31 of the 33 cases notified were cured without damage to sight. In one of the remaining cases, where the child was born and treated outside the Borough and was not under the supervision of the Council's Health Officers, there was complete blindness in one eye; and in the 18 other case the child was born in the Borough, but was admitted to hospital shortly afterwards where it stayed for six weeks, and subsequently was found to have permanent impairment of vision in both eyes. In 1920, there was a case of opnthalmia which finally went on to complete blindness, in regard to which no notification was sent to me ; thus the Council's Officers were unable to secure that treatment which has been so successful in the past three years. In this case the Council took proceedings against the medical practitioner who had failed to notify the disease and a fine of £5 with £1 1s. costs was imposed. It will be seen that there has been considerable success in the treatment of this disease in Kensington, and it is a great pleasure to be able to report that every case which has come to the knowledge of the Officers of the Public Health Department during the past two years has been cured without any impairment of vision, with the exception of the child who died of another complaint before the treatment was completed. These verv gratifying results are largely due to the efforts made by the Council's Health Officers to secure hospital treatment for these cases, and to the excellent arrangement which the Borough Council have entered into wich the Kensington District Nursing Association for the home treatment of this disease. 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 £200 paid last year to the Kensington District Nursing Association by the Council must be regarded as an economy of the wisest kind. 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 twenty-five notifications were received, 90 patients being certified as suffering from acute primary pneumonia and 35 from influenzal pneumonia. It is clear that many cases escaped notification. The number of deaths from pneumonia during the year was 217. There were 46 deaths certified to be due to influenza, the deaths from this disease in the three preceding years being 46, 45 and 86. 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.—Five cases of this disease were notified, and investigation revealed that four patients had been soldiers who had contracted the disease whilst abroad during the Great War. The remaining case originated in South Africa. Polio myelitis and Polio-encephalitis. —Five cases of these diseases were notified during the year, particulars of which are subjoined. 1. Female. Aged 6 years. Notified April 20th. Recovered. 2. Female. Aged 5 years. Notified August 11th. Removed to St. Mary's Hospital, July 27th. Recovered. 3. Female. Aged 19 years. Notified August 31st. Removed tc St. George's Hospital, August 30th. Died August 31st. 4. Female. Aged 3 years. Notified November 22nd. When last heard of was still in the Victoria Hospital for Children, Chelsea. 5. Male. Aged 2½ years. Notified November 30th. Still in hospital with infantile paralysis. Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no notifiable infectious diseases, other than those to which reference has been made, were notified during the year. NON-NOTIFIABLE DISEASES. Measles.—This disease caused 15 deaths during the year. The deaths in the three preceding years were 23, 1 and 58. 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. Four hundred and eighty-seven visits to cases of measles were paid by these officers during the year. Whooping Cough. —There were 23 deaths from this cause, all except two of the children dying being under the age of 5 years. The deaths in the three preceding years were 22, 22 and 27. The Women Health Officers paid 97 visits to cases of this disease during the year. 19 Canoer.—Cancer caused 269 deaths, and of this number 241 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 204 deaths were attributed; sarcoma and epithelioma were the assigned cause of 31 deaths; 34 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 1923. Parts Affected. Sex. Male. Female. Total. Buccal Cavity 8 2 10 Stomach, Liver, etc. - 39 22 61 Peritoneum, Intestines, Rectum . 25 38 63 Female Genital Organs - ... 28 28 Breast - ... 39 39 Skin - ... ....- ... Other and unspecified Organs - 35 33 68 Totals - 107 162 269 The deaths in the several wards, etc., are set out in the following table:— The Borough 269 North Kensington 111 South Kensington 154 Wards. St. Charles 29 Golborne 29 Norland 25 Pembridge 28 Holland 34 Earl's Court 34 Queen's Gate 26 Redcliffe 40 Brompton 20 Ward Unknown 4 The deaths from cancer are gradually growing in number, not only in Kensington, but throughout the whole country, and this disease, with the exception of affections of the heart, is now the commonest cause of death. During the year, a Departmental Committee on Cancer was appointed by the Minister of Health for the purpose of bringing together and analysing all the evidence available in regard to this disease, and if the labours of this Committee do not lead to any actual discovery, the public will, at least, know the present position of scientific knowledge in regard to cancer. In connection with the work of this Departmental Committee, every case of cancer of the breast proving fatal in Kensington in 1923 has been investigated by officers of the Public Health Department, and the particulars obtained have been forwarded to the Ministry of Health. TUBERCULOSIS. During the year 280 cases of pulmonary tuberculosis and 123 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. 1923. The Borough 849 682 564 429 543 432 582 407 374 339 403 North Kensington 642 516 423 300 406 331 445 294 272 233 267 South Kensington 186 138 133 127 137 101 137 113 102 106 136 Wards. St. Charles 146 117 93 75 113 79 104 70 66 48 61 Golborne 228 176 147 106 124 101 150 88 89 80 86 Norland 190 162 134 79 102 99 124 93 30 76 85 Pembridge 78 61 49 40 67 52 67 43 37 29 35 Holland 37 35 43 31 41 35 36 36 29 28 26 Earl's Court 51 40 29 40 35 20 31 25 24 24 28 Queen's Gate 34 17 10 14 20 23 16 15 15 20 22 Redcliffe 39 31 35 27 23 16 33 25 19 23 41 Brompton 25 15 16 15 18 7 21 12 15 11 19 Ward Unknown 21 28 8 2 - - - - - - - 20 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 formsi. 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 1923 280 117 66 123 35 19 152 85 Reference to the first of the two preceding tables will show that there was an increase in the number of notifications received in 1923, namely 403, as compared with 339 for 1922 and 374 for 1921. This does not necessarily mean an increased incidence of disease, but probably represents a more intensive search carried out by the Dispensary staff and the medical profession at large, perhaps associated with the special steps taken during the year to secure a more complete notification of the complaint. In support of this view, it should be noted that the death rate continues to show a steady fall, as shown in the last column of the second of the two preceding tables. This fall from 161 deaths per 100,000 in 1918 to 85 per 100,000 in 1923 is very satisfactory If it be true, as above suggested, that a more complete notification is now taking place, this in itself, by the increased opportunity of reaching the cases, should help in diminishing the mortality rate still further, as the first essential in trying to cope with the disease is a full and accurate knowledge of its incidence. Deaths from Tuberculosis in 1923 Allocated to District of Usual Residence of Patients. Pulmonary Tuberculosis. Other Forms of Tuberculosis The Borough 117 35 North Kensington 81 24 South Kensington 35 11 Wards. St. Charles 22 6 Golborne 22 8 Norland 28 3 Pembridge 9 7 Holland 10 1 Earl's Court 7 - Queen's Gate 5 5 Redcliffe 13 3 Brompton — 2 Ward Unknown 1 - 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 42 9 Patient's Home 49 10 Brompton Hospital 1 1 St. Luke's Home 1 — Outlying Hospitals 20 12 Other places outside the Borough 4 3 DISPENSARY TREATMENT OF TUBERCULOSIS. North Kensington Dispensary. The work of the Tuberculosis Dispensary at Ladbroke Grove has been carried on during the year 1923 on the same lines as planned by the Council when the Dispensary was taken over by 21 them at the beginning of 1922, experience not having shown need for material alteration in the original scheme. During the year, however, the scope of the work has been considerably increased by the decision of the Council to centre the Dispensary treatment for the whole of the Borough at Ladbroke Grove, instead of for the North area only, as from the 1st April, 1923, with the view to a closer union of the curative and preventive work. Though some of the patients from the South Kensington area have remarked on the increased distance and time involved in consequence of this change, the majority seem to be able to attend without undue inconvenience or any complaint being made. The marked increase in the number of patients and attendance figures may largely be accounted for in this way, but a contributing factor must be the increasing use of the Dispensary made by the doctors in the neighbourhood. Another development has been the adoption by the Board of Guardians, with the concurrence of the Council and the support of the London County Council, of the proposal that the Tuberculosis Officer should be appointed Visiting Medical Officer for Tuberculosis to St. Mary Abbot's Hospital. In consequence of this, the Tuberculosis Officer has visited the Tuberculosis Wards at St. Mary Abbot's Hospital one morning weekly since the beginning of October. The Medical Superintendent and the Medical Officers of that Institution have cordially welcomed this arrangement and have assisted the Tuberculosis Officer in carrying out his new duties. These changes have materially added to the work of the Tuberculosis Officer and his responsibilities, and the marked success which has attended Dr. Picard's efforts could not have been achieved without the loyal support which has been freely given by the internal Dispensary staff and the Women Health Officers. The number of new cases seen at the Dispensary during the year, with the original diagnosis, is shown in the following table:— New Cases. Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 189 239 166 192 736 (" Contacts" included in above) (47) (91) (84) (106) (328) New cases with Respiratory Tuberculosis 60 46 5 2 113=(14.3 per cent.) New cases with Non-Respiratory Tuberculosis 7 3 19 16 45=(5.7 „ ) New cases regarded as "Suspects" 34 47 25 27 133=(16.9 „ ) New cases not suffering from Tuberculosis 88 143 117 147 495=(62.9 „ ) If this table is compared with the one for 1922, the percentage of definite cases shows a decrease, which is mainly due to the examination of a larger relative and absolute number of "contacts" in whom the incidence of the disease is naturally smaller. The total number of new cases, 786, is considerably greater than in 1922, when 607 were seen (in both cases "contacts" are included). The increase can be accounted for by the greater area covered by the Dispensary and other reasons already mentioned, and, therefore, does not necessarily mean increased prevalence of disease. "Suspect" cases, whether "contacts" or otherwise, have long been a source of trouble in the Dispensary by remaining on the books with the diagnosis undetermined from one cause or another, and efforts have been made during the year to obviate this. A large measure of success has been achieved as, with 46 cases left over from last year and a further addition of 133 of these cases during the twelve months of 1928, there were not more than 26 doubtful cases outstanding at the end of this year and some of these are, of course, quite recent cases which had only just come under observation. The following table shows the disposal of the 179 "suspects ":— Diagnosed as suffering from respiratory tuberculosis 7 Diagnosed as suffering from non-respiratory tuberculosis 2 Discharged as non-tuberculous 114 Discharged as having ceased attendance 6 Placed under domiciliary observation 24 Remaining on Dispensary books at the end of the year 26 179 22 Cases were sent to the Dispensary through the following agencies:—The Public Health Department of the Council, the Ministry of Pensions, the London County Council, Hospitals, School Medical Officers, School Care Committees, the Invalid Children's Aid Association, the Charity Organisation Society, Infant Welfare Centres, the Jewish Board of Guardians, the Kensington Dispensary and Children's Hospital and private practitioners. The number sent up by medical men still rises, and the co-operation and support of local doctors is a great source of strength to the Dispensary. The treatment recommended for definite cases, which numbered 167 (120 Pulmonary and 47 other forms), was as follows:—Sanatoria, 49 ; Hospitals, 17 ; Dispensary, 54; Domiciliary, 17 ; Kensal House School, 2. In 28, no treatment, beyond advice on rest, work, recreation, diet, etc., together with observation of the progress of the case, was found necessary. The total number of attendances at the Dispensary during the year was 5,159 and the number of systematic physical examinations was 1,848, both showing a large increase on the figures for 1922. The Tuberculosis Officer made 99 " home " visits and the Women Health Officers 2,821. Reports on patients form an ever increasing part of the work. During 1923, 1,828 reports were sent to public authorities, this figure being more than 800 above the number called for in 1922 ; 256 reports were sent to private practitioners, the corresponding figure in 1922 being 209. The sputum examinations also show an increase. There were 578 examinations of sputum from 463 individual patients in attendance during the year. The number of patients showing tubercle bacilli present in the sputum was 117, or 25.3 per cent., the remaining 346, or 74.7 per cent., giving negative results. Apart from the routine examinations of new and old cases with consequent recommendations for treatment, either at the Dispensary or elsewhere, special efforts have been made to secure the examination of "contacts" of notified cases and the number examined, namely 328, compares very favourably with the figure, 183, for 1922. A further number of 104 "contacts" were ascertained to have been examined by their own doctors or by the School Medical Officer, making a total of 432 who could be satisfactorily accounted for. There were recorded a further 197 who either refused examination altogether, or ignored repeated requests for attendance. Considerable tact and repeated home visits are called for in persuading "contacts" to submit themselves for examination and the figures for 1923 represent an enormous amount of painstaking work on the part of the Tuberculosis Officer and the Women Health Officers. It has been felt that the mere fact of one negative examination of a "contact " may give rise to a false sense of security Though this one examination does from time to time show the source of infection of the original case and may also discover an early case of tuberculosis among the " contacts," yet it does not follow that all the "contacts" examined as soon as possible after a definite case in the family is discovered and who show no disease are really uninfected—the exposure to infection may have been too recent to give any indications. Efforts are being made, therefore, to secure a second examination of "contacts" of definitely infectious cases after approximately one year's interval, and it is hoped that this procedure may increase the chance of detecting and curing cases in the early stage of disease. South Kensington Dispensary. In past years there has been in operation an agreement between the Borough Council and the Brompton Hospital Authorities, under which one of the visiting physicians to the Hospital has acted as Tuberculosis Officer for South Kensington, and all patients residing in that portion of the Borough south of Kensington High Street, who were referred to the Tuberculosis Officer under the Tuberculosis Scheme, have been dealt with by him. It has been found 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 Council's experience of the combination of the work of treatment and prevention at the North Kensington Dispensary lead them to concentrate their work at the one Dispensary, and the agreement with the Brompton Hospital Authorities terminated on 31st March, 1923. It should be mentioned that 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. Kensington patients who visited that Institution received the best possible attention, and indeed they can still attend the Hospital if they so desire, in spite of the fact that it has ceased to act as a Dispensary of the Council. The record of work carried out at Brompton Hospital on behalf of the Council during the months of January, February and March of 1923 is as follows:— (1) New cases 19 (1) New-cases with pulmonary tuberculosis 4 (3) Newcases with non-pulmonary tuberculosis — (4) Total attendances at the Dispensary 311 (5) Visits to patient's homes by Tuberculosis Officer — (6) Visits to patients' homes by Dispensary Nurses 122 (7) Number of specimens of sputum examined 18 23 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 year 1923. The Board of Guadians, 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 Council's scheme for the dental treatment of tuberculous persons at the Dispensary has continued to work satisfactorily and the returns for the year show an in increase on those for 1923. Considerable difficulty, however, has been experienced in inducing consumptive patients to avail themselves of the facilities offered. In many cases, patients who are at work have complained that they cannot attend on Wednesday mornings, the time when the dental clinic is held at the Dispensary. To meet this objection, an arrangement has been in operation during the year whereby those who are at work can be seen between six and seven o'clock in the evening at the private surgery of the Councils Dentist at No. 281, Harrow Road. This arrangement has enabled dental treatment to be given to some patients who would otherwise have been precluded from this benefit. Even with this extended opportunity for treatment, the Tuberculosis Officer and the Women Health Officers have had to go to considerable trouble in persuading many of the patients to place themselves under the care of the Dentist. The provision of dentures and the filling of carious teeth in certain cases of tuberculosis assists very considerably in securing a permanent cure and it is, therefore, unfortunate that many patients are reluctant to avail themselves of the enhanced prospects of recovery offered by the Council. The work done during the year is shown in the following table:— No. of Dentist's attendances at Dispensary 49 No. of attendances of patients (including attendances at No. 281, Harrow Road) 224 No. of extractions 353 No. of fillings 10 No. of dentures arranged for 23 Extractions and fillings are performed for all patients free of charge, while the cost of the provision of dentures, together with the financial position of the persons receiving them, is reported to the Tuberculosis Care Committee who assess and collect payments on behalf of the Council. Of the 23 patients for whom the provision of dentures was arranged, 7 discontinued their attendances with the result that dentures could not be completed. Of the 16 remaining cases for which dentures were provided, 6 persons were so poor that no charge was made, and in the other 10 cases the assessments totalled £8 18s. The money collected by the Care Committee on behalf of the Council during the year, in respect of dentures provided since the commencement of the dental scheme in 1921, totalled £10 8s. No alteration has been made in the fees payable by the Council to the Dentist, which are 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 fee is paid for extractions previous to the fitting of dentures. The payments to the Dentist during the year amounted to £74 11s. SUPPLY OF EXTRA NOURISHMENT TO TUBERCULOUS PERSONS. Applications for the supply of extra nourishment to tuberculous persons are dealt with by the Tuberculosis Care Committee and, in order to secure uniformity, the following procedure is adopted in all cases. 1 —Applications are made upon a printed form, on which must be stated the financial circumstances of the family and other relevant particulars. The information is verified by the Women Health Officers who submit their reports to the Committee. 2.—Applications must be accompanied by a recommendation from the Tuberculosis Officer, or the medical practitioner in attendance. 3.—In appropriate cases, recommendations are made to the Public Health Committee that grants, usually consisting of supplies of milk and eggs, be made for periods not exceeding 28 days. 4.—If a renewal of the grant be desired, a further medical certificate must be submitted and any alteration in the circumstances of the case is reported by the Health Officer to the Care Committee. 24 As far as possible the Tuberculosis Care Committee confine the grants to patients requiring temporary assistance, chronic cases of poverty being more suitable for relief by the Guardians. Particulars of nourishment granted in 1923:— Number of patients assisted 8 Number of renewals of grants issued 7 No. of pints of milk granted. No of packets of malted milk granted. No. of eggs granted. 476 8 56 Total estimated cost to the Council of nourishment granted during the year £7 This expenditure is approved by the Ministry of Health and ranks for the Government grant of 50 per cent. ARTIFICIAL PNEUMOTHORAX TREATMENT. Artificial pneumothorax treatment, which can only be adopted at a well-equipped hospital, is occasionally recommended in order to stay the progress of somewhat advanced disease. This treatment is carried out for Kensington residents at the Brompton Hospital at a cost of 10s. 6d. for each administration. Treatment is given fortnightly in the early stages, and thereafter less frequently as the case progresses, the whole period of treatment generally occupying about two two years. The ordinary poor patient cannot, of course, afford this treatment and, in order that he shall not be precluded from its benefits, the Council have undertaken to bear the cost in suitable cases. When the Lady Almoner of the Hospital considers that a patient is unable to pay, she asks the Council to accept financial responsibility. These applications are placed before the Tuberculosis Care. Committee who investigate the home conditions and financial circumstances and make appropriate recommendations to the Public Health Committee. During the year the Council have agreed to pay for treatment in three cases. In two of these, refunds will be obtained from the Ministry of Pensions, the patents being ex-service men in receipt of pensions in respect of their disability due to tuberculosis. The estimated net cost to the Council for the year under review is £9 2s. THE BOROUGH TUBERCULOSIS CARE COMMITTEE. The Care Committee have met fortnightly during the year, and the attendance of members has been well maintained. The established principles of social service in aiding the patients after close consideration of the home conditions and financial position, as affected not only by the onset of the disease but during the course of treatment, whether at home or away from home, and upon return from institutional treatment, have been carefully followed, and in many cases real assistance has been given either to the patient or the family or both. This is all the more noteworthy in view of the fact that no fund is available for this purpose. Much time is devoted to a careful assessment of contributions in respect of hospital or sanatorium treatment and dental treatment. Applications for grants of nourishment, usually milk and eggs, have come before the Committee, and the recommendations made to the Public Health Committee have received sympathetic consideration. The Officers of the Committee have remained unaltered, viz.:- Chairman, Councillor Miss A. Carthew ; Vice-Chairman, Councillor Miss M. H. Joseph; Secretary, Miss F. C. Hargrave. The following changes have been made in the membership of the Committee:— (1) Councillor Dr. H. Robinson, J.P., Chairman of the Public Health Committee, took the place of Councillor Miss C. Keeling, J.P., late Chairman of the Public Health Committee, as a representative of the Council, on 1st November. Councillor Miss C. Keeling remained a member of the Committee, having been appointed to represent the Emergency Help Committee of the British Red Cross Society (Kensington Branch). (2) Miss G. M. Burton has taken the place of Dr. E. F. Hatton as a representative of the Invalid Children's Aid Association. (3) Miss L. C. Marx now represents Brompton Hospital in the place of Miss A. Moses. As the result of resolutions adopted by the Council, the Committee have been further strengthened by the welcome addition of representatives of the British Red Cross Society, the local Panel Committee and the United Services Fund. The constitution and membership of the Committee at the end of the year was as follows:— (1) Borough Council—Dr. H. Robinson, J.P., Chairman of the Public Health Committee, Councillor Miss M. H. Joseph, Councillor Miss M. Drysdale and Miss R. F. Alexander. 25 (2) London County Council—Dr. A. W. Sikes, Divisional Medical Officer, and Miss G. M. S. Paddon, District Organiser of the School Care Committees. (3) Kensington School Care Committees—Miss A. Webster. (4) Kensington Invalid Children's Aid Association—Miss G. M. Burton and Miss R. Mar wood..* (5) Kensington Charity Organisation Society—-Mrs. E. Weber and Miss O. A. Nixon. (6) Brompton Hospital—Miss L. C. Marx, Lady Almoner. (7) Kensington Board of Guardians—Councillor Miss A. G. E. Carthew. (8) Kensington District Nursing Association—Miss E. D. Gibbes. (9) Kensal House School—Miss C. D. Clay. (10) London Insurance Committee—Dr. H. H. Mills. (11) Local Panel Committee—Dr. A. K. Barrett and Dr. A. S. Herbert, (12) Kensington War Pensions Committee—One representative. (13) British Red Cross Society—Mrs. R. H. Burne and Miss F. M. Forbes. (14) British Red Cross Society (Emergency Help Committee)—Councillor Miss C. Keeling, J.P., and Miss O. A. Nixon. (15) United Services Fund—Miss M. Pickton. (16) Ex-officio members—The Medical Officer of Health, Tuberculosis Officer and two Women Health Officers. * Miss Marwood, who was a very valuable member of the Committee, died on April 7th, 1924. PREVENTIVE WORK IN RELATION TO TUBERCULOSIS. The treatment of tuberculosis is preventive in so far as it cures the patient and renders him non-infectious to others, but, in addition to this method of prevention, the Council, with a view to limiting the spread of disease, undertake various other measures, the most important of which may be briefly referred to here. Home Visiting. The number of home visits paid by the Council's Women Health Officers is shown in the following table: — Women Health Officers. total. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Tuberculosis. Pulmonary. First Visits 27 28 31 23 37 40 62 248 Re-Visits 233 216 358 344 65 377 348 1,941 Non-Pulmonary. First Visits 7 13 22 10 5 1 4 62 Re-Visits 54 157 170 142 11 11 25 570 * The total falls short of the total number of cases owing to patients liying in boarding houses, private hotels or large private residences not being included. As the housing conditions form such an important element in connection with tuberculosis, these home visits are of primary importance. The sleeping arrangements are frequently unsatisfactory and the Women Health Officers always enquire into thern. Wherever possible, desirable alterations are pointed out and urged upon the family. The following table giving the number of rooms occupied by the families of definite cases of tuberculosis and the number of occupants, ascertained by the Health Officers on their visits to the homes, is inserted to show the difficulties experienced in securing home isolation in many cases. Rooms No. of Occupants Cases. 