KEN 42 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1933 BY JAMES FENTON, M.D., D.P.H., Medical Officer of Health. Jas. Truscott & Son, Ltd., Printers, Suffolk Lane, London, E.C.4. SUMMARY OF STATISTICS for the Year 1933. Population (estimated) 181,100 Area of borough in acres 2,291 Density of population per acre 79 Number of marriages 1,927 Rateable value £3,335,398 Product of a ld. rate £13,898 Total. M. F. Live births legitimate 1,964 1,016 948 Birth rate 12.0 illegitimate 201 96 105 Still births 75 45 30 Rate per 1,000 total births 33 Deaths 2,336 1,025 1,311 Death rate 12.9 Percentage of total deaths occurring in public institutions 54% Deaths from puerperal causes:— Rate per 1,000 total (live and still) births Deaths Puerperal sepsis 3 1.7 Other puerperal causes 5 2.2 Total 8 3.5 Death rate of infants under one year of age:— All infants per 1,000 births 72 Deaths from measles (all ages) 3 Legitimate infants per 1,000 legitimate live births 68 „ whooping cough (all ages) 10 Illegitimate infants per 1,000 illegitimate live births 114 diarrhœa (under 2 years of age) 43 Deaths from phthisis 124 Phthisis death rate 0.68 Deaths from all forms of tuberculosis 138 Tuberculosis death rate 0.76 Deaths from the zymotic diseases 90 Zymotic death rate 0.49 3 Town Hall, Kensington, W.8. 5th June, 1934. 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 1933 upon the state of the public health in Kensington. The birth rate for the year under review is 12.0 per 1,000 population, which is the lowest recorded in Kensington; the rates for North and South Kensington respectively are also the lowest on record. The death rate of 12.9 shows a decline on that for the previous year and, with the exception of the rates for 1923, 1926 and 1930, is the lowest in the history of the borough. The infant death rate shows a decrease from 98 in the previous year to 7.2. Whilst this decline is gratifying, the rate is still too high. The rate of 98 in 1932 formed the subject of a detailed investigation during the past twelve months and the findings are shown on page 10. At the present time, the medical practitioners of the borough are making a close study into the causes of infant deaths and their report is awaited with interest. The year 1933 will be remembered as one during which the council devoted a considerable amount of attention to the housing problem. They successfully completed arrangements with the Kensington Housing Trust, the Peabody Donation Fund and the Sutton Dwellings Trust to build some hundreds of flats on the vacant land which they had recently acquired at Dalgarno Gardens ; thus, there will be available re.housing accommodation for people to be displaced from overcrowded houses and basement rooms. During.the year, the council secured in the London County Council (General Powers) Act of 1933, a section which enables them to close unsatisfactory basement rooms for living and sleeping purposes in areas declared to be improvement areas, and to close unfit individual rooms whether let separately or not in such areas. Moreover, they were successful in inducing the central authorities to adopt a standard of 450 cubic feet per person in sleeping rooms in such areas. In June, the council adopted a five years' housing programme and throughout the remaining period of the year much time was devoted to the preliminary steps to be taken in connection therewith. Scarlet fever was prevalent throughout the whole year, but it was of a very mild type and resulted in only one death. There was no other outstanding outbreak of infectious disease during the year, with the exception that just before the close measles became epidemic. 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 Vice. Chairmen 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. VITAL STATISTICS. The Royal Borough of Kensington as constituted under the London Government Aat, 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. Tire borough is further sub.divided into nine wards. North Kensington includes the wards of .St. Charles, Golbome, 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 for the purpose of this report, the population for 1933 has been estimated by the Registrar.General to be 181,100. 4 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 181,100 North Kensington 95,706 South Kensington 85,394 Wards. St. Charles 29,391 Golborne 23,980 Norland 21,930 Pembridge 20,405 Holland 18,651 Earl's Court 18,205 Queen's Gate 14,236 Redcliffe 21,742 Brompton 12,560 MARRIAGES. During the year, 1,927 marriages were registered, representing a rate of 10. 6 marriages per 1,000 of the population. The place of marriage is set out in the following table :— Church of England 710 Roman Catholic Church 259 Nonconformist Church 43 Jewish Church 7 Register Office 908 Total 1,927 BIRTHS. The number of births registered was 2,165, after correction for inward and outward transfers; and the birth rate for the borough was 12.0 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,016 948 1,964 Illegitimate 96 105 201 Totals 1,112 1,053 2,165 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various districts in the borough in 1933, and the rates for the previous five years:— District. 1933. Birth rates in previous years. No. of births. Birth rate. 1932. 1931. 1930. 1929. 1928. England and Wales 580,850 14.4 15.3 15.8 16.3 16.3 16.7 London 62,608 13.2 14.2 15.0 15.7 15.7 15.7 The Borough 2,165 12.0 12.9 14.2 14.6 14.4 14.3 North Kensington 1,547 16.1 17.3 19.6 19.0 19.3 18.7 South Kensington 554 6.5 7.7 7.8 8.2 7.7 8.0 Wards. St. Charles 529 18.0 19.5 21.6 17.9 17.9 20.2 Golborne 525 21.9 23.6 21.3 21.5 21.8 20.8 Norland 290 13.6 15.9 19.8 22.0 21.5 19.3 Pembridge 223 10.9 7.7 14.3 13.6 13.3 13.5 Holland 106 5.6 8.2 9.1 9.4 8.2 10.1 Earl's Court 145 7.9 9.6 9.2 9.8 8.7 8.7 Queen's Gate 80 5.5 5.7 5.1 5.2 6.2 5.7 Redcliffe 138 6.3 7.2 8.4 9.4 9.2 8.1 Brompton 85 6.7 7.2 5.8 5.3 5.0 6.3 Ward unknown 44 • • • ... ... ... ... ... 5 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 1933 12.0 Notification of Births Act, 1907—During the year, 2,165 live births to Kensington mothers were registered, and of this number 2,035 or 94 per cent, were notified in accordance with the requirements of the Act. The number of stillbirths notified was 78, and the number of births notified as having occurred in Kensington but belonging to other districts was 570. 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 20 897 917 „ „ „ parents — 33 . 33 „ „ „ medical practitioners 12 385 397 „ „ „ other persons 21 226 247 Births in the borough 53 1,541 1,594 Notified from institutions outside the borough ... 25 494 519 Totals ... 78 2,035 2,113 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1097. Year. Percentage. 1929 95 1930 97 1931 97 1932 98 1933 94 The importance of securing due compliance with the Notification of Births Act cannot be over.estimated, for the information obtained constitutes the starting point of the work of health visitors. DEATHS. The number of deaths registered in the borough during 1933 was 2,833, but this does not represent the true mortality among the population. 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 " non.residents " taking place in the institutions provided in Kensington for the reception of sick or infirm persons. Total deaths registered in the borough 2,833 Deaths of residents in public institutions, etc., beyond the borough ... 536 3,369 Deaths of non.residents in public institutions, etc., within the borough ... 1,033 Corrected number of deaths belonging to the borough 2,336 The corrected number of deaths gives a death rate of 12.9 per 1,000 living. 6 The following table shows the number of deaths and the death rates in England and Wales, London, Kensington and the various districts in the borough in 1933, and the rates for the previous five years:— District. 1933. Death rates in previous years. No. of deaths. Death rate. 1932. 1931. 1930. 1929. 1928. 1927. England and Wales 496,550 12.3 12.0 12.3 11.4 13.4 11.7 12.3 London 55,615 12.2 12.3 12.4 11.4 13.8 11.6 11.9 The Borough 2,336 12.9 13.6 14.0 12.7 15.4 13.0 13.8 North Kensington 1,235 12.9 13.8 13.8 12.6 15.4 13.4 13.8 South Kensington 1,074 12.6 12.4 13.3 12.5 14.5 12.1 13.4 Wards. St. Charles 321 10.9 12.7 12.5 11.7 13.9 12.0 12.9 Golborne 335 13.9 16.2 14.1 12.3 16.0 13.2 13.8 Norland 311 14.1 14.1 14.2 14.4 17.5 15.3 14.5 Pembridge 268 13.1 12.4 14.2 12.1 14.1 13.4 14.1 Holland 248 13.3 13.4 14.5 12.7 14.4 13.2 13.4 Earl's Court 248 13.1 13.3 14.1 15.0 15.9 13.5 13.7 Queen's Gate 164 11.5 12.6 10.8 11.2 12.7 10.0 13.2 Redcliffe 275 12.7 11.8 15.2 in 15.7 12.9 14.5 Brompton 139 1M 10.5 11.2 11.4 12.5 9.5 11.3 Ward Unknown 27 ... ... ... ... ... ... ... 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 13.36 1933 12.9 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 90 Epidemic influenza 92 Phthisis 124 Other tuberculous diseases 14 Cancer 310 Bronchitis 73 Pneumonia 191 Heart disease 588 Acute and chronic nephritis 55 Puerperal fever 3 Premature birth 36 Violence (including suicide 50) 137 Old age 31 All other causes 592 2,336 It will be seen that over one.third of the deaths, or 976, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 124 deaths. 7 The diseases described in the above list as the "principal zymotic diseases" are smallpox, 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. 1929 0.78 0.57 1930 0.62 0.58 1931 0.34 0.33 1932 0.99 0.61 1933 0.49 0.32 Cancer.—Cancer caused 310 deaths, and of this number 286 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 249 deaths were attributed; sarcoma and epithelioma were the assigned causes of 18 deaths; 43 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, 1933. Parts affected. Sex. Total. Male. Female. Buccal cavity 12 2 14 Lungs 12 7 19 Stomach, liver, etc. 26 37 63 Peritoneum, intestines, rectum 48 58 106 Female genital organs - 30 30 Male genito-urinary organs 3 - 3 Breast - 32 32 Skin 1 - 1 Other and unspecified organs 28 14 42 Totals 130 180 310 The deaths in the several wards, etc., are set out in the following table:— The Borough 310 North Kensington 156 South Kensington 149 Wards. St. Charles 40 Golborne 35 Norland 42 Pembridge 39 Holland 35 Earl's Court 28 Queen's Gate 29 Redcliffe 43 Brompton 14 Ward unknown 5 The number of deaths from this disease was 14 more than in the previous year 8 Table showing the number of deaths in 1933 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 28 — — 1 1 36 12 24 22 37 3 February 25 — — 2 1 31 16 21 12 41 2 March 25 — — 1 — 6 8 21 3 20 2 April 22 — — 1 4 3 12 20 4 14 4 May 20 — — — 3 1 9 30 4 13 3 June 17 — — — — — 6 22 6 8 5 July 15 1 — 1 2 — 5 25 4 5 3 August 12 — — 2 4 1 7 30 — 6 5 September 9 — — — 2 1 11 15 — 2 4 October 7 — — 1 2 1 3 29 2 3 5 November 4 1 1 — 1 1 16 21 5 6 8 December 2 — — — — , 5 7 25 3 16 3 December 30 — — 1 1 6 12 27 8 20 5 Totals 2 1 10 22 92 124 310 73 191 52 Infant Mortality. During the year 1933, there were 2,165 births and 157 deaths of children under the age of 12 months in the borough. These figures give an infant mortality rate (deaths of infants under 12 months to each 1,000 births) of 72. The following table gives the births and the infant deaths and death rates in England and Wales, London, Kensington and the various wards of the borough for the year 1933, and the infant death rates for the previous four years:— District. 1933. Infant mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infant mortality rate. 1932. 1931. 1930. 1929. England and Wales 580,850 36,760 64 65 60 66 74 London 62,608 3,892 59 66 65 64 70 The Borough 2,165 157 72 98 76 69 84 North Kensington 1,547 124 80 116 86 76 93 South Kensington 554 33 59 54 44 55 71 Wards. St. Charles 529 28 53 109 76 64 59 Golborne 525 47 89 112 97 81 121 Norland 290 34 117 142 84 70 88 Pembridge 223 15 67 120 92 96 101 Holland 106 9 85 83 54 84 96 Earl's Court 145 8 55 22 18 46 70 Queen's Gate 80 3 37 59 59 57 46 Redcliffe 138 9 65 70 67 43 54 Brompton 85 2 23 32 14 30 94 Ward unknown 44 2 — — — — — In considering the above and subsequent tables it must be remembered that the deaths of infants at any temporary address (institution or private house) to which the mother went for her confinement, and deaths of infants in institutions to which they were transferred for treatment from the place of birth, are allocated to the district of the usual residence of the mother. 9 INFANT MORTALITY RATES, 1896-1933. Period. England and Wales. London. Kensington. 1896-1900 156 162 176 1901-1905 138 139 144 1906-1910 117 114 120 1911-1915 109 110 110 1916-1920 90 90 96 1921-1925 76 71 83 1926-1930 66 64 77 1931 66 65 76 1932 65 66 98 1933 64 59 72 THE NUMBER OF DEATHS OF KENSINGTON INFANTS OCCURRING IN EACH MONTH DURING 1933. January 12 February 17 March. 18 April 16 May 13 June 10 July 10 August 10 September 8 October 15 November 9 December 19 10 CAUSES OF, AND AGES AT, DEATH OF INFANTS UNDER ONE YEAR OF AGE IN KENSINGTON DURING 1933. Causes of death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total 4 weeks. 1-3 months. 3—6 months. 6—9 months. 9—12 months. Total infant deaths under 1 year. 1. Common infectious diseases. (Whooping cough 4) (Diphtheria 1) - 1 - - - - 2 1 2 5 2. Digestive diseases - - - - - - 1 1 - 2 3. Pneumonia, bronchitis and other respiratory diseases. 1 1 2 - 4 3 2 5 8 22 4. Diarrhoea — — — 1 1 8 16 9 8 42 5. Complications of birth (Atelectasis 4) (Other complications 8). 10 1 1 — 12 — - —. - 12 6. Congenital malformation 5 1 1 1 8 1 - — 1 10 7. Premature birth 31 3 — I 35 1 - — — 36 8. Atrophy, debility and marasmus — 2 2 — 4 7 2 — 1 14 9. Other diseases:— (Cerebro-spinal meningitis 1) (Convulsions 1) (Violence 3) (Other conditions 9) 1 1 1 2 5 2 3 3 1 14 Totals 48 9 7 5 69 22 26 19 21 157 Death rate in each age period per 1,000 births 22.2 41 3.2 2.3 31.9 10.1 12.0 8.8 9.7 72 Percentage of total infant deaths occurring in each age period 30.5 5.7 4.5 3.2 44.0 14.0 17.0 12.1 13.3 During the year under review the high infant mortality rate of 98 recorded in the borough for 1932 occupied the serious attention of the council. One of the council's women health officers was detailed to conduct an investigation into the death of each of the 232 children under one year who died and for some weeks her whole time was occupied in this way. The officer enquired into the financial position of each family, the employment of the mother, the home conditions, cleanliness of the home and mentality of the mother, nutrition of the infant, the influence of migration, previous pregnancies, ante.natal care and whether the mother had attended at any of the infant welfare centres ; she also paid particular attention to the question of illegitimacy and the large number of deaths of children from enteritis. As a detailed report was issued to the council in October last, I do not propose to include it in this report, but merely to give the conclusions arrived at, which are as follows:— 1. The standard of general sanitation in Kensington is not responsible for the high infant death rate. 2. A considerable proportion of the poorest.class mothers do not take advantage of the facilities provided for the welfare of themselves and their babies at the infant welfare centres and ante.natal clinics. 11 3. Many families in the northern part of the borough are of the migratory type; they come and, go before the various maternity and child welfare agencies can get into touch with them. 4. In the year 1932 there was great economic depression, which must have had a detrimental effect on the health of many mothers and children. 5. There is evidence of lack of knowledge or indifference amongst some of the poorer mothers in regard to infant feeding. 6. The importance and value of breast feeding need to be more fully stressed. 7. There is evidence that a number of mothers were anxious to avoid childbirth and took steps to terminate pregnancy by methods which may have been injurious to the health of themselves and their unborn children. 8. The employment of expectant and nursing mothers on occupations outside the home does not appear to have had a detrimental effect upon the health of their infants. 