KEN 40 The Royal Borough or Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1931 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. K232.300.5,32. SUMMARY OF STATISTICS For the year 1931. Population 174,800 Area of borough in acres 2,291 Density of population per acre 76 Number of marriages 1,890 Rateable value £3,269,809 Product of a 1d. rate £13,624 Total. M. F. Live births legitimate 2,265 1,133 1,132 illegitimate 220 112 108 14.2 Still births 87 55 32 Rate per 1,000 total births 34 Deaths 2,455 1,066 1,389 Death rate 14. 0 Percentage of total deaths occurring in public institutions 49 % Number of women dying in, or in consequence of, childbirth „ other causes 8 Maternal death rate 6.0 Death rate of infants under one year of age per 1,000 live births :— legitimate, 65; illegitimate, 108; total, 76. Deaths from measles (all ages), Nil. „ whooping cough (all ages), 10. „ diarrhoea (under 2 years of age), 35. Deaths from phthisis 127 Phthisis death rate 0.70 Deaths from all forms of tuberculosis 148 Tuberculosis death rate 0.82 Deaths from the zymotic diseases 59 Zymotic death rate 0.84 3 Town Hall, Kensington, W. 8. 20th June, 1932. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lord, Ladies and Gentlemen, I have the honour to submit my annual report for 1931 upon the state of the public health in Kensington. The report for 1930 was a survey report dealing not only with the health of the borough for the year, but comprehensively with the measure of progress made during the previous five years in the improvement of the public health. In these circumstances, and in view of the need for strict economy at the present time, I have decided to make this report of a more brief character. It will review fully only those local conditions which have not been dealt with adequately in the preceding survey report and important circumstances which have arisen subsequently to the preparation of that report. VITAL STATISTICS. The Royal Borough of Kensington as constituted under the London Government Act, 1899, covers an area of 2,291 acres, and is co.extensive with the civil parish and registration district of the same name. The line of demarcation formed by Holland Park Avenue, High Street, Notting Hill Gate, and the Bayswater Road divides the borough into approximately equal halves described in previous years and in this report as North and South Kensington respectively. Each of these areas is co.terminous with the parliamentary division of the same name. The borough is further sub.divided into nine wards. North Kensington includes the wards of St. Charles, Golborne, Norland and Pembridge, whilst South Kensington is made up of the five other wards, namely, Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton. POPULATION. The population of the borough as ascertained at the census in 1931 was 180,681, but this is a provisional figure and, in order to ascertain the correct population, the Registrar.General will deduct from the total the number of persons who were temporary residents in the borough on the census night and add the number of permanent Kensington residents who spent the census night in other districts. The Registrar.General has, however, informed me that the statistics for 1931 should be based on an estimated population of 174,800. From this latter figure, the inhabitants in the different wards of the borough have been estimated to be as shown in the following table:— The Borough 174,800 North Kensington 93,362 South Kensington 81,438 Wards. St. Charles 26,303 Golborne 25,731 Norland 21,630 Pembridge 19,698 Holland 18,181 Earl's Court 17,625 Queen's Gate 13,476 Redcliffe 19,682 Brompton 12,474 MARRIAGES. During the year, 1,890 marriages were registered, representing a rate of 21.6 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 732 Roman Catholic Church 232 Nonconformist Church 40 Jewish Church 12 Register Office 874 Total 1,890 4 BIRTHS. The number of births registered was 2,485, after correction for inward and outward transfers ; and the birth rate for the borough was 14.2 per 1,000 population. Distributed according to sex and legitimacy the births were as follow:— Male. Female. Total. Legitimate 1,133 1,132 2,265 Illegitimate 112 108 220 Totals 1.245 1.240 2,485 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various districts in the borough in 1931, and the rates for the previous five years:— District. 1931. Birth rates in previous years. No. of births. Birth rate. 1930. 1929. 1928. 1927. 1926. England and Wales 632,580 15.8 16.3 16.3 16.7 16.7 17.8 London 70,622 15.0 15.7 15.7 15.7 16.1 17.1 The Borough 2,485 14.2 14.6 14.4 14.3 15.0 15.1 North Kensington 1,827 196 19.0 19.3 18.7 19.8 18.7 South Kensington 634 7.8 8.2 7.7 8.0 7.9 8.9 Wards. St. Charles 569 21.6 17.9 19.3 20.2 15.6 18.4 Golborne 548 21.3 21.5 21.8 20.8 23.7 21.8 Norland 428 19.8 22.0 21.5 19.3 22.9 21.1 Pembridge 282 14.3 13.6 13.3 13.5 16.5 12.2 Holland 166 9.1 9.4 8.2 10.1 10.5 9.6 Earl's Court 163 9.2 9.8 8.7 8.7 6.9 10.7 Queen's Gate 68 5.1 5.2 6.2 5.7 5.7 7.8 Redcliffe 164 8.4 9.4 9.2 8.1 8.1 9.2 Brompton 73 5.8 5.3 5.0 6.3 7.7 5.9 Ward unknown 24 ... ... ... ... ... ... The decline in the birth rate in Kensington since 1881, which is similar to that taking place throughout the country, is shown in the following table:— Period. Birth rate per 1,000 population. 1881-1885 26.1 1886-1890 23.5 1891-1895 22.0 1896-1900 21.6 1901-1905 20.4 1906-1910 18.7 1911-1915 19.1 1916-1920 17.2 1921-1925 17.2 1926-1930 14.6 1931 14.2 5 Notification of Births Act, 1907—During the year, 2,485 live births to Kensington mothers were registered, and of this number 2,409 or 97 per cent, were notified in accordance with the requirements of the Act. The number of stillbirths notified was 59, and the number of births notified as having occurred in Kensington but belonging to other districts was 154. The following table indicates the source of notification and the kinds of births notified. Source of notification. Number of births notified. Still births. Live births. Total births. Number notified by midwives 19 1,082 1,101 „ ,, „ parents — 61 61 ,, „ „ medical practitioners 8 341 349 ,, „ „ other persons 15 439 454 Births in the borough 42 1,923 1,965 Notified from institutions outside the borough 17 486 503 Totals 59 2,409 2,468 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907. Year. Percentage. 1927 96 1928 94 1929 95 1930 97 1931 97 The importance of securing due compliance with the Notification of Births Act cannot be over-estimated, for the information obtained constitutes the starting point of the work of health visitors. DEATHS. The number of deaths registered in the borough during the year was 2,646, 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 outside 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 2,646 Deaths of residents in public institutions, etc., beyond the borough 525 3,171 Deaths of non-residents in public institutions, etc., within the borough 716 Corrected number of deaths belonging to the borough 2,455 The corrected number of deaths gives a death rate of 14.0 per 1,000 living. 6 The following table shows the number of deaths and the death rates in England and Wales, London, Kensington and the various districts in the borough in 1931, and the rates for the previous five years:— District. 1931. Death rates in previous years. No. of deaths. Death rate. 1930. 1929. 1928. 1927. 1926. England and Wales 491,635 12.3 11.4 13.4 11.7 12.3 11.6 London 56,294 12.4 11.4 13.8 11.6 11.9 11.4 The Borough 2,455 14.0 12.7 15.4 13.0 13.8 12.8 North Kensington 1,293 13.8 12.6 15.4 13.4 13.8 . 12.9 South Kensington 1,087 13.3 12.5 14.5 12.1 13.4 11.8 Wards. St. Charles 330 12.5 11.7 13.9 12.0 12.9 10.7 Golborne 364 14.1 12.3 16.0 13.2 13.8 13.0 Norland 308 14.2 14.4 17.5 15.3 14.5 15.0 Pembridge 279 14.2 12.1 14.1 13.4 14.1 12.8 Holland 263 14.5 12.7 14.4 13.2 13.4 13.5 Earl's Court 248 14.1 15.0 15.9 13.5 13.7 13.1 Queen's Gate 145 10.8 11.2 12.7 10.0 13.2 8.5 Redcliffe 303 15.2 11.1 15.7 12.9 14.5 11.6 Brompton 140 11.2 11.4 12.5 9.5 11.3 11.5 Ward Unknown 75 ... ... ... ... ... ... The following table shows the Kensington death rates since 1896:— Period. Death rate per 1,000 living. 1896-1900 16.4 1901-1905 14.4 1906-1910 13.8 1911-1915 14.3 1916-1920 15.6 1921-1925 13.2 1926-1930 13.5 1931 14.0 Causes of Death.—The following list shows certain causes of death which are important in themselves or from the fact that they contributed a considerable share to the total mortality for the year :— Cause of death. Number of deaths Principal zymotic (or epidemic) diseases 59 Epidemic influenza 64 Phthisis 127 Other tuberculous diseases 21 Cancer 333 Bronchitis 136 Pneumonia 232 Heart disease 480 Bright's disease 76 Puerperal fever 7 Premature birth 41 Accidents 103 Old age 39 All other causes 737 2,455 It will be seen that over one.third of the deaths, or 975, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 127 deaths. 7 The diseases described in the above list as the " principal zymotic diseases " are small pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhoea. The following table shows the zymotic death rate for Kensington and London in each of the last five years. Deaths from principal zymotic diseases per 1,000 persons living. Period. Kensington London. 1927 0.36 0.41 1928 0.64 0.69 1929 0.78 0.57 1930 0.62 0.58 1931 0.34 0.33 Cancer.—Cancer caused 333 deaths, and of this number 309 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 281 deaths were attributed ; sarcoma and epithelioma were the assigned causes of 22 deaths; 30 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 trable:- DEATHS FROM CANCER, 1931. Parts affected. Sex. Total. Male. Female. Buccal cavity 7 5 12 Lungs 6 6 12 Stomach, liver, etc. 55 58 113 Peritoneum, intestines, rectum 38 41 79 Female genital organs ... 38 38 Breast ... 36 36 Skin 1 1 2 Other and unspecified organs 20 21 41 Totals 127 206 333 The deaths in the several wards, etc., are set out in the following table :— The Borough 333 North Kensington 156 South Kensington 177 Wards. St. Charles 42 Golborne 41 Norland 40 Pembridge 33 Holland 38 Earl's Court 44 Queen's Gate 17 Redcliffe 46 Brompton 21 Ward unknown 11 The number of deaths from this disease was 22 more than in the previous year. 8 Table showing the number of deaths in 1931 from certain diseases of public health importance, arranged in four-weekly periods. Four weeks ending Enteric fever. Scarlet fever. Whooping cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhœa . and enteritis. January 31 — — — 1 5 18 26 20 31 8 February 28 — — 1 — 27 23 26 32 30 2 March 28 — — — 2 14 11 21 18 27 3 April 25 1 — — — 4 9 27 11 18 4 May 23 — — — — 3 16 19 6 12 3 June 20 — 1 — 1 — 6 20 5 15 4 July 18 — — 2 1 1 4 31 4 7 1 August 15 — — — — — 3 29 2 9 — September 12 — — — 1 — 5 26 4 11 2 October 10 — — 1 — — 4 27 7 12 5 November 7 — — 2 — 2 7 31 8 19 1 December 5 — — 2 1 3 10 32 8 16 3 January 2 — — 2 — 5 11 18 11 25 4 Totals . 1 1 10 7 64 127 333 136 232 40 Infantile Mortality. During the year 1931, there were 2,485 births and 188 deaths of children under the age of 12 months in the borough. These figures give an infantile mortality rate (deaths of infants under twelve months to each 1,000 births) of 76. The following table gives the births and the infantile deaths and death rates in England and Wales, London, Kensington and the various wards of the borough for the year 1931, and the infantile death rates for the previous four years District. 1931. Infantile mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infantile mortality rate. 1930 1929 1928 1927 England and Wales 632,580 41,648 60 66 74 65 69 London 70,622 4,769 65 64 70 67 59 The Borough 2,485 188 76 69 84 83 66 North Kensington 1,827 158 86 76 93 93 73 South Kensington 634 28 44 55 71 66 53 Wards. St. Charles 569 43 76 64 59 58 86 Golborne 548 53 97 81 121 111 73 Norland 428 36 84 70 88 115 62 Pembridge 282 26 92 96 101 87 72 Holland 166 9 54 84 96 62 65 Earl's Court 163 3 18 46 70 75 31 Queen's Gate 68 4 59 57 46 87 25 Redcliffe 164 11 67 43 54 67 79 Brompton 73 1 14 30 94 24 31 Ward unknown 24 2 — — — — — 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. 9 INFANTILE MORTALITY RATES, 1896 1931. Period. England and Wales. London. Kensington. 1896-1900 156 162 176 1901-1905 138 139 144 1906-1910 117 114 120 1911-1915 109 110 110 1916-1920 90 90 96 1921-1925 76 71 83 1926-1930 66 64 77 1931 66 65 76 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1931. January 24 February 25 March 22 April 11 May 16 June 5 July 8 August 9 September 9 October 21 November 14 December 24 10 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1931. Causes of death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks Total 4 weeks. 1—3 months 3—6 months. 6—9 months. 9—12 months. Total infant deaths under 1 year. 1. Common infectious diseases (Whooping cough 2) (Diphtheria 1) (Erysipelas 1) — — — — — — 1 2 1 4 2. Tuberculosis — — — — — — — 1 — 1 3. Pneumonia, bronchitis and other respiratory diseases — 3 l 2 6 6 30 17 4 63 4. Enteritis — — — — — 6 12 9 5 32 5. Complications of birth (Atelectasis 4) 2 1 l — 4 — — — — 4 8. Congenital malformation 4 — — — 4 5 1 1 — 11 7. Premature birth 31 2 2 1 36 4 1 — — 41 8. Atrophy, debility and marasmus — 1 — — 1 7 5 2 1 16 9. Other diseases (Meningitis 2) (Convulsions 4) (Influenza 2) (Pyloric stenosis 3) (Other conditions 5) 2 1 1 1 5 4 2 2 3 16 Totals 39 8 5 4 56 32 52 34 14 188 Death rate in each age period per 1,000 births 15.7 32 2.0 1.6 22.5 12.8 20.9 13.6 5.6 76 Percentage of total infant deaths occurring in each age period 20.7 4.3 2.6 2.1 29.7 17.0 27.6 18.0 7.4 The high infant mortality rate which has persisted in the borough for many years has received considerable attention by the council, the appropriate committees and various voluntary organisations within the borough. In 1929, the medical practitioners working in North Kensington appointed a special subcommittee to investigate the problem and their report was published as an appendix to my annual report for 1930. This report, which was an admirable one, received much attention, but those who were responsible for its preparation concluded that a more detailed investigation was necessary before final opinions could be expressed. These doctors have, therefore, in conjunction with the Paddington and Hammersmith doctors, established a large and active committee which is investigating infant deaths in these three boroughs in co.operation with the medical officers of health. In this work, the doctors are receiving the help of the council's maternity and child welfare committee, the officers of the public health department and the various voluntary organisations in the borough. Similar assistance is being given in the other two boroughs and it is hoped eventually to publish a report of considerable value. 11 ABOVE STANDARD DEATHS. In almost every area there is a number of infant births and deaths occurring in those better class homes where it is reasonable to assume that the children receive every care and all requisite medical and nursing assistance. These are called " above standard " cases and, although it is difficult to make certain that none is included under this heading in which the attention of a woman health officer might prove beneficial, they are not generally visited because, in the first place, the health officer may not be welcomed and, in the second place, she can occupy her time more profitably in visiting homes in the poorer quarters. In 1931 the " above standard " notified births numbered 595 and the deaths 21, giving an infantile mortality rate of 37. The 1,873 notified births and 167 deaths not "above standard" in 1931 give an infantile mortality rate of 81. The causes of death in the " above standard " cases were as follow :— Premature birth 8 Congenital defects 3 Broncho pneumonia 3 Inanition 2 Hydrocephalus 1 Marasmus 1 Diarrhoea 1 Convulsions 1 Unknown 1 21 MATERNAL MORTALITY. In 1931 there were 15 deaths of Kensington women from diseases or accidents directly connected with child-birth, and this figure represents a death rate of six mothers per 1,000 births. The rate for London for 1931 was 3.80, and for England and Wales 4.11. Where the figures are small, a few deaths more or less make a big difference in the percentage. For example, in 1930 the Kensington rate was 2.3 per 1,000, whilst that for London was 3.33, and for England and Wales 4.40. Too much attention must, therefore, not be paid to fluctuations in percentages in any one borough from one year to another, but 15 deaths of Kensington women between the ages of 23 and 40 years occurring in the space of 12 months, in connection with the performance of a normal function, suggests a sufficiently serious state of affairs to warrant the closest investigation. As each of these deaths was reported, I arranged for the late Dr Remington Hobbs to make, in consultation with the doctor in charge of the case, a detailed examination into all the circumstances in order that reports could be submitted to the Ministry of Health for the information of a committee thereat enquiring into the causes of maternal mortality. At the request of the Ministry of Health and the medical profession, these reports are regarded as confidential by me and I have given an undertaking to keep no copies in the public health department. It is desirable, however, that the council should have some information and for this purpose the health visitors have made enquiries independently of Dr. Hobbs, the results of which are submitted in the following table :— 12 SUMMARY OF PARTICULARS RELATING TO MATERNAL DEATHS IN KENSINGTON IN 1931. Married or single. Cause of death. Did patient receive ante natal care ? Where did confinement take place ? Was a doctor in attendance at confinement ? Was a midwife in attendance at confinement ? Where did death take place ? When was patient admitted to hospital ? Remarks. M. Puerperal fever (after full term delivery). Yes (own doctor) Hospital Yes Yes Hospital Before confinement Suffered from chronic bronchitis. Normal labour, but fever developed after five days. „ „ „ Yes (midwife) Own home No Yes „ ••• Eight days after confinement. Temperature rose on fifth day after confinement and a doctor was called in. „ „ „ Yes (hospital) Own home No Yes „ ••• Three days after confinement. — „ „ „ Yes (hospital) Own home Yes No „ ••• Four days after confinement. — „ Puerperal fever (after miscarriage). No Own home No No „ ••• One day after miscarriage. — s. „ „ No Hospital Yes Yes „ ••• Before miscarriage Symptoms of miscarriage developed at home. M. Haemorrhage after confinement. Yes (nursing home) Nursing home Yes Yes „ ••• Immediately after confinement. — „ „ „ Yes (specialist) Nursing home Yes Yes Nursing home Entered nursing home before confinement. — „ Eclampsia Yes (hospital) Child unborn Yes Yes Hospital Day of death — „ „ ••• Yes (hospital) Hospital Yes Yes „ ••• Before confinement — „ Pneumonia at 32nd week of pregnancy and miscarriage. Yes (hospital) Hospital Yes Yes „ ••• Two days before con. ment. — S. Heart failure during delivery under anaesthesia. Yes (hospital) Child unborn Yes Yes ••• Three days before labour. — 13 There are three deaths not mentioned in the above table. One was due to puerperal fever following early miscarriage ; the second followed extra.uterine pregnancy and in this case the patient did not receive ante.natal care which might have saved her life ; in the third case, the expectant woman was found to be suffering from inflamed varicose veins and was advised by her doctor to take to her bed, but the advice was not accepted and a clot of blood caused death prior to labour. During the year, there was no instance where a general medical practitioner or a district midwife attended more than one fatal case. In 1931, there were 2,485 births in Kensington and of these 595 may be said to have occurred in families which are regarded as " above standard " financially and do not come within the scope of the council's maternity and child welfare scheme. In respect of 1,328 of the 1,890 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 established in the borough. The women who gave birth to the remaining 562 children may have received ante.natal attention from private medical men or at hospitals, but it is probable that the majority did not secure for themselves the advantages of skilled advice. Of the 15 women who died in the process of child.bearing during 1931, all but four had received ante.natal care ; but there is some evidence before me that this was not in all cases received early enough in pregnancy to be effective. I am satisfied that the council and the voluntary agencies with which they co.operate have established an adequate number of ante.natal clinics and that no woman should have any difficulty in securing pre.natal medical supervision free of cost to herself; but I am not satisfied that the working.class women are sufficiently educated in regard to the paramount importance of the skilled supervision of pregnancy. It is also unfortunate that of those seeking ante.natal advice many delay taking this step until pregnancy is far advanced. There is adequate accommodation in hospitals, nursing homes, etc., for those women who cannot be safely confined at home. The council, having secured the provision of a sufficient number of ante.natal clinics and having provided a maternity home, cannot do more at the moment than (a) to continue their educational efforts with a view to inducing every expectant woman in the borough to submit to skilled supervision from her own doctor or from one of the ante.natal clinics throughout the last five or six months of pregnancy, and (b) to satisfy themselves that the doctors at the ante.natal clinics have adequate facilities and time to carry out their duties with such care that every departure from the normal in a pregnant woman which is discoverable by medical skill will be detected and treated. GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. STAFF OF THE COUNCIL'S PUBLIC HEALTH DEPARTMENT. A list of the staff engaged in the public health department at the end of the year 1931 will be found in Table 7 of Appendix II. PROFESSIONAL NURSING IN THE HOME. As in past years, the Kensington District Nursing Association continued to carry out professional nursing in the homes of the poor. The number of cases nursed during 1931 was 1,947 and the number of visits paid 40,273. The following is a table of cases attended and visits paid by nurses of the Kensington District Nursing Association on behalf of the council from January 1st to December 31st, 1931 :— Cases. Visits. Maternity case 22 215 Miscarriages 48 517 Pneumonia (5 years of age and over) 94 1,292 „ (under 5 years of age) 120 1,947 Ophthalmia neonatorum and other inflammations of the eyes of newly.born children 28 409 Influenza (5 years of age and over) 53 412 „ (under 5 years of age) 2 34 Zymotic enteritis 58 424 Tuberculosis (5 years of age and over) 16 394 „ (under 5 years of age) — — Measles (5 years of age and over) 2 47 „ (under 5 years of age) 4 37 Measles & pneumonia (5 years of age and over) — — „ „ (under 5 years of age) 2 32 Whooping cough (under 5 years of age) 7 83 Erysipelas 8 121 Scarlet fever 1 9 Pemphigus 16 265 Acute rheumatism 9 133 Totals 490 6,371 14 For the splendid services rendered, the council paid to the association in 1931 a grant of £300. A trained nurse is employed by the Golborne infant welfare centre to undertake home nursing of expectant and nursing mothers and infants in the very poor area allocated to that centre. The cases attended and visits paid by the Golborne home nurse during the year are given in the following table :— Cases attended. Visits paid. Adults 31 136 Children under 5 years of age 185 1,308 Totals 216 1,444 Bronchitis 42 275 Ear discharges 5 82 Minor ailments 122 689 Measles 16 162 Totals 185 1,208 MIDWIFERY ARRANGEMENTS. The borough is well served in this respect. The Queen Charlotte's Hospital authorities maintain a district nurses' home in Ladbroke Grove, North Kensington, and during the year members of the staff thereat conducted 728 confinements, of which 650 were in Kensington homes. The borough council maintain a maternity home with ten beds and the London County Council have at St. Mary Abbots Hospital 20 beds for the confinement of poor women. The number of confinements dealt with by these three organisations, together with those taking place in outlying hospitals, leaves but a comparatively small number to be attended by private doctors and midwives in the homes. LEGISLATION IN FORCE LOCALLY. Notification of Zymotic Enteritis. At a meeting of the council on the 15th April, 1924, it was resolved :— " That this council do, under and pursuant to the provisions of Section 56 of the Public Health (London) Act, 1891, hereby order that Section 55 of the said Act, with respect to the notification of infectious disease, shall apply in their district to epidemic diarrhoea or zymotic enteritis in the case of infants up to 5 years of age." The order was approved by the Minister of Health on the 22nd April, 1924, and came into operation on the 1st July of that year. With the information secured by compulsory notification it was possible to take effective steps in regard to prevention and treatment of the disease, and in 1924 the council approved of a scheme for this purpose. A detailed report on notification and treatment of zymotic enteritis will be found on page 52. Notification of Acute Rheumatism. The Kensington (Acute Rheumatism) Regulations, 1927, came into force on the 1st October of that year and operated for a period of three years. During the year 1930 the Minister of Health renewed the regulations for a further period of three years. By-law Prohibiting the Fouling of Footpaths by Dogs. In 1921 the council made a by.law, which was sanctioned by the Home Office, prohibiting the fouling of footpaths by dogs. Two officers in the public health department make observations under the by-law, and during 1931 eleven breaches of the by.law were reported to the public health committee. Summonses were taken out and fines of 20s. in one case, of 10s. 6d. in another, 10s. in seven cases and 5s. in two were imposed. The number of convictions under this by.law during the past ten years is 67. 