1 2 3 4 5 6 7 9 9 10 11 12 1 6 9 5 4 4 1 - - - - - - =29 2 1 11 10 8 9 3 3 2 2 — — - =49 3 — 3 6 4 9 7 5 3 1 — — 1 =39 4 — 2 2 6 5 4 4 1 4 — — — =28 5 — — — 3 2 1 — — — — — — = 6 6 — 1 — - — — — — — — — - = 1 *152 26 Out of the total (167) new definite cases, 35 occupied the basement of the house. Provision of Bedding for Home Isolation. It is sometimes found that isolation of the patient in the home is not as satisfactory as it could be, owing to the inability of the family to provide sufficient bedclothes to allow him to have a separate bed. In such cases the Council loan beds, bedclothes, etc. if, after enquiry, the circumstances are suitable. At the present time there are 8 patients to whom bedsteads and bedding have been loaned. In 4 of these the assistance was given during the past 12 months and the articles loaned in 1923 are as follows :— Bedsteads 3 Mattresses 4 Bolsters 2 Pillows 4 Pillow-slips 6 Sheets 11 Blankets 8 Disinfection after Death or Removal to Hospital. Cases where bedding, etc., was disinfected by steam 138 Number of rooms disinfected 186 Bacteriological Examinations. Specimens of Sputum submitted by Medical Practitioners for bacteriological examination at the Lister Institute at the expense of the Council 140 Sputum Flasks. These are supplied to patients who are infectious, and advice is given in regard to the disposal of sputum. MATERNITY AND CHILD WELFARE. 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 continued to fall; the incidence of ophthalmia neonatorum has maintained its low level; there was comparatively little epidemic enteritis; and ihe 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. The Borough Council's scheme of Maternity and Child Welfare work includes the following amongst other activities :— (a) The Home Visiting of expectant and nursing mothers and children by the Council's staff of Women Health Officers. (b) Co-ordination of work of the Voluntary Maternity and Child Welfare Institutions in the Borough. (n) The subsidisation of the Voluntary Infant Welfare Institutions. (d) The provision of " Home Helps." (e) The provision of Hospital accommodation for infants. (f) The provision of Convalescent Home accommodation for mothers and infants. (g) The provision of home nursing for sick mothers and infants. (h) The supply of milk and meals free or at a reduced price to necessitous mothers and children under five years of age. (i) The distribution of pamphlets and booklets giving advice on various matters concerning the welfare of mothers and infants. WOMEN HEALTH OFFICERS. The Maternity and Child Welfare duties allotted to the Women Health Officers are as 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. 27 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 and meals free or below cost price. These officers also attend at the Infant Welfare Centres in their respective areas on doctors' consultation days in order to assist in the work and to co-ordinate their efforts with those of the salaried and voluntary workers attached to these institutions. The work performed by the Women Health Officers in 1923 in regard to Maternity and Child Welfare is summarised in the following table;— Description of Work. No. l No. 2 No. 3 Health Officers. Total No. 4 No. 5 No 6 No. 7 Visits to Infants under the age of 21 days. (First Visits) 12 360 383 314 289 364 403 2,125 Re-visits to Infants under the age of 12 months 176 816 624 951 1,227 605 773 5,172 Visits to Children between 1 and 5 years 341 852 938 937 1,037 916 531 5,552 Still-birth Enquiries 5 8 10 7 9 9 8 56 Visits to Ophthalmia Cases 3 1 7 5 4 2 7 29 Return Visits to Ophthalmia Cases 28 9 43 22 41 5 33 181 Visits to Measles Cases 236 56 13 43 64 19 56 487 Visits to Whooping Cough Cases 14 24 9 19 9 4 18 97 Visits to Puerperal Fever Cases 1 3 3 1 4 3 2 17 Infantile Death Enquiries 13 43 38 22 16 27 39 198 Investigations re Milk Applications 34 207 129 98 26 110 254 858 Ante-natal Visits 31 109 35 18 — 79 123 395 Half-days at Welfare Centres - 15 95 138 136 97 82 142 705 Special Visits 1,331 223 216 144 178 183 215 2,490 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 Centres are controlled by Voluntary Committees and two representatives from each of the Voluntary Committees serve on the Advisory Committee to the Council's Maternity and Child Welfare Committee (The work of the Advisory Committee is set out on Page 36). These institutions are mainly supported by (1) voluntary contributions, (2) grants from the Ministry of Health, and (3) grants from the Borough Council. The medical and nursing staffs are engaged by the Voluntary Committees. A Woman Health Officer is attached to each Welfare Centre and, except at Campden Hill, has an office on the premises where she keeps her records and in which she arranges home visiting work in consultation with the staff and the Voluntary Committee. The principal duties of a Welfare Centre a<e those of an educational institution—providing advice and teaching for the mothers in the care and management of little children with a view to maintaining them in good health. The work done by the Infant Welfare Centres during the year 1923 is shown in the following table :— 28 Particulars of Work done. Archer Street Bramley Road ] with Kenley Street branch Campden Hill Earl's Court. Golborne Lan- caster Road Raymede Totals 1—No. of births occurring in the area of the Centre suitable for Welfare attention 170 760 143 355 378 358 339 2503 2—No. of sessions at which doctor attended for infant consultations 91 199 93 102 99 97 150 831 3—No. of sessions at which doctor attended for special ante-natal consultations 21 2* 12 11 - 22 47 115 4—Total number of individual mothers who attended during the year 450 738 125 106 176 644 446 2685 5—Number of individual mothers who attended ante-natal sessions during the year 42 48 26 50 34 37 98 335 6—Total number of individual children who attended during the year (Old) 230 447 151 193 234 258 326 1839 ,, ,, ,, (New) 238 478 99 166 286 311 288 1866 7—Number seen by doctor at consultations— 1. Ante-natal mothers 45 104 85 108 33 213 240 828 2. Post-natal mothers 269 521 8 341 122 152 832 2245 3. Children 2695 5090 2201 3365 2347 3105 4897 23700 8—Average number seen by doctor at consultations— 1. Ante-natal mothers 2.1 — 7.1 9.8 — 9.7 5 2. Post-natal mothers 2.9 2.6 0.1 3.3 1.2 1.5 5.5 3. Children 29.6 25.6 23.7 32.9 23.7 32.0 32.6 9—Number of individual children weighed during the year 468 923 99 193 520 566 614 3383 10—Total weighings 3204 7052 2201 4022 3974 4057 8727 33237 11—Number of first visits paid by salaried workers to— 1. Expectant mothers 41 180 10 47 73 136 .198 685 2. Children ... 36 63 194 7 — ;J00 12—Total number of home visits paid by salaried workers to— 1. Expectant mothers 90 257 96 83 95 242 429 1292 2. Children 1568 1658 1054 1490 1528 1556 2608 11,462 13—Number of home visits paid to children by voluntary workers — 1. First visits — — — — — — — 2. Total visits - 283 - 6 5 1707 — 2,001 The home visiting figures do not include visits paid by the Council's Women Health Officers. •Ante-natal Clinic commenced in December, 1923. General Observations on the Work of the Infant Welfare Centres. Injant Consultation Sessions are held by medical officers in all Centres in the afternoons from 2 to 4 p.m. At Lancaster Road Centre there is one session held on Thursday mornings from 10 a.m. to ]2 noon. At four Centres there are two sessions per week; at two Centres three sessions per week; and at Bramley Road there are three in addition to the weekly session at the Branch in Kenley Street. The Centres are in every case fortunate in having very able and keen medical officers who show considerable ability and interest in their work. Special Ante-natal Sessions are held at all except the Golborne Centre where expectant mothers are seen privately on infant consultation days. The work of ante-natal consultations is growing as it becomes better known amongst mothers, and, in view of the excellent arrangements made by the Voluntary Committees, it is to be hoped that mothers will take full advantage ot them, and thus remove as far as possible all danger of disease and accident in their confinements. The guidance and teaching at all Centres is both individual and collective. Individual advice is given at the medical consultations and in the course of home visiting, collective advice being given to mothers by simple class teaching. Home Visiting.—Before the Maternity and Child Welfare work in the Borough was co-ordinated, overlapping in home visiting by the workers of the Municipal and Voluntary bodies was general, but since the inauguration of the present system, this waste of effort and source of annoyance to parents has been completely avoided. 29 The Council's Women Health Officers receive all notifications of birth, and these are transferred to History Cards. They pay all "first visits" to infants in order to ascertain certain information required by the Council in respect of births. If the mother of the child is in regular attendance at an Infant Welfare Centre, the Health Officer transfers the History Card to the Welfare Sister who pays the subsequent home visits. Apart from " first visits," the Council's Health Officer confines her attention to cases not in attendance at Welfare Centres or to difficult cases transferred back to her by the Welfare Sister. Thus a considerable reduction in the number of visits paid to homes has been secured, whilst at the same time the efficiency of the work has been increased. Only one set of records need be kept at each Centre instead of two sets formerly in existence, and consequently there is less time spent on clerical work than hitherto. 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. Therefore it is very satisfactory to observe that there has been a considerable increase during the past year in the amount of work performed by the Dental Clinics. 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 private 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 p rformed at the various centres in 1923. Centre No. of patients. No. of attendances. Extractions. Fillings Dentures Other Treatments. Archer Street 83 237 126 66 15 26 Bramley Road 48 146 186 30 14 12 *Campden Hill 2 3 5 — — 1 Earl's Court 147 437 399 177 43 52 Golborne 26 71 24† 1 3 5 Lancaster Road 48 112 143 36 5 22 Raymede 337 735 346† 16 25 14 -mere is no Dental Clinic on tne premises at tnis centre, ana cases are sent to a private dentist. During the year a change was made in the dentist employed and it has not been possible to obtain a complete record of the work done. †These figures represent the number of times gas was administered and not the number of teeth extracted. Details Concerning Individual Centres. Archer Street Infant Welfare Centre. This Centre serves the southern part of the Pembridge Ward. Infant consultations are held by the Medical Officer on two afternoons in each week and ante-natal and dental clinics are each held twice monthly. In addition to these activities a Sewing Class is held weekly and there are Boot, Clothing, Blanket, Maternity and Denture Clubs connected with the institution. The total attendances of mothers during the year 1923 were 708, and those of children were 3,721. Bramley Road Infant Welfare Centre. This Centre serves the Norland Ward and part of the St. Charles Ward, and has within its area one of the poorest districts in the Borough. It is the oldest of the Kensington Centres, having been established as far back as 1907. In fact it is one of the pioneer centres in the Country. In 1919, the work of this Centre had grown to such an extent that it was found necessary to open a Branch at the premises of the Kensington District Nursing Association in Kenley Street. Three infant consultation sessions are held weekly at Bramley Road and one at the Kenley Street Branch. Ante-natal clinics are held fortnightly. Arrangements are made for dental work to be carried out at the Minor Ailment Centre which is conducted on the Nursing Association's premises in Kenley Street. Knitting and Sewing Classes are held weekly, also a Maternity Club and Dental Savings Bank. The total attendances of mothers during the year were 1,905, and of children 7,230. 30 Campden Hill Infant Welfare Centre. This Centre, to which the Holland Ward is allotted, is housed in splendidly equipped premises which were specially erected for the purpose. Infant consultations are held twice weekly and ante-natal clinics once monthly. Knitting and Sewing Classes are held weekly and baths are provided for mothers. The Committee have an arrangement with a local dentist under which mothers can be sent to his private surgery for dental treatment. The total attendances of mothers during the year were 308, and of children 2,201. Special meetings for fathers are arranged from time to time. Earl's Court Infant Welfare Centre. The Welfare work for poor mothers and children in the Queen's Gate, Earl's Court, Redcliffe and Brompton Wards is performed at this institution. As most of the houses and flats in these Wards are occupied by persons who can afford private medical advice and treatment, one Centre is found sufficient; but owing to the large area to be covered, some mothers have to travel considerable distances to reach the Centre in Warwick Road. The size of the area increases the difficulty of home visiting. Infant consultations are held twice weekly, dental clinics once weekly, and ante-natal clinics once monthly. There is a Maternity Club. The total attendances of mothers during the year were 508, and those of children 4,198. Golborne Infant Welfare Centre. This Centre serves that part of the Golborne Ward north of the Great Western Railway main line. Although the area allotted to the Centre is small, it is one of the most densely populated districts in London. Most of the houses in the district were originally intended for one family only, but are now occupied by three to seven families each, without having been specially adapted for the purpose. The people living in this district are generally very poor and there is a very wide scope of work for the Welfare Centre Infant consultations are held twice weekly and ante natal cases are seen privately at these consultations. Mothers and children receive dental treatment at the Raymede Dental Clinic. Sewing and Cooking Classes are held, and dinners are provided for necessitous mothers free of cost or at reduced prices. A trained nurse is employed by the Committee of the Centre to assist in the home nursing of expectant and nursing mothers and sick infants. There is an average daily attendance of 36 children at the Day Nursery attached to this Centre. The total attendances of mothers during the year were 3,037 and those of children 4,556. Lancaster Road Infant Welfare Centre. This Centre serves parts of the Golborne, St. Charles and Pembridge Wards. Infant consultations are held three times a week and ante-natal clinics once monthly. Dressmaking, Boot repairing and Sewing Classes are held weekly. Dinners are provided free of cost or at reduced prices for necessitous expectant or nursing mothers. Dental treatment is provided at the Minor Ailment Centre in Kenley Street. Various clubs are organised for the benefit of mothers. A special feature of this Centre is the Father's Council, which was instituted in 1922, and was the first of its kind to be formed in the Country. The objects of the Council are (1) to bring home to fathers the responsibilities that rest upon them in giving the child a proper start in life, (2) to advance the interests of the Centre, and (3) to raise funds for the Centre by means of entertainments, etc. They are a most energetic body of men, and are taking a keen interest in the working of the institution. Many odd jobs and some decorating work have been done by them at the Centre in their leisure hours. The total attendances of mothers at the Centre were 4,269, and those of children 5,942. The daily number of. infants received in the Day Nursery attached to this Centre averages 23. Raymede Infant Welfare Centre. This Centre serves parts of the St. Charles and Golborne Wards, and is one of the largest institutions in Kensington. The corner house, in which the Centre is established, is particularly well adapted for the work to be carried out. Infant consultations are held on three afternoons each week and ante-natal sessions every Friday. A dental clinic is attached to the Centre. Sewing Classes are held weekly. Dinners are provided free of cost or at reduced prices for necessitous mothers and children. Various clubs for the benefit of mothers are organised. Special meetings for fathers are arranged from time to time. The total attendances of mothers during the year were 7,417, and those of children 13,011. In May, 1923, a Children's Massage, Medical Gymnastics, and Electrical Treatment Clinic was established on the premises at this Centre. 31 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, 1923:— 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 48 Total number of individual mothers who attended during year 152 Total number of individual children who attended during year (Old) 629 ,, „ „ (New) 668 Total attendances at Centre of mothers for all purposes (excluding the accompanying of children) 528 Total attendances of children at Centre for all purposes 9,496 Number seen by doctor at consultations :— 1. Ante-natal mothers 192 2. Post-natal mothers 336 3. Children 6,946 Average number seen by doctor at consultations :— 1. Ante-natal mothers 4 2. Post-natal mothers 7 3. Children 46 Number of individual children weighed 1,297 Total weighings 6,946 Collective instruction by lectures is not undertaken at Telford Road. Also, there is little home visiting; in fact, no area is allotted to this unit, therefore any visiting carried out would be in the district of one or other of the seven Welfare Centres, There is need of a Treatment Centre in Kensington. If the Telford Road Authorities were to discontinue the use of the existing institution as an Infant Welfare Centre for healthy babies and a scheme were arranged under which infants from Welfare Centres requiring treatment could be referred, when suitable, to Telford Road and returned to their respectiveWelfare Centres on completion of treatment, the Kensington Child Welfare scheme would be a splendid example of what can be done by voluntary effort. Under an arrangement with the County Council, certain minor defects and ailments discovered in children at the school medical examinations are treated at this Clinic and much useful work in this direction is being carried out. LADBROKE ROAD BABY IN-PATIENT HOSPITAL. This institution, which was opened in 1919, has 19 beds for the treatment of sub-acute and chronic diseases. Records for the year 1923 :— Number of infants in residence at commencement of year 17 Number of admissions during the year 145 Number of discharges during the year 132 Number of deaths during the year 14 Number in residence at end of year 16 Average duration of stay in hospital 40 days This institution is becoming increasingly useful and much valuable work has been carried out during the past year. The number of infants admitted in 1921 was 61, in 1922, 98, and in 1923, 145. The average duration of stay in hospital in 1921 was 58 days, in 1922, 46 days, and in 1923, 40 days. On discharge of a patient from this institution, a report giving the particulars of the disease from which the child has been suffering and the lines of treatment which should be followed after discharge is sent to me, with the result that the Council's Women Health Officers are able to take steps to secure in the home that treatment which close observation in hospital shows to be most suited to the particular case. This is of particular importance in the treatment of sub-acute and chronic diseases for which this Hospital is specially established. 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 1922, 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. 32 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, 991 individual expectant women attended the ante-natal sessions at this institution and about 750 of these were Kensington cases. The total number of attendances of all ante-natal cases was 2,449. MIDWIFERY ARRANGEMENTS. The number of home confinements attended by the staff of the North Kensington Queen Charlotte's District Nurses' Home during 1923 was 950, and about 750 of these were Kensington cases. The Earl's Court Infant Welfare midwifery scheme, 'established at the beginning of 1922, worked very successfully up to the Summer of 1923. In September the midwife attached to the Centre resigned, and the Committee, finding it possible to make arrangements with local midwives who had established themselves in South Kensington to attend confinements of working class mothers, decided not to continue the employment of a midwife on their staff. Several midwives are now carrying out the work formerly dealt with by the Earl's Court Centre midwife and are working harmoniously with the staff at the Centre. DAY NURSERIES. The following table shows a record of children s attendances at the five Day Nurseries in the Borough in the year 1923. Golborne. Kensal Creche (Medical Mission) Lancaster Road. Notting Hill Day Nursery St. Clement's, Treadgold St. Totals ]. Whole day attendances of children under 3 years of age . 5337 2060 2958 8794 2618 21,767 2. Whole day attendances of children over 3 years of age 2533 425 1181 3096 1248 8,483 3. Total whole day attendances 7870 2485 4139 11890 3866 30,250 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 - 524 626 391 1,541 6. Half-day attendances of children over 3 years of age 63 267 223 553 7. Total half-day attendances 587 893 — 614 2,094 8. Charges made for each attendance of a child — 5d. 6d. — 8d. — 9. Average daily attendance of children 36 11 234 53'5 18 — HOMES FOR DESERTED, WIDOWED OR UNMARRIED MOTHERS AND THEIR CHILDREN. A record of work done at the institutions in the Borough in 1923 is shown in the following table :— 4C6, Uxbridge Road. 2, Upper Phillimore Place Totals 1. No. of expectant or nursing mothers in residence at commencement of year. 7 5 12 2. No. admitted during the year 12 26 38 3. No. remaining in residence at the end of the year 10 5 15 4. Average duration of stay before confinement (in days) - 40.74 5. Average duration of stay after confinement (in days) 182 76.145 6. No. of infants and children under 5 years of age in residence at beginning of year 7 2 9 7. No. admitted during the year 12 26 88 8. No. remaining in residence at end of year 10 5 15 9. Average duration of stay (in days) 182 76-145 - 33 No. 466, Oxbridge Road is in the Borough of Hammersmith, but the Home is in every other sense a Kensington Institution. It is controlled by a Voluntary Committee of Kensington ladies and gives preference to Kensington girls. MOTHERCRAFT TRAINING SOCIETY (29-31, Trebovir Road). This institution receives paiients from all parts of the country and does not provide for Kensington cases any more than for those from other districts; therefore, although situated in the Royal Borough, it cannot be regarded as a Kensington institution in the same sense as the other units dealt with in this report. Besides giving treatment to children and advice to mothers, particularly in regard to dietetic errors, the institution is a teaching centre for practical training in Child Welfare. The courses of instruction are intended for general hospital nurses, maternity nurses and welfare workers. STATISTICS FOR THE YEAR ENDED 31st DECEMBER. 1923. No. of Infants in the Institution at the beginning of year 20 No. admitted during the year 99 No. discharged during the year 98 No. in residence at the end of the year 21 Average duration of stay of Infants in the Institution— Malnutrition Cases 66 days Breast Feeding Cases (Infants and Mothers) 21 days No. of Infants receiving out-patient treatment— New Cases 791 Attendances 4,536 No. of Mothers in the Institution at the beginning of the year 9 No. admitted during the year 50 No. discharged during the year 49 No. in at the end of the year 10 Average duration of stay of each mother in the Institution 21 days No. of Mothers receiving out-patient treatment in connection with the re-establishment of breast-milk 345 Owing to the lease of the premises in Trebovir Road expiring, this institution is about to remove to new buildings in the Borough of Hornsey. Excellent pioneer work has been carried out by the Mothercaft Training Society but the number of Kensington patients treated each year has been very small indeed, and the removal will not reduce to any appreciable extent the adequacy of the Child Welfare services available to Kensington mothers. Those children in need of the specialised form of treatment given will still be able to attend the institution after removal to Highgate Hill. NATIONAL CHILDREN'S ADOPTION ASSOCIATION HOSTEL (Tower Cressy, Campden Hill). This institution is situated in the Borough, but the work is national rather than localUnwanted infants are received from various parts of the country and are cared for until adopted by some reputable person. RECORD OF WORK DONE IN 1923. Number of children in the institution at the commencement of the year 18 Number admitted during the year 107 Number discharged during the year 106 Number in residence at the end of the year 19 Average duration of stay of each child in the institution 44 days THE CREAGH NURSERY TRAINING SCHOOL (No. 38, Holland Villas Road). This institution was opened in March, 1923, and has accommodation for 28 infants. As in the case of the National Children's Adoption Association Hostel at Tower Cressy, unwanted infants are received from various parts of the country, and cared for until adopted by some reputable person ; in addition, young ladies are trained in mothercraft. RECORD OF WORK DONE IN 1923. Number of children in the institution at the commencement of the year Nil Number admitted during the year 44 Number discharged during the year 18 Number in residence at the end of the year 26 Duration of stay of each child in the institution 6.9 months 34 CONVALESCENT HOMES. In 1923, the Borough Council paid subscriptions of £16 16s. Od. to the Evelyn Convalescent Cottage Home, Wargrave, Berkshire, and £8 8s. Od. to the Hambledon Cottage Home, Surrey. During the summer months, fifteen mothers with their babies and four without babies were sent to one or other of these Convalescent Homes for a fortnight's holiday. HOME HELPS. Two applications for Home Helps under the Council's scheme have been granted during the year. HOME NURSING. Nurses of the Kensington District Nursing Association undertake, when requested by the Medical Officer of Health, the home nursing of Measles, German Measles, Whooping Cough, Ophthalmia, Summer Diarrhoea, Tuberculosis and any other-disease for which nursing assistance is required. In addition, tne Association retain on their staff a trained nurse who is also a qualified midwife and who is available for the nursing of certain maternity and ophthalmia cases in which it is inadvisable, from the point of view of the spread of infection, for a midwife to continue in attendance. The nurses carry out their work with enthusiasm and ability, and those doctors who are called upon to attend the poor in the Borough appreciate very much the splendid assistance they get from these trained women. They are always willing to attend at any time they are called upon, and throughout the whole year the officers of the Public Health Department have not had one case where a request for nursing assistance has not been met promptly, even in times of pressure. For the splendid services rendered, the Council paid to the Association in 1923 a grant of £200. The following is a Table of cases attended and visits paid by nurses of the Kensington Nursing Association from January 1st to December 31st, 1923:— Cases. Visits. Maternity Cases - 85 1,349 Pneumonia 125 2,923 Ophthalmia Neonatorum and other Inflammations of the Eyes of Newly-born Children 61 1,131 Influenza 29 325 Infantile Diarrhoea 8 113 Tuberculosis 39 638 Measles 54 1,309 Septicaemia 2 14 Whooping Cough 6 125 Erysipelas 4 102 Totals 413 8,029 In my last Report mention was made of the employment by the Golborne Infant Welfare Centre of a trained nurse to undertake home nursing of expectant and nursing mothers and infants in the very poor area attached to that Centre. In order to avoid overlapping with the nurses of the Kensington District Nursing Association, the work of the Golborne Home Nurse has been mapped out at a conference attended by the Honorary Secretary of the Golborne Centre, the Superintendent of the Nursing Association and myself, and the rules laid down have been found to work quite satisfactorily. Certain types of cases have been attended by the Golborne Nurse and others by the nurses of the Association, and as a result of close co-operation and consultation between the Hon. Secretary of the Centre, the Superintendent of the Association and myself, there has been no trouble whatever in deciding the sphere of work for the staff of each organisation. The cases attended and visits paid by the Golborne Home Nurse during the past year are given in the following table:— Cases Attended. Visits Paid. Adults — 119 Children under 5 years of age 229 2019 Bronchitis 37 297 Ear Discharges 26 200 Minor Ailments 166 1522 35 It is a rule of the Nursing Association and of the Golborne Centre Committee that their staff shall carry out home nursing only in those cases where there is a medical man in attendance. It requires little thought to realise the importance of this rule and the serious consequences which might result if nurses did consent to deal with cases without medical supervision. In observing this important principle, difficulty has arisen in certain cases where the patient's family, being too poor to obtain private medical assistance, have sent for the nurse. This difficulty has now been removed by an arrangement under which the Relieving Officer, on receipt of a telephone message from one of the Council's Health Officers, or a nurse of the Association, or the Golborne Centre, will immediately secure the services of one of the Guardians' District Medical Officers. By this arrangement no case in the Borough need go without prompt and skilled medical attention. 