9. There is a need for continued and increased efforts on the part of the borough council and the various voluntary agencies in regard to the education of working.class mothers on matters relating to domestic hygiene, the importance of ante.natal care, infant feeding and child welfare. 10. The number of infant welfare centres and ante.natal clinics in the borough is adequate as is also the health visiting staff, but the ante.natal service should be reorganised in such a way that it will attract a larger proportion of expectant mothers to the clinics and secure their more regular attendance than has been the case hitherto. MATERNAL MORTALITY. In 1933, there were eight deaths of Kensington women from diseases or accidents directly connected with childbirth, and this figure represents a death rate of 3.5 per 1,000 births. The rate for England and Wales for 1933 was 4.42. Puerperal fever was the cause of three of the Kensington deaths, whilst accidents associated with pregnancy were responsible for the other five. Although the maternal death rate of 3.5 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. As an outcome of the investigations into the high infant mortality rate, the council were of the opinion that an improvement could be effected in the ante.natal service by the appointment of a whole.time medical officer to conduct the whole of the work of the various ante.natal clinics. The attendances of mothers at the Kensington clinics for some years has been low. It is tme that a large number of women receive ante.natal care from Oueen Charlotte's hospital and St. Mary Abbots hospital, whilst others are attended by their own private doctors, but nevertheless the ante.natal clinics co.ordinated in the council's scheme can accommodate many more women. It is hoped that the appointment of a whole.time ante.natal medical officer will secure a close contact between the clinics and the maternity homes and hospitals, and extend the usefulness of the work. The new doctor will also have time to study local conditions and administration, and to confer frequently with the medical officer of health. She will be able to conduct more ante.natal sessions than hitherto at the institutions and in this way it is hoped to make a material increase in the number of attendances thereat. On the 27th March, 1934, the council appointed Violet I. Russell, M.D., M.C.O.G., M.B.. B.S., M.R.C.S., L.R.C.P., to the position, and this officer will commence her duties in July next. 12 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. STAFF OF THE COUNCIL'S PUBLIC HEALTH DEPARTMENT. A list of the total staff engaged in the public health department at the end of the year 1933 will be found in Appendix II, Table VII. Vaccination Officer. Under the provisions of sections 2 and 18 of the Local Government Act, 1929, the functions of the Kensington board of guardians and vaccination officer in relation to vaccination were transferred to the Kensington borough council on the 1st April, 1930. The work of vaccination officers is a part of preventive medicine and, together with that of public vaccinators, has been largely responsible for the almost complete elimination of serious smallpox from this country. When smallpox becomes prevalent in a district, the medical officer of health must work in close touch with the vaccination officer and public vaccinators, and indeed, if the best results are to be obtained, these officers must act very largely under the direction of the medical officer of health. It was unfortunate that up to 1930 vaccination officers, whose work is so largely connected with the prevention of infectious disease, were appointed by boards of guardians, who were not directly concerned with this class of work. This difficulty was removed by the Local Government Act, 1929. Mr. A. H. Hinton, the vaccination officer, resigned his office on grounds of ill health on the 8th April, 1933, and his duties were taken over by Mr. J. H. Wilson, the chief clerk in the public health department, and Mr. D. C. Page was appointed clerical assistant. A record of the work of the vaccination officer will be found in Appendix II, Table VI. Infant Life Protection Officer. By the Transfer of Powers (London) Order, 1933, the functions of the London county council under the Children Act, 1908, and the Children and Young Persons Act, 1932, were transferred to the metropolitan borough councils on the 1st April, 1933. On the date of the transfer there were in Kensington 119 registered fostermothers and 133 fosterchildren. During the period from the 1st April to the 31st December, 1933, 52 fostermothers and 28 foster children were added to the register. Thirty.five fostermothers were removed from the register during that period. One of the council's health visitors was appointed to take over the duties of infant life protection visitor, and she immediately paid visits to all the fostermothers on the register. It was surprising to find that out of 113 fosterchildren under 5 years of age residing in the borough, only 34 attended the infant welfare centres. The infant life protection visitor thereupon made it her duty to interview all the fostermothers again in regard to this matter, and at the time of writing, out of 121 fosterchildren under 5 years of age on the register, 109 are in regular attendance at infant welfare centres, and the remaining 12 are seen regularly by private practitioners. From the 1st April to the 31st December, 1933, four deaths were reported. Enquiries were made into each case and it is satisfactory to be able to report that there was no cause for complaint against the fostermother in any case. . Legal proceedings were instituted in one case only, and these were taken against a fostermother for failing to notify the reception of a child under section 1 (7) of the Children Act, 1908, and section 65 of the Children and Young Persons Act, 1932. A penalty of £5 was imposed. The following is a record of the work carried out by the infant life protection visitor during the period from the 1st April to 31st December, 1933 :— Number of visits paid 1,326 ,, .fostermothers seen 1,136 special visits paid 190 „ children removed voluntarily 43 „ „ „ compulsorily 1 „ „ „ to hospital 14 „ deaths . 4 „ cases in which there was cause for complaint 1 „ cases recommended for prosecution 1 fostermothers added to register . 52 „ „ removed from register . . 35 ,, „ on register on the 1st April 119 „ „ „ „ 31st December 136 13 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 1933 was 2,115 and the number of visits paid 47,211. The following is a table of cases attended and visits paid by nurses of the association behalf of the council from the 1st January to the 31st December, 1933:— Cases. Visits. Maternity cases 25 339 Miscarriages 28 335 Pneumonia (5 years of age and over) 69 926 ,, (under 5 years of age) 31 524 Ophthalmia neonatorum and other inflammations of the eves of newly.born children 27 354 Influenza (5 years of age and over) 76 502 „ (under 5 years of age) 13 110 Enteritis and diarrhoea 104 923 Tuberculosis (5 years of age and over) 23 1,259 " (under 5 years of age) — — Measles (5 years of age and over) 2 24 ,, (under 5 years of age) 8 59 Measles and pneumonia (5 years of age and over) 1 7 „ ,, (under 5 years of age) — — Whooping cough (5 years of age and over) 1 17 ,, ,, (under 5 years of age) 9 86 Erysipelas 3 38 Diphtheria 1 6 Pemphigus 5 73 Acute rheumatism 14 538 Puerperal pyrexia 1 7 Totals 441 6,127 For the splendid services rendered, the council paid to the association in 1933 a grant of £300. 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 636 confinements, of which 567 were in Kensington homes. The borough council maintain a maternity home with ten beds, the London county council have at St. Mary Abbots Hospital 48 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 55. 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. In 1930 and again in 1933 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. Three officers in the public health department make observations under the by-law, and during the year 13 breaches of the by-law were reported to the public health committee. Summonses were taken out and fines of 20s. in three cases and 10s. in ten cases were imposed. The number of convictions under this by-law during the past 12 years is 94. 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, a maternity ward and a separate wing for private patients of moderate means, an X-ray and electro-therapeutic department, a casualty department and various clinics. The present accommodation is 82 beds. The scheme when completed will provide an additional 56 beds, making a total of 138 beds, a nurses' home, a post-mortem and pathological deDartment. and administration offices, etc. The work performed at the hospital during the year 1933 was as follows:— In-patients. (a) General wards 1,194 (b) Private wards 307 Out-Patients. Total number of new out-patients 11,667 ,, „ „ out-patients' attendances 58,990 Number of casualties 4,547 Other Treatments. Number of operations—major 1,037 minor 728—1,765 Dental cases 2,342 Massage 2,724 Light treatments 1,326 Superficial therapy 723 Actual patients X-rayed 2,231 Ante-natal Clinic and Maternity Ward. Total number of attendances 1,487 Number of patients admitted to maternity ward 176 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 58 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 22 General surgical 15 Ear, nose and throat 9 Rheumatism 4 Eye 1 Skin 1 Observation ward 4 Private ward 2 Total 58 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 1933. (a) In-Patients. Total number of available beds on 31st December, 1933 58 Average number of available beds during year 54.62 Average number of patients resident daily throughout year 45.59 Number of in-patients in the hospital at beginning of year 36 Number of in-patients admitted during year 1,290 Number of in-patients in the hospital at end of year 52 Average number of days each patient was resident 13.62 Number of patients admitted and discharged during year who were resident for (i) only 1 day 17 (ii) 2 and 3 days 475 (b) Out-Patients. Total number of new out-patients 9,895 Total number of out-patients' attendances 74,956 Number of casualty patients among new out-patients 1,741 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 1933 is as follows:— Number of sessions held 48 Number of individual patients examined— Kensington 295 Hammersmith 56 Other boroughs 17 Total attendances of patients— Kensington 1,170 Hammersmith 232 Other boroughs 73 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 (hi) non.urgent cases of parturition, between the hours of li p.m. and 8 a.m. if letters of admission to maternity hospitals are produced; (b) Fever hospitals of patients suffering from infectious disease ; (c) General hospitals and institutions of non.infectious cases when application is made through the county council's public assistance department. The borough council have entered into an agreement with the county council under which the latter have agreed to remove, between the hours of 8 a.m. and 11 p.m., non.urgent Kensington maternity cases to hospitals at the request of the borough medical officer of health, and the former have agreed to pay the cost. SCHOOL TREATMENT CENTRES. There is in Notting Dale a school treatment centre managed by a sub-committee of the Princess Louise Hospital Board of Management, and the work performed thereat during 1933 was as follows:— Eye cases New cases. Total attendances. 448 1,200 Aural cases 457 944 Minor ailment cases 1,566 17,392 Dental cases 1,025 1,811 A school treatment centre has also been established at the Baby Clinic premises in Tavistock Road, and the record of work for the year 1933 is as follows:— New cases. Total attendances. Minor ailment cases 3,168 24,726 Dental cases 1,655 2,982 Light treatment 62 1,102 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 1933 are as follows:— Tonsils and adenoids 568 Eyes (new cases) 393 Dental cases 465 X-ray cases 14 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 1933 in Kensington. TABLE SHOWING NUMBER EXAMINED AND DEFECTS FOUND Boys. Girls. Number examined Entrants. 774 Age 8. 617 Age 12. 756 Age 14. 717 Entrants. 780 Age 8. 640 Age 12. 803 Age 14. 795 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Malnutrition 13 5 7 4 9 4 2 2 9 6 12 8 10 5 2 2 Skin disease 10 8 3 3 5 3 6 4 9 7 7 4 6 5 ... ... Defective teeth ... 294 ... 204 ... 230 ... 241 ... 297 ... 183 ... 159 ... 201 Enlarged tonsils 89 17 40 9 31 10 24 4 83 19 41 9 30 6 39 9 Adenoids 11 6 2 2 1 • •• 1 ... 8 5 1 ... 2 2 2 1 Enlarged tonsils and adenoids 50 28 11 5 8 5 2 1 52 35 9 5 11 9 10 9 Other nose and throat defects 14 7 10 6 6 2 4 2 9 4 9 7 12 5 6 ... Enlarged glands 66 5 54 2 45 1 31 1 55 8 35 3 31 2 24 ... Eye disease 38 19 16 8 8 6 7 2 25 17 12 7 10 6 6 2 Vision defects ... ... ... 44 ... 88 ... 67 ... ... ... 48 ... 96 ... 80 Otorrhoea 14 7 6 3 8 4 5 4 13 8 9 5 3 2 3 1 Other ear disease 8 3 1 1 3 1 1 1 1 ... 7 3 1 ... Defective hearing 2 ... 3 ... 2 1 1 1 2 ... 4 3 1 ... 2 2 Speech defects 2 ... 3 ... 1 1 6 ... 2 ... 2 ... 1 ... 1 1 Heart defects 17 1 9 3 19 3 10 2 11 1 13 2 16 ... 16 2 Anaemia 18 2 10 3 22 3 9 ... 4 1 7 2 17 4 9 2 Lung defects 29 11 11 3 3 1 2 ... 15 5 4 2 7 2 2 1 Nervous defects 6 3 6 4 10 2 2 ... 9 2 3 14 3 3 2 Phthisis ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other T.B. disease ... ... ... ... 1 ... 1 ... ... ... ... 1 ... Rickets 7 3 2 ... 4 ... 2 ... 2 ... 1 1 ... 4 ... Spinal deformities 3 3 3 1 10 9 7 6 1 1 8 7 16 8 17 9 Other deformities 4 ... 6 1 15 4 7 2 4 1 6 2 12 6 6 6 Other defects 21 13 14 5 23 9 16 3 17 10 19 9 28 11 14 5 Number of children noted for treatment 367 269 325 302 368 266 287 303 * 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 either or both eyes. Entrants Boys 774 200 570 4 138 614 22 - 761 12 1 757 17 - 407 214 153 - - - Girls 780 232 544 4 182 582 16 — 760 14 6 769 10 1 408 231 141 — — — Age 8 Boys 617 209 406 2 115 473 27 2 602 13 2 598 19 - 325 215 77 305 185 100 Girls 640 193 445 2 121 497 21 1 597 37 6 617 23 - 385 205 50 341 176 110 Age 12. Boys 756 226 526 4 155 569 32 - 737 19 - 740 15 1 502 229 25 475 147 133 Girls 808 255 551 - 164 622 22 - 773 31 4 796 12 - 627 165 16 487 182 136 Age 14. Boys 717 219 497 1 182 524 11 - 706 11 - 707 9 1 457 226 34 467 127 122 Girls 795 279 516 — SS0 554 11 - 767 28 — 777 18 — 586 194 15 509 158 126 Total 5,887 1,813 4,055 19 1,287 4,435 162 3 5,703 165 19 5,761 123 3 3,697 1,679 511 2,584 975 727 Percentage 30.8 68.9 0.3 21.9 75.3 2.3 96.9 2.8 0.3 97.8 2.1 0.1 62.8 28.5 8.7 60.3 22.7 17.0 London 54.5 44.8 0.7 20.8 74.9 4.3 96.4 3.2 0.4 98.2 1.7 0.1 69.4 26.0 4.6 63.2 20.3 16.5 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, the Women's Co.operative Society and other organisations. The report of the health lecturer's work appears on page 33. A special feature of the health lecturer's activities during the year has been instruction in the importance of ante.natal care. Talks were given on this subject at all the infant welfare centres and the Baby Clinic. SUBSCRIPTIONS BY THE BOROUGH COUNCIL TO VOLUNTARY HEALTH ORGANISATIONS DURING 1933. 