KEN 41 The Royal Borough of Kensington, THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1932 BY JAMES FENTON, M.D., Medical Officer of Health. Vail & Co., Printers and Stationers, 170, Farringdon Road, E.C. 300.5.33. O. 4694. SUMMARY OF STATISTICS For the year 1932. Population (estimated) 16 13,500 Area of borough in acres 2,291 Density of population per acre 80 Number of marriages 1,783 Rateable value £3,25) 14,335 Product of a 1d. rate £13,726 Total. M. F. Live births legitimate 2,163 1,077 1,086 Birth rate 12 9 illegitimate 199 100 99 Still births 80 46 84 Rate per 1,000 total births 84 Deaths 2,490 1,103 1,387 Death rate 13.6 Percentage of total deaths occurring in public institutions 65% Deaths from puerperal causes:— Deaths Rate per 1,000 total (live and still) births. Puerperal sepsis 4 1.6 Other puerperal causes 6 2.0 Total 9 3.8 Death rate of infants under one year of age :— All infants per 1,000 births 98 Deaths from measles (all ages) 45 Legitimate infants per 1,000 legitimate live births 92 „ whooping cough (all ages) 86 Illegitimate infants per 1,000 illegitimate live births 166 „ diarrhoea (under 2 years of age) 62 Deaths from phthisis 107 Phthisis death rate 0.58 Deaths from all forms of tuberculosis 127 Tuberculosis death rate 0.69 Deaths from the zymotic diseases 182 Zymotic death rate 0.99 3 Town Hall, Kensington, W.8. 15th June, 1933. 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 1932 upon the state of the public health in Kensington. During the previous year, medical inspectors of the Ministry of Health made a general survey of the public health services provided by the borough council, and in July last a communication was received from the Ministry in which there appear the following paragraphs :— " It appears that, so far as can be judged from a general survey, a reasonable, and in some instances, a high standard of efficiency and progress is being maintained in the discharge by the council of their functions in relation to public health. In particular, the Minister notes with interest the arrangements made by the council to provide treatment for children suffering from rheumatism and to investigate the causes of acute rheumatism ; to investigate methods of taking samples of milk for bacteriological purposes ; to standardise the receptacles for the storage of refuse ; to stimulate interest in health questions generally ; and to maintain close co.operation with the voluntary associations which provide maternity and child welfare services in the borough. He (the Minister) has no doubt that in any general review of their expenditure the council will fully appreciate the need for special consideration of services such as those for attending to the health of mothers and children which are urgently required on grounds of public health, and will keep under constant review the manner in which they can best assist in securing the maintenance of these services at an adequate standard, a matter which the continuing high infant mortality rate in Kensington renders of special importance." The birth rate for the year under review was 12.9 per 1,000 living, which is the lowest recorded in Kensington. The death rate of 13.6 per 1,000 living was 0.4 below the rate for the preceding year. There were 98 deaths of infants under the age of twelve months for every 1,000 children born. This is the highest rate in the borough since 1921. At the present time a detailed investigation is being made into the factors contributing to this high rate, but it is safe to say that the difficult economic conditions through which the nation has passed must have played a definite part. There was the unusual number of 415 cases of diphtheria notified during the year, but at no period was the disease prevalent in epidemic form ; and, although the majority of the cases occurred in the poorer areas, all parts of the borough were affected. Notwithstanding the fact that there were 1,133 cases of smallpox notified in London during the year, there was only one case reported in the borough. In this connection, it should be mentioned that whilst the latest figures show that 40.1 per cent. of the children in England and Wales are vac cinated within the first twelve months of life, the figure in Kensington is over 70 per cent. The high degree of immunity in Kensington indicated by this percentage of infants vaccinated is an important factor in the freedom which the borough has enjoyed for so long. In the past six years there have been in London 9,270 notified cases of smallpox and the total number in Kensington has been only 12. The condition of the housing accommodation of the working classes has received a good deal of attention during the past twelve months and the housing section of this report contains a brief summary of surveys which have been made and particulars of the efforts which the council have made to secure legislation to enable them to obtain a higher standard of habitability than they have been able to obtain under existing legislation. The presentation of this report affords me an opportunity of expressing my appreciation of the full measure of support which has been accorded to me by the Mayor, the Chairmen and ViceChairmen of the various committees, and all members of the council. I wish specially to thank the Town Clerk and the other chief officers, particularly at the present time, for the housing activities of the council during the past year involved a greater strain on the resources of the public health department than had hitherto been experienced, and the support received from them proved invaluable. The staff of the department have worked loyally during a heavy year, and have shown great enthusiasm in their endeavour to give efficient service to the council. 4 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 180,677 persons; but on subtracting the number of visitors in Kensington on the census night and adding to the total the number of Kensington residents who spent that night outside the borough, the true population is found to be 183,893. For the purpose of this report, the population for 1932 has been estimated at 183,500. 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 183,500 North Kensington 96,318 South Kensington 87,182 Wards. St. Charles 29,491 Golborne 24,082 Norland 22,120 Pembridge 20,625 Holland 19,081 Earl's Court 18,705 Queen's Gate 14,686 Redcliffe 21,947 Brompton 12,763 Population by sex. Area. 1921. 1931. Males. Females. Males. Females. Administrative County of London 2,071,579 2,412,944 2,044,108 2,352,895 Kensington 67,805 108,054 71,004 109,673 North Kensington 41,251 51,421 42,800 51,918 South Kensington 26,554 56,633 28,204 57,755 The proportion of females per 1,000 males in London has fallen from 1,165 in 1921 to 1,151 in 1931, the numerical excess of females being now 308,707, as compared with 341,365 in 1921. In Kensington, the proportion of females per 1,000 males is 1,544, which is a higher figure than that in any other metropolitan borough except Hampstead, where the proportion is 1,547 per 1,000.. The proportion for North Kensington is 1,213 per 1,000, and for South Kensington 2,048 per 1,000. In London generally, up to the age of ten years there is a preponderance of males. At subsequent ages there is a preponderance of females, which grows with advancing ages. Between the ages of 20 and 29, there are 14,976 more females than males. After the latter age, however, females show a rapid increase owing to their lower death rate, until at the age of 60 and over there are 1,361 females to every 1,000 males, whereas the females at all ages per 1,000 males in the county number 1,151. In Kensington, between the ages of 10 and 29, there are 11,133 males, and 13,840 females. Between the ages of 30 and 49, there are 19,452 males and 33,302 females. From the age of 50 onwards there are 16,380 males and 29,810 females. It will be seen that there is not a great difference between the number of males and females in London at what might be called the marriageable ages; indeed, between the ages of 20 and 29 there are in London only 1,044 females who are marriageable (single, widowed or divorced) to every 1,000 marriageable males of the same age. In Kensington, the number of marriageable females between the ages of 20 and 29 to each 1,000 marriageable males of the same age is 1,743. 5 MARRIAGES. During the year, 1,783 marriages were registered, representing a rate of 195 per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 654 Roman Catholic Church 228 Nonconformist Church 26 Jewish Church 9 Register Office 866 Total 1,783 MARITAL CONDITION. The number of married women under 45 years of age per 1,000 females of all ages in Kensington is 176. This figure is slightly lower in Chelsea, St. Marylebone and Westminster, but all other metro politan boroughs show a higher figure. Thus, Kensington has a heavy preponderance of unmarried females. Indeed, between the ages of 15 and 44, there are in Kensington 35,552 single, widowed or divorced women out of a total of 56,859 females between these ages, whereas in London as a whole the number of single, widowed or divorced women between the ages of 15 and 44 is 645,084 out of a total of 1,170,817 females of these ages. BIRTHS. The number of births registered was 2,362, after correction for inward and outward transfers ; and the birth rate for the borough was 129 per 1,000 population. Distributed according to sex and legitimacy the births were as follow:— Male. Female. Total. Legitimate 1,077 1,086 2,163 Illegitimate 100 99 199 Totals 1,177 1,186 2,862 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various districts in the borough in 1932, and the rates for the previous five years:— District. 1932. Birth rates in previous years. No. of births. Birth rate. 1931. 1930. 1929. 1928. 1927. England and Wales 614,820 15.3 15.8 16.3 16.3 16.7 16.7 London 67,371 14.2 15.0 15.7 15.7 15.7 161 The Borough 2,362 12.9 14.2 14.6 14.4 14.3 150 North Kensington 1,663 17.3 19.6 190 19.3 18.7 19.8 South Kensington 669 7.7 7.8 8.2 7.7 8.0 7.9 Wards. St. Charles 576 19.5 21.6 17.9 19.3 20.2 15.6 Golborne 569 23.6 21.3 21.5 21.8 20.8 23.7 Norland 330 15.9 19.8 22.0 21.5 19.3 22.9 Pembridge 158 7.7 14.3 13.6 13.3 13.5 16.5 Holland 157 8.2 9.1 9.4 8.2 10.1 10.5 Earl's Court 179 9.6 9.2 9.8 8.7 8.7 6.9 Queen's Gate 84 5.7 5.1 5.2 6.2 5.7 5.7 Redcliffe 157 7.2 8.4 9.4 9.2 8.1 8.1 Brompton 92 7.2 5.8 5.3 5.0 6.3 7.7 Ward unknown 30 ... ... ... ... ... ... 6 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 1932 12.9 Notification of Births Act, 1907—During the year, 2,362 live births to Kensington mothers were registered, and of this number 2,327 or 98 per cent. were notified in accordance with the requirements of the Act. The number of stillbirths notified was 73, and the number of births notified as having occurred in Kensington but belonging to other districts was 481. 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 17 1,026 1,043 „ „ „ parents — 33 33 „ „ „ medical practitioners 16 352 368 „ ., ,, other persons 18 401 414 Births in the borough 46 1,812 1,858 Notified from institutions outside the borough 27 515 542 Totals 2,327 2,400 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907. Year. Percentage. 1928 94 1929 95 1930 97 1931 97 1932 98 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. 7 DEATHS. The number of deaths registered in the borough during the year was '2,930, 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 2,930 Deaths of residents in public institutions, etc., beyond the borough 497 3,427 Deaths of non.residents in public institutions, etc., within the borough 937 Corrected number of deaths belonging to the borough 2,490 The corrected number of deaths gives a death rate of 13 6 per 1,000 living. 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 1932, and the rates for the previous five years:— District. 1932. Death rates in previous years. No. of deaths. Death rate. 1931. 1930. 1929. 1928. 1927. 1926 England and Wales 484,083 12.0 12.3 11.4 13.4 11.7 12.3 11.6 London 55,505 12.3 12.4 11.4 13.8 11.6 11.9 11.4 The Borough 2,490 13.6 14.0 12.7 15.4 13.0 13.8 12.8 North Kensington 1,833 13.8 13.8 12.6 15.4 13.4 13.8 12.9 South Kensington 1,084 12.4 13.3 12.5 14.5 12.1 13.4 11.8 Wards. St. Charles 375 12.7 12.5 11.7 13.9 12.0 12.9 10.7 Golborne 391 16.2 14.1 12.3 16.0 13.2 13.8 13.0 Norland 311 14.1 14.2 14.4 17.5 15.3 14.5 15.0 Pembridge 256 12.4 14.2 12.1 14.1 13.4 14.1 12.8 Holland 255 13.4 14.5 32.7 14.4 132 13.4 13.5 Earl's Court 250 13.3 14.1 15.0 15.9 13.5 137 13.1 Queen's Gate 185 12.6 10.8 11.2 12.7 10.0 13.2 8.5 Redcliffe 260 11.8 15.2 111 15.7 12.9 14.5 11.6 Brompton 134 10.5 11.2 11.4 12.5 9.5 11.3 11.5 Ward Unknown 73 ... ... ... ... ... • •• ... 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 1932 13.6 8 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 182 Epidemic influenza 79 Phthisis 107 Other tuberculous diseases 20 Cancer 296 Bronchitis 80 Pneumonia 188 Heart disease 567 Bright's disease 55 Puerperal fever 4 Premature birth 37 Violence (including suicide 46) 145 Old age 45 All other causes 685 2,490 It will be seen that over one-third of the deaths, or 942, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 107 deaths. The diseases described in the above list as the " principal zymotic diseases " are small pox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhoea. The following table shows the zymotic death rate for Kensington and London in each of the last five years:— Deaths from principal zymotic diseases per 1,000 persons living. Period. Kensington London. 1928 0.64 0.69 1929 0.78 0.57 1930 0.62 0.58 1931 0.34 0.33 1932 0.99 0.61 Cancer.—Cancer caused 296 deaths, and of this number 269 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 254 deaths were attributed ; sarcoma and epithelioma were the assigned causes of 13 deaths; 29 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following table :— DEATHS FROM CANCER, 1932. Farts affected. Sex. Total. Male. Female. Buccal cavity 7 4 11 Lungs 13 17 30 Stomach, liver, etc. 40 35 75 Peritoneum, intestines, rectum 43 81 74 Female genital organs • •• 17 17 Male genito-urinary organs 21 ... 21 Breast • • • 29 29 Skin 1 • • • 1 Other and unspecified organs 25 13 38 Totals 150 146 296 9 The deaths in the several wards, etc., are set out in the following table:— The Borough 296 North Kensington 142 South Kensington 154 Wards. St. Charles 34 Golborne 24 Norland 38 Pembridge 46 Holland 37 Earl's Court 31 Queen's Gate 30 Redcliffe 39 Brompton 16 Ward unknown 1 The number of deaths from this disease was 37 less than in the previous year. Table showing the number of deaths in 1932 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. Diarrhoea and enteritis. January 31 - - 4 2 20 14 23 14 38 4 February 28 - - 5 5 14 11 20 13 30 4 March 27 - - 6 3 15 11 21 8 23 8 April 24 - - 5 2 7 12 15 10 17 5 May 22 - - 4 - 3 13 24 7 13 8 June 19 - - 4 - 4 7 21 6 12 7 July 17 - - 2 4 - 8 24 1 11 3 August 16 - - 3 1 - 10 28 3 5 7 September 11 - 1 2 3 - 7 25 1 4 5 October 9 - 1 - 2 2 6 21 1 10 5 November 6 - - 1 1 6 4 22 6 8 1 December 8 - - - 3 4 4 31 8 10 3 December 31 1 1 - 3 4 5 21 7 7 8 Totals 1 3 36 29 79 107 296 80 188 68 10 Infantile Mortality. During the year 1932, there were 2,362 births and 232 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 98. The following table gives the births and the infantile deaths and death rates m England ant Wales, London, Kensington and the various wards of the borough for the year 1932, and th infantile death rates for the previous four years District. 1932. Infantile mortality rates in previous four years. No. of births No. of deaths of children under year of age. Infantile mortality rate. 1931 1930 1929 1928 England and Wales 614,320 39,706 65 60 66 74 65 London 67,371 4,640 66 65 64 70 67 The Borough 2,362 232 98 76 69 84 83 North Kensington 1,663 193 116 86 76 93 93 South Kensington Wards. 669 36 51 44 55 71 66 St. Charles 576 63 109 76 64 59 58 Golborne 569 64 112 97 81 121 111 Norland 330 47 142 84 70 88 115 Pembridge 158 19 120 92 96 101 87 Holland 157 13 83 54 84 96 62 Earl's Court 179 4 22 18 46 70 75 Queen's Gate 84 5 59 59 57 46 87 Redcliffe 157 11 70 67 43 54 67 Brompton 92 3 32 14 30 94 24 Ward unknown 30 3 — — — — 11 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1932. Causes of death Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total 4 weeks 1—3 months 3—6 month 6—9 month 9—12 months. Total infant deaths under 1 year 1. Common infectious diseases (Whooping cough 16) (Diphtheria 1) (Measles 6) — — — — — 2 5 6 10 23 2. Digestive Diseases — — — — — — 3 1 1 5 3. Pneumonia, bronchitis and other respiratory diseases 3 1 — — 4 12 9 10 10 45 4. Enteritis — — — 1 1 10 27 13 6 57 5. Complications of birth (Atelectasis 10) (Other complications 9) 19 — — — 19 — — — — 19 6. Congenital malformation 2 1 — 1 4 3 — — — 7 7. Premature birth 25 4 1 2 32 2 2 1 — 37 8. Atrophy, debility and marasmus 1 — — — 1 9 10 — — 20 9. Other diseases (Cerebro Spinal Meningitis 2) (Convulsions 5) (Influenza 1) (Violence 3) (Other conditions 8) 3 2 3 — 8 2 7 2 — 19 Totals 53 8 4 4 69 40 63 33 27 232 Death rate in each age period per 1,000 births 224 34 1.7 1.7 29.6 17 26.6 139 11.4 98 Percentage of total infant deaths occurring in each age period 22.9 3.5 1.7 1.7 29.7 17.2 27.2 14.2 11.6 If the statistics of the borough are traced back for thirty or forty years, it will be seen that, although the Kensington infantile mortality rate has shown in most years a gratifying decline, it has except on very few occasions, been higher than the rate for London or for England and Wales. Since the War, this problem has received close attention by the council and various voluntary organisations. The results of an extensive investigation by officers of the public health department were carefully and sympathetically considered by the council in 1922, and since that time every effort has been made, in conjunction with voluntary associations, to provide the borough with a complete and efficient maternity and child welfare service. Indeed, every recommendation I have submitted to the council in favour of the development of a new branch of the service has been adopted ; and the voluntary associations have shown the greatest enthusiasm in carrying out efficiently that part of the council's maternity and child welfare scheme entrusted to their care. For several years after 1922, the infant death rate fell satisfactorily, but then it began to increase up to 1929. In the latter year, I addressed a meeting of the North Kensington Medical Society, at which this problem was considered. The doctors expressed a desire to help the council in the matter. They appointed a special committee to conduct an investigation into the death of every North Kensington child under twelve months of age occurring in 1930 ; and their report appeared as an appendix to my annual report for that year. Although their report was a valuable document 12 in that it gave the unbiased views of private medical men and women with a wide experience amongst the poor, it left many questions unanswered. With a view to investigating the problem more deeply and more widely, the doctors in North Kensington formed a new committee in conjunction with their colleagues in Hammersmith and Paddington for the purpose of making a detailed medical study of the first twelve months of life of every child born in the year 1932 in the poorer parts of the three boroughs. As those children born towards the end of 1932 will not have reached one year of age until the end of 1933, the report on the medical enquiry will not be available until 1934. Whilst the doctors' findings are awaited with considerable interest, the high Kensington infantile death rate of 98 for the year 1932 calls for immediate consideration by the council. To enable this to be done, I have for some weeks been studying the records available in the public health department so as to be able to submit an appropriate review ; but as my research continued, the problem became more complicated. Eventually, I came to the decision to omit from my annual report all but bare statistics and to arrange for one of the council's experienced women health officers to devote the whole of her time for several weeks to a personal investigation into each of the 232 infant deaths which went to make that high rate. During the course of the summer, a special report on this detailed investigation will be published. MATERNAL MORTALITY. In 1932, there were nine deaths of Kensington women from diseases or accidents directly connected with childbirth, and this figure represents a death rate of 3.8 per 1,000 births. The rate for England and Wales for 1932 was 4.06. Puerperal fever was the cause of four of the Kensington deaths, whilst accidents associated with pregnancy were responsible for the other five. Although the maternal death rate of 3.8 shows a decline on the figure for the previous year and is slightly lower than the average for recent years, it is still too high ; and efforts must be made to secure that every working.class expectant woman in Kensington shall receive the advantages of that skilled advice which is available for them at the borough ante.natal clinics, the hospitals or from private medical practitioners. The problem is one of educating the mothers of North Kensington in regard to the benefits to be derived by taking advantage of the facilities which have been provided, and the council's health lecturer is making "The Value of Ante.Natal Care" a special subject in her course of lectures for 1933. 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 1932 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 1932 was 2,340 and the number of visits paid 48.064. The following is a table of cases attended and visits paid by nurses of the Association on behalf of the council from January 1st to December 31st, 1932:— Cases. Visits. Maternity cases 27 356 Miscarriages 18 174 Pneumonia (5 years of age and over) 59 1,066 „ (under 5 years of age) 69 1,093 Ophthalmia neonatorum and other inflammations of the eyes of newly.born children 34 546 Influenza (5 years of age and over) 58 647 „ (under 5 years of age) — — Enteritis and diarrhoea 120 1,326 Tuberculosis (5 years of age and over) 29 1,072 „ (under 5 years of age) 1 22 Measles (5 years of age and over) 25 378 „ (under 5 years of age) 160 2,094 Measles & pneumonia (5 years of age and over) 3 59 „ „ (under 5 years of age) 31 592 Whooping cough (5 years of age and over) 5 298 „ „ (under 5 years of age) 9 152 Erysipelas 2 22 Scarlet fever — — Pemphigus 7 78 Acute rheumatism 24 523 Diphtheria 3 16 Totals 684 10,315 For the splendid services rendered, the council paid to the association in 1932 a grant of £300. 13 A trained nurse was employed by the Golborne infant welfare centre until October 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 26 35 Children under 5 years of age 213 883 Totals 239 918 Bronchitis 29 68 Ear discharges 6 30 Minor ailments 150 669 Measles 28 116 Totals 213 883 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 746 confinements, of which 610 were in Kensington homes. The borough council maintain a maternity home with ten beds, the London County Council have at St. Mary Abbots Hospital 36 beds for the confinement of poor women, and the Princess Beatrice Hospital in South Kensington has a maternity ward. 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." 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 53. 