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 49. GRANTS TO MATERNITY AND CHILD WELFARE INSTITUTIONS PAID BY THE BOROUGH COUNCIL FOR THE YEAR 1923. £ s. d. The Archer Street Infant Welfare Centre 104 0 0 The Bramley Road „ „ „ (with Kenley Street Branch) 259 0 0 The Campden Hill „ „ „ 79 0 0 The Earl's Court „ „ „ 104 0 0 The Golborne „ „ „ 176 0 0 The Lancaster Road „ „ ,, 154 0 0 The Raymede „ „ „ 154 0 0 Evelyn Convalescent Cottage Home 16 16 0 Hambledon Cottage Home 8 8 0 The Ladbroke Road Baby Hospital 200 0 0 The Kensington District Nursing Association 200 0 0 These grants have been sanctioned by the Minister of Health, with the result that 50 per cent, will be refunded to the Council by the Government in all except the last mentioned, in respect of which the Government's contribution is £50. GRANT TO HOSPITALS, ETC. In addition to the above mentioned grants, the Council gave the following subscriptions during the year. £ s. d. West London Hospital 10 10 0 Kensington and Fulham General Hospital 5 5 0 St. Mary's Hospital 10 10 0 Paddington Green Children's Hospital 5 5 0 Kensington Dispensary and Children's Hospital 5 5 0 Kensal Gospel and Medical Mission 5 5 0 Chelsea Hospital for Women 5 5 0 Brompton Hospital for Consumption 10 10 0 Kensington District Nursing Association 5 5 0 Western Ophthalmic Hospital 5 5 0 These subscriptions are not strictly in respect of Maternity and Child Welfare work, but this is the most suitable place in this Report in which to record them. The sanction of the Ministry of Health is not applied for in respect of these subscriptions and no Government contribution is received. HOSPITAL LETTERS. In return for subscriptions, the Council receive a number of hospital letters which entitle patients to treatment. In addition, many private subscribers make a practice of forwarding their letters to the Town Hall, knowing that they will be distributed to the most needy people by the Council's Health Officers, who have an intimate knowledge of the poor. The number of hospital letters issued to Kensington poor people during the year by officers of the Public Health Department was 510, and in each case careful enquiry was made in order to make certain that the patient was a deserving one. 36 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. Lady Davison was appointed Chairman in November, 1922, and it was a matter of great regret to the Committee that she felt compelled to retire in November, 1923, owing to her expected absence from Town during the Winter. Lady Davison was succeeded in the Chair by Lady Maurice, and Miss G. B. Wood has been appointed Vice-Chairman. 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. An arrangement was made with the Queen Charlotte's Hospital Authority for the Hospital to give the Medical Officer of Health a weekly list of the names and addresses of all expectant women who engage the services of the Hospital midwives for home confinement. This list enables the Welfare Sisters or the Council's Women Health Officers to visit the homes to ascertain if any domestic or hvgienic precautions can be taken in advance with a view to securing greater safety in delivery. The importance of this arrangement can be readily understood when it is mentioned that the Queen Charlotte's Hospital midwives attend about 750 confinements in the Borough each year, and that owing to pressure of work, they generally do not have the opportunity of visiting the home until labour has commenced. Much consideration has been given to the question of providing accommodation for the confinement of women whose home conditions are not suitable for this purpose, and the Committee have placed before the Council's Maternity and Child Welfare Committee a draft scheme for utilising a ward in the St. Mary Abbot's Hospital. It is proposed that the Council should maintain beds in one of the existing wards of the Hospital, and that cases should be admitted to the Institution upon the recommendation of the Medical Officer of Health, without the necessity of application being made to the Relieving Officer. The beds would he available for married women of all classes whose applications are approved by the Maternity and Child Welfare Committee, who would assess payments to be made by the mothers. The draft scheme has met with the approval of the Maternity and Child Welfare Committee and the Board of Guardians, but final details have to be arranged before it can be submitted to the Borough Council and the Ministry of Health. In the latter part of the year, the Advisory Committee were requested by the Committee of the Kensington Dispensary and Children's Hospital, Church Street, to consider how the needs of North Kensington in respect of hospital accommodation for children could best be met by the Hospital. Owing to the great and practical interest shown in the matter by Her Royal Highness Princess Louise, Duchess of Argyll, President of the Hospital, and Alderman A. J. Allen, M.A., J.P., Mayor of the Royal Borough, it has been possible to make considerable progress. A Hospital Re-Establishment Committee has been set up for the purpose of collecting funds and transferring the work of the Hospital from Church Street to a more suitable position in North Kensington. Her Royal Highness, Princess Louise, has graciously consented to be President of the Hospital Re-Establishment Committee, His Worship the Major has accepted the position of Chairman of the Committee, Sir Alfred Rice-Oxley has been appointed the Vice-Chairman, Lord Balfour of Burleigh has been appointed Hon. Treasurer, and Miss Davenport the Hon. Secretary. In addition, a large number of well-known and influential ladies and gentlemen have consented to serve on the Committee. There is no doubt that, owing to the changes in the residential character of the immediate neighbourhood of the present Hospital in Church Street, which has resulted in a steady decline in the number of attendances, the Hospital will better serve the purpose of the Borough as a whole if removed to North Kensington. If the labours of the Re-Establishment Committee meet with success and it is found possible to erect a Children's Hospital in North Kensington, a very great step forward will have been taken in reducing sickness and increasing the health and happiness of the poor children in that district. The work of the Advisory Committee in co-ordinating the efforts of the numerous voluntary organisations connected with Child Welfare work is growing more and more important, and it is difficult to conceive how the voluntary work in Kensington could continue on sound lines without it. Apart from the very successful co-ordination of voluntary effort, many recommendations on questions concerning Child Welfare have been forwarded to the Maternity and Child Welfare Committee, and also a large amount of routine work in connection with the organisation of Infant Welfare Centres has been carried out during the year. 37 FOOD SUPPLY. All premises in the Borough where food is sold or prepared for sale are regulated by Section 8 of the London County Council (General Powers) Act, 1908. Premises where milk is sold are required to be kept in accordance with the Dairies, Cowsheds and Milkshops Order, 1885, and the Regulations made thereunder by the Council. Unsound food is dealt with under Section 47 of the Public Health (London) Act, 1891. Proceedings in cases of adulteration are instituted under the Sale of Food and Drugs Acts. Milk Supply.—The Dairies, Cowsheds and Milkshops Order, 1885, requires the Council to keep a Register of persons from time to time carrying on the trade of dairymen or purveyors of milk and provides that a person may not carry on the trade unless he is registered. Under Section 5 of the London County Council (General Powers) Act, 1908, the Council are authorised to remove from or refuse to enter upon the Register the name of any person selling or proposing to sell milk on premises which are for any reason unsuitable for the purpose In November, 1920, the Council resolved that the presence upon any premises of such articles as (1) paraffin, (2) loose pickles, (3) vinegar (except in sealed bottles), (4) fish, (5) meat of all forms (except when in sealed tins or glass), (6) fruit, (7) vegetables, (8) coals or coke, and (9) wood (except in bundles, provided the same be not kept in the milk store), would constitute a source of contamination rendering the said premises unsuitable for the sale of milk, and the registration of persons entitled to carry on the trade of a purveyor of milk in Kensington has been subject to the resolution being complied with. Section 2 of the Milk and Dairies (Amendment) Act, 1922, empowers the Council to refuse to enter any person's name on the Register or to remove his name from that Register, if they are satisfied that the public health is or is likely to be endangered by any act or default of his in relation to the quality, storage or distribution of milk. During the year 27 applications for registration were received from persons who proposed to sell milk, and all were granted. The alterations made in the Register of Milk Purveyors in 1923 are summarised in the following table :— Class of Premises Milkshops. General Stores. Restaurants. Totals. Transferred 14 6 - 20 Vacated and removed from Register — — — — Premises added to Register 5 1 1 7 On Register December 31st, 1922 116 20 32 168 On Register December 31st, 1923 121 21 33 175 Increase + Decrease — + 5 + 1 + 1 + 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 175 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 724, and notices were served requiring the remedy of defects which were found on 10 of the premises visited. Milk (Special Designations) Order, 1923.—The Minister, in exercise of the powers conferred upon him by Section 3 of the Milk and Dairies (Amendment) Act, 1922, has issued an Order, which prescribes the conditions subject to which licences may be granted for the sale of milk as " Certified," " Grade A (Tuberculin Tested)," " Grade A," or " Pasteurised." Licences may be granted to two classes of persons, namely :— (1) Those who sell milk either by wholesale or retail; and (2) " Producers," i.e., persons owning or having control of herds from which milk is sold. Under the Order the Council are authorised to grant licences to persons other than a producer to sell milk under any of the special designations above mentioned. Every licence granted is valid for a period ending on the 31st day of December in the year in respect of which it is granted. The Order lays down a schedule of fees to be paid by applicants for licences. The licences granted in 1923 were as follows :— (a) Dealers' licences to use the designation " Certified Milk " 52 (b) Dealers' licences to use the designation "Grade A (Tuberculin Tested) Milk " 4 (c) Dealers' licences to use the designation "Pasteurised Milk " 1 In each case the licence has been granted for the purpose of authorising the dealer to sell specially designated milk from shops within the Borough. No application has been made for a licence giving authority to set up bottling or pasteurising establishments within the Borough. 38 In order to ascertain whether the specially designated milk being sold in the Borough complies with the standards prescribed by the Order of 1923, sixteen samples of " Certified Milk " and one sample of "Tuberculin Tested Milk" have been submitted to the Clinical Research Association for bacteriological examination. In all except three cases, the milk was found to have a degree of> purity higher than that laid down in the Regulations. In the three cases, the examination revealed the presence of bacteria in the following numbers:— Certified Milk Sample No 9 1,940,000 bacteria per 1 c.c. „ „ „ 10 680,000 „ „ „ „ „ 11 230,000 „ „ The maximum number of bacteria per c.c. allowed in "Certified Milk" by the Regulations is 30,000. In addition, l/10th c.c. of milk must, on bacteriological examination, be found to be free from coliform organisms, but in each of these three samples, these organisms were found in this quantity of milk. On receiving these results, the premises in Kensington from which the samples were obtained were very thoroughly inspected, and in each case it was quite clear that the impure condition of the milk was in no way due to defective arrangements either in storage or distribution on the part of the retailers, but was probably due to faulty technique on the part of the producers who are licensed directly by the Ministry of Health. The facts were reported to the Public Health Committee who directed that they should be communicated to the Ministry of Health. The Public Health (Condensed Milk) Regulations, 1923.—These Regulations, which prescribe the labelling and composition of Condensed Milk, came into operation on November 1st. The provisions as to labelling and composition are set out in the schedule to the Regulations, and provision is made for the enforcement of Part II. of the Regulations, which relates to the sale of condensed milk in this country, by the Local Authorities appointing analysts under the Sale of Food and Drugs Acts, on lines following as nearly as may be the procedure under these Acts. Every tin or other receptacle containing condensed milk must bear a label upon which is printed a declaration in prescribed form. All condensed milk must contain not less than the appropriate percentages of milk fat and milk solids as specified in the following Table:— Description of Condensed Milk. Percentage of Milk Fat. Percentage of all milk solids including fat. Full cream, unsweetened 9.0 31.0 Full cream, sweetened 9.0 31.0 Skimmed, unsweetened — 20.0 Skimmed, sweetened - 26.0 Six samples of condensed milk were taken towards the end of the year and each was found to comply in all respects with the new Regulations. 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. Not one of the three hundred and forty-two samples of milk analysed in 1923 was found to contain colouring matter. Milk Utensils in Infected Houses.—The practice commenced in 1922 of sending information to milk retailers supplying milk to houses in which cases of infectious disease are being nursed at home was continued throughout the year, and from the date of the receipt of my notification to the date of a later communication stating that the house is free from infection, no milk vessel belonging to the dealer has been allowed to enter the home in question. The procedure seems to meet with general favour and the dealers invariably express their thanks for the information received. 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 there is no milk being produced in Kensington. Ice Cream.—At the end of the year 158 premises were shown in the Register of places within the Borough where ice cream is prepared or sold, twenty-seven having been removed during the year. The trade is mainly regulated under the London County Council (General Powers) Act, 1902, which makes it an offence to store ice cream in a sleeping room or in any shed or room in which there is an inlet to a drain. Vendors of ice cream are also required to notify the occurrence of infectious disease among their employees or persons living on their premises. The Act further provides that every itinerant vendor shall exhibit on his barrow the name and address of the person from whom the ice cream has been obtained. Two hundred and ninety visits to ice cream premises have been made by the inspectors during the year. 39 The powers under the Public Health (London) Act, 1891, and the London County Council <General Powers) Act, 1902 and 1908, enable the Council to exercise efficient control where the vendors and premises are known, but, inasmuch as ice cream may be made under unsatisfactory • conditions on premises other than those where it is stored, a system of compulsory registration of premises where the commodity is manufactured, stored or sold and of itinerant vendors of ice cream, should be introduced. In addition, byelaws are needed to secure the sale of ice cream from street barrows being conducted under clean conditions. Bakehouses.—There are 90 bakehouses in the Borough, and of this number 67 are underground. As a result of 281 inspections, which were made during the year, 15 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 267. 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 1922 and 1923, 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, 1922 295 188 112 40 55 102 17 809 No. added Removed 52 48 3 1 5 27 0 131 32 22 6 1 11 17 0 89 On Register Dec. 31st, 1923 315 209 109 40 49 112 17 851 The inspections of the above premises during the year numbered 1,124, and resulted in the discovery of the following; defects which were remedied after the service of notices :— Defects found. Number of Defects. W.C. defective 1 Drains defective 3 Refuse deposited 5 Want of cleanliness 32 Defective ashpit accommodation 14 Other defects 27 Total number of defects found 82 Unsound Food.—The unsound food surrendered and destroyed during the year is shown in the following list:— Oranges (cases) 29 Pig's carcase and offal 2 Pig's head 1 Plaice (boxes) 2 Plaice (stones) 4 Rabbits 68 Skate (stones) 6 Tomatoes (lbs.) 384 40 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 ot Food and Drugs Act, 1875, and during the year the Inspector collected 694, of which 56 or 8T per cent. were adulterated. Particulars of formal sampless collected are as follows :— Nature of Sample. Number Taken. Number Adulterated. Arrowroot 2 ... Beans (Tinned) 4 4 Borax 4 ... Brawn 8 ... British Wine 4 2 Butter 64 ... Cayenne Pepper 2 ... Cheese 18 ... Citric Acid 6 ... Cocoa 11 ... Coffee 10 ... Coffee Essence 2 ... Cornflower 12 ... Cream 11 4 Cream Cheese 4 ... Flour 6 ... Fruit Syrup 2 ... Golden Syrup 5 2 Gregory Powder 5 ... Ground Ginger 4 ... Lard 6 ... Lemonade Crystals 2 ... Malt Vinegar 6 ... Margarine 27 .... Milk 253 6 Mincemeat 7 1 Mustard 2 ... Mustard Mixture 2 ... Peas (Tinned) 16 10 Pepper 9 ... Pork Pie 1 ... Potted Meat 12 ... Prescriptions 22 2 Preserved Cream 3 3 Rice 12 ... Sausages 28 13 Self-raising Flour 9 ... Spinach (Tinned) 2 ... Sponge Cake 25 6 Sweets 18 ... Tartaric Acid 6 ... Tongue 4 ... Veal, Ham and Egg Pie 1 ... Vinegar 26 1 Whisky 7 1 Wood Vinegar 4 1 Total 694 56 41 (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. Beans (Tinned) 1 1 Borax 1 ... Brawn - 4 ... Butter 32 ... Calves Feet Jelly 1 ... Cheese 2 ... Citric Acid 3 ... Cocoa 1 ... Coffee 1 ... Coffee and Chicory Essence 5 1 Condensed Sweetened Full Cream Milk 3 ... Condensed Sweetened Machine Skimmed Milk 2 ... Condensed Unsweetened Full Cream Milk 1 ... Cream 6 1 Cream Cheese 2 1 Custard Powder 7 ... Dried Milk 3 ... Fish Paste 4 1 Flour 1 ... Fruit Syrup 1 ... Golden Syrup 1 ... Gregory's Powder 3 ... Ground Ginger 5 • •• Lemon Curd 3 ... Margarine 16 ... Meat Paste 16 3 Milk 89 4 Milk Powder- 1 ... Mincemeat 3 ... Mixed Vegetables (Tinned) 1 ... Mustard 1 ... Peas(Tinned) 9 9 Pepper 2 ...... Plain Cake O KJ ... Pork Pie 2 ... Potted Meat 6 ... Prawns 2 ... Preserved Cream 1 1 Raspberry Squash Powder 1 ... Sausages 9 6 Self Raising Flour 4 ... Sponge Cake 18 2 Sweets 4 ... Sweet Spirit of Nitre 2 ... Tartaric Acid 3 ... Tea 1 ... Tongue 2 ... Tripe 3 1 Vinegar 12 ... Whisky 2 2 Total 306 33 No legal proceedings can be taken in respect of an informal sample, but, when adulteration is discovered, formal samples are obtained immediately and necesaary action taken. 42 Summary of the Results of Analysis of the 89 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. Beans (Tinned) 0.966 grains of Crystallised Sulphate of Copper per pound Informal sample Beans (Tinned) 3.312 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Beans (Tinned) 2.125 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £3 and 10s. 6d. costs Beans (Tinned) 1.435 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £2 and 10s. 6d. costs Beans (Tinned) 0.414 grains of Crystallised Sulphate of Copper per pound Vendor cautioned British Wine 0.787 grains of Salicylic Acid per pint Vendor cautioned British Wine 0.22 grains of Salicylic Acid per pint No action Coffee Essence 0'72 grains of Salicylic Acid per Pint Informal sample Cream 12.642 grains of Boric Acid per pound Informal sample Cream 16.730 grains of Boric Acid per pound Proceedings. Fined £2 and 10s. 6d. costs Cream 15.617 grains of Boric Acid per pound Proceedings. Fined £2 and 10s. 6d. costs Cream 19.705 grains of Boric Acid per pound No action Cream 5.551 grains of Boric Acid per pound Vendor cautioned Cream Cheese 87.81 per cent, of the required fat deficient Informal sample Fish Paste 7.189 grains of Boric Acid per pound Informal sample Golden Syrup 70 per cent, of Starch Glucose Syrup Proceedings. Fined 10s. and 10s. 6d. costs Golden Syrup 70 per cent, of Starch Glucose Syrup Proceedings. Fined 10s. and 10s. 6d. costs Meat Paste 6.937 grains of Boric Acid per pound Informal sample Meat Paste 6.566 grains of Boric Acid per pound Informal sample Meat Paste 6.321 grains of Boric Acid per pound Informal sample Milk 5.5 per cent, of extraneous water Informal sample Milk 3 per cent, of extraneous water Informal sample Milk 8 per cent, of the required fat deficient Informal sample Milk 4.5 per cent, extraneous water - Informal sample Milk 9 per cent, of the required fat deficient. Proceedings dismissed. Warranty defence Milk 2 per cent, of the required fat deficient Vendor cautioned Milk 36.3 per cent of the required fat deficient Proceedings. Fined £5 and 10s. 6d. costs Milk 14 per cent, of the required fat deficient Summons withdrawn Milk 3.5 per cent, of extraneous water Vendor cautioned Milk 1.5 per cent, of extraneous water No action Mincemeat 0.42 grains of Salicylic Acid per pound No action Peas (Tinned) 1.932 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £2 and 10s. 6d. costs Peas (Tinned) 1.242 grains of Crystallised Sulphate of Copper per pound Vendor cautioned Peas (Tinned) 1.104 grains of Crystallised Sulphate of Copper per pound Vendor cautioned 43 Article Analysed. Nature and Amount of Adulteration. Action taken. Peas (Tinned) 1.656 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.518 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.380 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.380 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.380 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.462 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.311 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.242 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 1.573 grains of Crystallised Sulphate of Copper per pound Informal sample Peas (Tinned) 2.07 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Peas (Tinned) 1.435 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £'6 and 10s. 6d. costs Peas (Tinned) 1.380 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Peas (Tinned) 0.772 grains of Crystallised Sulphate of Copper per pound Vendor cautioned Peas (Tinned) 1.449 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £1 and 10s. 6d. costs Peas (Tinned) 1.518 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £2 and 10s. 6d. costs Peas (Tinned) 2.760 grains of Crystallised Sulphate of Copper per pound Proceedings. Fined £5 and 10s. 6d. costs Prescription 9.6 per cent, of the required Sodium Salicylate deficient Vendor cautioned Prescription 12 per cent, of the required Potassium Bromide deficient Vendor cautioned Preserved Cream 23.429 grains of Boric Acid per pound Informal sample Preserved Cream 19.705 grains of Boric Acid per pound No action Preserved Cream 18.592 grains of Boric Acid per pound No action Preserved Cream 16.350 grains of Boric Acid per pound No action Sausages 16.730 grains of Boric Acid per pound Informal sample Sausages 13.755 grains of Boric Acid per pound Informal sample Sausages 12.642 grains of Boric Acid per pound Intormal sample Sausages 18.347 grains of Boric Acid per pound Informal sample Sausages 13.832 grains of Boric Acid per pound Informal sample Sausages 11.900 grains of Boric Acid per pound Informal sample Sausages 17.479 grains of Boric Acid per pound Vendor cautioned Sausages 10.661 grains of Boric Acid per pound No action Sausages 8.799 grains of Boric Acid per pound No action Sausages 8.057 grains of Boric Acid per pound No action Sausages 7.931 grains of Boric Acid per pound No action 44 Article Analysed. Nature and Amount of Adulteration. Action taken. Sausages 14.994 grains of Boric Acid per pound Vendor cautioned Sausages 13.881 grains of Boric Acid per pound Vendor cautioned Sausages 12.768 grains of Boric Acid per pound Vendor cautioned Sausages 16.856 grains of Boric Acid per pound Vendor cautioned Sausages 13.881 grains of Boric Acid per pound Vendor cautioned Sausages 11.102 grains of Boric Acid per pound Vendor cautioned Sausages 10.759 grains of Boric Acid per pound Vendor cautioned Sausages 6.531 grains of Boric Acid per pound Vendor cautioned Sponge Cake 16.730 grains of Boric Acid per pound Informal sample Sponge Cake 5.950 grains of Boric Acid per pound Informal sample Sponge Cake 18.718 grains of Boric Acid per pound Proceedings. Summons dismissed Sponge Cake 18.466 grains of Boric Acid per pound Proceedings. Summons withdrawn Sponge Cake 15.491 grains of Boric Acid per pound Proceedings. Summons withdrawn Sponge Cake 7.385 grains of Boric Acid per pound No action Sponge Cake 19.586 grains of Boric Acid per pound Proceedings. Fined £2 and 21s. costs Sponge Cake 5.131 grains of Boric Acid per pound Vendor cautioned Tripe 5.572 grains of Boric Acid per pound Informal sample Vinegar 1.5 per cent. of required Acetic Acid deficient Informal sample Vinegar 6 per cent. of the required Acetic Acid deficient Informal sample Vinegar 4 per cent. of the required Acetic Acid deficient No action Whisky 45.7 degrees under proof Proceedings. No conviction but ordered to pay £2 2s. costs Wood Vinegar 2.5 per cent. of the required Acetic Acid deficient Vendor cautioned It will be seen that proceedings were taken in twenty-two cases, the fines and costs amounting to £56 Os. 6d. COMPOSITION OF MILK SUPPLIED IN KENSINGTON. It is well known that the "limits" of 3 per cent. of fat and 8.5 per cent. of non-fatty solids, which are taken by the Ministry of Agriculture as the primary criteria of genuineness of milk, are figures very much below those found in normal cow's milk. The following may be taken as the average composition of cow's milk :— Water 87.4 per cent. Fat 3.7 „ „ Non-fatty solids 8.9 „ „ Of 253 formal samples of milk taken under the Food and Drugs Act in 1923, only 6 were certified by the Public Analyst as adulterated, i.e., containing less than 3 per cent. of fat or 8.5 of non-fatty solids. These particulars, however, do not give any indication of the general quality of the milk supplied in Kensington, therefore, it will be interesting to note the average composition of the samples taken in the Borough during the year. These figures are given in the following table:— 45 Average Composition of Formal Milk Samples taken in 1923. Months. Number of Formal Samples Taken. Average Composition of all Samples Submitted. Genuine and Adulterated. Average Composition of Genuine Samples. Ministry of Agriculture Standard. Percentage of Milk Fat. Percentage of Solids not Fat. Percentage of Milk Fat. Percentage of Solids not Fat Percentage of Milk Fat. Percentage of Solids not Fat. January 18 3.64 8.83 3.64 8.83 3.0 8.5 February 32 3.71 8.85 3.71 8.85 March 16 3.63 8.79 3.63 8.79 April 38 3.59 8.80 3.59 8.80 May 18 3.45 8.93 3.49 8.93 Tune 16 3.52 8.88 3.56 8.88 July 11 3.40 8.79 3.65 8.79 August 33 3.69 8.73 3.71 8.75 September 20 3.63 8.78 3.63 8.80 Average Composition, of Normal Cow's Milk. October 36 3.80 8.87 3.80 8.87 November 14 3.70 8.92 3.70 8.92 Percentage of Milk Fat. Percentage of Solids not Fat. December 1 3.13 877 3.13 8.77 Averages for the Year 253 3.64 8.83 3.66 8.83 3.7 8.9 It is interesting to note that the average fat content of Kensington samples exceeded the Ministry of Agriculture standard by over 20 per cent or, in other words, the samples would have been returned as genuine by the Public Analyst even though 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 (or each month of the year is well above the legal standard and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content as low as 3 per cent. Cream Regulations.