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 Kensington District Nursing Association 5 5 0 St. Mary's Hospital 10 10 0 West London Hospital 10 10 0 Princess Beatrice Hospital 10 10 0 Western Ophthalmic Hospital 5 5 0 Kensal Gospel and Medical Mission 5 5 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 National Hospital for Diseases of the Heart 5 5 0 Charity Organization Society 5 0 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 400 0 0 Notting Hill Day Nursery 455 0 0 Baby Clinic 786 0 0 Bramley Road Infant Welfare Centre 430 0 0 Baby Hospital 1,482 0 0 Queen Charlotte's Hospital AnteNatal Clinic 45 0 0 Campden Hill Infant Welfare Centre 255 0 0 Princess Louise Hospital 400 0 0 Golborne Infant Welfare Centre 712 0 0 Kensington District Nursing Association 300 0 0 Kenley Street Infant Welfare Centre 400 0 0 Evelyn Convalescent Home 16 16 0 Lancaster Road Infant Welfare Centre 585 0 0 Hambledon Convalescent Home 8 8 0 Wayside Cottage Convalescent Home 26 19 6 Raymede and Sutton Trust Infant Welfare Centres 619 0 0 Mutual Registration of Assistance Society 10 0 0 South Kensington Infant Welfare Centre 398 0 0 Association of Infant Welfare and Maternity Centres 8 8 0 Golborne Day Nursery 197 0 0 Lancaster Road Day Nursery 323 0 0 Queen Charlotte's Hospital (Maternity Home) 1,149 15 0 St. Clement's Day Nursery 291 0 0 18 SANITARY CIRCUMSTANCES OF THE AREA. REFUSE COLLECTION. During the past year certain of the council's mechanical vehicles have been replaced by new ones with larger bodies. A number of horse.drawn vehicles have also been converted to trailers, and a number of similar new trailers built. These changes in the work of collection have effected a reduction in the number of horses employed on the work, and have also lessened the cost. Practically the whole of the council's vehicles are now loaded from the rear, and during the coming year the few remaining high.loading horse vans will be converted to low. and rear.loading. The daily collection from traffic.congested streets has further been increased from 14 to 19 thoroughfares, and the collections in these are carried out, in certain thoroughfares, before 9 a.m., and in others before 10 a.m. The council continues to collect refuse in the borough not less frequently than twice weekly. The refuse disposed of at Yeading and Harefield', Middlesex, has been considerably decreased ; 30.9 per cent, is disposed of in the refuse destructor installation at the Wood Lane depot, and 58.4 per cent, is barged away from the Chelsea wharf to a dump beyond Tilbury, Essex. The number of the council's standard type of dustbins sold continues to increase, and 537 were purchased by householders during 1933. A further improvement has been obtained in the storage of refuse, and the use of 1,280 dustholes and unsatisfactory receptacles has been discontinued and portable dustbins substituted during the past four years. The number of containers supplied to premises where large quantities of refuse accumulate has been increased to 63. REFUSE REMOVAL FROM MEWS. Eight portable containers have been substituted for common dustbins in seven mewsways in the borough during the past year, and the method continues to prove a satisfactory arrangement for the storage of house refuse in those particular mews in which there is a number of dwellings, stables and costermongers' stores. The close co.operation between the officers of the public health department and the borough engineer's department has resulted in a continuance of hygienic conditions in mewsways. 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:— Plans submitted Voluntary work. Work under notice. 306 68 Plans approved by the council 306 68 Total reconstruction of drains of premises 63 51 Partial reconstruction of drains of premises 143 116 Repairs to drains by " Economic Method " 31 23 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 3,725 817 19 SANITARY INSPECTION. The following table shows a summary of the inspections, etc., carried out by the male sanitary inspectors during the year:— DESCRIPTION OF INSPECTIONS, &c. NUMBER OF DISTRICT. Housing Inspector. Grand Total 1 o 3 4 5 6 7 8 9 10 Total complaints received 197 269 248 188 251 220 205 170 256 202 — 2,206 Public Health (London) Act, 1891. Complaints received 104 120 138 85 136 218 194 163 250 182 1,590 Houses inspected on complaint 121 123 150 89 136 236 194 170 263 187 — 1,669 „ after infectious disease 217 237 131 289 174 82 59 59 79 45 — 1,372 Re.inspections 896 335 1,732 1,585 1,125 1,272 2,183 794 2,348 1,433 — 13,703 By.Laws re houses let in lodgings Complaints received 93 149 110 103 115 2 11 7 6 20 - 616 Houses inspected on complaint 92 152 110 108 115 2 11 7 6 20 — 623 First annual inspections (furnished houses) - 6 4 31 - 1 1 — — 43 Re.inspections „ „ — — — 2 1 31 — 3 — — — 37 First annual inspections (unfurnished houses) 202 362 160 263 390 50 28 33 48 30 - 1,566 Re.inspections „ „ 1,965 1,899 1,037 1,753 1,365 108 202 37 136 103 58 8,663 Housing Acts, 1925 & 1930— Initial inspections (including preparation or revision of house.to. house card) 665 170 297 161 188 11 73 65 72 113 142 1,957 Re.inspections 29 47 53 10 24 17 1 — 84 — 1,540 1,805 Underground living rooms. Primary inspections 19 18 27 27 31 8 - 5 20 55 210 Re.inspections - 27 13 29 9 13 - - 9 5 9 114 Drainage. House drains tested and inspected 147 52 92 125 156 92 327 42 319 83 104 1,539 Voluntary drainage work. Applications made 28 6 42 59 15 57 90 98 271 156 - 822 Plans submitted 11 8 28 30 29 32 60 43 71 62 - 374 Inspections of workshops 13 14 31 70 58 2 69 93 57 36 — 443 ,, factories 21 40 34 119 33 4 10 13 48 2 — 324 „ bakehouses 10 20 11 25 24 5 11 27 41 10 — 184 „ ice cream premises 14 16 10 — 12 — — 2 11 — — 65 „ other food premises 258 112 90 169 437 237 33 86 74 42 — 1,538 „ mews 109 279 53 58 113 83 298 239 144 215 — 1,590 Smoke observations 20 1 6 37 4 54 — 69 3 — — 194 Other inspections 480 712 569 333 408 505 413 823 590 260 155 5,248 Canal boats inspections — — — — — — — — — — 38 38 Common lodging house inspections — — — 71 — — — — — — — 71 20 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 Inspec. tor. Grand Total l 2 3 4 5 6 7 8 9 10 Kind of notices issued. Public Health (London) Act, 1891. Intimations 315 433 501 348 431 74 117 80 191 83 — 2,573 Statutory notices 61 73 88 41 96 12 18 14 46 5 — 454 Final notices 14 26 20 8 32 — 2 1 15 — — 118 Summonses issued — 2 11 4 4 — — — 2 — — 23 Housing Acts, 1925 and 1930. Sect. 17 (1930) (Repairs) - - - - - - - - - - 125 125 Sec. 127 (1925) (Power of entry) - - - - - - - - - - 436 461 Underground room habitation — — 2 2 — — 2 — — — — 6 Removal of manure 2 13 — 1 — 1 — — — 2 — 19 Smoke nuisance notices - - - - - - - - - - - - Rent Restrictions Act certificates — — 1 — 1 — — 1 — 1 — 4 Special notices included under Public Health (London) Act, 1891, relating to factories - - 2 4 1 - - - 1 - - 8 „ workshops — — 7 — 1 — — — 1 3 — 12 „ bakehouses — 1 1 — 1 — — 1 — — — 4 Other notices 6 36 18 65 14 — — — 50 2 — 191 Report of waste of water to M.W.B. 10 15 6 19 13 2 2 6 4 — — 77 „ dangerous structures to L.C.C 15 14 7 27 11 1 1 10 2 16 104 Canal boats - - - - - - - - - - - - 21 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 8 4 14 20 15 4 18 5 16 5 6 115 Defective drains repaired 19 26 39 30 14 11 46 19 30 19 6 259 House drains cleansed 35 26 23 60 45 14 11 20 44 12 — 290 Water-closets reconstructed 7 38 59 12 47 16 82 31 66 12 6 366 „ repaired 36 19 20 32 81 7 20 9 26 14 7 271 ,, supplied with water 6 1 65 43 8 2 12 — 42 7 6 292 „ new provided 18 9 11 35 6 47 63 56 35 114 — 394 Soil pipes ventilated, repaired, &c. 4 7 16 15 14 5 52 11 48 10 3 185 ,, new provided 7 8 14 35 20 17 27 7 34 14 10 178 Baths, new provided 4 2 13 35 10 74 129 101 76 124 — 568 Sinks, „ „ 27 15 70 39 71 82 104 39 86 105 14 652 Lavatory basins, new provided 9 1 15 56 10 152 250 503 370 562 — 1,928 Cisterns cleansed 5 11 4 11 125 — 6 1 5 1 2 171 „ covered — 10 4 5 17 — 2 — 2 — 1 41 „ abolished 3 — 5 — 1 — — 1 — — 5 15 Taps fixed on rising main 9 4 15 10 32 3 2 1 3 — — 79 Yards, areas paved, drained, repaired 31 33 58 42 94 4 6 6 27 8 42 351 Dustbins provided 27 79 54 62 137 7 15 42 54 22 2 501 Ashpits abolished — — — 1 2 — 1 2 1 — 2 9 Accumulations of filth, &c., removed 16 48 28 27 55 3 24 26 5 12 244 Animals removed 3 1 9 7 1 3 — 24 Overcrowding abated 10 8 1 12 7 2 — — — 2 — 42 Underground rooms, illegal occupation discontinued — 5 3 2 5 2 11 3 - 1 5 37 Roofs repaired 84 125 26 46 130 3 1 9 19 6 43 492 Houses provided with water above basement floor 2 2 7 3 1 3 20 — — 1 2 41 Dampness in dwellings remedied 99 40 50 61 76 3 — 7 37 9 20 402 Closing Orders made under Housing Acts— (a) Houses — — — — — — — — — — — — (b) Parts of houses — — — — — — — — — — 25 25 (c) Underground rooms — — — — — — — — 1 — — 1 Closing Orders determined — 3 — — — — — — — 3 Repairs of houses completed under the Housing Act, 1930 — — — — — — — — — — 137 137 Infectious disease cases removed 179 138 104 158 140 61 72 30 66 33 981 Houses disinfected after infectious diseases (including bedding, clothing, &c.) 260 138 153 159 183 70 147 51 178 41 — 1,380 Rooms in such houses disinfected after infectious disease 264 142 157 162 198 117 163 55 178 50 — 1,486 Houses cleansed under houses let in lodgings by-laws 150 256 141 197 347 52 32 - 23 23 — 1,221 Verminous houses cleansed (including bedding, clothing, &c.) 85 24 21 43 38 20 22 10 80 34 — 377 Verminous rooms cleansed in such houses 128 69 26 68 44 20 32 18 112 38 — 555 Dirty bedding cleansed 21 8 10 6 1 1 — — 52 2 — 101 „ „ destroyed 2 2 2 3 2 1 — — 1 — — 13 Other sanitary works executed 281 238 118 50 225 15 48 1 75 30 6 1,087 22 SUMMARY OF LEGAL PROCEEDINGS TAKEN IN 1933. Offence. No. of summonses. Magistrate's decision. Failure to carry out sanitary repairs 12 In five cases the summonses were withdrawn, the work having been carried out. Order made for work to be carried out in 28 days in one case; in 21 days in one case; in 14 days in two cases; in 7 days in three cases. Failure to comply with by-laws for houses let in lodgings. 5 Fined £2 in two cases; fined £2 and order for work to be carried out in 14 days in one case; order for work to be carried out in 7 days in one case; summons withdrawn, the by-law having been complied with in one case. Failure to abate overcrowding 1 Fined 10s. Failure to comply with the L.C.C. by-laws in connection with drainage work. 5 Fined £1 in two cases; £2 in one case; £3 in one case; £4 in one case. Allowing a dog to deposit its excrement on the public footway. 13 Fined 10s. in ten cases; £1 in three cases. Total 36 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 194 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. Six nuisances were discovered. As the primary action taken by the sanitary inspectors resulted in the abatement of the nuisance, written intimation notices were not served. MORTUARY AND CHAPEL OF REST. During the year under review complaints were received regarding the public mortuary during the hot weather and, in order to remedy this, the council installed a refrigerating plant for the reception of four bodies. The introduction of this plant has proved entirely satisfactory, and it is hoped that no complaints will be received in the future. In addition, the council have provided in the chapel an altar, flower vases, etc., curtains and suitable electric light fittings, thereby greatly increasing the amenities of the mortuary. The council have also arranged for a new flooring to be laid in the chapel, which will improve its appearance. During the year 141 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 14 At the request of undertakers 39 At the request of coroner 83 By the police 5 141 In 83 cases, post-mortem examinations were made under the coroner's warrant. Thirty-four 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. 23 PUBLIC BATHS AND WASH-HOUSES. There are at the public baths a men's first class swimming bath with a capacity of 120,000 gallons, a women's first class swimming bath with a capacity of 45,000 gallons, and a second class men's bath and second class women's bath, each of which holds 45,000 gallons. There are 13 men's and 7 women's first class slipper baths and 34 men's and 20 women's second class slipper baths, and 6 special warm baths. The number of bathers using the swimming baths and slipper baths in the last five years is shown in the following table:— Year. Bathers. 1929 246,085 1930 238,262 1931 218,158 1932 232,384 1933 235,860 In the wash-house or laundry department, there were 88 wash-tubs in use in 1933. The number of women using the wash-tubs in the last five years is shown in the following table :— Year. Washers. 1929 96,192 1930 92,381 1931 90,066 1932 89,766 1933 82,715 There are 8 washing machines and the number of women using these machines in 1933 was 18,577. 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 12, 65, 17 and 10 parts of chlorine per 100,000, the limit set by the above acts being 30 parts per 100,000. The public analyst made an examination of the flock submitted as sample No. 2, which contained 65 parts of chlorine, and whilst it had the appearance of rag flock he was of the opinion that it could not be defined as such and was therefore not subject to the Regulations made under the Rag Flock Acts. INCREASE OF RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-33. Applications made to the council in 1933 for certificates under the Acts totalled seven, and four 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 1933, the canal boat inspector made 38 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 Kensignton, and no cases of infectious disease were reported. 24 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 incapacitated persons living under insanitary conditions. During the year one case was dealt with. It was that of a woman of 78 years of age who was compulsorily removed in 1929 but had been discharged in April, 1930. This woman made a practice of wandering the streets in the night-time, collecting old rubbish and storing it in her rooms, which were consequently in a crowded and offensive condition. As far back as 1925 this woman came under the notice of the sanitary inspector and, after the instigation of legal proceedings, nine cartloads of rubbish were removed from her rooms. When she was eventually removed in 1929, ten cartloads of rubbish (weighing 5 tons 1 cwt.) were removed. On the present occasion, a large quantity of rubbish was removed, the total weight of which was 3 tons 12 cwts. 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 155 Total number of visits paid 2,722 Number of poison baits laid during the year 97,610 „ „ disappeared 90,320 „ „ removed by the rat officer 7,290 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 17 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 89 Number of sewer defects allowing egress of rats made good 10 Number of statutory notices served under the Rats and Mice (Destruction) Act, 1919 — Number of premises cleared of rats 162 During the National Rat Week, held in November, special measures of rat destruction were put in hand in the borough council sewers, at the borough council depots and on railway and canal property in the borough. A report of the work done was subsequently published. NUISANCES FROM PIGEONS. Section 52 of the London County Council (General Powers) Act, 1927, provides that, for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation at any place in the borough of house doves or pigeons having, or believed by the borough council to have no owner, or of preventing or minimising any such nuisance, annoyance or damage which might, in the opinion of the council, be so caused, the council may seize and destroy or sell any such house doves or pigeons in excess of such number as the council may consider reasonable, and take such steps as they may deem necessary for this purpose. It is necessary, however, in the first place for the council tc 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 1933, 287 pigeons were killed and 52 eggs destroyed. Since June, 1928, when the council first took action under this section, 1,438 pigeons have been destroyed. 