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 the year 14 breaches of the by.law were reported to the public health committee. Summonses were taken out and fines of 20s. in two cases, 10s. in seven cases and 5s. in five were imposed. The number of convictions under this by.law during the past 11 years is 81 14 THE PRINCESS BEATRICE HOSPITAL. The Princess Beatrice Hospital, formerly known as the Kensington, Fulham and Chelsea General Hospital, was rebuilt during 1930-31, and was reopened early in 1932. The first section now completed includes men's, women's and children's medical and surgical wards, maternity ward and a separate wing for private patients of moderate means, X-ray and electro-therapeutic department, casualty department and various clinics. The present accommodation is 80 beds. The scheme when completed will provide an additional 56 beds, making a total of 136 beds, nurses' home, post-mortem and pathological department, administration offices, etc. The work performed at the hospital during the year 1932 was as follows :— 1. In-Patients. (a) General wards 858 (b) Private wards 188 2. Out-Patients. Total number of new out-patients 10,171 „ „ out-patients' attendances 45,013 Number of casualties 3,666 3. Other Treatments. Number of operations—major 686 minor 330—1,016 Dental cases 1,447 Massage 2,827 Light treatments 382 Superficial therapy 241 Actual patients X-rayed 1,205 4. Ante-natal Clinic and Maternity Ward. Total number of attendances 693 Number of patients admitted to maternity ward 114 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 Eye 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 1932. (a)—In.Patients. 1. Total number of available beds on 31st December, 1932 50 2. Average number of available beds during year 46.40 3. Average number of patients resident daily throughout year 41.53 4. Number of in-patients in the hospital at beginning of year 11 5. Number of in-patients admitted during year 1,134 6. Number of in-patients in the hospital at the end of year 36 7. Average number of days each patient was resident 13.71 8. Number of patients admitted and discharged during year who were resident for (i) only 1 day 30 (ii) 2 and 3 days 422 (b)—Out-Patients. 1. Total number of new out-patients 10,188 2. Total number of out-patient attendances 76,726 3. Number of casualty patients included in No. 1 above 1,746 15 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 1932 is as follows :— Number of sessions held 50 Number of individual patients examined— Kensington 278 Hammersmith 54 Other boroughs 13 Total attendances of patients— Kensington 1,062 Hammersmith 205 Other boroughs 43 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 Managment, and the work performed thereat during 1932 was as follows :— New cases. Total attendances. Eye cases 442 1,136 Aural cases 426 835 Minor ailment cases 1,668 19,806 Dental cases 1,141 2,022 A school treatment centre has also been established at the Baby Clinic premises in Tavistock Road and the record of work for the year 1932 is as follows :— New case Total attendances. Minor ailment cases 3,581 25,334 Dental cases 1,598 2,878 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 1932 are as follows:— Tonsils and adenoids 356 Eyes (new cases) 250 Dental cases : (gas, 178 ; fillings, 238) 416 X.ray cases 12 16 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 1932 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. 903 713 948 510 837 679 1,038 525 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. . Cases. * Cases. • Malnutrition 11 10 5 2 10 6 2 2 13 12 4 3 13 11 2 2 Skin disease 12 9 7 7 7 7 3 3 5 3 1 1 6 6 5 2 Defective teeth 352 212 223 ... 151 325 182 218 147 Enlarged tonsils 125 22 47 13 59 9 19 6 100 15 43 11 75 14 23 10 Adenoids 7 3 1 1 ... ... ... ... 4 2 3 2 5 4 3 2 Enlarged Tonsils and adenoids 56 33 24 14 10 9 6 5 48 24 21 16 22 15 6 3 Other nose andthroal defects 11 5 5 5 3 4 ... 6 2 7 4 8 4 4 ... Enlarged glands 98 16 65 3 47 4 22 ... 85 13 46 3 47 1 17 ... Eye disease 25 27 18 8 15 7 3 2 25 15 17 7 18 10 7 1 Vision defects ... ...0 ... 53 ... 109 ... 52 ... ... ... 55 ... 125 ... 56 Otorrhoea 13 7 4 2 5 3 3 1 14 9 3 3 10 7 2 ... Other ear disease 6 1 5 2 1 1 1 ... 8 2 3 1 5 4 2 2 Defective hearing 1 ... 1 1 4 1 2 2 2 1 2 ... 2 2 2 ... Speech defects 2 1 4 ... 6 1 1 ... 3 ... ... ... 1 ... ... ... Heart defects 37 ... 26 2 48 1 19 2 33 1 12 1 53 6 25 2 Anaemia 18 2 20 2 23 ... 6 2 9 1 14 2 23 2 9 Lung defects 20 5 9 3 6 3 1 1 20 7 9 4 9 3 3 2 Nervous defects 7 3 11 1 6 1 5 ... 4 3 9 2 6 4 1 ... Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other T.B. disease ... ... 1 1 ... ... 1 ... ... ... ... ... ... ... ... ... Rickets 13 ... 4 ... 5 ... 3 ... 1 ... 3 ... 1 ... ... ... Spinal deformities 1 ... 2 2 8 5 8 7 ... ... 2 2 30 24 12 9 Other deformities 6 3 5 ... 14 6 6 2 3 ... 11 4 13 5 11 8 Other defects 23 14 18 9 15 9 11 7 16 9 27 14 41 19 19 8 Number of children noted for treatment 433 292 353 217 400 266 398 222 * Defects however slight are included under "cases"; those severe enough to require treatment are shown under *. TABLE SHOWING THE CONDITIONS IN REGARD TO CLOTHING, NUTRITION, CLEANLINESS, TEETH AND VISION OF THE CHILDREN EXAMINED. Age Groups. 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 cither Entrants Boys 903 229 663 11 186 681 36 . 867 35 1 864 39 — 467 286 150 — — — Girls 837 280 546 11 192 614 29 2 799 35 3 821 15 1 454 249 134 — — _ Age 8. Boys 713 184 528 6 71 600 40 2 683 30 — 692 21 — 424 207 82 863 645 87 Girls 679 202 474 3 108 541 29 1 623 47 9 661 18 — 432 191 56 358 202 109 Age 12. Boys 948 272 672 4 157 744 47 .— 925 22 1 934 12 2 689 236 23 644 147 156 Girls 1,038 354 681 3 160 841 33 4 969 59 10 1,001 36 1 789 229 20 62b 239 175 Age 14. Boys 510 166 343 1 115 376 18 1 493 17 491 19 — 327 168 15 308 114 8 Girls 525 173 351 1 120 388 17 — 502 19 4 507 18 — 361 142 21 880 104 88 Total 6,153 1,860 4,253 40 1,109 4,785 249 10 5,861 264 28 5,971 178 4 3,943 1,709 501 2,631 1,051 627 Percentage 30.2 69.2 0.6 18.0 77.8 4.2 95.2 4.3 0.5 97.0 2.9 0.1 64.1 27.8 8.1 60.1 24.0 15.9 London 58.2 41.1 0.7 21.1 74.3 4.6 96.0 3.6 0.4 97.5 2.4 0.1 687 26.3 5.0 61.7 21.3 17.0 17 HEALTH PROPAGANDA The borough council did not hold a health week during the year, but health propaganda work was conducted by the council's health lecturer at the infant welfare centres and Baby Clinic. Lectures have also been given at Harrow Mission, St. Mary Abbots Girls' Club and the London county council schools. The report of the health lecturer's work appears on page 32. A special feature of the health lecturer's activities during the year has been instruction in the disposal of house refuse. Talks were given on this subject at the elementary schools and all the infant welfare institutions. SUBSCRIPTIONS BY THE BOROUGH COUNCIL TO VOLUNTARY HEALTH ORGANISATIONS DURING 1932. Subscriptions to Hospitals, etc. £ s. d. £ s. d. Cancer Hospital 5 5 0 Paddington Green Children's Hospital 5 5 0 Chelsea Hospital for Women 5 5 0 St. Mary's Hospital 10 10 0 Kensington District Nursing Association 5 5 0 West London Hospital 10 10 0 Western Ophthalmic Hospital 5 5 0 Princess Beatrice Hospital 10 10 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 Kensal Gospel and Medical Mission 5 5 0 Charity Organization Society 5 0 0 National Hospital for Diseases of the Heart 5 5 0 Invalid Children's Aid Association 35 0 0 Payments to Maternity and Child Welfare Institutions £ s. d. £ s d Archer Street Infant Welfare Centre 404 5 0 Baby Clinic 706 0 0 Baby Hospital 1,467 0 0 Bramley Road Infant Welfare Centre 400 15 0 Queen Charlotte's Hospital natal Clinic 45 0 0 Campden Hill Infant Welfare Centre 255 0 0 Princess Louise Hospital 400 0 0 Kensington District Nursing Association 300 0 0 Golborne Infant Welfare Centre 714 17 0 Kenley Street Infant Welfare Centre 420 17 0 Evelyn Convalescent Home 16 16 0 Hambledon Convalescent Home 8 8 0 Lancaster Road Infant Welfare Centre 534 4 0 St. Mary's Convalescent Home 52 10 0 Raymede and Sutton Trust Infant Welfare Centres 611 19 0 Wayside Cottage Convalescent Home 11 5 3 Mutual Registration of Assistance Society 10 0 0 South Kensington Infant Welfare Centre 430 6 0 Association of Infant Welfare and Maternity Centres 8 8 0 Golborne Day Nursery 208 0 0 Lancaster Road Day Nursery 323 0 0 Queen Charlotte's Hospital (Maternity Home) 1,152 18 0 St. Clement's Day Nursery 291 0 0 Notting Hill Day Nursery 429 0 0 SANITARY CIRCUMSTANCES OF THE AREA. REFUSE COLLECTION. The work of conversion of horse-drawn vans from high-loading to low-loading bodies has continued, and there is now a large proportion of the council's vehicles fitted with low rear-loading bodies. The advantages of the new type of body are that the work of collection is facilitated, the refuse is practically out of sight in the vehicle, and the nuisance caused by dust, etc., from loading is reduced to a minimum. The daily collection in traffic-congested streets has been increased from eight to fourteen thoroughfares, and the collections in these are carried out before 9 a.m. The daily early morning collection also operates in a number of other streets and blocks of flats. The council continue to collect refuse in the remainder of the borough not less frequently than twice weekly. Twenty-two per cent. of the Kensington refuse is barged away from Kensal Wharf to Yeading and Harefield, Middlesex ; 34 per cent, is disposed of in the refuse destructor installation at the Wood Lane Depot; and 44 per cent. is barged away from the Chelsea Wharf to a dump beyond Tilbury, Essex. The adoption of the council's standard type of dustbin continues to increase and, during 1932, 903 dustbins were sold to householders. The storage of refuse in 1,203 dustholes or other unsatisfactory receptacles has been discontinued, and portable dustbins have been substituted. The number of large portable containers supplied to premises where large amounts of refuse accumulate has been increased to 50. 18 REFUSE REMOVAL FROM MEWS. The common dustbins installed by the council in 1921, in 18 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. In two mewsways the owners have adopted the container system. 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, and (b) all drainage 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 232 76 Plans approved by the council 232 76 Total reconstruction of drains of premises 40 50 Partial reconstruction of drains of premises 60 23 Repairs to drains by " Economic Method " 5 10 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 2,753 1,212 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. 1 NUMBER OF DISTRICT Housing Inspector. Grand Total 2 3 4 5 6 7 8 9 10 Total complaints received . 396 251 143 283 225 203 193 215 286 139 - 2,334 Public Health (London) Act, 1891. Complaints received 303 104 84 150 124 199 183 213 278 124 - 1,762 Houses inspected on complaint 303 112 90 157 128 211 200 229 290 135 - 1,855 „ after infectious disease 222 264 135 141 133 88 79 67 100 8 - 1,240 Re-inspections 546 462 1,237 1,623 1,345 1,419 1,731 545 2,183 758 - 11,849 By-Laws re houses let in lodgings Complaints received 93 147 59 133 101 4 10 2 8 15 - 572. Houses inspected on complaint. 93 149 59 136 110 4 11 2 8 15 - 587 First annual inspections (furnished houses) - 2 5 8 - 11 - - 1 12 - 39 Re-inspections „ „ - - - 7 - 11 - - - 23 - 41 First annual inspections (unfurnished houses) 197 467 264 93 312 85 61 33 51 10 - 1,573 Re-inspections „ „ 31 1,675 1,794 691 1,060 325 272 16 334 119 127 6,444 Housing Acts, 1925 & 1930— Initial inspections (including preparation or revision of house-to-house card) 69 242 173 144 150 31 69 105 85 39 129 1,236 Re-inspections 2 59 82 38 1 23 - 1 147 1 1,390 1,744 Underground living Primary inspections 427 734 712 587 444 351 41 34 22 - 73 3,425 Re-inspections - 185 316 36 22 70 120 86 45 - 78 958 Drainage. House drains tested and in spected 43 103 127 78 88 73 495 44 273 62 187 1,573 Voluntary drainage work Applications made 50 7 17 55 43 63 114 122 114 111 - 696 Plans submitted 9 4 7 18 16 25 39 35 41 38 - 232 Inspections of workshops 4 35 41 10 39 8 24 79 51 84 - 375 „ factories 11 25 32 14 37 21 5 14 13 10 - 182 „ bakehouses 29 19 9 7 24 3 14 13 19 9 - 146 „ ice cream premises 20 12 2 11 17 - - 8 1 - - 71 „ other food premises 355 100 236 102 454 227 57 98 73 53 - 1,755 „ mews 122 202 182 63 106 95 299 231 106 175 - 1,681 Smoke observations 30 2 8 8 1 — 8 67 — — - 124 Other inspections 525 321 537 570 496 384 493 1,121 560 172 15 5,194 Canal boats inspections - - - - - - - - - - - - „ ,, re-inspections - - - - - - - - - - 39 39 19 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 8 9 10 Kind of notices issued. Public Health (London) Act, 1891. Intimations 191 423 227 488 298 81 98 102 234 63 - 2,205 Statutory notices 15 118 33 75 95 11 26 8 26 14 - 421 Final notices 3 8 3 17 34 - 3 - 15 - - 83 Summonses issued - 1 - 1 5 - 1 - 7 - - 15 Housing Acts, 192S and 1930. Sect. 17 (1930) (Repairs) - - - - - - - - - - 148 148 Sec. 127 (1925) (Power of entry) - - - - - - - - - - 530 530 Underground room habitation - 10 - 2 - - - - - - - 12 Removal of manure 6 - 4 - - - - - 1 1 - 12 Smoke nuisance notices 2 - - - - - - 2 - - - 4 Rent Restrictions Act certificates - 1 - - - - - - 1 - - 2 Special notices included under Public Health (London) Act, 1891, relating to factories - - 1 4 8 2 7 - 2 - - 24 ,, workshops - 1 1 1 10 - - 2 2 - - 17 „ bakehouses - - — 2 3 - - 5 2 - - 12 Other notices - 49 60 16 15 - - 1 25 - - 166 Report of waste of water to M.W.B. „ dangerous structures to 4 13 11 6 6 4 - 9 5 - - 58 L.C.C. 4 9 14 5 8 1 4 - 3 - 2 50 Canal boats - - - 20 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 3 7 16 14 20 3 20 5 14 2 1 111 Defective drains repaired 12 5 16 37 28 5 31 35 14 9 5 197 House drains cleansed 28 22 18 24 40t 8 23 24 17 5 — 209 Water-closets reconstructed 10 24 16 56 62 14 45 19 22 '5 3 276 ,, repaired 118 20 15 16 60 3 12 13 33 4 7 301 ,, supplied with water 15 13 30 76 10 - 4 2 47 - 11 208 „ new provided 7 4 16 9 10 30 61 41 33 25 — 236 Soil pipes ventilated, repaired, &c. 7 9 8 19 10 9 20 23 38 - 3 146 „ new provided 5 9 16 18 28 10 39 12 14 — 10 161 Baths, new provided 17 1 9 19 20 31 93 76 63 24 — 353 Sinks, „ „ 29 7 30 71 71 24 74 39 59 12 13 429 Lavatory basins, new provided 14 1 10 36 8 209 195 454 314 86 1 1,328 Cisterns cleansed 4 — 12 2 67 2 — — 16 — 1 104 „ covered 7 2 18 - 4 — 4 — — 35 „ abolished 1 — — 2 3 - — 1 — - 2 9 Taps fixed on rising main 5 — 7 7 20 - 3 1 1 — 1 45 Yards, areas paved, drained, repaired 31 29 34 39 65 2 2 26 6 64 298 Dustbins provided 44 41 52 32 111 11 14 65 64 51 4 489 Ashpits abolished 7 — 2 — 2 — — 1 1 — 3 16 Accumulations of filth, &c., removed 13 13 13 14 29 3 3 21 7 - 24 140 Animals removed 2 — — — 3 1 1 2 — — — 9 Overcrowding abated 7 21 18 5 8 1 — — — — — 60' Underground rooms, illegal occupation discontinued 4 18 6 7 11 6 - - - - - 52 Roofs repaired 41 84 31 17 73 9 20 12 29 11 87 414 Houses provided with water above basement floor 1 1 3 7 6 3 1 22 Dampness in dwellings remedied 55 49 53 50 64 4 11 11 64 9 39 409 Closing Orders made under Housing Acts— (a) Houses - - - - - 1 - - - - - - (b) Parts of houses 1 (c) Underground rooms 2 — 2 - — 4 — — — — — 8 Closing Orders determined — 11 1 - - - - - - - - 12 Repairs of houses completed under the Housing Act, 1930 - - - - - - - - - - 120 120 Infectious disease cases removed 315 267 106 187 100 67 42 16 67 2 - 1.169 Houses disinfected after infectious diseases (including bedding, clothing, &c.) 204 170 116 188 209 93 120 31 294 20 - 1,445 Rooms in such houses disinfected after infectious disease 370 171 125 195 217 134 127 34 297 27 - 1,697 Houses cleansed under houses let in lodgings by-laws 46 221 177 73 287 29 41 3 42 18 - 937 Verminous houses cleansed (including bedding, clothing, &c.) 46 70 45 23 23 3 8 7 41 3 2 271 Verminous rooms cleansed in such houses 94 94 76 33 25 8 19 7 71 5 3 435 Dirty bedding cleansed — 12 30 6 7 — — — — — — 55 „ „ destroyed — — 12 - 1 — — — 1 2 — 16 Other sanitary works executed 38 88 58 68 43 28 41 84 38 14 5(J0 21 Summary of Legal Proceedings taken during the year, 1932. Nature of offence. No. of summonses. Magistrate's decisions. Failure to carry out sanitary repairs. 7 Order made for work to be carried out within 30 days in one case ; in 28 days in one case ; in 14 days in four cases. Summons withdrawn in one case, the work having been carried out. Failure to comply with by-laws for houses let in lodgings. 1 Fined £4. Failure to abate overcrowding. 2 Fined 40s. in one case, and 5s. in one case. Permitting overcrowding. 1 Summons withdrawn. Failure to pay expenses incurred under Section 17 of the Housing Act, 1930. * 1 Summons withdrawn, amount having been paid. Failure to comply with the L.C.C. by.laws in connection with drainage work. 7 Fined £3 in one case ; £4 in one case; £8 in one case ; and 20s. in four cases. Allowing a dog to deposit its excrement on the public footway. 14 Fined 20s. in two cases ; 10s. in seven cases ; and 5s. in five cases. Failure to give information as to interest in premises. 1 Summons withdrawn, information supplied. The defendant was ordered to pay two guineas costs. Total 34 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 124 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. Four nuisances were discovered and written intimation notices were served. In each instance, the action taken resulted in the abatement of the nuisance. MORTUARY AND CHAPEL OF REST. During the year 156 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 17 At the request of undertakers 43 At the request of coroner 91 By the police 5 156 In 91 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. 22 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 woman'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. 1928 257,703 1929 246,085 1930 238,262 1931 218,158 1932 232,384 In the wash-house or laundry department, there were 88 wash-tubs in use in 1932. The number of women using the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1928 97,110 1929 96,192 1930 92,381 1931 90,066 1932 89,766 There are 8 washing machines and the number of women using these machines in 1932 was 18,825. 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, 10, 13 and 17 parts of chlorine per 100,000, the limit set by the above acts being 30 parts per 100,000. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920.23. Applications made to the council in 1932 for certificates under the Acts totalled seven, and two certificates were granted. CANAL BOATS ACTS, 1877 AND 1884. 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 1932, the canal boat inspector made 39 inspections, all of which were re.inspections. No notices were served upon the owners or occupiers for contraventions. No births or deaths occurred on boats whilst lying at the wharves in Kensington, and no cases of infectious disease were reported. 23 REMOVAL OF AGED, INFIRM OR PHYSICALLY INCAPACITATED PERSONS. Under Section 28 of the London County Council (General Powers) Act, 1928, the borough council have power to remove to a hospital, infirmary, institution or other similar place, aged, infirm or physically incapcitated persons living under insanitary conditions. During the year, one case was dealt with. It was that of a woman who lived alone in a slip room on the ground floor. She was 74 years of age and had no source of income other than the old age pension of ten shillings per week. Her husband was dead and she had one son who had not visited her for five years and made no allowance. She was living under deplorably filthy and verminous conditions. She refused to go to hospital and on the 1st March a magistrate's order for her compulsory removal to the Kensington Institution was obtained. On the 21st June the court ordered her detention for a further period of three months, which expired on the 20th September. Up to January, 1933, the woman remained in the institution voluntarily, but then came out; and, at the time of writing (May, 1933), she is looked after by friends. No circumstances have arisen which would warrant her removal again to the Institution. 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 from 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 .... 169 Total number of visits paid .... '2,796 Number of poison baits laid during the year - - 101,350 „ „ disappeared - - - 92,900 „ „ removed by the rat officer - 8,450 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 22 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats .... 127 Number of sewer defects allowing egress of rats made good 7 Number of statutory notices served under the Rats and Mice (Destruction) Act, 1919 -• - - 1 Number of premises cleared of rats ... 183 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 ca:used 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 1932, 202 pigeons were killed and 36 eggs destroyed. Since June, 1928, when the council first took action under this section, 1,151 pigeons have been destroyed. 24 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 — 1 1 Bakers 38 35 73 Basket makers 2 — 2 Blacksmiths 12 — 12 Blind makers 1 — 1 Boot makers and repairers • 64 16 80 Builders 45 9 54 Cabinet makers 10 3 13 Cigarette makers 2 1 3 Coach builders 10 3 13 Coal wharves 2 — 2 Cooked meat dealers — 2 2 Cycle repairers 5 1 6 Dyers 2 2 4 Electricity generating stations — 2 2 Electric light fitting makers 3 3 6 Firewood choppers 3 3 6 Furriers 4 — 4 Gas works — 2 2 Ice cream manufacturers 3 — 3 Instrument makers — 3 3 Ironmongers 2 — 2 Ladder makers 1 1 2 Lampshade makers 2 — 2 Laundries 4 12 16 Marine stores 1 — 1 Masons 1 1 2 Metal workers 9 4 13 Motor engineers and garages 39 26 65 Motor spirit dealers — 1 1 Photographers 3 — 3 Piano makers — 1 1 Picture frame makers 7 — 7 Pipe makers — 1 1 Printers 5 7 12 Saddlers 2 — 2 Sausage makers 7 6 13 Sign writers 5 — 5 Steam pressers 4 1 5 Sundry businesses 59 12 71 Sweet manufacturers 2 1 3 Tailors 76 1 77 Timber merchants 1 — 1 Trunk makers 3 — 3 Undertakers 6 1 7 Upholsterers 21 — 21 Washing machine manufacturers — 1 1 Watch makers 7 — 7 Wax figure manufacturers 2 1 3 Wheelwrights — 2 2 Total 473 168 641 25 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 2 — 2 Boot makers and repairers 2 1 3 Corset makers 7 — 7 Dressmakers and ladies' tailors 245 2 247 Dyers 2 1 3 Embroidery workers 5 — 5 Florists 10 — 10 Furriers 14 1 15 Hairdressers 18 — 13 Invisible menders 3 — 3 Jewellers 1 2 3 Knitted goods 1 — 1 Lace workers 8 — 3 Lampshade makers 2 — 2 Laundries 87 42 79 Milliners 44 — 44 Outfitters 13 — 13 Photographers 4 — 4 Picture frame makers 1 — 1 Restaurants 8 — 3 Sundry businesses 39 7 46 Toy makers 1 — 1 Umbrella makers 1 — 1 Upholsterers 8 — 8 Weavers 1 — 1 Total 464 56 520 Home Work.—Of the 149 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 45 Outworkers in domestic workshops 12 Outworkers in their own homes 92 Total number of outworkers 149 The factories and workshops referred to in the above list are included in the tables which show the trades carried on in the factories and workshops on the council's register. The nature of the work given out to the 92 home workers on the register is as follows :— Tailoring 52 Dressmaking 24 Bootmaking 6 Outfitting 3 Linen working 2 Drapery 1 Fancy goods 1 Blouse making 1 Confectionery 1 Umbrella making 1 92 26 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 74 ,, workshop ,, 650 „ home worker inspections 378 ,,work-place 29 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) 250 23 — Workshops (including workshop laundries) 1,007 25 — Workplaces (other than outworkers' premises) ... 196 15 — Total 1,453 63 — II.—Defects Found. Particulars. Number of Defects. Number of prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisatues under the Public Health Acts:— Want of cleanliness 74 74 — — Want of ventilation 3 3 — — Overcrowding 2 2 — — Want of drainage of floors 2 2 — — Other nuisances 28 28 2 — Sanitary accommodation (a) insufficient 6 6 — — (b) unsuitable or defective 16 16 — — (c) not separate for the sexes 2 1 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (SS. 97 to 100) — — — — Other offences — — — — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops) (Transfer of Powers) Order, 1921) — — — — Total 133 132 2 — 27 MATERNITY AND CHILD WELFARE. Under the borough council's scheme of maternity and child welfare work, complete arrangements are made for the medical supervision of children under the age of five years, and for the care and after-care of expectant and nursing mothers. The scheme includes infant welfare centres, day nurseries, ante-natal clinics, a maternity home, hospital and convalescent treatment, the supply of extra nourishment, home nursing and various other services which can be of help in the effort to reduce infant and maternal mortality. During the year under review there has been no change of note in the services provided by the council, and the scheme has worked smoothly. 