—The Public Health (Milk and Cream) Regulations, 1912, made by Local Government Board in pursuance of the powers conferred by Section I of the Public Health (Regulations as to Food) Act, 1907, came into force on October 1st, 1912. They prohibit absolutely the presence of any kind of preservative in milk or in cream containing less than 35 per cent. of milk fat, and the addition of any thickening substance of any kind except sugar to cream. In the case of cream containing 35 per cent. of fat or more, the effect of the Regulations is to permit the addition of boric acid, borax or hydrogen peroxide, provided the cream so preserved is sold in vessels bearing a label with a printed declaration of the percentage of borax or peroxide which has been used. The addition of any other kind of preservative is prohibited. These Regulations were amended by the Public Health (Milk and Cream) Regulations, 1917, so as to limit the boric acid and borax which may be added to cream containing 35 per cent. or more of fat, to an amount not exceeding 0'4 per cent. by weight of the cream. These amending Regulations also provide that the declaratory label must state that the cream is not suitable for infants or invalids. On the ground that the addition of preservatives in any quantity to cream is unnecessary, the Council have taken no action under these Regulations. In all cases of milk and cream samples submitted to the Public Analyst, an examination for preservatives is made, and if any be found, the Public Health Committee consider the question of instituting proceedings under the Food and Drugs Act, even though in the case of borax or boric acid in cream the amount found be less than that allowed by the amending Regulations. Margarine and Butter Substitutes.—Under Section 9 of the Margarine Act, 1887, and Section 7 (4) of the Sale of Food and Drugs Act, 1899, manufacturers and wholesale dealers in margarine and margarine cheese are required to register their premises with the local authority. By Section 1 (1) of the Butter and Margarine Act, 1907, these requirements were extended to butter factories and to the premises of wholesale dealers in milk-blended butter. The following premises in the Borough are registered in accordance with the requirements of the above Acts :— Lipton, Ltd. 210, Portobello Road. „ „ 145, Brompton Road. E. C. Nicholls 19, Church Street. Maypole Dairy Co., Ltd. 196, Portobello Road. Home and Colonial Stores, Ltd. 136, Portobello Road. „ „ „ 184, Portobello Road. „ „ ,, 20, Chepstow Mansions. „ ,, ,, 71, Notting Hill Gate. „ „ „ 171, Earl's Court Road, „ „ „ 98, Golborne Road. Pearks, Ltd. 76, Golborne Road. „ 62. Princes Road. ,, 165, Portobello Road. 46 Sale of Food Order, 1921.—This Order placed upon Local Authorities certain duties in regard to— (1) the sale of bread and tea by weight. (2) the labelling of imported produce, (3) the composition of jam and marmalade, dripping, margarine, and other edible fats. The provisions of that part of the Order dealing with the sale of bread and tea by weight are administered by the London County Council, but the Borough Council are required to enforce the remaining sections of the Order. Since this Order was published an Amending Order has been issued, which cancels certain sections of the original, with the result that the only part now to be enforced by the Borough Council is that which relates to the labelling of imported produce (lard excepted). A further Amending Order, dated September 1st, 1922, removes bacon and ham from the list of imported foods which must not be exposed for sale by retail unless they bear a label containing the words " Imported" in letters easily readable by customers. Under the Expiring Laws Continuance Act, 1923, the Order, with the amendments above indicated, is continued in force until December 1924. FOOD POISONING. No instance of food poisoning was brought to my notice during the year. PRESERVATIVES AND COLOURING MATTER IN FOOD. For many years the Council of the Royal Borough of Kensington have given particular attention to the enforcement of the law for ensuring food purity, especially in connection with the addition of chemical preservatives and colouring matter to foodstuffs, and, as may be expected in the case of a high-class residential borough such as Kensington, an attempt has been made to obtain the highest possible degree of food purity consistent with modern facilities for production, storage and transport. In several directions the Council have adopted a standard of purity, as regards the addition of preservatives and colouring matter, more stringent than that in use by many other local authorities, but in no case have they required dealers to comply with a standard which is not reasonably attainable. The Need of Fixed Standards of Purity. The main difficulty experienced by local authorities in dealing with the addition of preservatives to foodstuffs lies in the absence of reliable and authoritative standards of purity for their guidance. Section 3 of the Sale of Food and Drugs Act of 1875 makes it an offence to mix any article of food with any material so as to render it injurious to health; it is also illegal to sell any article so mixed. Section 6 prohibits the sale to the prejudice of the purchaser of any article of food which is not of the nature, substance and quality demanded. It is, however, left to the local authority in each case to determine whether any particular article of food purchased by the Inspector under the Act is sufficiently injurious to health as to warrant a prosecution under Section 3, or whether the purchaser is prejudiced to such an extent as to justify proceedings under Section 6. The decision of the local authority to issue a summons in any particular case depends on various considerations, but mainly on the advice of their Medical Officer of Health and on the expert knowledge and experience of individual members of the Public Health Committee. As Councillors of local authorities and Medical Officers of Health vary widely in their views on the use of preservatives and colouring matter in food, the action taken against retailers differs considerably throughout the country. Also, magistrates give decisions which vary in different courts. For instance, several retailers were convicted during 1923 at the Kensington Petty Sessional Court for selling tinned peas containing less than two grains per pound of copper sulphate, whereas a prosecution against a Woolwich retailer for selling tinned peas containing over three grains per pound was dismissed a few months ago at the Magistrate's Court in that district. The magistrates are not responsible for these conflicting decisions because they have to decide on the evidence which comes before them. This great difference in the practice of local authorities and in the decisions of magistrates is unsatisfactory alike to (a) local authorities, (b) producers, (c) retailers and (d) consumers. It is recognised that it is not practicable that statutes such as the Sale of Food and Drugs Act, 1875, which must of necessity be couched in general terms, should go into details in regard to each kind of preservative and preserved foodstuff in use, but, nevertheless, definite legal standards of purity should be laid down. The Public Health Act, 1875, the Public Health (London) Act, 1891, the Public Health Act, 1896, and the Public Health (Regulations as to Food) Act, 1907, give all the power necessary to the Minister of Health to lay down standards, and he has availed himself of such power in regard to milk and cream in the Regulations of 1912 and 1917 and condensed milk in the Regulations of 1923. It is desirable that the Minister should make Regulations defining the maximum amounts of each preservative and colouring agent which may be added to the various foodstuffs usually preserved or coloured. 47 • The Regulations so far made are not binding on local authorities, and an amendment of the law is needed so as to secure that when the addition of any preservative or colouring matter to any particular foodstuff is controlled by Regulation, the dealer should not be exposed to the risk of prosecution under the Sale of Food and Drugs Act, 1875, in regard to the addition of that preservative or colouring matter, provided that there is no breach of the Regulations; in other words, any article of food conforming to the standards laid down by the Regulations should be regarded as genuine for the purposes of Sections 3 and 6 of the Sale of Food and Drugs Act, 1875, in so far as the addition of preservatives or colouring matter is concerned. In stating that legal standards of purity should be fixed, I am not admitting the necessity of adding preservatives to any foodstuffs; indeed, 1 believe that by the adoption of more cleanly methods of production, rapid transport and a more extended use of cold storage, preservatives could be dispensed with entirely, or, at least, the amounts now commonly used could be very considerably reduced. In this connection, it is interesting to note the change which has taken place in recent years in regard to the addition of preservatives to milk. In 1901, chemists, producers and retailers in milk stated before a Departmental Committee that it was absolutely essential to have preservative in milk and that it was almost impossible for poor people in London to get good fresh milk without the use of preservative. It was estimated that at that time about fifty per cent, of the dairymen in London used preservative. Experience in Kensington shows that in a very few years following the labours of the Departmental Committee in 1901, it was found possible to supply a central area of the Metropolis with milk completely free from preservative. Since 1906, 4,954 samples of milk taken in Kensington have been examined and not one was found to contain boric acid. On one occasion, namely in 1915, formalin was found in a sample of milk. No other preservative has been found in milk since 1901. On reviewing the evidence placed before the Departmental Committee in 1901, the state of the milk trade in regard to preservatives at that time, and the change which took place within the next few years, I consider it is justifiable to take the view that it should be possible to eliminate or reduce the amount of preservative in other articles of food, many of which do not deteriorate so rapidly as milk. Since 1900, 205 samples of cream have been taken in Kensington for analysis under the Sale of Food and Drugs Act, and 102, or 49.7 per cent., of these were free from preservative. In view of the fact that practically half the samples of cream taken in Kensington for many years past have been free from preservative, is must be possible to carry on a cream trade without the use of preservative. Cold storage is now in use in almost every butcher's shop, and it retailers in dairy produce adopted some system of refrigeration, the need for preservative would not be felt. In addition to finding boric acid in milk and cream, the Kensington Public Analyst has found this chemical present, either as such, or as a mixture with borax, in sausages, meat extracts, meat juices, potted meats, potted fish, potted caviare, cheese, butter, margarine, wine, Devonshire cream, mincemeat, sponge cakes and liquid eggs. He has found salicylic acid in meat juices, syrups, jams, lager beer, wines, British wines and lime juice ; formaldehyde in milk; and benzoic acid, probably present as benzoate of soda, in non-alcoholic and medicated wines. Copper has been found in peas, beans, capers, spinach and gherkins. The articles found adulterated in the past twelve months are indicated on pages 42 to 44 of this report, but it may be useful to consider the extent to which preservatives and colouring matter have been found in some of the more commonly adulterated articles during the present century. TABLE showing the extent to which boric acid has been found in some of the more commonly adulterated articles which have been taken in Kensington since 1900 for analysis under the Sale of Food and Drugs Act, 1875. Name of article sampled. No. of samples taken for analysis since 1900. No. found to contain boric acid. Percentage free from preservative. Highest amount of boric acid found in any one sample. (grains per pouns) Lowest amount of boric acid found in any one sample.  Cream 205 103 49.7 37.08 2.97 Sausages 382 90 76.96 31.48 4.95 Potted meat, potted fish, meat pastes and fish pastes 322 38 88.21 49.58 4.21 Brawn 56 10 82.14 12.14 6.06 Butter 2264 1669 26.2 Margarine 150 142 5.33 *In no case did the amount of boric acid found in butter or margarine exceed *5 per cent., or 35 grains per lb., the amount recommended as a maximum by the Departmental Committee in 1901, and. as a rule, the quantity was much smaller. 48 • It will be seen that a considerable percentage of samples taken have been found to be free from boric acid and, in these circumstances, it is considered that there should be no difficulty in eliminating this drug altogether if the methods of production, transport and storage were clean and satisfactory. Since 1900, 136 samples of tinned peas have been taken for analysis under the Sale of Food and Drugs Act, 1875, and 95 of these contained copper, the highest amount found in any one sample being equivalent to 4.87 grains of copper sulphate per pound. Fifty samples of other tinned vegetables (beans, capers, spinach, gherkins) have been examined since 1900, and 18 of these have been found to contain copper, the highest amount found in any one sample being equivalent to 7.17 grains of copper sulphate per pound. The practice of adding copper sulphate to tinned vegetables is prohibited in America, and all samples of tinned vegetables of American origin taken in Kensington have been found to be free from copper. Copper sulphate does not improve the food value or taste of the vegetables; it is not added as a preservative but merely to give the article a bright green colour. This seems an insufficient reason for adding this irritant and poisonous drug to foodstuff intended for human consumption, and it is unfortunate that effect has not been given so far to the recommendation of the Departmental Committee in 1901 that the use of copper sulphate for the greening of preserved foods should be prohibited. Since 1900, 24 samples of g.nger, raisin, orange and elder wine have been taken, and 5 were found to contain salicylic acid, the highest quantity present being 1.75 grains per pint. Ten samples of lime juice cordial have been taken since 1900, 4 of these being found to contain salicylic acid, the highest amount being 6.13 grains per pint. The experience in Kensington in regard to the addition of preservative to butter is interesting when compared with the experience in milk, for whilst the practice of adding preservative to milk, an article that deteriorates rapidly, has entirely disappeared, it is increasing in the case of butter, which in its natural state keeps longer. In 1900, 95 per cent. of the samples of butter were free from preservative. In 1923, only 23 per cent. of the samples taken were free. The following is a list of the samples of sponge cake taken in Kensington during the year 1923, and found to contain boric acid:— Date of purchase of sample. Amount of boric acid found present. February 22nd 18.46 grains per lb. „ „ 18.71 „ „ „ 15.49 „ „ April 20th 7.38 ,, „ July 13th 16.73 „ „ July 27th 19.58 „ „ August 10th 5.95 „ „ August 15th 5.13 „ „ It is true that there is some difference of opinion on the question of the addition of boric acid to cream, but I cannot see any justification for the quite unnecessary practice of adding this drug to such an article as sponge cake, which already keeps well and is mainly intended for invalids and children. As pointed out in the Ministry of Health Circular No. 381, dated March 20th, 1923, the Bakers' Allied Trade Association passed a resolution on February 1st, 1923, to the effect that the sale of liquid whole egg (from which the boric acid in sponge cakes originates) would be made on the understanding that this preparation should not be used in the manufacture of sponge fingers, sponge biscuits and small plain sponge cakes, and that invoices should bear a statement accordingly, but it does not appear from the analysis of samples taken in Kensington since the resolution was passed that it has had the desired effect. Owing to the wide range of foodstuffs being treated with preservative to-day, it is possible that as much as 40 grains of boric acid, or even more, may be consumed daily by an individual through the medium of various articles of diet. In these circumstances, the desirability of control by prescription of limits must be recognised, and it is to be hoped that standards of purity will be fixed before long. Declarations. If preservatives and colouring matters are to be allowed in foodstuffs there should be a full and clear declaration made at the time of purchase as to the nature and amount of the adulterant added, in order that the consumer may know exactly what he is buying. The declaration should preferably be printed, and should be fixed on the container, if the article be sold in one. Printed or other declarations should be prescribed in each case by Regulation, and care should be taken that they cannot be made ambiguous or misleading; In illustration of the need of this precaution, attention may be called to the following declarations which have appeared on samples of tinned vegetables taken recently in Kensington:— 1. The colour of these peas is preserved by sulphate of copper, the smallest quantity possible being used to ensure Finest Quality and is not injurious to health. (Copper equivalent to 14 grains of copper sulphale per lb. was found by the Public Analyst.) 49 2. In accordance with the method which has been followed for many years past and approved by the highest authorities, the contents of this package have been prepared with a small quantity of copper. (Copper equivalent to 1.3 grains of copper sulphate per lb. was found by the Public Analysts 3. The colour of these beans is preserved by sulphate of copper, the smallest quantity of copper being used to ensure finest quality and is not injurious to health. (Copper equivalent to 21 grains of copper sulphate per lb. was found by the Public Analyst.) 4. SUPPORT HOME INDUSTRIES. The colour of these Peas is preserved by Sulphate of Copper, the smallest quantity possible being used to ensure finest quality. (Copper equivalent to 1.5 grains of copper sulphate per lb. was found by the Public Analyst). Power to take proceedings against persons adding preservatives or colouring matter. As far back as 1890, the Vestry of Kensington urged the Local Government Board to introduce a Bill for the amendment of the Sale of Food and Drugs Act, 1875, so that the manufacturers of, and wholesale dealers in, adulterated articles may be rendered liable to penalties as well as retailers. No less than 15 of the other local authorities in the Metropolis expressed concurrence with the views of the Kensington Vestry, and communicated with the Local Government Board in favour of the Act being amended in the direction indicated. In 1892, the Vestry again invited the Local Government Board's attention to this matter. In 1894, a conference of local authorities of London, convened by the Vestry of St. George's, Hanover Square, passed resolutions in favour of bringing the manufacturers of, and wholesalers in, adulterated articles within the scope of the Sale of Food and Drugs Act. Under the law as it now stands, the person selling an article to an Inspector of a local authority is responsible under the Sale of Food and Drugs Act, 1875, and it is not uncommon to hear a retailer inform the magistrates that he was unaware of the presence of preservative in respect of which the prosecution had been taken, until he received the summons. The magistrates sometimes reply that the defendant could have protected himself by obtaining a report from a private analyst. Such a course is possible, and, indeed, probably profitable in the case of a large firm, but it seems unreasonable to expect a small retailer to consult an analyst at a cost of several guineas in respect of each consignment of goods which may contain preservative. The retailer is frequently innocent, and he should be afforded some protection in this matter. In the case of articles in bottles, tins, cartons, packets, etc., in which the container is unopened by the retailer and sold exactly as received by him, the law should require a printed label stating, not only the kind and amount of preservative or colouring matter, but also the name and address of the person responsible for the actual adulteration. In the case of foreign articles, the name and address should be that of the importer. When a label does not conform with the Regulations made in respect thereof, the local authority should be empowered to take proceedings at a Court having jurisdiction within their own area against the person who is responsible for the issue of the declaration, namely, the person whose name and address is on the label, and they should not be required to proceed against the retailer. If a sample be found to contain preservative (1) not allowed by regulation, (2) not mentioned: on the label, (3) in excess of that allowed by regulation, or (4) in excess of that stated on the label, and such sample was sold by the retailer in an unopened container, the person whose name and address appear on the label, and not the retailer, should be made responsible at law. In this way the small retailer, who cannot afford the services of an analytical chemist, could protect himself by the mere precaution of seeing that the name and address of the producer are on the label. Cases will occur in which a sample does not reach the required standard of purity, and does not bear the name and address of the producer. Owing to the article having passed through the hands of various middlemen in the market, it might be difficult and expensive to trace the producer. In view of this, the law should make the retailer responsible if he sells an article which does not bear the name and address of the producer, and is found to contain preservative in excess of that allowed by the Regulations made in respect thereof. If the retailer fails to take the simple precaution indicated he cannot reasonably object to being saddled with the responsibility. There is nothing new in asking for the name of the producer to appear on the container, for it is required in the case of certified milk and condensed milk by the Regulations controlling the sale of these articles. Anything in the nature of the warranty defence, so common in milk cases, should be cautiously avoided. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The Council's scheme for the supply of milk to expectant and nursing mothers and infants under the age of five years, and the supply of dinners to expectant and nursing mothers has been 50 described in detail in previous reports, and no modification has been required during the past twelve months. In the year 1923 there were 577 grants of milk made by the Council's Milk SubCommittee. Two hundred and sixteen of the grants were in response to new applications, and the remaining 361 were renewals of grant. Sixty-six applications for dinners were granted; 31 of these were new applications, and 35 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. 14,852 Free 213 y 6 Particulars of Dried Milk supplied free or below Cost Price under the Council's Scheme. No. of packets of Milk granted. Price per lb. packet paid by Recipients. Estimated Cost to Council. £ s. d. 156 Free 13 1 6 Particulars of Dried Milk supplied at Cost Price under the Council's Scheme. Name of Welfare Centre at which the dried milk was distributed No. of 1lb. packets sold. Value of milk sold. £ s. #] Archer Street 2,316 166 12 0 Bramley Road 930 64 3 4 Earl's Court 6 0 9 0 Golborne 208 16 9 0 Lancaster Road 1,087 87 8 2 Raymede 1,855 146 5 4 - 6,402 481 6 10 Particulars of Dinners supplied under the Council's Scheme. No. of Dinners granted. Price per Dinner paid by Recipients. Estimated Cost to Council. £ s. d. 1290 Free 32 5 0 20 2d. 0 6 8 32 11 8 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. 51 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. 48 £3 15 10 95 £2 7 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 13'2 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 1,412. 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 280, 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 larndries 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. 