25 FACTORIES AND WORKSHOPS. The following table shows the various trades and occupations carried on in registered workshops and factories where men are employed:— Trade or Business. Workshops. Factories. Total. Aerated water manufacturers — 2 2 Bakers 40 33 73 Basket makers 2 1 3 Blacksmiths 11 — 11 Blind makers 1 — 1 Boot makers and repairers 66 17 83 Builders 39 7 46 Cabinet makers 6 3 9 Cigarette makers 2 — 2 Coach builders 8 3 11 Coal wharves 2 — 2 Cooked meat dealers — 2 2 Cycle repairers 4 1 5 Dyers 4 2 6 Electricity generating stations — 2 2 Electric light fitting makers 4 4 8 Firewood choppers 2 3 5 Furriers 4 — 4 Gas works — 2 2 Ice cream manufacturers 3 — 3 Instrument makers — 2 2 Ironmongers 2 — 2 Ladder makers 1 1 2 Lampshade makers 1 — 1 Laundries 6 12 18 Marine stores 1 — 1 Masons 1 1 2 Metal workers 7 4 11 Motor engineers and garages 37 24 61 Motor spirit dealers 1 — 1 Photographers 3 — 3 Piano makers — 1 1 Picture frame makers 11 — 11 Pipe makers 1 — 1 Printers 5 7 12 Saddlers 2 — 2 Sausage makers 8 6 14 Sign writers 6 — 6 Steam pressers 3 1 4 Sundry businesses 49 10 59 Sweet manufacturers 2 1 3 Tailors 77 — 77 Timber merchants 7 — 7 Trunk makers 2 — 2 Undertakers 7 1 8 Upholsterers 17 1 18 Washing machine manufacturers 1 1 2 Watch makers 5 — 5 Wax figure manufacturers 2 1 3 Wheelwrights 1 1 Total 463 157 620 26 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 2 — 2 Blind makers 1 — 1 Blouse makers 2 — 2 Boot makers and repairers 1 1 2 Corset makers 9 — 9 Dressmakers and ladies' tailors 238 3 241 Dyers 8 1 9 Embroidery workers 1 — 1 Florists 12 — 12 Furriers 15 1 16 Hairdressers 13 — 13 Invisible menders 3 — 3 Jewellers 1 2 3 Knitted goods 1 — 1 Lace workers 5 — 5 Lampshade makers 2 — 2 Laundries 36 38 74 Milliners 40 — 40 Outfitters 14 — 14 Photographers 4 — 4 Picture frame makers 2 — 2 Restaurants 3 — 3 Sundry businesses 30 6 36 Toy makers 1 — 1 Umbrella makers 1 — 1 Upholsterers 8 — 8 Weavers 1 - 1 Total 454 52 506 Home work.—Of the 145 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 38 Outworkers in domestic workshops 10 Outworkers in their own homes 97 Total number of outworkers 145 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 97 home workers on the register is as follows:— Tailoring 42 Dressmaking 28 Bootmaking 12 Outfitting 5 Drapery 2 Linen working 2 Blouse making 1 Fancy goods 1 Confectionery 1 Embroidery 2 Box making 1 97 27 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 94 „ workshop inspections 650 „ home workers' inspections 300 ,, workplace inspections 24 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) 488 31 — Workshops (including workshop laundries) 1,125 37 — Workplaces (other than outworkers' premises) 213 9 — Total 1,826 77 — II.—Defects Found. Particulars. Number of Defects. Number of Prosecutions. Found. Remedied. Referred to h.m. Inspector. Nuisances under the Public Health Acts:— Want of cleanliness 73 73 1 — Want of ventilation 2 2 — — Overcrowding 2 2 — — Want of drainage of floors 3 3 — — Other nuisances 38 38 1 — Sanitary accommodation:— Insufficient 3 3 — — Unsuitable or defective 19 18 — — Not separate for sexes 10 9 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (Ss. 97-100) — 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) 16 8 13 — Total 166 156 15 — III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. HOME OFFICE TABLES. 28 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 a special investigation was conducted by the council into the high infant mortality rate of 98 which occurred in the year 1932. The report on this enquiry will be found on page 10. As a result, the council came to the conclusion that the ante-natal service was in need of re-organisation. There were ten different doctors engaged in ante-natal work in Kensington infant welfare institutions ; these were in private practice and attended sessions at the infant welfare institutions, averaging about one session per fortnight. They were not in the habit of meeting together to discuss common problems, and it was difficult for the medical officer of health to confer with them as occasion required. As most of their time was devoted to private work, they had little opportunity of studying local administration, conditions, etc. Owing to these disadvantages and administrative difficulties in securing a close contact between the clinics and the maternity homes and hospitals, and in extending the usefulness of the work, the council decided to appoint a full-time medical officer to conduct the whole of the ante-natal work in the Kensington maternity and child welfare institutions. This officer will commence her duties in July next. The question of providing gynaecological treatment for women also occupied the council's attention during the year, and they approved of a scheme of co-operation between the gynaecological clinic which had been established by the North Kensington Women's Welfare Centre at No. 12, Telford Road, W. 10, and the infant welfare institutions of the borough. The gynaecological clinic was opened in January, 1933, and a session is held weekly on Thursday afternoons. The council have decided to make a grant of £20 to the institution in respect of Kensington women treated thereat. The clinic has been very useful in obtaining suitable treatment for mothers, who willingly avail themselves of this source of help, and the infant welfare institutions are co-operating with the clinic. The council's scheme for the provision of extra nourishment to necessitous mothers and infants under five years of age was also reviewed during the year. It was felt that more dinners should be provided for expectant and nursing mothers, and arrangements have since been made for six local bodies who have established dinner centres in the borough to supply free dinners on behalf of the borough council. In addition, a scheme of co-operation between the borough council and the public assistance department of the London county council was entered into whereby expectant and nursing mothers in receipt of poor-law relief could be given extra nourishment by the borough council through the maternity and child welfare institutions. It is provided (a) that the grants of milk in these circumstances should be regarded as additional and not as part of the ordinary relief, and (b) that there should be no material interval between the recommendation for a milk allowance and the granting of the allowance. The scheme has been put into operation, but owing to the short time it has been working it is not possible to make any comments on it. The maternity and child welfare services provided by the council have operated satisfactorily during the past year. The voluntary committees have worked in close co-operation with the borough council and have conducted the various voluntary institutions with efficiency and zeal. 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 1933 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) 337 207 226 258 370 77 171 1,646 Re-visits to infants (0-1 year) 416 474 732 519 900 179 540 3,760 Visits to children between 1 and 5 years 900 1,104 1,380 673 830 538 898 6,323 Still-birth enquiries 12 6 6 7 13 1 — 45 Visits to ophthalmia cases 17 4 8 5 13 — — 47 Return visits to ophthalmia cases 16 9 10 5 67 — — 107 Visits to measles cases 36 11 23 3 94 7 1 175 Visits to whooping cough cases 57 18 49 10 91 25 24 274 Visits to puerperal fever cases 5 4 2 1 — — 1 13 Visits to puerperal pyrexia cases 19 6 2 9 9 4 — 49 Visits to enteritis cases 65 34 59 17 21 2 1 199 Infantile death enquiries 19 21 12 22 32 6 11 123 Investigations re milk applications 324 73 119 494 284 77 48 1,419 Ante-natal visits 155 208 158 171 99 136 141 1,068 Half-days at welfare centres 187 146 132 119 205 101 119 1,009 Special visits 390 333 298 295 162 545 407 2,430 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. 29 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 1933 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 93 259 80 214 170 312 247 240 69 1,684 2. No. of sessions at which doctor attended for infant consultations 46 103 91 147 51 131 151 98 51 869 3. No. of sessions at which doctor attended for special ante-natal consultations 22 51 13 24 25 21 27 24 23 230 4. Total number of individual mothers who attended during the year 321 507 196 446 303 761 530 377 167 3,608 5. No. of individual mothers who attended ante-natal sessions during the year 67 114 26 54 59 98 101 85 42 646 6. Total number of individual children who attended during the year— 1. Children 0 to 1 year 172 323 106 319 225 479 376 249 91 2,340 2. „ 1 to 5 years 184 200 109 256 164 372 462 226 159 2,132 7. Total attendances at centre of mothers for all purposes (excluding the accompanying of children and for the purpose of buying dried milk or other article) 566 1,569 930 1,316 2,213 4,508 2,678 1,783 947 16,510 8. Total attendances at centre of children for all purposes— 1. Children 0 to 1 year 1,999 3,880 1,302 3,195 2,619 5,415 4,764 2,504 1,086 26,764 2. „ 1 to 5 years 1,256 2,383 1,345 5,584 1,615 4,770 4,037 2,968 1,390 25,348 9. Total attendances at dinners (included in Nos. 7 and 8 above)— 1. Mothers — — — 85 — 2,728 — — — 2,813 2. Children — — — 716 — 1,595 — — — 2,311 10. Total attendances at doctors' consultations— 1. Ante-natal mothers 184 555 104 145 240 354 217 269 101 2,169 2. Post-natal mothers 61 179 — 381 64 127 228 471 118 1,629 3. Children 0 to 1 year 687 2,263 1,100 1,765 1,007 2,664 2,329 1,495 565 13,875 4. „ 1 to 5 years 456 1,141 915 1,948 618 1,188 2,042 1,291 787 10,386 11. Average attendances at doctors' consultations— 1. Ante-natal mothers 8 11 8 6 10 17 8 11 4 9 2. Post-natal mothers 1 2 — 2 1 1 2 5 2 2 3. Children 0 to 1 year 15 22 12 12 20 20 15 15 11 16 4. „ 1 to 5 years 10 11 10 13 12 9 13 13 15 12 12. Number of individual children weighed during the year 356 523 207 575 385 858 763 462 251 4,380 13. Total weighings 3,132 6,162 2,400 7,419 4,234 8,522 8,938 4,875 2,410 48,092 14. Number of first visits paid to— 1. Expectant mothers 33 65 — 78 69 213 169 — 35 662 2. Children 0 to 1 year 26 22 — — — 284 — — — 332 15. Total number of home visits paid to— 1. Expectant mothers 124 191 85 13 145 213 237 74 73 1,155 2, Children 0 to 1 year 790 615 380 363 395 853 756 850 219 5,221 3. „ 1 to 5 years 824 446 461 318 379 1,072 707 797 384 5,388 30 table showing the dental treatment performed at the centres in 1933. Centre. No. of patients. No. of attendances Extractions. Fillings. Dentures. Other treatments. Archer Street 95 267 85 28 13 31 Bramley Road 31 67 22 1 4 3 Campden Hill 21 39 24 — 1 1 Golborne 12 12 9 — 3 Kenley Street 73 156 64 1 7 55 Lancaster Road 143 356 131 61 17 109 Raymede and Sutton Trust 296 523 241 21 15 181 South Kensington 77 137 188 12 9 54 Totals 748 1,557 764 124 66 437 THE BABY CLINIC, No. 92, TAVISTOCK ROAD. The Baby Clinic acts both as a treatment centre and as an 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 the 31st December, 1933:— Number of sessions at which doctors attended for infant consultations 151 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 48 Total number of individual mothers who attended 218 Total number of individual children who attended (old) 322 (new) 575 Total attendances of mothers for all purposes (excluding the accompanying of children) 845 Total attendances of children for all purposes 0-1 year 1,925 1-5 years 12,576 Number seen by doctor at consultations:— 1. Ante-natal mothers 240 2. Post-natal mothers 576 3. Children 5,285 Average number seen by doctor at consultations:— 1. Ante-natal mothers 5 2. Post-natal mothers 12 3. Children 35 Number of individual children weighed 897 Total weighings 5,285 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 except four, which are occupied by Paddington patients, are available for children belonging to the borough. The following is the record for the year 1933:— Number of infants in residence at commencement of the year 19 Number of admissions during the year 286 Number of discharges during the year 256 Number of deaths during the year 24 Number in residence at end of the year 25 Average duration of stay in hospital 31 days. ARTIFICIAL SUNLIGHT TREATMENT. (The Baby Clinic and Hospital.) Artificial sunlight treatment is administered at the Baby Clinic and Hospital. During the year 4,368 treatments were given and the average weekly attendance was 84 ; 264 children were treated. 31 MASSAGE AND ELECTRICAL TREATMENT CENTRE. Massage and electrical treatment is undertaken at the Princess Louise Kensington Hospital for Children, and the following is a record of the work conducted thereat during 1933:— New cases— Under 5 years of age 47 Over 5 years of age 128 175 Discharged— Under 5 years of age 43 Over 5 years of age 109 152 Transferred to other hospitals because over age 8 Total cases treated 262 Total treatments given 5,415 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 centres. QUEEN CHARLOTTE'S HOSPITAL ANTE-NATAL CLINIC. Two ante-natal sessions are held weekly at the Queen Charlotte's Hospital ante-natal clinic at No. 240, Ladbroke Grove. The total number of sessions held was 102. Six hundred and sixty-four women attended and of this number 590 were Kensington women. KENSINGTON MATERNITY HOME. The borough council maternity home is conducted by the Queen Charlotte's Hospital authorities at 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 purposes 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 antenatal clinic which is held at Invermead on Mondays at 2 p.m. Statement of work done during last five years. 1929. 1930. 1931. 1932. 1933. No. of applications for admission 177 164 160 161 173 No. of applications accepted 162 158 156 160 173 No. of applications withdrawn after acceptance 17 14 26 26 22 No. of women confined during the year 141 142 130 128 136 The gross cost of the scheme to the council during 1933 was £1,149 15s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £504 10s. 0d. Payments made by patients totalled £495 9s. 6d. GYNAECOLOGICAL CLINIC. This clinic was established by the North Kensington Women's Welfare Centre at No. 12 Telford Road, in January, 1933. A record of the work done during the year is as follows:— Individual patients examined 179 Kensington patients 64 Total attendances 349 Attendances of Kensington patients 144 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. 32 The following table shows a record of children's attendances at the day nurseries in 1933:— Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. 1. Whole-day attendances of children under 3 years of age 5,210 2,457 7,389 2,413 17,559 2. Whole-day attendances of children over 3 years of age 3,000 3,393 2,222 1,041 9,656 3. Total whole-day attendances 8,210 5,940 9,611 3,454 27,215 4. Charges made for each attendance of a child 8d. 9d. 8d. 1s. — 5. Half-day attendances of children under 3 years of age - - 837 492 1,329 6. Half-day attendances of children over 3 years of age — — 649 194 843 7. Total half-day attendances — — 1,486 686 2,172 8. Charges made for each attendance of a child — — 4d. 6d. — 9. Average daily attendance of children 36.3 26.8 48.2 20 — 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 1933, 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 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 — Hambledon Cottage Home, Surrey. No. of mothers admitted with babies 5 No. of mothers admitted without babies Wayside Convalescent Home, Sunningdale. No. of mothers admitted with babies 10 No. of mothers admitted without babies — 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 £52 3s. 6d. 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. 