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 1932 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) 362 241 259 358 401 77 203 1,901 Re-visits to infants (0-1 year) 423 465 535 723 1,079 256 466 3,947 Visits to children between 1 and 5 years 1,051 1,028 1,146 673 874 636 796 6,204 Still-birth enquiries 7 6 13 5 11 1 7 50 Visits to ophthalmia cases 7 10 7 9 11 2 — 46 Return visits to ophthalmia cases 5 21 18 16 33 1 — 94 Visits to measles cases 135 199 210 61 323 168 214 1,310 Visits to whooping cough cases 23 64 39 13 101 86 72 398 Visits to puerperal fever cases — 1 2 — 2 — — 5 Visits to puerperal pyrexia cases 7 4 5 3 7 1 3 30 Visits to enteritis cases 54 11 37 13 21 — — 136 Infantile death enquiries 37 26 24 30 34 10 18 179 Investigations re milk applications 266 45 44 470 277 14 136 1,252 Ante-natal visits 111 72 110 114 83 143 204 837 Half-days at welfare centres 183 143 127 123 196 103 115 990 Special visits 199 303 280 311 181 349 388 2,011 The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of this report dealing with those subjects, and a complete record of the work performed by each woman health officer during the year appears in Table V of Appendix II. 28 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 work done at the infant welfare centres during the year 1932 is shown in the following table :— Particulars of work done. Archer Street. Bramley Road Campden Hill. Golborne. Kenley Street. Lancaster Road. Raymede. South Kensington Sutton Trust. Totals. 1—No. of births occurring in the area of the centre suitable for welfare attention 90 268 73 251 217 375 311 261 64 1,910 2—No. of sessions at which doctor attended for infant consultations 48 103 89 110 50 132 150 99 50 831 3—No. of sessions at which doctor attended for special ante-natal consultations 22 50 13 23 26 22 26 24 25 231 4—Total number of individual mothers who attended during the year 308 473 187 474 291 811 471 361 202 3,578 5—Number of individual mothers who attended ante-natal sessions during the year 50 115 34 47 77 80 81 82 59 625 6—Total number of individual children who attended during the year— • 1. Children 0 to 1 year 198 297 118 272 198 420 347 221 121 2,192 2. „ 1 to 5 years 134 159 86 324 132 452 430 215 208 2,140 7—Total attendances at centre of mothers for all purposes (excluding the accompanying of children and for the purpose ot buying dried milk or other article) 648 1,635 1,125 1,013 2,095 4,769 2,659 1,900 800 16,654 8—Total attendances at centre of children for all purposes— 1. Children 0 to 1 year 2,043 3,153 1,303 3,'203 1,928 5,571 4,295 2,316 1,268 25,080 2. „ 1 to 5 years 1,145 '4048 1,260 4,107 1,405 5,966 3,961 2,467 1,685 24,044 9—Total attendances at dinners (included in Nos. 7 and 8 above)— 1. Mothers — — — — 2,777 — — — 2.777 2. Children — — — — — 2,470 — — 2,470 10—Total attendances at doctors' consultations— 1. Ante-natal mothers 203 563 72 122 306 270 2U5 271 110 2,122 2. Post-natal mothers 92 154 — 295 115 120 184 561 126 1,647 3. Children 0 to 1 year 762 1,717 1,022 1,539 709 2,673 2,082 1,450 622 12,576 4. „ 1 to 5 years 433 952 846 1,462 536 1,281 1,982 1,227 1,026 9,745 ll--Average attendances at doctors' consultations— 1. Ante-natal mothers 9 11 5 5 12 12 8 11 4 9 2. Post-natal mothers 2 1 — 3 2 1 1 5 2 2 3. Children 0 to 1 year 16 16 11 14 14 20 14 14 12 14 4. „ 1 to 5 years 9 9 9 13 11 10 13 12 21 12 12—Number of individual children weighed during the year 332 456 204 596 330 872 777 406 327 4.300 13—Total weighings 14—Number of first visits paid to— 2,961 5,065 2,345 6,757 3.326 9,012 8,067 4,412 2,953 44,898 1. Expectant mothers 23 64 — 78 81 211 135 — 50 642 2. Children 0 to 1 year 21 33 — — — — — — 54 1-5—Total number of home visits paid to— 1. Expectant mothers 115 109 45 161 166 211 100 49 87 1,043 2. Children 0 to 1 year 744 577 292 1,090 403 906 858 757 462 6,089 3. „ 1 to 5 years 877 466 462 1,012 399 1,008 744 974 417 6,359 29 TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE CENTRES !N 1932. Centre. No. of patients. No. of attendances. Extractions. Fillings. Dentures. Other treatments. . . Archer Street 99 234 86 20 12 8 Bramley Rd. 29 59 26 — 5 — Campden Hill 11 15 9 — — 1 Golborne 13 37 15 — 1 21 Kenley Street 116 128 39 — 9 80 Lancaster Road 124 338 122 24 19 96 Raymede and Sutton Trust 300 608 268 41 26 273 South Kensington 57 102 99 8 — 55 Totals 749 1,521 664 93 72 534 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, 1932:— Number of sessions at which doctors attended for infant consultations 142 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 48 Total number of individual mothers who attended 209 Total number of individual children who attended (old) 425 „ „ „ (new) 572 Total attendances of mothers for all purposes (excluding the panying of children) 927 Total attendances of children for all purposes j0-1year 1,988 1-5 years 13,974 Number seen by doctor at consultations :— 1. Ante-natal mothers 144 2. Post-natal mothers 672 3. Children 5,822 Average number seen by doctor at consultations :— 1. Ante-natal mothers 3 2. Post-natal mothers 14 3. Children 41 Number of individual children weighed 997 Total weighings 5,822 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 34 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 1932 :— Number of infants in residence at commencement of the year 29 Number of admissions during the year 281 Number of discharges during the year 248 Number of deaths during the year 43 Number in residence at end of the year 19 Average duration of stay in hospital 33 days. A new external fire escape was provided at this institution during the year, and the borough council granted £100 towards the cost of the construction thereof. 30 ARTIFICIAL SUNLIGHT TREATMENT. (The Baby Clinic and Hospital.) Artificial sunlight treatment is administered at the Baby Clinic and Hospital. During the past year, 5,206 treatments were given and the average weekly attendance was 100; 321 children were treated. MASSAGE AND ELECTRICAL TREATMENT CENTRE. Massage and electrical treatment is undertaken at rhe Princess Louise Kensington Hospital for Children, and the following is a record of the work conducted thereat during the year 1932 : — New cases— Under 5 years of age 63 Over 5 years of age 133 196 Discharged— Under 5 years of age 36 Over 5 years of age 128 164 Transferred to other hospitals because over age 12 Total cases treated 246 Total treatments given 4,815 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 and South Kensington 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 104. Eight hundred and eleven women attended and of this number 611 were Kensington women. KENSINGTON MATERNITY HOME. On the 1st October, 1931, the borough council maternity home was transferred from St. Mary Abbots Hospital to Queen Charlotte's Hospital, Marylebone Road. The home at the latter institution consisted of two wards with five beds in each, and the rules for the conduct of the home were identical with those which were in operation when the council maintained the home at St. Mary Abbots Hospital. On the 1st October, 1932, the Queen Charlotte's Hospital authorities, with the approval of the borough council, transferred the maternity home to " Invermead," No. 341, Goldhawk Road, Shepherd's Bush. " Invermead," which is an auxiliary hospital of Queen Charlotte's, is a large house situated in pleasant grounds and is well adapted for the purpose of a maternity home. There are twenty beds, ten of which are used by Hammersmith borough council patients and ten by Kensington borough council patients. Arrangements have been made for women to be admitted to the home to attend a special ante-natal clinic which is held at " Invermead " on Mondays at 2 p.m. Statement of work done during last five years. 1928 1929. 1930. 1931, 1932. No. of applications for admission 185 177 164 160 161 No. of applications accepted 170 162 158 156 160 No. of applications withdrawn after acceptance 14 17 14 26 26 No of women confined during the year 143 141 142 130 128 The gross cost of the scheme to the council during 1932 was .£1,146 12s. Od. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £495 lis. Od. Payments made by patients totalled £496 8s. Od. 31 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. The following table shows a record of children's attendances at the day nurseries in the year 1932:- Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. 1. Whole day attendances of children under 3 years of age 3,557 2,356 6,355 2,544 14,812 2. Whole day attendances of children over 3 years of age 1,885 3,085 1.974 2,704 8,214 3. Total whole day attendances 5,442 5,441 8,329 1,381 23,026 4. Charges made for each attendance of a child 10d. 9d. 8d. U- — 5. Half-day attendances of children under 3 years of age — — 751 401 1,152 6. Half-day attendances of children over 3 years of age — — 279 227 506 7. Total half-day attendances 1,030 628 1,658 8. Charges made for each attendance of a child — 4d. 6d. — 9. Average daily attendance of children 24 24'4 43 21 — 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 1932, 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 11 No. of mothers admitted without babies 5 Evelyn Convalescent Cottage Home, Wargrave, Berkshire. No. of mothers admitted with babies 10 No. of mothers admitted without babies 2 Hambledon Cottage Home, Surrey. No. of mothers admitted with babies 4 No. of mothers admitted without babies — Wayside Convalescent Home, Sunningdale. No. of mothers admitted with babies 4 No. of mothers admitted without babies - 1 The St. Mary's and Wayside Convalescent Homes are open for the reception of patients throughout the year, but the Evelyn and Hambledon Homes are closed during the winter months. The total cost to the council for convalescent treatment during the year was £95 8s. 4d. 32 HEALTH LECTURER. The council's health lecturer, who was appointed in 1926, has continued to carry out valuable work in educating mothers in public and personal hygiene. In addition, she has lectured at many women's and girls' clubs, etc., and from reports received her lectures appear to have been much appreciated. The following is a record of the work of the health lecturer during the year 1932 :— Number of lectures. Number attending. Average attendance at lecture. Archer Street I. W. C. 40 469 11.7 Bramley Road „ 62 590 9.5 Campden Hill „ 46 810 17.6 Golborne „ 44 539 12.2 Kenley Street „ 47 682 14.5 Lancaster Road „ 42 1,158 27.6 Raymede „ 39 638 16.4 South Kensington I.W.C. 50 906 18.1 Sutton Trust „ 41 606 14.8 Baby Clinic 44 558 12.7 Other institutions 15 2,397 159.8 Totals 470 9,353 199 HOME HELPS. Fourteen applications were received during the year for the provision of home helps under the council's scheme. The assistance requested was granted in 11 cases for a period of 14 days each, in 2 cases for a period of one month and in one case for three weeks. The gross cost of the scheme to the council during the year was £24 15s. Od. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The expenditure on extra nourishment to expectant and nursing mothers during the year 1932 showed a marked increase. At the beginning of the year, the council estimated for an expenditure of £250, but owing to the difficult economic conditions prevailing and increased unemployment and distress in North Kensington, it was necessary for the council to reconsider their expenditure on extra nourishment, and a further sum of £250 was provided in July. By January, 1933, this further sum had been expended, and the council voted an additional £300 to enable them to continue this service until the end of the financial year, namely, the 31st March, 1933. In the year January to December, 1932, there were 1,848 grants of milk made by the council's milk applications sub-committee. Five hundred and eleven of the grants were in response to new applications, and the remaining 1,337 were renewals of grant. Under the council's scheme, 41,381 pints of fresh milk were granted free of charge at a cost of £563 lis. 2d. ; 1919 packets of dried milk were granted free of charge at a cost of £137 4s. lid. 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. ol lib. packets sold. Value of milk sold. £ s. d. Archer Street 1,223 81 4 10 B ram ley Road 1,003 70 1 7 Campden Hill 573 41 0 5 Go) borne 788 56 12 2 Kenley Street 903 60 17 10 Lancaster Road 3,795 269 9 7 Raymede 2,753 197 3 2 Totals - 11,038 £776 9 Seven applications for dinners were granted; two of these were new applications, and five were renewals. The cost of the dinners amounted to £3 10s. Od. 33 Birth Control. In 1931, the Council resolved that they would pay a fee of five shillings in respect of each married woman referred for birth control advice by a Kensington infant welfare centre to the North Kensington Women's Welfare Centre (Birth Control Clinic). The council have laid down rigid conditions controlling their grants. The medical officer of the infant welfare centre must furnish to the birth control clinic a certificate stating that the patient 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. When the certificate has been endorsed to the effect that the patient has received birth control advice, it is forwarded to the Town Hall, where it is examined by the appropriate committee, who resolve to make a grant if the facts are satisfactory. During the year 1932, six applications were received and four were granted at a total cost to the council of £1. Travelling Expenses of Women Breast-feeding Infants Admitted to Hospitals. During the year, three applications were received for payment by the borough council of travelling expenses to and from hospital of women who were breast-feeding infants admitted as in-patients to hospitals for treatment. These were granted and the total payments amounted to £1 3s. lOd. 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. Amongst the many activities of this committee during the year was the preparation of a scheme whereby infants in need of medical attention attending infant welfare centres could be transferred to the baby clinic for treatment and back again to the welfare centres on recovery. The scheme has been put into operation and is working satisfactorily. At the present time, the committee are formulating a scheme for the transfer of post-natal women attending infant welfare centres to the new gynaecological clinic which has been recently established by the North Kensington Women's Welfare Centre at No. 12, Telford Road. The advisory committee is of great value in maintaining efficiency and uniformity in the work of the various voluntary institutions in the borough. HOUSING. DENSITY OF POPULATION IN LONDON, KENSINGTON AND THE VARIOUS DISTRICTS OF THE BOROUGH AT THE 1931 CENSUS. On th6 1931 census night (26th-27th April) there were living in Kensington 180,677 persons. Of these, 6,262 were visitors, whilst 9,478 Kensington residents spent that night outside the borough. Thus the true population of Kensington in 1931 was 183,893, which represents an increase of 4,818 over the census figure for 1921. Kensington is one of the four boroughs in London where the migration element of movement inward was greater in the last intercensal period than the movement outward. The other three boroughs are Hampstead, Lewisham and Wandsworth. It is a matter of considerable importance that Kensington, which is almost a central metropolitan borough, does not show a decline in population in the same way as the central boroughs, but is actually one of the four districts, the other three being on the periphery of the county, where the migration element of movement is inward on balance. Whilst there is room in these three peripheral boroughs (Hampstead, Lewisham and Wandsworth) for the housing of those who migrate into them, there is very little open space in Kensington for the housing of new immigrants. The proximity of the Royal Borough to the business, social and pleasure centres of the metropolis is a great attraction. Thus the tendency towards inward migration is likely to be maintained with the result that the council must continue to give unrelaxing attention to the prevention of overcrowding in order to avoid the evils arising therefrom. POPULATION PER ACRE. Area. Year. 192.1. 1931. Administrative County of London 59.9 58.7 Kensington 77.0 78.9 N. Kensington 102.8 105.1 S. Kensington 59.1 61.7 Densities of population in the metropolitan area vary widely, being at the maximum in such boroughs as Shoreditch, Southwark and Stepney, where the averages per acre are 147, 151 and 127 respectively. In Woolwich, Lewisham and Wandsworth the figures are 17, 31 and 38 respectively. 34 POPULATION PER ACRE IN KENSINGTON WARDS. 1921. 1931. North Kensington— Golborne 233 210 Norland 113 111 Pembridge 103 106 St. Charles 61 72 South Kensington— Brompton 59 58 Earls Court 73 75 Holland 39 39 Queens Gate 80 84 Redcliffe 73 79 When the population of London is reviewed in individual wards, it is found that St. George'sin-the-East in Stepney has the highest number of persons per acre—237. The next in order of density is St. John's in Southwark—230. The Golborne ward of North Kensington is third— 210 persons per acre. The Golborne ward has a much higher figure than any other in the borough, the next being the Norland ward. It is distinctly satisfactory to note that in these two wards, wherein the council's main housing problems exist, there has been a decline in the number of persons per acre in the last intercensal period, whereas in all the other wards except Brompton and Holland there has been an increase. The decline, which is considerable in the Golborne ward, is undoubtedly due in large part to the transfer of many families to new houses built by the borough council, the county council and voluntary housing associations, combined with the council's determined efforts in recent years to enforce the law in regard to overcrowding. There is only one ward (St. Charles) in the borough where there has been any considerable increase in the number of persons per acre ; this is due almost entirely to the large amount of new housing accommodation which has been erected on vacant land by the councU and the Sutton Trust. POPULATION PER RESIDENTIAL ACRE. Population per acre is not always a valuable index of the congestion of individuals and, indeed, may be misleading, for certain wards may contain large areas of open land, factory sites and railway tracks, which are not available for housing purposes. The people living in the residential part of a ward may be very congested on space, but there may be large areas inaccessible to the public which would have the effect of giving the impression that the ward is not overcrowded. In these circumstances, a more helpful figure of population density is that which is based on residential area, and the following table shows the residential acreage of London, Kensington and the wards of the borough, together with the number of persons per residential acre in 1921 and 1931 :— *Residential acreage in 1921. Persons per Residential Acre. 1921. 1931. Administrative County of London 34,883 129 126 Kensington 1,351 130 132 North Kensington 499 185 182 Golborne 72 370 329 Norland 142 155 152 Pembridge 145 136 141 St. Charles fl40 173 181 South Kensington 852 97 101 Brompton 118 108 106 Earls Court 163 107 113 Holland 283 71 67 Queens Gate 118 120 123 Redcliffe 170 111 127 * Residential acreage is the total area less (a) roads, (t) open spaces, and (c) land covered by buildings other than dwellings † Collected tor 1931. During the last intercensal period there has been an increase of four people per residential acre in South Kensington, but a decline of three in North Kensington. The two wards where the majority of the poor residents live—Golborne and Norland—both show a decrease in the number of persons per residential acre. 35 DWELLINGS, ROOMS AND FAMILIES IN KENSINGTON AT THE 1931 CENSUS. In the consideration of the statistics relating to dwellings, rooms and families, it is necessary to have in mind the following definitions :— Private Family.—Any person or group of persons in separate occupation of any premises or part of premises is treated as a separate family, lodgers being so treated only when boarding separately and not otherwise. Private families comprise all such families with the exception of those enumerated in (i) institutions, or (ii) business establishments or boarding houses in which the number of resident trade assistants or resident boarders exceeds the number of members of the employer's or householder's family (including private domestic servants). Structurally Separate Dwelling.—A structurally separate dwelling is any room or set of rooms intended or used for habitation, having separate access either to the street or to a common landing or staircase. Thus each flat in a block ot flats is a separate unit; a private house which has not been structurally sub-divided is similarly a single unit whether occupied by one family or several families. But where a private house has been sub-divided into maisonettes or portions, each having its front door opening on to the street or on a common landing or staircase to which visitors have access, then each such portion is treated as a separate unit. Rooms.—These are the usual living rooms, including bedrooms and kitchens, but excluding sculleries, landings, lobbies, closets, bathrooms or any warehouse, office or shop rooms. 1921 1931. Increase or Decrease. North Kensington. South Kensington. North Kensington. South Kensington. Number. Percentage. N. Ken. S. Ken. 1 N. Ken. S. Ken. Structurally separate dwellings occupied 11,663 15,393 12,732 16,267 + 1,069 + 874 + 9.17 + 5.68 Rooms occupied 77,061 117,320 81,432 115,824 + 4,371 — 1,496 + 5.67 — 1.27 Private families 23,639 19,362 26,051 21,662 + 2,412 + 2,300 + 10.20 + 11.88 Population in private families 87,987 70,412 89,443 69,048 + 1,456 — 1,364 + 1.65 — 1.94 Excess of private families over occupied dwellings 11,976 3,969 13,319 5,395 + 1,343 + 1,426 + 11-21 + 35.93 The structurally separate dwellings occupied in Kensington now number 28,999, as compared with 27,056 in 1921, so that the net effect of all new construction, conversions and demolition during the past ten years is an increase of 1,943 in the number of structurally separate dwellings, or 7-18 per cent. The increase of 874 in South Kensington is due (i) largely to the conversion of singlefamily houses into several self-contained flats or maisonettes, each of which comes within the definition of a structurally separate dwelling, and (ii) to the erection of large blocks of flats on sites previously occupied by single-family houses. Whilst the number of structurally separate dwellings in South Kensington shows an increase of 874, there has not been any considerable increase in the amount of accommodation available. It will be seen that in South Kensington there are 1,496 fewer rooms occupied than there were ten years ago, although there has been an increase of 2,300 in the number of families. Individual families living in South Kensington are occupying on the average less accommodation than hitherto, and the average size of the family is getting less. In the old days the occupier of a large house had under his roof his staff of servants, including in many cases married couples. To-day many of these occupiers live in maisonettes, and their servants are more often daily workers who live as separate families elsewhere. In South Kensington there are 5,395 more private families than occupied dwellings, which shows an increase of 35-93 per cent, on the figure for 1921. In North Kensington there are now 1,069 more structurally separate dwellings occupied than there were in 1921. A few new houses have been built by private enterprise, and in a few cases houses have been converted into self-contained maisonettes, which are regarded as structurally separate dwellings ; but the increase is almost entirely due to the erection of 540 flats by the Sutton Trust, over 300 flats and cottages by the borough council, and flats and houses by voluntary housing bodies. The fact that the increase in structurally separate dwellings is due largely to new construction in North Kensington, whereas in South Kensington it is due chiefly to conversion of houses into maisonettes, may be inferred from the increase of 4,371 in the number of rooms occupied in North Kensington, as compared with the decrease of 1,496 rooms occupied in South Kensington. The number of private families in North Kensington shows an increase of 2,412, whereas the number of structurally separate dwellings occupied increased by only 1,069. Thus there is a growing 36 tendency for families to live together in one unit of occupation ; but this does not necessarily indicate overcrowding, for the population in private families in North Kensington has increased by only 1,456, or 1.65 per cent., whereas the actual number of rooms occupied has increased by 4,371, or 5-67 per cent. Although the number of private families in North Kensington has increased at a greater rate than the number of structurally separate dwellings, the average number of persons in each family is smaller than it was ten years ago. STRUCTURALLY SEPARATE DWELLINGS—KENSINGTON. 