15 GENERAL HOSPITAL. The Princess Beatrice Hospital, formerly known as the Kensington, Fulham and Chelsea General Hospital, was reopened to in.patients on the 31st December, 1931. The new section of the hospital contains a maternity ward, a children's ward, and general wards for men and women. The total number of beds available for in.patients is 76. A further wing is being added later, when the total complement of beds in the in.patient department will be 136. The work performed at the hospital during the year 1931 was as follows :— I.—Out-Patients. Total number of new out-patients 7,460 „ „ ,, out.patient attendances 39,052 Number of casualty patients 2,768 II.—Other Treatments. Number of operations 224 „ „ dental cases 1,202 „ „ massages 2,378 THE PRINCESS LOUISE KENSINGTON HOSPITAL FOR CHILDREN. This institution meets the medical and surgical needs of the children in North Kensington and adjacent districts. In addition to a large out.patient department, there is an in.patient department of 50 beds. The hospital is now a recognised training school for nurses. There are X.ray, dental, ophthalmic and massage departments and a fully equipped operating theatre. The beds are allocated as follows :— General medical 21 General surgical 14 Ear, nose and throat 9 Rheumatism 4 Ophthalmia 1 Skin 1 Total 50 The fact that the public appreciate the services rendered by the hospital may be gathered from the following figures of work done during the year 1931. (a)—In.Patients. 1. Total number of available beds on 31st December, 1931 50 2. Average number of available beds during year 45.53 3. Average number of patients resident daily throughout year 40.88 4. Number of in.patients in the hospital at beginning of year 31 5. Number of in.patients admitted during year 1,326 6. Number of in.patients in the hospital at the end of year 11 7. Average number of days each patient was resident 11 .09 8. Number of patients admitted and discharged during year who were resident for (i) only 1 day 51 (ii) 2 and 3 days 541 (b)—Out.Patients. 1 Total number of new out-patients 10,734 2. Total number of out-patient attendances 80,018 3. Number of casualty patients included in No. 1 above 1,665 16 RHEUMATISM SUPERVISORY CENTRE. In October, 1927, the borough council established a rheumatism supervisory centre at the Princess Louise Kensington Hospital for Children for the supervision and treatment of children suffering from acute rheumatism. Further information in regard to this centre will be found in Appendix I of this report. The record of work carried out at the centre during the year 1931 is as follows :— Number of sessions held 49 Number of individual patients examined— Kensington 268 Hammersmith 60 Other boroughs 14 Total attendances of patients— Kensington 982 Hammersmith 184 Other boroughs 49 AMBULANCE FACILITIES. The London County Council provide ambulances free of cost for the conveyance to— (a) Hospitals or private residences of :— (i) persons meeting with accidents or suffering from sudden illnesses ; (ii) parturient women, if the case is one of urgency, on the application of a qualified medical practitioner or certified midwife, and (iii) non.urgent cases of parturition, between the hours of 11 p.m. and 8 a.m. if letters of admission to maternity hospitals are produced. (b) Fever hospitals for patients suffering from infectious disease. (c) General hospitals and institutions of non.infectious cases when application is made through the county council's public assistance department. The borough council have entered into an agreement with the county council under which the latter have agreed to remove, between the hours of 8 a.m. and 11 p.m., non.urgent Kensington maternity cases to hospitals at the request of the borough medical officer of health and the former have agreed to pay the cost. SCHOOL TREATMENT CENTRES. There is in Notting Dale a school treatment centre managed by a sub.committee of the Princess Louise Hospital Board of Management Committee, and the work performed thereat during 1931 was as follows :— New cases. Total attendances. Eye cases 449 1,157 Aural cases 493 967 Minor ailment cases 2,027 23,502 Dental cases 1,211 2,059 A school treatment centre has also been established at the Baby Clinic premises in Tavistock Road and the record of work for the year 1931 is as follows :— New cases. Total attendances. Minor ailment cases 3,432 27,235 Dental cases 1,851 3,223 In addition there is a school treatment centre at the Princess Louise Kensington Hospital for Children and the particulars of the cases treated thereat during 1931 are as follows :— Tonsils and adenoids 410 Eyes (new cases) 345 Dental cases : (gas, 124; fillings, 352) 476 X-ray cases 16 17 SCHOOL MEDICAL SERVICE. Sir Frederick Menzies, the county medical officer, has kindly made it possible for me to give the following particulars of the routine medical examination of elementary school children carried out in 1931 in Kensington. TABLE SHOWING NUMBER EXAMINED AND DEFECTS FOUND Number examined Boys. Girls. Entrants. Age 8. Age 12. Age 14. Entrants. Age 8. Age 12. Age 14. 1,120 755 671 494 1,129 762 698 498 Defect. Cases. Cases referred for treatment. Cases. Cases referred fortreatment. Cases. Cases referred for treatment. Cases. Cases referred for treatment. Cases Cases referred for treatment. Cases. Cases referred for treatment. Cases Cases referred for treatment. Cases. Cases referred for treatment. Malnutrition 4 3 6 6 4 4 1 1 1 1 5 2 5 4 1 • •• Skin disease 27 22 9 8 9 6 6 5 24 16 15 13 3 3 4 2 Defective teeth ... 403 ... 182 ... 157 ... 115 ... 406 ... 221 ... 150 ... 108 Enlarged tonsils 192 39 81 18 48 14 22 3 176 40 80 18 49 10 23 8 Adenoids 13 5 4 1 2 1 ••• ••• 7 7 ••• ... ... ... ... ... Tonsils & adenoids 69 47 30 22 9 3 1 1 81 50 26 20 7 5 7 6 Other nose & throai 18 4 6 4 9 5 ... ... 13 3 9 7 6 8 ... ... Enlarged glands 166 16 82 8 32 4 25 1 137 19 83 6 24 ... 15 ... Eye disease 28 22 15 7 11 6 10 4 28 17 19 6 13 11 7 3 Defective vision ... ... ... 64 ••• 95 ... 40 ... ... ... 53 ... 83 ... 47 Otorrhoea 20 13 11 8 8 8 3 3 25 18 7 4 5 4 3 2 Other ear disease 4 3 6 5 ... ... ... ... 7 4 ... ... 3 2 1 1 Defective hearing ... ... 1 1 2 2 1 ... ... ... 1 ... 1 1 ... ... Speech defects 2 ... 2 ... 2 ... 1 ... 2 ... ... l ... ... ... 1 ... Heart defects 35 5 14 ... 15 3 13 ... 27 3 28 ... 11 1 12 ••• Anaemia 11 4 6 3 7 5 3 1 8 2 9 3 6 3 5 1 Lung defects 25 6 8 6 3 2 2 1 37 15 7 5 6 1 5 3 Nervous system 7 3 4 1 6 3 1 1 6 1 7 2 2 1 6 3 Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other tubercular disease 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 Rickets 28 1 12 ... 5 ... 2 ... 6 1 5 ... 7 ... 1 ••• Spinal deformities ... ... 2 1 4 1 ... ... ... ... 5 2 12 10 10 6 Other deformities 7 2 4 1 ... 4 4 2 11 3 4 ... 8 2 4 1 Other defects 26 13 14 11 14 7 5 ... 41 25 24 14 16 4 14 6 Number of children noted for treatment 521 300 264 164 538 318 259 169 TABLE SHOWING THE CONDITIONS IN REGARD TO CLOTHING, NUTRITION, CLEANLINESS, TEETH AND VISION OF THE CHILDREN EXAMINED. Age Group. Number examined. Clothing and boots. Nutrition. Cleanliness of head. Cleanliness of body Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either eye- Entrants Boys 1,120 354 754 12 145 955 20 _ 1,049 67 4 1,059 60 1 615 306 199 _ _ _ Girls 1,129 399 722 8 174 935 20 _ 1,035 85 9 1,076 53 — 623 308 198 — Age 8. Boys 755 184 565 6 86 629 40 _ 710 43 2 712 42 506 166 83 405 215 122 Girls 702 229 532 1 93 646 23 — 690 64 8 729 33 — 491 195 76 434 212 104 Age 12. Boys 671 174 494 3 86 560 25 _ 640 30 1 637 32 2 469 174 28 413 189 119 Girls 698 221 476 1 70 604 24 _ 648 46 4 670 27 1 524 160 14 444 133 118 Age 14. 491 159 334 1 58 427 9 _ 485 8 1 479 15 _ 354 123 17 339 84 70 Girls 498 174 324 — 84 402 12 _ 471 24 3 483 14 1 366 117 15 321 88 88 Total 6,067 1,894 4,201 32 796 5,158 173 _ 5,728 367 32 5,845 276 5 3,948 1,549 630 2,356 921 621 Kensington percentages 30. 9 68.6 0.5 13.0 84.2 2.8 93.5 6.0 0.5 95.4 4.5 0.1 64.4 25.3 10.3 61.3 22. 6 16.1 London percentages 60.8 38.5 0.7 20.6 74.9 4.5 95.5 4.0 0.5 97.3 2.6 0.1 66.2 27.4 6.4 53 .5 23. 5 18 .0 18 HEALTH PROPAGANDA. The borough council held another health week from the 4th to the 10th October inclusive. Many voluntary organisations offered their help and clergymen in the borough co-operated by preaching sermons on Sunday, the 4th October, on the subject of health. Special lectures were arranged at the Latymer Mission, The Quest, The Venture, the Magnet Girls' Club, St. David's Hostel, St. Mark's Church and the Gospel Mission, Redfield Lane. The Imperial Institute arranged for film displays to take place twice daily throughout the week. A health concert was arranged at the Venture on the 10th October ; it was well attended, and the chief item was a play dealing with the importance of introducing vegetable products in the daily diet. From the 6th to the 9th October, a health exhibition was held at the Town Hall. Her Royal Highness the Princess Louise, Duchess of Argyll, V.A., C.I., G.B.E., intended to open the exhibition on the first day, but in her absence through illness the ceremony was performed by His Worship the Mayor. On the second day the opening ceremony was performed by Councillor the Right Hon. the Countess of Limerick. The public health department arranged a stand on which were demonstrated :— (a) sanitary inspection of premises, (b) control and prevention of infectious diseases, (c) model drainage, (d) methods of disinfection, (ie) destruction of household pests, (/) protection of food supply, (g) model clothing for children from birth to five years of age, and (h) the work of the dispensary in the prevention of tuberculosis. The borough engineer also provided an interesting exhibit demonstrating :— (a) filtration of swimming bath water, (b) dust removal, (c) street cleansing, and (d) road paving, etc. The maternity and child welfare section, arranged by the voluntary committees of the infant welfare centres and baby clinic, comprised the following exhibits :— (a) dental exhibit, (b) babies of all nations, (c) baby's bath and bed, \d) an old and a modern nursery, (e) an improvised room, (/) sunlight treatment, (g) good and bad foods, and (h) a model day nursery. Other exhibits were provided by voluntary societies in the borough. Various bodies and selected firms contributed additional exhibits. During the exhibition, lectures were given each morning to parties of school children, and evening entertainments dealing with health subjects were given by the following schools :— (a) St. Clement's (girls, boys and infants), (b) Barlby Road (junior school), (c) Buckingham Terrace (infants), and (d) Oxford Gardens (girls). The health exhibition was even more successful than the previous one held in 1928 and it is estimated that over 20,000 people attended. COMPETITIONS. Competitions were arranged in connection with the health exhibition, and during the year two competitions were held at women's clubs ; these were keenly contested and prizes were awarded to the successful entrants. They dealt with health subjects. OTHER HEALTH SERVICES. There are no fever hospitals within the borough, but several provided by the London County Council are within easy reach. The arrangements for the treatment of tuberculosis and the organisation for maternity and child welfare work are discussed further on in this report. Kensington enjoys a great advantage in possessing a large number of ladies and gentlemen who give freely of their time and money to voluntary bodies interested in the health and welfare of the poorer members of the community. Not only are all the maternity and child welfare institutions in Kensington organised on a voluntary basis, but there are at work in the borough a branch of the Charity Organisation Society, a branch of the Invalid Children's Aid Association, a branch of the British Red Cross Society, the Kensington Council of Social Service, School Care Committees, a Tuberculosis Care Committee and a number of other bodies managed and financed on voluntary lines by Kensington residents. The council have endeavoured with marked success to work in close co.operation with these organisations and the relationship between them has always been a happy one. 19 SUBSCRIPTIONS BY THE BOROUGH COUNCIL TO VOLUNTARY HEALTH ORGANISATIONS DURING 1931. Subscriptions to Hospitals, etc. £ s. d. Cancer Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 Kensington District Nursing Association 5 5 0 Kensington, Fulham and Chelsea General Hospital. 10 10 0 Kensal Gospel and Medical Mission 5 5 0 National Hospital for Diseases of the Heart 5 5 0 Paddington Green Children's Hospital 5 5 0 St. Mary's Hospital 10 10 0 West London Hospital 10 10 0 Western Ophthalmic Hospital 5 5 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 Charity Organization Society 5 0 0 Invalid Children's Aid Association 5 0 0 Payments to Maternity and Child Welfare Institutions. £ s. d. Archer Street Infant Welfare Centre 420 10 0 Bramley Road 405 6 0 Campden Hill 255 0 0 Earl's Court 418 0 0 Golborne 702 0 0 Kenley Street 383 5 0 Lancaster Road 541 0 0 Raymede 546 0 0 Golborne Day Nursery 197 0 0 Lancaster Road Day Nursery 323 0 0 St. Clement's Day Nursery 281 0 0 Notting Hill Day Nursery 429 0 0 Baby Clinic 656 0 0 Baby Hospital 1,557 0 0 Queen Charlotte's Hospital Ante.Natal Clinic 145 0 0 Princess Louise Hospital 400 0 0 Kensington District Nursing Association 300 0 0 Evelyn Convalescent Home 16 16 0 Hambledon Convalescent Home 8 8 0 St. Mary's Convalescent Home 27 18 0 George Whitlaw Convalescent Home 19 18 0 Mutual Registration of Assistance Society 10 0 0 Association of Infant Welfare and Maternity Centres 8 0 0 London County Council (Maternity Home) 426 4 0 Queen Charlotte's Hospital (Maternity Home) 286 13 0 On October 1st, 1931, the borough council maternity home was transferred to the Queen Charlotte's Hospital. 20 SANITARY CIRCUMSTANCES OF THE AREA. REFUSE COLLECTION. The conversion of horse-drawn vans from the high-loading to the low-loading bodies, and the discarding of other vans for motor vehicles has been continued throughout the year, and a steady improvement has been effected in the collection service. There is an improved daily collection in eleven main streets where there is traffic congestion, and a daily collection is undertaken before 9 a.m. in a number of other streets and blocks of flats. In a number of other cases, there is a thrice-weekly collection, and in the rest of the borough it is twice weekly. Twenty-two per cent. of the Kensington refuse is barged away from Kensal Wharf to dumps at Yeading and Harefield, Middlesex ; 34 per cent. is disposed of in the refuse destructor installation at Wood Lane ; and 44 per cent. is barged away from the Chelsea Wharf to a dump beyond Tilbury, Essex. The Council have introduced standardised dustbins, and during the year 922 of these were sold to residents. Four hundred and fifty dust.holes have been abolished and replaced by dustbins. In premises where a large amount of refuse accumulates, the Council's cleansing superintendent has endeavoured to have the container system instituted and up to the present time 45 containers have been installed in the borough. REFUSE REMOVAL FROM MEWS. The common dustbins installed by the council in 1921, in 20 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 problem of securing hygienic conditions in mewsways has been tackled with considerable success during past years as a result of close co.operation between the officers in the public health department and the borough engineer's department. SEWERAGE AND DRAINAGE. Every house in the borough is connected with the water carriage system for the disposal of sewage and, generally speaking, house drainage in Kensington is very satisfactory. The following table deals with (a) drainage work undertaken voluntarily by owners and supervised by the officers of the public health department from the 1st January to the 31st December, and (b) all drainge work required by notices served under the Public Health (London) Act, and carried out under the supervision of the sanitary inspectors :— Voluntary work. Work under notice. Plans submitted 207 27 Plans approved by the council 207 27 Total reconstruction of drains of premises 39 12 Partial reconstruction of drains of premises 62 12 Repairs to drains by " Economic Method " 21 3 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 2,111 875 21 SANITARY INSPECTION. The following table shows a summary of the inspections, etc., carried out by the male sanitary inspectors during the year:— DESCRIPTION OF INSPECTIONS. &c. NUMBER OF DISTRICT Housing Inspector. Grand Total 1 2 3 4 5 6 7 8 9 10 Total complaints received 315 190 150 292 266 199 199 188 261 137 7 2,204 Public Health (London) Act, 1891. Complaints received 204 96 124 186 171 197 182 180 250 134 7 1,731 Houses inspected on complaint 199 100 133 190 167 216 200 200 257 131 7 1,800 „ after infectious disease 220 142 112 130 113 73 43 56 76 15 6 986 Re-inspections 1,040 244 1,119 1,390 1,193 1,342 1,535 631 1,521 1221 17 11,253 By-Laws re houses let in lodgings Complaints received 111 94 26 106 95 2 17 8 11 3 — 473 Houses inspected on complaint 111 98 26 112 89 8 14 8 11 3 — 480 First annual inspection (furnished Houses) — 6 1 6 4 5 — — 1 — — 23 Re-inspections „ „ — 12 — 7 14 37 — — 1 — — 71 First annual inspection (unfurnished houses) 91 359 208 200 474 112 27 25 112 32 — 1,640 Re-inspections „ „ 296 1,828 1,207 807 1,316 523 339 15 424 166 272 7,223 Housing Acts, 1925 & 1930— Initial inspections (including preparation or revision of house to house card) 88 151 174 120 144 77 88 83 98 92 124 1,239 Re-inspections 42 125 112 215 220 78 94 40 27 35 1,67'2 2,660 Underground living rooms. Primary inspections 4 29 47 6 22 12 6 — 18 19 92 255 Re-inspections 2 22 75 — 13 33 2 — 13 83 53 296 Drainage. House drains tested and inspected 52 49 116 50 96 79 465 54 223 312 153 1,649 Voluntary drainage work Applications made 42 — 7 40 13 67 6 63 70 126 — 434 Plans submitted 10 — 8 22 27 19 21 23 29 48 — 207 Inspections of workshops 21 41 93 44 87 14 50 114 80 31 — 575 „ factories 33 34 27 23 43 2 7 20 3 6 3 201 „ bakehouses 35 25 28 13 34 16 21 28 23 6 — 229 „ ice cream premises 43 1 8 1 8 1 4 4 2 7 — 79 „ other food premises 141 72 86 56 277 219 15 82 173 156 — 1,277 „ mews 225 167 217 95 87 204 177 308 346 163 8 1,997 Smoke observations 82 1 3 5 3 19 13 89 8 55 3 281 Other inspections 661 261 485 563 481 347 357 913 583 365 92 5,108 Canal boats inspections — — — — — — — — — — 10 10 „ „ re-inspections — — — — — — — — — — 63 63 22 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc., found in the various districts during the year:— NUMBER OF DISTRICT. Housing Inspector. Grand Total 1 2 3 4 5 6 7 8 9 10 Kind of notices issued. Public Health (London) Act, 1891. Intimations 200 391 215 444 496 103 86 87 192 90 2 2,306 Statutory notices 24 137 26 72 52 24 15 4 30 8 1 393 Final notices 4 26 6 17 30 2 7 2 8 3 — 105 Summonses issued — 3 — 3 6 — — — — 2 — 14 Housing Acts, 1925 and 1930. Sect. 17 (1930) (Repairs) — — — — — — — — — — 174 174 Sec. 127 (1925) (Power of entry) — — — — — — — — — — 649 649 Underground room habitation — 10 2 — — — — — 1 — — 13 Removal of manure 15 — 1 1 — — — 1 — 7 — 25 Smoke nuisance notices — — — — — — — 2 — — — 2 Rent Restrictions Act certificates — 1 — — — — 3 3 — — — 7 Special notices included under Public Health (London) Act, 1891, relating to factories 7 — 1 2 9 — — 3 — — — 22 „ workshops 8 2 1 4 2 1 8 3 1 4 — 34 „ bakehouses — 1 — 2 4 — — — — 2 — 9 Other notices — 16 3 6 10 — — — 2 1 — 38 Report of waste of water to M.W.B. 1 20 12 5 5 3 6 21 19 2 4 98 „ dangerous structures to L.C.C. 1 8 9 7 4 5 1 — 2 — 6 43 Canal boats — — — — — — — — — — 13 13 23 Summary of Works completed under the Supervision of the Sanitary Inspectors during the Year. DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Housing Inspector. Grand Total. 1 2 3 4 5 6 7 8 9 10 House drains reconstructed 7 2 10 14 15 5 17 5 15 8 2 100 Defective drains repaired 11 4 6 25 27 15 27 23 18 45 2 203 House drains cleansed 34 32 23 28 44 21 16 46 36 65 — 345 Water-closets reconstructed 23 10 13 42 66 10 16 21 31 49 4 285 „ repaired 134 10 22 28 94 24 20 11 21 55 17 436 „ supplied with water 6 3 9 82 16 14 8 6 34 137 12 327 „ new provided 10 — 17 24 19 27 32 24 33 110 1 297 Soil pipes ventilated, repaired, &c. 8 4 11 20 20 10 17 17 42 55 2 206 „ new provided 8 2 14 14 30 19 22 9 19 48 2 187 Baths, new provided 19 — 18 22 23 33 42 34 75 95 — 361 Sinks, ,, „ 36 — 22 62 50 28 42 19 65 83 18 425 Lavatory basins, new provided 18 — 11 50 37 95 97 188 212 214 — 922 Cisterns cleansed 6 4 3 8 69 6 4 6 1 4 5 116 „ covered 6 2 4 8 31 4 1 1 — 1 3 61 „ abolished — — — — — 7 — 1 — — — 8 Taps fixed on rising main 3 1 2 6 16 1 3 10 97 — 139 Yards, areas paved, drained, repaired 54 7 28 28 78 17 5 16 1 60 155 449 Dustbins provided 59 41 30 24 139 16 13 40 10 45 29 446 Ashpits abolished — 4 2 1 11 1 1 4 — 9 12 45 Accumulations of filth, &c., removed 15 25 15 16 44 12 7 40 26 149 84 433 Animals removed 1 3 1 7 5 — — 1 — — 6 24 Overcrowding abated 12 6 7 3 2 3 1 — 2 2 — 38 Underground rooms, illegal occupation discontinued 3 13 5 — 12 3 1 2 3 4 27 73 Roofs repaired 85 110 65 28 137 18 26 25 79 72 178 823 Houses provided with water above basement floor 2 6 6 5 9 2 10 1 — 19 17 77 Dampness in dwellings remedied Closing Orders made under 98 67 86 34 79 10 23 11 45 21 77 551 Housing Acts— (a) Houses — — — — — — — — — — — — (b) Parts of Houses — — — — — — — — — — — — (c) Underground Rooms 1 2 — — 2 1 — — — — — 6 Closing Orders determined — — 1 — — — — — — — — 1 Repairs of houses completed under the Housing Act, 1930 — — — — — — — — — — 196 196 Infectious disease cases removed 155 43 88 97 80 45 29 23 59 4 — 623 Houses disinfected after infectious diseases (including bedding, clothing, &c.) 168 46 90 157 150 97 90 44 133 39 — 1,014 Rooms in such houses disinfected after infectious disease 206 48 94 172 171 147 107 59 138 49 — 1,191 Houses cleansed under houses let in lodgings by-laws 59 208 141 95 390 54 26 5 17 14 — 1,009 Verminous houses cleansed (including bedding, clothing, &c.) 59 40 64 35 56 2 38 21 18 15 19 367 Verminous rooms cleansed in such houses 134 45 80 51 61 2 56 30 22 18 42 541 Dirty bedding cleansed 12 5 30 11 23 5 — 2 3 4 — 95 „ „ destroyed — 1 2 1 1 2 — 1 1 — — 9 Other sanitary works executed 84 93 107 71 128 51 76 35 54 116 102 917 24 Summary of Legal Proceedings taken during the year 1931. Nature of offence. No. of summonses. Magistrates' decisions. Failure to carry out sanitary repairs 3 Fined 20s. and order made for work to be carried out within 14 days in one case. Summonses withdrawn, the work having been carried out, in 2 cases. Failure to comply with by-laws for houses let in lodgings. 4 Summons withdrawn, the by-laws having been complied with, in each of the 4 cases. Failure to abate overcrowding 3 Summons withdrawn, the overcrowding having been abated in one case; fined 20s. in one case; and 40s. in one case. Permitting overcrowding 2 Summons withdrawn, the overcrowding having been abated, in each case. Failure to abate indecent occupation 1 Summons withdrawn, the indecent occupation having been abated. Failure to abate overcrowding and indecent occupation. 1 Fined 5s. Failure to pay expenses incurred under Section 17 of the Housing Act, 1930. 1 Order made for payment of expenses with interest and costs. Failure to deposit plans and notify alteration to drainage system. 1 Fined 20s. Failure to comply with the L.C.C. by-laws in connection with drainage work. 2 Fined 20s. in each case. Allowing a dog to deposit its excrement on the public footway. 11 Fined 20s. in one case; 10s. 6d. in one case; 10s. in 7 cases; and 5s. in 2 cases. Total 29 SMOKE ABATEMENT. The borough contains but few factories or other work-places where there is a considerable fuel consumption, and thus the problem of smoke abatement is not a very large one. Nevertheless, in a borough which is essentially residential in character, it is very desirable that the nuisance from smoke should be reduced to a minimum; and during the year the council's sanitary inspectors made 281 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. Two nuisances were discovered and written intimation notices were served. In each instance, this resulted in the abatement of the nuisance. MORTUARY AND CHAPEL OF REST. During the year 169 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 19 At the request of undertakers 5 At the request of coroner 134 By the police 9 167 In 134 cases, post-mortem examinations were made under the coroner's warrant. Thirty-one bodies were deposited in the Chapel of Rest, Avondale Park. This building is of considerable convenience to those poor persons in Notting Dale who live in perhaps one or two rooms and have no satisfactory accommodation for the bodies of dead relations pending the day of the funeral. 