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 941. The factories at which men alone were employed numbered 216. It should be noted that by Section 157, the provisions of the Factory and Workshop Act, 1901, relating to temperature, drainage of floors, the exhibition of abstracts and certain other matters do not apply to workshops conducted on the system of not employing children, young persons or women. In London, both in factories and workshops, the provision of sanitary conveniences is regulated by Section 38 of the Public Health (London) Act, 1891, the standard adopted being that required by the Sanitary Accommodation Order of 4th February, 1903. The following table shows the various trades and occupations carried on in registered workshops and factories where men alone are employed:— 52 Trade ok Business. Workshops. Factories. Total. Aerated water manufacturer — 4 4 Baker 57 31 88 Basket maker 7 — 7 Blacksmith 30 1 31 Boot maker 161 11 172 Builder 92 9 101 Cabinet maker and joiner 40 3 43 Carver and gilder 8 — 8 Coach builder 30 3 33 Cycle maker 10 — 10 Electric generating works — 13 13 Firewood manufacturer 13 3 16 French polisher 2 — 2 Marble mason 6 3 9 Marine stores 21 — 21 Printer 2 19 21 Saddler 18 — 18 Tailor 117 — 117 Trunk maker 17 — 17 Umbrella maker 5 — 5 Undertaker 10 — 10 Upholsterer 33 3 36 Watch maker 37 3 40 Wig makerand hairdresser 9 — 9 Sausage maker 1 17 18 Sundry businesses 215 93 308 Total 941 216 1,156 WOMEN'S WORKSHOPS. The number of workshops and factories at which female labour was employed at the end of 1923 was 535, 184 in North Kensington and 351 in South Kensington. The number of persons employed varies with the period of the year, being, of course, greatest during the "season" 53 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 1 — 1 Blouse maker 2 — 2 Boot maker and repairer 3 1 4 Boot closer 1 — 1 Cabinet maker — 1 1 Chemist 1 — 1 Cigarette maker 1 — 1 Corset maker 7 — 7 Dressmaker and ladies' tailor 195 4 199 Dyer and cleaner 24 3 27 Fancy work and painting 1 — 1 Florist 13 — 18 Furrier 14 2 16 Hairdresser 15 — 15 Hair-dye manufacturer 1 — 1 Invisible mending 1 — 1 Jeweller 1 1 2 Lace worker 7 — 7 Lampshade maker 2 — 2 Laundry 38 45 83 Milliner 41 — 41 Non-inflammable composition manufacturer — 1 1 Outfitter 12 1 13 Pastry cook 1 — 1 Photographer 11 — 11 Pictorial advertisements 1 — 1 Picture frame maker — 1 1 Pipe maker — 1 1 Powderpuff maker 1 — 1 Printing — 2 2 Restaurant 2 — 2 Sweet maker 1 — 1 Tailor 50 — 50 Toilet requisites 1 — 1 Typist 1 — 1 Toy maker 2 — 2 Umbrella maker 2 — 2 Upholsterer 9 1 10 Weaving 3 — 3 Wire brush maker 1 — 1 Wig maker 1 — 1 Total 471 64 535 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. 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—Nine workrooms were cleansed and whitewashed after notice and three other sanitary defects were dealt with. Sanitary Conveniences.—During the year two defective sanitary conveniences in workshops were found and remedied. HOME WORK. Of the 190 outworkers registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshops Act, 1901, others work in domestic workshops, whilst the remainder are the genuine "Home Workers" engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The number of outworkers belonging to each of these three classes is shown in the following Table:— The number of outworkers belonging to each of these three classes is shown in the following T able:— 54 Outworkers in Workshops or Factories 39 Outworkers in Domestic Workshops 35 Outworkers in their own Homes 116 Total number of Outworkers 190 The factories and workshops referred to in the above list are included in the tables which show the trades carried on in the factories and workshops on the Council's register. The nature of the work given out to the 116 home workers on the register is as follows:— Tailoring 51 Dressmaking 33 Bootmaking 16 Outfitting 4 Shirtmaking 4 Millinery 2 Embroidery 1 Furrier 1 Drapery 1 Cleaning 1 Glovemaking 1 Weaving 1 116 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 Officer under the Factory and Workshops' Acts, so far as it is capable of being expressed in this form:— 1. No. of Factory Inspections 91 2. „ Workshop „ 514 3. „ Home Workers Inspections 132 4. „ Work Place „ 15 5. Sanitary Defects Remedied. (a) Additional means of ventilation provided — (b) Rooms cleansed and whitewashed 9 (c) Miscellaneous defects remedied 3 (d) Sanitary conveniences, defects remedied 2 „ „ insufficient — „ „ not separate for sexes — Home Office Tables. The following tables contain a summary of the inspections made and the defects found and remedied in workshops and factories within the Borough, where men, women, young persons or children are employed. In Table IV. the chief classes of workshops are set forth. Table V. shows the number of cases in which action was taken in matters referred to the Council by H.M. Inspectors. I.—Inspections. Premises. Number of Inspections. Written Notices. Prosecutions. Factories (including Factory Laundries) 219 3 - Workshops (including Workshop Laundries) 867 12 — Workplaces (other than Outworkers' premises included in Table 3 of this Section of the Report) 15 — — Total 1101 15 — 55 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 15 15 — — Want of ventilation 1 1 — — Overcrowding 1 1 — — Want of drainage of floors - — — — Other nuisances 11 11 — — Sanitary accommodation insufficient — — — — unsuitable or defective 6 6 — — not separate for sexes 1 1 — — Offences under the Factory and Workshops Act:— Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses (SS. 97 to 100) 15 15 - - Other Offences (Excluding offences relating to outwork which are included in Table 3 of this Section of the Report.) - - - - Total 50 50 — — *Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act as remediable under the Public Health Acts. III. -Home Work. NATURE OF WORK. (1) OUTWORKERS' LISTS, SECTION 107. OUTWORK IN UNWHOLESOME PREMISES, SECTION 108. OUTWORK IN INFECTED PREMISES. SECTIONS 109, 110. Lists received from Employers. Notices served on Occupiers as to keeping or sending lists. (8) Prosecutions. Instances (11) Notices served. (12) Prosecutions (13) Instances. (14) Orders made (s. 110). (15) Prosecutions (Sections 109, 110). (16) Sending twice in the year. Sending once in the year. Failing to keep or permit inspection of lists. (9) Failing to send lists. (10) Lists. (2) Outworkers. Lists (6) Outworkers. Contractors. 3) Workmen. (4) Contractors. (6) Workmen. (7) Wearing apparel— making, &c. 33 21 316 4 11 47 - - - - - - - - cleaning and washing 3 16 1 — — — 2 — — — — — — — — Household linen 2 7 1 — — — 2 — — — — — — — — Lace, lace curtains and nets 2 — 3 — — - 2 - : . . — — — — — — — Furniture and upholstery 1 — — — — — — — — — — — — — — Electric-plate — — — — — — — — — — — — — — — Umbrellas, etc 3 3 6 — — — 1 — — — — — — — — Total 44 47 327 4 — 11 54 — — — — — — — 56 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 195 Workshop Laundries 38 Workshop Bakehouses 57 Other Workshops 1,122 Total number of workshops on Register 1,412 V.—Other Matters. Class. Number. Matters notified to H.M. Inspectors of Factories:— Failure to affix Abstract of the Factory and Workshop Act (s. 133) — Notified by H.M. Inspectors 10 Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts, but not under the Factory and Workshop Act (s. 5) Reports (of action taken) sent I to H.M. Inspectors 10 Other — Underground Bakehouses (s. 101) :— Certificate granted during the year — In use at the end of the year 67 57 58 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.—On the 31st March, 1923, the date on which the Brompton Hospital ceased to carry out the Dispensary treatment of tuberculosis for South Kensington patients on behalf of the Borough Council, Dr. Burrell, a Visiting Physician at the Hospital, ceased to act as part time Assistant Medical Officer of Health. In July, 1923, Dr. Picard, was appointed to act as Visiting Medical Consultant for Tuberculosis to the St. Mary Abbot's Hospital and this new appointment has necessitated a weekly visit to that institution. Male Sanitary Inspectors.—Mr. G. M. Pettit, who had held the position of Chief Sanitary Inspector in the Borough with distinction for 24 years, retired from office on account of ill-health on the 31st March, 1923. On his retirement, the Council passed a resolution expressing their appreciation of the valuable work Mr. Pettit had performed in the Borough. It is with great regret that I have to record that his active and useful life came to a close on May 4th, 1924. Subsequent to Mr. Pettit's resignation, Mr. Henry Dawes was appointed Senior Sanitary Inspector, in accordance with the requirements of Section 7 of the Public Health (Officers) Act, 1921. Mr. Dawes remains the District Inspector of No. 10 District (Brompton area) and performs in his new position a few additional duties which, owing to their nature, cannot well be divided amongst the other Inspectors. For instance, he collects the necessary samples under the Rag Flock Act, and under the Milk (Special Designations) Order. The remaining duties hitherto performed by the Chief Sanitary Inspector have been divided up and allotted to the various District Inspectors. For the purposes of sanitary inspection the Borough is divided into ten districts, one of which is allotted to each of the ten male Sanitary Inspectors, who carry out duties under the Public Health Acts, the Housing Acts, 1890-1923, the Sale of Food and Drugs Acts, the London County Council (General Powers) Acts and, so far as men's factories and workshops are concerned, under the Factory and Workshops Act, 1901. Consequent on the Council's Special Housing Resolutions of January 11th, 1923, Mr. L. W. Burrell was appointed Temporary Sanitary Inspector, and commenced his duties on May 1st, 1923. This Inspector has been engaged in the inspection, measuring up, and registration of houses let in lodgings in the Golborne Ward and in issuing the necessary Public Health notices required to bring these houses up to the standard of habitability decided upon by the Council. 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. Clerical Staff.—As a resnlt of the increase of work thrown on the Public Health Department mainly in connection with tuberculosis, a fifth-class clerk was added to the staff on March 13th, 1923. There are now six clerks and a shorthand-typist. Other Staff.—There are:— (а) Four Disinfectors, including a man who acts as engineer. (b) A Mortuary Keeper. (c) A Sanitary Labourer who assists in drain testing. (d) A Superintendent and Matron of the 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. LEGAL PROCEEDINGS. Legal proceedings were instituted in 30 cases, particulars of which are summarised in the following list:— 59 Legal Proceedings under the Public Health (London) Act, 1891, Metropolis Local Management Act, and Housing, Town Planning, etc., Acts. 1890-1923, etc. Date. Name and Address of Defendant. Offence. Result. Jan. 2nd F. J. Bryant, 42, Coram Street. Failure to comply with the Magistrate's order in regard to 57, Southam Street. Fined £5. Feb. 20th E. W. Bowes, 78, Walmer Road. Failure to carry out sanitary repairs at 177, Kensal Road. Order made for work to be carried out within 28 days. Mar. 6th A. Hayden, Couchmore Farm, Long Ditton, Surrey. For removing offensive matter in an unsuitable carriage or vessel, on two days. Fined 20s. for each offence. „ „ J. Harman, 35, Earls Court Road. Failure to carry out sanitary repairs at 21, Cope Place. Order made for work to be carried out within 7 days. April 17th E. Jones, 138, Lancaster Road. Failure to carry out sanitary repairs at 11, St. Mark's Road. Order made for work to be carried out within 14 days. May 1st T. Myland, 9, Blenheim Terrace, St. John's Wood. Failure to carry out sanitary repairs at 35, Manchester Road. Order made for work to be carried out within 21 days. T. Pollard, 48,52 and 54, Richmond Road. Failure to comply with notice to strip and cleanse the walls and ceilings and to destroy the vermin at 1, Coleherne Mews. Fined £5. June 5th Mrs. L. M. Walker-Jones, 12, Campden Grove. For allowing a dog to deposit its excrement upon the public footway. Fined 5s. „ „ J. Gunsberg, 14a, Lunham Road, Upper Norwood. Failure to carry out sanitary repairs at 10,Colville Gardens. Order made for work to be carried out within 21 days. July 17th Mrs, M. M. Davey, 12, Prince of Wales Terrace. Failure to provide proper ashpit accommodation at 12, Prince of Wales Terrace. Summons withdrawn, work having been carried out. 99 99 J. Madden, 55, Bramley Road. Failure to carry out sanitary repairs at 25, Blechynden Street. Order made for work to be carried out within 7 days. „ „ Do. Failure to comply with by-laws for houses let in lodgings at 25, Blechynden Street. Fined 40s. „ „ Do. Failure to carry out sanitary repairs at 27, Blechynden Street. Order made for work to be carried out within 7 days. J uly 31st Do. Failure to comply with by-laws for houses let in longings at 27, Blechynden Street. Summons withdrawn, work having been carried out. Oct. 2nd The Misses Braggiotti, 10, Westgate Terrace. Failure to carry out cleansing works at 10, Westgate Terrace. Summons withdrawn, work having been carried out. 60 Date. Name and Address of Defendant. Offence. Result. Oct. 16th Mrs. M. Tunks, 31, Wallingford Avenue. Failure to carry out sanitary repairs at 215, Cornwall Road. Order made for work to be carried out within 28 days. „ „ T. Crosson, 38. Sydney Road, Richmond. Failure to carry out sanitary repairs at 1, Hurstway Street. Order made for work to be carried out within 28 days. „ „ H. Blundell, 78, Elderfield Road, Clapton. Failure to provide a proper supply of water to the upper storeys at 78, Silchester Road. Order made for work to be carried out within 28 days. Nov, 6th E. Cook & Co., Ltd., The Soapery, Bow. For removing offensive matter through the public streets during prohibited hours. Fined 40s. „ S. Skelton, 173, King's Road, N.W. Failure to comply with by-laws for houses let in lodgings at 2, Tottenham Street. Summons withdrawn, the work having been carried out. „ Do. Failure to carry out sanitary repairs at 2, Tottenham Street. Order made for work to be carried out within 21 days. „ J. Denyer, 8, Golborne Gardens. Failure to carry out sanitary repairs at 28, Hazelwood Crescent. Summons withdrawn, the work having been carried out. Dec. 4th Rider & Sons, 132, Ladbroke Grove. Failure to provide sufficient W.C. accommodation at 37, Blechynden Street. Fined 40s. „ 18th F. Campion, 29, Brook Green Road. Failing to provide a proper supply of water to the upper storeys at 32, Walmer Road. Order made for work to be carried out within 28 days. „ H. Sear, 11, Treverton Street. For unlawfully preventing the owner from complying with the provisions of the Public Health (London) Act, 1891. Order made for the Owner to be admitted. „ E. W. Bowes, 78, Walmer Road. Failure to carry out sanitary repairs at 69, Kensal Road. Order made for work to be carried out within 28 days. „ Do. Failure to comply with bylaws for houses let in lodgings at 69, Kensal Road. Fined 40s. „ Do. Failure to carry out sanitary repairs at 147, Kensal 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 147, Kensal Road. Fined 40s. „ Do. Failure to provide sufficient W.C. accommodation at 65, Kensal Road. Fined 20s. In addition to the above, there were issued under the Food and Drugs Acts 22 summonses, particulars of which are given on pages 42 to 44. 61 DISINFECTION. Bedding, clothing, etc., are disinfected at the Council's Disinfecting Station at Wood Lane by exposure to steam under a pressure varying between 15 and 20 lbs. above atmospheric pressure for fifteen minutes. Soiled linen is disinfected by boiling under a pressure of 10 lbs. above atmospheric pressure for ten minutes in a rotary washing machine. A formalin cupboard is used for the disinfection by formalin of leather, furs and other articles which cannot be exposed to high temperatures. Rooms vacated by persons suffering from infectious disease are disinfected by gaseous formaldehyde, which is generated by the volatilisation of paraform tablets, 20 tablets being used for each 1,000 cubic feet of room space. Verminous rooms are disinfected by the burning of 2 lbs. of sulphur for each 1,000 cubic feet. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1923. Nature of Infection. Premises Disinfected. Rooms Disinfected. Disinfections at Wood Lane. No. of Articles Disinfected. Scarlet Fever 215 297 213 3,460 Diphtheria 248 337 230 3,576 Enteric Fever 14 16 13 179 Measles 57 96 9 73 Consumption 120 186 138 1,621 Vermin 134 169 83 648 Other Diseases 211 252 248 2,668 Total 999 1,353 934 12,225 * This table does not include the work carried out at Wood Lane on behalf of the Paddington Borough Council. The total weight of the bedding, clothing, &c., of Kensington residents disinfected was 30 tons, 12 cwts. and 23 lbs. The number of articles disinfected was 11,480 and the number disinfected and washed, 745. In addition, the laundry work for the Medicinal Baths was performed at the Disinfecting Station; the number of articles washed was: Towels, 10,108; Sheets, 501; and Dressing Gowns and Blankets, 86. The disinfection of clothing, bedding, and other articles required in connection with infectious disease in Paddington has been carried out in the past on behalf of the Council of that Borough by a private firm of contractors. Early in 1923, the Paddington Medical Officer of Health found the contractor's machinery to be defective, and required certain improvements and repairs to be carried out. At the same time the Paddington Medical Officer interviewed me to ascertain whether the Kensington Borough Council could undertake to carry out disinfection of articles of clothing, etc., at the Council's Wood Lane Disinfecting Station during the carrying out of the necessary improvements and repairs by the Paddington contractors. I indicated that it was possible for the Kensington Authority to perform this work and having agreed upon the necessary arrangements with my colleague, to which the approval of the Public Health Committee and Council was given, the disinfection of Paddington articles at the Council's Wood Lane Disinfecting Station commenced in January, 1923, and continued throughout the whole year. The total weight of Paddington articles dealt with at Wood Lane during the year was 18 tons 17 cwt. 2 qrs. 15 lbs. and the Kensington Borough Council received £283 4s. 4d. in respect of this work. This amount represents a charge at the rate of 15s. per cwt. of articles disinfected, a sum agreed upon between the Paddington Medical Officer of Health and myself and approved by the Public Health and Finance Committees of both Authorities. The Paddington Authority have been responsible for the collection and removal of the articles to the Council's Wood Lane Station, and for the subsequent return of these articles to the homes in Paddington, the Kensington Authority merely carrying out the disinfection at the Station. The Paddington Authority, having decided not to enter into a further contract with the private firm which had hitherto carried out their work and having found that the work carried out by the Kensington Authority has been satisfactory, have now entered into an agreement with the Council for the disinfection of all articles removed from Paddington homes to be performed at the Kensington Station for a period of twelve months commencing April 1st, 1924, this period to be continued from time to time as may be agreed upon. As the Paddington Council require certain of the articles to be washed after disinfection, the charge is to be 20s. per cwt. of articles dealt with, but there is a proviso in the agreement that the minimum payment per annum shall be £700. 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. 62 Books from private subscribing libraries found in infected houses are dealt with as follows: (a) Books which have not been exposed to infection.—Disinfected by formalin vapour and returned to the subscriber. (b) Books which are believed to be infected.—A notification is sent to the Librarian. The holder is informed that the books will not be accepted at the Library and that they can be disinfected by formalin or destroyed at his option; he is advised that destruction is the only really safe method of dealing with the books but that this will only be carried out on the understanding that the Council will not pay compensation. The number of books from the Kensington Public Libraries destroyed during the year by the Officers of the Public Health Department was 41; the number of private library books destroyed was 18; and the number disinfected by formalin and returned to the householders was 16. VERMINOUS ROOMS CLEANSED BY LANDLORDS. Six hundred and eight verminous rooms were cleansed during the year in response to notices served under the powers conferred by the London County Council (General Powers) Acts, 1904 and 1922. 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, 695 new movable ash-bins of galvanised iron have been provided during the year, and 89 fixed ash-pits of brick have been abolished under the powers conferred by Section 23 of the London County Council (General Powers) Act, 1904. REFUSE REMOVAL FROM MEWS. The common dustbins installed by the Council in July, 1921, in 21 mewsways in North Kensington at the expense of the owners, have continued to prove a satisfactory arrangement for storing house refuse in these particular mews in which there are a number of dwellings, stables and costermongers' stores. The difficulty in dealing with refuse in these so-called "mixed mewsways" has not been entirely removed because, although the house refuse is provided for in separate bins, it is still a common practice to place trade refuse, especially decomposed fruit and vegetables, into the manure pits and crates, with the result that those persons who have contracted to remove the manure object to removing a mixture of manure and trade refuse, and those who are responsible for the removal of trade refuse object on the ground that it is mixed with stable manure. The remedy is to put a stop to the practice of the placing of trade refuse in manure pits and crates, but it is almost impossible to do this, particularly as there is no enactment or by-law under which offenders can be adequately dealt with. It is true that under Section 33 of the Public Health (London) Act, 1891, the Council are required to remove any trade refuse if called upon to do so by the owner or occupier, but they are entitled to claim a reasonable payment for carrying out this duty. In view of the charge the Council can make, the costermongers do not take advantage of this Section in securing removal of their refuse, but simply dump it in any convenient manure pit or crate. Owing to the refusal of the manure contractor to remove the manure when mixed with trade refuse and the difficulty of preventing the costermongers dumping their refuse in manure pits or crates, these receptacles often remain unemptied for long periods and considerable nuisance arises. The pits and crates become full and overflowing, and the refuse is littered over the mewsway owing to the activities of children and fowls. It will be seen that the site becomes an excellent breeding place for flies and a good foraging place for rats. With a view to remedying matters, steps have been taken throughout the year to prevent the inhabitants keeping hens and ducks in mewsways, and this action has resulted in some improvement- 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 Engiheer and then handed on to the Public Health Department. During the year 55 house drains have been reconstructed under notices served by the Sanitary Inspectors. 63 PUBLIC CONVENIENCES. The Council provide six public lavatories containing water-closets; two are for men only, and in four accommodation is provided for both sexes. In addition there are 12 urinals for men under the charge of the Council. In the women's lavatories there is free accommodation for those who are unable to pay. There are also conveniences for men and women at eleven railway stations in the Borough. The public-house urinals entered from the street and available to the public number 75. The public conveniences in the Borough have been regularly inspected during the year, those for women in stations and elsewhere having been kept under observation by the Women Health Officers. BACTERIOLOGICAL WORK. The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Gardens, S.W.1, for the bacteriological examination, at the expense of the Council, of specimens from Kensington cases sent to them by medical practitioners in regard to diphtheria, tuberculosis, typhoid fever, syphilis and other diseases. The examinations in 1923 were as follows:— Disease suspected. No. of examinations. No. of positive results. Diphtheria 559 79 Tuberculosis 140 22 Typhoid Fever 8 2 Gonorrhoea 6 2 Dysentery 3 — In addition to these examinations at the Lister Institute, 596 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. There are at the Public Baths, a Men's First Class Swimming Bath with a capacity of 120,000 gallons, a Women's First Class Swimming Bath with a capacity of 45,000 gallons, and a Second Class Men's Bath and Second Class Women's Bath each of which holds 45,000 gallons. The charge for admission to the First Class Baths is 8d.; 3d. is charged for admission to the Second Class Baths, children being admitted at half price. There are 13 Men's and 7 Women's First Class Slipper Baths and 34 Men's and 20 Women's Second Class Slipper Baths. The charge for a First Class Warm Slipper Bath is 8d., and for a Second Class, 3d., whilst the charges for a First Class Cold Slipper Bath and for a Second Class Cold Slipper Bath are 4d. and l½d. respectively. There are 6 special Warm Baths for the use of which a charge of 1/- is made. The number of bathers using the Swimming Baths and Slipper Baths in the last five years is shown in the following table:— Year. Bathers. 1919 259,200 1920 319,991 1921 292,464 1922 245,374 1923 251,069 In the Wash-house or Laundry Department, there were 90 wash-tubs in use in 1923. In order to prevent the wash-tubs being used by professional laundry-women, to the exclusion of women doing their own family washing, the charges were amended during the year. The revised prices to be paid by a user of a wash-tub are as follows:— 2d. for each of the first four hours on any one day. 4d. for the fifth hour on any one day, and 6d. for the sixth and every succeeding hour on any one day. The number of women using the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1919 82,002 1920 88,207 1921 103,207 1922 100,546 1923 110,252 64 MORTUARY AND CHAPEL OF REST. During the year 86 bodies were deposited in the Public Mortuary under the following circumstances:— At the request of relatives or friends of the deceased 50 At the request of undertakers 14 By the Police 22 86 In 28 cases, post-mortem examinations were made under the Coroner's warrant. Thirty-one bodies were deposited in the Chapel of Rest, Avondale Park. RAG FLOCK ACT, 1911. Four samples of rag flock were analysed and reported on during the year. They contained 29, 18.75, 17.5 and 15 parts of chlorine per 100,000, the limit set by the Regulations being 30 parts. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-23. Under Section 2 of the Rent and Mortgage Interest (Restrictions) Act of 1920, 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 Council or otherwise that his application is well founded. Section 5 of an amending Act passed on the 31st July, 1923, provides that where the tenant has obtained from the Council a certificate that the house is not in a reasonable state of repair and has served a copy of the certificate upon the landlord, production of such certificate shall be a good defence to any claim against him for the payment of the 40 per cent, increase of rent permitted under the 1920 Act. Section 18 of the 1923 Act provides that for the purposes of the Act of 1920 the certificate of the Council as to the condition of a dwelling-house shall specify what works require to be executed in order to put the dwelling-house into a reasonable state of repair, and that on any application being made to the Council for such a certificate or report, a fee of one shilling shall be payable. Applications made to the Council in 1920 for certificates totalled 10 and the number granted was 2. The figures for 1921 were 42 applications and 21 certificates granted; for 1922, 19 applications and 9 certificates granted ; and for 1923, 38 applications and 17 certificates granted. This comparative failure by tenants to attempt to make use of these provisions of the Acts is probably due mainly 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. 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 cleansing of verminous persons is carried out at the Medicinal Baths, Blechynden Mews. The building was specially constructed for the work and consists of a Waiting Room, a Shampoo Room, three Bath Rooms, three Dressing Rooms, and a Disinfecting Room with a very efficient high pressure steam disinfector. 