1921. 1931. Increase or decrease. Rooms per dwelling occupied 7.18 6.80 — 0.38 Private families per occupied dwelling 1.55 1.65 + 0.10 Rooms occupied per family 4.52 4.13 — 0.39 Persons per room 0.81 0.80 — 0.01 Persons per private family 3.68 3.32 — 0.36 The average number of rooms per structurally separate occupied dwelling in the borough is now 6.80, as compared with 5-75 for London. In Kensington the net result of all new construction, conversions, etc., has been a slight reduction from the average of 7-18 in 1921. SIZE OF STRUCTURALLY SEPARATE DWELLINGS OCCUPIED—KENSINGTON. Number of Rooms. 1921. 1931. Number, Percentage. Number. Percentage. 1—3 5,584 20 5,409 19 4—5 5,137 18 6,248 22 6—8 8,610 32 9,115 31 9 or more 8,475 30 8,227 28 DISTRIBUTION OF FAMILIES ACCORDING TO NUMBER OF ROOMS OCCUPIED- KENSINGTON. Number of rooms. Private Families. Number in 1931. Increase or Decrease, 1921—1931. Distribution. % 1921. 1931. 1 6,289 + 267 14.0 13.2 2 10,890 + 1,467 21.9 22.8 3 9,864 + 2,084 18.1 20.7 4 6,641 1,273 12.5 13.9 5 3,259 + 464 6.5 6.8 6—7 4,833 + 504 10.1 10.1 8—9 2,552 — 168 6.3 5.4 10 or more 3,385 — 1,179 10.6 71 Totals 47,713 + 4,712 100.0 100.0 It will be observed that 56.7 per cent. of the families in the borough are satisfied with, or unable to command more than, the limited housing accommodation represented by one, two or three rooms, the corresponding figure for London as a whole being 58.8 per cent. In Kensington, the percentage of families occupying four or five rooms is 20.7, the figure for London being 27.7. Only 22.6 per cent. have more than five rooms, the figure for London being 13.5 per cent. In Kensington there has been an increase in the number of structurally separate dwellings with eight or fewer rooms, and a decrease in the number with nine or more rooms. The decline of 248 in the number of large houses with nine or more rooms is due to many having been converted into self-contained maisonettes or demolished and replaced by blocks of flats. A somewhat similar chang is taking place throughout the country. 37 PRIVATE FAMILIES—KENSINGTON. Families living in single occupation of separate premises 20,764 „ „ two to a dwelling 5,832 „ „ three or more to a dwelling 21,117 Total 47,713 Concurrently with an increase of 7.18 per cent. in the number of structurally separate dwellings occupied in the borough since 1921, the number of private families has grown by 10.96 per cent. The average number of families per occupied dwelling in 1921 was 1.59, and in 1931 this figure had risen to 1.65. Of the 47,713 private families in Kensington, 56.5 per cent have their correspondence delivered through communal letter boxes and share a common water supply and common sanitary arrangements. DISTRIBUTION OF PRIVATE FAMILIES ACCORDING TO NUMBER OF PERSONS IN FAMILY—KENSINGTON. Number in family. Private families. Rooms per family. Persons per room. Number in 1931. Increase or decrease. 1921—1931. Distribution par cent. 1921. 1931. 1921. 1931. 1921. 1931. 1 8,049 + 1,790 14.5 16.9 2.20 2.18 0.45 0.46 2 11,609 + 2,248 21.7 24.3 3.49 3.39 0.57 0.59 3 9,760 + 1,613 18.9 20.4 4.19 4.07 0.71 0.74 4 7,225 + 723 15.1 15.1 4.88 4.63 0.82 0.86 5 4,638 — 77 11.0 9.7 5.53 5.20 0.90 0.96 6-7 4,608 — 477 11.9 9.8 6.23 6.03 1.03 1.05 8-9 1,324 — 757 4.9 2.8 7.35 7.60 1.14 1.09 10 or more 500 — 351 2.0 1.0 10.39 10.02 1.07 0.98 47,713 + 4,712 100.0 100.0 4.52 4.13 0.81 0.80 The number of private families in the borough has increased in the last intercensal period by 4,712, or 10.9 per cent., but the population in those families has increased by only 92 persons. The average size of a private family in Kensington in 1921 was 3.68 persons, whereas in 1931 it was only 3.32. This increase in the number of private families, coupled with an almost unchanged number of persons therein, is an inevitable consequence of the maintenance of a high marriage rate in conjunction with a steady reduction in the birth rate. Although the number of rooms per family has decreased from 4.52 to 4.13, the number of persons per room (0.80) is slightly lower than it was ten years ago (0.81). Without taking into consideration the type of accommodation and the actual size of rooms, the figures justify the inference that, since the over-all average person per room density has been reduced, the Kensington population is on the whole better housed that it was in 1921. This is no doubt the case; but it must be remembered that the continual breaking up of families into smaller units with fewer children has made the population harder to house by reducing the number of those types of families which are economically housed and increasing those which are more expensively accommodated. A family of two or three persons either have or would like to have a sitting-room and a kitchen, whereas a family of six or seven persons still want only one sitting-room and one kitchen. A man and wife with six young children (a population of eight) can manage well with three bedrooms and one kitchen—a total of four rooms; whereas two separate families, each consisting of a man and wife and two children (a population of eight) require six or eight rooms. Thus the continued reduction in the average size of families is in itself amortizing a portion of the additional housing accommodation built in the last decade, some part of that provision having been absorbed in coping with the effect of changes adverse in themselves to the maintenance of satisfactory housing conditions. 38 More definite evidence of improvement is forthcoming from the figures illustrating the relative incidence of excessive room densities. From the following table it will be seen that a considerable reduction has been effected in both the numbers and proportions scheduled in the '* overcrowded* 'r category of two persons per room. 1921. 1931, Kensington private families with density of more than two persons per room 4,403 3,463 Percentage to total private families 10-2 7-2 (Ditto—County of London) 9-9 7-5 Kensington population in such families 26,456 19,985 Percentage to total private family population16-7 12-6 (Ditto—County of London) 6-1 13-1 The above table shows that the percentages in Kensington are more satisfactory than those for London as a whole, whereas the reverse was the case ten years ago. It is unfortunate that the figures for North and South Kensington cannot be given separately, for the combination of the more ample room accommodation in South Kensington with the more restricted accommodation in North Kensington gives a figure which does not correctly represent the two areas separately. Nevertheless, it is an outstanding fact that the number of " overcrowded" families in Kensington has, in the space of ten years, been reduced by 940, and the population therein by 6,471. 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 1932 ; but a block of 20 flats in Lancaster Road was commenced in the latter part of the year and completed early in 1933. During 1932, the council resolved to appoint a whole-time woman house property-manager. 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 own 24 freehold houses, 80 freehold flats and 51 leasehold houses. No new accommodation was provided by the Trust during the year 1932. 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 twelve houses and the leaseholds of two. At the end of the year they held 146 freehold houses, 56 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 built 540 flats. F. During the year the council acquired the last remaining building site of any size in the borough. It measures approximately 9£ acres and adjoins the Sutton Trust Estate. The Peabody Donation Trust have taken over on a long lease at a nominal rent about 5 acres and propose to build several hundreds of flats. The Sutton Trust have purchased one acre so as to provide further working-class accommodation. The Kensington Housing Trust are hoping to build working-class flats on one acre, and the remainder of the site will be used as a recreation ground and for the erection of a community centre. The new dwellings to be erected on this site will provide considerable accommodation for those families now living under unsatisfactory conditions in other parts of the borough. • The ratio of two or more persons per room has been utilised as a comparative index figure for the purposes of measuring the prevalence and distribution of overcrowded conditions. The use of this ratio implies no judgment whatever as to what in effect constitutes overcrowding. Without measuring the rooms and taking other factors into consideration, it cannot be said that the presence of two or more persons in a room denotes overcrowding ; but the greater the proportion in any population of persons housed at the higher ranges of density, the greater will be the prevalence of real overcrowding in that population. 39 COMMON LODGING HOUSES. The following table shows details of the accommodation available in the five common lodging houses in the borough :— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed in 1932. Male. Female. Total. Golborne Chesterton, Ada Elizabeth 194, Kensal Road — 71 71 Norland Hankins, John W. 28 & 30, Crescent Street 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 120 139 259 BASEMENT ROOMS. There are in North Kensington about 6,500 houses wherein the floor of the lowest or basement rooms is below the street level. Approximately 1,000 of these houses are occupied by single families in comfortable circumstances, or are boarding-houses or residential hotels; and the basement rooms are used, as was originally intended, for cooking purposes, food storage, etc. In the remaining houses, the basements are used as private dwellings by members of the working classes, many of whom live and sleep therein. An exhaustive survey of these basement dwellings was made during 1932 by the officers of the public health department. Basement Front Rooms. The basement front rooms included in the survey numbered 5,619; 5,253 of these are underground rooms, that is to say, the surface of the floor is three feet or more below the level of the adjoining street. Two thousand three hundred of the underground front rooms are used for sleeping purposes, and in many cases for day-time living purposes in addition; 2,033 are used for day-time living purposes only. When an underground room is not seven feet from floor to ceiling or does not comply with regulations approved by the Minister of Health, the borough council can close it for sleeping purposes under the powers granted by Section 18 of the Housing Act, 1925, and Section 20 of the Housing Act, 1930. Many of these rooms have been closed, and the only result is that the families live in the basement front rooms in the day-time and sleep in the basement back rooms. Many of these underground front rooms which are not fit for sleeping purposes are also not fit for day-time living purposes ; further, it is probably true that no public health advantage is gained by making people sleep in the back rooms and live in the front rooms. Indeed, such a change is possibly even more harmful to health. Basement Back Rooms. The survey covered 5,244 basement back rooms. In most of these, the floor is at or near the level of the back yard, with the result that only 1,186 are technically underground. Thus the existing underground room legislation referred to above does not apply to 4,058 basement back rooms. Section 20 of the Housing Act, 1930, enables the borough council to close a single room, whether it is a basement room or not, if it is unfit for human habitation, provided that it is let as a separate tenement. The vast majority of the basement back rooms in North Kensington are let in conjunction with basement front rooms or rooms upstairs. Thus the council are not only precluded from dealing with most of the basement back rooms by means of underground room regulations, but they are also precluded from using Section 20 of the Housing Act, 1930. Basement back rooms, even though not technically underground, are often more unsatisfactory than basement front rooms ; the window is generally smaller, and the outlook is often into a small, badly lighted back yard perhaps with overhanging trees or shut in by high walls. The back rooms generally have a smaller cubic capacity than the front rooms. General Observations. The survey undertaken covered 5,403 basements with 10,863 rooms. Of these, 4,134 are used for sleeping purposes, and the number of ^fersons sleeping in them is 8,898. In only 27 of the 5,403 basements was there found evidence of a damp-proof couise ; it is probable that a damp-proof course is present in more cases, but is hidden by the cement rendering which is commonly applied to walls as a remedy for dampness. The majority of the basements have wooden floors. In only 317 is there evidence of a concrete oversite. 40 Following their consideration of the survey, the council represented to the Ministry of Health and the London County Council that existing legal powers are not sufficient to enable them to deal with unsatisfactory basement rooms adequately; with the result that the county council included in their 1933 General Powers Bill a clause which will enable the council to close such rooms for living and sleeping purposes in any area declared to be an improvement area. The clause will further enable the council to close any individual room in an improvement area for living and sleeping purposes, irrespective as to whether that rocm is let separately or in conjunction with other rooms. MEASURES TAKEN TO DEAL WITH OVERCROWDING AND INDECENT OCCUPATION. In houses let in lodgings, of which there are several thousand in Kensington, the council can take action to prevent overcrowding unless each cccupant has the amount of cubic feet of air space set out below :— Each person over 10 years, must have in a Each person under 10 years, must have in a room used exclusively for sleeping c. ft. room used for living and sleeping c. ft. room used exclusively for sleeping c. ft. room used for living and sleeping. c. ft. Existing by-laws for a rent-restricted room in a house let in lodgings 300 400 150 200 Existing by-laws for a decontrolled room in a house let in lodgings 400 400 300 300 In private dwelling houses there is no legal standard of overcrowding, but the sanitary inspectors regard such a condition to exist unless the occupants are provided with the air space set out above. In houses let in lodgings it is illegal to permit a sleeping room to be occupied by persons of the opposite sex over 12 years of age not living as man and wife; there is no power to deal with such indecent occupation in private dwelling houses. When a sanitary inspector discovers a case of overcrowding in any house, or a case of indecent occupation 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 seven years and the effectiveness of the action taken can be deduced therefrom. 1926 1927 1928 1929 1930 1931 1932 Overcrowding :— Intimation notices served103 88 72 33 25 42 84 Statutory notices' served where the intimation notice was not complied with ... 38 28 10 13 10 7 6 Summonses issued 6 9 3 3 5 3 3 Indecent Occupation :— Intimation notices served 79 92 84 23 27 16 28 Statutory notices served where the intimation notice was not complied with12 2 e 1 7 1 — Summonses issued — 1 1 — — As only 32 summonses were eventually issued in 447 cases of overcrowding, and only two summonses in regard to 349 cases of indecent occupation in the seven years, it will be seen that 764 families were able to improve their accommodation without the council having to resort to extreme measures. Moreover, the figures for 1932 suggest that those on whom notices were served had less difficulty in securing alternative accommodation than was experienced in previous years. These conclusions are borne out by the results of the survey made in 1932. In this survey of 10,863 basement rooms, of which 4,134 were used for sleeping purposes, only one case of indecent occupation was found. Cases of overcrowding were not specially recorded during the survey, but it is safe to say that very few instances were noted where the amount of air space fcr each person required by law was not available. Unfortunately, the legal standard for overcrowding is a low one, with the result that in some cases a man and his wife with eight children can live in two rooms and still come within it. The council have made representations to the Ministry of Health and the county council asking that they should be allowed to enforce in improvement areas a standard of 450 cubic feet of air space for every person in a room used wholly or partly for sleeping purposes. With a view to securing the greatest possible advantage from new houses provided by the borough council, the county council and housing associations working in Kensington, arrangements were made in 1925 for those persons managing the new houses to notify the medical 41 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 owners (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 95 68 New houses provided by the London county council 320 164 New houses provided by public utility societies, etc 367 221 FITNESS OF HOUSES. Work under Sections 17-20 of the Housing Act, 1930. The following table gives a statement of the action taken and the results obtained during 1932 :— Sections 17 and 18. No. of notices served in 1931 which were outstanding on 1st January, 1932 51 No. of notices served from 1st January to 31st December, 1932 148 No. of appeals by owners to the County Court Nil No. of notices satisfactorily complied with by the owners 118 No. of cases in which the council carried out the work in default of the owners 2 No. of notices in respect of which satisfactory progress was being made on 31st December, 1932 42 No. of notices in respect of which nothing had been done at the end of the year (the time allowed has not expired in these cases) 37 No. of 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 £53 Sections 19 and 20. No. of unfit houses demolished by the owners during the year 3 No. of cases in which the council accepted undertakings from the owners that the houses would not be used for human habitation (these houses still remain unoccupied) 2 No. of cases in which the council accepted undertakings from the owners that the premises would not be used for human habitation until schedules of repairs necessary to render them fit were complied with 2 Although the council have been carrying out section 17 class of work for about ten years, it has only been during the last three years that certain members of the staff have concentrated their time wholly upon it. In those three years the number of notices served has been 510, and the number of houses which have been brought up to a very satisfactory standard of repair is 505. From the commencement of the work about ten years ago up to 31st December, 1932, the council's expenditure in carrying out work in default of owners has been £3,297 10s. Of this total the amount recovered is £2,937 4s. 3d., and the outstanding amounts with interest are now being collected. The only loss has been a small one of £2. It is a matter of interest that there has been no appeal against any notice under section 17 of the Housing Act, 1930. Section 17 work involves very close co-operation between the Town Clerk, the Borough Engineer and myself, and the satisfactory results which have been achieved would not have been possible had it not been for the advice and help which have been given by these chief officers; and I would like to express my gratitude for the assistance they have given. The staffs of their departments have been responsible for a large amount of the work, and all the officers have performed their duties as one team. 42 CLEARANCE AREAS. The following is a tabular statement in regard to the clearance areas which I have represented since the introduction of the Housing Act, 1930 :— Description Of area. Date of declaration by the council. Number of occupants. Remarks. Nos. 36-52, Talbot Grove (even). Nos. 1-13, Talbot Mews (odd). Nos. 23, 24, 25 & 26, Talbot Mews. 27th January, 1931 170 Additional houses were included so as to provide a site of suitable size and shape. Demolition has been commenced, and two new blocks of flats have been erected. Further action towards completion of scheme is in progress. Nos. 1, 3 & 5, Adair Road. Nos. 86, 88, & 90, Southam Street. 28th July, 1931. 112 ... Ready for demolition as soon as accommodation for displaced people can be found. Nos. 1-16, Barker Street. 28th July, 1931. 257 No demolition steps have been taken, for alternative accommodation for the people to be displaced is not yet available. Nos. 1, 2, 3, 4 & 5, Wornington Mews. No. 88, Wornington Road. 27th January, 1931. 29 Council found alternative accommodation for occupants who needed help, and the owners were then permitted to recondition the dwelling house and to convert the mews dwellings into commercial premises. IMPROVEMENT AREAS. The council have given close consideration to the possibility of applying the new improvement area procedure of the Housing Act, 1930 ; and to enable this to be done successfully they have made representations for further powers, which are now being sought in the London County Council (General) Powers Bill. BY-LAWS RELATING TO HOUSES LET IN LODGINGS. During 1932, forty-three houses were placed on the council's register of houses let in lodgings and one was removed ; the total number registered at the end of December, 1932, was 3,132. 