25 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. 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, and 6 special warm baths. The number of bathers using the swimming baths and slipper baths in the last five years is shown in the following table:— Year. Bathers. 1927 249,838 1928 257,703 1929 246,085 1930 238,262 1931 218,158 In the wash-house or laundry department, there were 88 wash-tubs in use in 1931. The number of women using the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1927 103,657 1928 97,110 1929 96,192 1930 92,381 1931 90,066 There are 8 washing machines and the number of women using these machines in 1931 was 19,100. RAG FLOCK ACTS, 1911-1928. These Acts prohibit the sale or use, for the purpose of making any article of upholstery, cushions or bedding, of unclean flock manufactured from rags. Four samples of rag flock were analysed and reported upon during the year. They contained 7, 8, 10 and 70 parts of chlorine per 100,000, the limit set by the above acts being 30 parts per 100,000. Three of the samples were in accordance with the requirements of the above acts, but the fourth was later ascertained to have been taken from flock belonging to a mattress which was in the shop for the purpose of being remade for a customer. In the circumstances, no action was taken. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-23. Applications made to the council in 1931 for certificates under the Acts totalled 10, and seven certificates were granted. CANAL BOATS ACTS, 1877 AND 1884. The Grand Junction Canal runs through the extreme northern portion of the borough for about half-a-mile of its length. There are three docks connected with this portion of the canal, in which there is accommodation for 20 to 30 boats. As is well known, many of these boats are used for dwelling purposes by the boatmen and their families. The Kensington borough council are vested with authority to enforce the Canal Boats Acts and Regulations on all boats entering that portion of the Grand Junction Canal which is within the boundaries of the borough. During the year 1931, the canal boat inspector made 73 inspections, 10 of which were initial inspections, and 63 re-inspections. Thirteen notices were served upon the owners or occupiers for the following contraventions :— Certificate of registration not produced 6 Woodwork of cabin defective 1 Absence of receptacle for drinking water 1 Absence of copy of certificate of registration 6 Improper mixing of sexes 9 23 No births or deaths occurred on boats whilst lying at the wharves in Kensington, and no cases of infectious disease were reported. 26 THE RATS AND MICE (DESTRUCTION) ACT, 1919. 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 practicable steps to destroy the rats or to prevent their premises becoming infested. A rat officer is employed to assist in the work of rat destruction under the supervision of the sanitary inspectors. He has carried out good work during the year as is evidenced by the following table:— Number of individual premises visited by the rat officer on receipt of complaint 195 Total number of visits paid 2,606 Number of poison baits laid during the year 104,870 „ „ disappeared 95,720 „ „ removed by the rat officer 9,150 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 18 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 66 Number of sewer defects allowing egress of rats made good 6 Number of statutory notices served under the Rats and Mice (Destruction) Act, 1919 - Number of premises cleared of rats 171 During the National Rat Week, held in November, special measures of rat destruction were put in hand in the borough council sewers, at the borough council depots and on railway and canal property in the borough. A report of the work done was subsequently published. NUISANCES FROM PIGEONS. Section 52 of the London County Council (General Powers) Act, 1927, provides that, for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation at any place in the borough of house doves or pigeons having, or believed by the borough council to have no owner, or of preventing or minimising any such nuisance, annoyance or damage which might, in the opinion of the council, be so caused, the council may seize and destroy or sell any such house doves or pigeons in excess of such number as the council may consider reasonable, and take such steps as they may deem necessary for this purpose. It is necessary, however, in the first place for the council to obtain consent to the measures adopted by them from the person or body in whom the building or land upon which the birds congregate is vested. During the year 1931, 351 pigeons were killed and since June, 1928, when the council first took action under this section, 949 have been destroyed. INSPECTION OF PUBLIC HOUSES. In 1930 the council decided that a routine inspection should be made of all public houses in the borough with a view to securing improvements in the sanitary conditions where necessary. At the time of writing this report, the total number of public houses inspected has been 51, and in 28 instances sanitary notices were issued. In the majority of cases the notices required cleansing work only. Very few serious sanitary defects were found. 27 FACTORIES AND WORKSHOPS. The following table shows the various trades and occupations carried on in registered workshops and factories where men are employed:— Trade or Business. Workshops. Factories. Total. Aerated water manufacturers — 2 2 Bakers 40 33 73 Basket makers 1 — 1 Blacksmiths 12 — 12 Blind makers 1 — 1 Boot makers and repairers 66 14 80 Builders 42 10 52 Cabinet makers 7 3 10 Cigarette makers 2 1 3 Coach builders 11 3 14 Coal wharves 2 — 2 Cooked meat dealers — 2 2 Cycle repairers 6 1 7 Dyers 2 2 4 Electricity generating stations — 4 4 Electric light fitting makers 3 3 6 Firewood choppers 3 3 6 Furriers 4 — 4 Gas works — 2 2 Ice cream manufacturers 4 — 4 Instrument makers — 3 3 Ironmongers 2 — 2 Ladder makers 1 1 2 Lampshade makers 2 — 2 Laundries 4 14 18 Marine stores 1 — 1 Masons 2 1 3 Metal workers 9 5 14 Motor engineers and garages 34 25 59 Motor spirit dealers 3 — 3 Photographers 3 — 3 Piano makers — 1 1 Picture frame makers 8 — 8 Pipe makers — 1 1 Printers 5 7 12 Saddlers 1 — 1 Sausage makers 7 6 13 Sign writers 4 — 4 Steam pressers 4 1 5 Sundry businesses 41 16 57 Sweet manufacturers 2 1 3 Tailors 75 1 76 Timber merchants 1 — 1 Trunk makers 1 — 1 Undertakers 5 1 6 Upholsterers 22 — 22 Washing machine manufacturers — 1 1 Watch makers 6 — 6 Wax figure manufacturers 1 1 2 Wheelwrights — 2 2 Total 450 171 621 28 Factories and workshops where women are employed.—The following table shows the various trades and occupations carried on in registered workshops and factories where women are employed:— Trade or Business. Workshops. Factories. Total. Bakers 1 — 1 Blind makers 1 — 1 Blouse makers 3 — 3 Boot makers and repairers 2 1 3 Corset makers 9 — 9 Dressmakers and ladies' tailors 254 1 255 Dyers 6 1 7 Embroidery workers 6 — 6 Florists 10 — 10 Furriers 13 1 14 Hairdressers 13 — 13 Invisible menders 3 — 3 Jewellers 1 2 5 Knitted goods 3 — 3 Lace workers 3 — 3 Lampshade makers 2 — 2 Laundries 36 43 79 Milliners 39 — 39 Outfitters 8 — 8 Photographers 5 — 5 Picture frame makers 1 — 1 Restaurants 4 — 4 Sundry businesses 28 7 35 Toy makers 1 — 1 Umbrella makers 1 — 1 Upholsterers 8 — 8 Weavers 2 — 2 Total 463 56 519 Home Work.—Of the 193 outworkers registered, some are employed on premises which are factories or workshops within the meaning of the Factory and Workshop Act, 1901, others work in domestic workshops, whilst the remainder are the genuine " home workers" engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The number of outworkers belonging to each of these three classes is shown in the following table:— Outworkers in workshops or factories 56 Outworkers in domestic workshops 15 Outworkers in their own homes 122 Total number of outworkers 193 The nature of the work given out to the 122 home workers on the register is as follows :— Tailoring 71 Dressmaking 31 Bootmaking 7 Outfitting 3 Drapery 2 Linen working 2 Fancy goods 1 Blouse making 1 Confectionery 1 Embroidery 1 Dyeing and cleaning 1 Umbrella making 1 122 29 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. The appended table summarises the work for the year of the women health officers under the Factory and Workshop Acts, so far as it is capable of being expressed in this form :— No. of factory inspections 85 „ workshop „ 763 „ home worker inspections 299 „ work-place „ 16 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, or young persons are employed:— I.—Inspections. Premises. Number of Inspections. Written notices. Prosecutions. Factories (including factory laundries) 352 22 - Workshops (including workshop laundries) 1,356 45 - Workplaces (other than outworkers' premises) 158 8 - Total 1,866 75 - 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 132 132 - - Want of ventilation 7 7 - - Overcrowding 1 1 - - Want of drainage of floors 7 7 - - Other nuisances 25 25 - - Sanitary accommodation (a) insufficient 6 5 - - (b) unsuitable or defective 11 11 - - (c) not separate for the sexes 2 2 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) 1 1 - - Breach of special sanitary requirements for bakehouses (SS. 97 to 100) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) 6 6 - - Total 198 197 - - III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. 30 MATERNITY AND CHILD WELFARE. The borough council's scheme of maternity and child welfare work in operation in 1930 has been continued during 1931, and the following additions to the service have been made during the year (a) An obstetric specialist has been appointed as a part-time officer, and his services are available to any doctor in the borough who needs assistance in attending to a necessitous woman in a difficult or complicated confinement. (b) Sterilised maternity outfits are now stocked at the infant welfare centres and can be obtained by any expectant woman at cost price. (c) In the case of women who are unable to afford birth control advice, the Council decided during the year that they would pay to the North Kensington Women's Welfare (Birth Control) Centre five shillings in respect of each married woman referred thereto by a Kensington infant welfare centre, on receipt of a medical certificate, signed by one of the medical officers at the infant welfare centre, stating that the woman is a nursing mother and that further pregnancy would be detrimental to health. The certificate must state the exact medical or surgical condition which renders further pregnancy harmful, and must also be endorsed by the medical officer at the birth control centre. WOMEN HEALTH OFFICERS. Seven women health officers are attached to the infant welfare centres serving the borough, and the work performed by these officers during the year 1931 in regard to maternity and child welfare is summarised in the following table:— Description of work. Health officers. No. 1. No. 2. No. 3. No. 4. No. 5. No. 6. No. 7. Total. First visits to infants (0-1 year) 350 235 246 339 340 94 210 1,814 Re-visits to infants (0-1 year) 763 490 522 686 1,125 422 616 4,624 Visits to children between 1 and 5 years 1,583 1,559 1,469 913 775 839 829 7,967 Still-birth enquiries 8 8 9 4 10 — 9 48 Visits to ophthalmia cases 6 16 14 3 11 1 3 54 Return visits to ophthalmia cases 12 13 34 3 52 1 1 116 Visits to measles cases 8 14 20 4 73 15 3 137 Visits to whooping cough cases 21 29 33 1 138 29 47 298 Visits to puerperal fever cases — — 1 4 2 — 2 9 Visits to puerperal pyrexia cases 9 16 7 13 11 3 3 62 Visits to enteritis cases 20 5 49 5 6 — 2 87 Infantile death enquiries 29 23 21 42 38 4 15 172 Investigations re milk applications 103 38 37 187 240 16 79 700 Ante-natal visits 55 55 72 131 111 90 190 704 Half-days at welfare centres 168 140 138 136 207 96 116 1,001 Special visits. 174 203 341 223 259 397 298 1,895 The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of tliis report dealing with those subjects, and a complete record of the work performed by each woman health officer during the year appears in Table V of Appendix II. INFANT WELFARE CENTRES. There are eight voluntary infant welfare centres in Kensington and one branch centre. 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 which is most accessible to the mother. The branch centre was established by the committee of the Raymede infant welfare centre in March, 1931, and serves an area in the extreme north-eastern part of the borough. A large amount of new property has been erected in this district, including the Sutton Trust buildings. The Sutton Trustees built the branch centre premises and let them to the voluntary committee at a nominal rent of £5 per annum. 31 The work done at the infant welfare centres during the year 1931 is shown in the following table:— Particulars of work done. Archer Street. Bramley Road Campden Hill. Earl's Court. Golborne. Kenley Street. Lancaster Road. Raymede. Sutton Trust. Totals. 1—No. of births occurring in the area of the centre suitable for welfare attention 106 246 82 259 248 185 412 343 36 1917 2—No. of sessions at which doctor attended for infant consultations 74 124 90 103 132 77 136 152 40 928 3—No. of sessions at which doctor attended for special ante-natal consultations 22 50 12 24 23 25 22 51 2 231 4—Total number of individual mothers who attended during the year 324 474 190 334 415 264 751 463 26 3241 5—Number of individual mothers who attended ante-natal sessions during the year 36 92 39 99 45 58 89 95 5 558 6—Total number of individual children who attended during the year— 1. Children 0 to 1 year 174 307 125 234 257 184 388 393 87 2149 2. „ 1 to 5 years 166 176 86 195 298 142 410 300 166 1939 7—Total attendances at centre of mothers for all purposes. (Excluding the accompanying of children and for the purpose of buying dried milk or other article) 544 1276 1047 2202 965 2174 3798 2816 97 14919 8—Total attendances at centre of children for all purposes— 1. Children 0 to 1 year 1834 2999 1422 2134 2996 1685 4629 4743 647 23069 2. „ 1 to 5 years 1392 2379 1196 2490 4055 1424 6245 4532 1091 25302 9—Total attendances at dinners (Included in Nos. 7 and 8 above)— 1. Mothers — — — — 100 — 1759 — — 1859 2. Children — — — — — — 2754 — — 2754 10—Total attendances at doctors' consultations— 1. Ante-natal mothers 90 401 114 302 114 255 284 330 5 1895 2. Post-natal mothers 106 188 2 515 389 222 124 230 92 1868 3. Children 0 to 1 year 927 1960 1197 1406 1662 983 2573 2650 383 13741 4. „ 1 to 5 years 602 1256 808 1355 1832 823 1300 2260 809 11045 11—Average attendances at doctors' consultations— 1. Ante-natal mothers 4 8 9 12 5 10 13 7 2 8 2. Post-natal mothers 1 1 — 5 3 3 1 3 2 2 3. Children 0 to 1 year 12 16 13 14 13 13 19 17 10 15 4. „ 1 to 5 years 8 10 9 13 14 11 10 15 20 12 12—Number of individual children weighed during the year 340 483 215 395 555 326 798 679 253 4034 13—Total weighings 2786 5221 2375 4309 6693 3071 7969 8541 1738 42703 14—Number of first visits paid by salaried workers to— 1. Expectant mothers 20 51 — — 106 96 166 123 32 594 2. Children 0 to 1 year 37 11 — — — 4 — — — 52 15—Total number of home visits paid by salaried workers to— 1. Expectant mothers 122 127 61 49 228 196 172 165 48 468 2. Children 0 to 1 year 808 544 309 852 1192 356 973 1239 188 6461 3. „ 1 to 5 years 820 450 378 1019 1645 495 588 791 174 6360 16—Number of home visits paid to children by voluntary workers— 1. Total visits 0 to 1 year — — — — — — — — — — 2. „ „ 1 to 5 years — — — — — — — — — — 32 TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE CENTRES IN 1931. Centre. No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other treatments. Archer Street 95 231 89 26 9 29 Bramley Rd. 40 101 28 2 11 2 Campden Hill 15 25 14 — — 1 Earl's Court 64 181 141 3 19 27 Golborne 25 40 26 — — 14 Kenley Street 60 127 57 2 8 2 Lancaster Road 122 393 167 58 28 21 Raymede 337 720 290 29 30 371 Totals 758 1,818 812 120 105 467 THE BABY CLINIC, No. 92, TAVISTOCK ROAD. The Baby Clinic acts both as a treatment centre and infant welfare centre, but it is not an infant welfare centre in the same sense as the other nine; nevertheless, much valuable work is performed. The following are the records for the year ending December 31st, 1931:— Number of sessions at which doctors attended for infant consultations 152 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 217 Total number of individual children who attended during year (old) 738 „ „ „ (new) 557 Total attendances at centre of mothers for all purposes (excluding the accompanying of children) 823 Total attendances of children at centre for all purposes 0.1 year 2,919 1-5 year 13,114 Number seen by doctor at consultations :— 1. Ante-natal mothers 240 2. Post-natal mothers 528 3. Children 6,384 Average number seen by doctor at consultations :— 1. Ante-natal mothers 5 2. Post-natal mothers 11 3. Children 42 Number of individual children weighed 1,295 Total weighings 6,384 Collective instruction by lectures is undertaken at Tavistock Road by the council's health lecturer, but there is little home visiting. 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. THE BABY IN-PATIENT HOSPITAL, No. 1, LADBROKE SQUARE. This institution acts as the in-patient department of the Baby Clinic. The wards are capable of accommodating thirty-four beds. Four beds are reserved for children recommended by the Kensington infant welfare centres, but all the beds are available for children belonging to the borough. The following is the record for the year 1931 :— Number of infants in residence at commencement of the year 29 Number of admissions during the year 230 Number of discharges during the year 213 Number of deaths during the year 17 Number in residence at end of the year 29 Average duration of stay in hospital 40 days. ARTIFICIAL SUNLIGHT TREATMENT. (The Baby Clinic and Hospital.) Artificial sunlight treatment is administered at the Baby Clinic and Hospital. During the past year, 6,945 treatments were given and the average weekly attendance was 144 ; 279 children were treated. 33 MASSAGE AND ELECTRICAL TREATMENT CENTRE. Massage and electrical treatment is undertaken at the Princess Louise Kensington Hospital for Children and the following is a record of the work conducted thereat during the year 1931:— New cases— Under 5 years of age 33 Over 5 years of age 109 142 Discharged— Under 5 years of age 30 Over 5 years of age 115 145 Transferred to other hospitals because over age 9 Total cases treated 191 Total treatments given 4,314 The borough council make an annual grant to the authorities of the hospital for this treatment. Massage treatment for children is also provided at the Campden Hill infant welfare centre. QUEEN CHARLOTTE'S HOSPITAL ANTE-NATAL CLINIC. Two ante-natal sessions are held weekly at the Queen Charlotte's Hospital Ante-natal Clinic at No. 240, Ladbroke Grove. The total number of sessions held was 102. Eight hundred and thirty-seven women attended and of this number 710 were Kensington women. KENSINGTON MATERNITY HOME. Until the 30th September, 1931, the Kensington maternity home consisted of a detached ward of ten beds in the southern portion of the grounds of St. Mary Abbots Hospital. On the 1st October the home was transferred to Queen Charlotte's Hospital, two wards (with five beds in each) being reserved for the council at that institution. The rules which have been issued for the conduct of the present home and for the guidance of patients are almost the same as those which were in operation when the council maintained the home in St. Mary Abbots Hospital. Statement of work done during last five years. 1927. 1928. 1929. 1930. 1931. No. of applications for admission 143 185 177 164 160 No. of applications accepted 137 170 162 158 156 No. of applications withdrawn after acceptance 10 14 17 14 26 No. of women confined during the year 126 143 141 142 130 The gross cost of the scheme to the council during 1931 was £705 19s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £504 3s. Od. Payments made by patients totalled £471 13s. Od. DAY NURSERIES. There are four day nurseries in the borough, namely :— The Golborne Day Nursery. The Lancaster Road Day Nursery. The Notting Hill Day Nursery. The St. Clement's Day Nursery. 34 The following table shows a record of children's attendances at the day nurseries in the year 1931:— Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. 1. Whole day attendances of children under 3 years of age 3284 2676 7530 2294 15784 2. Whole day attendances of children over 3 years of age 1676 3038 2251 1546 8511 3. Total whole day attendances 4960 5714 9781 3840 24295 4. Charges made for each attendance of a child 10d. 9d. 8d. 1/- — 5. Half-day attendances of children under 3 years of age — — 903 432 1335 6. Half-day attendances of children over 3 years of age — — 393 211 604 7. Total half-day attendances — — 1296 643 1939 8. Charges made for each attendance of a child — — 4d. 6d. — 9. Average daily attendance of children 29 26 49 22 — CONVALESCENT HOMES. The council, under their maternity and child welfare scheme, provide convalescent home treatment for mothers with babies under the age of six months. The following table shows the institutions to which mothers and infants were sent during 1931, together with the number of cases admitted. Each mother and baby stays in the home for a period of 14 days. St. Mary's Convalescent Home, Birchington-on-Sea, Kent. No. of mothers admitted with babies 9 No. of mothers admitted without babies 3 Evelyn Convalescent Cottage Home, Wargrave, Berkshire. No. of mothers admitted with babies 7 No. of mothers admitted without babies 4 Hambledon Cottage Home, Surrey. No. of mothers admitted with babies 3 No. of mothers admitted without babies — George Whitlaw Convalescent Home, Taplow, Bucks. No. of mothers admitted with babies 9 No. of mothers admitted without babies 1 The St. Mary's Convalescent Home is open for the reception of patients throughout the year, but the Evelyn, Hambledon, and George Whitlaw Homes are closed during the winter months. The total cost to the council for convalescent treatment during the year was £73. In September, 1931, the council discontinued sending mothers to the George Whitlaw Convalescent Home and arrangements have been made for more mothers than hitherto to stay at the St. Mary's Convalescent Home during the year 1932. HEALTH LECTURER. In 1926, the council appointed a qualified health lecturer to organise and conduct a continuous educational campaign in public and personal hygiene amongst those members of the community who most need enlightenment in the interests of themselves, their families, and those with whom they come in contact. The officer appointed is now lecturing at infant welfare centres on consultation days, at ante-natal clinics, women's and girls' clubs, etc. 35 The following is a record of the work of the health lecturer during the year 1931:— Number of lectures. Number attending. Average attendance at lecture. Archer Street I. W. C. 36 294 8.2 Bramley Road ,, 32 363 11.3 Campden Hill „ 34 574 16.9 Earl's Court „ 86 1,124 13.1 Golborne „ 42 449 10.7 Kenley Street „ 37 617 16.5 Lancaster Road „ 36 879 24.4 Raymede „ 53 776 14.6 Sutton Trust „ 19 189 9.9 Baby Clinic „ 35 342 9.8 Other institutions 18 2,288 127.0 Totals 428 7,895 18.4 HOME HELPS. Five applications were received during the year for the provision of home helps under the council's scheme. The assistance requested was granted in four cases for a period of 14 days each ; the remaining application was granted for 28 days. The gross cost of the scheme to the council during the year was £9 10s. 0d. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. In the year 1931, there were 850 grants of milk made by the council's milk applications sub-committee. Two hundred and sixty-two of the grants were in response to new applications, and the remaining 588 were renewals of grant. Under the council's scheme, 23,408 pints of fresh milk were granted free of charge at a cost of £312 13s. 3d. ; 628 packets of dried milk were granted free of charge at a cost of £47 2s. 0d.; and 80 dinners were granted free of charge at a cost of £2. The following table gives particulars of the dried milk supplied at cost price under the council s scheme:— Name of welfare centre at which the dried milk was distributed. No. of 1lb. packets sold. Value of milk sold. £ s. d. Archer Street 1,174 88 1 0 Bramley Road 1,045 78 7 6 Campden Hill 794 59 11 0 Golborne 606 43 9 0 Kenley Street 797 59 14 6 Lancaster Road 4,436 332 14 0 Raymede 2,832 212 8 0 Totals 11,684 £874 5 0 Four applications for dinners were granted; one of these was a new application, and three were renewals. The Mutual Registration of Assistance Society (a branch of the Charity Organization Society) has been of considerable help to the council's milk applications 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 ADVISORY COMMITTEE TO THE BOROUGH MATERNITY AND CHILD WELFARE COMMITTEE. The advisory committee was established in 1920. The committees of the infant welfare institutions in the borough each nominate yearly two of their members to serve on this committee. It co-ordinates the work of the nine infant welfare centres, the four day nurseries, and the Baby Clinic and Hospital. The committee is of great value in maintaining the high standard of voluntary work carried out in the borough. 