33 The following is a record of the work of the health lecturer during 1933:— Number of lectures. Number attending. Average attendance at lecture. Archer Street I. W. C. 41 337 8.2 Bramley Road 48 520 10.8 Campden Hill „ 38 576 15.2 Golborne „ 49 623 12.7 Kenley Street ,, 42 668 15.9 Lancaster Road „ 66 1,634 24.8 Raymede ,, 36 654 18.2 South Kensington I.W.C 47 835 17.8 Sutton Trust „ 46 723 15.8 Baby Clinic 43 422 9.8 Other institutions 18 945 52.2 Totals 474 7,937 16.75 HOME HELPS. Sixteen applications were received during the year for the provision of home helps under the council's scheme. The assistance requested was granted in 14 cases for a period of 14 days each, and in one case for three weeks ; and one applicant cancelled her request. The gross cost of the scheme to the council during the year was £23 5s. 0d. SUPPLY OF EXTRA NOURISHMENT FOR EXPECTANT AND NURSING MOTHERS AND FOR INFANTS. The expenditure on extra nourishment to expectant and nursing mothers and infants during 1933 showed a further increase. At the beginning of the year, the council estimated for an expenditure of £900, but owing to the difficult economic conditions still prevailing, it was necessary for the council to reconsider their expenditure on extra nourishment, and a further sum of £300 was provided to enable them to continue this service until the end of the financial year, namely, the 31st March, 1934. In the year January to December, 1933, 2,177 grants of milk were made by the council's applications sub-committee. Three hundred and ninety-six of the grants were in response to new applications, and the remaining 1,781 were renewals of grant. Under the council's scheme, 59,764 pints of fresh milk were granted free of charge at a cost of £812 0s. 8d. ; 2,843 packets of dried milk were granted free of charge at a cost of £203 4s. 5d. The following table gives particulars of the dried milk supplied at cost price under the council's scheme:— Name of welfare centre at which the dried milk was distributed. No. of 1-lb. packets sold. Value of milk sold. £ s. d. Archer Street 926 66 17 4 Bramley Road 1,119 79 19 0 Campden Hill 279 19 15 3 Golborne 842 58 18 6 Kenley Street 1,274 87 12 5 Lancaster Road 3,398 245 11 8 Raymede 2,786 198 13 11 South Kensington 144 10 4 0 Totals 10,768 £767 12 1 Six applications for dinners were granted ; three of these were new applications, and three were renewals. The cost of the dinners amounted to £3 0s. 0d. 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 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 34 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 1933, six applications were received and five were granted at a total cost to the council of £1 5s. 0d. 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 £2 5s. 4d. 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, which 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 for the transfer of post-natal women attending infant welfare centres to the new gynaecological clinic which has recently been established by the North Kensington Women's Welfare Centre at No. 12, Telford Road. The committee also reviewed the report of the medical officer of health on the high infant mortality rate of 1932, and made valuable suggestions in regard to the existing services to the maternity and child welfare committee. The ante-natal service provided by the voluntary committees on behalf of the council also occupied the attention of the committee on several occasions, and it was owing to their sympathetic help that the arrangement for one medical officer to take over the whole of the ante-natal work at the infant welfare institutions was made so harmoniously with the various voluntary institutions. The advisory committee is of great value in maintaining efficiency and uniformity in the work of the various voluntary institutions in the borough. HOUSING. SPECIAL POWERS FOR DEALING WITH UNDERGROUND 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. 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. 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. 35 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. The survey undertaken covered 5,403 basements with 10,863 rooms. Of these, 4,134 are used for sleeping purposes, and the number of persons sleeping in them is 8,898. In only 27 of the 5,403 basements was there found evidence of a damp-proof course ; it is probable that a dampproof 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. The council have been endeavouring for several years to prevail upon the central authorities to grant more adequate powers for dealing with the problem of the occupation of unsatisfactory basement rooms, and following consideration of the survey they made further representations, with the result that an appropriate section was included in the London County Council (General Powers) Act of 1933. The section provides that, in a declared improvement area, the council can close underground rooms for sleeping, or for living, or for both purposes, if these do not comply with the regulations relating to such rooms. The section also enables the council to close any unfit room in an improvement area for living and sleeping purposes, irrespective of whether that room is let separately or in conjunction with other rooms. It was realised that there might be some difficulty in persuading Parliament to give these new powers for application throughout the borough and consequently the council asked that they should apply only to declared improvement areas. Kensington is the only authority in the country entrusted with these special measures, and their application will be watched with considerable interest. THE PROBLEM OF CLOSED BASEMENT ROOMS. Unoccupied basement rooms tend to become a source of nuisance to the remaining tenants of the house and to the neighbourhood. In view of the council's power to close unsatisfactory basement rooms in improvement areas, it is desirable that they should possess some power of control after the vacation of such rooms. The first code of improvement area by-laws for Kensington provides that, where a closing order has been made, the occupier must remove any rubbish or refuse from the room and keep it clean and wholesome, and, in so far as it is necessary for effective cleansing, the owner must strip off all unclean or unwholesome paper and remove any woodwork affected by vermin or by wet or dry rot. Moreover, the London County Council (General Powers) Act, 1933, provides that, whilst a closing order remains in force, no person shall use the room otherwise than for a purpose approved by the Kensington borough council. POWERS FOR DEALING WITH OVERCROWDING AND INDECENT OCCUPATION. (a) Overcrowding. The Housing Act, 1930, provides that a code of by-laws must be made in respect of each improvement area declared. The by-laws are intended to prevent and abate overcrowding, and generally to secure improvement of housing conditions and subsequent maintenance of a proper standard of housing conditions in a declared area. The Minister of Health has issued model improvement area by-laws for the guidance of local authorities, and these suggest that in an improvement area each person over 10 years of age (or 5) shall have 40 square feet of floor space, and each person under 10 years of age (or 5) shall have 30 square feet, in a sleeping apartment. In a room 8 feet high this would give a person over 10 years of age (or 5) 320 cubic feet of free air space, and a person under 10 years of age (or 5) 240 cubic feet. The county council have introduced standard by-laws for application to improvement areas in London, and these require 400 cubic feet of air space for each person over 10 years of age and 300 cubic feet for each person under 10 years of age, in a room used as a sleeping apartment. The borough council have urged that in a fully built-up area such as North Kensington, where owing to its proximity to the centre of London, there is a great demand for housing accommodation, and where a large percentage of the rooms are used for both living and sleeping purposes, the standards proposed by the Minister of Health and the London county council are not adequate to enable satisfactory conditions to be maintained. These standards would enable the usual type of house let in lodgings in North Kensington to be occupied by such a large number of persons as to create congestion on the site and to produce unreasonably heavy wear and tear, particularly in the passages, staircases and other parts of the house in common use. These considerations caused the council to press for a higher cubic capacity standard, and it is pleasing to record that the first set of improvement area by-laws for Kensington provides that in each house in an improvement area every person, irrespective of age, shall have 450 cubic feet of air space in an apartment used wholly or partly for sleeping purposes. (b) Indecent occupation. The model improvement area by-laws of the Ministry of Health provide that an occupier of a house shall not knowingly permit it to be occupied at any one time by such a number of persons that the sleeping accommodation will be insufficient to allow the separation of persons of opposite sexes over the age of 14 years, other than persons living together as husband and wife. If the accommodation occupied by a family were sufficient to allow the separation of the sexes, the council would be unable to take action under such by-laws, even if they found evidence of indecent occupation. Thus, this provision is much less stringent than that which the council have hitherto exercised under their own (now repealed) by-laws in respect of houses let in lodgings. Under these old by-laws 36 they were in past years able to take action if they found indecent occupation, no matter what the actual accommodation may have been. Happily, the standard by-laws of the London county council provide that no person, whatever the accommodation he may have, shall permit persons of the opposite sexes over 12 years of age and not being persons living together as husband and wife, to occupy the same sleeping apartment in a house let in lodgings. Not only is this provision more rigid, but it also reduces the age from 14 to 12 years. The council can now apply in improvement areas the same control in this matter as they exercised years ago under their own by-laws. It may be mentioned that the enforcement of this provision was not faced with any real difficulty, for in their action the council had public opinion behind them. These legislative improvements, which have been secured in the past 12 months and which will apply in improvement areas, represent the successful conclusion of efforts made by the borough council during the course of some years and it is hoped that they will enable effective steps to be taken to deal with the most important local housing problems, namely, occupation of unsatisfactory basement rooms, and overcrowding. THE FIVE YEARS PROGRAMME. In a circular issued on the 6th April, 1933, the Minister of Health requested that each local authority should prepare and submit to him a programme of slum clearance and improvement of housing conditions to be carried out not later than 1938, and he asked that the statement should contain the following information:— (i) A list of areas in which clearance is necessary, with information of the number of houses to be demolished in each, and of the number of their inhabitants. (ii) A list of areas in which improvement by way of reconditioning or other means is necessary, with information as in (i) above. (iii) A time-table for the initiation, progress and completion of action to secure clearance or improvement, as the case may be, of all these areas. (iv) A time-table of re-housing co-ordinated with the displacements contemplated by the time-table of clearance operations. The Minister urged that each local authority should make an immediate beginning by the declaration as clearance or improvement areas of such areas as could be dealt with at once. He also asked that the programmes should be submitted to him not later than the 30th September, 1933. The following is a brief statement of the programme adopted by the council on the 13th June, 1933:— 1. Clearance Areas. It was proposed that the houses in the following areas should be demolished:— Description of Area. No. of houses. No. of persons in occupation who would be displaced on demolition. Southam Street and Adair Road corner 6 93 Barker Street 16 257 Hayden's Place and Tavistock Mews 9 31 Bramley Mews 13 43 Silvester Mews 18 79 East Mews Road 14 60 Manchester Mews 4 16 80 579 2. Improvement Areas. The following is a list of the seven areas recommended for treatment as unprovement areas:— Area. Estimated No. of persons to be displaced. By demolition of unfit houses. By enforcing new bylaws for overcrowding in improvement areas. By closure of unsatisfactory basement rooms and other individual unfit rooms. Total. Southam Street area 178 620 612 1,410 Treverton Street area 73 118 228 419 Bolton Road area 140 246 46 432 Crescent Street area — 163 176 339 Blechynden Street area — 24 — 24 Camelford Road area — 11 116 127 Portland Road area 101 86 4 191 Totals 492 1,268 1,182 2,942 37 The following is a summary of particulars of the seven improvement areas:— Total number of houses in improvement areas 910 Population „ „ „ 12,010 Number of families „ „ „ 3,364 Number of houses suggested for demolition 85 (Eight of these are large tenement houses). Total number of families to be displaced 676 Total number of persons to be displaced 2,942 When the 1,268 persons have been displaced on account of their overcrowded conditions, there will remain vacant approximately 104 one-roomed tenements, 93 two-roomed tenements and 17 three-roomed tenements. These vacated rooms can be taken over by congested families in the remaining parts of the houses in which the rooms are situated, or may be re-occupied by smaller families from elsewhere. 3. Individual Houses not Capable of Repair at a Reasonable Cost. The following were included in the five years programme as dwellings to be dealt with as unfit for occupation. In each case they are mews dwellings with stables, garages or store places below. No. of No. of No. of persons houses. families. to be displaced Stanley Gardens Mews 9 9 41 Pelham Mews 11 11 50 Roseland Place 5 5 15 Albion Place 4 4 12 29 29 118 4. Houses for Re-conditioning under Section 17 of the Housing Act, 1930. It was estimated that it will be necessary to deal with 300 houses outside the above-mentioned areas under this heading during the next five years, but this work will involve no displacements. 5. Statement of Total Demolitions, Closures and Displacements of Persons for whom New Housing Accommodation will be Required. Description. Houses to be demolished. Houses to be closed (all mews dwellings). Total no. of persons displaced by demolition, closure or application of other powers and for whom new accommodation will be required. Clearance areas 80 — 579 Improvement areas 85 — 2,618* Individual unfit houses — 29 118 Totals 165 29 3,315* * The figure of persons to be displaced from improvement areas was calculated on the assumption that every person over 10 years of age would have 400 cubic feet and every person under 10 years of age would have 300 cubic feet of free air space in a sleeping room. In the first set of improvement area by-laws the standard has now been fixed at 450 cubic feet per person, irrespective of age, and, based on this standard, the figure 2,618 becomes 3,354, and the figure 3,315 becomes 4,051. 6. Rehousing Schemes. Shortly before the council prepared their five years programme they purchased 9£ acres of land at Dalgarno Gardens, North Kensington, and arrangements were made with the Kensington Housing Trust, the Peabody Donation Fund and the Sutton Dwellings Trust, for the erection of flats or tenements thereon. Furthermore, the council contemplated in their five years programme that either they or public utility societies would erect new housing accommodation on some of the 38 areas to be cleared. The following table shows the proposals included in the five years programme in this respect:— BUILDING SCHEMES APPROVED. No. of flats or tenements. No. of habitable rooms. No. of persons for whom accommodation is available. Housing society's or council's scale. 1½ persons per habitable room. Dalgarno Gardens Housing Site. Peabody Donation Fund 363 1,004 1,607 (13/5) 1,506 Sutton Swellings Trust 102 347 694 (2) 520 Kensington Housing Trust 80 295 492 (12/3) 442 Tenements to be erected by Council. Talbot Grove and Mews 44 186 279 279 Adair Road and Southam Street 9 33 49 49 Total 3,121 2,796 BUILDING SCHEMES SUGGESTED. (Council or Public Utility Society.) Silvester Mews *34 136 — 204 East Mews Road 15 60 — 90 Bosworth Road 6 24 — 36 Treverton Street 6 24 — 36 Total Say, 366 366 Grand Total 3,487 3,162 * In a five-storey building. It will be seen, therefore, that if the maximum accommodation in the above tables is available, there is a surplus accommodation for 172 persons if the 400 c. ft. scale is adopted and a minus accommodation figure of 564 persons if the 450 c. ft. scale is adopted. If it is based on the lower density of l£ persons per room throughout, there is a deficiency of accommodation for 153 persons and 889 persons respectively. The five years programme sets out a time-table showing the number of persons to be displaced in each of the five years and the amount of rehousing accommodation which will become available in each of these years. This time-table has been prepared so as to secure that as persons are displaced from their existing homes there will be new housing accommodation ready for them. All the rehousing accommodation is within the borough. PROGRESS MADE WITH THE FIVE YEARS PROGRAMME. Clearance Areas. 