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, 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 1932 :— No. of houses inspected under the by-laws 1,600 Total number of inspections 8,097 No. of instances where the houses were cleansed under the by-laws 937 HOUSING STATISTICS FOR 1932. The Minister of Health has required that certain information shall be given in this Annual Report, and I now beg to submit particulars requested by him in Circular 1269 :— 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) 6,666 (b) Number of inspections made for the purpose 26,756 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,206 (b) Number of inspections made for the purpose 1,744 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 6 (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 2,479 43 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 123 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 148 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 118 (b) By local authority in default of owners 2 B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,205 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 2,205 (b) 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 0 (2) Number of dwelling-houses demolished in pursuance of demolition orders 3 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 9 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 18 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 1932, twelve samples were so taken, and one only of these was found to contain tubercle bacilli. The result in this case was communicated to the medical officer of health of the county in which the milk was produced. Of 325 formal samples of milk taken under the Food and Drugs (Adulteration) Act in 1932, 9 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 during the year. These figures are given in the following table :— Average composition of formal milk samples taken in 1932. Months. Number of formal samples taken. Average composition of all samples submitted, genuine and adulterated. Average composition of genuine samples. Ministry of Agriculture standard. Percentage of milk fat. Percentage of solids not fat. Percentage of milk fat Percentage of solids not fat. Percentage of milk fat. Percentaee of solids not fat.[/### January 13 3.57 8.70 3.58 8.78 3.0 8.5 February 41 3.40 8.63 3.46 8.64 March 35 3.32 8.60 3.36 8.69 April 26 3.52 8.66 3.55 8.66 May 18 3.39 8.66 3.39 866 June 24 3.33 8.77 3.36 8.76 July 48 3.55 8.72 3.55 8.72 August 6 3.58 8.78 3.58 8.78 September 37 3.98 8.87 3.98 8.87 Average composition of normal cow's milk. October 18 4.04 8.94 4.04 8.94 November 42 4.00 8.94 4.00 8.94 December 17 3.89 8.86 3.89 8.86 Percentage of milk fat. Percentage of solids not (at. 325 363 8.76 3.65 8.77 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. 44 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 1932 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. Dairvmen. Dairies and milkshops. T ransfers 20 20 Added to register 24 1 1 Vacated and removed from register 1 — — Dairymen with premises outside the borough added to register _ 3 On register January 1st, 1932 49 158 151 On register December 31st, 1932 72 162 152 (+) Increase. (—) Decrease + 23 +4 ' + 1 The total number of inspections of dairies and milkshops in the borough in 1932 was 420. During the year 1932, proceedings were taken in respect of milk being bottled in streets in four cases. In one case, a fine of £3 3s. was imposed, and in another a fine on £1 Is. Od. ; the other two summonses were dismissed. 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 bv applicants for licences. The licences granted in 1932 were as follows :— (a) Dealers' licences to use the designation "Certified Milk " 7 (b) Dealers' licences to use the designation " Grade A (Tuberculin Tested) Milk " 8 (c) Dealers' licences to use the designation " Pasteurised Milk " 43 In all but nine 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, twenty-two samples of "Certified Milk," and twenty-five 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 :— Special class of milk. Maximum number of bacteria permitted per c.c. Standard for bacillus coli. " Certified Milk " 30,000 Must not be found in onetenth c.c. "Grade A. (Tuberculin Tested) Milk" 200,000 Must not be found in onehundredth 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." Sample collected Oil Bacteria per 1 c.c. Coli per l/10th c c. Sample collected on Bacteria per 1 c.c. Coli per l/10th c.c. *24th May 116,000 Nil. 26th July 550 Nil. 24th May 940 ,, 24th August 6,800 ,, 14th June 29,000 ,, 30th August 360 ,, 14th June 300 ,, 31st August 1,550 ,, 21st June 1,100 ,, 31st August 1,040 ,, *24th June 906,600 Present. 27th September 560 ,, *28th June 9,200 ,, 27th September 440 ,, * 5th July 6,600 ,, 27th September 1,300 ,, *12th July 13,400 ,, 31st October 390 ,, 19th July 19,600 Nil. 31st October 270 ,, 19th July 730 ,, 30th November 380 ,, The results in each case were forwarded to the Minister of Health, who grants the licences to producers. Those indicated by an asterisk do not comply with the standards laid down for certified milk. Special examinations were made at the retailers' premises and in each case they were found to be satisfactory. 45 " Pasteurised, Milk." Sample collected on Bacteria per 1 c.c. Sample collected on ria per 1 c.c. ‡*20th January 299,000 16th March 3,900 *10th February 35,000 16th March 6,900 *10th February 49,000 8th June 4,200 *10th February 30,000 8th June 8,500 *17th February Plates uncountable owing to spreading organisms 21st June 15,900 †*28th June 1,108,000 * 5th July 80,000 17th February ,, 22nd September 1,320 17th February ,, 22nd September 1,100 * 2nd March ,, * 4th October 41,000 * 2nd March 14,700 * 4th October 32,000 * 9th March Plates uncountable owing to spreading organisms * 2nd November 46,000 8th November 1,800 8th November 5,500 * 9th March ,, ‡ No action was taken in this case, owing to the method of sampling being experimental. † Proceedings were taken in respect of this sample and a fine of £4, together with one guinea costs, was imposed. The samples marked with an asterisk were taken from bulk supplied immediately before delivery to hospitals and similar institutions. The other samples were from milk which had been bottled on the pasteuriser's premises, and it is significant that only two have a bacterial count in excess of 7,000 organisms per cubic centimetre 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 135 slaughterhouse inspections were made. The following table shows the number of animals slaughtered in the borough in 1932 :— Month. Animals slaughtered. Beasts. Sheep. January 1 42 February 2 30 March 3 37 April 5 32 May 4 28 June 3 37 July 4 31 August — 12 September 3 29 October 1 38 November — 51 December 4 134 Totals 30 501 Diseased meat condemned during this period was as follows :— Forequarters 2 Livers 7 Lungs 17 Slaughter Houses.—These were licensed by the London County Council last October, and of the four Kensington licences granted in 1931 only two were renewed in 1932. The 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 147 inspections which were made during the year, three notices were served for the cleansing of walls and ceilings. 46 Registration of Food Premises.—The London County Council (General Powers) Act, 1932, which received the Royal Assent on the 12th Juty last, requires the registration with the borough council of premises used for the following purposes :— (a) The sale, manufacture or storage of ice-cream ; (b) (i) The preparation or manufacture of sausages, or potted, pressed, pickled or preserved meat, fish or other food intended for sale ; (ii) The cooking of meat or fish intended for sale. Registration of ice-cream premises was previously provided for in the London County Council (General Powers) Act, 1928, and at the end of the year, 166 premises were in the council's register. Of these 69 are registered as premises where ice-cream is manufactured and sold, and the remaining 97 as premises where ice-cream is sold but not manufactured. The 1928 Act, however, did not give the council power to refuse registration or to remove premises from the register if they were found unsuitable. The present Act grants this power to the council, not only in respect of ice-cream premises, but in respect of all others mentioned therein. Premises which have been regarded as registerable under heading (b) above are those where the following articles are prepared or manufactured or cooked :— Sausages and allies—large and small, with or without skins. Saveloys. Haggis. Black puddings. Rissoles. White puddings Bladders of lard. Meat—potted, pressed, pickled, preserved. Potted meat or head, tongues, etc. Meat pastes. Meat extracts. Faggots. Cooked meats, sheepshead, etc., pork. Dripping. Brawn. Brisket (pressed). Meat and pork (pressed). ,, ,,(pickled). Meat pies, pork pies. Trotters (pickled). Hams Bacon / boiled, cooked, smoked or cured or otherwis preserved. Fish—potted, pressed, pickled, preserved. Pastes—various. Pickled or soused fish. Cured or dried fish. Canned fish. Eel pies and jellied eels. Fried fish. Other Foods—potted, pressed, pickled, preserved. Canned soups containing meat. Hors d'oeuvres, if containing meat or fish. Applications for registration in respect of 240 premises were received up to the end of the year ; and of this number 194 have been registered. In the remaining cases, 14 were found to be outside the scope of the Act, and 32 were held over pending the completion of minor works. The following is a summary of the various types of premises which have been registered :— 1. Manufacture of ice-cream 69 2. Storage of ice-cream 97 3. Butchers' shops, including premises used for the manufacture of sausages and the preservation of meat 89 4. Cooked meat shops 57 5. Fishmongers' premises—premises used for the purpose of cooking or curing fish (excluding fried fish shops) 12 6. Fried fish shops 36 360 Under section 6 of the Act, power is given to the London county council to make by-laws in regard to food premises ; so far, none has been made, but draft by-laws are under consideration. 47 Inspection of Food Premises.—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, etc., mentioned above, 1,768 inspections of food premises during the year. Merchandise Marks Acts, 1887-1926.—Under section 2 of the Act of 1926, Orders in Council may be made prohibiting the sale or exposure for sale in the United Kingdom of imported goods specified, unless such goods bear an indication of origin. 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. Proceedings were instituted against four persons for illegally marking Jersey tomatoes. In one case a fine of 10s. was imposed, and in another 5s., whilst in the other two cases the defendants were cautioned. In six other instances officers of the council served cautions 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 1932. 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. One set of premises appeared in the register at the commencement of the year, and another was added during the year. In neither place, however, is artificial cream being made at the present time. Unsound Food.—Under the provisions of section 47 of the Public Health (London) Act, 1891, authorised officers of the council are empowered to seize and carry before a magistrate any diseased, or unsound, or unwholesome food deposited for sale or exposed for sale, and the magistrate before whom such food is carried may make an Order for its destruction. Proceedings may be taken against the person in whose possession the food was at the time of seizure. Particulars of offences occurring in Kensington during the past year together with the results of action taken are as follow : Offence. Action taken. Exposing for sale 78 unsound turkeys Proceedings. Fined £10. „ „ 21 „ chickens „ „ £10. ,, ,, ,, figs ,, „ £5 48 Under the provisions of subsection 8 of section 47 of the Public Health (London) Act, 1891, any persons having in their possession food intended for sale which is diseased or unsound, or unfit for human consumption, may surrender it to the council for destruction as trade refuse. The unsound food surrendered and destroyed during the year is shown in the following list :— Apples (lbs.) 128 Meat (canned) (tins) 26 Asparagus (crates) 10 Milk (canned) (tins) 34 Chocolates (lbs.) 14 Onions (lbs.) 50 Chocolate cream walnuts (lbs.) 26 Potatoes (cwts.) 5 Ducks 14 Rabbits, skinned (lbs.) 42 Fish (canned) (tins) 88 Tomatoes (lbs.) 168 Fish (wet) (stones) 10½ Turkeys 253 Fruit (canned) (tins) 510 Vegetables (canned) (tins) 132 Grapes (cwts.) 12 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. (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 692, of which 17 or 2.4 per cent, were adulterated. Particulars of formal samples collected are as follows :— Number Number Nature of sample. taken. adulterated. Almonds, ground 6 Apricots, dried 9 — Brawn 3 — Butter 32 — Cakes, sponge 15 — Caviare 1 1 Cheese 11 — Cinnamon, ground 6 — Cocoa 3 — Coffee 8 — Coffee and chicory 1 — Cordial, lime-juice 3 — Cream 16 — Ham 8 — Honey 6 — Ice-cream 6 — Lard 24 — Lemon cheese 9 — Margarine 30 Milk 325 9 Mincemeat 6 — Mustard 3 — Mustard mixture 3 — Oil, camphorated 2 1 Paste, fish 17 — Paste, meat 1 — Pepper 3 — Powder, baking 3 — Prunes 3 — Raisins 3 — Rice 15 1 Rice, ground 2 — Sago 2 — Sausages 24 2 Semolina 3 — Sulphur, milk of 3 — Sultanas 3 — Sweets 15 — Tapioca 2 — Tea 17 — Vinegar 31 3 Whisky 6 — Wine, British 3 — Totals 692 17 49 (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 :— Number Number Nature of sample. taken adulterated. Bacon 3 — Barley, pearl 3 — Brawn 3 — Butter 15 — Cakes, fish 1 — Caviare 1 l Cheese 6 — Cherries, glacè 1 — Cocoa 3 — Coffee 2 — Coffee and chicory 1 — Cream 5 — Cream, salad 1 — Cream, tinned 2 — Currants 3 — Dripping 6 — Flour 1 Fruit, dried 1 — Fruit, tinned 9 1 Honey 3 — Jam, gooseberry 1 — Jelly, fruit 4 Lard 3 — Margarine 15 Milk 122 5 Milk, condensed, machine skimmed 3 — Milk, dried 2 — Milk, hot 1 Mincemeat 3 Oil, camphorated 4 2 Oil, olive 3 Paste, fish 6 Paste, meat 3 — Peas, tinned 3 " Pentacreme" 1 — Pie, meat 5 — Powder, lemonade 3 — Powder, liquorice 6 — Rissoles 1 Sausages 12 3 Soup, dessicated 1 — Suet, shredded 3 — Sweets 7 — Tart, Cornish, cream 1 — Tea 3 — Tomato purèe 2 — Tomatoes, tinned 2 — Treacle 1 — " Trex" 1 — Vinegar 16 1 Wine, British 1 — Totals 309 13 50 The following is a summary of the results of analysis of the 30 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 11.2 grains of boric acid per pound. Vendor cautioned. „ 9.9 „ „ „ Informal sample. Fruit, tinned 2.9 „ tin „ „ „ Milk 30 per cent. extraneous water. Proceedings. Fined £5 and 10s. 6d. costs. „ 4 „ „ „ „ „ £1 „ „ „ 3 „ „ „ No action. „ 3 „ „ „ Informal sample. „ 2 „ „ „ „ „ „ 1 „ „ „ „ „ „ 0.9 „ „ „ No action. „ 0.7 ,, ,, „ „ „ 27 „ of required fat deficient. Proceedings. Fined £5 and 10s. 6d. costs. „ 19 „ „ „ Informal sample. „ 17 „ „ „ Proceedings. Fined £3 and £3 3s. costs. „ 12 „ „ „ „ „ £2 2s. and 10s. 6d. costs. „ 12 „ „ „ „ „ £2 and 10s. 6d. costs. „ 7 „ „ „ Informal sample. Oil, camphorated 19.3 „ „ camphor deficient Proceedings. No conviction recorded on defendant paying £5 5s. costs. „ „ 18 „ „ „ Informal sample. „ „ 16 „ „ „ „ „ Rice 4.2 grains of extraneous mineral matter per pound. Vendor cautioned. Sausages 260 parts of sulphur dioxide per million (presence of preservative not disclosed). „ „ „ 260 „ „ „ Informal sample. 11 247 „ „ „ „ „ 11 137 „ „ „ Vendor cautioned. 11 123 „ „ „ Informal sample. Vinegar 92 per cent, of required acetic acid deficient. Proceedings. Fined £2 and 14s. costs. 11 91 „ „ „ Informal sample. 11 22 „ „ „ Proceedings. Fined £2 2s. and 14s. costs. 11 14 „ „ „ Proceedings. No conviction recorded on defendant paying 10s. 6d. costs. The total number of prosecutions under the Food and Drugs (Adulteration) Act was 10, the fines and costs amou ting to £45 3s. 6d. The Public Health (Condensed Milk) Regulations, 1923-1927, and the Public Health (Dried Milk) Regulations, 1923-1927.—During the year, three samples of condensed milk and two of dried milk were taken and each was found to comply with the regulations in every respect. Food Poisoning.—Section 7 of the London County Council (General Powers) Act, 1932, which requires every medical practitioner in London to notify the medical officer of health of any person whom he suspects or finds to be suffering from food poisoning, came into operation during the year. Shortly afterwards a circular letter was sent to all doctors practising in Kensington, calling attention to their new responsibilities. In the remaining part of the year 453 cases were notified in London. The number notified in Kensington was 26 ; there were 17 in the Golborne ward, four in the Norland ward and five in the St. Charles ward. It will be observed that all the Kensington cases occurred in the three northern wards where the majority of the poor live. It is significant that not a single case was reported from South Kensington. 51 In the cases notified an analysis of the foods suspected of causing the illness was made and resulted as follows :— Food causing illness. No. of cases. Haddock 1 Kosher meat 1 Fried fish 1 Steak and kidney pudding 1 Pork sandwiches 1 Dried prunes 1 Sausage rolls 1 Breakfast sausage 1 Eels 1 Meat pie 1 Bacon and beer 1 Pork 1 Crab salad 1 Unknown 13 It will be seen that in 13 cases no particular food was suspected, and in the remaining 13 cases a different type of food was suspected in every case. Several articles of food were submitted to the bacteriologist for examination, but in no case was a report received from him regarding the presence of any of the salmonella group of organisms. It is also worthy of mention that in every case the illness was only a mild one, and the patient recovered in a day or two. Careful enquiries were made in all the cases notified, and it is clear that there was no outbreak of food poisoning in the borough. Many of the cases notified must be regarded as suspicious rather than as actual cases of food poisoning. 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 (not induced). 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 1928-32. Year. Small pox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthal. mia neonatorum. Puer. peral fever. Puerperal pyrexia Pneumonia. Malaria. Encephalitis le. tbargica. P. m'itis & polio. encephalitis. ‡ Acute rheumatism. Cerebro spina) mening. itis. Dysentery. itis. Total. 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 1981 2 385 222 16 61 13 8 61 253 1 1 — 46 7 17 41 1,134 1932 1 478 415 14 81 16 8 31 233 3 2 2 50 10 25 88 1,452 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. 52 Table showing Cases of Infectious Diseases occurring in 1932, arranged in Four-Weekly Periods (January 3rd, 1932, to December 31st 1933). Four Weeks ending Small pox. Scarlet fever Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puer. peral fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Polio myelitis. Total. January 31 26 20 1 3 3 __ 1 46 - - 5 __ 1 2 - 108 February 28 1 35 33 — 5 — 2 2 20 - 1 2 5 — 1 — 107 March 27 — 27 17 1 6 1 1 5 33 - — 8 3 1 — — 103 April 24 — 37 22 1 8 1 1 1 17 - — 4 1 4 — 97 May 22 — 30 21 1 7 2 1 2 11 - — 1 - — 4 — 80 June 19 — 40 32 3 8 1 — 4 7 - — 2 — — 3 — 100 July 17 — 34 54 2 2 1 — 2 6 - 1 5 — — 11 118 August 16 — 25 31 1 7 1 — 1 1 2 — 2 — 2 10 — 83 Sept. 11 — 23 32 1 6 — 1 — 4 — — 4 — 2 27 — 100 October 9 — 57 29 — 5 1 1 3 7 — — 4 — 12 17 1 137 November 6 — 59 43 1 7 1 — 4 19 1 — 5 — 3 4 1 148 December 3 — 41 41 1 7 — — 1 42 — — 7 — — 3 143 »1 31 - 44 40 1 10 4 1 5 20 - — 1 1 - 1 — 128 Totals • j„ 478 415 14 81 16 8 31 233 3 2 50 10 25 83 2 1,452 Cases of mistaken diagnosis are excluded from the above table. 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 72 of this report. Smallpox.—During 1932 there was a decrease in the number of smallpox cases notified in London. One thousand one hundred and thirty-three cases occurred in the metropolitan area, as compared with 1,452 in the previous year. There were only three deaths from this disease in London during the year. Twenty-five of the 29 metropolitan boroughs were affected. Only one case of smallpox was notified in the borough and it occurred in a private house in North Kensington. The patient was a man aged twenty-five years who was an optician employed in Acton. No information could be obtained as to how he contracted the disease. He was removed to hospital and subsequently recovered. The contacts were urged to be vaccinated or revaccinated as a precautionary measure if this had not already been carried out, and all necessary vaccinations were performed by the public vaccinator for North Kensington. During the year many Kensington residents had been in contact with cases in other districts, and 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 83. Scarlet Fever.—The number of cases notified during the year was 504, of which 465 were removed to hospital. Twenty-six patients notified as suffering from scarlet fever were found, after admission to hospital, not to be suffering from any infectious illness, with the result that they were returned home. The following table shows the number of cases notified in the various wards in each fourweekly period during 1932 :— 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. 13. Period No. 13 London 900 912 1,006 956 1,096 1,054 1,034 848 792 1,296 1,639 1,408 1,270 The Borough 26 35 27 37 30 40 34 25 23 56 59 41 45 North Kensington 19 25 23 27 18 32 23 20 19 40 45 28 31 South Kensington 7 10 4 10 12 8 11 5 4 16 14 13 14 Wards. St. Charles 4 7 8 11 8 14 11 7 6 18 12 15 17 Golborne 2 7 5 7 3 4 5 6 3 4 4 3 3 Norland 11 8 8 3 6 10 6 5 9 8 19 9 7 Pembridge 2 3 2 6 1 4 1 2 1 10 10 1 4 Holland 3 1 1 2 7 3 1 1 1 11 5 6 - Earl's Court 1 1 1 3 3 3 1 — 1 — 3 2 7 Queen's Gate 1 — — — — 1 — — — 4 1 3 3 Redcliffe 2 5 2 4 2 1 7 2 1 1 5 2 2 Brompton — 3 — 1 — — 2 2 1 — — — 2 Cases of mistaken diagnosis are excluded from the above table 53 Throughout the year, scarlet fever was mild in type, as is reflected in the fact that there were only three fatal cases. The deaths in the preceding years were one, three and one. There were 41 instances where more than one case occurred in the same house. Eight of the 478 definite 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 eight, with a view to ascertaining the source of infection. As a preventive measure, the Kensington borough council have agreed to provide material for the Dick test for medical practitioners attending poor residents and local voluntary hospitals, and during the year an expenditure of £3 16s. 0d. was incurred in respect of this service. Diphtheria.—Four hundred and forty-four cases of diphtheria were notified during the year, 407 of which were removed to hospital. Twenty-nine 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. Although it cannot be said that a definite epidemic of diphtheria prevailed during the year, the disease was throughout the twelve months more prevalent than in any other year since the War. It showed the same distribution throughout the various parts of the borough as has been noted in previous years and local circumstances could not be found to be responsible in any way for this higher incidence in 1932. The following table shows the number of cases notified in the various wards in each fourweekly period during 1932 :— 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 619 656 521 465 591 613 577 530 540 779 809 781 673 The Borough 20 33 17 22 21 32 54 28 35 29 43 41 40 North Kensington 19 32 13 20 17 25 46 25 34 23 38 32 38 South Kensington 1 1 4 2 4 7 8 3 1 6 5 9 2 Wards. St. Charles 5 9 3 3 3 8 11 7 16 9 9 10 18 Golborne 8 16 5 9 5 12 22 5 10 9 18 13 12 Norland 5 6 2 5 8 3 7 8 5 — 8 2 3 Pembridge 1 1 3 3 1 2 6 5 3 5 3 7 5 Holland — 2 — 1 — — 2 1 1 — 1 Earl's Court — 1 1 1 1 2 2 — — 3 — 2 — Queen's Gate — — 2 4 4 1 — — 2 4 1 Redcliffe 1 — 1 1 — 1 2 — 2 3 2 - Brompton — - - - - - - - — - - 1 - Cases of mistaken diagnosis are excluded from the above table. There were 26 instances where more than one case occurred in the same house. The number of Kensington deaths was 29, representing a case mortality of 7 per cent. In the three preceding years the deaths were 7, 13 and 11. During the year, 1,992 throat swabs were examined at the council's laboratory at St. Mary Abbots Hospital, and of these 177 gave a positive result. There were no " return " cases reported during the year. Thirteen cases of diphtheria were reported from St. Mary Abbots Hospital, 32 from St. Charles Hospital, three from the Kensington Institution, and five from the Princess Louise Kensington Hospital for Children. 