36 HOUSING. Owing to the large amount of inward and outward migration of people, both in regard to the borough and the various wards, which has taken place since the census year of 1921, the old figures of population which have been used for the last ten years cannot be relied upon and any deduction therefrom may be erroneous. In these circumstances, it may be wise to defer a comprehensive survey of the housing position until the detailed figures of the 1931 census are available. The Minister of Health has, however, required that certain information shall be given in this annual report and I now beg to submit particulars requested by him in circular 1206. 1. Inspection of dwelling-houses during the year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,168 (b) Number of inspections made for the purpose 27,375 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded .under the Housing Consolidated Regulations, 1925 1,239 (b) Number of inspections made for the purpose 3,899 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 57 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 2,584 2. Remedy of defects during the year without service of formal notices:— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 104 3. Action under statutory powers during the year:— A. Proceedings under sections 17, 18 and 23 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 174 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (а) By owners 195 (б) By local authority in default of owners 1 B.—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,306 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (а) By owners 2,306 (б) By local authority in default of owners Nil C.—Proceedings under sections 19 and 21 of the Housing Act, 1930:— (1) Number of dwelling-houses in respect of which demolition orders were made 2 (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil D.—Proceedings under section 20 of the Housing Act, 1930:— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 7 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 1 E.—Proceedings under section 3 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which notices were served requiring repairs Nil (2) Number of dwelling-houses which were rendered fit after service of formal notices;— (a) By owners Nil (b) By local authority in default of owners Nil 37 (3) Number of dwelling-houses in respect of which closing orders became operative in pursuance of declarations by owners of intention to close Nil F.—Proceedings under sections 11, 14 and 15 of the Housing Act, 1925:— (1) Number of dwelling-houses in respect of which closing orders were made Nil (2) Number of dwelling-houses in respect of which closing orders were determined, the dwelling-houses having been rendered fit Nil (3) Number of dwelling-houses in respect of which demolition orders were made Nil (4) Number of dwelling-houses demolished in pursuance of demolition orders Nil HOUSES OWNED BY THE LOCAL AUTHORITY. The Council are the owners of 120 houses and flats which they built prior to the War in Kenley Street, Hesketh Place and Runcorn Place abutting on Avondale Park. They also possess 387 flats and 54 cottages which have been built or acquired since the War at an approximate cost of £343,852. No new accommodation was provided during the year 1931. ACCOMMODATION PROVIDED BY HOUSING ASSOCIATIONS. The property owned by the several voluntary housing associations operating within the borough is shown below. A. The Kensington Housing Trust, during the year, completed two blocks of flats in Silchester Road, one containing ten dwellings and the other containing eight- They were opened by H.R.H. The Princess Louise, Duchess of Argyll, in July, 1931. At the end of the year the Trust held 24 freehold houses, 80 freehold flats and 51 leasehold houses. B. The Wilsham Housing Trust own 133 single family houses, 50 self-contained flats and 52 houses let in lodgings. C. The Improved Tenements Association acquired during the year the freeholds of six houses and the leaseholds of seven. At the end of the year they held 134 freehold houses, 54 leasehold houses and 32 freehold ground rents. D. Several smaller housing associations, closely associated in management with the Wilsham Trust, owned at the end of the year 38 houses and 9 flats. E. In the year 1929 the Sutton Trustees acquired a large building plot of about eight acres in Dalgarno Gardens and commenced to build 540 flats. The total cost of the scheme was £301,136, and before the end of 1931 all the flats were occupied. COMMON LODGING HOUSES. The following table shows details of the accommodation available in the six common lodging houses in the borough:— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed in 1931. Male. Female. Total. Golborne Chesterton, Ada Elizabeth 194, Kensal Road — 71 71 Norland Woodhouse, Jane E. 10, Crescent Street — 25 25 ,, Hankins, John W. 28 & 30, do 54 — 54 ,, Woodhouse, Jane E. 40, do. — 25 25 ,, Alexander, Agnes Mary 25 & 27. do. — 43 43 ,, Cooper, Sagle 66, St. Ann's Road 66 — 66 Totals 120 164 284 38 MEASURES TAKEN TO DEAL WITH OVERCROWDING AND INDECENT OCCUPATION. When a sanitary inspector discovers a case of illegal overcrowding in any house, or a case of indecent occupation (persons of the opposite sexes over twelve years of age, not living together as man and wife, occupying the same bedroom) in a house let in lodgings, an intimation notice is served and the facts are reported to the next meeting of the public health committee. The following table shows the number of cases of overcrowding and indecent occupation detected in the last six years and the effectiveness of the action taken can be deduced therefrom. 1926 1927 1928 1929 1930 1931 Overcrowding:— Intimation notices served 103 88 72 33 25 42 Statutory notices served where the intimation notice was not complied with 38 28 10 13 10 7 Summonses issued 6 9 3 3 5 3 Indecent Occupation:— Intimation notices served 79 92 84 23 27 16 Statutory notices served where the intimation notice was not complied with 12 2 6 1 7 1 Summonses issued - - 1 - 1 - As only 29 summonses were eventually issued in 363 cases of overcrowding, and only two summonses in regard to 321 cases of indecent occupation in the six years, it will be seen that 653 families were able to improve their accommodation without the council having to resort to extreme measures. Moreover, the figures for 1931 suggest that those on whom notices were served had less difficulty in securing alternative accommodation than was experienced in previous years. With a view to securing the greatest possible advantage from new houses provided by the borough council, the London county council and housing associations working in Kensington, arrangements were made in 1925 for those persons managing the new houses to notify the medical officer of health immediately of the name and address of each tenant selected for a new home. The information has enabled the officers of the public health department to know several weeks in advance of rooms which will become vacant, with the result that they have been able to approach the persons in control (frequently before they were aware that vacancies would arise in the near future) and urge that the rooms might be let to Kensington families known to the public health department to be living under overcrowded or unsatisfactory conditions. The results have been as follows:— No. of houses let and notified to M.O.H. in advance of occupation. No. of instances in which rooms vacated have been let to Kensington families living under unsatisfactory or overcrowded conditions. New houses provided by the borough council 84 59 New houses provided by the London county council 267 138 New houses provided by public utility societies, etc 351 210 FITNESS OF HOUSES. Work under Section 17 of the Housing Act, 1930. The following table gives a statement of the action taken and the results obtained during 1931:— Notices served in 1930 which were outstanding on 1st January, 1931 75 Notices served from 1st January to 31st December, 1931 174 Appeals by owners to the County Court Nil Notices satisfactorily complied with by owners 195 Cases in which the council carried out the repairs in default of owners 1 Notices in respect of which satisfactory progress was being made on 31st December, 1931 28 39 Notices in respect of which nothing had been done at end of the year (the time allowed had not expired in these cases) 22 Cases in which the Council's contractors were engaged in executing repairs in default of owners at the end of the year Nil Total expenditure incurred by the Council in executing repairs during the year £108 0 0 From the time the council hrst started this class of work about ten years ago to 31st December, 1931, their total expenditure in carrying out work in default of owners has been £3,244 10s. 0d., and the total amount recovered has been £2,643 7s. 0d. In the case of one debt, interest amounting to £2 has been waived. The remaining outstanding sum continues to be a charge upon the premises and, together with interest, is being collected by the council. The council have not incurred any financial loss in this work with the exception of the small item of £2 which they cancelled. A conspicuous feature of the work under section 17 during the year 1931 has been the absence of difficulty encountered by the council's staff in dealing with owners and tenants. There was much opposition to this type of work in earlier days; but it has disappeared and the change is due to the fact that owners generally have recognised that the council have been reasonable in their requirements but firm in their intention that these shall be carried out. During the entire year, there has not been one instance where the council have been obstructed in exercising their powers. Furthermore, there have been during the year no appeals to higher authority against the action of the council. As the result of long experience, a very efficient system has been evolved. Excellent work is being carried out, and there is no doubt that, by the exercise of their powers under the Housing Acts, the council are securing a much higher standard of comfort and habitability in the working class housing accommodation in the borough. CLEARANCE AREAS. Since November, 1930, I have submitted representations to the council to the effect that the dwelling houses in the undermentioned areas are, by reason of disrepair or sanitary defects, unfit for human habitation or are, by reason of their bad arrangement, or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants of the area, and that the other buildings in the area are for like reasons dangerous or injurious to the health of the inhabitants. I have also expressed the opinion that the most satisfactory method of dealing with the conditions in the areas is the demolition of all the buildings therein. No. of occupants. (i) Nos. 1, 3 and 5, Adair Road, and 86, 88 and 90 Southam Street 112 (ii) Nos. 36 to 52 (inclusive), Talbot Grove, 1 to 13 (inclusive), Talbot Mews, and 23 to 26 (inclusive), Talbot Mews 170 (iii) Wornington Mews (including No. 88, Wornington Road) 29 (iv) Barker Street 257 In each case the council declared these areas to be clearance areas and passed appropriate resolutions. In view of the difficulty of securing alternative accommodation for persons who would be displaced by the demolition of the insanitary property in these areas, it was decided to proceed in the first place with the Talbot Mews area. By the compulsory acquisition and demolition of several other properties adjoining this area, it is possible to build on the cleared site accommodation for a larger number of persons than those residing there. Such a course will enable a number of persons to be transferred subsequently to vacant accommodation at Talbot Mews from other clearance areas so that demolitions can proceed expeditiously within these other areas without creating hardship by displacing people from their homes without offering them alternative accommodation. In due course, the Talbot Mews scheme was submitted to the Minister of Health; a local enquiry was held on September 17th and the Minister's confirmation was subsequently received. Preparations are now well in hand and the actual work of demolition has commenced. OTHER AREAS REQUIRING ATTENTION. The council have had before them representations that the following areas call for attention. Gadsden Mews. This is an area comprising 14 mews dwellings which should be regarded as a small clearance area. It is not desirable that new houses should be erected on the site after demolition owing to the fact that it is rather closed in by surrounding buildings. In view of the difficulty of securing alternative accommodation, this area might be left until the housing shortage becomes less acute. 40 Bolton Road. There were in this road 33 houses, but within the past year or so ten have been demolished by a business man who proposes to erect premises for commercial purposes. Careful consideration must be given with a view to deciding whether the remaining 23 houses should be regarded as constituting a clearance area or an improvement area. Bramley Mews. There are 14 dwellings in this mews, with about 45 occupants. At present they do not constitute a clearance or improvement area, but it is possible that they may call for attention during the course of the next five years. Hayden's Place (including Tavistock Mews). This is a site comprising 11 or 12 houses which have no yards; the water closets are without external walls and, in some cases, have inadequate ventilation. This appears to be a small clearance or improvement area. Other Areas. There are other areas in North Kensington which appear to come within the category of improvement areas. These have not yet been defined. BY-LAWS RELATING TO HOUSES LET IN LODGINGS. At the beginning of 1923, there were on the council's register of houses let in lodgings 2,169 houses, and in the first month of that year it was resolved to appoint additional staff to make a routine inspection of all houses on the register, to bring them up to the standard enforceable under the by-laws then in operation, and also to inspect all other houses let in lodgings with a view to placing on the register those which it was thought desirable should be brought under periodical review. In March, 1926, when the present code of by-laws came into operation, the number on the register had reached 3,651. The introduction of the new by-laws, with their altered requirements, called for re-inspection, and two temporary sanitary inspectors, who had been retained for housing work, commenced to " comb through " the borough again. Owing to the altered definition of a house let in lodgings, which resulted in a house occupied by two families only or by one family with two lodgers being non-registerable, there has been a gradual decline in the number of houses on the register, and the figure at the end of December, 1931, was 3,090. The formidable task of making detailed inspections of all houses let in lodgings in the borough, which was commenced in 1923, was completed in the early weeks of 1931, and the council now have a valuable record of all houses inspected. The by-laws for houses let in lodgings have proved to be of the greatest use and, together with the work under Section 17 of the Housing Act already referred to, they are a valuable instrument in maintaining habitable conditions in houses let in lodgings in North Kensington. The following is a record of the work carried out under the by-laws during the year 1931 :— No. of houses inspected under the by-laws 2,143 Total number of inspections 9,437 No. of instances where the houses were cleansed under the by-laws 1,009 FOOD SUPPLY. MILK SUPPLY. Milk and Dairies (Consolidation) Act, 1915.—When the Act came into operation the council decided that a number of samples of milk should be taken each year for the purpose of examination for the presence of tubercle bacilli. In the year 1931, 20 samples were so taken, and all were certified as being free from tubercle bacilli. Of 314 formal samples of milk taken under the Food and Drugs (Adulteration) Act in 1931, 13 were certified by the public analyst as adulterated, i.e., containing less than 3 per cent, of fat or 8.5 per cent, of non-fatty solids. These particulars, however, do not give any indication of the general quality of the milk supplied in Kensington; therefore, it will be interesting to note the average composition of the samples taken in the borough during the year. These figures are given in the following table :— 41 Average composition of formal milk samples taken in 1931. 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 o milk fat. Percentage of solids not fat. Percentage of milk fat. Percentage of solids not fat January 31 3.58 8.72 3.59 8.80 3.0 8.5 February 31 3.59 8.98 3.59 8.98 March 24 3.59 8.81 3.59 8.81 April 31 3.49 8.74 3.51 8.76 May 30 3.36 8.79 3.37 8.81 June July 24 12 3.43 3.64 8.78 8.78 3.43 3.64 8.78 8.78 August 30 3.57 8.68 3.61 8.69 September 27 3.68 8.80 3.71 8.80 Average composition of normal cow's milk. October 29 3.78 8.82 3.78 8.82 November 30 3.88 8.77 3.88 8.79 December 15 3.61 8.66 3.61 8.66 Percentage of milk fat. Percentage of solids not fat. 314 3.60 8.78 3.61 8.79 3.7 8.9 The table shows that the average fat and non-fatty solid content for each month of the year is well above the legal standard, and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content as low as 3 per cent. Milk and Dairies (Amendment) Act, 1922, and Milk and Dairies Order, 1926.—A summary of the alterations made in the register of dairymen and dairies during the year 1931 and the number of persons and dairies registered at the end of the year is shown in the following table:— Purveyors of milk in sealed bottles. Dairymen. Dairies and milkshops. Transfers – 13 13 Added to register 13 2 2 Vacated and removed from register – 5 5 Dairymen with premises outside the borough added to register – 1 – On register January 1st, 1931 36 160 154 On register December 31st, 1931 49 158 151 (+) Increase. (—) Decrease. + 13 -2 -3 The total number of inspections of dairies and milkshops in the borough in 1931 was 446. During the year 1931, proceedings were taken in respect of milk being bottled in streets in four cases. In one case, a fine of £2 was imposed, in two a fine of £1, and in the other a fine of 10s. Proceedings under the Milk and Dairies Order were taken against two itinerant purveyors of milk. The men, who were not registered dairymen, were seen selling milk from a horse-drawn vehicle in the northern part of the borough. The vehicle was in a dirty condition, as also was the milk in one of the churns. Observation was kept and the two men were seen to carry the vessels and utensils into a tenement house, and a subsequent inspection of the house revealed that the utensils and churns were being stored in a bedroom. This room was found to be in an extremely filthy condition. The following table shows the result of the prosecutions:— Offence. Result. Failing to keep clean the interior of a cart used for the each defendant fined £5. conveyance of milk. Failing to keep in a state of thorough cleanliness vessels Ditto. used or intended to be used for containing milk. Carrying on the trade of dairyman without being registered Ditto. Using unregistered premises as a dairy One defendant fined £10; the other £5. In addition to the above, one of the defendants was fined £5 for obstruction. 42 Milk (Special Designations) Order, 1923.—Under the Order the council are authorised to grant licences to persons other than producers to sell milk under special designations. Every licence granted is valid for a period ending on the 31st 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 1931 were as follows:— (a) Dealers' licences to use the designation "Certified Milk" 13 (b) Dealers' licences to use the designation "Grade A (Tuberculin Tested) Milk" 14 (c) Dealers' licences to use the designation "Pasteurised Milk" 41 In all but three cases the licences were granted for the purpose of authorising the dealers to sell specially designated milk from shops within the borough. No application was made for a licence to set up a pasteurising establishment within the borough. During the year, six samples of "Certified Milk," two of "Grade A (Tuberculin Tested) Milk," and 24 of "Pasteurised Milk" were taken for the purpose of ascertaining whether they complied with the bacteriological standards laid down in the Milk (Special Designations) Order, which are as follows :— Maximum number of Special class of milk. bacteria permitted per c.c. Standard for bacillus coli. "Certified Milk" 30,000 Must not be found in one- tenth c.c. "Grade A. (Tuberculin Tested) Milk" 200,000 Must not be found in one- hundredth c.c. "Pasteurised Milk" 100,000 No standard provided. The results of the examinations, together with the action taken, are shown in the following tables:- "Certified Milk." Coli per Sample collected on Bacteria per 1 c.c. l/10th c.c. 21st April 2,900 Nil. 2nd June 1,490 „ 5th August 4,800 „ 11th August 820 „ 15th September 2,800 „ 17th November 1,500 „ "Grade A. (Tuberculin Tested) Milk." Coli Per l/100th c.c. 21st April 6,000 Nil. 16th December 1,180 „ "Pasteurised Milk." Sample collected on Bacteria per 1 c.c. Action taken. 24th March 4,600 24th March 12,100 14th April 3,600 14th April 5,600 12th May 43,000 12th May 6,900 2nd June 386,000 Proceedings :—* Fined £5 and £10 10s. 0d. costs. 1st September 3,880 1st September 82,000 8th September 3,080 8th September 14,900 15th September 3,400 9th October 196,000 Proceedings :—†Fined £5 and £2 2s. Od. costs. 9th October 1,222,000 †do. 9th October 187,000 †do. 9th October 562,000 †do. 14th October 458,000 No action taken. 14th October 112,000 No action taken. 4th November 5,600 4th November 8,900 10th November 6,800 17th November 6,200 24th November 38,000 24th November 35,000 * In this case the defendant was also fined £1 for selling pasteurised milk in the borough without having a licence. †These four samples were taken from the same vendor, who was also fined £5 and £2 2s. costs for selling pasteurised milk in the borough without having a licence. 43 London County Council (General Powers) Acts, 1902, 1908 and 1928. Control of Ice Cream.— The number of ice cream premises on the council's register is 140, and during the past year 180 visits to these premises were made by the inspectors. Public Health (Meat) Regulations, 1924.—These Regulations provide that no person may slaughter any animal without first giving verbal or written notice to the council of his intention. Upon receipt of such notice, the council's food inspector attends during the slaughtering process whether by day or night, and examines all carcases immediately afterwards. During the year 258 slaughterhouse inspections were made. The following table shows the number of animals slaughtered in the borough in 1931:— Month. Beasts. Animals Slaughtered. Swine. Sheep. January 6 135 32 February — 158 68 March — 91 47 April — 110 38 May — 10 42 June — — 44 July — 20 48 August 5 94 121 September 9 102 135 October 3 63 38 November 7 196 63 December 2 292 68 Totals 32 1,271 744 Diseased meat condemned during this period was as follows:— Carcases (including organs) 7 Forequarters 4 Plucks 66 Heads 66 Livers 22 Lungs 52 Slaughter Houses.—These are licensed annually by the London county council in the month of October, and the four Kensington licences granted in 1930 were renewed in 1931. These premises are kept in a cleanly condition, and from a structural point of view are not open to objection. By-laws prescribing humane slaughtering came into operation in London in 1924, and approved methods have been adopted at each of the slaughterhouses in the borough. The council's food inspector makes frequent inspections to satisfy himself that these humane methods of slaughtering are applied satisfactorily. Bakehouses.—There are 85 bakehouses in the borough, and of this number 62 are underground. As a result of 227 inspections which were made during the year, nine notices were served for the cleansing of walls and ceilings. Other Places where Food is Prepared.—In addition to the premises dealt with above, other places in the borough where food is prepared or exposed for sale are required to be kept in accordance with the provisions of the London County Council (General Powers) Act, 1908. There were, in addition to the inspection of dairies, ice cream premises, etc., mentioned above, 1,278 inspections of food premises during the year. Merchandise Marks Acts, 1887-1926.