1. Adair Road and Southam Street Corner. This area was declared to be a clearance area on the 28th July, 1931. The property was acquired voluntarily by the council, and, as a consequence, there was no local enquiry by the Ministry of Health. In view of the difficulty of securing alternative accommodation, the area had not been cleared by 1933, and, therefore, it was included in the five years programme. The six houses have now been demolished ; nine flats are being erected and will be ready for occupation during 1934. 39 2. Barker Street. This area was declared to be a clearance area by the council on the 28th July, 1931, but in the absence of alternative housing accommodation for the persons to be displaced nothing further had been done up to the time of preparation of the five years programme. In the early part of 1934 the council made an order for the demolition of the buildings and subsequently a local enquiry was held by the Ministry of Health. 3. Hayden's Place and Tavistock Mews. The council declared this area on the 3rd October, 1933. On the 6th March, 1934, they made an order for the demolition of the buildings and subsequently a Ministry of Health local enquiry was held. 4. Silvester Mews. The council declared this area on the 3rd October, 1933. On the 6th February, 1934, they decided to secure the clearance of the area and made an order for the compulsory purchase of the land. A local enquiry was subsequently held by the Ministry of Health. 5. Brantley Mews. 6. East Mews Road. 7. Manchester Mews. No official action has yet been taken in regard to these three areas, which are included in the five years programme. 8. Gadsden Mews. This mewsway was included in the Southam Street improvement area in the five years programme and the houses therein were scheduled for demolition as part of the improvement area procedure. It was subsequently decided that it would be more satisfactory to treat the mewsway as a clearance area ; consequently, on the 9th January, 1934, the council declared the area to be a clearance area, and on the 6th March, 1934, they made an order for the demolition, which was followed by a Ministry of Health local enquiry. There are 14 dwellings in Gadsden Mews and their demolition will involve the displacement of 44 persons. 9. Edenham Mews. This mewsway was included in the Southam Street improvement area and the buildings therein were scheduled for demolition ; but, as in the case of Gadsden Mews, it was subsequently decided that it would be more satisfactory to deal with the area as a clearance area, and on the 6th February, 1934, it was declared to be a clearance area. Further action is pending. There are in Edenham Mews ten buildings, and their demolition will involve the displacement of 34 persons. Improvement Areas. 1. Southam Street Area. Following the adoption of the five years programme, negotiations were commenced with the county council in regard to improvement area procedure, and it was eventually decided that the Southam Street improvement area should be divided into two separate areas, namely, Southam Street area No. 1 and Southam Street area No. 2. On the 28th November, 1933, the council requested the county council, in accordance with the provisions of Section 70 of the London County Council (General Powers) Act, 1933, to pass resolutions declaring that the Southam Street areas should be respectively defined on maps and declared to be improvement areas. The county council made the necessary declaration on 23rd January, 1934 ; they also made a code of improvement area by-laws for application to these two areas in February, 1934, and these were confirmed by the Minister in April, 1934. During 1933 two sanitary inspectors were busily engaged in making surveys of the two Southam Street improvement areas so that there would be in readiness a list of all the families to be displaced immediately the necessary powers were granted. In view of the vast amount of work to be undertaken in improvement areas, the public health committee set up in 1933 a defective houses sub-committee. In the early part of 1934 the subcommittee commenced the task of making inspections of basement rooms and interviewing families living under overcrowded conditions in the Southam Street areas. Some of the basement rooms have already been closed officially, and a number of others have been scheduled for closure immediately new housing accommodation becomes available for the tenants to be displaced. 2. Crescent Street area. On the 11th July, 1933, the council requested the county council, in accordance with the provisions of Section 70 of the London County Council (General Powers) Act, 1933, to pass a resolution declaring that the area should be defined on a map and declared to be an improvement area, and after various conferences in regard to boundaries and other details the appropriate declaration was made in the early part of 1934. The county council have forwarded draft by-laws which they propose should be made in respect to this area. The by-laws are identical with those which apply to the Southam Street areas. 3. Other areas. No official action has yet been taken in regard to the other improvement areas included in the five years programme, but steps will be taken in these cases so as to synchronise displacements with the provision of new housing accommodation. 40 Individual Houses not .Capable of Repair at a Reasonable Cost. During 1933, closing orders were issued in respect of the nine houses in Stanley Gardens Mews and the eleven houses in Pelham Mews. In the case of the former mews three houses are now empty, and in the latter case all the eleven houses have been cleared of tenants. Official action has not yet been taken in regard to Roseland Place and Albion Place. Reconditioning. The work under this heading is dealt with on page 42. It will be observed that considerable progress has been made in connection with the five years programme, and at the time of writing (April, 1934) the programme is proceeding in clocklike fashion. HOUSING ACCOMMODATION ALREADY PROVIDED OR APPROVED BY THE BOROUGH COUNCIL. The following is a list of the properties owned and managed by the borough council:— Situation of properties. No. of houses or flats. Kenley Street, Seymour King Buildings, 4, Hesketh Place, and 6, Runcorn Place 120 St. James's Place, Bosworth Road, Sirdar Road, Hesketh Place and Windsor House 103 Adair Road and Southam Street (To be completed during 1934.) 9 Powis Square, Colville Terrace, Elgin Crescent, 85, Ladbroke Grove, 47, Bassett Road and 20a, Adair Road 102 (conversions) St. Quintin Estate (Sec. 1 & 2) and Avondale Park Gardens 116 St. Quintin Estate (Sec. 3, 4 & 5), Threshers Place, etc. 131 L.C.C. Wormholt Estate (Right to nominate tenants) 99 135-137, Lancaster Road 20 Talbot Grove and Mews (To be completed during 1935.) 44 The council have adopted the Octavia Hill system of management by women property managers for their properties in the Notting Dale and Kensal Town districts of the borough. ACCOMMODATION PROVIDED IN THE BOROUGH 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. In the latter part of the year work was begun on a site at Dalgarno Gardens, about one acre in extent, leased to the Trust by the Kensington Borough Council at a peppercorn rent for 999 years. The proposed building will comprise eighty flats, and it is hoped that they will be ready for occupation in the autumn of 1934. B. The Wilsham Housing Trust own 75 single family houses, 66 self-contained flats and 54 houses let in lodgings. C. The Improved Tenements Association acquired during the year the freeholds of ten houses and the leaseholds of fifteen. At the end of the year they held 173 freehold houses, 67 leasehold houses and 53 freehold ground rents. D. Several smaller housing associations, closely associated in management with the Wilsham Trust, owned at the end of the year 39 houses and 14 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. In 1932 the council acquired the last remaining building site of any size in the borough. It measures approximately 9J acres and adjoins the Sutton Trust Estate. The Peabody Donation Fund have taken over on a long lease at a nominal rent about five acres of the land and are building blocks of flats which will eventually provide accommodation for 1,607 persons. Accommodation will be available in 1934 for 645 persons, in 1936 for 554 persons, and in 1938 for 408 persons. As mentioned above, the Kensington Housing Trust have taken over at a nominal rent one acre of the land and are now building flats to accommodate 492 persons. The Sutton Trustees have purchased approximately one acre of the land and are now engaged in building flats which are expected to be ready in 1934 and to provide accommodation for 694 persons. The total number of flats which will ultimately be erected at Dalgarno Gardens by these three housing associations is 545. 41 COMMON LODGING HOUSES. The Transfer of Powers (London) Order, dated March 9th, 1933, transferred as from the 1st April, 1933, the functions of the London county council with respect to common lodging houses in Kensington to the borough council. Common lodging houses must be licensed annually, and the licences in force when the council took over expired in June, 1933. Applications for renewal of licences were received in respect of each of the five common lodging houses in the borough and the public health committee, after consideration of all the circumstances, decided to renew them on the same terms as the ones which were granted the previous year by the county council. The following table shows details of the accommodation available in the common lodging houses :— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed in 1933. Male. Female. Total. Golborne Chesterton, Ada Elizabeth 194, Kensal Road — 71 71 Norland Hankins, John W. 28 & 30, Crescent Street 54 — 54 M 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 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 occupant has the amount of cubic feet of air space set out below :— Each person Each person over 10 years under 10 years must have in a must have in'a room used room used room used room used exclusively. for living exclusively for living for sleeping and sleeping for sleeping and sleeping c. ft. c. ft. c. ft. 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 sexes 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. 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. Overcrowding 1927 1928 1929 1930 1931 1932 1933 Intimation notices served 88 72 33 25 42 84 45 Statutory notices served where the intimation notice was not complied with 28 10 13 10 7 6 4 Summonses issued 9 3 3 5 3 3 1 Indecent Occupation :— Intimation notices served 92 84 23 27 16 28 37 Statutory notices served where the intimation notice was not complied with 2 6 1 7 1 - - Summonses issued - 1 - 1 - - - As only 27 summonses were eventually issued in 389 cases of overcrowding, and only two summonses in regard to 307 cases of indecent occupation in the seven years, it will be seen that 667 families were able to improve their accommodation without the council having to resort to extreme measures. 42 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 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 instances in which No. of houses let rooms vacated have and notified to been let to Kensington M.O.H. in advance families living under of occupation. unsatisfactory or overcrowded conditions. New houses provided by the borough council 106 74 New houses provided by the London county council 363 196 New houses provided by public utility societies, etc. 367 221 FITNESS OF HOUSES. Housing Act, 1930. The following table gives a statement of the action taken and the results obtained during 1933 under Sections 17 and 18 of the Housing Act, 1930 :— Notices served in 1932 which were outstanding on 1st January, 1933 79 Notices served from 1st January to 31st December, 1933 125 Section 17 notices withdrawn 6 Appeals by owners to the County Court (these have all been withdrawn or adjourned) 6 Notices satisfactorily complied with by the owners 137 Cases in which the council carried out the work in default of the owners ... Nil Notices in respect of which satisfactory progress was being made on 31st December, 1933 20 Notices in respect of which nothing had been done at the end of the year (the time allowed had not expired in these cases) 35 Cases in which the council's contractors were engaged in executing repairs in default of owners at end of the year 1 Total expenditure incurred by the council in executing repairs during the year Nil From the commencement of this work about eleven years ago up to the 31st December, 1933, the council have expended £3,297 10s. 0d. in carrying out work in default of owners. Of this sum £3,202 10s. 4d. has been recovered, and the outstanding amount of £94 19s. 8d. with interest is now being collected. In this period 997 houses have been dealt with under Housing Act repair procedure. Of this number no less than 635 houses have been dealt with in the last four years, during which time certain members of the staff have concentrated their time wholly upon this class of work. 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 my colleagues ; 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. During the year the council made closing orders under Sections 19 and 20 of the Housing Act, 1930, in respect of one underground room, with the result that the use thereof for sleeping purposes has been prohibited. The council also made closing orders in respect of 25 mews dwellings. In 16 cases these orders have been complied with, but in nine the tenants have not yet left. The council took action in 1933, under Sections 19 and 20, in respect of two dwelling.houses ; and in each case the owner gave an undertaking that he would make the house fit for habitation. In one case he has done so and the undertaking has been cancelled. In the other nothing has yet beeh done, and the house remains unoccupied. An undertaking given in 1932 in respect of another house was cancelled in 1933, the owner having carried out the necessary work. 43 BY-LAWS RELATING TO HOUSES LET IN LODGINGS. During 1933, twenty-nine houses were placed on the council's register of houses let in lodgings and two were removed ; the total number registered at the end of December, 1933, was 3,159. 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 main taining 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 1933 :— No. of houses inspected under the by-laws 2,232 Total number of inspections 10,874 No. of instances where the houses were cleansed under the by-laws 1,221 HOUSING STATISTICS FOR 1933. 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 1346 :— 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) 7,088 (b) Number of inspections made for the purpose 29,696 (2) (a) Number of dwelling.houses (included under sub.head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,957 (b) Number of inspections made for the purpose 2,080 (3) Number of dwelling.houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation (excluding properties mentioned in five years programme) 2 (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 2,847 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 149 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 125 (2) Number of dwelling.houses which were rendered fit after service of formal notices :— (a) By owners 137 (b) By local authority in default of owners Nil B.