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.ll, or from the public health department at the Town Hall. The anti-toxin is obtainable at all hours of the day and night from Mr. 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 1932 the borough council supplied 151,000 units of anti-toxin for 17 patients at a cost of £11 18s. (6d. 54 The borough council undertake to supply toxoid-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 toxoid-antitoxin supplied during 1932 was £3 9s. 9d. At the time of writing, consultations are taking place with medical practitioners in the borough with a view to ascertaining whether it is possible to introduce a scheme whereby medical practitioners immunise poor patients in their homes or in surgeries in return for a fee paid by the council in respect of each patient immunised; and the borough council have provided in their estimates for the year 1933-34 a sum of £250 to meet the cost in the event of such a scheme materialising. Enteric Fever.—Fourteen cases of this disease were notified; eight were removed to hospital and two to nursing homes. The cases notified in the three preceding years were 16, 32 and 17. There was one death from this disease as against one, one and none in the preceding years. One patient notified as suffering from enteric fever was afterwards found not to have contracted the disease. Five were notified from the southern division of the borough and nine came from North Kensington. In six cases 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 contracted the disease from his brother ; but the remaining five had not been out of London for some time prior to their illness. Erysipelas.—Eighty-one cases were notified during the year, 55 of which were removed to hospital. There were seven deaths from this cause, the deaths in the three preceding years being three, four and two. Ophthalmia Neonatorum.—The following table gives particulars of ophthalmia cases notified in 1932 and the results of treatment. Case No. Cases. Vision unimpaired. Vision impaired. Total blindness. Death. Treated. Notified. At home. In hospital. 1 January 4 Yes Yes _ - 2 ,, 8 — Yes Yes — — 3 ,, 30 Yes Yes, from another cause 4 March 7 - Yes Yes — —- 5 April 16 - Yes Yes — - 6 ,, 25 Yes — Yes — — — 7 May 6 Yes — Yes — — 8 June 8 Yes — Yes — — — 9 July 4 Yes — Yes — — — 10 August 6 - Yes — — — Yes, from another cause 11 October 7 — Yes Yes — — - 12 Nov. 1 — Yes Yes — —- - 13 Dec. 5 — Yes Yes — — - 14 ,, 19 Yes — Yes — — - 15 ,, 20 — Yes Yes — — - 16 ,, 30 - Yes ? — Still attending hospital. From the above table, it will be seen that 13 cases recovered without any injury to sight; two cases died from another disease ; and one case is still attending hospital. Puerperal Fever.—During the year, eight cases of this disease were notified. Three were treated at home and recovered ; one was confined in Queen Charlotte's Hospital and died; one was confined in St. Charles Hospital and recovered ; two were removed to that institution and recovered ; and one was a case removed to that hospital with pleurisy and pneumonia, a miscarriage followed and the patient died. There were four deaths attributed to this disease, but in only two instances had a notification been received. 55 Puerperal Pyrexia.—Thirty-one cases of puerperal pyrexia were notified during the year. Two occurred in nursing homes ; 16 in hospitals to which the patients had been removed prior to their confinements ; and 13 in the homes of the patients. Of the 13 confined at home, 10 were subsequently removed to hospital for treatment, whilst the remaining three received medical attention in their own homes. One of the notified cases of puerperal pyrexia proved fatal. The woman was confined in St. Mary's Hospital and transferred to Queen Charlotte's Hospital, where she died. In 1926, the Ministry of Health issued the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, which provided for the more complete notification of all cases of puerperal fever and puerperal pyrexia. In connection with these regulations, the Minister of Health issued Circular 722, which suggested that notification should be supplemented, when necessary, by facilities for assistance in diagnosis and for the treatment of patients who are not able to secure adequate treatment for themselves. At that time, the Council appointed the late Dr. Remington Hobbs, the medical superintendent of St. Mary Abbots Hospital, to the position of consulting gynaecologist, but this officer died in May last and the Council arranged for Dr. A. Morris Johns, a consultant at Queen Charlotte's Hospital, to carry out the duties previously performed by Dr. Hobbs. In addition to his services as consultant gynaecologist, Dr. Morris Johns undertakes the detailed confidential enquiry into each maternal death occurring in Kensington, which the Minister of Health has requested the borough council to carry out. For these services, Dr. Morris Johns receives a fee of three guineas in respect of each case attended by him on behalf of the council as consultant gynaecologist and one guinea for each enquiry into a maternal death. The fees for consulting work amounted to £6 6s. 0d., and for enquiry work to £5 5s. 0d. in 1932. Malaria.—Three cases of this disease were notified during the year, and investigations revealed that the disease had been contracted in the West Indies in one case, and in India in another; the third was induced whilst the patient was an inmate of a mental hospital. Encephalitis Lethargica.—In 1932, there were two cases reported in Kensington . The patients were females aged two and 50 years respectively. One case was notified on February 6th and recovered. The other was notified on June 14th and proved fatal. Poliomyelitis and Polio-Encephalitis.—Two cases of poliomyelitis or polio-encephalitis were notified to the public health department during the year 1932. Both were adults aged 26 and 49 years respectively. The former died and the latter recovered. Cerebro-Spinal Meningitis.—There were ten cases of this disease notified during the year ; particulars are subjoined :— Cerebro-Spinal Meningitis.—There were ten cases of this disease notified during the year ; particulars are subjoined :— No. Sex. Age. Date of notification. Result. 1 F. 40 January 30th. Recovered. 2 F. 5 mos. „ 24th. Died. 3 F. 3¾ February 3rd. do. 4 M. 25 „ 12th. Recovered. 5 M. 3½ „ 15th. do. 6 F. 5 March 7 th. Died. 7 M. 6 „ 8th. do. 8 M. 5 „ 12th. do. 9 M. 2 „ 29th. do. 10 M. 9 December 22nd. do. 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 thirty-three notifications were received, 171 patients being certified as suffering from acute primary pneumonia and 62 from influenzal pneumonia. The number of deaths from pneumonia during the year was 188, and 38 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 since 1930, 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. 56 The following is a report by Dr. Carter giving particulars of cases of enteritis dealt with during the year under review. The council's scheme for the treatment of enteritis in the patients' homes has worked quite smoothly. Last summer, there was a severe heat wave, the high temperatures resembling the years 1911 and 1921, when epidemics occurred. I attended fifty-six cases and paid ninety visits. No case proved fatal. Eight cases were sent into hospital. These were found to be due to Sonne dysentery and were highly infective, but no deaths occurred amongst them. The symptoms in some of the cases last year were severe with high temperatures. Dietetic errors were the causes in the majority of the infants. Amongst the older children, mucous colitis was the cause and this was successfully treated by intestinal lavage combined with temporary feeding with malted milk. In many cases there was great difficulty in resuming the normal diet and the changes in the food had to be made gradually. The notification of diarrhoea, apart from zymotic enteritis, has brought to light a number of cases of malnutrition and these are the difficult cases to treat, as the child's resisting powers have been considerably lowered before it is attacked with vomiting and diarrhoea. Dysentery. An outbreak of Sonne dysentery occurred during the year. Twenty-five cases were notified, one in January, five in March and the rest between June and October. Only one death occurred, the child being rather emaciated. Twenty-two oases were seen in children of one year of age and over. The Sonne organism was isolated in each case. The majority of the patients were sent to fever hospitals because of the infectivity of the disease. The children generally began to recover in four days from the date of onset and routine treatment was quite satisfactory. The medical officer of health requested me to write an account of the disease, which was circulated to the general practitioners in the neighbourhood. When cases of Sonne dysentery occur in a subacute form, they are very apt to be overlooked, and it is probable that some of the infectivity of summer diarrhoea is due to this cause. The origin of the outbreak was not ascertained. A number of cases occurred in the Sutton Dwellings, but other districts of North Kensington showed the presence of the disease. One case of Flexner dysentery occurred. Health Visitors' Notes. Eighty-three cases were notified. From January to June 30th, there were 14, from July 1st lo October 31st, 62, and from November 1st to December 31st there were seven. Of these 38 were one year of age and over, and 45 were under one year. Fifteen cases were sent into hospital. The following table shows the food on which the patients were fed :— Dried Milk 14 *Mixed diet 31 Cows' milk 17 Breast milk 12 Condensed milk 9 * " Mixed diet" means vegetable soup or gravy, and bread, custard or milk pudding, at midday meal. The other meals consist of cows' milk. Amongst the 83 notified cases, 32 were severe and 51 were mild. District Nursing Association. The district nurses under Miss Eales attended 120 cases of infantile diarrhoea. From January 1st to June 30th, there were 43 cases, and from July 1st to December 31st, 77 cases. The nurses paid 1,326 visits. Two deaths occurred whilst the nurses were in attendance and five amongst infants removed to hospital. These children were very ill when the nurses were called in and intestinal lavage only was given. During the year, 20 individual doctors in the neighbourhood availed themselves of the help of the nurses and the full routine treatment was carried out in 63 cases. Deaths from Diarrhoea and Enteritis. There were 57 deaths from diarrhoea or enteritis (in children under one year of age) during the year. Seven deaths occurred amongst those which had been notified. Reference has already been made to these in the nurses' report. Fifty deaths occurred amongst children who had not been notified and had not received the nurses' treatment in the homes. Out of 57 deaths, 52 cases died in hospitals. (Signed) RONALD CARTER. Dysentery.—Twenty-five cases of dysentery occurred during the year. One was of the Flexner variety and 24 cases were infected with the Sonne organism. Of the Sonne cases, three occurred in the Baby Hospital, two in the Princess Louise Kensington Hospital for Children, ten in private houses ; the remaining nine cases were reported from a large block of residential flats occupied by persons of the working class and are referred to by Dr. Carter in his report on enteritis. All the cases occurred in North Kensington. Acute Rheumatism.—During the year under review, 50 cases of this disease were notified, 14 of which were removed to hospital for treatment. The fifth annual report on the working of the rheumatism scheme during the period 1st October, 1931, to 30th September, 1932, 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. 57 Non-Notifiable Diseases. Measles.—There were 45 deaths from measles in Kensington during the year. The women health officers paid 1,310 visits to measles patients. Four hundred and eleven cases were removed to the London county council hospitals. In July last, the night sister at a local voluntary babies hospital was removed to a fever hospital with measles. In view of the fact that the patient had, during the course of her duties, been in every ward and probably spread infection throughout the hospital, it was decided that, with a view to preventing an outbreak of measles, the remainder of the staff and all patients who had not suffered from the disease should be injected with measles convalescent serum. This precautionary measure was duly carried out and no further cases occurred. It was not necessary to put the hospital into quarantine for 21 days as had been the practice in the past, and not one patient showed any discomfort as a result of the injection. The same procedure was also adopted on another occasion during the year at a nursery training school in the borough, with equally satisfactory results. In December, the borough council authorised the medical officer of health to incur expenditure for a similar purpose on any subsequent occasion should the necessity arise. Whooping Cough.—There were 36 deaths from this cause. The deaths in the three preceding years were 10, 4, and 65. The women health officers paid 398 visits to cases of this disease during the year. The number of cases admitted to hospitals from Kensington was 141. In 1930, the council authorised the medical officer of health to open special whooping cough clinics in the event of the disease appearing in epidemic form in the borough, and for this purpose a sum of £150 has been provided annually for several years in the council's estimates. The arrangements provided for the clinics to be opened at the Baby Clinic at No. 92, Tavistock Road, and at the Kenley Street Minor Ailment Centre. Up to last year, it had not been necessary to take any action in this respect, but during July it seemed that whooping cough was appearing in epidemic form in the northern part of the borough, for several of the women health officers reported an increasing number of cases in their districts. After consulting the doctors and welfare workers at the infant welfare institutions, it was decided to open a whooping cough clinic at the Baby Clinic. Fifty-four patients attended the clinic; but by the middle of August it was clear that the epidemic was subsiding rapidly and the clinic was closed on the 27th of that month. Cleansing of Verminous Persons. The cleansing of verminous persons is carried out at the medicinal baths, Blechynden Mews. The record of work done during the year 1932 is as follows :— The cleansing of verminous persons is carried out at the medicinal baths, Blechynden Mews. The record of work done during the vear 1932 is as follows :— Scabies— Total cleansings. Adults 294 School-children 438 Children under five years 66 Common lodging house cases 3 Verminous conditions— Adults 22 School-children 3,166 „ „ (impetigo and verminous) 194 Children under five years 1 Common lodging house cases 28 Other conditions— Adults 5 School-children 1 Common lodging houses cases 1 Total 4,219 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 9,232 articles were so dealt with and, in addition, 420 blankets and sheets, and 311 articles of night clothing. Of the 3,799 school children cleansed at the medicinal baths in 1932, 318 only were compulsory cases ; the remainder attended voluntarily. Verminous Premises Cleansed. Two hundred and seventy-one 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 60 Number of rooms sprayed 82 58 Disinfection. *SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1932. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Smallpox 3 11 4 176 Scarlet fever 494 536 521 7,169 Diphtheria 385 403 376 4,783 Enteric fever 13 8 30 472 Paratyphoid fever 11 16 31 432 Measles 441 494 38 626 Consumption 178 220 175 1,789 Cancer 55 60 113 1,029 Vermin 158 250 107 1,158 Other diseases 442 483 337 3,641 Totals 2,175 2,486 1,732 21,275 * 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 49 tons 19 cwts. 2 qrs. 19 lbs. The number of articles disinfected only was 20,203 and the number disinfected and washed, 1,072. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved in 1932 the washing of 9,927 towels, 248 sheets and 54 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 1932 was 21 tons 4 cwts. 0 qrs. 8 lbs. The number of articles disinfected only was 5,684 and the number disinfected and washed was 1,993. 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 85. The number of private subscribing library books destroyed was 30, and the number disinfected by formalin and returned to the householders was 21. Bacteriological Work. The work performed by the bacteriologist for the council during the year 1932 was as follows :— Disease suspected. Examinations. Positive. Diphtheria 1,992 177 „ (animal inoculations) 12 2 Tuberculosis (sputum) 302 38 „ (faeces) 1 — (fluid) 1 — „ (urine) 2 — Typhoid fever (blood) 20 3 „ (faeces) 8 2 „ (urine) 1 — Dysentery (faeces) 50 24 „ (urine) 4 — Gonorrhoea 5 4 Ringworm 18 3 Cerebro-spinal meningitis 2 — The following examinations were also carried out :— Milk (bacterial count) 59 „ (tubercle bacilli) 12 „ (fat estimation) 7 In addition to these examinations at the Kensington laboratory, 502 specimens of sputum -were examined at the tuberculosis dispensary. 59 TUBERCULOSIS. During the year 210 cases of pulmonary tuberculosis and 50 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 daring each year since 1923. District Years. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. The Borough 403 314 292 317 252 276 241 260 245 260 North Kensington 267 228 207 227 166 179 156 178 149 174 South Kensington 136 86 85 90 86 97 85 82 96 86 Wards. St. Charles 61 45 52 50 39 48 39 56 49 55 Golborne 86 65 56 69 53 57 41 46 40 48 Norland 85 75 67 59 44 49 43 42 31 42 Pembridge 35 43 32 49 30 25 33 34 29 29 Holland 26 30 27 20 11 25 20 21 17 25 Earl's Court 28 13 18 25 25 20 21 19 23 17 Queen's Gate 22 17 13 15 10 11 7 8 9 8 Redcliffe 41 15 18 22 25 26 25 20 32 24 Brompton 19 11 9 8 15 15 12 14 16 12 Medical practitioners are reporting cases at an earlier stage of the disease than was the practice several years ago. This year there were only 14 out of 127 persons dying from tuber¬culosis who had not been notified prior to death whereas in 1931 there were 29 unnotified out of 148 deaths, and in 1930, 41 out of 165. The following summary shows the age and sex distribution of the cases notified and the deaths from this disease during the year :— Age periods. New cases† Deaths. Respiratory. Non-respiratory. Respiratory. Non-respiratory. M. F. M. F. M. F. M. F. 0 — 1 — — — — — 1 3 1 4 6 3 — 1 2 5 4 2 5 5 — — 2 2 10 3 2 3 2 — — 1 — 15 10 14 4 5 4 2 — 3 20 5 17 3 1 5 7 1 1 25 27 31 — 5 11 8 2 — 35 19 18 2 2 15 12 — 2 45 18 12 — — 13 6 — — 55 14 6 1 1 12 5 1 — 65 and upwards 1 3 — — 3 1 •— 2 Totals 104 106 23 27 66 41 8 12 †Primary notifications of persons notified during life to be suffering from tuberculosis. 60 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1922, 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. if notifications. No. of deaths. Deaths per 100,000 persons living. No. of deaths. Deaths per 100,000 persons living 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 ]60 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 21 12 148 82 1932 210 107 58 50 20 11 127 69 It will be seen that the number of notifications in 1932 was higher than in the preceding year, though the number of deaths, 127, was the lowest on record. Deaths from Tuberculosis in 1932 Allocated to District of Usual Residence of Patients. Pulmonary Non-pulmonary tuberculosis. tuberculosis. The Borough 107 20 North Kensington 69 14 South Kensington 38 6 Wards. St. Charles 14 5 Golborne 20 5 Norland 22 4 Pembridge 11 2 Holland 9 — Earl's Court 11 2 Queen's Gate 1 — Redcliffe 16 1 Brompton 3 1 The places where deaths from tuberculosis occurred are set forth in the following list :— Pulmonary Non-pulmonary tuberculosis. tuberculosis. Patient's home 30 8 St. Mary Abbots Hospital 30 3 St. Charles Hospital 24 3 Princess Louise Kensington Hospital for Children — 1 Outlying hospitals 14 3 Other places outside the borough ,, ,, 9 2 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations were introduced with a view to :— (1) preventing persons suffering from respiratory tuberculosis entering upon an occupation involving the handling of milk ; and (2) enabling local authorities, in proper cases and with suitable safeguards, to require persons engaged in such occupation to discontinue their work when found to be suffering from the disease in an infective stage. During the year no case occurred which required the attention of the Council under these regulations. 61 THE COUNCIL'S SCHEME FOR THE PREVENTION AND TREATMENT OF TUBERCULOSIS. 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 218 349 178 142 887 New cases with respiratory tuberculosis 73 80 10 5 168 (18-9 per cent.) New cases with non-respiratory tuberculosis 8 9 11 8 36 ( 4.0 „ ) New cases regarded as "suspects" 7 17 8 5 37 ( 4.1 „ ) New cases not suffering from tuberculosis 130 243 149 124 646 (72.8 „ ) This table shows an increase of 13 in the number of respiratory cases seen at the dispensary over last year. The total number of non-respiratory cases is 3 more than in 1931, being 36 instead of 33. 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 29 respiratory cases and 6 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 57 for 1931. 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 last named numbered 234. The treatment recommended for the cases diagnosed at the dispensary as suffering from tuberculosis, which numbered 204 (pulmonary 168 and non-pulmonary 36), was as follows :— sanatoria, 142 ; domiciliary, 17 ; St. Mary Abbots and other hospitals, 35 ; dispensary, 10. The total number of attendances by patients at the dispensary was 2,499, and 1,625 systematic examinations were made. The number of visits paid by the tuberculosis officer was 127, of which 52 were consultations at home with the doctor in charge of the case. Written reports on cases to public authorities numbered 1,605, and to doctors 342. The total number of sputum examinations was 502 from 402 individual cases. One hundred and thirty-six specimens showed tubercle bacilli to be present, and 366 gave negative results. Records. 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, 1932 347 347 184 187 No. of cases notified for the first time during the year 104 106 23 27 No. of cases brought to notice otherwise than by notification 22 17 5 5 No. of cases removed from the register during the year on account of having:— (a) been cured 20 21 24 12 (6) removed from district 52 71 22 21 (c) died 68 44 5 10 (d) been inaccurately diagnosed 1 3 — — No. of cases remaining on the register on 31st December, 1932 332 331 161 176 62 The number of patients on the dispensary register on 31st December, 1932, was 858, whilst at the beginning of the year they numbered 883. A comparison of the dispensary figures with the total number on the notification register (1,000) 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. Prior to the 1st April, 1932, X-ray examination work in connection with the diagnosis of tuberculous patients was conducted free of charge at St. Mary Abbots Hospital, but on that date a new agreement was entered into between the borough council and the London county council whereby the latter body undertake this work at a cost of 7s. 6d. for each X-ray examination, 7s. 6d. for the first photograph taken and 2s. 6d. for each subsequent one. As the council's tuberculosis officer, visits St. Mary Abbots Hospital by arrangement, at least once a week, and is able to see the patients under X-ray examination, a photograph is not always necessary ; thus the expenditure incurred by the council for this service is limited. During the year, 12 X-ray examinations were conducted free of charge and 31 at a total cost of £11 7s. 6d. Home Visiting. The number of home visits paid in 1932 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 17 25 16 29 3 34 40 164 Re-visits 125 192 174 139 18 278 238 1,164 Non-pulmonary. First visits 3 7 8 5 - 12 6 41 Re-visits 49 154 110 71 — 210 69 663 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 con¬nection with treatment in residential institutions under the London county council's tuberculosis scheme. The following table, giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1932 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 13 7 2 1 - - - - - - 23 2 — 11 13 9 7 7 — 1 — — 48 3 1 8 4 7 8 7 5 2 1 1 44 4 — — 4 7 7 5 2 — — 2 27 5 — 1 2 2 — — 5 1 — 1 12 6 — — 1 1 — 2 — — — — 4 158 63 This total falls 46 short of the total number of cases owing to patients living in boarding houses, private hotels and large private residences not being included. The following table shows the room space per occupant for the last eight years 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 1932. ditto .67 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 665 contacts traced by the dispensary service in 1932. Of these, 393 were examined one or more times by the tuberculosis officer, 112 were examined by their own doctors or had been recently examined at school, while 160 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 1932. 