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. 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. 65 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 Officer of Health of the Borough 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. By an agreement entered into with the Paddington Borough Council, the cleansing at the Medicinal Baths of residents of that Borough commenced on January 1st, 1924. The agreement gives an indemnity to the Council of the Royal Borough similar to that given by the Hammersmith and Fulham Authorities. The record of work done at the Medicinal Baths during the year is as follows:— Total Cleansings. Scabies— Adults 117 Schoolchildren 308 Children under five years 30 Verminous Conditions:— Adults 36 Schoolchildren 3,418 Children under five years 1 Other Conditions— Adults 1 Schoolchildren 7 Children under five years Total 3,918 The high pressure steam disinfector at the Medicinal Baths is proving of great value, and an attempt is being made to disinfect as much clothing and bed linen as possible during the personal cleansings, in order to obviate, as far as possible, re-infection of persons cleansed on return to their homes. In addition to the disinfection of the clothing worn by persons on their visit to the Medicinal Baths, 836 other articles of clothing, 501 sheets, 86 Blankets, and certain other articles have been dealt with. The work carried out at the Medicinal Baths is most encouraging in its results, the marked improvement in the general condition of the children being sent from the schools for cleansing being easily noticeable as compared with conditions several years ago. At the 3,418 cleansings, only 87 children were found to be infested with lice, the remainder showing only eggs of lice on their heads or clothing. FOULING OF FOOTPATHS BY DOGS. Towards the end of 1921, the Council succeeded in obtaining the approval of the following By-law for the good rule and government of the Royal Borough:— "No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. "Any person offending against this by-law shall be liable to a penalty not exceeding 40s. "This by-law shall cease to be in force after 31st day of December, 1923, unless a by-law confirming and continuing its provisions has been duly made and come into force before that date." This by-law was made in pursuance of Section 23 of the Municipal Corporations Act, 1882, Section 16 of the Local Government Act, 1888, and Section 5 of the London Government Act, 1889. It will be noticed that the by-law was intended to lapse after an interval of two years, namely, on the 31st December, 1923, unless a further by-law had been made and had come into operation before that date. In view of this time limit, the Council, being satisfied from their experience that this measure had proved useful, made another by-law on the 31st July, 1923, in terms identical with the first one with the exception that the paragraph giving a time limit was omitted. This new by-law was sanctioned in due course by the Home Secretary, and the Council have now a permanent measure by which they can secure a considerable improvement in the cleanliness of the public footways. The Council have issued pamphlets which have been posted in various places in the Borough and delivered by hand to a large number of dog owners. The matter has also received notice in the local press. Two officers of the Council's Public Health Department make observations and during 1923 they reported four breaches of the by-law to the Public Health Committee. In two cases a 66 warning was issued, and in the other two, summonses were taken out. The Magistrates convicted and imposed a fine of 5s. in the first case, and in the second case the summons could not be served owing to the fact that the offender had given a false name and address to the Council's officer. There is no doubt that the condition of foot pavements has improved considerably since the by-law came into operation. 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 Committee, and each Sanitary Inspector makes inspections in his district for the purpose of detecting rat-infested premises and reports to the Medical Officer of Health cases in which the occupiers are not taking all practical steps to destroy the rats or to prevent their premises becoming infested. A Rat Officer is employed at a wage of £4 per week to assist in the work of rat destruction under the supervision of the Sanitary Inspectors. He has carried out good work during the year as is evidenced by the following table:— Number of individual Premises visited by the Rat Officer on receipt of complaint 350 Total number of visits paid 2,436 Number of Poison Baits laid during the year 37,940 „ „ disappeared 35,440 „ ,, removed by the Rat Officer 2,500 Number of premises where concreting of basement floors has been carried out under the direction of Sanitary Inspectors to prevent ingress of rats 25 Number of premises where other repairs have been carried out under the direction of Sanitary Inspectors to prevent the ingress of rats 44 Number of sewer defects allowing egress of rats made good 15 Number of Statutory Notices served under the Rats and Mice (Destruction) Act, 1919 10 Number of premises cleared of rats 263 Barium Carbonate has been the poison in general use, but in a few cases Extract of Squills has been tried. Each bait contains sufficient poison to kill one rat, and is made up to about the size of a lump of sugar by adding meal, flour, fat and other ingredients known to be attractive to rodent vermin. The laying and removing of baits and the giving of advice occupies a good deal of the Rat Officer's time, but the simple poisoning of rats would be of little practical value unless the means of ingress to premises were dealt with, therefore this Officer supplements the work of Sanitary Inspectors in searching for rat inlets and also helps them in inducing occupiers to concrete rat holes, basement floors, etc. From the above table it will be seen that a considerable amount of concreting and other repair work has been carried out for the purpose of preventing rats obtaining an entrance to premises, and it may be mentioned that on 33 occasions during the year the foot pavement was taken up in various parts of the Borough in order to destroy rat runs and nests underneath. It is not an uncommon experience to find that rats make their way through defects in sewers, particularly the old brick sewers, to the under side of the foot pavement. Owing to the warmth derived from the sun's rays striking down on the pavement, this position appears to be favourable for nesting purposes. In addition to being warm, the position is one where the rats are not likely to be disturbed whilst rearing their young. From their runs and nests immediately underneath the foot pavement, the rats, in order to obtain food, make their way into the basements of neighbouring houses and shops 67 through holes in walls below the ground level which have been made for conveying gas or water pipes or electric mains into the buildings. These holes are not always concreted or cemented up when the pipes have been laid and the rats are able to bore through between the pipes and the brickwork. The 33 discovered instances during the past year of this system of life amongst rats in various parts of North and South Kensington indicate the importance of thoroughly closing up all holes which may be made below the ground level in the walls of houses and business premises. In each instance the removal of the rat runs and cementing of these holes have removed the trouble. In many cases, rats have been found to gain access to buildings through broken ventilating gratings in walls below the ground floor level. The renewal of the defective grating, together with the laying of a few poison baits, removes the trouble. Premises adjacent to railway lines often suffer severely from rat infestation and much attention has been given during the past year to complaints in several roads adjoining railways, particularly Warwick Road, Blechynden Street, Silchester Road and Walmer Road. The Council's Wood Lane Depot and the Lots Road and Kensal Road Wharves have received constant attention, with the result that the number of rats caught at these places has been reduced to less than half the numbers caught several years ago. Sewer men in the Borough Engineer's Department, on completing work at manhole entrances, make a practice of leaving a number of baits on ledges above the level of the water in the sewers. During the National Rat Week Campaign, held in November, the Borough Surveyor placed at my disposal a gang of flushers, who laid 12,000 poison baits at a large number of manhole entrances. A lantern slide, stressing the importance of rat destruction and indicating that advice thereon could be obtained at the Town Hall, was shown at each performance at various Cinematograph Theatres in the Borough during Rat Week. Of the two common kinds of rats, the brown variety is the one more commonly found in this Borough, the black rat having been discovered on only two occasions since 1920. It is the latter which is the more likely to spread disease and it is thus fortunate that such trouble as does arise is almost invariably due to the less dangerous variety. HOUSING OF THE WORKING CLASSES. DENSITY OF POPULATION IN LONDON, KENSINGTON AND THE VARIOUS DISTRICTS OF THE BOROUGH AT THE 1921 CENSUS. Area in statute acres Total Population. Persons per acre. * Residential area in acres. 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 Wards. St. Charles 401 24.268 10,836 13,432 61 140 173 Golborne 113 26,329 12,718 13,611 233 72 366 Norland 195 22,106 9,922 12,184 113 142 156 Pembridge 193 19,969 7,775 12,194 103 145 138 Holland 484 18,874 6,087 12,787 39 283 67 Earl's Court 244 17,912 5,997 11,915 73 163 110 Queen's Gate 173 13,777 4,145 9,632 80 118 117 Redcliffe 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 total area less (1) roads, (2) open spaces, and (3) land covered by buildings other than dwellings. 68 PRIVATE FAMILIES AND DWELLINGS AT THE 1921 CENSUS. Private Families. Population in Private Families. Structurally Separate Dwellings Occupied. Rooms Occupied. Per sons perRoom. 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 Redcliffe 4,985 17,423 3,477 28.047 0.62 Brompton 2,610 10,381 2,267 18,351 0.57 DEFINITIONS OF TERMS USED IN THE ABOVE TABLE. Private Family.—Any person or group of persons in separate occupation of any premises or part of premises is treated as a separate family, lodgers being so treated only when returned as boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) Institutions, or (ii) Business establishments or boarding-houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwellings.—A structurally separate dwelling is defined as any room or set of rooms, intended or used for habitation, having separate 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 bouse has been subdivided into maisonettes or portions, each having its front door opening on to the street or on to a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Where an undivided private house is used partly for business or professional purposes, it is treated as occupied by a private family unless the portion used for non-domestic purposes consists of at least three rooms and is more than one quarter of the whole. The dwellings shown in this Table are those occupied by private families only. Rooms.—The rooms enumerated are the usual living rooms including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms, or any warehouse, office, or shop rooms. HOUSING ACCOMMODATION PROVIDED BY THE COUNCIL BEFORE THE WAR. The number of tenements for the working classes provided, prior to the War, by the Council under the Housing Acts, is shown in the following Table:— Rooms in Tenement Number of Tenements. Rent per Week. 1 26 3/5 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 8 and contain accommodation for 416 persons. Ward Name of Keeper Address of Common Lodging House No. of Lodgers for which licensed in 1928. 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, Mark 66, St. Ann's Road 66 — 66 „ Rusha, Alfred 34 & 36, Sirdar Road - 45 45 Totals 195 221 416 69 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. Of the 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 purpose. 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 rooms, and special powers for the control of such houses are needed. Dr. Barnardo's Home for Women at No. 12, Penzance Place was discontinued as a common lodging house in August, 1923, and is now used as a workplace by the Church Army under the title of "Disabled Ex-service Men's Industries." This Home did not come within the strict definition of a common lodging house, inasmuch as lodgers therein were not asked for payment, but Dr. Barnardo's Association voluntarily submitted an application for a license each year. On the instructions of the Public Health Committee, I made an inspection of the Women's Common Lodging Houses in Kensington in December, 1922, and after receiving rny report, the Council directed me to appear before the County Council at the annual Licensing Meeting in June to oppose the re-licensing of the Common Lodging House situated at Nos. 34, and 36, Sirdar Road. Certain alterations had been effected subsequent to my inspection and, on Counsel for the owner of the Common Lodging House promising other improvements, the County Council renewed the license conditionally on these being carried out. 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, 6, or perhaps even 7 families. it is impossible to estimate the population living in these tenement houses, but, at a low estimate, it is certainly not less than 55,000. Conditions arising from the War, including the high cost of repairs and labour, nave 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. In order to impress upon the County Council the urgent 70 need of new by-laws under Section 26, a deputation from the Borough Council appeared before the County Council's Public Health Committee in February, 1923. The number of houses let in lodgings on the Council's Register at the end of the year was 2,428, 269 houses having been added during the preceding twelve months. 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 1923 numbered 7,903. The owners of fourteen of these houses were summoned for breaches of the lodging house by-laws, or for failure to carry out sanitary works required by the Council. Houses Let in Furnished Rooms.--Of the 2,428 lodging houses on the Council's Register, 89 were in 1923 let in furnished rooms, the average rent charged being at the rate of 7/- per week per room. The following figures show the number of houses let in-furnished rooms in the different parts of the Borough. Norland Ward 52 St. Charles Ward 14 Pembridge Ward 11 Golborne Ward 12 Other Wards 0 89 These houses constitute the most unsatisfactory and undesirable form of housing accommodation and it is therefore very pleasing to note that the number of dwellings of this type in the Borough is gradually diminishing. In 1912 there were 187, no less than 103 being in the Notting Dale area. In 1920 the number in the Borough was 101; in 1921 and 1922, 95; and in 1923, 89. The total number of inspections of these houses in 1923 was 1410. RETURN OF BASEMENT DWELLINGS IN THE BOROUGH, IN NORTH AND SOUTH KENSINGTON AND IN THE SEVERAL WARDS. No. of basements used for dwelling purposes. No. of basement dwellings with ceilings at or below street level. No. of basement dwellings in which the width of the front area does not exceed 3 feet. No. of basement dwellings in which the width of the front area exceeds 3 feet and does not exceed 4 feet. The Borough - 13,095 684 1,233 2,087 North Kensington 5,180 338 689 855 South Kensington 7,915 346 544 1,232 Wards. St. Charles 1,212 33 150 181 Golborne 1,155 88 26 43 Norland 1,394 123 330 474 Pembridge 1,419 94 183 157 Holland 1,618 134 26 72 Earl's Court 1,863 121 65 28 Queen's Gate 1,071 13 96 95 Redcliffe 1,949 63 148 175 Brompton 1,414 15 209 862 HOUSE REPAIRS AND IMPROVEMENTS IN HOUSING CONDITIONS. No subject has occupied more of the time and attention of the Public Health Committee during the past year than that of house repair and improvement of existing housing accommodation. This difficult problem has also received a considerable amount of attention by the Council and by various organisations interested in the Borough. It is well known that during the War and for some time after its termination, the cessation of building operations by private individuals and the prohibitive cost of material and labour combined to bring about a position, as regards the number of persons occupying tenement houses and the state of repair in which these houses were kept, which the Council were practically powerless to remedy substantially. 71 In the latter months of 1923, it was fell that the time had arrived when, in view of the reduction in the cost of works of reparation, the Council might reasonably proceed to institute more active measures, and they considered what further steps they could take to improve the standard of housing conditions, particularly in regard to houses let in lodgings. A Sub-Committee of the Public Health Committee was appointed and, as a result of their enquiries and deliberations, a Special Council Meeting was called for January 11th, 1923. At this Meeting a series of resolutions, embodied in the report of the Sub-Committee, were approved by the Council. It was then generally agreed that the scheme of work outlined in these resolutions would, if systematically carried out, materially improve the conditions existing in a large number of the tenement houses in the poorer parts of the Borough. The Council will expect the work of the past year, in pursuance of the policy laid down by them in January, 1923, to be set out fully in this report and, therefore, I propose to quote the resolutions seriatim and to state what has been achieved in regard to each. RESOLUTION "A."—That a specified minimum (say not less than 400) of "tenement houses," or houses intended for the working classes which are let in lodgings or oclupied by members of more than one family, be registered annually. RESOLUTION "B."—That a temporary Sanitary Inspector be engaged to enable the inspection, measuring, etc., of the houses proposed to be placed on the register to be carried out. The Council proceeded to appoint a Temporary Sanitary Inspector, and the sanction thereto having been obtained from the Minister of Health, the officer appointed commenced work on May 1st, 1923. By the end of the year, 236 houses in the Golborne Ward had been inspected and measured by the Temporary Inspector and placed on the Council's Register of Houses Let in Lodgings* The total number of houses inspected by this officer was 242, but owing to the conditions of occupation the Public Health Committee decided not to recommend registration of six. The number of visits paid by the Temporary Inspector to these houses was 967. The drains were tested in every case and 21 notices were served in respect of the defects found. Nine of the houses inspected did not possess one W.C. apartment for every 12 occupants, as required by the County Council's by-laws, and notices were served calling for additional accommodation in each case. In 31 cases where the only water tap was in the basement, an additional supply was required under Section 78 of the London County Council (General Powers) Act, 1907. In addition to the defects mentioned above, many houses were found to have dirty and defective ceilings and walls, defective roofs, dampness, and other common defects. The Sanitary Notices served in respect of the defects found in the 242 houses dealt with by the Temporary inspector were as follows:— Intimation Notices 278 Statutory Notices 45 Final Notices 11 By the end of the year, 52 of these houses had been brought up to the highest possible standard which can be enforced under the Public Health Act and the By-laws made thereunder, and were transferred from the care of the Temporary Sanitary Inspector to the Inspector in charge of the District. In all other cases the work of repair was in progress at the end of the year, and at the present time (May, 1924) practically all the repairs required have been completed. It is pleasing to be able to report that the work called for in the 278 intimation notices served by the Temporary Inspector has been carried out so satisfactorily that in only two cases has it been found necessary to issue summonses. RESOLUTION "C."—That the landlord or owner of any tenement house or house let in lodgings be required to provide and maintain, in connection with such house, water closet accommodation in the proportion of not less than one water closet for every twelve persons. (By-law 26 made by the London County Council under the Public Health (London) Act, 1891). RESOLUTION "D."—That a proper and sufficient provision for the supply of water for domestic purposes be required on the upper storeys of tenement houses. (London County Council (General Powers) Act, 1907, Section 78). RESOLUTION "E."—That the regulations prescribed by the Council with regard to underground rooms be strictly enforced. These Resolutions do not apply only to those houses in the area being dealt with by the Temporary Sanitary Inspector, but to the Borough generally. It was not possible for the requirements to be enforced forthwith in all houses in the Borough, and it was, therefore, necessary to decide upon a scheme of work to be followed by the staff of the Public Health Department with a view to securing, in the most effective manner possible, the wishes of the Council. •At the time of writing this report (May, 1924) the Temporary Inspector has completed twelve months' work and I am able to record that the total of 400 per annum, suggested in Resolution "A," has been exceeded. 72 On January 30th, 1923, submitted a report to the Public Health Committee which stated what special housing work the staff could carry out without seriously interfering with their normal duties. It was pointed out that each Inspector ordinarily spends a large amount of time on housing work; he inspects registered houses let in lodgings once a year as far as possible; re-inspections are frequently made; he attends to complaints and also undertakes routine inspections of both registered and unregistered houses under the Housing and Public Health Acts. The report expressed the opinion that in addition to continuing his ordinary housing duties and his other work, each Inspector could inspect ten tenement houses per month and serve the necessary notices with a view to bringing such houses up to the standard prescribed by the Council. The report suggested that the houses for examination should be selected in a definite order, the streets in the Borough being taken in alphabetical order and the houses in these streets in numerical order. This report having been adopted by the Public Health Committee, the work of inspecting these ten houses per month was commenced by each Inspector in the month of February. The following table shows the number of houses let in lodgings on the Council's Register at the commencement of the year, the number of these houses specially inspected by the ten District Sanitary Inspectors with a view to bringing them up to the standard fixed at the commencement of the year, and some of the main requirements called for in notices served as a result of the inspections. District No. of houses on Register at commencement of year No. of houses inspected in accordance with Council's Resolutions of Jan. 11th, 1923 Particulars of notices served Additional W.C. accommodation required Installation of supply of water on upper storey Cleansing General repairs 1 246 101 5 21 71 25 2 359 125 3 20 108 108 3 250 102 3 34 33 19 4 244 106 3 54 69 78 5 196 98 1 1 66 47 6 36 35 4 1 20 18 7 336 116 — 57 73 18 8 167 107 2 40 26 42 9 298 85 — 16 44 28 10 37 37 1 8 28 37 2,169 912 22 252 538 420 The number of underground rooms inspected by the ten District Sanitary I nspectors was 358, and the number reported to the Public Health Committee for closure under the Council's Regulations was 20. In eleven cases, the owners made the necessary alterations immediately. Closing Orders were issued in nine cases, and, in all but one, alterations were effected by the owner to make the rooms comply with the Council's Regulations. In this one case the Closing Order became effective. These inspections under the heading of Resolutions " C," "D," and "E," do not include any of those carried out by the Temporary Inspector referred to under Resolutions " A " and " B. " RESOLUTION " F."—That Closing Orders under Section 17 (2) of the Housing, Town Planning, etc., Act, 1909, be made where necessary. The Council made Closing Orders in respect of three houses. In one case the house is now unoccupied, and legal proceedings between the freeholder and the leaseholder are pending; in the other two cases, the houses were purchased by the Improved Tenements Association, Ltd., and will shortly be put into a good state of repair. There were other houses in respect of which Closing Orders might reasonably have been served in normal times, but in view of the absence of alternative accommodation, the Council endeavoured with a fair amount of success to secure habitable conditions for the occupants by the use of Section 28 of the Housing Act of 1919. RESOLUTION " G."—That the London County Council, and, if necessary, the Minister of Health, be asked to receive a deputation, consisting of our Chairman (Councillor Miss Keeling), our Vice-Chairman (Councillor Dr. Robinson), and Councillor Brooke-Little, with the Medical Officer of Health, on the subject of the delay in issuing the pro-posed by-laws of the London County Council under Section 26 of the Housing, Town Pfenning, etc., Act, 1919, for houses let in lodgings or occupied by members oi more than one family. 73 The deputation referred to in the Reso ut on was received by the Public Health Committee of the County Council in February, 1923, when Councillor Miss Keeling, supported by the other members mentioned, submitted a carefully prepared argument showing that present legislation is not sufficient to enable the Council to deal adequately with houses let in lodgings and that the issue of the new code of by-laws foreshadowed in Section 26 of the 1919 Housing Act is urgently needed for the purpose of preventing further depreciation in this class of housing accommodation. The County Council have now adopted a series of new by-laws under the above-mentioned Section, and it is proposed to forward these to the Minister of Health for his approval after the various Metropolitan Borough Councils have submitted their observations thereon. It may be mentioned that the Housing Act of 1919 provided that by-laws for houses let in lodgings made under Section 26 of that Act, would apply to the whole area of the Administrative County of London, but Section 14 of the 1923 Housing Act empowers the County Council to make the by-laws applicable to individual boroughs or parts of boroughs. RESOLUTION " H."—That renewed representations be made to the Minister of Health and the London County Council urging that this Council should be em-powered to license annually such registered houses as are wholly or partially let in furnished rooms. A letter was addressed to the Minister of Health in March, 1923, reminding him that representations were made by the Council to the President of the Local Government Board in 1912 in favour of legislation being promoted to provide for the annual licensing of houses let in furnished rooms, and intimating that the Council were still of the opinion that such power is needed in order to enable the Council to exercise satisfactory control over these houses. No reply has been received to this communication. RESOLUTION " I."