—Under section 2 of the Act of 1926, Orders in Council mav be made prohibiting the sale or exposure for sale in the United Kingdom of imported goods 44 The Orders which have so far been made in regard to imported foodstuffs are:— Order. Relating to:— Merchandise Marks (Imported Goods) Honey and fresh apples. No. 3 Order, 1928. Merchandise Marks (Imported Goods) Currants, sultanas, raisins, eggs in shell, dried eggs No. 5 Order, 1928. and oat products. Merchandise Marks (Imported Goods) Raw tomatoes. No. 4 Order, 1929. Merchandise Marks (Imported Goods) Frozen and chilled salmon and sea trout. No. 8 Order, 1931. Frequent inspections were made throughout the year to ensure that the requirements of these Orders were observed, and cautions were served in ten instances where infringements occurred. Agricultural Produce (Grading and Marking) Act, 1928.—This Act empowers the Minister of Agriculture and Fisheries to make Orders for the grading and marking of agricultural produce of England and Wales. A series of Regulations has been made by the Minister under the Act, and these provide grade designations to indicate specific standard qualities of the various foodstuffs mentioned, but it is not compulsory for all such foodstuffs to be so marked. When, however, the goods are marked, they must conform to the standards laid down in the Regulations. Special provisions are contained in the Agricultural Produce (Grading and Marking) (Eggs) Regulations, which provide for the marking of eggs which have been preserved by immersion in lime-water, water-glass or oil. Frequent inspections have been made and no offences were observed in 1931. Artificial Cream Act, 1929.—This Act has for its object the regulation of the manufacture and sale of artificial cream. The council are required to keep a register of all premises where artificial cream is manufactured, sold, exposed or kept for sale. Only one set of premises appears in the register. Unsound Food.—Under the provisions of section 47 of the Public Health (London) Act, 1891, any persons having in their possession food intended for saie which is diseased or unsound, or unfit for human consumption, may surrender it to the council for destruction as trade refuse. The unsound food surrendered and destroyed during the year is shown in the following list:— Bacon (lbs.) 14 Meat (canned) (tins) 27 Cauliflower (sacks) 6 Milk (canned) (tins) 16 Dates (cwts.) 4 Pears(crates) 2 Fish (canned) (tins) 79 Rabbits (lbs.) 84 Fruit (canned) (tins) 240 Skate (lbs) 77 Haddocks (fresh) (lbs.) 14 Soup (canned) (tins) 4 Head, pig (lbs.) 8 Tongue, spiced (lbs.) 36 Vegetables (canned) (tins) 76 In no instance during the year was unsound food seized. The Food and Drugs (Adulteration) Act, 1928.—The council's food inspector is the sampling officer under the Act, and he is instructed to take samples in any place within the borough. The samples procured are of two kinds, namely, formal and informal. 45 (a) Formal Samples.—These are samples which are taken strictly in conformity with the requirements of the Food and Drugs (Adulteration) Act, 1928, and during the year the food inspector collected 666, of which 19 or 2.8 per cent, were adulterated. Particulars of formal samples collected are as follows :— Nature of sample. Number taken. Number adulterated. Almonds, ground 6 — Butter 45 — Butter substitute 1 — Caviare 1 1 Cakes, sponge 12 — Cheese 12 — Cocoa 8 — Coffee 3 — Coffee and chicory 3 — Cream 18 — Dripping 6 — Fruit, dried 12 — Ginger, ground 3 — Honey 6 – Iodine, tincture of 1 — Lard 18 — Lemon cheese 6 — Margarine 24 — Meat pie 3 — Milk 314 13 Mincemeat 6 — Oatmeal 4 — Oil, camphorated 5 1 Paste, fish 10 – Paste, meat 10 — Pepper 3 — Powder, lemonade 3 — Rice 12 — Rice, ground 2 — Sausages 42 3 Suet, shredded 6 — Tapioca 3 — Tea 12 – Vinegar 36 1 Vitacream 1 — Whisky 6 — Wine, British 3 – Totals 666 19 46 (b) Informal Samples.—These are taken without compliance with the strict formalities of the Food and Drugs (Adulteration) 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. Butter 22 — Caviare 1 — Cakes, sponge 3 — Cheese 6 — Chocolate, bittermints 2 — Chocolate, block 1 — Cocoa 3 — Coffee paste 1 — Cream 10 — Dripping 3 — Flour 3 — Fruit, canned 3 — Fruit, dried 3 — Honey 4 — Jam 5 — Jelly, fruit 3 — Lard 9 — Lemon cheese 3 — Margarine 12 — Mayonnaise 1 — Milk 154 4 Milk, condensed, full cream 1 — Milk, condensed, machine skimmed 8 — Mincemeat 3 — Mustard 3 — Oil, camphorated 3 — Paste, fish 3 — Paste, meat 7 — Peas, canned 6 — Pepper 3 — Sausages 21 9 Sulphur, milk of 1 — Tea 4 — Vinegar 18 — Vitacream 1 — Totals 334 13 47 The following is a summary of the results of analysis of the 37 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. Caviare 23.3grainsof boric acid per pound. Proceedings. Fined £2 and 10s. 6d. costs. Milk 35 per cent. of the required fat Informal sample. deficient. „ 10 „ „ „ Proceedings. Fined £2 and 10s. 6d. costs. „ 6 per cent, extraneous water. „ „ £2 „ 10s. 6d. costs. „ 6 „ „ „ „ No conviction recorded on „ 3.5 „ „ „ } defendant paying £10 10s. costs. „ 3 „ „ „ Informed sample. „ 2.7 „ „ „ No action. „ 2 „ „ „ Vendor cautioned. „ 2 „ „ „ Informal sample. „ 1.5 „ „ „ Proceedings. Summons withdrawn on payment of £2 2s. costs. „ 1 „ „ „ No action. „ 1 „ „ „ Vendor cautioned. „ Artificially coloured. Informal sample. } „ „ „ „ „ „ Proceedings. Fined £4 and £2 2s. „ „ „ costs. „ „ „ Oil, camphorated 52 per cent, of camphor deficient. Proceedings. Fined £2 2s. and 14s. costs. Sausages 7.9 grains of boric acid per pound. „ „ £10 and 10s. 6d. „ „ 377 parts of sulphur dioxide per Vendor cautioned. million (presence of preservative not disclosed). „ 357 „ „ „ Informal sample. „ 315 „ „ „ „ „ 310 „ „ „ „ „ „ 300 „ „ 288 „ „ „ „ „ „ 178 „ „ „ „„ 30 „ „ „ No action. Vinegar 2 per cent. of the required acetic Vendor cautioned. acid deficient. 48 Record of other proceedings taken under the Food and Drugs (Adulteration) Act, 1928. Nature of offence. Result of proceedings. Selling margarine otherwise than as margarine * Fined £2. Exposing for sale margarine not properly marked * Fined £2. Selling margarine in a wrapper not properly marked. *Fined £2. Selling margarine in a wrapper not properly marked Fined £1 and 14s. costs. * These convictions were recorded against the same defendant ; he was also ordered to pay 14/- costs. The total number of prosecutions under the Food & Drugs (Adulteration) Act was 16, the fines and costs amounting to £48. The Public Health (Condensed Milk) Regulations, 1923-1927, and the Public Health (Dried Milk) Regulations, 1923-1927.—During the year, nine samples of condensed milk were taken and each was found to comply with the Regulations in every respect. No samples of dried milk were examined. Public Health (Preservatives, etc., in Food) Regulations, 1925-1927.—Thirteen contraventions of the Regulations occurred during the year. In two cases, the offence consisted of selling articles of food containing boric acid, and proceedings were taken against the vendors. In the remaining 11 cases, the offence consisted of selling sausages containing sulphur dioxide without disclosing its presence at the time of sale ; the amount used in each instance was below the limit which would have been allowed if there had been a declaration. Details of the contraventions and results of action taken are included in the preceding tables. Chemical and Bacteriological Examination of Food.—A number of samples of food were submitted to the laboratory at St. Mary Abbots Hospital. There was no outbreak of food poisoning during the year. THE PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. NOTIFIABLE INFECTIOUS DISEASES. The following diseases are compulsorily notifiable in Kensington:— Acute encephalitis lethargica. Influenzal pneumonia. Acute polio-encephalitis. Malaria. Acute polio-myelitis. Membranous croup. Acute primary pneumonia. Ophthalmia neonatorum. Acute rheumatism. Plague. Anthrax. Puerperal fever. Cerebro-spinal fever. Puerperal pyrexia. Cholera. Relapsing fever. Continued fever. Scarlatina or scarlet fever. Diphtheria. Smallpox. Dysentery. Tuberculosis. Erysipelas. Typhoid or enteric fever. \ Glanders. Typhus fever. Hydrophobia. Zymotic enteritis. Table showing Notifications of certain Infectious Diseases received in 1927-31. Year. Small pox. Scarlet fever. Diph. theria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puer. peral fever. †Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. P. m'ltis & polioence phalitis. ‡Acute rheumatism. Cerebro spina) meningitia. Dysent. ery. *Enteritis. Total. 1927 — 251 356 10 59 17 3 44 241 2 5 2 48 5 2 41 1,086 1928 — 365 274 75 59 11 7 33 154 7 4 1 153 1 — 99 1,221 1929 5 483 297 15 75 22 13 41 260 2 5 1 81 2 2 114 1,418 1930 4 411 329 32 68 11 8 24 221 3 2 1 99 3 3 85 1,304 1931 2 385 222 16 61 13 8 61 253 1 1 — 46 7 17 41 1,134 Cases of mistaken diagnosis are excluded from the above table. † Puerperal pyrexia became notifiable on October 1st, 1926. ‡ Acute rheumatism in children under 16 years of age became notifiable in Kensington on October 1st, 1927. * Zymotic enteritis in children under 5 years of age became notifiable in Kensington on July 1st, 1924. The other London boroughs in which this disease is notifiable are Fulham, Finsbury, Poplar, Southwark, Deptford, Greenwich, Woolwich and Paddington. 49 Table showing Cases of Infectious Diseases occurring in 1931, arranged in Four-Weekly Periods (January 4th, 1931, to January 2nd, 1932). Four Weeks ending Small pox. Scarlet fever Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Total. January 31 – 27 14 – 2 – – 4 46 – – 10 – 1 4 108 February 28 – 31 29 – 5 – – 5 52 – – 4 – 3 1 130 March 28 – 23 18 1 9 1 4 24 6 2 – – 88 April 25 1 23 15 – 2 1 – 2 17 – – 2 – – 2 65 May 23 – 23 16 4 4 – 8 6 10 – – 5 1 — 2 74 June 20 – 22 16 1 2 1 7 7 1 – 3 1 – 4 65 July 18 – 20 12 1 2 1 – 6 5 – – 8 – 2 3 60 August 15 – 19 10 1 2 1 4 4 7 – 1 1 5 55 Sept. 12 – 24 19 2 8 1 4 8 1 – 6 73 October 10 34 21 2 6 2 1 6 13 1 – – 7 93 November 7 – 53 18 2 6 1 – 6 31 – – 1 3 121 December 5 – 45 17 1 8 2 – 6 21 1 2 2 8 1 114 January 2 1 41 17 1 5 2 – 1 12 — – 4 – 1 3 88 Totals 2 385 222 16 61 13 8 61 253 1 1 46 7 17 41 1,134 Cases of mistaken diagnosis are excluded from the above table. * One case of puerperal pyrexia was subsequently notified as puerperal fever and is included under both headings. A table, showing the number of cases of infectious disease notified in the various age periods, notified in the various wards, and admitted to hospital, and the deaths from these diseases during the year, will be found in Appendix II on page 71 of this report. Smallpox.—During 1931 there was a large decrease in the number of smallpox cases notified in London. One thousand four hundred and fifty-two cases occurred in the metropolitan area, as compared with 5,152 in the previous year. There were only two deaths from this disease in London during the year. Twenty-five of the 29 metropolitan boroughs were affected. Two cases of smallpox were notified in Kensington and both occurred in private houses in the northern part of the borough. The first case was that of a child aged 13 years, who attended a secondary school in Willesden and normally lived with her aunt in that district. She came to stay with her mother in Kensington for the Christmas holiday, developed smallpox and was removed to hospital. The patient recovered. The second case was that of a male resident aged 54 years. He was removed to hospital and subsequently recovered. The contacts in each case were urged to be vaccinated or revaccinated as a precautionary measure if it had not already been carried out. All vaccinations and revaccinations were performed by the public vaccinators. During the year many Kensington residents had been in contact with cases in other districts, and also several came to live in the borough who had been in contact with cases on board ships. These contacts were kept under daily observation until all possibility of developing the disease had disappeared. The object of repeatedly visiting these contacts is to secure prompt isolation before the patient becomes infectious in the event of smallpox developing. The total number of contacts kept under observation during the year was 239. Scarlet Fever.—The number of cases notified during the year was 415, of which 375 were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1931:— 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. 888 946 838 813 858 728 851 851 800 1.228 1,319 1,121 920 The Borough 27 31 23 23 23 22 20 19 24 34 53 45 41 North Kensington 21 25 15 17 16 16 17 14 20 29 43 38 28 South Kensington 6 6 8 6 7 6 3 5 4 5 10 7 13 Wards. St. Charles 5 6 3 3 4 5 6 4 9 12 24 20 15 Golborne 6 7 3 5 6 7 4 2 5 3 3 1 5 Norland 7 9 5 6 4 1 5 7 4 11 11 12 5 Pembridge 3 3 4 3 2 3 2 1 2 3 5 5 3 Holland 2 3 2 – 1 1 – – 1 – 3 – 2 Earl's Court 1 1 1 1 2 2 1 1 1 1 3 1 7 Queen's Gate 2 1 3 2 3 2 – 1 – 1 3 3 – Redcliffe 1 1 2 2 1 1 1 – 1 1 1 3 3 Brompton – – – 1 – – 1 3 1 2 – – 1 Cases of mistaken diagnosis are excluded from the above table. 50 Thirty patients notified as suffering from scarlet fever were found, after admission to hospital, not to be suffering from any infectious illness at all, with the result that they were returned home. Throughout the year, scarlet fever was mild in type, as is reflected in the fact that there was only one fatal case. The deaths in the preceding years were two, one and three. There were 23 instances where more than one case occurred in the same house. Six of the 385 cases of scarlet fever were patients in the same houses as persons who had within the previous 28 days returned from hospital after having been treated for this disease. Cases of this kind are called " return " cases, and a very careful investigation was made in each of the six, with a view to ascertaining the source of infection. The following particulars are of interest in regard to these six "return" cases. A girl, aged 11 years, was removed to a fever hospital suffering from scarlet fever. Nine days after her discharge another girl, aged nine years, residing in the same house, but not of the same family, fell ill with scarlet fever. The girl aged 11 years was re-examined but showed no signs of the disease. A girl, aged five years, contracted scarlet fever and was removed to a fever hospital. Twenty days after her discharge, her sister, aged 1¼ years, contracted the disease. On examination the primary patient appeared perfectly well. The sister was removed to hospital and no further cases occurred. A boy, aged five years, fell ill with scarlet fever and was removed to a fever hospital. He was discharged and seven days afterwards four other children in the same family contracted scarlet fever and were removed to hospital. The discharged patient appeared to have completely recovered and no further cases occurred. Preventive work in respect of scarlet fever has advanced rapidly in recent years, and the Dick test and immunisation against this disease have received considerable support in medical circles. The Kensington borough council have always been anxious to adopt measures of preventive medicine if, in their opinion, results are likely to justify the expenditure involved. In March, 1931, the council agreed to provide free of charge the material for the Dick test to medical practitioners attending the poorer residents of the borough. Diphtheria.—Two hundred and fifty-six cases of diphtheria were notified during the year, 211 of which were removed to hospital. The following table shows the number of cases notified in the various wards in each fourweekly period during 1931:— 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 847 820 671 600 611 586 671 544 564 577 715 696 607 The Borough 14 29 18 15 16 16 12 10 20 20 18 18 16 North Kensington 13 21 13 13 14 14 5 8 15 18 14 12 12 South Kensington 1 8 5 2 2 2 7 2 5 2 4 6 4 Wards. St. Charles 3 7 5 4 7 5 3 2 3 5 4 2 3 Golborne 3 8 3 5 4 3 1 3 3 5 3 1 3 Norland 4 3 3 1 3 3 1 2 7 4 6 6 5 Pem bridge 3 3 2 3 — 3 — 1 2 4 1 3 1 Holland — — 1 — — 1 — — 2 — 1 1 1 Earl's Court — 4 1 — — — 1 — 1 1 1 2 1 Queen's Gate 1 2 2 1 1 — 2 L 1 — — — — Redcliffe — 2 1 — 1 1 3 — 1 1 1 2 2 Brompton — — — 1 _ — 1 1 — 1 1 — Cases of mistaken diagnosis are excluded from the above table. Thirty-four patients notified as suffering from diphtheria were found after admission to hospital not to be suffering from any infectious disease at all, with the result that they were returned home. The number of Kensington deaths was seven, representing a case mortality of 3 per cent. In the three preceding years the deaths were 15, 11 and 13. During the year, 1,583 throat swabs were examined at the council's laboratory at St. Mary Abbots Hospital, and of these 101 gave a positive result. There were no "return" cases reported during the year, but there were 11 instances where more than one case occurred in the same house. During the year, 26 cases of diphtheria were reported from St. Mary Abbots Hospital, ten from St. Charles Hospital, three from the Kensington Institution, two from the Baby Hospital, No. 1, Ladbroke Square, and two from the Princess Louise Kensington Hospital for Children. 51 Under the Anti-toxin Order, 1910, the council are empowered to supply diphtheria antitoxin for administration to patients who are too poor to pay, and on signing the necessary declaration that the patient cannot afford specific treatment, a medical man can obtain a free supply from Mr. Evans, chemist, at No. 138, Ladbroke Grove, W.11, Mr. W. Reeves, chemist, at No. 81, Cornwall Road, W.11, or from the public health department at the Town Hall. The anti-toxin is obtainable at all hours of the day and night from Mr. Evans' and Mr. Reeves' premises, and during office hours from the Town Hall. When the Town Hall is closed, applications for anti-toxin can be made to Mr. Britton, 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 1931 the borough council supplied 206,000 units of anti-toxin for 29 patients at a cost of £13 13s. 6d. The borough council undertake to supply toxin-antitoxin for the Schick test and immunisation to any medical practitioner in the borough who may be co-operating with the medical officer of health in an attempt to limit the spread of diphtheria in any institution, provided that the consent of the authorities of the institution and of the parents or guardians of the children concerned be obtained. The cost to the Council of toxin-antitoxin supplied during 1931 was £7 13s. Enteric Fever.—Sixteen cases of this disease were notified; 11 were removed to hospital and two to nursing homes. The cases notified in the three preceding years were 32, 17 and 80. There was one death from this disease as against 1, 0 and 0 in the preceding years. Five patients notified as suffering from enteric fever were afterwards found not to have contracted the disease. Seven were notified from the southern division of the borough and nine came from North Kensington. In one case there was evidence that the disease had been contracted abroad; two patients had paid visits to the country a short time before the date of attack; one had contracted the disease aboard a ship whilst on a voyage to England ; but the remaining 12 had not been out of London for some time prior to their illness. Erysipelas.—Sixty-one cases were notified during the year, 31 of which were removed to hospital. There were three deaths from this cause, the deaths in the three preceding years being 4, 2 and 4. Ophthalmia Neonatorum.—The following table gives particulars of ophthalmia cases notified in 1931 and the results of treatment. Case No. Notified. Cases. Treated. Vision unimpaired. Vision impaired. Total blindness. Death. At home. In hospital. 1 March 25 — Yes Yes — — - 2 April 16 — Yes ? — — Yes, from another cause 3 June 9 — Yes — Blind in left eye — 4 July 8 — Yes ? — — Removed to another borough 5 August 12 — Yes Yes — — — 6 „ 29 Yes — Yes — — — 7 Sept. 1 — Yes Yes — — — 8 Oct. 6 — Yes Yes — — — 9 27 ft ~ ' — Yes Yes — — — 10 Nov. 12 — Yes Yes — — — 11 „ 25 — Yes Yes — — — 12 „ 28 — Yes Yes — — — 13 Dec 1 Yes — Yes — — — From the above table, it will be seen that ten cases recovered without any injury to sight; one case died from another disease ; and one removed to another borough. The child whose vision was impaired was born in hospital and received continuous institutional treatment for five months before being discharged. In this case, everything possible was done to prevent blindness, but the conditions were generally unsatisfactory from the onset of the disease. 52 Puerperal Fever.—During the year, eight cases of this disease were notified. Three were admitted to St. Mary Abbots Hospital after confinement and recovered; three were confined in that institution, of which two made satisfactory recoveries and one died; one was confined in Queen Charlotte's Hospital and recovered ; and one was confined in Fulham Hospital, but was subsequently discharged and could not be traced. There were seven deaths attributed to this disease, but in only two instances had a notification been received. Puerperal Pyrexia.—Sixty-one cases of puerperal pyrexia were notified during the year. Three occurred in nursing homes ; 26 in hospitals to which the patients had been removed prior to their confinements ; and 32 in the homes of the patients. Of the 32 confined at home, 24 were subsequently removed to hospital for treatment, whilst the remaining eight received medical attention in their own homes. One of the notified cases of puerperal pyrexia proved fatal. The woman was confined at home and subsequently removed to St. Mary Abbots Hospital. During the year, the council retained the services of the late Dr. Remington Hobbs as their consultant gynaecologist under the Public Health (Puerperal Fever and Puerperal Pyrexia) Regulations, 1926. Dr. Hobbs was consulted by local practitioners in 45 cases. Thirty-four cases of puerperal sepsis were admitted from their homes to St. Mary Abbots Hospital for treatment by him. , Malaria.—One case of this disease was notified during the year, and investigations revealed that the disease had been contracted in India. Encephalitis Lethargica.—In 1931, there was only one case reported in Kensington. The patient was a female aged 48 years. The case was notified on November 25th and proved fatal. Poliomyelitis and Polio-Encephalitis.—No case of poliomyelitis or polio-encephalitis was notified to the public health department during the year 1931. Cerebro-Spinal Meningitis.—There were seven cases of this disease notified during the year ; particulars are subjoined:— No. Sex. Age. Date of notification. Result. 1 F. 1 March 10th. Died. 2 M. 38 18th. do. 3 F. 5 May 4th. do. 4 F. 2¼ June 19th. do. 5 M. 14 July 30th. Recovered. 6 M. 5 November 30th. do. F. 8 December 2nd. Died. Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia but the only kinds notifiable are acute primary pneumonia and influenzal pneumonia. Two hundred and fifty-three notifications were received, 213 patients being certified as suffering from acute primary pneumonia and 40 from influenzal pneumonia. The number of deaths from pneumonia during the year was 232, and 64 deaths were certified to be due to influenza. Zymotic Enteritis or Summer Diarrhoea.—In 1924, the borough council adopted a scheme for the control and treatment of zymotic enteritis or summer diarrhoea. The scheme has operated during the summer months—in 1924, from the 1st July to the 30th September; in 1925-1929 from the 1st June to the 30th September; and in 1930 and 1931, from the 1st July to the 31st October. The council retain the part-time services of Dr. Ronald Carter, who has made a special study of zymotic enteritis. Dr. Carter pays periodical visits to the various infant welfare centres, where he is consulted in reference to difficult cases. He also sees cases in their homes which are not attended by other doctors. The following is a report by Dr. Carter giving particulars of cases of enteritis dealt with during the year under review. The summer last year was cold and wet, so that heat can scarcely be regarded as a contributory cause of intestinal disease in 1931. The council's scheme has worked quite smoothly, and there have been no complaints. The local medical practitioners availed themselves of the help of the nurses iu 15 cases. 