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 18 Patients' attendances 71 Number of fillings — Number of extractions 70 Number of dentures arranged for 8 Artificial Pneumothorax Treatment. In recent years there has been a growing tendency for artificial pneumothorax to be prescribed by sanatorium doctors as a routine measure in the early stages of the disease, and in 1932 the council undertook to pay for the treatment in 25 cases at a cost of £165 18s. 6d. The corresponding figures for 1931 were 11 and £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 :— 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. 1928 23 901 1929 28 1,327 1930 18 946 1931 16 394 1932 30 1,094 The nurses carry out their work splendidly and are very much appreciated by the poor. Supply of Extra Nourishment to Tuberculous Persons. Eight persons received extra nourishment during the year. The total amount supplied was 220 pints of milk and 220 new laid eggs, at a cost to the council of £7 9s. 0d. Arrangements for "Care" and "After Care." In July, 1922, the council approved a proposal for the constitution of a borough tuberculosis care committee, and this committee, which commenced its activities in December of that year, undertakes all the "care" and " after-care " work in the borough. 64 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, 1931. Meetings are held weekly at the Paddington tuberculosis dispensary, No. 20, Talbot Road. The class has been continued throughout 1932 and at the end of the year six patients from Kensington were in regular attendance and a favourable report was received of their work. There are at present no vacancies in the class. 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. The Central Fund is experiencing some difficulty in disposing of the gloves, and asks for the co-operation of the Kensington tuberculosis care committee and any other persons interested in this work. 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 two of these the assistance was given for the first time during the past 12 months, the articles issued being as follows :— Bedsteads 2 Mattresses 2 Bolsters 1 Pillows 5 Pillow-slips 9 Sheets 9 Blankets 6 Quilts 2 Mattress covers 2 The total stock of bedding, etc., on loan on 31st December, 1932, was :— Bedsteads 6 Mattresses 5 Bolsters 2 Pillows 10 Pillow slips 18 Sheets 21 Blankets 19 Quilts 5 Mattress covers 4 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 175 Number of rooms disinfected 220 Bacteriological Examinations. Specimens of sputum submitted by medical practitioners for bacteriological examination at the expense of the council:— Examined at the council's laboratory 302 Examined by the tuberculosis officer 502 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. 65 APPENDIX I. Fifth Annual Report on the Kensington Rheumatism Scheme. (October 1st, 1931—September 30th, 1932) 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 fifth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was completed on the 30th September, 1932. The functions of this centre are 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. Under the Kensington (Acute Rheumatism) Regulations, 1930, acute rheumatism 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 detailed particulars are given below. It will be seen that the notification figures show a steady decline ; this is probably due to the notification in the first years of an accumulation of patients in whom the first symptoms had occurred before the year 1927. 1927-28. 1928-29. 1929-30. 1980-31. 1931-32. Source of notification. No. of notifications. No. of patients notified in the year who attended the Centre. No. of notifications. No. of patients notified in the year who attended the Centre. No. of notifications No. of patients notified in the year who attended the Centre. No. of notifications. No. of patients notified in the year who attended the Centre. No. of notifications. No. of patients notified in the year who attended the Centre. Rheumatism 32 32 37 37 12 12 9 9 12 12 supervisory centre. Private medical 53 40 32 28 21 practitioners. School medical 28 63 1 33 20 36 12 31 1 12 officers. Hospitals and 46 27 31 17 7 institutions. Totals 159 95 105 70 95 48 66 40 41 24 The percentage attendance of the notified cases at the supervisory centre remains very stationary, as the following table shows :— 1928-28 60% 1928-29 66% 1929-30 50% 1930-31 60% 1931-32 60% The compulsory notification of cases of juvenile rheumatism in the Royal Borough of Kensington has been in force for five years, and the question now arises as to whether it should continue. It will be seen that the number notified has declined each year. This is due partly to the fact that a proportion of the patients notified in the earlier years of compulsory notification might or might not have been suffering from notifiable rheumatism at the actual time of notification, but they have had juvenile rheumatism at some previous date before compulsory notification was in force. This proportion is being gradually reduced. For 66 example, a child might have been sent up by the Invalid Children's Aid Association or the school medical officer to the supervisory centre because he was ailing or complaining of pains in the limbs ; his condition on visiting the centre might have been doubtfully rheumatic, and would not have warranted notification were it not for the fact that the history revealed that the child had had chorea or acute rheumatism at some previous date before compulsory notification ; such cases were frequently notified. Again, general practitioners and school medical officers notified cases with such signs as mitral stenosis, although the children may have had no present symptoms of the infection ; they were notified because the doctors knew from the history and the signs found that the children had had juvenile rheumatism with cardiac involvement, and that they had not been previously notified because the disease occurred before compulsory notification. As the period of notification lengthens, this type of notification will not occur as frequently. Juvenile rheumatism does not resemble most other notifiable diseases in which one attack usually confers an immunity and second attacks are therefore uncommon. In these other diseases the notification statistics are straightforward ; in rheumatism, however, not only does one attack fail to confer an immunity, but it definitely increases the danger of the occurrence of subsequent attacks. Until notification has been in force for a few years, therefore, the number of notifications does not give any real indication of the number of cases occurring for the first time in the borough during any particular year. For this reason only, therefore, it would seem to be a pity to cease to notify just when the statistical value is becoming apparent. There are other reasons, however, in favour of the continuance of compulsory notification :— (1) The etiological investigations up to the present have been mainly negative in character. Investigations into environmental factors have revealed that no evidence can be produced to show that there is any connection between the onset of juvenile rheumatism and damp areas, rat infested areas, and various soils. The only definite positive finding is that rheumatism increases directly with poverty and the overcowding and malnutrition consequent on this state. It appears, therefore, that further etiological investigations will have to be made. For this purpose the notification lists will be of value. (2) When a child is first seen by the general practitioner, or at a supervisory clinic or ordinary out¬patient department of a hospital, the history given is extremely vague. It may not be the mother who brings up the child, or if it is, her recollection of the child's previous illnesses is often very inadequate. She may forget that the child has had any suggestive symptoms, or alternatively she may say that a nervous fidgety child has had St. Vitus Dance, or a debilitated flat-footed child has had rheumatism. If, however, it is found that the child has, at some time, been notified under the Royal Borough of Kensington scheme, it is definitely established that the child has had one of the notifiable rheumatic conditions. (3) It was pointed out in the second annual report that though notification would not be likely to supply a large proportion of the cases sent to the supervisory centre, it is bound to keep under supervision certain cases which would otherwise be neglected and so run unnecessary risks of cardiac complications. It is true that in order to be notified the cases must have come under medical care on at least one occasion, but unfortunately private medical practice in this country has but little opportunity to concern itself with persons not actually ill. There is enormous scope for preventive work and for the supervision of the healthy in private practice, but as yet medical evolution has not accomplished any considerable development along these lines, and the incomes of the class of family amongst which juvenile rheumatism is rife are such that, as a rule, the child has not only to be ailing but quite definitely ill before the fee can be found for the private practitioner. Social Services. In the annual report of the Kensington rheumatism supervisory centre for the year 1931-32, details were given of the work carried out by the honorary secretary of the rheumatism supervisory scheme and her assistants, and it is not intended in this report to repeat them, but to illustrate briefly instances in which the services of social workers are of extreme value in connection with the work of the centre. On the first attendance of a child at the centre, many problems may arise. For example, if the home conditions, etc., have not been investigated and the physician in charge is therefore not familiar with them, much valuable time is wasted. Before a child is summoned to attend the centre, it is the practice for a social worker to visit the home with a view to obtaining details of the family circumstances, and explaining to the mother the importance of the disease from which the child is suffering, and the dangers that may result if proper precautions are not taken. Further, if the child is very ill, the social worker will probably warn the parents that it may be necessary to send the child to hospital for in-patient treatment. Considerable help in the choice of treatment is very often given to the physician in charge by the social worker's knowledge of the home conditions and financial circumstances of the family. For example, a child suffering from a choreic or cardiac condition can often safely be allowed to receive home treatment when the parents are of good social class and intelligent, whereas if the child comes from an overcrowded tenement, where he cannot get proper rest or the necessary attention from his mother, hospital treatment is essential. Lack of proper feeding, and insufficient sleep play an important part in choreic cases. Many poor, ignorant mothers have been gradually educated by the tactful social worker in the importance of proper nourishment and adequate rest. Tonsillectomy and remedial exercises are two methods of treatment ordered by the physician in charge, which are often disliked and objected to by parents; tonsillectomy because of fear of operations, and remedial exercises because of the time which has to be given by the parents to supervision of the child during the course of the exercises. The social worker is often able to impress on parents the necessity for these forms of treatment, and to secure either their sanction to the operation or their enthusiasm in seeing that the child has his exercises regularly. Private doctors frequently send patients to the centre for diagnosis and advice upon treatment, but in many cases the mother is not quite certain whether the physician in charge is to treat the child or only to act as a consultant. Here again the social worker will investigate and consult the private doctor concerned, with a view to ascertaining his exact wishes, and valuable co-operation between the centre and the private practitioners in the borough is thus ensured. In the early days of the centre, close co-operation with parents was very difficult, and it was only by the continued efforts of the voluntary workers, involving much time and patience, that this was effected. In some cases the difficulty still arises. Social work in connection with the centre is thus essential to complete successfully the work of the physician in charge. The social workers on the staff of the Kensington Rheumatism Supervisory centre at the present time are as follows :—one honorary secretary, Mrs. Jacobson, one paid secretary, Miss Butler, and three voluntary home visitors, Miss Dudley Baxter, Miss Reitlinger. and Miss Greer. Their work is invaluable; it is due to their patience and perseverance that children attend so regularly, and that few cases lapse through need of visiting. 67 PART II. THE WORK OF THE CENTRE. by JANET K. AITKEN, M.D., M.R.C.P. In the five years 1927-1932 during which the centre has been in existence, 1,102 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 from that borough. Cases attending the Centre. 1929-30 1930-31 1931-32 Kensington 128 177 266 Hammersmith 35 40 47 Other boroughs 10 17 12 173 234 325 During the year 1931-32, 48 sessions have been held at the Princess Louise Hospital, and the average attendance has risen from 23.7 in 1930-31, to 25.4 in 1931-32; the total number of attendances during this year has risen from 1,160 to 1,254. Average attendance per session of Kensington patients 21.1 „ ,, ,, ,, other ,, 4.3 25.4 The total number of attendances of patients during 1931-32 is as follows:— Kensington Notified cases (a) New 24 (b) Old 370 Unnotified cases (a) New 80 (b) Old 545 Hammersmith (a) New 20 (b) Old 169 Hounslow (a) New (b) Old 5 Paddington (a) New 3 (b) Old 10 Chelsea (a) New 2 (b) Old — Various boroughs (b) Old 26 1,254 The new Kensington cases in 1931-32 were recommended to attend the clinic from the following sources:— Invalid Children's Aid Association 15 School medical officers 25 Princess Louise Hospital 15 Other hospitals and institutions 12 Private practitioners 5 Notifications 16 Public health department 1 Parents 15 104 The disposal of cases which attended the centre may be summarised as follows :— Tonsillectomy at Princess Louise Hospital 9 Admission to Princess Louise Hospital 22 Admission to St. Mary Abbots Hospital 2 Admission to other hospitals 10 Special schools 1 Special heart homes— 1. Carshalton 10 2. West Wickham 2 3. Lancing 2 Convalescent homes 8 Referred to massage department for special chest expansion exercises 18 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. 68 Clinical Report. In the report of 1930-31, an investigation into the value of tonsillectomy in cases of juvenile rheumatism was reported. An analysis of 544 cases was undertaken mainly to find out whether tonsillectomy had any value in the prevention of the onset of juvenile rheumatism, but it also revealed certain suggestions with regard to the progress of the disease after tonsillectomy. The summary was as follows :— (1) There is no definite evidence that tonsillectomy is of value in preventing the onset of juvenile rheumatism. (2) 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. It was realised that some of these suggestions were not in accordance with the evidence produced by some other workers, notably that of Dr. Leonard Findlay, Dr. James Macfarlane and Dr. Mary Stevenson, reporting cases seen at the Department of Paediatrics, Glasgow University, and Royal Hospital for Sick Children, Glasgow. These workers agree that tonsillectomy may modify the severity of the juvenile rheumatism as far as cardiac involvement is concerned, when the manifestation of the disease is arthritic, but they do not agree that the same modification holds good in the case of chorea. Their conclusions are as follows :— A preliminary tonsillectomy or one performed early during the course of the infection may possibly, in the case of arthritis, render the heart less liable to be attacked, but not so in the case of chorea. Tonsillectomy in the case of carditis following arthritis seems to have a beneficial effect on the progress of the disease, but not so in carditis following chorea. It was decided therefore to undertake further investigations on these lines, as it was realised that in some of the cases mentioned in the previous analysis a long enough period had not elapsed since the onset of juvenile rheumatism or of chorea on which to base statistics relating to the progress of the disease. All the cases now reported have been under observations for a minimum of two years since the attack discussed in the report, and in all cases where no carditis has been noted there has been chorea or a definite arthritis ; pains in the limbs only, however suggestive it is that these pains are rheumatic in origin, have not been included. On account of the suggestion that the value of tonsillectomy varies in children in whom the manifestation of rheumatism is arthritic as opposed to those whose rheumatism takes the form of chorea, three groups have been taken. In all three carditis may or may not be present as will be shown in the sub-divisions :— Group 1 Arthritic cases. „ 2 Cases of chorea „ 3 Cases of chorea and arthritis. Each group is divided and then sub-divided as follows :— P. Cases with no cardiac disease. (Potential cardiac disease.) A. Cases with transient carditis during acute phase. B. Cases with continued signs of cardiac involvement, but no symptoms of the disease. C. Cases with signs and moderate symptoms of carditis. D. Cases with signs and marked symptoms of carditis. GROUP I. Arthritic cases. Number of cases. Classification when first seen. Classification at least two years later. Progress in reference to cardiac condition. Progress in reference to general health. Tonsillectomised later. Nontonsillec tomised later. Improved. Unchanged. Deteriorated. Improved. Unchanged. Deteriorated. I. Non-tonsillectomised before onset of juvenile rheumatism. (a) Requiring tonsillectomy. (b) Not requiring tonsillectomy. II. Tonsillectomised incompletely before onset of juvenile rheumatism. III. Tonsillectomised before onset of juvenile rheumatism. IV. Cases from Group la tonsillectomised before 2nd attack. 70 10 16 21 13 P 4 A 11 B 18 C 36 D 1 P 1 A 5 B 3 C 1 D — P 1 A 3 B 9 C 3 D — P 2 A 9 B 7 C 3 D P 1 A 2 B 2 C 8 D — P 3 A 7 B 26 C 14 D 5 P 1 A 5 B 4 C — No further op. p i A 3 B 8 C 2 D — P 1 A 9 B 10 C 1 D — P 1 A 2 B 4 C 5 D 1 P — A 4 B 7 C 4 D — Complete tonsillectomy. P — A — B 2 C — D — 1 10% 14 20% 1 6.2% 2 9.5% 2 15% 9 90% 51 73% 15 94% 18 85.5% 10 77% 5 7% 1 5% 1 8% 8 80% 41 58.5% 10 62.5% 16 76% 7 54% 2 20% 20 28.5% 5 31.2% 4 19% 5 38% 9 13% 1 6.2% 1 5% 1 8% 69 In this group 117 cases have been analysed, and, in division IV, thirteen of the 55 cases who required tonsillectomy which were tonsillectomised before a second attack have been re-grouped. It will be noted that the percentages which improved or deteriorated both as regards the cardiac condition and as regards the general health do not vary very markedly in each group. In division la twenty per cent, improved as regards the cardiac condition ; these were nearly all cases which when first seen were placed in sub-division C and which when last seen were placed in sub-division B, that is to say, the signs of heart disease remained but the symptoms disappeared. On the other hand 7 per cent, definitely deteriorated. The general health in this group is the least good. Division 1& shows the best progress as none deteriorated both as regards cardiac condition or general health. Only one or 10 per cent, improved as regards cardiac condition, but it must be noted that it was hardly possible for any of the others to improve in this respect as they are all in the first three subdivisions—that is, cases with no carditis, or cases with transitory signs only which cannot improve their cardiac condition. The others were cases with signs of rheumatic carditis which are not limited to the acute phase and these do not commonly disappear. Similarly the progress in division III is satisfactory—only 9.5 per cent, improved as regards their cardiac condition, but again there were only three which were not in subdivision P.A.B. and two of these improved. In this group, however, one deteriorated. The analysis seems to show; therefore that the progress in those cases which did not require tonsillectomy and those which were tonsillectomised before the onset of juvenile rheumatism is rather more satisfactory than in those who required tonsillectomy at the onset of juvenile rheumatism. The analysis also confirms my previous findings that tonsillectomy may modify the disease as far as cardiac involvement is concerned, for when last seen In division la 65 per cent, of the cases are in subdivision P.A.B. and 35 per cent, in C. and D. In division 16 100 per cent, of the cases are in subdivision P.A.B. and 0 per cent, in C. and D. In division III 95 per cent, of the cases are in subdivision P.A.B. and 5 per cent, in C. and D. In division IV 54 per cent, of the cases are in subdivision P.A.B. and 46 per cent, in C. and D. From this point of view also cases which had not been tonsillectomised but which did not require tonsillectomy are the most satisfactory, but those which have had complete tonsillectomy before the onset of the disease are nearly as good. That the cardiac condition in division IV is less good than the tonsillectomised cases in division I a does not suggest that tonsillectomy before a second attack is disadvantageous, for in division IV all the cases have had second attacks; whereas division I a includes these, and also a number of cases which have had only one attack. It is not very common for a carditis to occur in a second attack if the heart has escaped in the first, but a second attack will commonly aggravate an existing carditis. Discussion of division II is omitted, as it is often impossible to be sure whether tonsillar remnants are infected or not. GROUP II. Choreic cases. Number of cases. Classification when first seen. Classification at least two years later. Progress in reference to cardiac condition. Progress in reference to general health. Tonsillectomised later. Nontonsillec tomiseJ later. Improved. Unchanged. Deteriorated. Improved. Unchanged. Deteriorated. I. Non-tonsillectomised before onset of chorea. (a) Requiring tonsillectomy. (b) Not requiring tonsillectomy. II. Tonsillectomised incompletely before onset of chorea. III. Tonsillectomised before onset of chorea IV. Cases from division I a tonsillectomised before 2nd attack. V. Cases from division la. No further attacks of chorea 2 years after tonsillectomy. 