—That Section 28 of the Housing, Town Planning, etc., Act, 1919, be put in force wherever the Public Health Committee advise that specified premises are suitable to be dealt with under that Section. Section 28 of the Housing, Town Planning, etc., Act, 1919, has not been applied extensively by the Council in the past. Notices under this Section have been served in respect of 85 premises, the notices in 54 cases being issued prior to December 31st, 1922, and in the other 31 cases during the year 1923. The results of action taken are as follows:— No. of houses in respect of which Section 28 notices have been served 85 No. of houses in which the repairs have been carried out by the owner 32 No. of houses in which the Council have carried out the work in default of the owner 5 No. of houses in which repairs have been partially carried out by the owner at the time of writing (May, 1924) 14 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, 1891, and the by-laws thereunder in order to secure the execution of the works originally embodied in the Section 28 notices. Amendments to Section 28, made by the Housing Act of 1923, remove many of the difficulties which previously made the Section almost impossible to enforce. These amendments, together with the money voted by the Council for improvement purposes, should help considerably towards securing satisfactory housing conditions in the future. RESOLUTION "J."—That a sum be provided in next year's Estimates to defray the cost of works of repair to be carried out to properties under Section 28 of the Housing, Town Planning, etc., Act, 1919, the amounts expended being recoverable as a charge on the said properties. Subsequent to the passing of this Resolution, the Council provided in their estimates for the financial year commencing April 1st, 1923, the sum of £5,000 for the purpose indicated in the Resolution, and of this amount £303 has been spent during the year. In two of the five houses repaired at the expense of the Council, the latter are collecting rents and managing the property; in one case the owner has entered into an agreement to repay the Council by a series of monthly instalments of £2 each; and in the remaining two the method of repayment has not yet been settled. During the year the Council recovered £88 of their expenditure. The actual amount of money spent has been small, but the results following the provision of the £5,000 have been large. This ±'5,000 in reserve has enabled the Council to induce the owners of derelict property to carry out their responsibilities. Without this sum ready to hand in the case of the refusal on the part of the owners to comply with the notices served by the Sanitary Inspectors, the Council could not have achieved that success which has attended their efforts in pressing owners to put their poor class property into a habitable state of repair. There is no doubt that the actual expenditure of money in the repair of their property by owners, as a result of the Council's policy, is many times greater than the £5,000 which the Council might have spent. 74 RESOLUTION "K."—That a sum be provided during the next financial year either from capital or revenue tor acquiring and reconstructing houses under Part III. of the Housinng Act, 1890, in such cases as the Council may approve. At the Special Estimates Meeting of the Council in 1923, the sum of £5,000 was provided for the purpose of acquiring and reconstructing houses in accordance with this Resolution, but at the end of the year 1923 there had been no expenditure under this heading. In the first three months of 1924, which are included in the financial year for which the £5,000 was provided, the Council resolved to purchase, for the purposes indicated in this Resolution, one house, eighteen flats with spare land adjoining, and two buildings partially converted into six flats. All the property purchased is freehold, and the total cost is about £1,600. The Council have negotiated for a number of other houses, but the reason that purchase was not completed appears in the notes under Resolution ".M." RESOLUTION " L:"—That a specific area be selected by the Public Health C ommittee as the area to be dealt with comprehensively in the first instance, and that every house in the selected area be dealt with as far as may be necessary and practicable. The specific area dealt with in the first instance was that part of the Golborne Ward north of the Great Western railway line, and by the end of the year every house occupied by members of more than one family in that district had been placed on the Council's Register of Houses Let in Lodgings. At the present time there remain in that area not more than fifty houses unregistered, these being occupied by one family in each. This area received the attention of the Inspector of the district throughout the year, and the Temporary Inspector was engaged in it from May 1st to December 31st. The number of Sanitary Notices served by these two Inspectors during 1923 was as follows:— Intimation Notices 731 Statutory Notices 172 Final Notices 43 Summonses 10 The following table shows, as far as can be set out in tabular form, the improvements resulting from the issue of the notices. Houses cleansed 272 House Drains re-constructed 6 Defective Drains repaired 13 House Drains cleansed 64 Water Closets constructed, repaired, &c. 165 „ „ supplied with water 10 „ „ new provided 2 Soil-pipes, ventilated, repaired, &c. 14 „ new provided 4 Cisterns cleaned, covered, &c. 47 Yards, areas paved, drained, repaired 140 Dustbins provided 160 Ashpits abolished 28 Accumulations of filth, &c., removed - 78 Animals removed 22 Overcrowding abated 16 Underground Rooms, illegal occupation discontinued 2 Roofs repaired 134 Houses provided with water above basement floor 48 Dampness in Dwellings remedied 99 Other sanitary improvements 453 The general sanitary condition of this particular district has shewn considerable improvement and the effect of the activity of the Council's staff is apparent in many houses which have been reclaimed from the almost uninhabitable condition into which they had drifted during the War period. There remain in the district only three unoccupied houses. One of these was closed by order of the Council during the year, and the other two, which have been derelict for some time, have been recently purchased by the Council. Much has been accomplished in this poor area, but it now becomes the task of the officers of the Council to maintain and improve the standard which has been reached. This will involve a large amount of painstaking work. RESOLUTION " M."—That the Council do co-operate, as far as possible, through the Medical Officer of Health and otherwise, with the Improved Tenements Association, or any similar public society whose objects include the improvement of housing conditions. 75 It is beyond dispute that the Council's ownership and management of a number of houses and tenements in the Notting Dale area during the present century has helped in the social improvements which have taken place in that district, but the Public Health Committee recognise that there are many objections to the local authority of any area becoming property owners on a large scale and they have not felt disposed to acquire neglected and dilapidated houses except in cases where the dwellings could not be placed in good ownership by any other plan. A number of houses in a bad state of repair as a result of mismanagement and neglect came to the notice of the Committee in 1923, and in some of these, where experience has shown that there were no prospects of the owners making any serious attempt to improve conditions, the houses were brought to the notice of the Improved Tenements Association, Limited, or the Wilsham Housing Trust, with a suggestion that the question of purchase might be considered. The Improved Tenements Association, Limited, are a small company established in 1900 for the acquisition of house property—freehold and leasehold—in certain poorer parts of the Borough with the object of providing better housing of the working classes by:— (a) not allowing over-crowding in the houses purchased, and (b) keeping the houses in good sanitary and structural repair. The Directors, Secretary and Treasurer give their services without remuneration. An average dividend of 3 per cent, has been paid since the inauguration of the Association. Prior to 1923, the properties bought and placed under improved management were:— 17 Freehold Houses in Princes Road, 1 Leasehold House in Silchester Terrace, 4 „ „ in Walmer Road, 4 „ Houses in Mersey Street, 3 Leasehold „ in „ „ and 2 „ „ in Wilsham Street. 31 houses in all. The Association have expressed their desire to acquire more property in poorer parts of the Borough, and thus to take an active part in raising the standard of living in districts where the conditions are not satisfactory. Their purchases in 1923 included three derelict houses in Southam Street, two groups of houses in Sirdar Road, and a corner block of five houses at the junction of Bangor Street and Sirdar Road, and they have recently decided to acquire a further twelve houses in the Notting Dale area. The Wilsham Housing Trust, an organisation established to carry on the excellent work performed by Dr. Schuster in the Notting Dale area, have, in addition to making other housing improvements, bought four houses brought to their notice by the Council. These purchases, which will secure considerable improvement in the housing conditions in the districts in which the properties are situated, have solved housing difficulties which confronted the Council. The purchases by the Council, to which reference is made in the notes under Resolution "K," were not decided upon until both the organisations above mentioned had indicated that they were not prepared to acquire the properties. It will be seen that the co-operation sanctioned in the Resolution has been satisfactory in that a considerable amount of very poor class property, much of which was under very bad management, has been placed under satisfactory ownership without the Council being called upon to incur a heavy capital expenditure. RESOLUTION " N."—That.any properties coming into the possession or care of the Council as a result of action taken by them under any of these recommendations be managed on the " Octavia Hill " system. All properties purchased by the Improved Tenements Association, Limited, and the Wilsham Housing Trust are placed under the "Octavia Hill" system, and very satisfactory improvements have resulted in the cleanliness and tidiness of the houses. No special arrangements have been as yet made by the Council for the management of the houses which they have recently decided to acquire. RESOLUTION " O."—That, with a view to obviating any avoidable delay in the service of statutory notices, particulars of any such notices of an urgent nature be submitted to the Public Health Committee fortnightly. With the exception of the usual vacations and on one or two other occasions, the Public Health Committee have met fortnightly throughout the year, and they have established a Public Health (Defective Houses) Sub-Committee under the chairmanship of Mr. Councillor BrookeLittle for the purpose of dealing with many housing questions which have called for detailed consideration. 76 General Observations. The effort made by the Public Health Committee to comply with the Council's Resolutions of January 11th, 1923, which has been outlined above, will, I hope, be considered satisfactory. It may be regarded as work which is mainly an addition to the normal work carried on in previous years and does not indicate the full measure of improvement in housing conditions which has been effected. During the year the ten district Sanitary Inspectors spent a considerable proportion of their time on housing duties and, indeed, in various directions not covered by the Council's Resolutions, very active steps have been taken with a view to securing remedies for defects discovered. It will, therefore, be useful to give a general summary of all the housing work carried out in the year by the officers of the Public Health Department. The Sanitary Inspectors inspected 6,112 individual houses, and the total number of visits paid was 27,006. In 1,238 instances the houses were subjected to a detailed survey under the Housing (Inspection of District) Regulations, 1910. The 2,428 houses let in lodgings in the Council's Register at the end of the year 1923, had been visited on 7,903 occasions. The issue of notices resulted in the general cleansing of 1,005 houses. Four hundred and thirty-five underground rooms were surveyed, and 20 were reported to the Public Health Committee for closure. Orders were issued in 9 cases. Three thousand and eighty-three of the houses visited were found not to be in all respects reasonably fit for habitation. In many cases the defects were of a simple nature and easily remedied, but in a large number the repair works required were extensive in character. In 173 cases the necessary repairs were carried out on verbal representations being made to the owner, but notices were served under the Public Health and Housing Acts in regard to 2,910 houses. Some indication of the results of the Inspector's efforts, supported as they were by the Public Health Committee and the Council, may be gathered from the fact that in no fewer than 2,733 instances the defects were remedied during the year or in the early part of 1924. A pleasing feature of the year's work has been the very small number of objections raised by those on whom notices have been served, and I think owners generally may be congratulated on having given comparatively little trouble by complying expeditiously with the Council's requirements. Possibly as a result of the Council's present policy, many owners of working class property have carried out a considerable amount of repair work voluntarily before the houses came under official inspection. The following is a tabulation of the principal improvements secured during the year as a result of the issue of notices under the Public Health Acts :— Houses cleansed 1005 House drains reconstructed 55 Defective drains repaired 126 House drains cleansed 378 Water-closets constructed, repaired, etc. 567 Do. supplied with water 306 Do. new provided 69 Soil-pipes ventilated, repaired, etc. 115 Do. new provided 47 Cistern cleaned, covered, etc. 223 Yards, areas paved, drained, repaired 381 Dustbins provided 695 Ashpits abolished 89 Accumulations of filth, &c., removed 281 Animals removed 53 Overcrowding abated 31 Underground rooms, illegal occupation discontinued 20 Roofs repaired 657 Houses provided with water above basement floor 203 Dampness in dwellings remedied 314 Other important repairs 1338 (These figures include those given in the table under Resolution " L.") In taking stock of the volume of housing work performed by the Sanitary Inspectors, it must be borne in mind that these officers are responsible for other important branches of Public Health work, such as the taking of samples under the Sale of Food and Drugs Acts, the inspection of food supplies, the supervision of dairies, the inspection of factories and workshops, the prevention of 77 infectious disease, etc., and it is essential to the welfare of the Borough that the standard of efficiency attained in these branches should not be lowered by unduly concentrating the efforts of the staff of the Public Health Department on housing work. In spite of the work accomplished there is still much to be done. There are over 3,000 houses let in lodgings not on the Council's Register of such dwellings, and in many cases these require careful inspection for the purpose of determining whether registration is needed. Of the 2,169 houses on the Register at the beginning of 1923, 912 have been subjected to detailed inspection with a view to bringing them up to the standard decided upon by the Council in January, 1923. It will take at least another eighteen months of steady work in order to deal with the remaining 1,257. In considering the work which lies ahead, there is one important point to be remembered in regard to tenement houses, particularly those occupied by many families, and in which almos every room is used for living and sleeping purposes. As soon as repair and cleansing works have been completed deterioration sets in again. When, therefore, the owners have spent considerable sums of money in carrying out the requirements of the Council in these houses, it is desirable that the Sanitary Inspectors should pay visits as frequently as possible in order to ensure, as far as is in their power, that the efforts of the owners are not neutralised by the gross neglect and carelessness of indifferent tenants. The work is never ending, but there is ample evidence that the standard of housing conditions in North Kensington is gradually improving—with perseverance and goodwill on the part of all concerned, this progress can be maintained with the result that the inhabitants will enjoy better health and greater happiness. 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 of the Council, purchased, in the northern halt 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 £84,518 and the total annual rentals (exclusive of rates and taxes) amount to £5,630. (b) Mary Place Scheme. This scheme, comprising a group of 32 cottages known as Avondale Park Gardens, was completed in 1922, and the cost for land, building, etc., was £41,892. Each of these cottages consists of two living rooms and three bedrooms and the total rentals amount to £1,290 per annum (exclusive of rates and taxes). These 32 cottages provide accommodation for about 250 persons. v(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. Of the flats, 32 contain a living room, kitchen and three bedrooms ; the remaining 44 flats consist of living room, kitchen and two bedrooms. The total rentals amount to £2,846 per annum (exclusive of rates and taxes). The cost of erecting these 8 cottages and 76 flats amounts, up to the present time, to £85,066, and accommodation has been found for about 400 persons. There is now in course of erection the third section of the scheme, comprising of 5 cottages and 38 flats. The contract price for the construction of the buildings is £21,677, but this figure is subject to variation on completion of the work. Particulars of accommodation provided in this third section and rents to be charged are appended. 78 Net weekly rent. Approximate total of rent, rates, etc. A. 5 cottages, containing living room, kitchen, scullery, 3 bedrooms and bathroom 19s. Od. 25s. 6d. B. 12 flats on the ground floor, containing living room, kitchen-scullery combined, 8 bedrooms and bathroom 15s. 6d. 20s. 6d. C. 12 flats on the first floor, containing living room, kitchen-scullery combined, 3 bedrooms and bathroom 16s. 6d. 21s. 6d. D. 3 flats on the first floor, containing living room, kitchen-scullery combined, 2 bedrooms, 1 small bedroom and bathroom 16s. 0d. 21s. 0d. E. 7 flats on the ground floor, containing living room, kitchen-scullery combined, 2 bedrooms and bathroom 13s. 0d. 17s. 0d. F. 4 flats on the first floor, containing living room, kitchen-scullery combined, 2 bedrooms and bathroom 13s. 6d. 17s. 6d. The above-mentioned rents are somewhat in excess of those charged for the cottages and flats of the first and second sections of the scheme, but the accommodation generally in this further section is better than in the earlier ones. 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 Kensington since the war other than by the Council, is that in connection with Dr. Schuster's housing programme in the Notting Dale area. Prior to 1923, Dr. Schuster had erected 11 cottages in Mary Place, 4 cottages in Threshers Place, 2 cottages in Tobin Street, 13 flats in Walrner Road, Princes Road, Threshers Place and Tobin Street, and he had converted 4 houses in Kenley Street into 10 flats. During the 12 months under review, the Wilsham Housing Trust, an organisation carrying on Dr. Schuster's work, have completed one 6-roomed house, one 4-roomed house, one group of eight 4-roomed flats, one group of four 4-roomed cottage flats, and one group of two 4-roomed cottage flats. No. 36, St. Ann's Road, which was formerly the Red Lion Public House, has been converted into four self-contained flats. Although not strictly within the definition of new housing accommodation, a large amount of extra accommodation has been provided in various parts of the Borough during the year by the conversion of houses, previously occupied by one family, into self-contained flats or maisonettes. It is estimated that about 100 houses have been converted into approximately 250 flats. HOUSING STATISTICS FOR 1923. Number of new houses erected during the year :— (a) Total 16 (6) With State assistance under the Housing Acts, 1919 or 1923: (i) By the Local Authority Nil (ii) By other bodies or persons Nil 1.—Unfit Dwelling-houses. Inspection—(1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 6,112 (2) Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 1,238 (3) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (4) Number of dwelling houses (exclusive of those referred to under the preceding heading) found not to be in all respects reasonably fit for human habitation 3,083 2.—Remedy of Defects without Service of Formal Notices. No. of defective dwelling houses rendered fit in consequence of informal action by the Local Authority or their officers 173 79 3.—Action under Statutory Powers. A.—Proceedings under Section 28 of the Housing, Town Planning, etc., Act, 1919. (1) Number of dwelling houses in respect of which Notices were served requiring repairs 31 (2) Number of dwelling houses which were rendered fit:— {a) By owners 10 (b) By Local Authority in default of owners 4 (3) Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close Nil B.—Proceedings under Public Health Acts. (1) Number of dwelling houses in respect of which Notices were served requiring defects to be remedied 2,879 (2) Number of dwelling houses in which defects were remedied — (a) By owners 2,719 (b) By Local Authority in default of owners Nil C.—Proceedings under Sections 17 and 18 of the Housing, Town Planning, etc., Act, 1909 (1) Number of representations made with a view to the making of Closing Orders— Dwelling-houses 3 Underground Rooms 20 (2) (a) Number of dwelling houses in respect of which Closing Orders were made 3 (b) Number of underground rooms in respect of which Closing Orders were made 9 (3) Number of dwelling houses in respect of which Closing Orders were determined, the dwelling houses having been rendered fit Nil (4) Number of dwelling houses in respect of which Demolition Orders were made Nil (5) Number of dwelling houses demolished in pursuance of Demolition Orders Nil I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 80 APPENDIX. TABLE I. Vital Statistics of Whole District during 1923 and previous Years. Year. 1 Population estimated to Middle of each Year. 2 Births. Total Deaths Registered in the District. Transferable Deaths. Nett Deaths belonging to the District Uncorrected Number. 3 Nett. of Nonresidents registered in the District. 8 of Residents not rgistered in the District. 9 U nder 1 Year of Age At all Ages. Number. 4 Rate* 5 Number. 6 Rate.* 7 Number. 10 Rate per 1,000 Nett Births 11 Number. 12 Rate. * 13 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 ‡1164,470 B 157,886 D 2,281 2,653 16.1 8,429 18.8 1,454 438 270 102 2,413 15.2 1920 ‡165,496 B 164;177 D 3,997 4,020 24.3 2,436 14.8 753 510 325 81 2,193 18.4 1921 175,859 (Census) 3,159 3,288 18.7 2,656 15.1 727 496 363 110 2,425 18.8 1922 ‡179,100 2,993 8,152 17.6 2,814 15.7 894 507 257 82 2,427 1.36 1923 178,500 3,042 8,121 17.5 2,551 14.8 839 484 218 70 2,196 12.3 • 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 1021. Area of District in acres (exclusive of area covered by water) 2290 Total population at all ages 175,859 Total families or separate occupiers 48,001 81 TABLE II. Cases of Infectious Disease notified during the Year, 1923. 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) 223 6 75 95 25 17 5 ... 41 69 35 18 18 8 11 14 9 216 Erysipelas 67 1 1 4 12 14 23 12 12 18 12 7 3 2 5 5 3 32 Scarlet fever 205 3 58 96 26 21 1 ... 30 47 22 22 18 8 6 35 17 197 Typhus fever ... ... ... ... ••• ... ... ... ... ... ... ... ... ... ... ... ... ... Enteric fever 12 ... ... 2 5 3 2 ... 1 ... 4 1 1 2 2 1 ... 9 Continued fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Puerperal fever 15 ... ... ... 5 9 1 ... ... 6 5 1 1 ... ... 2 ... 7 Encephalitis Lethargica 8 ... ... 1 ... 2 ... ... ... ... 1 ... ... 1 ... 1 ... 3 Cerebro-Spinal Meningitis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Poliomyelitis and Polio-Encephalitis 5 ... 2 2 1 ... ... ... 2 ... ... ... 1 1 ... 1 ... 4 Pulmonary Tuberculosis 280 ... 4 11 74 124 56 11 39 50 58 23 19 26 15 36 14 153 Other forms of Tuberculosis 123 2 20 55 24 14 7 1 22 36 27 12 7 2 7 5 5 47 Ophthalmia N eonatorum 21 21 ... ... ... ... ... ... 5 3 4 1 2 1 1 ... 4 12 Primary Pneumonia 90 1 8 21 11 23 21 5 15 28 16 12 4 3 5 4 8 54 Influenzal Pneumonia 35 2 4 ... 5 12 4 8 1 24 4 4 ... ... 1 1 ... 17 Malaria 5 ... ... 1 2 2 ... ... 1 ... ... 2 ... ... ... 2 ... ... Totals 1084 36 172 288 190 241 120 37 169 281 188 103 74 54 53 107 55 751 82 TABLE III. Causes of, and Ages at, Death during the Year 1923. 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 2,196 218 61 28 42 78 254 572 948 Enteric Fever 2 ... ... ... ... 1 1 ... ... 8mall-pox ... ... ... ... ... ... ... ... ... Measles 15 8 10 2 ... ... ... ... ... Scarlet Fever 2 ... ... ... ... 1 1 ... ... Whooping-Cougb 23 13 7 1 2 ... ... ... ... Diphtheria 14 1 8 4 5 1 ... ... ... Influenza 46 ... 1 ... ... ... 5 14 26 Encephalitis Lethargica 1 ... ... ... ... ... 1 ... ... Meningitis 7 2 ... ... 2 ... 1 2 ... Tuberculosis of Respiratory System 117 ... 1 ... 2 18 58 86 7 Other tuberculous diseases 85 4 4 5 1 8 8 4 ... Cancer, Malignant disease 269 ... ... ... ... 2 26 121 120 Rheumatic Fever 4 ... ... 1 3 ... ... ... ... Diabetes 21 ... ... ... ... ... 1 6 14 Cerebral Haemorrhage, etc. 106 ... ... ... ... 1 7 41 57 Heart Disease 292 ... ... ... 1 8 29 77 177 Arterio-sclerosis 122 ... ... ... ... ... 5 81 86 Bronchitis 171 9 ... 1 ... 2 8 87 119 Pneumonia (all forms) 217 49 ... 9 8 4 27 29 76 Other respiratory diseases 48 4 ... 1 2 ... 8 9 24 Ulcer of Stomach or Duodenum 15 ... ... ... ... ... 5 6 4 Diarrhoea, etc. 67 46 ... ... ... ... 1 18 4 Appendicitis and Typhlitis 15 ... ... ... 2 ... 2 5 6 Cirrhosis of Liver 11 ... ... ... ... ... 2 8 1 Acute and Chronic Nephritis 52 ... ... ... 1 8 8 19 21 Puerperal Sepsis 7 ... ... ... ... 2 4 1 ... Other accidents and diseases of Pregnancy and Parturition 10 ... ... ... ... ... 10 ... ... Congenital Debility and Malformation, Premature Birth 61 59 1 ... ... 1 ... ... ... Suicide 28 ... ... ... ... 4 5 9 5 Other deaths from violence 60 8 5 1 9 7 4 18 18 Other Defined Diseases 865 25 6 8 8 10 47 88 183 Causes ill-defined or unknown 8 ... ... ... ... ... ... 8 ... 83 TABLE IV. INFANT MORTALITY DURING THE YEAR 1923. Nett Deaths from stated Causes, at Various Ages, under One Year of Age. Cause of Death. U nder 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 45 10 4 4 68 31 59 39 26 218 Uncertified ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... Chicken-pox • • • ... ... ... ... ... ... ... ... ... Measles ... ... ... ... ... ... ... 2 1 8 Scarlet Fever ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... 1 6 3 3 18 Diphtheria and Croup ... ... ... ... ... ... ... ... 1 1 Erysipelas ... ... ... ... ... ... 1 ... ... 1 Tuberculous Meningitis ... ... ... ... ... ... 1 ... 2 3 Abdominal Tuberculosis ... ... ... ... ... ... 1 ... ... 1 Other Tuberculous Diseases ... ... ... ... ... ... ... ... ... ... Meningitis (not Tuberculous) ... ... ... ... ... ... 1 1 ... 2 Convulsions 1 ... ... ... 1 ... ... ... ... 1 Laryngitis ... 1 ... ... 1 ... ... ... ... 1 Bronchitis ... ... 1 ... 1 4 8 ... 1 9 Pneumonia (all forms) ... 2 1 1 4 8 18 12 12 49 Diarrhoea ... ... ... ... ... ... 