53 I attended 29 cases in their own homes and paid 77 visits during the year. I saw two cases of dysentery in which the Flexner bacillus was isolated. These cases did not have routine treatment, as I sent them into hospital. There was an outbreak of Sonne dysentery in the nursery of St. Mary Abbots Institution. Seven suspected cases were reported, but the Sonne bacillus was isolated in only three instances. The infection was traced to a child who was admitted to the nursery from a home in North Kensington. All the children did very well. They were immediately isolated, and no further cases occurred. Another attack of Sonne dysentery occurred in the Separation Block at St. Mary Abbots Hospital in November. Nine cases were reported, and the Sonne bacillus was found in each case. The infection was introduced into the wards by a child who was admitted for broncho-pneumonia and began to have diarrhoea, with blood and mucus, six days after admission. The child's parents removed him from hospital and he was treated at home. The other eight cases were sent to the Western Fever Hospital and did very well. The ages of the children varied from seven months to 2½ years. They had no fever or vomiting and did not appear to be ill. The majority of the diarrhoea cases in the homes were suffering from acute dyspepsia, in which vomiting was the chief symptom. A considerable number, however, had symptoms of enteritis as well. In the mild cases there was no rise of temperature, but the acute enteritis cases had fever which varied between 100º and 104°, with dehydration. Nearly all the acute cases I saw were due to dietetic causes, the balance of the various foods being faulty. In some cases contamination of cow's milk appeared to be the cause. There were cases of chronic diarrhoea in which wasting due to food disorders was the real cause, the diarrhoea being a symptom produced by a slight infection of the intestine and soon subsiding with treatment. These cases suffered from subnormal temperatures, and the susceptibility to infection can only be overcome by gradually increasing the amount of food, thereby increasing the child's weight so that resistance to infection can be strengthened. The wasted child requires more attention to its diet after the diarrhoea has subsided than is necessary in the case of a child of normal weight for its age. Intestinal septicaemia was another cause of chronic diarrhoea. This was greatly benefited by foutine treatment. The appetite returns very rapidly when the motions become healthy in appearance. Mucous disease in older children, from two to four years of age, was also responsible for chronic diarrhoea. These children are pale and wasted, and have no appetite. They are sometimes suspected to be suffering from tuberculosis. All the symptoms clear up with routine treatment, and the children make a good recovery when put on a well balanced diet. Early rickets with diarrhoea was another condition seen. Here again, after the diarrhoea had subsided, fresh air, dieting and cod-liver oil produced good results. These cases do not go to doctors until some definite bone changes are visible. Coeliac disease, in which fat cannot be absorbed and growth is impaired, was also observed. The notification of diarrhoea apart from zymotic enteritis has brought to light a number of cases of malnutrition which would pass unnoticed in the ordinary way. It is useless in these cases merely to cure the diarrhoea and to leave the original cause untreated. With regard to vitamins, it is well to remember that a properly balanced diet has sufficient of these in it to satisfy the demands of the body. Vitamins will not remedy a deficient food supply. Health Visitors' Notes. Forty-one cases were notified. Of these, 17 were under one year of age and 24 were one year and over. The number of families in which the patient was the only case was 33, and the number of families in which more than one case occurred was four. The following table shows the food on which the patients were fed. Diet. Cases. Cow's milk 3 Breast only 4 Dried milks 6 *Mixed diet 23 Breast and cow's milk 4 Condensed milks 1 * " Mixed diet " means vegetable soup or gravy, and bread, custard or milk-pudding at the midday meal. The other meals consist of cow's milk. Amongst the 41 notified cases, 19 were severe and 22 were mild. Fifteen of the notified cases were not attended by the district nurses. Eight of these were severe and seven were mild. Kensington District Nursing Association. The district nurses under Miss Eales attended 52 cases of diarrhoea, 26 of which were notified. Not one of these proved fatal. Twenty-one cases of diarrhoea occurred between the 12th January and the 31st June, and 31 between the 1st July and the 31st December. There have been no deaths in the homes whilst the nurses were attending. Seven cases were sent into hospital, and one of these died. The fatal case was really one of broncho-pneumonia, and diarrhoea occurred secondarily when the child's strength was failing. The nurse attended this case for only two days before removal to hospital. The nurses paid 465 visits. Three of the cases required a large number of visits ; in one the nurses paid 36 visits, in another 23, and in the third 24. Deaths from Diarrhoea and Enteritis in 1931. There were 40 deaths from diarrhoea recorded during the year. Thirty-seven deaths occurred amongst cases which were not notified, and three amongst those notified. The district nurses attended one unnotified case which proved fatal. Reference has already been made to this in the nurses' report. Amongst the 40 registered deaths from diarrhoea, broncho-pneumonia or bronchitis was included as a cause of death in 12 cases, septicaemia in one case, and the remainder were attributed to gastro-enteritis, infective enteritis, or diarrhoea. (Signed) RONALD CARTER. 54 Dysentery.—Seventeen cases of dysentery occurred during the year. One was of the Flexner variety and 16 cases were infected with the Sonne organism. Of the Sonne cases, two occurred amongst the staff of the Princess Louise Hospital; two in private houses, one in North Kensington and one in South Kensington ; the remaining 12 cases were reported from St. Mary Abbots Hospital and are dealt with by Dr. Carter in his report on enteritis. Acute Rheumatism.—During the year under review, 46 cases of this disease were notified, 18 of which were removed to hospital for treatment. The fourth annual report on the working of the rheumatism scheme during the period 1st October, 1930, to 30th September, 1931, prepared by the physician in charge of the centre and the medical officer of health, appears as Appendix I to this report. 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.—There were no deaths from measles in Kensington during the year. The women health officers paid 137 visits to measles patients. Forty-four cases were removed to the London county council hospitals. Whooping Cough.—There were ten deaths from this cause. The deaths in the three preceding years were 10, 65 and 4. The women health officers paid 298 visits to cases of this disease during the year. The number of cases admitted to hospitals from Kensington was 68. In 1930, the council approved of a scheme to be put into operation on the appearance of an epidemic of whooping cough, and they resolved to establish two clinics for the treatment of the disease, one at the school treatment centre in Kenley Street and the other at the Baby Clinic and school treatment centre at No. 92, Tavistock Road. As whooping cough did not appear in epidemic form during the year 1931, there was no occasion to put the scheme into operation. Disinfection. * SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1931. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Smallpox 8 21 19 1,813 Scarlet fever 410 487 461 7,450 Diphtheria 209 233 201 2,795 Enteric fever 18 22 29 651 Paratyphoid fever 6 7 13 330 Measles 62 81 50 121 Consumption 164 205 186 1,627 Cancer 68 91 129 1,563 Vermin 163 241 113 1,048 Other diseases 413 467 333 3,428 Totals 1,521 1,855 1,534 20,826 * 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, etc., of Kensington residents disinfected was 48 tons 13 cwts. 3 qrs. 12 lbs. The number or articles disinfected only was 19,670 and the number disinfected and washed, 1,156. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved in 1931 the washing of 10,769 towels, 239 sheets and 50 other articles. The Paddington authority have entered into an agreement with the council for the disinfection of all articles removed from Paddington homes to be performed at the Kensington disinfecting station. As the Paddington council require certain of the articles to be washed after disinfection, the charge was fixed at 20s. per cwt. of articles dealt with, but there is a proviso in the agreement that the minimum payment per annum is to be £600. The weight of Paddington articles disinfected in 1931 was 24 tons 17 cwts. 2 qrs. 25 lbs. The number of articles disinfected was 9,342 and the number disinfected and washed was 2,279. 55 Disinfection of Library Books. In view of the difficulty of securing efficient disinfection of books, the libraries committee authorise the medical officer of health to destroy all public library volumes removed from infected houses; this gives Kensington borrowers protection from infection from the council's books. The number of books from the Kensington public libraries destroyed during the year by the officers of the public health department was 72. The number of private subscribing library books destroyed was 21, and the number disinfected by formalin and returned to the householders was 16. Bacteriological Work. The work performed by the bacteriologist for the council during the year 1931 was as follows :— Disease suspected. Examinations. Positive. Diphtheria 1,583 101 „ (virulence test) 5 3 Tuberculosis (sputum) 321 38 „(faeces) 1 - „ (animal inoculations) 20 - „(fluid) 1 - Typhoid fever (blood) 25 - „ (faece) 14 - „ (urine) 10 - Dysentery (faeces) 26 8 Gonorrhoea 4 3 Ringworm 13 1 Cerebro-spinal meningitis 1 - The following examinations were also carried out :— Milk (bacterial count) 36 „ (tubercle bacilli) 20 In addition to these examinations at the Kensington laboratory, 500 specimens of sputum were examined at the tuberculosis dispensary. Cleansing of Verminous Persons. The cleansing of verminous persons is carried out at the medicinal baths, Blechynden Mews. The record of work done at the medicinal baths during the year 1931 is as follows :— Total Scabies— cleansings. Adults 273 School-children 551 Children under five years 87 Verminous conditions— Adults 26 School-children ... ... 3,117 Children under five years ... 6 Common lodging house cases 28 Other conditions— Adults 14 School-children 175 Children under five years 7 Total 4,284 The clothing worn by persons on their visit to the medicinal baths is disinfected, together with such other articles of clothing as the patients may bring. Altogether 9,046 articles were so dealt with and, in addition, 557 blankets and sheets, and 387 articles of night clothing. Of the 3,117 school children cleansed at the medicinal baths in 1931, 211 only were compulsory cases ; the remainder attended voluntarily. Verminous Premises Cleansed. Three hundred and sixty-seven verminous houses were cleansed during the year by landlords in response to notices served under the powers conferred by the London County Council (General Powers) Act, 1922. The council's rat officer, in addition to his duties under the Rats and Mice (Destruction) Act, carries out disinfection of verminous premises in certain cases. The following is a summary of his activities in this direction :— Number of premises visited 30 Number of rooms sprayed 52 56 TUBERCULOSIS. During the year 205 cases of pulmonary tuberculosis and 40 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 1922. District. 1922. 1923. 1924. 1925. Years. 1928. 1929. 1930. 1931. 1926. 1927. The Borough 339 403 314 292 317 252 276 241 260 245 North Kensington 233 267 228 207 227 166 179 156 178 149 South Kensington 106 136 86 85 90 86 97 85 82 96 Wards. St. Charles 48 61 45 52 50 39 48 39 56 49 Golborne 80 86 65 56 69 53 57 41 46 40 Norland 76 85 75 67 59 44 49 43 42 31 Pembridge 29 35 43 32 49 30 25 33 34 29 Holland 28 26 30 27 20 11 25 20 21 17 Earl's Court 24 28 13 18 25 25 20 21 19 23 Queen's Gate 20 22 17 13 15 10 11 7 8 9 Redcliffe 23 41 15 18 22 25 26 25 20 32 Brompton 11 19 11 9 8 15 15 12 14 15 It will be seen that the number of notifications in 1931 was lower than in the preceding year, and only four more than the figure for 1929, which was the lowest on record. Medical practitioners are reporting cases at an earlier stage of the disease than was the practice several years ago, but as 29 out of the 148 persons dying from tuberculosis in 1931 had not been notified prior to death some improvement is desirable in this respect in order that the Council's machinery for the prevention of the spread of infection may be put into operation at the earliest possible moment. The following summary shows the age and sex distribution of the cases notified and the deaths from this disease during the year:— Age periods. (Years). New cases† Deaths. Pulmonary. Non-pulmonary. Pulmonary. Non-pulmonary. M. F. M. F. M. F. M. F. 1—7 — — — 1 — — 1 1—5 — — 2 — — 1 2 3 5—10 1 — 2 2 — 2 1 2 10—15 1 4 3 5 — 1 — 2 15—20 11 8 11 4 6 7 1 3 20—25 21 19 2 2 10 8 1 1 25—35 23 30 1 2 11 10 — 1 35—45 18 9 — 1 11 10 — — 45—55 24 12 1 1 15 9 — — 55—65 11 8 — — 14 3 2 1 65 and upwards 4 1 — — 6 3 — — Totals 114 91 22 18 73 54 7 14 † Primary notifications of persons notified during life to be suffering from tuberculosis. From the above table it will be seen that the disease commonly attacks people at the period of their maximum value to the home, the family and the nation. Apart from causing deaths of persons in the prime of life, it handicaps many by reducing their working capacity for several years before death. 57 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1921, together with the number of deaths and death rates in each year:— Year. Pulmonary tuberculosis. Other forms of tuberculosis. Tuberculosis (all forms). No. of notifications. No. of deaths. Deaths per 100,000 persons living. No. of notifications. No. of deaths. Deaths per 100,000 persons living. No. of deaths. Deaths per 100,000 persons living 1921 288 153 87 86 32 18 185 105 1922 252 139 78 87 30 17 169 95 1923 280 117 66 123 35 19 152 85 1924 236 120 67 78 29 16 149 83 1925 235 134 75 57 25 14 159 89 1926 248 130 72 69 30 17 160 89 1927 178 114 65 74 26 15 140 80 1928 212 107 60 64 25 14 132 74 1929 188 120 68 53 17 10 137 78 1930 202 140 78 58 25 14 165 92 1931 205 127 70 40 21 12 148 82 Deaths from Tuberculosis in 1931 Allocated to District of Usual Residence of Patients. Pulmonary tuberculosis. Non-pulmonary tuberculosis. The Borough 127 21 North Kensington 88 17 South Kensington 39 4 Wards. St. Charles 15 5 Golborne 30 7 Norland 30 2 Pembridge 13 3 Holland 9 1 Earl's Court 11 1 Queen's Gate 1 – Redcliffe 14 1 Brompton 4 1 The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary tuberculosis. Non-pulmonary tuberculosis. Patient's home 46 5 St. Mary Abbots Hospital 48 6 St. Charles Hospital 4 — Princess Louise Kensington Hospital for Children – 1 Outlying hospitals 21 8 Other places outside the borough 8 1 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations were introduced with a view to — (1) preventing persons suffering from respiratory tuberculosis entering upon an occupation involving the handling of milk ; and (2) enabling local authorities, in proper cases and with suitable safeguards, to require persons engaged in such occupation to discontinue their work when found to be suffering from the disease in an infective stage. During the year no case occurred which required the attention of the Council under these regulations. 58 THE COUNCIL'S SCHEME FOR THE PREVENTION AND TREATMENT OF TUBERCULOSIS. The Staff Engaged on Tuberculosis Work. The staff at the dispensary consists of a tuberculosis officer, one indoor nurse who also acts as dispenser, a clerk, and two caretakers (man and wife). These officers give whole-time service to tuberculosis work. The borough is divided into seven areas for the purpose of home visiting in connection with tuberculosis work, and a woman health officer is allocated to each. These officers visit the tuberculosis dispensary daily for the purpose of obtaining information as to visits necessary to be paid, and they confer weekly with the tuberculosis officer, when they report to him in regard to the home visits paid in the previous week. Approximately three-sixteenths of the time of these seven women health officers is devoted to tuberculosis work. Dispensary Diagnosis and Treatment. The number of new cases seen at the dispensary during the year, with the original diagnoses made, is shown in the following table:— New Cases. Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 246 336 130 135 847 New cases with respiratory tuberculosis 85 64 3 3 155 (18.3 per cent.) New cases with non-respiratorytuberculosis 13 9 7 4 33 ( 3.8 ,, ) New cases regarded as "suspects" 4 12 6 1 23 ( 2.7 „ ) New cases not suffering from tuberculosis 144 251 114 127 636 (75 .0 „ ) This table shows an increase of 24 in the number of respiratory cases seen at the dispensary over last year. This increase is partly due to the inclusion under a new regulation of the Ministry of Health of certain special cases undergoing institutional treatment, and to the greater proportion of the total notifications in the borough being dealt with by the dispensary. The total number of non-respiratory cases is fewer than in 1930, being 33 instead of 38. The "suspects" are those cases remaining on the books at the end of the year whose diagnosis has not been completed, and do not represent, as in former years, the total number of "suspect" cases dealt with during the year. There were in addition 41 respiratory cases and 10 non-respiratory cases added to the dispensary register during the year upon removal into the borough of patients from other districts, as compared with a total of 102 for .1930. Cases came to the dispensary of their own accord or were sent up through one of the following agencies : the public health department of the council, the Ministry of Pensions, hospitals, school medical officers, the Kensington public assistance department, the Invalid Children's Aid Association, the Charity Organisation Society, clergy and private practitioners. Primary consultation cases with the latter numbered 293. The treatment recommended for the cases diagnosed at the dispensary as suffering from tuberculosis, which numbered 188 (pulmonary 155 and non-pulmonary 33), was as follows:— sanatoria, 118; domiciliary, 10; St. Mary Abbots and other hospitals, 55; dispensary, 5; Kensal House School, 2. The total number of attendances by patients at the dispensary was 2,730, and 1,588 systematic examinations were made. The number of visits paid by the tuberculosis officer was 130, of which 33 were consultations at home with the doctor in charge of the case. Written reports on cases to public authorities numbered 1,618, and to doctors 452. The total number of sputum examinations was 500 from 428 individual cases. One hundred and thirty-five specimens showed tubercle bacilli to be present, and 365 gave negative results. 59 An analysis of the tuberculosis register is shown in the following table.— Pulmonary. Non-pulmonary. Males Females Males Females No. of cases on the register of notifications on 1st January, 1931 357 343 177 199 No. of cases notified for the first time during the year 114 91 22 18 No. of cases brought to notice otherwise than by notification 25 23 12 14 No. of cases removed from the register during the year on account of having:— (a) been cured 11 4 11 18 (6) removed from district 49 56 12 12 (c) died 74 42 3 6 (d) been inaccurately diagnosed 2 1 – – No. of cases remaining on the register on 2nd January, 1932 347 347 184 187 The number of patients on the dispensary register on 31st December, 1931, was 883, whilst at the beginning of the year they numbered 877. A comparison of the dispensary figures with the total number on the register (1,065) shows that the majority of the tuberculosis cases are dealt with through the council's scheme—over 80 per cent. Residential Institutional Treatment, Light Treatment, X-Ray Diagnosis, etc. The facilities available for residential institutional treatment at sanatoria and St. Mary Abbots Hospital, for medical consultations, X-ray diagnosis and light treatment, will be found on page 82 of the annual report for 1928, which also contains reference to the close co-operation of the council's staff with general medical practitioners and other bodies and institutions. There were 42 X-ray examinations of dispensary patients during the year, apart from those made in St. Mary Abbots Hospital of patients sent in there from the dispensary. Home Visiting. The number of home visits paid in 1931 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 26 16 18 29 17 23 48 177 Re-visits 173 178 216 194 192 203 237 1,393 Non-pulmonary. First visits 4 3 25 4 2 4 5 47 Re-visits 61 148 122 84 44 90 61 610 Housing conditions form an important element in regard to tuberculosis, and home visits are valuable in this connection. The sleeping arrangements are frequently unsatisfactory and the women health officers always enquire into them. Wherever possible, desirable alterations are pointed out and urged upon the family. Reports are also made upon sanitary defects and special economic and other difficulties, and efforts are made to deal with them. These visits are additional to those made by the Charity Organisation Society and the Invalid Children's Aid Association, who undertake the weekly collection of any assessment made in connection with treatment in residential institutions under the London County Council's tuberculosis scheme. 60 The following table giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1931 by the tuberculosis officer, and the number of occupants ascertained by the women health officers on their visits to the homes, is inserted to show the difficulties experienced in securing home isolation in many cases:— No. of Rooms. No. of occupants. 1 2 3 4 5 6 7 8 9 10 Total Cases. 1 4 3 4 1 – – – – – – 12 2 – 9 10 17 8 8 3 – – – 55 3 – 1 5 12 12 4 2 – – – 36 4 1 2 7 9 9 4 3 2 2 – 39 5 – 1 1 6 4 2 2 1 – – 17 6 – – – – 2 2 – – – – 4 163 This total falls 25 short of the total number of cases owing to patients living in boarding houses, private hotels and large private residences not being included. It is now seven years since this table was first given in the annual report, and it is interesting to note that the overcrowding which is so often associated with tuberculosis shows slight improvement as follows:— 1925. Amount of room space per occupant .55 1926. ditto. .58 1927. ditto. .59 1928. ditto. .61 1929. ditto. .67 1930. ditto. .73 1931. ditto. .70 The Following-up of Patients in Cases of Doubtful Diagnosis. Patients often do not realise the importance of allowing the tuberculosis officer to complete his diagnosis. When a "suspect" has failed to keep an appointment, he is visited at home by a woman health officer, who gives him a definite appointment with the tuberculosis officer at the dispensary so that he will not be kept waiting. If he fails to keep this appointment, second and third visits are paid for the same purpose, when, if of no avail, the case is dropped for the time being. Examination and Systematic Supervision of Home Contacts. There were 547 contacts traced by the dispensary service in 1931. Of these, 375 were examined one or more times by the tuberculosis officer, 76 were examined by their own doctors or had been recently examined at school, while 96 refused examination or failed to attend after three appointments had been given them. The endeavour to secure a second and subsequent examinations of the "home contacts" of infectious cases after approximately one year's interval, especially young adult cases whose age renders them more vulnerable, has been continued. These examinations are not included in the above totals. Dental Treatment of Tuberculous Persons. Mr. A. Dreaper, l.d.s. (r.c.s.), who was appointed by the council in 1927 as dental officer, continued to act in this capacity during 1931. The work at the dispensary during the year is shown in the following table:— Dentist's attendances at the dispensary 48 Number of individual patients treated 16 Patients' attendances 115 Number of fillings 3 Number of extractions 73 Number of dentures arranged for 9 61 Artificial Pneumothorax Treatment. During the year the council undertook to pay for artificial pneumothorax treatment in 11 cases, and the payments amounted to £68 5s. 0d. Home Nursing. The cases of tuberculosis attended and the visits paid by the nurses of the Kensington District Nursing Association during the past five years are shown in the following table:— Year. Cases. Visits. 