17 5 2 4 2 10 1 had 2 attacks before. P 3 A 8 B 6 C — D — P 3 A 1 B 1 C — D — P — A — B 2 C — D — P 1 A 3 B — C — D — P — A 1 B 1 C — D — P 4 A 1 B 5 C — D — P 2 A 5 B 6 C — D—- P 3 A I B 1 C — D — P — A — B 1 C 1 D — P 1 A 3 B — C — D — P — A 1 B 1 C — D — P 4 A 1 B 5 C — D — P 13 attacks A 3 B C D 17 100% 5 100% 1 50% 4 100% 2 100% 10 100% 15 1 1 88% 6% 6% 5 100% 1 1 1 50% 50% 50% 4 100% 1 1 50% 50% 10 100% 70 An analysis of Group II shows that the carditis associated with chorea only is less severe than when arthritis is also present or is the only other manifestation. In Group II twenty-eight cases are analysed, and only one is placed in a subdivision below B. In the four cases tonsillectomised before the onset of chorea none had a permanent heart lesion. The progress is satisfactory in all groups, though it is again slightly better in divisions 16 and III. In this group of chorea only it would seem also that tonsillectomy may modify the disease as far as cardiac involvement is concerned. In division la 65 per cent, of the cases are in subdivision P.A. and 35 per cent, in B. and C. In division lb 80 per cent, of the cases are in subdivision P.A. and 20 per cent, in B. and C. In division III 100 per cent, of the cases are in subdivision P.A. and 0 per cent, in B. and C. Two of the thirteen cases of division la, who had been tonsillectomised after the onset of chorea, had had second attacks ; neither had a further carditis, but in one of them the general health was very poor. Ten of these cases, however, had had no further attacks of chorea during the two years or more following tonsillectomy, and in all the general health was greatly improved. GROUP III. Arthritic and choreic cases. Number of cases. Classification when first seen. Classification at least two years later. Progress in reference to cardiac, condition. Progress in reference to general health. Tonsillectomised later. Nontonsillec tomised later. Improved. Unchanged- Deteriorated. Improved. Unchanged. Deterlorated. I. Non-tonsillectomised before onset of arthritis and chorea. (а) Requiring tonsillectomy. (б) Not requiring tonsillectomy. II. Tonsillectomised incompletely before onset of arthritis and chorea. III. Tonsillectomised before onset of arthritis and chorea. IV. Cases from division la tonsillectomised before (а) 2nd attack (б) 3rd attack V. Cases from division la. No further attacks of chorea 2 years after tonsillectomy. 23 3 2 I 1st attack 4 arthritic only 2nd choreic. 1st 2 attack choreic 2nd arthritic only 1st and , 2nd 1 attack arthritic 3rd choreic. All attacks arthritic and choreic. 5 1 had 2 attacks chorea before tonsillectomy. P 4 A 3 B 5 C 10 D 1 P 1 A 1 B 1 C - D - P 1 A - B - C 1 D - P 3 A - B 1 C 2 D - P A B - C 2 D - P 1 A 1 B 1 C 2 D - P 2 P 2 A3 A - B 7 B I C 4 C 3 D - D 1 P 1 A 1 B 1 C D - I p 1 A B C 1 I D - P 3 A - B 2 C 1 D - P A B 1 ci D1 A 1 B 2 C 1 D - 3 20 — 6 15 2 13% 87% 26% 65.3% 8.7% 3 3 100% 100% 2 1 1 100% 50% 50% 15 5 1 17% 83% 83% 17% 1 1 2 50% 50% 100% 1 4 5 20% 80% 100% An examination of Group III again suggests that the progress of the disease is best in division lb. In division III the figures are not so good as in Group I, but there are only two cases in this group, one showed a very satisfactory progress, the other had a fairly severe cardiac lesion and the condition did not change. Divisions IV and V are interesting. The progress of 13 of the 16 cases from lb which had been tonsillectomised later is 71 shown. (In the other three no further attacks of chorea have occurred, but two years have not elapsed since tonsillectomy.) In five of these cases chorea has occurred after tonsillectomy, although the rheumatic manifestation had previously been arthritic. On the other hand five have had no further attacks of chorea since tonsillectomy, one having had two attacks previous to the operation. It is realised that the number of cases of chorea is very limited, and that the findings must therefore be provisional. As far as the investigation has been able to find, however, there is no evidence to suggest that there is any appreciable difference between the value of tonsillectomy in arthritic juvenile rheumatism and chorea. The cases which have been analysed have all attended the Kensington supervisory centre. Cases which have been lost sight of have been omitted, and it is realised that the tendency at such a clinic may be to lose sight of severe cases in a rather high proportion. Such cases are often spending long periods of their lives in institutions, and it is not easy to trace what has happened to them, or a very severe case may never attend the supervisory centre. This should not affect the investigations undertaken, but it may give an undue optimism as to the progress of juvenile rheumatism should the figures be examined from that point of view. Summary. There is some evidence suggesting that preliminary tonsillectomy, ia those requiring this operation, may modify the severity of juvenile rheumatism as far as cardiac involvement is concerned in those in whom the manifestation is choreic, as well as those in whom it is arthritic. The progress of the disease is the most satisfactory in cases who have healthy tonsils. In those whose tonsils are unhealthy there is some evidence to suggest that preliminary tonsillectomy is beneficial as far as the progress of the disease is concerned both in choreic and arthritic cases. APPENDIX II. TABLE I. Vital Statistics of Whole District for 1932 and previous Years. Year. Population estimated to middle of each year. Births. Total deaths registered in the district. Transferable deaths. Net deaths belonging to the district. Uncorrected number. Net. of nonresidents registered in the district. of residentsnot registered in the district. Under 1 year of age At all ages. 1 Number. Rate.* Number. Rate.* Number. Rate per 1,000 net births. Number. Rate. * 2 3 4 5 6 7 8 9 10 11 12 13 1927 ‡176,700B 176,500D 2,270 2,657 15.0 2.550 14.4 656 546 176 66 2,440 18.8 1928 ‡178,400B 178,200D 2,184 2,559 14.3 2,477 18.8 694 543 213 83 2,326 13.0 1929 ‡176,000B 175,800D 2,189 2,544 14.4 2 889 16.4 738 552 213 84 2,708 15.4 1980 176,000 2,154 2,580 14.7 2,401 13.6 749 590 177 69 2,242 12.7 1981 174,800 2,111 2,485 14.2 2,646 15.1 716 525 188 76 2,455 14.0 1932 183,500 2,245 2,362 12.9 2,930 15.4 937 497 232 98 2,490 13.6 * Rates calculated per 1,000 of estimated population. ‡ B. Population as estimatsd by the Registrar-General for the calculation of birth rate. D. ,, „ ,, „ „ „ death rate. At Census of 1931. Area of district in acres (exclusive of area Total population at all ages 183,893 covered by water) 2,291 Total families or separate occupiers 47,713 72 TABLE II. Table showing the number of cases of infectious disease notified in the various age periods and wards; the number admitted to hospitals; and the total deaths from these diseases in 1932:— Notifiable Disease. Number of cases notified. Total cases notified in each ward. Cases admitted to 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 1 - - - - - - - - 1 - - - - - - 1 - - - - - 1 - Scarlet fever 478 3 11 30 39 46 188 73 25 50 8 5 — 139 56 108 49 42 27 12 34 11 439 3 Diphtheria (including membranous croup) 415 14 23 43 44 32 149 47 18 36 6 3 — 111 146 61 45 7 13 18 13 1 378 29 Enteric fever 15 — — — — 1 — 2 5 1 4 2 — 3 1 1 3 4 — 1 2 — 9 1 Puerperal fever 8 — — — — — — — — 6 2 — — 1 2 2 1 — 2 — — — 4 4 Puerperal pyrexia 31 - - - - - - - 2 26 3 — — 7 8 5 3 1 2 2 2 1 28 0 Primary pneumonia 171 21 25 17 12 11 11 15 5 11 15 16 12 39 84 17 11 3 4 3 8 2 56 24 Influenzal pneumonia 62 1 1 1 — — 1 3 2 16 9 21 7 6 16 10 4 7 5 5 6 3 33 38 Dysentery 25 2 9 3 3 2 5 1 — — — — — 19 5 — 1 — — — — — 25 1 Erysipelas 81 2 1 1 2 — 7 1 4 11 15 26 11 17 20 9 9 4 9 6 3 4 55 7 Encephalitis lethargica 2 - - - - - - - - 1 - 1 - - - - - 1 - - - 1 — 4 Cerebro-spinal meningitis 10 1 — 1 2 •— 4 — — 1 1 — — 3 4 2 1 - - - - - 10 8 Polio-myelitis and polio-encephalitis 2 - - - - - - - - 1 - 1 - - 1 - - 1 - - - - 2 2 Pulmonary tuberculosis 210 — 1 2 — 1 6 5 24 80 37 50 4 45 37 31 21 17 15 8 24 12 177 107 Other forms of tuberculosis 50 1 2 3 3 2 10 5 9 9 4 2 — 10 11 11 8 8 2 — — — 30 20 Ophthalmia neonatorum 16 16 - - - - - - - - - - - 6 4 4 1 1 — — — — 11 — Malaria 3 — — — — — — — — — 1 1 1 1 — — 2 — — — — — 1 — *Enteritis (diarrhoea) 83 45 20 7 6 5 - - - - - - - 35 17 22 9 - - - - - 15 68 †Acute rheumatism 50 — — — 2 1 23 22 2 — — — — 10 10 21 5 1 1 — 2 — 14 3 Totals 1,713 106 93 108 113 101 404 174 96 250 105 128 35 452 422 304 174 97 80 55 94 35 1,288 319 * Notifiable only in children under the age of 5 years. † ,, ,, ,, ,, ,, 16 ,, Cases of mistaken diagnosis are excluded from the above table. 73 TABLE III. Causes of Death at Different Periods of Life in 1932. 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 4b years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and upwards ALL CAUSES M. 1,103 180 35 85 27 18 48 53 129 190 241 197 F. 1,387 102 29 26 25 41 46 77 120 167 295 459 Typhoid and paratyphoid fevers M. 1 ... ... ... ... ••• ... ... ••• 1 ... ••• F. ... ... ... ... ... ... ... ... ••• ... ... ••• Measles M. 20 3 11 5 1 ... ... ... ... ... ... ... F. 25 3 11 9 1 ... ... ... ... ... 1 ... Scarlet fever M. 1 ... ... ... ... 1 ... ... ... ... ... ... F. 2 ... • •• 1 1 ... ... ... ... ... Whooping-cough M. 19 7 7 5 ... ... ... ... ... ... ... ... F. 17 9 5 2 1 ... ... ••• ... ... ... Diphtheria M. 16 ... 3 8 5 ... ... ... ... ... ... ... F. 13 1 1 6 5 ... ... ... ... ... ... ... Influenza M. 24 ... 1 ... 1 ... ... ... 4 3 8 7 F. 55 1 1 ... 1 2 3 4 5 11 11 16 Encephalitis lethargica M. 1 ... ... ... ... ... ... ... ... 1 ... ... F. 3 ... ... ... ... ... ... 1 1 ... 1 ... Cerebro-spinal fever M. 5 1 ... ... 1 ... ... ... ... ... ... ... F. 3 l ... 1 l ... ... ... ... ... ... ... Tuberculosis of respiratory system M. 66 ... 1 ... ... 8 9 11 18 15 8 1 F. 41 ... ... ... ... 13 9 8 6 4 1 ... Other tuberculous diseases M. 9 ... ... 3 2 1 ... 1 1 1 ... ... F. 11 ... 1 ... 2 2 1 2 2 ... ... 1 Syphilis M. 5 1 ... ... ... ... ... ... 2 ... 2 ... F. 6 ... ... ... ... ... 1 2 3 ... ... ... General paralysis of the insane, tabes dorsalis M. 7 ... ... ... ... ... 1 1 3 ... 2 ... F. ••• ... ... ... ... ... ... ... ... ... ... ... Cancer, malignant disease M. 113 ... ... ... 1 ••• 1 7 19 39 32 14 F. 183 ... ... 1 ... 2 4 11 27 40 60 38 Diabetes M. 5 ... ... ... ... ... ... ... ... 1 3 1 F. 20 ... ... ... ... ... ... ... 3 8 8 Cerebral haemorrhage, etc. M. 31 ... ... ... ... ... ... 2 2 7 13 7 F. 70 ... ... ... ... ... 1 ... 5 7 27 29 Heart disease M. 232 ... ... ... 2 1 5 7 21 47 80 69 F. 335 ... ... ... 1 4 1 4 21 31 92 181 Aneurysm M. 5 ... ... ... ... ... 1 1 ... 3 ... ... F. 3 ... ... ... ... ... ... ... ... ... 3 ... Other circulatory diseases M. 51 ... ... ... ... ... ... ... 2 11 18 20 F. 87 ... ... ... ... ... ... ... 3 13 28 43 Bronchitis M. 36 2 ... ... ... ... ... 3 3 5 8 15 F. 44 2 ... ... ... ... ... ... ... 5 8 29 Pneumonia (all forms) M. 98 23 7 3 3 ... 5 3 14 12 19 9 F. 90 18 4 3 ... 8 6 7 6 8 6 29 Other respiratory diseases M. 9 ... ... ... ... ... 1 ... 1 2 2 3 F. 9 ... ... ... 1 ... 2 1 1 ... 1 3 Peptic ulcer M. 13 ... ... ... ... ... 1 2 2 4 4 ... F. 13 ... ... ... ... ... ... 1 2 1 6 3 Diarrhœa, etc. M. 41 35 3 ... ... ... ... ... ... 2 1 ... F. 27 22 2 ... ... 1 . .. 1 ... 1 ... ... Appendicitis M. 10 ... ... ... ... ... 4 1 3 ... 1 1 F. 9 ... ... ... 3 2 1 1 ... ... 2 ... Cirrhosis of liver M. 7 ... ... ... ... ... ... ... 3 2 2 ... F. 6 ... ... ... ... ... ... 1 2 ... 2 1 Other diseases of liver, etc. M. 7 ... ... ... ... ... 1 ... 1 3 1 1 F. 8 ... ... ... ... ... ... ... 1 2 1 4 Other digestive diseases M. 20 1 ... 1 ... ... 2 1 6 2 2 5 F. 28 4 ... 1 ... 1 ... 2 3 5 5 7 Acute and chronic nephritis M. 33 ... ... 1 ... ... 3 3 7 5 9 5 F. 29 ... ... ... ... 1 ... 1 4 6 9 8 Puerperal sepsis F. 4 ... ... ... ... 1 ... 3 ... ... ... ... Other puerperal causes F. 5 ... ... ... ... 1 2 2 ... ... ... ... Congenital debility, premature birth, malformations, etc. M. 52 51 ... 1 ... ... ... ... ... ... ... ... F. 37 37 ... ... ... ... ... ... ... ... ... ... Senility M. 14 ... ... ... ... ... ... ... ... ... 1 13 F. 31 ... ... ... ... ... ... ... ... ... 2 29 Suicide M. 28 ... ... ... ... 2 6 1 8 4 6 1 F. 18 ... ... ... ... ... 1 8 2 4 3 ... Other violence M. 51 3 ... 3 4 3 7 6 2 8 7 8 F. 48 ... 3 1 3 4 3 2 5 7 5 15 Other defined diseases M. 72 3 1 2 7 2 1 3 7 12 17 17 F. 106 3 1 1 5 4 11 13 21 19 13 15 Causes ill-defined or unknown M. 1 ... 1 ... ... ... ... ... ... ... ... ... F. 1 1 ... ... ... ... ... ... ... ... ... ... 74 TABLE IV. INFANT MORTALITY DURING THE YEAR 1932. Net Deaths from stated Causes, at Various Ages under One Year of Age. Cause of death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under one year. All Certified 51 8 3 4 66 38 59 32 27 222 causes. Uncertified 2 ... 1 ... 3 2 4 1 ... 10 Measles ... ... ... ... ... ... 1 1 4 6 Whooping-cough ... ... ... ... ... 2 4 4 6 16 Diphtheria ... ... ... ... ... ... ... 1 ... 1 Influenza ... ... 1 ... 1 ... ... ... ... 1 Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... Cerebro spinal meningitis ... ... ... ... ... ... 2 ... ... 2 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 1 ... 1 4 Pneumonia 3 1 ... ... 4 10 8 10 9 41 Other respiratory diseases ... ... ... ... ... . . • • •• ... ... ... Diarrhœa, etc, ... ... ... 1 1 10 27 13 6 57 Congenital debility 19 ... ... ... 19 ... ... ... ... 19 Malformation 2 1 ... 1 4 3 ... ... ... 7 Premature birth 25 4 1 2 32 2 2 1 ... 37 Deaths from violence ... ... 1 • •• 1 1 1 ... ... 3 Atrophy, debility and marasmus 1 ... ... ... 1 9 10 ... ... 20 Other digestive diseases ... ... ... ... ... ... 3 1 1 5 Other diseases 3 2 1 ... 6 1 4 2 ... 13 Totals 53 8 4 4 69 40 63 33 27 232 Net birth in the year of legitimate, 2,163. Net deaths in the year of legitimate infants, 199. illegitimate, 199. illegitimate infants 33. 75 TABLE V. The Work of the Women Health Officers for the Year 1932. HEALTH OFFICERS Total. 1 2 3 4 5 6 7 Child Welfare- First visits to infants (0-1 year) 362 241 259 358 401 77 203 1,901 Return visits to infants (0-1 year) 423 465 535 723 1,079 256 466 3,947 Total visits to children (1-5 years) 1,051 1,028 1,146 673 874 636 796 6,204 Stillbirth enquiries 7 6 13 5 11 1 7 50 Visits to ophthalmia cases 7 10 7 9 11 2 — 46 Return visits to ophthalmia cases 5 21 18 16 33 1 — 94 Visits to measles cases 135 199 210 61 323 168 214 1,310 Visits to whooping cough cases 23 64 39 13 101 86 72 398 Visits to puerperal fever cases — 1 2 — 2 — — 5 Visits to puerperal pyrexia cases 7 4 5 3 7 1 3 30 Visits to enteritis cases 54 11 37 13 21 — — 136 Infantile death enquiries 37 26 24 30 34 10 18 179 Milk investigations 266 45 44 470 277 14 136 1,252 Ante-natal visits 111 72 110 114 83 143 206 839 Half-days at welfare centres 183 143 127 123 196 103 115 990 Special visits 199 303 280 311 181 349 388 2,011 Tuberculosis— Pulmonary.—First visits 17 25 16 29 3 34 40 164 Re-visits 125 192 174 139 18 278 238 1,164 Non-Pulmonary—First visits 3 7 8 5 — 12 6 41 Re-visits 49 154 110 71 — 210 69 663 Rheumatism— First visits to cases notified 11 3 8 7 18 4 3 54 Factories and Workshops Act— Inspections of factories 3 23 35 1 — 6 6 74 Inspections of workshops 5 11 24 6 31 395 178 650 Inspections of outworkers' premises 25 5 10 12 81 207 38 378 Inspections of other workplaces — — — 3 — 15 11 29 Total Visits 3,128 3,059 3,241 3,195 3,785 3,008 3,211 22,609 Notices issued under the Public Health Act- Intimation notices — — — — — 1 1 2 Statutory notices - - - - - - - - Final notices — — — — — — — — Summonses — - — - — - - - 76 TABLE VI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1931. 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, 1932. Column I. successfully 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. 1931. 1st January to 31st Dec. North 1,189 842 5 206 63 11 33 21 8 1,852 South 852 645 11 63 36 19 28 40 10 Total 2,041 1,487 16 269 99 30 61 61 18 TABLE VII. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1932. (as required by Ministry of Health Circular 359). Year of appointment. Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A.W.K. Picard, M.D. 1922 Consultant Medical Officers (Part time). Hugh R. Carter, M.D., (Treatment of zymotic enteritis) 1924 Janet K. Aitken, M.D., (Rheumatism supervisory clinic) 1927 Thomas S. Keith, M.B., B.S. (Lond.), (Bacteriologist) 1928 Alan Morris Johns, M.D., (Consultant gynaecologist and obstetrician) 1932 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 James Carver, M.B., F.R.C.S. (Public vaccinator, St. Mary Abbots Hospital) 1932 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 Victor R. Minter 1932 Beatrice J. Fenton (Temporary) 1930 Ronald F. Rogers ( „ ) 1931 Sanitary Inspectors. *Nelson Males (Senior inspector) 1897 *Charles G. Sexton 1898 *Thomas Cutting 1900 *George W. McQuinn 1901 †John McDermid 1920 ¶†Henry W. Walters (Food inspector) 1925 ¶†Cecil R. Webb 1925 ¶†Redmond J. McCarthy 1926 ¶§John S. Wheeler 1930 ¶§Donald J. Hunt 1931 ¶§Frederick G. Bishop 1931 ¶§Ronald V. Coombs (Temporary) 1932 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 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. W. Whale 1932 * 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 (except Miss Haycock) have undergone 3 years general hospital, training and have secured the certificate of general nursing proficiency, and are qualified health visitors. 78 INDEX. page Advisory committee 33 Acute rheumatism 56 ,, ,, Appendix I Agricultural Produce (Grading and Marking) Act, 1928 47 Ambulance facilities 15 Areas, clearance and improvement 42 Artificial Cream Act, 1929 47 „ pneumothorax treatment 63 ,, sunlight treatment 30 Baby Clinic 29 „ Hospital 29 Bacteriological examination (tuberculosis) 64 „ work (infectious disease) 58 Bakehouses 45 Basement rooms 39 Baths and washhouses 22 Bedding for home isolation of tuberculous patients 64 Births 5 „ notified (table) 6 Birth control 33 Birth rate decline (table) 6 Births, wards and rates (table) 5 Canal Boats Acts, 1877 & 1884 22 Cancer 8 Care and after-care of tuberculous patients 63 Cerebro-spinal meningitis 55 Chapel of Rest 21 Clearance areas 42 Closing Orders in respect of underground rooms 43 Common lodging houses 39 Convalescent homes 31 Day nurseries 31 Deaths 7 ,, causes of 8 „ from certain diseases (table) 9 ,, from cancer (table) 8 „ wards and rates (table) 7 „ from tuberculosis, in wards (table) 60 Dental treatment at infant welfare centres 29 „ „ for tuberculous patients 68 Diarrhoea, summer 55 Diphtheria 53 Disinfection 58 „ (tuberculosis) 64 Dispensary diagnosis and treatment of tuberculosis 61 Distribution of families (housing) 36 Dwellings, rooms and families (housing) 35 Dog nuisances 13 Doubtful diagnosis of tuberculosis 63 Drainage 18 Dwelling houses, inspection of 42 Dysentery 56 Employment of tuberculous patients 64 Encephalitis lethargica 55 Enteric fever 54 Electrical treatment 30 Erysipelas 54 Extra nourishment for expectant and nursing mothers and their infants 32 Extra nourishment for tuberculous patients 63 PAGE Factories and workshops 24 Fitness of houses 41 Following-up of tuberculous patients 63 Food, inspection and supervision of 43 Food and Drugs (Adulteration) Act, 1928 48 ,, ,, ,, ,, (proceedings under) 50 Food premises, inspection of 47 Food poisoning 50 Food supply 43 „ unsound 47 Fouling of footpaths by dogs 13 General provision of health services in area 12 Grants to maternity and child welfare institutions 17 Handicrafts class for tuberculous patients 64 Health lecturer 32 „ propaganda 17 Home contacts of tuberculosis 63 „ helps 32 „ Office tables (Factory and Workshops) 26 „ nursing, (Golborne infant welfare centre) 13 ,, nursing of tuberculous patients 63 „ visiting „ ,, 62 Hospital, general 14 Houses let in lodgings 42 Housing 33 „ accommodation owned by council 38 „ accommodation provided by housing associations 38 „ action under statutory powers 41 „ statistics 42 Ice cream 46 Improvement areas 42 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1923 22 Indecent occupation 40 Infant consultations at welfare centres 28 Infant mortality— 10 Deaths, causes of 11 ,, each month (table) 10 ,, in wards (table) 10 Infant mortality rates (table) 10 Infant welfare centres 28 Infectious disease 51 „ „ cases in four-weekly periods (table) 52 Introduction 3 Kensington District Nursing Association 12 Legal proceedings (sanitary administration) 21 Legislation (local) 13 Light treatment for tuberculosis 62 London County Council (General Powers) Act, 1932 46 & 50 Malaria 55 Marriages 5 Marital condition 5 Massage 30 Maternal Mortality 12 79 INDEX—continued. PAGE Maternity and child welfare 27 ,, home 30 Measles 57 Medicinal baths 57 Merchandise Marks Acts, 1887-1926 47 Midwifery arrangements 13 Milk and Dairies (Amendment) Act, 1922 44 Milk and Dairies (Consolidation) Act, 1915 43 Milk and Dairies Order. 1926 44 Milk (Special Designations) Order, 1923 44 Milk supplied in Kensington 43 Mortuary 21 Non-notifiable diseases 57 Notifiable infectious diseases 51 Notification of Births Act, 1907 6 Notifications of infectious diseases 1928 to 1932 (table) 51 Notifications of tuberculosis, age & sex distribution 59 Notifications of tuberculosis, deaths and death rates since 1922 (table) 60 Notifications of tuberculosis in wards since 1923 (table) 59 Nursing (professional) in the. home 12 Ophthalmia neonatorum 54 Outworkers 25 Overcrowding 40 Pigeons, nuisance from ... ... 23 Pneumonia and influenzal pneumonia ... 55 Pneumothorax treatment for tuberculosis 63 Population 4 & 33 Poliomyelitis and polio-encephalitis 55 Prevention of infectious disease 51 Princess Beatrice Hospital 14 Princess Louise Hospital 14 Proceedings under Housing Act, 1930 43 „ „ Public Health Acts (Housing) 43 Propaganda 17 Public Health (Condensed Milk) lations, 1923-1927 50 Public Health (Dried Milk) Regulations, 1923-1927 50 „ ,, (Meat) Regulations, 1924 45 „ „ (Prevention of Tuber. culosis) Regulations, 1925 60 Puerperal fever 54 ,, pyrexia 55 Queen Charlotte's Hospital ante-natal clinic 30 Rag Flock Acts, 1911-1928 22 Rats and Mice (Destruction) Act, 1919 23 Records (tuberculosis) 61 Refuse collection 17 „ removal from mews 18 Registration of houses let in lodgings 42 „ „ food premises 46 Remedy ot defects without service of notices 43 Removal of aged, infirm or physically incapacitated persons 23 Residential institutional treatment of tuberculosis 62 Rheumatism supervisory centre 15 PAGS Samples adulterated (table) 50 „ formal (table) 48 „ informal (table) 49 Sanitary circumstances of the area 17 „ inspection 18 Inspections made (table) 18 Legal proceedings (table) 21 Notices issued (table) 19 Works completed (table) 20 Scarlet fever 52 School medical service 16 School treatment centres 15 Sewerage and drainage 18 Shelters (tuberculosis) 64 Slaughterhouses 45 Smallpox 52 Smoke abatement 21 Sputum flasks 64 Statistics, summary of 2 ,, vital 4 Subscriptions to hospitals, etc. 17 Travelling expenses of women breastfeeding infants 33 Tuberculosis 59 „ new cases (table) 61 Unsound food 47 Verminous persons, cleansing of 57 „ premises cleansed 57 Vital statistics 4 Whooping cough 57 Women health officers 27 Work done at infant welfare centres (table) 28 X-ray diagnosis of tuberculosis 62 Zymotic enteritis 55 „ death rate (table) 8 APPENDIX I. Fifth Annual Report on the Kensington Rheumatism Scheme 65 APPENDIX II. Causes of Death at Different Periods of Life in 1932 (Table III) 73 Infantile Mortality during 1932 (Table IV) 74 Infectious Disease, Cases notified during 1932 (Table II) 72 Staff of Public Health Department (Table VII) 77 Vaccination Officer's Return for 1931- 1932 (Table VI) 76 Vital Statistics for 1932 and previous years (Table I) 71 Work of Women Health Officers for 1932 (Table V) 75