—Proceedings under Public Health Acts :— (1) Number of dwelling.houses in respect of which notices were served requiring defects to be remedied2,573 (2) Number of dwelling.houses in which defects were remedied after service of formal notices :— (a) By owners 2,573 (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 Nil (2) Number of dwelling.houses demolished in pursuance of demolition orders Nil , (3) Number of dwelling.houses in respect of which undertakings were given that the premises would not be used for human habitation 2 (4) Number of cases in which the undertaking was cancelled, the owner having carried out the necessary work 2 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— 1 (2) Number of mews dwellings in respect of which closing orders were made ... 25 (3) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 3 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 1933, twenty.nine samples were so taken, and one only of these was found to contain tubercle bacilli. The result in this case was communciated to the medical officer of health of the county in which the milk was produced. 44 Of 322 formal samples of milk taken under the Food and Drugs (Adulteration) Act in 1933, 11 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 1933. Months. Number of formal samples taken. Average composition of all samples submitted, genuine and adulterated. Average composition of genuine samples. Ministry of Agriculture standard. Percentage of milk fat. Percentage of solids not fat. Percentage of milk fat. Percentage of solids not fat. Percentage of milk fat. Percentage of solids not fat. January 18 3.71 8.84 3.71 8.84 3.0 8.5 February 28 3.66 8.78 3.66 8.78 March 28 3.63 8.79 3.63 8.79 April 25 3.58 8.77 3.58 8.77 May 46 3.47 8.96 3.53 8.93 June 18 3.51 8.80 3.51 8.80 July 29 3.66 8.71 3.72 8.72 August September 14 36 3.84 3.89 8.57 8.74 3.84 3.89 8.57 8.74 Average composition of normal cow's milk. October November 31 43 3.88 3.77 8.78 8.59 3.88 3.87 8.78 8.97 Percentage of milk fat. Percentage of solids not fat. December 6 3.77 8.83 3.77 8.83 322 3.71 8.77 3.73 8.79 3.7 8.9 The table shows that the average fat and non.fatty solid content for each month of the year is well above the legal standard, and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content as low as 3 per cent. Milk and Dairies (Amendment) Act, 1922, and Milk and Dairies Order, 1926.—A summary of the alterations made in the register of dairymen and dairies during the year 1933 and the number of persons and dairies registered at the end of the year is shown in the following table :— Purveyous of milk in sealed bottles. Dairymen. Dairies and milkshops. Transfers — 17 17 Added to register 13 9 3 Vacated and removed from register — 6 4 Dairymen with premises outside the borough added to register _ 14 — On register January 1st, 1933 72 162 152 On register December 31st, 1933 85 179 151 (+) Increase. (—) Decrease + 13 + 17 — 1 The total number of inspections of dairies and milkshops in the borough in 1933 was 403. During the year two persons were convicted of carrying on the trade of a dairyman in the borough without being registered. In one case the defendant was trading in Kensington from premises situated in an adjoining borough, and a fine of £1 was imposed. The other case presented considerable difficulty. In December, 1932, upon receipt of an application for registration in respect of premises which were already registered, the council's food inspector visited the premises in order to carry out an inspection. He was interviewed by a man whom he knew well and who was the defendant in the proceedings which followed. This man appeared to have a considerable interest in the business, but when questioned alleged that he was only an employee acting on behalf of the person who had applied for registration. During the next few weeks a number of samples of milk were taken, and on each occasion the inspector was served by the defendant, but the applicant's name was given each time as that of the owner of the business. Shortly afterwards three men commenced selling milk from the same premises and it was found that each had paid a sum of money to the defendant for the purpose of purchasing a milk round. Proceedings were taken against the defendant for (a) selling milk without being registered, (b) failure to supply to an officer of the council information reasonably required by him, and (c) selling milk from a vehicle not having the name and address of the vendor inscribed thereon. A conviction was recorded in each case, and fines and costs amounting to £47 10s. Od. were imposed. The premises concerned were subsequently removed from the register. 45 Milk (Special Designations) Order, 1923.—Under the Order the council are authorised to grant licences to persons other than producers to sell milk under special designations. Every licence granted is valid for a period ending on the 31st December in the year in respect of which it is granted. The Order lays down a schedule of fees to be paid by applicants for licences. The licences granted in 1933 were as follows:— (a) Dealers' licences to use the designation " Certified Milk " 12 (b) Dealers' licences to use the designation " Grade A (Tuberculin Tested) Milk" 18 (c) Dealers' licences to use the designation " Pasteurised Milk " 42 In all but five 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.four samples of " Certified Milk," seven of " Grade A (Tuberculin Tested) Milk," and sixteen of " Pasteurised Milk " were taken for the purpose of ascertaining whether they complied with the bacteriological standards laid down in the Milk (Special Designations) Order, which are as follows :— Maximum number of Special grade of milk. bacteria permitted per c.c. Standard for bacillus coli. " Certified Milk " 30,000 Must not be found in one. tenth c.c. " Grade A. (Tuberculin Tested) Milk " 200,000 Must not be found in one. hundredth c.c. " Pasteurised Milk " 100,000 No standard prescribed. The results of the examinations, together with the action taken, are shown in the following tables:- " Certified Milk." Sample collection on Bacteria per 1 c.c. Coli per 1/10th c.c. Sample collection on Bacteria per 1 c.c. Coli per 1/10th c.c. 28th March 600 Nil. 9th August ... 27,800 Nil. 4th April 500 „ „ „ 770 Present. 11th „ 280 „ 15th „ 690 Nil. 9th May 310 „ „ „ 1,150 „ „ „ 270 „ 19th September 960 „ 13th June 200 „ „ „ 470 „ „ „ 570 „ 26th 180 „ 20th „ 820 „ „ „ 3,100 „ 12th July 580 „ 10th October ... 360 „ „ „ 220 „ „ „ 500 „ 18th „ 1,880 „ 14th November 360 „ 31st „ 570 „ „ „ 3,500 „ The results in each case were forwarded to the Minister of Health, who grants the licences to producers. " Grade A (Tuberculin Tested) Milk." Bacteria Coli per Sample collected on per 1 c.c. l/100th c.c. 26th April 210 Nil. 420 31st July 1,740 12th September 310 „ 13th „ 540 17th October 230 „ 31st „ 1,360 " Pasteurised Milk." Sample collected on Bacteria per 1 c.c. Sample collected on Bacteria per 1 c.c. 28th March Plates 18th July 4,480 countable 12th September 61,000 owing to 3rd October 3,100 spreading „ „ 29,600 organisms. 28th November 27,000 4th April Do. „ „ 1,800 11th „ 10,000 13th December 4,800 16th May 2,500 „ „ 1,000 „ „ 5,100 30th „ 7,500 With one exception, every sample of graded milk came within the standards prescribed in the Order. With the exception of two certified " and three " pasteurised " samples, the results show that these designated milks were of a very high degree of purity. The council have for some years taken firm action with a view to securing a high degree of purity in designated milks, and it must be gratifying to note the extraordinary improvements over previous years which the results for 1933 show. 46 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 127 slaughterhouse inspections were made. There were slaughtered in the borough in 1933, 6 beasts and 585 sheep. Fourteen lungs were condemned. Slaughter.houses.—On the 1st April, 1933, the duties relating to the licensing and supervision of slaughter.houses, formerly carried out by the London County Council, were transferred to the metropolitan borough councils by virtue of the Transfer of Powers (London) Order, 1933. The licences granted by the London county council in October, 1932, in respect of two slaughterhouses in Kensington were extended in October last by the borough council until the 30th June, 1934. The premises are kept in a cleanly condition, and from a structural point of view are not open to objection. Slaughter of Animals Act, 1933.—Section 1 of this Act provides that every animal slaughtered in a slaughter.house or knackers' yard, shall be instantaneously slaughtered, or shall by stunning, be instantaneously rendered insensible to pain until death supervenes, and that such slaughtering or stunning shall be effected by means of a mechanically operated instrument. This requirement does not apply in the case of any animal slaughtered for consumption by members of the Jewish or Mohammedan faiths. An exception is also made in respect of sheep ; the Act provides that if a local authority require humane methods applied to the slaughter of these animals, they must pass an appropriate resolution. Such a resolution was passed by the borough council. Section 3 of the Act places upon the council the entirely new duty of licensing slaughtermen, and up to the end of the year, three applications were received. In each case a licence, expiring on the 30th June, 1934, was granted. Provisions relating to slaughter.houses and knackers' yards, and requirements in connection with the slaughtering of animals therein, are contained in the second schedule of the Act. These requirements, with minor modifications, are similar to those contained in existing by.laws. By.laws prescribing the humane slaughtering of all animals, other than those intended for consumption by members of the Jewish faith, have been in operation in London since 1923, and the council's food inspector makes frequent inspections to satisfy himself that 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 208 inspections which were made during the year, four notices were served for the cleansing of walls and ceilings. Registration of Food Premises.—The London County Council (General Powers) Act, 1932, 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. 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—jotted, 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 otherwise preserved. 47 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. Towards the end of the year 1932, an inspection of all food shops in the borough was undertaken with a view to ascertaining which should be registered. In the case of those premises coming within the scope of the Act, the occupier was informed of the new legislation and he was given particulars of any alterations, cleansing or repairs which would be required by the council before registration would be granted. This work was completed by the end of May, 1933. During the year under review, the total number of food premises registered was fifty.nine. The council now have at their disposal a complete card index record of all registerable food premises. The following is a summary of the alterations made in the council's register of food premises during 1933 :— On register Dec. 31, 1932. Added to register during 1933. On register Dec. 31, 1933. Manufacturers of ice.cream 69 6 75 Storage and sale of ice.cream 97 14 111 Butchers' shops, including premises used for manufacture of sausages and the preservation of meat 89 14 103 Cooked meat shops 57 16 73 Fishmongers' shops—premises used for the purpose o cooking or curing fish (excluding fried fish shops) 12 5 17 Fried fish shops 36 4 40 Totals 360 59 419 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. 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, 2,504 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. Merchandise Marks (Imported Goods) Butter. No. 1 Order, 1932. Frequent inspections were made throughout the year to ensure that the requirements of these Orders were observed. Proceedings were instituted against a butcher for marking as " Empire," meat which had been imported from the Argentine and a fine of £5 was imposed. In a number of instances, imported tomatoes exposed for sale were not properly marked and officers of the council served notices in respect of these infringements. 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 48 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 1933. 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. Two sets of premises appeared in the register at the commencement of the year, and none 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 unsound meat Proceedings. Fined £25. „ „ „ „ „ £10 and £1 : Is. Od. costs. „ „ £5 and £20 costs. „ „ „ „ Summons dismissed on payment of £5 : 5s. Od. costs. 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 (cwts.) 8 Meat (stones) 200 Chocolates and sweets (lbs.) 21 Meat, canned (tins) 137 Cherries (lbs.) 56 Milk, canned (tins) 90 Dates (lbs.) 12 Peaches (cwts.) 3½ Fish, canned (tins) 98 Peas, split (lbs.) 61 Fish, wet (stones) 7½ Potatoes (lbs.) 56 Fruit, canned (tins) 1,054 Poultry (head) 212 Grapefruit (cases) 10 Rabbits, skinned (lbs.) 100 Grapes (lbs.) 120 Vegetables, canned (tins) 304 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 676, of which 13 or 1.9 per cent, were adulterated. (b) Informal Samples.—These are taken without compliance with the strict formalities of the Food and Drugs (Adulteration) Act, 1928, and serve to show the conditions obtaining without disclosing to the vendor the fact that the samples are being taken for analysis. 49 Particulars of formal and informal samples collected are as follows : Nature of sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Almonds, ground 6 — — — Apples — — 4 — Barley, pearl 3 — — — Brawn 3 — — — Butter 39 — 16 — Cakes, sponge 18 — 3 — Caviare — — 1 — Cheese 12 — 3 — Chicken and ham (tinned) — — 1 — Chocolates 6 — 2 — Chutney — — 2 — Cocoa 3 — — — Coffee 9 — — —— Cream 18 — 3 — ,, tinned — — 6 — Dripping 18 — 6 — Faggots — — 1 — Flavouring essence — — 3 — Flour, self.raising — — 3 — Fruit, dried 15 — — — Ginger.beer — — 1 — Ham 3 — 1 — Honey 3 — 6 — Indigestion mixture — — 1 — Tam — — 6 — Lard 18 — 6 — Lemon cheese 9 — — — Lemon squash —— — 1 — Margarine 25 — 12 — Mayonnaise — — 1 — Meat pie — — 2 — Milk 322 11 148 4 ,, condensed — —— 7 — hot 9 1 — — „ skimmed 2 — — — Mincemeat 6 3 — Mustard 3 — 1 1 Nitre, sweet spirit of — — 4 2 Oil, camphorated 1 — — — Paste, fish 12 — 3 — ,, meat 2 — 3 — Pears — — 1 — Peas, canned 2 — 6 — Pepper 9 — — — Powder, custard 8 — — — ,, lemonade 4 — 3 — „ liquorice — — 3 — Pilchards, canned —' — 1 — Prawns, imported — — 1 —r Ouinine, amon.tinct. — — 3 — Raspberries, tinned — — 1 — Rice 18 1 6 — Salad cream — — 2 — Sardines, canned — — 3 — Sausages 24 — 11 — Sausages, breakfast 3 — 2 — Sausage.meat 1 — — — Steak and kidney pie — — 1 — Suet, shredded 3 — — — Tartar, cream of — — 3 — Tea 9 — — — Tomato relish — — 1 — Vinegar 24 — 12 — Whiskey 6 — 1 — Yoghourt — — 2 — Totals 676 13 323 8 50 The following is a summary of the results of analysis of the 21 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. Milk 13 per cent. of the required fat Informal sample. deficient. ,, 12 ,, 10 No action. ,, 8 ,, ,, ,, Proceedings. Summons dismissed. ,, 7 No action. ,, 7 ,, ,, ,, Proceedings. Summons dismissed. ,, 6 Informal sample. ,, 6 Vendor cautioned. Milk (hot) 5 Milk 5 Informal sample. 29 ,, of extraneous water 27 Proceedings. Fined £20. * ,, 23 Proceedings. Summons dismissed on * ,, 18 ment of £2 2s. costs. Proceedings. Fined £20. ,, 2 ,, Proceedings. Summons dismissed. Mustard (mixed) ,, ,, 10 „ wheat starch; 65.3 Informal sample. per cent, water. Nitre, sweet spirit 100 ,, of required ethyl ni- of trite deficient. 