1927 22 804 1928 23 901 1929 28 1,327 1930 18 946 1931 16 394 The nurses carry out their work splendidly and are very much appreciated by the poor. Supply of Extra Nourishment to Tuberculous Persons. Five persons received extra nourishment during the year. The total amount supplied was 55 pints of milk and 55 new laid eggs, at a cost to the council of £1 17s. 3d. Arrangements for "Care" and "After Care." In July, 1922, the council approved a proposal for the constitution of a borough tuberculosis care committee, and this committee, which commenced its activities in December of that year, undertakes all the "care" and "after-care" work in the borough. Arrangements for Finding Employment. The difficulties of a care committee in securing work for persons whose physical capacity is limited will be readily appreciated, but every effort is made in this matter. In some instances the intervention of the tuberculosis care committee has resulted in employers holding open the positions of men about to undergo sanatorium treatment. Handicrafts Class. The handicraft class formerly held, but abandoned at the end of 1929 owing to the difficulty in maintaining satisfactory attendance, has been revived under the auspices of the Central Fund for the Industrial Welfare of Tuberculous Persons, who invited joint action by the boroughs of Paddington, St. Marylebone and Kensington. A class for glove making was started in October. Meetings are held weekly at the Paddington tuberculosis dispensary, No. 20, Talbot Road. It is too early to speak about success, particularly in view of past experience, but it is hoped that a permanent class will result. At the end of the year the tuberculosis officer for Paddington reported that several pairs of quite good gloves had been completed and the makers were to receive a few shillings for their efforts. The Central Fund appear to think the scheme worth pursuing, at any rate for a while, and are commencing a further course of 12 lessons when the present course is finished. Ten patients were sent from Kensington, but many have not attended regularly. New patients have however been enrolled, and the defaulters have been visited to encourage them to persevere. The Kensington borough council disinfects all gloves made by exposing them to formalin vapour, which has been shown by experiment to be completely effective as a sterilizer without injuring the texture or colour of the gloves. Provision of Shelters at the Homes of Patients. The council are prepared to loan shelters and they keep several in readiness at their Wood Lane depot but, at the present time, none is in use. Provision of Bedding for Home Isolation. At the present time there are eight patients to whom bedsteads and bedding are being loaned. In four of these the assistance was given for the first time during the past 12 months, the articles issued being as follows:— Bedsteads 4 Bolsters 4 Pillow-slips 14 Blankets 9 Mattresses 4 Pillows 5 Sheets 13 Quilts 4 Mattress covers 4 62 The total stock of bedding, etc., on loan on 31st December, 1931, was:— Bedsteads 5 Bolsters 5 Pillow slips 19 Blankets 17 Mattresses 6 Pillows 9 Sheets 21 Quilts 5 Mattress covers 5 Disinfection after Death or Removal to Hospital. In all cases after death from tuberculosis the council offer disinfection. This offer is also extended when patients enter hospitals or sanatoria and when they change their residence. Disinfection is also carried out upon request by the tuberculosis officer or private practitioners. The following table shows the number of disinfections carried out during the year:— Cases where bedding, etc., was disinfected by steam 186 Number of rooms disinfected 205 Bacteriological Examinations. Specimens of sputum submitted by medical practitioners for bacteriological examination at the expense of the council:— Examined at the council's laboratory 321 Examined by the tuberculosis officer 500 Sputum Flasks. These are supplied to patients who are infectious, and advice is given in regard to the disposal of sputum. I have the honour to be, My Lord, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 63 APPENDIX I. Fourth Annual Report on the Kensington Rheumatism Scheme. (October 1st, 1930—September 30th, 1931,) by James Fenton, M.D., D.P.H., and Janet K. Aitken, M.D., M.R.C.P.) PART I. GENERAL. by JAMES FENTON, M.D., D.P.H. The fourth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was completed on the 30th September, 1931. The function of this clinic is to assist in the early diagnosis of rheumatism in children (the early treatment of this disease being of paramount importance) and also to compile statistics with a view to determining etiological factors and thereby assist in the prevention of rheumatism. The statistics, up to date, are mainly negative in character. Under the Kensington (Acute Rheumatism) Regulations, 1930, acute rheumatism, as defined in these regulations, was made a notifiable disease for a further period of three years from the 1st October, 1930. The regulations, like their predecessors of 1927, define acute rheumatism as denoting the following conditions, occurring separately or together in a child under the age of sixteen years:— (a) rheumatic pains or arthritis, if accompanied by a rise of temperature; (b) rheumatic chorea; (c) rheumatic carditis. Response to Notification. The notifications under the Kensington (Acute Rheumatism) Regulations, for the fourth year, October, 1930, to September, 1931, show a reduction in number from 95 to 69, or 30 per cent. In the second year, there was a reduction of 34 per cent., and in the third year 9.9 per cent. It was pointed out last year that a reduction might be expected for the following reasons:— (a) the notification in the first years of an accumulation of patients, in whom the first symptoms had occurred before the year 1927; (b) the fact that it would not be necessary to notify again in later years a case in which there had been a previous attack during the period since notification was begun in 1927; (c) the natural tendency of practitioners to forget to notify a disease, not usually notifiable, some time after their first interest in this new duty had been aroused. It appears, however, that the third reason cannot have had much effect on the figures this year, as, although there is a general reduction, the proportion sent to the rheumatism supervisory centre by private medical practitioners is high. This indicates a satisfactory co-operation between the general medical practitioner and the centre. An Analysis of the Sources of Notification. Analysis of (first) notifications of acute rheumatism. First year, 1927-1928 Second year, 1928-1929 Third year, 1929-1930 Fourth year, 1930-31 Private medical practitioners 53 40 32 28 Rheumatism supervisory centre 32 37 12 9 School medical officers 28 1 20 12 Hospitals and institutions other than St. Mary Abbots Hospital 27 15 19 13 St. Mary Abbots Hospital 19 12 12 4 159 105 95 66 Although the number of cases notified is lower than in previous years, the percentage of new notified cases referred to the supervisory centre is greater, which suggests that the centre is becoming increasingly appreciated by the doctors. In 1930-31, 45 per cent. of the notified cases attended the centre, whereas in the previous year the percentage was only 38. New Cases from Kensington Attending the Rheumatism Supervisory Centre. 1927-1928 1928-1929 1929-1930 1930-1931 Total. Notified 63 33 36 31 163 Unnotified 93 107 92 110 402 156 140 128 141 565 64 INVESTIGATIONS CONCERNING ETIOLOGY. Contact Cases. In view of the statement in the Medical Research Council's report on acute rheumatism in children that "there is at least a ground for suspecting that rheumatism can be conveyed in some way from person to person, and that, as might be expected, closeness of contact favours its transmission," investigations are being made into the sleeping accommodation of rheumatic children. Last year, 78 cases were analysed, this year 52 have been added, making 130 cases in all. The following is an analysis of the 130 cases:— 1930 1931 Total Per cent. Group 1. Child sleeping in room in which no other children sleep 19 20 39 30.0 Group 2. Child sharing room or bed with another child or children 59 32 91 70.0 (a) child in separate bed 14 10 24 18.5 (b) child sharing bed with one to four other children 45 22 67 51.5 In group 1, therefore, the question of the spread of rheumatic infection by close contact during sleeping hours between one child and another does not arise. In group 2, there is no evidence that sleeping in the same bed as compared with sleeping in the same room gives a higher incidence of contact cases. An analysis of group 2 cases. (а) In 14 + 10 = 24 (or 18.5 per cent.) rheumatic cases, the child attending the clinic sleeps in a single bed, but one or more other children occupy the same room. In 11 + 9 = 20 cases (or 83. 3 per cent.) the other child or children show no evidence of rheumatism. In 3 + 1 = 4 cases (or 16.7 per cent.) there is evidence of rheumatism in the children occupying the same room. (b) In 45 + 22 = 67 (or 51.5 per cent.) rheumatic cases attending the clinic the child shares his or her bed with another child or other children. In 37 + 19 = 56 cases (or 83.5 per cent.) there is no evidence of rheumatism in the children occupying the same bed. In 8 + 3 = 11 cases (or 16-5 per cent.) there is evidence of rheumatism in the children occupying the same bed. Thus in group 2(a), the possible contact cases are 16.7 percent., and in group 2(b), where the chance of infection is greater the possible contact cases are 16.5 per cent. In the first series alone in group 2(a) the possible contact cases were 21.5 per cent., and in group 2(b), they were 18 per cent. The addition of the second group slightly alters the percentages, making them almost equal in the two groups. The number of cases analysed is still very small and no definite conclusion can be drawn from them. Up to the present there is no evidence that the very close contact of sleeping in the same bed as opposed to the less close contact of sleeping in the same room, but in separate beds, has caused a greater spread of rheumatism. Taking group 2 as a whole, it appears that in 15, or 16.5 per cent., there was more than one case of rheumatism in the family, but it is not possible to draw any conclusion from this observation alone, as so many other factors such as heredity, clothing, feeding and lack of maternal care must be considered. Environmental Factors. Careful comparisons have been made between a map showing the distribution in the borough of notified rheumatism cases during the four years 1927-1931, and maps showing:— (a) damp areas; (b) rat-infested areas; (c) various soils; (d) poverty. In the first three cases, no definite connection can be shown. Evidence of Dampness. Information concerning the presence of dampness in the rooms occupied by the rheumatic children notified during the year 1930-1931 shows that the health visitors reported dampness to be present in 14 instances, while in 52 instances no dampness was found. Dampness present 14 (20 per cent.) Dampness absent 52 (80 per cent.) In pursuance of the policy of the two previous years, the houses reported by the health visitors to be damp were reinspected by the sanitary inspectors. Dampness confirmed by the sanitary inspectors 6 No dampness remediable under the Public Health (London) Act, 1891 8 14 During the year, the proportion of damp houses reported by the health visitors has decreased from 39 per cent, in 1929-1930, to 20 per cent., and thenumber confirmed by the sanitary inspectors reduced the figure still further. 65 In only one house from which juvenile rheumatism had been notified was there serious dampness. Also, the incidence this year again confirms the observation of last year that the areas in which the largest number of rheumatic cases occur do not coincide with certain small damp areas where there is difficulty in preventing dampness. Rats and Soil. The areas of incidence of juvenile rheumatism this year confirm the opinion previously expressed that there is no evidence to show an environmental etiological connection between this disease and areas where rats are prevalent or the soil is clay. Poverty. In the first annual report of the rheumatism scheme, it was stated that about 90 per cent. of the acute rheumatism notifications came from North Kensington. The same figure applies to the distribution between North and South Kensington of the second, third and fourth year's notifications ; and the combined figures show that in a series of 428 notifications only 36, or 8 per cent., come from South Kensington., The incidence of a disease is also related to the number of susceptible persons, and in the case of a malady such as juvenile rheumatism, which has a particular age incidence, the population must be corrected for age ; therefore, the ratio of the total number of children under sixteen in North and South Kensington has been calculated. This calculation, based on the Census figures for 1921, corrected by the births and child deaths in each year since 1921, is presented below :— Ward. Estimated population in wards, 1931. Estimated child population under 16 years of age in 1931. Notifications of acute rheumatism under 16 years of age. 1927- 28 192829 192930 193031 North Kensington 93,362 32,295 147 95 86 61 St. Charles 26,303 9,539 34 22 19 17 Golborne 25,731 9,932 44 39 30 13 Norland 21,630 8,136 55 28 29 26 Pembridge 19,698 4,688 14 6 8 5 South Kensington 81,438 11,026 12 10 9 5 Holland 18,181 3,048 9 3 5 3 Earls Court 17,625 2,545 1 1 2 — Queens Gate 13,476 1,252 1 — — 1 Redcliffe 19,682 2,852 1 6 1 1 Brompton 12,474 1,329 — — 1 — It will be seen that North Kensington has 74.5 per cent. of the children under sixteen years of age and 91.5 per cent. of the notified cases, whereas South Kensington has 25.5 per cent. of the children under sixteen years of age and only 8.5 per cent. of the notified cases. The 66 cases notified during 1930-1931 are distributed in a way similar to that of the 1927-8-9 notifications and show a definite grouping in the "poor" areas of the Golborne, Norland and St. Charles wards of North Kensington. On investigating the home conditions of 52 of this year's notified cases and adding the figures of the 78 cases already reported, it is found that in 33, or 25 per cent., the homes can be described as being reasonably comfortable, while in 97, or 75 per cent., the circumstances were reduced or very poor. The enlarged statistics, therefore, continue to support the view of Dr. Alison Glover, who holds that the incidence of acute rheumatism increases directly with poverty, malnutrition, overcrowding and bad housing, and do not support those who hold that the incidence is greater in the artisan class, or in those just above the poverty line rather than in classes below that line. Social Services. Various enquiries have been made during the year about the social services associated with the medical work of the clinic. The following is the usual routine, and is carried out under the supervision of the honorary secretary, Mrs. Jacobson, who has largely initiated and organised the system. The honorary secretary is also a member of the Invalid Children's Aid Association (Kensington Branch), and works in close co-operation with that society. (1) When the honorary secretary is informed through the Invalid Children's Aid Association or health authorities, or possibly from neighbours while visiting another case, that a child is ailing and the symptoms are suggestive of rheumatism, the home of this child is visited and enquiries are made as to whether the child is under treatment. If it is found that this is not the case, it is suggested that the child should be sent either to a private doctor or to the rheumatism centre, according to the means of the patient. (2) All cases in Kensington which are sent to the centre are visited after their first attendance. If a child is found to be suffering from rheumatism, it is sent home from the centre to rest in bed under the care of a general medical practitioner or to await admission to a hospital. If the case is one of doubtful rheumatism needing special rest and perhaps the attendance in the home of the district nurse twice daily for taking the pulse and the temperature, the honorary secretary or her assistant visits the home to see that the prescribed routine is carried out. A card giving details of the home conditions, which are required for the investigations into the etiology of rheumatism, is filled in by the health visitor in notified cases, and by the social worker in unnotified cases. (3) At the centre, the doctor indicates in each case at what future date the child should attend. This is noted by the honorary secretary and an appointment is made. If there is no active rheumatism the doctor may not wish to see the child for some months. The home is then visited or a postcard is sent a week before the appointment in order to remind the parents. If the appointment is not kept, a second one is made and a further reminder is sent. 66 (4) After a child has been discharged from hospital, or returned from convalescence, or discharged by the private doctor, the home is visited to see that the child continues to attend the supervisory centre. (5) Letters are written by the honorary secretary on behalf of the medical officer to the school authorities if it is thought advisable to limit the child's activities, and reasons are given for the suggestion. (6) When cases are sent from boroughs other than Kensington, letters are written to the local Invalid Children's Aid Association if it is thought necessary that the child should be visited. (7) When the medical officer recommends that a child should attend a P.D. school, the honorary secretary communicates with the authorities of the London County Council who are concerned. (8) A record of cases and visits is kept by the honorary secretary. PART II. THE WORK OF THE CENTRE. By JANET K. AITKEN M.D., M.R.C.P. In the four years 1927-1931 during which the centre has been in existence, 777 cases of rheumatism or potential rheumatism have been supervised. Although the centre was primarily established to deal with cases from Kensington, it has been the custom to accept cases from other boroughs whenever advice was required. The borough of Hammersmith have made a grant towards the expenses of the centre (which is held at the Princess Louise Kensington Hospital for Children), and to the medical officers, in order that the centre may be responsible for the supervision of certain cases referred to the centre from that borough. Cases attending the Centre. 1929-30 1930-31 1927-31 Kensington 128 177 601 Hammersmith 35 40 140 Other Boroughs 10 17 36 173 234 777 During the year 1930-31, 48 sessions have been held at the Princess Louise Hospital, and the average attendance has risen from 16.3 in 1929-30, to 23.7 in 1930-31; the total number of attendances during this year has risen from 784 to 1,160. Average attendance per session of Kensington patients 18.9 other „ 4.8 23.7 The total number of attendances of patients during 1930-31 is as follows:— Kensington Notified cases (a) New 31 (b) Old 359 Unnotified cases (a) New 110 (b) Old 428 Hammersmith (a) New 33 (b) Old 158 Hounslow (a) New 1 (b) Old 0 Paddington (a) New 4 (b) Old 9 Chelsea (a) New 0 (b) Old 6 Various boroughs (b) Old 21 1,160 The new Kensington cases in 1930-31 were recommended to attend the clinic from the following sources:— Invalid Children's Aid Association 27 School medical officers 35 Princess Louise Hospital 45 Other hospitals and institutions 10 Private practitioners 6 Notifications 11 Public health department 1 Parents 6 141 The disposal of cases which attended the centre may be summarised as follows:— Tonsillectomy at Princess Louise Hospital 20 Admission to Princess Louise Hospital 34 Admission to St. Mary Abbots Hospital 12 Admission to other hospitals 5 Special schools 4 Special heart homes— 1 Carshalton 17 2. West Wickham 8 3. Lancing 4 Convalescent homes 13 Referred massage department for special chest expansion exercises 12 67 Cases which were admitted to Princess Louise Hospital and St. Mary Abbots Hospital sometimes had tonsillectomy performed during their stay in hospital when the acute stage was quiescent. Cases were admitted to other hospitals either because they were over the age for admission to Princess Louise Hospital or because they did not live in Kensington. The admission to convalescent homes is arranged through the lady almoner at Princess Louise Hospital or through the Invalid Children's Aid Association. Value of Tonsillectomy in Rheumatism Cases. The group of cases analysed in the 1929-30 annual report has been enlarged to include 544 cases. These are divided into three groups, namely:— (а) Cases in which the onset of symptoms was after complete tonsillectomy. The date of cardiac involvement in relation to tonsillectomy is often not known, but in rheumatic cases of this group there was no history of pains before tonsillectomy, although there was often history of constant colds and sometimes of tonsillitis; (b) Cases in which the first onset of symptoms was after incomplete tonsillectomy ; (c) Cases which had not had tonsillectomy or in which the first onset of symptoms was before tonsillectomy. This group was not divided into those with healthy tonsils and those with unhealthy tonsils owing to the difficulty of making this differentiation accurately. A cases. Percentage of total of 101. B cases. Percentage of total of 50. C cases. Percentage of total of 393. Severe rheumatic carditis 1 59% 1 68% 18 73.5% Milder cases but notifiable under scheme 20 10 104 Chorea 14 5 48 Rheumatic pains with no pyrexia or carditis 25 18 112 Probably not rheumatic 24 41% 16 32% 95 26.5% Definitely not rheumatic 17 0 16 101 50 393 Cases in group C who had complete tonsillectomy later, and who have developed further symptoms since that date are as follows:— 2 developed more severe heart lesion. 2 developed chorea. 1 had a second attack of chorea. 14 had second attack of juvenile rheumatism with cardiac involvement. 38 continued to have rheumatic pains. Without comparing a group of children who had had tonsillectomy and later had rheumatism or remained healthy with a similar group who had not had tonsillectomy, it is not possible to obtain satisfactory statistics as to the value of tonsillectomy in the prevention of juvenile rheumatism. These statistics are not easy to obtain in hospital as the healthy children are not attending. It is difficult therefore to make any comparison between these groups; and the 50 cases in which incomplete tonsillectomy had been performed are omitted, as in some the throat appeared healthy, although some tonsillar remnants were present, whereas in others the throat was definitely unhealthy. In investigating the cases which have been sent up to the rhematism clinic, it is of interest to compare the percentage of cases diagnosed as definitely rheumatic in children who have had complete tonsillectomy, with the percentage of definitely rheumatic children who still have their tonsils intact. It will be seen that in the former 58 per cent. were diagnosed as juvenile rheumatism and in the latter 73.5 per cent. were rheumatic. However, from these figures it cannot be shown that tonsillectomy is of any marked value in preventing the onset of rheumatism in children; also it will be noted that out of 101 children who had had complete tonsillectomy 60 developed rheumatism for the first time after the operation, and that 57 children who had not had tonsillectomy at their first attack showed further rheumatic symptoms after the operation. Most of the children who had definitely infected tonsils during their first attack have had tonsillectomy at a later date, but in a number of cases such a short time has elapsed since the operation that no conclusion can be drawn. It does appear, however, that tonsillectomy has had some beneficial effect in modifying the severity of the disease as far as cardiac involvement is concerned. Out of 282 rheumatic children whose tonsils were intact, there were 18 cases, or 6.3 per cent., classified as severe, whereas in the other group only one out of 57, or 1.8 per cent., was severe. In chorea there is no evidence to suggest that tonsillectomy prevents the onset of the disease. Among 101 patients who had had complete tonsillectomy there are 14, or 14 per cent., cases of chorea, whereas among 393 patients who had not had their tonsils removed there are 48, or only 12 per cent., cases of chorea. On the other hand, of the 14 patients who had chorea where onset was after complete tonsillectomy, none had carditis (although one developed carditis during a second attack which was after tonsillectomy), whereas of the 48 cases before tonsillectomy 11, or 23 per cent., had an associated heart lesion, so that again the severity in respect of cardiac involvement is modified by tonsillectomy. Summary. There is no definite evidence that tonsillectomy is of value in preventing the onset of juvenile rheumatism. There is some evidence to suggest that tonsillectomy may modify the severity of the disease as far as cardiac involvement is concerned. In chorea it is less common to find an associated cardiac lesion after tonsillectomy. 