2 ... 2 4 Enteritis ... ... ... 1 1 6 16 16 8 42 Gastritis ... ... ... ... ... ... 1 ... ... 1 Syphilis ... ... ... ... ... ... 4 2 1 7 Rickets ... ... ... ... ... ... ... ... ... ... Suffocation, overlaying 1 ... 1 ... 2 1 ... ... ... 3 Injury at birth 8 ... ... ... 8 ... ... ... ... 8 Atelectasis 4 ... ... ... 4 ... ... ... ... 4 Congenital Malformation 8 ... ... ... 8 8 1 1 ... 8 Premature Birth 22 8 ... 1 26 2 1 ... ... 29 Atrophy, Debility, and Marasmus 8 8 ... ... 11 4 7 ... ... 22 Other causes 3 1 1 1 6 2 1 2 ... 11 45 10 4 4 63 81 59 39 26 218 legitimate, 2,916. Nett Births in the year illegitimate, 205. legitimate infants, 192. Nett Deaths in the year of illegitimate infants, 26. 84 TABLE V. Causes of Death at different periods of life in the Year 1923. 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 1 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... 1 1 2 Black water Fever 4 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 2 Measles 6 15 10 5 3 ... 6 4 1 1 10 5 15 ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 7 2 1 1 ... ... ... ... ... ... ... ... ... ... ..... ... 1 1 ... ... ... ... ... 1 1 2 Whooping-Cough 8 23 11 12 6 7 4 3 ... 1 10 11 21 1 1 ... ... ... ... ... ... ... ... 1 1 2 Diphtheria 9 A 14 6 8 1 ... 1 2 1 3 3 5 8 3 2 ... 1 ... ... ... ... ... ... 3 3 6 Influenza 10 46 16 30 ... ... 1 ... ... ... 1 ... 1 ... ... ... ... 3 2 5 9 7 19 15 30 45 Erysipelas 18 4 2 2 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... 1 2 ... 2 1 3 Pyaemia, Septicaemia 20 3 1 2 ... 1 ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 ... ... ... 1 1 2 Pulmonary Tuberculosis 28 A B 117 66 51 ... ... ... 1 ... ... ... 1 1 ... 2 8 10 28 25 25 11 5 2 66 50 116 Tuberculous Meningitis 30 19 11 8 2 1 2 1 3 ... 7 3 10 3 2 1 1 ... 2 ... ... ... ... 4 5 9 Tuberculosis of Peritoneum, &c. 31A B 4 2 2 ... 1 ... ... l ... 1 1 2 ... ... 1 ... ... ... ... 1 ... ... 1 1 2 Tuberculosis of Spinal Column 32 4 4 ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 1 ... ... ... ... ... 4 ... 4 Tuberculosis of Joints 33 2 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... .. ... ... ... ... 2 ... 2 Tuberculosis of other Organs 34 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Disseminated Tuberculosis 35 4 1 3 ... ... ... 1 ... ... ... 1 1 ... ... 1 1 ... ... ... 1 ... ... 1 2 3 Rickets 36 1 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Syphilis 37 10 5 5 4 8 ... 1 ... ... 4 4 8 ... ... ... ... 1 1 ... ... ... ... 1 1 2 Other Venereal Diseases 38 1 .... 1 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Cancer 39-45 269 107 162 ... ... ... ... ... ... ... ... ... ... ... 1 1 10 16 45 76 51 69 107 162 269 Other Tumours 46 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 Rheumatic Fever 47 4 2 2 ... ... ... .... ... 1 ... 1 1 ... 1 ... ... ... ... ... ... ... ... 2 1 3 Chronic Rheumatism, &c. 48 ABC 9 1 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 1 3 1 8 9 Diabetes 50 21 10 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 2 6 8 10 11 21 Exophthalmic Goitre 51 3 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 1 ... ... 1 2 3 Leucocytliaemia, &c. 58AB 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Anaemia Chlorosis 54 16 3 13 ... ... ... ... ... ... ... ... ... ... ... ... ... l 5 1 4 1 4 3 13 16 Other General Diseases 55 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Alcoholism 56 4 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... 1 ... 4 4 Lead Poisoning 57B 1 1 ..... ... .... .... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Total for General Diseases 606 266 310 16 15 15 13 6 7 37 35 72 11 8 17 16 46 57 82 116 78 108 229 305 534 85 TABLE V.—continued. CAUSES OF DEATH. Classification No. TotalsAll Ages Under 1 year. 1 and under 2 years. 2 and under 5 years. TotalsUnder 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 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 Tota Brought forward 606 266 340 16 15 15 13 6 7 37 35 72 11 8 17 16 46 57 82 116 73 108 229 305 534 II.—DISEASES OF THE NERVOUS SYSTEM AND OF THE ORGANS OF SPECIAL SENSE. Encephalitis 60 4 2 2 ... ... ... ... 1 ... 1 ... 1 ... ... ... 1 ... 1 ... ... 1 ... 1 2 3 Meningitis 61BC 7 8 4 1 1 ... ... ... ... 1 1 2 ... 2 ... ... ... 1 2 ... ... ... 2 3 5 Locomotor Ataxy 62 5 4 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 1 1 ... 4 1 5 Other Diseases of the Spinal Cord 63AB 14 6 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 1 4 5 6 8 14 Cerebral Haemorrhage, Apoplexy 64 AE 106 41 65 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 3 14 27 23 34 41 65 106 Softening of Brain 65 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 2 4 2 6 Paralysis without specified cause 66AC 6 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 i 2 2 3 3 6 General Paralysis of the Insane 67 12 9 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 7 2 ... ... 9 3 12 Other forms of Mental Alienation 68 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 1 ... 4 4 Epilepsy 69 14 7 7 ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 2 2 2 1 2 7 7 14 Infantile Convulsions under 5 years 71AB 8 1 2 1 ... ... 2 ... ... 1 2 8 ... ... ... .... ... ... ... ... ... ... ... ... ... Other Diseases of the Nervous System 74 AD 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... 1 2 ... 4 2 6 Mastoid Disease 76 A 2 1 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... 1 ... ... 1 1 2 Other Diseases of the Ears 76B 4 4 ... ... ... ... 1 ... 1 ... 1 ... 3 ... ... ... ... ... ... ... 3 ... 8 Total for Diseases of the Nervous System, and of the Organs of Special Sense 193 89 104 2 1 ... 2 2 4 3 7 2 2 4 4 10 12 33 37 86 46 85 101 186 III.—DISEASES OF THE CIRCULATORY SYSTEM. Acute Endocarditis 78AC 8 5 8 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 1 2 1 5 3 8 Valvular Disease 79A 125 51 74 ... ... ... ... ... ... ... ... ... ... 1 5 3 8 16 23 19 15 35 51 74 125 Fatty Degeneration of the Heart 79B 21 8 16 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 5 5 3 10 8 16 24 Other Organic Diseases of the Heart 79C 143 56 87 ... ... ... ... ... ... ... ... ... ... ... ...... ... ... 4 11 14 45 69 56 87 143 Angina Pectoris 80 15 7 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 6 7 7 8 15 Carried forward 1114 482 632 18 16 15 15 8 7 41 38 79 13 12 26 23 05 90 157 193 180 276 441 594 1035 86 TABLE V.— continued. CAUSES OF DEATH. Classification No. Totals All Ages Under 1 year. 1 and under 2 years. 2 and under 5 years TotalsUnder 5 Years. 5 and under 15 years. 15 and under 25 years. 25 and under 45 years. 45 and undsr 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 1114 482 682 18 16 15 15 8 7 41 38 79 13 12 26 23 65 90 157 193 180 276 441 594 1035 DISEASES OF THE CIRCULATORY SYSTEM—continued. Arterial Sclerosis, &c. 81AC 122 60 62 ... ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 23 8 32 54 60 62 122 Cerebral Embolism and Thrombosis 82A 16 5 11 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 3 11 5 11 16 Other Embolism and Thrombosis 82B 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 Diseases of the Veins 88 AB 2 2 . . . ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Total for Diseases of the Circulatory System 457 195 262 ... ... ... ... ... ... ... ... ... ... 2 5 8 14 21 67 48 109 188 195 262 457 IV.—DISEASES OF THE RESPIRATORY SYSTEM. . Diseases of the Larynx 87AC 8 2 1 1 ... ... ... 1 ... 2 ... 2 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Myxœdema 88 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Bronchitis 89 & 90 171 79 92 4 5 ... ... ... 1 4 6 10 ... ... 1 1 1 2 22 15 51 68 75 86 161 Broncho-pneumonia 91 134 55 79 20 25 9 8 5 2 34 35 69 ... ... 1 1 ... 4 9 6 9 83 21 44 65 Lobar-pneumonia 92A 54 32 22 1 1 ... 1 2 ... 3 2 5 ... 1 2 ... 9 8 8 2 10 9 29 20 49 Pneumonia (type not stated) 92B 29 16 13 1 1 2 ... ... 3 1 4 ... ... ... ... 2 4 3 1 8 7 13 12 25 Empyema 93A 2 1 1 ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... ... ... ... ... 1 1 2 Other Pleurisy 93B 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... 3 1 4 2 6 Pulmonary Congestion, &c. 94AD 12 4 8 2 1 ... ... ... ... 2 1 3 ... ... ... ... ... ... ... 1 2 6 2 7 9 Asthma 96 11 4 7 ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 3 ... 1 6 4 7 11 Emphysema 97 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 2 ... 2 Fibroid Disease of Lung 98A 2 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 1 2 Other Diseases of the Respiratory System 98B 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... ... 1 2 3 Total for Diseases of the Respiratory System 431 201 230 29 33 11 9 8 3 48 45 93 2 3 4 2 14 19 46 29 87 132 153 185 338 Carried forward 1687 751 936 47 49 26 21 16 16 89 83 172 15 15 80 25 84 109 228 230 305 474 662 853 1515 87 TABLE V.— continued. CAUSES OF DEATH. Classification No. TotalsAll Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. TotalsUnder 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 1687 751 936 47 49 26 21 16 10 89 83 172 15 15 80 25 84 109 228 230 305 474 662 853 1515 Y.—DISEASES OF THE DIGESTIVE SYSTEM. Tonsillitis 100 A 3 1 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... ... 1 2 3 Diseases of Oesophagus 101 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Perforating Ulcer of Stomach 102 15 9 6 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 2 5 1 1 3 9 6 15 Inflammation of Stomach 103 A 3 1 2 1 ... ... 1 ... ... 1 1 2 ... ... ... ... ... ... ... ... ... 1 ... 1 1 Other Diseases of the Stomach 103 B 1 1 ... ... ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Diarrhoea and Enteritis 104 & 105 AH 67 28 39 20 26 1 2 ... ... 21 28 49 ... ... ... ... ... 1 4 9 3 1 7 11 18 Appendicitis 108 15 10 5 ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 1 3 3 10 5 15 Hernia 109A 8 5 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 3 2 5 3 3 Intestinal Obstruction 109 B 17 7 10 ... 1 ... ... 1 ... 1 1 2 ... ... ... ... 2 4 2 2 2 3 6 9 15 Other Diseases of the Intestines 110 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Yellow Atrophy of Liver 111 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Hydatid Liver 112 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Cirrhosis of the Liver, &c. 113 AC 11 4 7 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 4 4 1 4 7 11 Biliary Calculi 114 4 2 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 2 1 ... 2 2 4 Other Diseases of the Liver 115 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 2 2 Peritonitis (cause unstated) 117 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 1 3 4 Other Diseases of Digestive System 118 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 2 2 Total for Diseases of the Digestive System 158 69 89 21 27 2 8 1 ... 24 30 54 1 1 ... ...— 7 17 24 25 13 16 45 59 104 VI.—NON-VENEREAL DISEASES OF THE GENITO URINARY SYSTEM AND ANNEXA. Acute Nephritis 119 2 ... 9 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 ... 2 2 Bright's Disease, &c. 120AB 50 29 21 ... ... ... ... ... ... ... ... ... 1 ... 2 1 5 2 9 10 12 8 29 21 50 Other Diseases of the Kidney 122AD 4 1 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 1 ... ... 1 3 4 Diseases of the Bladder 124 7 4 3 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 2 1 1 2 4 8 7 Diseases of the Urethra 125AB 9 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 ... 2 Diseases of the Prostate 126 15 15 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 2 ... 12 ... 15 ... 15 Cellulitis of Scrotum 127 1 1 ... 1 ... ... ... ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Fibroid Tumour of Uterus 129 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 2 2 Septic Endometritis 130 ] ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Double Pyosalpinx 132 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Paget's Disease 133 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 1 Total for non Venereal Diseases of the Genito-Urinary System and Annexa 86 52 84 1 ... ... ... ... ... 1 ... 1 1 ... 8 1 6 7 16 15 25 11 51 84 85 Carried forward 1931 872 1059 69 76 28 27 17 10 114 113 227 17 16 33 26 97 133 268 270 343 501 768 946 1704 88 TABLE V.—continued. CAUSES OF DEATH. Classification No. Totals All Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. TotalsUnder 5 years. S 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 1931 872 1059 69 76 28 27 17 10 114 113 227 17 16 33 26 97 133 268 270 343 501 758 946 1704 VII.—THE PUERPERAL STATE. Accidents of Pregnancy 134AD 6 ... 6 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 ... ... ... ... ... 6 6 Puerperal Haemorrhage 135 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Other Accidents of Childbirth 136 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... ... ... 2 2 Puerperal Fever 137 7 7 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 4 ... 1 ... ... ... 7 7 Puerperal Embolism 139 B 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Total for Diseases of the Puerperal State 17 17 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 14 ... 1 ... ... ... 17 17 VIII.—DISEASES OF THE SKIN AND OF THE CELLULAR TISSUE. Senile Gangrene 142A 3 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 9 ... 3 ... 3 Carbuncle 143 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 Phlegmon, Acute Abscess 144 A.B 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Diseases of the Integumentary System 145 6 3 3 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ... 1 3 1 ... ... 3 2 5 Total for Diseases of the Skin and of the Cellular Tissue 11 7 4 ... 1 ... ... ... ... ... 1 1 ... ... ... ... ...- 1 5 1 2 1 7 8 10 IX.—DISEASES OF THE BONES AND OF THE ORGANS OF LOCOMOTION 146 7 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 X.—M ALFORM ATIONS. Congenital Malformation 150AD 10 5 5 4 4 ... 1 ... ... 4 5 9 ... ... 1 ... ... ... ... ... ... ... 1 ... 1 XI.—DISEASES OF EARLY INFANCY. Premature Birth 151A 29 15 14 15 14 ... ... ... ... 15 14 99 ... ... ... ... ... ... ... ... ... ... ... ... ... Infantile Atrophy, Debility and Marasmus 151B 22 11 11 11 11 ... ... ... ... 11 11 22 ... ... ... ... ... ... ... ... ... ... ... ... ... Icterus Neonatorum 151C 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Atelectasis 152B 4 3 1 3 1 ... ... ... ... 3 1 4 ... ... ... ... ... ... ... ... ... ... ... ... ... Injuries at Birth 152C 3 1 2 1 2 ... ... ... ... 1 2 3 ... ... ... ... ... ... ... ... ... ... ... ... ... Total for Diseases of Early Infancy 61 31 30 31 30 ... ... ... ... 31 30 61 ... ... ... ... ... ... ... ... ... ... ... ... ... Carried forward 2031 916 1115 104 111 28 28 17 10 149 149 298 17 16 34 28 97 148 274 272 345 502 767 966 1738 89 TABLE V.-continned. CAUSES OF DEATH. Classification No. TotalsAll Ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. TotalsUnder 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 2031 916 1115 104 111 28 28 17 10 149 149 298 17 16 34 28 97 148 274 272 345 502 767 966 1783 XII.—OLD AGE. Old Age 154AB 79 24 55 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 23 55 24 55 79 XIII.—AFFECTIONS PRODUCED BY EXTERNAL CAUSES. • Suicide by Poison 155 6 4 2 ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... 2 2 ... 4 2 6 Suicide by Asphyxia 156 6 6 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 ... 8 ... ... ... 6 ... 6 Suicide by Hanging 157 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 ... 1 Suicide by Drowning 158 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Suicide by Firearms 159 5 4 1 ... ... ... ... . ... ... ... ... ... ... ... 1 2 ... 2 ... ... ... 4 1 5 Suicide by Cutting or Piercing Instruments 160 8 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 1 ... 2 1 8 Suicide by Jumping from High Place 161 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 Burns 167 7 8 4 ... ... ... ... ... 1 2 8 5 ... ... ... ... ... ... ... ... 1 1 1 1 2 Absorption of Deleterious Gases (Overlain, &c.) 168 8 4 4 ... ... ... ... ... ... 2 1 3 ... ... ... ... 1 ... ... 1 1 1 2 3 5 Accidental Drowning 169 3 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... ... 1 2 8 Injury by Fall 172 17 9 8 ... ... ... ... ... ... ... ... ... ... ... ... 1 2 ... 5 1 2 6 9 8 17 Injury by Machines 174 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 1 1 Injury by other Crushing (vehicles, railways, &c.) 175 22 13 9 ... ... 1 ... ... ... 1 ... 1 7 1 2 1 ... ... 2 2 1 5 12 9 21 Injury by Animals 176 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... 1 Effects of Heat 179 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 ... 1 Total for Affections produced by External Causes 83 50 33 2 1 8 2 ... l 5 4 9 7 2 7 4 7 2 15 7 9 14 45 29 74 XIV.—ILL DEFINED CAUSES. 188-189 8 2 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 1 ... ... 2 1 3 Grand Totals 2196 992 1204 106 112 31 30 17 11 154 153 307 24 18 41 32 104 150 292 280 377 571 838 1051 1889 90 TABLE VI. Summary of Inspections, &c., done by the Male Sanitary Inspectors during the year 1923. DESCRIPTION OF WORK, &c NUMBER OF DISTRICT Grand Total ] 2 2A 8 4 5 6 7 3 9 10 Complaints received 297 210 — 143 247 197 215 172 184 289 249 2203 Public Health (London) Act, 1891. Houses inspected on complaint 206 101 — 156 231 199 270 185 198 293 238 2077 „ after Infectious Disease 81 105 — 61 64 86 40 49 47 68 37 638 Primary Routine House Inspections - 3 — 49 36 33 6 89 263 172 83 734 Re-inspections 1040 375 — 627 1207 1426 1024 1009 899 1281 738 9826 Bye-Laws re Houses Let in Lodgings Complaints received 91 103 — 10 43 — — 5 6 — 4 262 First Annual Inspection (Furnished Houses) 5 9 _ 52 12 — 11 — — — — 89 Re-inspections „ „ 18 24 — 735 118 — 426 — — — — 1321 First Annual Inspection (Unfurnished Houses) 177 276 — 94 158 108 10 86 1ll 216 44 1280 Re-inspections „ „ 1065 1296 — 335 633 558 334 345 119 259 269 5213 Housing Acts, 1890-1919. Initial Inspections 124 115 242 79 62 95 32 95 98 71 52 1065 Re-inspections 50 11 725 9 68 51 231 50 30 5 271 1501 Underground Living Rooms. Primary Inspections 86 106 77 21 35 44 7 20 6 11 22 435 Re-inspections — 9 28 — 20 — 8 — 2 4 176 247 Drainage. House Drains Tested and Inspected 15 137 242 71 28 10 25 18 25 65 47 683 Re-inspections — 210 25 27 94 21 — — 3 31 38 449 Inspections of Workshops 7 15 — 19 13 38 30 21 155 24 31 353 „ Factories — 6 — 19 15 1 2 7 67 4 7 128 „ Bakehouses 44 16 — 54 15 34 20 15 18 50 15 281 „ Slaughterhouses - — 30 — 200 — — 19 18 — — — 267 „ Dairies, Cowsheds and Milkshops - 90 32 — 36 51 97 103 83 69 104 59 724 „ Ice Cream Premises 26 41 — 26 14 26 20 9 35 55 38 290 „ other Food Premises 142 121 — 82 65 227 111 54 36 160 126 1124 „ Mews 367 166 585 186 401 261 301 515 765 291 3838 Smoke Observations 114 — — — 10 8 — 57 90 103 382 Other Inspections 557 469 4 245 405 289 259 163 419 250 202 3262 Food and Drugs Acts, &c. Samples taken (formal & informal) 125 125 — 125 125 — 125 125 — 125 125 1000 Notices Issued. Public Health (London) Act, 1891. Intimations 363 453 278 215 457 202 153 159 142 314 143 2879 Statutory Notices 67 127 45 27 152 43 42 26 20 86 32 567 Final 10 32 11 7 46 6 8 3 2 9 3 137 Summonses issued 1 10 — — 10 1 — — 2 5 29 Housing Acts, 1890 1919. 34 Sect. 36, 1909 — 22 — 100 15 4 38 — — — 213 Sect. 17, 1909 — 2 — 3 1 — 1 5 — — — 12 Sec. 28, 1919 — 1 — 18 7 — 15 — — — — 41 Underground Room Habitation — — — — 2 — — — 4 1 — 7 Removal of Manure 9 — — — 5 — — — — — 3 17 Smoke Nuisance Orders — — — — — 1 — — — 1 Rent Restrictions Act Certificates 1 — — — 4 8 1 1 — 2 17 Special Notices included under Public Health (London) Act, 1891, relating to Factories — — — — — — — — — 1 — 1 „ Workshops — — — — 1 — — — 1 1 1 4 „ Bakehouses — — — — — — — — — 1 1 Other Notices — — — 1 — — — — 2 2 4 9 Report of Wast e of Water to M. W. B. 8 2 — 2 19 — 7 — — 24 4 66 „ Dangerous Structures to L.C.C. 7 9 — 4 52 — 1 3 — 1 1 78 91 TABLE V1A. Summary of Works completed by the Sanitary Inspectors during the Year 1923. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Grand Total 1 2 2a 3 4 5 6 7 8 9 10 House Drains re-constructed 3 6 — 2 5 1 11 1 — 19 7 55 Defective Drains repaired 12 13 — 11 9 2 9 10 7 32 21 126 House Drains cleansed 43 64 — 10 15 20 21 8 28 121 48 378 Water-closets reconstructed, repaired, &c. 142 160 5 37 28 60 28 6 14 38 49 567 Water-closets supplied with water 13 2 8 5 19 63 3 5 9 132 47 306 Water-closets, new, provided 2 2 — 2 2 2 3 — 43 13 69 Soil-pipes ventilated, repaired, &c. 6 11 3 1 14 — 4 2 7 63 4 115 Soil-pipes, new, provided 4 4 — — 2 3 2 — 3 23 6 47 Cisterns cleaned, covered, &c. 19 44 3 10 19 1 1 3 5 105 13 223 Yards, Areas paved, drained, repaired 51 129 11 16 41 14 17 5 18 40 39 381 Dustbins provided 84 145 15 30 77 32 25 25 34 170 58 695 Ashpits abolished 9 24 4 1 5 2 1 6 2 13 22 89 Accumulations of filth, &c., removed 24 76 2 3 28 5 5 7 20 25 86 281 Animals removed 11 22 - 4 6 - 2 2 1 — 5 53 Overcrowding abated 9 16 — 4 1 — — — 1 31 Underground Rooms, illegal occupation discontinued 4 2 _ — 1 1 — — 4 6 2 20 Roofs repaired 78 115 19 42 91 71 27 11 31 142 30 657 Houses provided with water above basement floor 27 26 22 40 31 1 — 20 15 19 2 203 Dampness in Dwellings remedied 25 76 23 10 68 37 6 5 15 32 17 314 Houses closed under Sect. 17, Housing Act, 1909 — 1 — — — — — — — — — 1 Repairs of Houses completed under Sect. 28, Housing Act, 1919 — 1 — 4 4 — 1 — — — — 10 Infectious Disease Cases removed 81 84 — 48 56 67 18 20 19 61 29 483 Houses Disinfected after Infectious Diseases (including Bedding, Clothing, &c,) 61 91 — 41 52 62 23 38 19 57 31 475 Rooms in such Houses, disinfected after Infectious Disease 64 126 — 44 61 68 30 72 39 118 48 670 Houses cleansed under Houses Let in Lodgings By-laws 98 191 1 33 85 63 23 72 17 96 15 694 Verminous Houses cleansed (including Bedding, Clothing, &c. 105 69 11 39 36 2 8 21 3 9 8 311 Verminous Rooms cleansed in such Houses 265 82 15 124 42 2 12 33 2 20 11 608 Dirty Bedding cleansed 8 1 1 — 10 — — — 1 3 — 24 Dirty Bedding destroyed 1 1 1 — 4 1 — 2 — 2 — 12 Other Sanitary Works executed 64 312 141 161 186 184 63 52 14 35 126 1,338 92 TABLE VII. The Work of the Women Health Officers for the Year 1923. HEALTH OFFICERS Total 1 2 3 4 5 6 7 Child Welfare First Visits to Infants- 12 360 383 314 289 364 403 2,125 Return Visits to Infants 176 816 624 951 1,227 605 773 5,172 Visits to Children between 1 and 5 years 341 852 938 937 1,037 916 531 5,552 Stillbirth Enquiries 5 8 10 7 9 9 8 56 Visits to Ophthalmia cases 3 1 7 5 4 2 7 29 Return Visits to Ophthalmia cases 28 9 43 22 41 5 33 181 Visits to Measles cases 236 56 13 43 64 19 56 487 Visit to Whooping Cough cases 14 24 9 19 9 4 18 97 Visits to Puerperal Fever cases 1 3 3 1 4 3 2 17 Infantile Death Enquiries 13 43 38 22 16 27 39 198 Milk Investigations 34 207 129 98 26 110 254 858 Ante-Natal Visits 31 109 35 18 — 79 123 395 Half-days at Welfares 15 95 138 136 97 82 142 705 Special Visits 1,331 223 216 144 178 183 215 2,490 Tuberculosis— Pulmonary.—First Visits 27 28 31 23 37 40 62 248 Re-Visits 233 216 358 344 65 377 348 1,941 Non-Pulmonary—First Visits - 7 13 22 10 5 1 4 62 Re-Visits 54 157 170 142 11 11 25 570 Factories and Workshops Act. Inspections of Factories 17 21 23 12 5 2 9 89 Inspections of Workshops 168 30 31 33 162 33 54 511 Inspections of Outworkers' Premises 53 5 13 18 2 36 17 114 Inspections of other Workplaces — — — — — 11 6 17 Total Visits 2,799 3,276 3,234 3,299 3,288 2,919 3,129 21,944 Notices issued under the Public Health Act— Intimation Notices — 2 4 2 — 1 1 10 Statutory Notices — — — — — — — — Final Notices — — — — — — — — Summonses — — — — — — — — 93 TABLE VIII. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1922. DATE. Registration Sub-Districts comprised in Vaccination Officer s District. 1 Number of Births returned in Birth List Sheets. 2 Number of these Births duly entered in Columns 1, 2, 4, and 5 of the Vaccination Register (Birth List Sheets), viz,: Number of these Births which are not entered in the Vaccination Register, on account, (as shown by Report Book) of Column I. Successfully Vaccinated. 3 Column II. Removed to other Districts and notified to Vaccination Officers of the Districts. 9 Removal to places unknown, or which cannot be reached, and cases not having been found. 10 Not accounted for. Total Number of Certificates of Successful Vaccination received during the Calendar Year, 1923. Insusceptible of Vaccination. 4 Certificate of Conscientious Objection. 6 Column V, Dead, Un vaccinated. 7 Postpone ment by Medical Certificate. 8 1922 1st January to 31st Dec. North 1,908 1,175 3 378 105 23 55 163 6 2,328 South 857 590 2 123 41 8 28 63 2 Total 2,765 1,765 5 501 146 31 83 226 8 94 TABLE IX. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1923. (as required by Ministry of Health Circular 359). Year of Appointment Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A. W. K. Picard, M.D. 1922 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 George W. Herrick 1923 John S. Russell 1923 Sanitary Inspectors. *Henry Dawes (Senior Inspector) 1893 *Nelson Males 1897 *Charles G. Sexton 1898 *Thomas Cutting 1900 *James R. Bagshaw 1901 *Edward J. Bennett 1901 *George W. McQuinn 1901 *Joseph H. Fowles 1902 †John Mc Dermid 1920 †Hubert J. Green 1922 tLeslie W. Burrell 1923 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, Miss Carter and Mr. Russell. INDEX. page Administration 58 Advisory Committee to the Maternity and Child Welfare Committee— Work of the 86 Annual Grants to Child Welfare Institutions 85 Artificial Pneumothorax Treatment 24 Bacteriological Work 68 Bakehouses 89 Births 4 Birth Rates, Death Rates, and Infantile Mortality Rates in 29 Metropolitan Cities and Boroughs (Table) 18 Cancer 19 Chapel of Rest 64 Cleansing of Verminous Persons Act, 1897 64 Common Lodging Houses 68 Convalescent Homes 84 Council's Housing Programme 68 Cowsheds 88 Creagh Nursery Training School 88 Cream Regulations 45 Day Nurseries 82 Deaths 6 „ Causes of (Tables) 7 and 82 „ Causes of at age periods, Table V. (Appendix) 84.89 Dental Treatment of Tuberculous Persons 28 Diphtheria 15 Disinfection 61 Dispensary Treatment of Tuberculosis 20 Dogs, Fouling of Pavement by 65 Drainage Work 62 Dried Milk, Supply of 50 Dust Removal 62 Encephalitis Lethargica 17 Enteric Fever 17 Erysipelas 17 Factories and Workshops 51 Food Supply 87 Grants to Hospitals 85 Health Visitors, Duties and Work of 26 Home Nursing by Kensington District Nursing Association 84 Home Office Tables (Factory and Workshop) 54.57 Homes for Deserted, Widowed or Un.- married Mothers and their Children 82 Home Work 58 Hospital Letters 85 Houses, Let in Lodgings 69 Housing of the Working Classes 67 Housing Statistics for 1928 78 Ice Cream 88 Illegitimate Children, Births and Deaths of 11 Increase of Rent and Mortgage Interest (Restrictions Act), 1920-1928 64 Infantile Mortality 8 „ „ during the year (Table IV. Appendix) 88 PAGE Infant Welfare Centres 27 Infectious Disease, Cases notified during the year (Table II. Appendix) 81 Influenzal Pneumonia 18 Ladbroke Road Hospital 81 Legal Proceedings 58 Malaria 18 Margarine and Butter Substitutes 45 Marriages 4 Maternal Mortality 12 Maternity and Child Welfare 26 Measles 18 Men's Workshops 51 Midwifery Arrangements 82 Milk Supply 87 Milk Supply for Expectant and Nursing Mothers 49 Mortuary 64 Mothercraft Training Society 83 National Children's Adoption Association Hostel 88 Notification of Births Act, 1907 5 Notifiable Infectious Diseases 14 Ophthalmia Neonatorum 17 Pneumonia 18 Polio-Myelitis 18 Population 4 Preservatives and Colouring Matter in Food 46 Prevalence of Disease 14 Public Baths and Washhouses 68 Public Conveniences 63 Public Health Department Staff 58 and 94 Puerperal Fever 17 Rag Flock Act, 1911 64 Rats and Mice (Destruction) Act, 1919 66 Refuse Removal from Mews 62 Sale of Food and Drugs Acts 40 Sanitary Inspectors (Male), Summary of Work done during the Year (Tables VI. and VIa.) Appendix 90-91 Scarlet Fever 15 Slaughter-houses 89 Small-Pox 14 Statistics, Summary of 2 Telford Road Clinic 81 Tuberculosis 19 „ Care Committee 24 Unsound Food 89 Vaccination Officer—Return for 1922 (Table VIII.) Appendix 93 Verminous Rooms Cleansed 62 Vital Statistics 4 ,, „ for whole District, 1923, and previous years (Table I.) Appendix 80 Whooping Cough 18 Women's Workshops 52