68 CLINICAL REPORT. Age and Sex. The rheumatism scheme of the Royal Borough of Kensington concerns itself only with children under the age of sixteen years. In the third annual report a graph was reproduced representing the age incidence of juvenile rheumatism. It was found that the highest peak occurred at the age of eight and that there was a secondary peak at twelve years old. In commenting on the report Dr. Alison Glover suggested that an explanation of the secondary peak at twelve years old might be due to the fact that there is a routine examination of children in the schools at this age, and that in consequence cases would be sent up by the school medical officer in greater numbers at the age of twelve. It was decided therefore to investigate this point, and a series of 440 cases have been analysed, and the results shown in the table and graphic reproduction below. The children sent up to the clinic by private doctors, Princess Louise Hospital, and the Invalid Children's Aid Association, or any other source, have no routine age examination, so they have been separated from those sent up by the school medical officer. It must be noted, however, that the age at which the child is sent up by the school medical officer is not always coincident with the age when rheumatic symptoms have first manifested themselves. The school medical officer may send a child for supervision at the centre for various reasons—because he thinks the child is suffering from juvenile rheumatism at the time of examination, because he finds evidences of rheumatic carditis which are not active at the moment but are proof that the child has had rheumatic carditis, or because he knows from the history that a child has been attended at home or in hospital for juvenile rheumatism at some previous date. It has been necessary therefore in separating the cases sent up by the school medical officer from all other cases, to sub-divide the former again into two groups, (i) those sent up at the time when juvenile rheumatism first manifested itself and (ii) those in whom the onset of juvenile rheumatism was before the recommendation by the school medical officer that the child should attend the clinic. In the latter group the routine examination of school children at the ages of eight and twelve would not affect the age incidence graph, as the first incidence was at varying times before the school medical officer sent up the child. For instance, in one case a child was sent up for the first time at thirteen years of age, but she was known to have had rheumatic fever at four years, and is therefore included in the four year old cases. In the former group, however, the routine examination of cases at the ages of eight and twelve might easily reveal more cases at these ages, and so affect any true estimation of the age incidence in juvenile rheumatism. A. From all sources except school medical officer (sub-divided). B. From school medical officer (sub-divided). C. Total male and female from all sources. D. Total sent up by school medical officer. E. Total sent up by school medical officer and whose first manifestation of juvenile rheumatism coincided with the time at which they were sent up. F. Total from all sources less E. Female. Male. Ages. Rheumatism. Chorea. Rheumatism. Chorea. C. D. E. F. A. B. A. B. A. B. A. B. 3 3 — 1 — 3 — 1 — 8 — — 8 4 10 2 2 — 5 — — — 19 2 — 19 5 22 1 3 — 12 1 — — 39 2 — 39 6 22 5 6 — 16 2 3 — 54 7 3 51 7 13 7 6 2 17 7 4 — 56 16 9 47 8 35 14 11 1 22 10 5 1 99 26 17 82 9 15 8 2 — 16 1 4 1 47 10 5 42 10 18 4 3 1 14 2 2 1 45 8 3 42 11 18 2 1 1 9 3 — — 34 6 2 32 12 26 9 2 — 10 7 3 — 57 16 15 42 13 14 2 4 — 5 1 — — 26 3 2 24 14 2 — — — 2 — — — 4 — — 4 15 — — — — 1 1 — — 2 1 1 1 198 54 41 5 132 35 22 3 490 97 57 433 69 Out of a total of 490 cases 61 per cent. were female and 39 per cent. male, or the proportion of male to female is as 1:1.6. Taking the chorea cases alone the proportion of male to female is as 1:1.8. The proportion of males is higher in this series than in some others—the average has been stated to be 1:3. It will be seen from the table and graph that it is a fact that more cases were sent to the clinic by the school medical officers at the ages of eight and twelve than at other ages; also in a large proportion of these cases the medical officer had discovered the rheumatic symptoms or signs when they were occurring for the first time. At the age of eight, 17 out of 20 sent up are in group E, and at the age of twelve, 15 out of 20 are in group E; group F, where group E cases are subtracted, is therefore a truer indication of age incidence than group C. There is still a high peak incidence at eight; this gradually decreases until eleven years. It rises again slightly at the age of twelve, but to a less degree than in group C. Dr. Glover's suggestion is, therefore, correct that the age incidence is affected by the routine examinations by school medical officers at eight and twelve. The general outline is modified; it is not, however, actually altered. Course of two cases of Juvenile Rheumatic Carditis. (1) Case 1 is reported to show how prolonged may be the course of even a mild case of juvenile rheumatic carditis. A girl, seven years old, was admitted to hospital in December, 1930. She had pains in the limbs suggesting rheumatism and the general health was very poor. She had no definite indication of carditis although there was a rough systolic murmur in the pulmonary area probably congenital in origin. After a fortnight in bed she developed mild but definite chorea and had a soft apical systolic murmur. She progressed well and after three months was allowed to get up for a short time. Immediately the pulse rate went up and there was a definite 70 triple rhythm heard and the heart was slightly enlarged. She was put back to bed for two months, improved, and in two months was allowed to get up. The same thing occurred. This time she was rested completely for four months and was put out on a balcony. But when she got up she again developed a triple rhythm, was pale, and lost weight, so she was put back to bed again. After three months more she seemed to have really got rid of the infection, and had no further relapse on getting up. In this case there was never any pyrexia, the signs were never severe though definite, and yet it was over a year before signs of activity disappeared. (2) Case 2 is reported to show how severe symptoms may develop in a mild case in spite of rest in bed. A girl aged ten was admitted into hospital with mild chorea. There was no sign of carditis. The choreic symptoms rapidly improved, but three weeks later the patient, in spite of having been kept in the prone position during that time, developed rheumatic myocarditis of sudden onset. Within a day or two the pulse became raised, the heart enlarged; the apex beat diffuse, with the area of cardiac dullness enlarged to the left to three quarters of an inch external to the nipple line ; there was a gallop rhythm. In both these cases the course was disappointing. In both cases treatment was begun in the very early stages and yet in one the disease was very prolonged, and in the other severe involvement of the heart developed. They are, however, exceptions. The writer would again like to emphasise her opinion that there is still much investigation to be done on the earliest signs and symptoms of juvenile rheumatism, because the early diagnosis is of vital importance in that early treatment does usually minimise the duration and severity of the disease. APPENDIX II. TABLE I. Vital Statistics of Whole District for 1931 and previous Years. Year. Population estimated to middle of each year. Births. Total deaths registered in the district. Transferable deaths. Net deaths belong:ng to the district. Uncorrected number. Net. of nonresidents registered in the district. of residentsnot registered in the district. Underlyearof age At all ages. Number. Rate. * Number. Rate.* Number. Rate per 1,000 net births. Number. Rate. • 1 2 3 4 5 6 7 8 9 10 11 12 13 1926 ‡180,000 B 179,800 D 2,405 2,717 15.1 2,564 14.2 816 557 164 60 2,305 12.8 1927 ‡176.700B 176.500D 2,270 2,657 15.0 2,550 14.4 656 546 176 66 2,440 13.8 1928 ‡1178,40013 178,200D 2,184 2,559 14.3 2,477 13.8 694 543 213 83 2,326 13.0 1929 ‡1176,OOOB 175,800D 2,139 2,544 14.4 2.889 16.4 733 552 213 84 2,708 15.4 1930 176.000 2,154 2,580 14.7 2,401 13.6 749 590 177 69 2,242 12.7 1931 174,800 2,111 2,485 14.2 2,646 15.1 716 525 188 76 2,455 14.0 * Rates calculated per 1,000 of estimated population. ‡ B. Population as estimated by the Registrar-General for the calculation of birth rate. D. „ „ „ „ „ „ „ death rate. At Census of 1921. Area of district in acres (exclusive of area Total population at all ages 175,859 covered by water) 2,291 Total families or separate occupiers 48,001 71 TABLE II. Table showing the number of cases of infectious diseases notified in the various age periods and wards; the number admitted; and the total deaths from these disease in 1931:- Notifiable Disease. Number of cases notified. Total cases notified in each ward. Cases admittd toe hospital .Total deaths At all ages At ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and over. Small pox 2 — — — — — - 1 — — — 1 — 1 — 1 — — — — — — 2 — Cholera — — — — — — — — — — — — — — — — — — — — — — — — Dysentery 17 2 6 4 1 ~~ 1 — — 1 2 — — 5 3 3 1 — 1 4 — — 15 — Plague — — — — — — — — — — — — — — — — — — — — — — — — Diphtheria (including membranous croup) 222 10 14 13 15 18 80 22 16 29 3 2 — 53 46 48 26 7 12 11 15 4 211 7 Erysipelas 61 1 2 — 1 — 3 4 5 9 8 21 7 8 16 13 3 3 6 1 9 2 31 3 Scarlet fever 385 3 17 25 31 32 152 49 20 43 10 3 — 116 57 87 39 15 23 21 18 9 375 1 Typhus fever — — — — — — — — — — — — — — — — — — — — — — — — Enteric fever 16 — — 1 1 1 1 — 1 7 2 1 1 4 — 2 2 1 2 3 2 — 11 1 Continued fever — — — — — — — — — — — — — — — — — — — — — — — — Puerperal fever 8 — — — — — — — — 8 — — — 2 — 1 2 — 2 — 1 — 8 7 Puerperal pyrexia 61 — — — — — — — 5 49 7 — — 8 22 11 5 5 3 1 5 1 51 Encephalitis lethargica 1 — — — — — — — — — — 1 — — — — — — — — — — 1 2 Cerebro-spinal meningitis 7 1 — 1 — 2 1 1 — — 1 — — 2 3 1 — — — — 1 — 7 6 Polio-myelitis and polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — Pulmonary tuberculosis 205 — — — — — 1 5 19 93 27 55 5 39 31 23 23 14 21 7 32 15 150 127 Other forms of tuberculosis 40 1 2 — — — 4 8 15 7 1 2 — 10 9 8 6 3 2 2 — — 23 21 Ophthalmia neonatorum 13 13 — — — — — — — — — — — 1 4 3 3 1 — — 1 — 11 — Primary pneumonia 213 30 25 11 13 8 23 8 12 28 15 25 15 47 86 33 22 4 2 8 9 2 94 27 Influenzal pneumonia 40 1 2 1 1 — 4 1 1 13 7 6 3 6 7 8 4 4 2 2 4 3 15 19 Malaria 1 — — — — — — — — — 1 — — — — — 1 — — — — — — — *Enteritis (diarrhoea) 41 17 13 7 4 — — — — — — — — 11 10 12 2 — — 3 3 — 14 40 †Acute rheumatism 46 1 — 1 2 1 27 13 1 — — — — 9 12 18 4 1 — 1 1 — 18 6 Totals 1,379 80 81 64 69 62 297 112 95 287 84 117 31 322 306 272 143 58 77 64 101 36 1,147 267 * Notifiable only in children under the age of 5 years. † „ „ „ „ „ 16 „ Cases of mistaken diagnosis are excluded from the above table. 72 TABLE III. Causes of Death at Different Periods of Life in 1931. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and upwards ALL CAUSES M. 1,066 112 22 20 8 37 36 51 101 194 255 230 F. 1,389 76 20 13 22 41 47 66 126 184 351 443 Typhoid and paratyphoid fevers M. 1 ... ... ... ... 1 ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Measles M. ... ... ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever M. ... ... ... ... ... ... ... ... ... ... ... ... F. 1 ... ... ... ... ... ... 1 ... ... ... ... Whooping-cough M. 4 1 1 2 ... ... ... ... ... ... ... ... F. 6 1 4 ... 1 ... ... ... ... ... ... ... Diphtheria M. 3 ... 1 ... 1 1 ... ... ... ... ... ... F. 4 1 ... 1 2 ... ... ... ... ... ... ... Influenza M. 19 2 1 ... ... ... ... 4 2 3 3 4 F. 45 ... ... ... ... 2 2 ... 4 6 14 17 Encephalitis lethargica M. ... ... ... ... ... ... ... ... ... ... ... ... F. 2 ... ... ... ... ... ... ... 1 1 ... ... Cerebro-spinal fever M. 2 ... ... ... ... 1 ... 1 ... ... ... ... F. 4 ... 1 2 1 ... ... ... ... ... ... ... Tuberculosis of respiratory system M. 73 ... ... ... ... 16 11 11 15 14 4 2 F. 54 ... 1 ... 3 15 10 10 9 3 3 ... Other tuberculous diseases M. 7 ... 1 1 1 2 ... ... ... 2 ... ... F. 14 1 1 2 4 4 1 ... ... 1 ... ... Syphilis M. 4 2 ... ... ... ... ... ... ... 1 ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... General paralysis of the insane, tabes dorsalis M. 5 ... ... ... ... ... ... 1 1 1 2 ... F. 2 ... ... ... ... ... ... ... 2 ... ... ... Cancer, malignant disease M. 133 ... ... ... ... 1 2 4 20 43 40 22 F. 200 ... ... ... ... ... 2 14 21 43 77 38 Diabetes M. 4 ... ... ... ... ... ... 1 ... 1 1 1 F. 17 ... ... ... ... ... ... ... 4 2 8 3 Cerebral hæmorrhage, etc. M. 38 ... ... ... ... ... ... 1 1 12 13 11 F. 75 ... ... ... ... ... ... ... 7 17 17 34 Heart disease M. 190 ... ... ... ... 2 1 3 14 31 75 64 F. 290 ... ... ... ... 2 2 8 19 34 92 133 Aneurysm M. 11 ... ... ... ... ... ... 1 2 6 1 1 F. 6 ... ... ... ... ... 1 ... 1 2 1 1 Other circulatory diseases M. 54 ... ... ... ... ... ... ... 3 11 11 29 F. 81 ... ... ... ... ... ... ... 3 8 29 40 Bronchitis M. 59 3 ... ... ... ... ... 1 6 12 18 19 F. 77 4 1 ... ... ... ... 1 3 6 20 42 Pneumonia (all forms) M. 107 34 9 6 1 1 1 4 11 8 16 16 F. 125 22 10 6 4 3 2 3 7 13 24 31 Other respiratory diseases M. 8 ... ... ... ... 1 1 ... ... 4 ... 2 F. 21 ... ... ... ... 1 1 2 2 1 5 9 Peptic ulcer M. 22 ... ... ... ... ... 1 2 4 9 4 2 F. 5 ... ... ... ... ... ... ... 3 2 ... ... Diarrhœa, etc. M. 25 20 3 ... ... ... ... 1 ... ... ... 1 F. 15 12 ... ... ... ... ... ... 1 2 ... ... Appendicitis M. 5 ... ... 1 ... ... ... ... ... 1 1 2 F. 10 ... ... 1 2 ... ... 2 2 2 1 Cirrhosis of liver M. 8 ... ... ... ... ... ... 1 3 1 3 ... F. 11 ... ... ... ... ... ... 1 3 2 2 3 Other diseases of liver, etc. M. 6 ... ... ... ... ... 1 ... ... 1 2 2 F. 9 ... ... ... ... ... ... ... ... 3 4 2 Other digestive diseases M. 24 2 1 1 1 ... ... 1 3 6 6 3 F. 30 1 ... ... ... 2 1 ... 7 3 8 8 Acute and chronic nephritis M. 24 ... ... ... ... ... 2 1 2 3 8 8 F. 42 ... ... ... 1 1 ... 3 2 9 12 14 Puerperal sepsis F. 7 ... ... ... ... 1 3 3 ... ... ... ... Other puerperal causes F. 8 ... ... ... ... 2 4 1 1 ... ... ... Congenital debility, premature birth, malformations, etc. M. 44 42 ... 2 ... ... ... ... ... ... ... ... F. 30 30 ... ... ... ... ... ... ... ... ... ... Senility M. 15 ... ... ... ... ... ... ... ... ... 1 14 F. 24 ... ... ... ... ... ... ... ... ... 1 23 Suicide M. 32 ... ... ... ... 1 5 6 6 8 4 2 F. 13 ... ... ... ... ... 5 4 2 2 ... ... Other violence m. 49 1 2 7 2 7 6 1 4 5 9 5 F. 57 1 1 ... 1 2 3 3 3 10 9 24 Other defined diseases M. 89 5 2 ... 1 3 5 6 4 11 32 20 F. 103 3 ... 2 4 4 10 12 14 12 22 20 Causes ill-defined or unknown M. 1 ... 1 ... ... ... ... ... ... ... ... ... F. 1 ... ... ... ... ... ... ... ... ... 1 ... 73 TABLE IV. INFANT MORTALITY DURING THE YEAR 1931. Net Deaths stated Causes, at Various Ages under One Year of Age. Causes of death Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under one year. All causes. Certified 36 8 4 3 51 31 50 33 13 178 Uncertified 3 ... 1 1 5 1 2 1 1 10 Measles ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 1 ... 2 Diphtheria ... ... ... ... ... ... ... ... 1 1 Influenza ... ... ... ... ... ... ... ... 2 2 Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... Meningococcal meningitis ... ... ... ... ... ... 1 1 ... 2 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... 1 ... 1 Bronchitis ... ... ... 1 1 2 4 ... ... 7 Pneumonia ... 3 1 1 5 4 26 17 4 56 Other respiratory diseases ... ... ... ... ... ... ... ... ... ... Diarrhœa, etc, ... ... ... ... ... 6 12 9 5 32 Congenital debility ... 1 ... ... 1 7 5 2 1 16 Malformation 4 ... ... ... 4 5 1 1 ... 11 Premature birth 31 2 2 1 36 4 1 ... ... 41 Deaths from violence ... ... 1 ... 1 ... ... ... 1 2 Other defined diseases 4 2 1 1 8 4 1 2 ... 15 Totals 39 8 5 4 56 32 52 34 14 188 legitimate, 2,265. Net births in the year of illegitimate, 220. legitimate infants, 161. Net deaths in the year of . illegitimate infants 27. 74 TABLE V. The Work of Women Health Officers for the Year 1931. HEALTH OFFICERS Total. 1 2 3 4 5 6 7 Child Welfare- First visits to infants (0-1 year) 350 235 246 339 340 94 210 1,814 Return visits to infants (0-1 year) 763 490 522 686 1,125 422 616 4,624 Total visits to children (1-5 years) 1,583 1,559 1,469 913 775 839 829 7.967 Stillbirth enquiries 8 8 9 4 10 — 9 48 Visits to ophthalmia cases 6 16 14 3 11 1 3 54 Return visits to ophthalmia cases 12 13 34 3 52 1 1 116 Visits to measles cases 8 14 20 4 73 15 3 137 Visits to whooping cough cases 21 29 33 1 138 29 47 298 Visits to puerperal fever cases — — 1 4 2 — 2 9 Visits to puerperal pyrexia cases 9 16 7 13 11 3 3 62 Visits to enteritis cases 20 5 49 5 6 — 2 87 Infantile death enquiries 29 23 21 42 38 4 15 172 Milk investigations 103 38 37 187 240 16 79 700 Ante-natal visits 55 55 72 131 111 90 190 704 Half-days at welfare centres 168 140 138 136 207 96 116 1,001 Special visits 174 203 341 223 259 397 298 1,895 Tuberculosis— Pulmonary.—First visits 26 16 18 29 17 23 48 177 Re-visits 173 178 216 194 192 203 237 1,393 Non-Pulmonary—First visits 4 3 25 4 2 4 5 47 Re-visits 61 148 122 84 44 90 61 610 Rheumatism— First visits to cases notified 8 6 14 4 11 1 2 46 Factories and Workshops Act— Inspections of factories 4 23 47 3 — 5 4 86 Inspections of workshops 15 12 27 6 40 468 188 756 Inspections of outworkers' premises 23 7 14 13 75 182 33 347 Inspections of other workplaces — — — 1 — 8 4 13 Total Visits 3,623 3,237 3,496 3,032 3,779 2,991 3,013 23,171 Notices issued under the Public Health Act— Intimation notices — — — — 1 2 3 Statutory notices — — — — — — — — Final notices — — — — — — — — Summonses — — — — — — — — 75 TABLE VI. Vaccination officer's Return Respecting The Vaccination of Children Whose Births were Registered in 1930. DATE. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth list sheets. Number of these births duly entered in columns 1, 2, 4, and 5 of the vaccination register (birth list sheets), viz.: Number of these births which are not entered in the vaccination register, on account, (as shown by report book) of Total number of certificates of successful vaccination received during the calendar year, 1931. Column I. success fully vaccinated. Column II. Column V. dead, unvaccinated. Postponement by medical certificate. Removal to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Insusceptible of vaccination. Certificate of conscientious objection. 1930. 1st January to 31st Dec. North 1,264 896 2 226 63 22 28 19 8 1,858 South 889 651 9 87 39 25 35 32 11 Total 2,153 1,547 11 313 102 47 63 51 19 TABLE VII. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1931. (as required by minister of health circular 359). Year of appointment Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A. W. K. Picard, M.D. 1922 Consultant Medical Officers (Part time). Hugh R. Carter, M.D., (Treatment of zymotic enteritis) 1924 Remington Hobbs, M.D., (Consultant gynaecologist) 1926 Janet K. Aitken, M.D., (Rheumatism supervisory clinic) 1927 Thomas S. Keith, M.B., B.S. (Lond.), (Bacteriologist) 1928 Public Vaccinators. Owen W. Roberts, M.R.C.S., L.R.C.P. (Public vaccinator, North Kensington) 1930 George A. Henderson, L.R.C.P.I., L.R.C.S.I. (Public vaccinator, South Kensington) 1930 Remington Hobbs, M.D., M.R.C.P., M.R.C.S. (Public vaccinator, St. Mary Abbots Hospital) 1930 Basil Hood, M.R.C.S., L.R.C.P. (Public vaccinator, St. Charles Hospital) 1930 Clerical Staff. James H. Wilson (Chief clerk) 1900 Francis W. Gascoyne 1919 John S. Russell 1923 Denis C. Page 1925 Arthur L. Vague 1927 Francis T. Pearce 1929 Ronald D. Callis 1929 Sanitary Inspectors. * Henry Dawes (Senior inspector) 1893 *Nelson Males 1897 *Charles G. Sexton 1898 *Thomas Cutting 1900 *George W. McQuinn 1901 †John McDermid 1920 ¶†Henrv W. Walters (Food inspector) 1925 ¶†Cecil R. Webb 1925 ¶†Redmond J. McCarthy 1926 ¶§John S. Wheeler 1930 ¶§Donald J. Hunt 1931 ¶§Frederick G. Bishop (Temporary) 1931 Vaccination Officer. Arthur H. Hinton 1930 Women Health Officers. ‡†*Miss W. H. E. Whitbread 1920 †*Mrs. V. A. Ross 1921 ‡†*Miss E. M. Law 1922 Miss A. E. Haycock 1922 ‡†*Miss K. M. Roe 1926 ‡§Miss E. Mogridge 1929 †Miss P. Bing 1930 ‡Miss B.I. Brady (Temporary) 1931 Health Lecturer. Mrs. M. Hayman 1926 Mortuary Keeper. Arthur C. Britton 1930 Disinfecting Staff. Albert Nunn (Chief disinfector) 1906 George H. I. Harris 1914 William Taylor 1926 Walter D. Strong 1928 Ernest G. Manning 1931 Medicinal Baths Staff. A. V. Boddington (Superintendent) 1929 Mrs. R. Webber (Matron) 1913 Rat Officer. Walter E. Weedon 1926 Drain Testing Assistants. William Clancy 1903 Charles H. Coombs 1927 Caretakers, Tuberculosis Dispensary. Mr. & Mrs. H. Lake 1921 * Certificate of the Royal Sanitary Institute. † Certificate of the London Sanitary Inspectors Examination Board. ‡ Certified Midwife. ¶ Certificate for Meat and other Foods. § Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. All the Women Health Officers have undergone 3 years general hospital training and have secured the certificate of general nursing proficiency. 77 INDEX. page SUMMARY OF STATISTICS 2 INTRODUCTION 3 VITAL STATISTICS. 3 Births 4 Births Notified (Table) 5 Birth Rate, Decline in (Table) 4 Births, Wards and Rates (Table) 4 Cancer 7 Causes of Death 6 Deaths 5 Deaths from Certain Diseases (Table) 8 Deaths, Wards and Rates (Table) 6 Infantile Mortality— 8 Deaths, Above Standard 11 Deaths, Causes of (Table) 10 Deaths each Month (Table 9 Deaths in Wards (Table) 8 Infantile Mortality Rates (Table) 9 Marriages 3 Maternal Mortality 11 Notification of Births Act, 1907 5 Population 3 Summary of Maternal Deaths 12 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA 13 Ambulance Facilities 16 Dogs, Fouling of Footpaths by 14 General Hospital 15 Grants to M. & C.W. Institutions 19 Health Competitions 18 Health Propaganda 18 Health Week and Exhibition 18 Home Nursing, Golborne Infant Welfare Centre 14 Kensington District Nursing Association 13 Legislation in force Locally 14 Midwifery Arrangements 14 Nursing, Professional, in the home 13 Other Health Services 18 Princess Beatrice Hospital 15 Princess Louise Hospital for Children 15 Rheumatism Supervisory Centre 16 School Medical Service 17 School Treatment Centres 16 Subscriptions to Hospitals and Voluntary Health Organisations 19 Zymotic Enteritis 14 PAGE SANITARY CIRCUMSTANCES OF THE AREA 20 Canal Boats Acts, 1877 & 1884 25 Chapel of Rest 24 Factories and Workshops 27 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923 25 Mortuary, Public 24 Pigeons, Nuisances from 26 Public Baths and Washouses 25 Public Houses, Inspection of 26 Rag Flock Acts, 1911-1928 25 Rats and Mice (Destruction) Act, 1919 26 Refuse Collection 20. Refuse Removal from Mews 20. Sanitary Inspection— 21 Inspections made (Table) 21 Legal Proceedings 24 Notices issued (Table) 22 Works completed (Table) 23 Sewerage and Drainage 20 Smoke Abatement 24 MATERNITY AND CHILD WELFARE. 30 Advisory Committee 35 Artificial Sunlight Treatment 32 Baby Clinic 32 „ Hospital 32 Convalescent Homes 34 Day Nurseries 33 Dental Treatment 32 Extra Nourishment, Supply of 35 Health Lecturer 34 Home Helps 35 Infant Consultations 31 Infant Welfare Centres— 31 Massage and Electrical Treatment Centre 33 Maternity Home 38 Queen Charlotte's Hospital Ante-Natal Clinic 33 Women Health Officers 30 Work done at Infant Welfare Centres in 1931 (Table) 31 HOUSING. 36 Action under Statutory Powers 36 Areas (other) requiring attention 39 Clearance Areas 39 Closing Orders, Underground Rooms 36 Common Lodging Houses 37 78 INDEX—continued. page Dwelling Houses, Inspection of 36 Fitness of Houses 38 Houses Let in Lodgings (By-laws for) 40 Housing Accommodation owned by Council 37 „ „ provided by Housing Associations 37 „ Statistics 36 Indecent Occupation, Measures taken to deal with 38 Overcrowding, Measures taken to deal with 38 Proceedings under Public Health Acts 36 Proceedings under sections 11, 14 & 15 of the Housing Act, 1925 37 Proceedings under Sections 17, 18. 19, 21 & 23 of the Housing Act, 1930 38 Registration of Houses Let in Lodgings 40 Remedy of defects without service of Notices 36 INSPECTION AND SUPERVISION OF FOOD 40 Agricultural Produce (Grading and Marking) Act, 1928 44 Artificial Cream Act, 1929 44 Bakehouses 43 Bacteriological Examination of Food 48 Food Supply 40 Food and Drugs (Adulteration) Act, 1928 44 „ „ „ Proceedings taken under 47 Ice Cream, Control of 43 London County Council (General Powers) Acts, 1902, 1908 and 1928 43 Merchandise Marks Acts, 1887-1926 43 Milk and Dairies (Amendment) Act, 1922 41 Milk and Dairies (Consolidation) Act, 1915 40 Milk and Dairies Order, 1926 41 Milk (Special Designations) Order, 1928 42 Milk supplied in Kensington, Composition of 41 Other Places where Food is prepared 43 Public Health (Condensed Milk) Regulations, 1923-1927 48 Public Health (Dried Milk) Regulations, 1923-1927 48 ,, „ (Meat) Regulations, 1924 43 „ „ (Preservatives in Food) Regulations, 1925-1927 48 Samples, Formal (Table) 45 Samples, Informal (Table) 46 Slaughterhouses 43 Unsound Food 44 PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. 48 Bacteriological Work 55 PAGE Cerebro Spinal Meningitis 52 Diarrhoea, Summer 52 Diphtheria 50 Disinfection 54 Dysentery 54 Encephalitis Lethargica 52 Enteric Fever 51 Erysipelas 51 Infectious Cases in Four-Weekly Periods 49 Malaria 52 Measles 54 Medicinal Baths 55 Non-Notifiable Diseases 54 Notifiable Infectious Diseases 48 Notifications of Infectious Diseases (Table) 1927-1931 48 Ophthalmia Neonatorum 51 Other Notifiable Diseases 54 Pneumonia and Influenzal Pneumonia 52 Poliomyelitis and Polio-Encephalitis 52 Puerperal Fever 52 „ Pyrexia 52 Rheumatism, Acute 54 Scarlet Fever 49 Smallpox 49 Verminous Persons, Cleansing of 55 „ Premises Cleansed 55 Whooping Cough 54 Zymotic Enteritis 52 TUBERCULOSIS. Artificial Pneumothorax Treatment 61 Bacteriological Examinations 62 Bedding for Home Isolation, Provision of 61 Care and After-Care, Arrangements for 61 Council's Scheme 58 Deaths in Wards (Table) 57 Dental Treatment 60 Disinfection 62 Dispensary Diagnosis and Treatment 58 Doubtful Diagnosis 60 Employment, Arrangements for finding 61 Extra nourishment, Supply of 61 Following Up of Patients 60 Handicrafts Class 61 Home-Contacts, Examination and Supervision of 60 Home Nursing 61 „ Visiting 59 Light Treatment 59 Notifications, Age & Sex distribution 56 Notifications, Deaths and Death Rates since 1921 (Table) ... ... 57 Notifications in Wards since 1922 (Table) 56 New Cases (Table) 58 79 INDEX—continued page Public Health (Prevention of Tuberculosis) Regulations, 1925 57 Records 59 Residential Institutional Treatment 59 St. Mary Abbots Hospital 82 Shelters 61 Sputum Flasks 62 X-ray Diagnosis 59 APPENDIX I. Fouth Annual Report on the Kensington Rheumatism Scheme 63 page APPENDIX II. Causes of Death at Different Periods of Life in 1931 (Table III) 72 Infantile Mortality during 1931 (Table IV) 73 Infectious Disease, Cases notified during 1931 (Table II) 71 Staff of Public Health Department (Table VII) 76 Vaccination Officer's Return for 1930- 1931 (Table VI) 76 Vital Statistics for 1931 and previous years (Table I) 70 Work of Women Health Officers for 1931 (Table V) 74