30 ,, ,, ... . . Rice 25 grains of extraneous mineral Vendor cautioned. matter per lb. **Sausages 41 parts of sulphur dioxide per Informal sample. million. * These samples were obtained from the same vendor. ** This sample of sausages was reported adulterated owing to the presence of the preservative not being disclosed at the time of sale. The total number of prosecutions under the Food and Drugs (Adulteration) Act was 8, the fines and costs amounting to £62 2s. Od. The Public Health (Condensed Milk) Regulations, 1923.1927, and the Public Health (Dried Milk) Regulations, 1923.1927.—During the year, seven samples of condensed milk were taken and each was found to comply with the regulations in every respect. No samples of dried milk were taken. Food Poisoning.—Section 7 of the London County Council (General Powers) Act, 1932, 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. During the year, 434 cases were notified in London. The number notified in Kensington was 28 ; there were 18 in the Golborne ward, four in the Norland ward, five in the St. Charles ward and one in the Pembridge ward. It will be observed that all the Kensington cases occurred in the four northern wards where the majority of the poor live. It is significant that not a single case was reported from South Kensington. 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. Food causing illness. No. of cases. Fish 7 Meat pie 1 Fish, fried 3 Pork chops 1 Ice.cream 3 Bacon 1 Tinned foods 3 Roast beef 1 Sausages 1 Cockles and ice.cream 1 Saveloys and stewed eels 1 Rabbit 1 Black pudding 1 Unknown 2 Steak 1 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. 51 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 1929.33. Year. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. †Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. P. m'itis & polioence phalitis. Acute rheumatism. Cerebro spinal meningitis. Dysentery. *Enteritis. Total. 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 a 8 24 221 3 2 1 99 3 3 85 1,304 1931 2 385 222 16 61 13 8 61 253 1 1 — 46 7 17 41 1,134 1932 1 478 415 14 81 16 8 31 233 3 2 2 50 10 25 83 1,452 1933 — 617 295 11 97 6 10 49 208 1 — 1 62 5 6 106 1,474 Cases of mistaken diagnosis are excluded from the above table. †Puerperal pyrexia became notifiable on 1st October, 1926. ‡Acute rheumatism in children under 16 years of age became notifiable in Kensington on 1st October, 1927. * Zymotic enteritis in children under 5 years of age became notifiable in Kensington on 1st July, 1924. The other London boroughs in which this disease is notifiable are Fulham, Finsbury, Poplar, Southwark, Deptford, Greenwich, Woolwich and Paddington. Table showing Cases of Infectious Diseases occurring in 1933, arranged in Four.Weekly Periods (1st January, 1933, to 30th December, 1933). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Polio myelitis. Total. January 28 — 38 38 — 9 — 1 3 38 — 3 — — 2 — 132 February 25 — 46 17 — 6 1 1 4 35 — 4 3 — 3 — 120 March 25 — 45 32 1 11 — — 6 15 — 6 — 1 1 — 118 April 22 — 43 23 — 9 — — 4 10 — 1 — — 5 — 95 May 20 — 38 13 — 5 — — 9 13 — 3 — — 11 — 92 June 17 — 63 23 2 4 — 2 9 — 6 1 — 20 — 130 July 15 — 54 31 4 3 2 2 7 8 — 5 — — 13 — 129 August 12 — 47 28 1 7 — 1 3 4 — 5 — 23 1 120 September 9 — 34 16 — 6 — 1 5 6 — 7 — 1 18 — 94 October 7 — 33 12 — 4 2 — 1 18 — 3 — 2 5 — 81 November 4 — 83 18 — 9 — 3 2 14 — 4 — 1 4 — 138 December 2 — 43 23 1 16 — — 2 16 1 13 1 1 1 — 118 30 — 50 21 i 8 1 1 1 22 — 2 — — 107 Totals — 617 295 11 97 6 10 49 208 I 62 5 6 106 I 1,474 Cases of mistaken diagnosis are excluded from the above table. 52 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 69 of this report. Smallpox.—During 1933 there was a large decrease in the number of smallpox cases notified in London. Five hundred and thirty.four cases occurred in the metropolitan area, as compared with 1,133 in the previous year. There was only one death from this disease in London during the year. Nineteen of the 29 metropolitan boroughs were affected. No case of smallpox was notified in the borough during the year 1933. 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 66. Scarlet Fever.—The number of cases notified during the year was 638, of which 628 were removed to hospital. Twenty.one 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 four-weekly period during 1933:- District. Period No. 1 Period No. 2 Period No. 3 Period No. 4 Period No. 5 Period No. (5 Period No. 7 Period No. 8 Period No. 9 Period No. 10 Period No. 11 Period No. 12 Period No. 13 London 1,091 1,118 1,324 1,300 1,269 1,469 1,746 1,593 1,228 2,168 2,827 2,648 2,146 The Borough 38 46 45 43 38 63 54 47 34 33 83 43 50 North Kensington 26 28 28 32 32 52 39 38 27 29 61 34 42 South Kensington 12 18 17 11 6 11 15 9 7 4 22 9 8 Wards. St. Charles 14 10 16 8 8 15 12 11 7 12 17 14 20 Golborne 7 8 5 13 12 21 9 10 5 2 17 9 2 Norland 3 7 4 8 9 10 12 12 12 10 21 6 12 Pembridge 2 3 3 3 3 6 6 5 3 5 6 5 8 Holland 2 1 5 2 3 7 7 3 3 — 7 4 3 Earl's Court 2 5 3 — — 1 1 1 — 2 4 2 2 Queen's Gate 4 4 5 3 1 1 2 1 1 1 3 2 3 Redcliffe 2 6 2 3 2 1 4 2 1 1 6 1 — Brompton 2 2 2 3 — 1 1 2 2 — 2 — — Cases of mistaken diagnosis are excluded from the above table. Although there was a considerable increase in the number of cases notified throughout the year, scarlet fever was mild in type, as is reflected in the fact that there was only one fatal case. The deaths in the preceding years were three, one and three. There were 49 instances where more than one case occurred in the same house. Ten of the 617 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 ten, 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 3s. was incurred in respect of this service. Diphtheria.—Three hundred and twenty.six cases of diphtheria were notified during the year, 325 of which were removed to hospital. Thirty.one 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. 53 The following table shows the number of cases notified in the various wards in each four-weekly period during 1933:— District. Period No. 1 Period No. 2 Period No. .1 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 596 545 644 593 676 679 708 630 669 907 1,080 1,016 941 The Borough 38 17 32 23 13 23 31 28 16 12 18 23 21 North Kensington 36 17 26 20 11 21 26 23 13 9 15 23 18 South Kensington 2 — 6 3 2 2 5 5 3 3 3 — 3 Wards. St. Charles 12 9 4 5 2 5 10 3 5 4 5 15 5 Golborne 18 4 14 5 3 6 5 5 3 3 6 5 3 Norland 3 3 6 6 5 3 6 12 5 2 4 1 9 Pembridge 3 1 2 4 1 7 5 3 — — — 2 1 Holland — — 2 3 — — 1 2 1 — 1 — 1 Earl's Court — — — — — 1 — — — — — — Oueen's Gate 1 —— 4 — — — 3 2 — 1 — — — Redcliffe 1 —— — — 2 1 — 1 1 — 1 — 2 Brompton — — — — — — 1 — 1 2 1 — — Cases of mistaken diagnosis are excluded from the above table. There were 25 instances where more than one case occurred in the same house. The number of Kensington deaths was 22, representing a case mortality of 7 per cent. In the three preceding years the deaths were 39, 7 and 13. During the year, 2,061 throat swabs were examined at the council's laboratory at St. Mary Abbots Hospital, and of these 100 gave a positive result. There were no " return " cases reported during the year. Nine cases of diphtheria were reported from St. Mary Abbots Hospital, 17 from St. Charles Hospital, five from the Kensington Institution, and two 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. 135, 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 1933 the borough council supplied 241,000 units of anti.toxin for 28 patients at a cost of £20 10s. Od. 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 1933 was 12s. lid. The council have recently instituted a scheme whereby medical practitioners can immunise poor patients in their homes or in surgeries in return for a fee of ten shillings paid by the council in respect of each patient immunised. In addition, Dr. Guy Bousfield has been appointed by the council to conduct a Schick.testing clinic at No. 119, Ladbroke Grove, W.ll, from 2—4 p.m. on the first and second Fridays in each alternate month of the year. For his services, he is to be paid a fee of two guineas per session. The borough council have provided in their estimates for the year 1934.35 a sum of £300 to meet the cost of the scheme. Enteric Fever.—Eleven cases of this disease were notified ; six were removed to hospital and two to nursing homes. The cases notified in the three preceding years were 14, 16 and 32. There were two deaths from this disease as against one in each of the preceding years. Five cases were notified from the southern division of the borough and six came from North Kensington. In two cases there was evidence that the disease had been contracted abroad ; one contracted the disease from contact with another case in hospital; but the remaining eight had not been out of London for some time prior to their illness. Erysipelas.—Ninety.seven cases were notified during the year, 76 of which were removed to hospital. There were ten deaths from this cause, the deaths in the three preceding years being seven, three and four. 54 Ophthalmia Neonatorum.—The following table gives particulars of ophthalmia cases notified in 1933 and the results of treatment:— Case. No. Cases. Vision unimpaired. Vision impaired. Total blindness. Death. Notified. Treated. At home. In hospital. 1 Feb. 10 Yes — Yes — — — 2 June 15 Yes — Yes —— — — 3 July 4 — Yes Yes — — — 4 Sept. 21 Yes — Yes — — — 5 „ 26 — Yes Yes — — — 6 Dec. 13 — Yes ? — — Still attending hospital. From the above table, it will be seen that five cases recovered without any injury to sight ; and one case is still attending hospital. Puerperal Fever.—During the year, ten cases of this disease were notified. One was treated at home and recovered ; one was confined at home, subsequently removed to Queen Charlotte's Hospital and recovered ; one was confined in St. Charles' Hospital and recovered ; four were confined at home, subsequently removed to St. Charles' Hospital and recovered ; one was confined at home, removed to St. Mary Abbots Hospital and recovered; one was confined at home, removed to the Hammersmith Hospital and died ; and one was a Kensington woman, confined in a nursing home in St. Marylebone, who died. There were three deaths attributed to this disease, but in only one instance had a notification been received. Puerperal Pyrexia.—Forty.nine cases of puerperal pyrexia were notified during the year. Twenty.seven occurred in hospitals to which the patients had been removed prior to their confinements, and 23 in the homes of the patients. Of the 22 confined at home, 14 were subsequently removed to hospital for treatment, whilst the remaining eight received attention in their own homes. Five of the notified cases of puerperal pyrexia proved fatal. Two were confined in St. Mary Abbotts Hospital and died there ; one was confined at home, removed to Queen Charlotte's Hospital and died ; and one was confined in Oueen Charlotte's Hospital and died. In 1936, the Ministry of Health issued the Public Health (Notification of Puerperal Fever and Puerperal Pyrexia) Regulations, 1926, which provide 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 723, 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. The council have appointed Dr. A. Morris Johns, a consultant at Queen Charlotte's Hospital, to the position of consulting gynaecologist and, in addition, 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. Od., and for enquiry work to £13 13s. Od. in 1933. Malaria.—One case of this disease was notified during the year, and investigations revealed that the disease had been contracted in India. Encephalitis Lethargica.—No case was reported in Kensington during 1933. Poliomyelitis and Polio.Encephalitis.—One case of poliomyelitis was notified to the public health department during the year 1933. The patient was a child aged 3 A years, who recovered. Cerebro.Spinal Meningitis.—There were five cases of this disease notified during the year; particulars are subjoined :— No. Sex. Age. Date of notification. Result. 1 F. 7 mos. February 2nd. Recovered. 2 F. 2 years. 10th. do. 3 M. 6 mos. 14th. do. 4 M. 11 mos. June 12th. Died. 5 F. 4 mos. November 16th. do. 55 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 eight notifications were received, 151 patients being certified as suffering from acute primary pneumonia and 57 from influenzal pneumonia. The number of deaths from pneumonia during the year was 191, and 92 deaths were certified to be due to influenza. Zymotic Enteritis or Summer Diarrhœa.—In 1921, the borough council adopted a scheme for the control and treatment of zymotic enteritis or summer diarrhoea. The scheme has operated since 1930 during the summer months—from the 1st July to the 31st October. The council retain the part.time services of Dr. Ronald Carter, who has made a special study of zymotic enteritis. Dr. Carter pays periodical visits to the various infant welfare centres, where he is consulted in reference to difficult cases. He also sees cases in their homes which are not attended by other doctors. The following is a report by Dr. Carter, giving particulars of cases of enteritis dealt with during the year under review :— The council's scheme for the treatment of zymotic enteritis in the patients' homes during the period 1st July to 31st October has worked quite smoothly. Last summer was a phenominally hot one, the heat continuing for about four months. We have to go back to the summer of 1911 to find any parallel. In 1911 there was a severe epidemic and also in 1921. During last summer, I saw a few isolated cases only of infective enteritis with high temperatures ; the great majority of cases of diarrhoea and vomiting being due to dietetic causes. I saw ten cases in their own homes and paid twenty.five visits between 1st January and 30th June, a period prior to the introduction of the council's scheme. From 1st July to 31st October, I attended thirty cases and paid one hundred and thirty visits. In November and December, after the council's scheme had ended, I saw five more cases and paid fifteen visits. I have paid two or three visits daily in some urgent cases. There can be no doubt that most cases require daily visits for the first few days until acute symptoms subside. As these cases occur at any time in the year, I propose that my services should be available during the whole year in future. No case proved fatal in the home. I sent three cases to hospital because they suffered from toxaemia and so required special treatment and nursing which could not be carried out in the home. These three children ultimately died in hospital. Two of the fatal cases were under.weight for their age ; they were looked after by foster. mothers who took every possible care of them. They did not react to the routine treatment in the way that a child living under more normal conditions would do. These children took the malted food well for two or three days, and then showed signs of collapse, the diarrhoea meanwhile having subsided so that there was no marked dehydration ; the vomiting, however, returned and signs of toxaemia supervened. The third child was well nourished but was being given too much cows' milk for its age and weight and, in addition, was having cod liver oil and malt. The child was only four months old. The mother was very young and did not understand the importance of measuring the food. With regard to foster.children, I have noticed during the last few years that some of them are a good deal below normal weight and show signs of anaemia. I have seen no case of Sonne dysentery this year nor any case of paratyphoid. I think there is no doubt that all children suffering from dietetic disorders are best treated in their own homes. In this way they are protected from other sources of infection such as occur in the wards of a hospital. Health Visitors' Notes. One hundred and six cases were notified. Of these, forty.seven were one year of age and over, and fifty.nine were under one year. Out of forty.seven cases of one year and over, twenty.two were noted as severe and twenty.five as mild ; out of fifty.nine cases under one year, thirty were severe and twenty.nine mild in type. In only five out of one hundred and six notifications was there more than one case of diarrhoea in the family. In these five families, two of the children died. The following table shows the food on which they were fed :— †Mixed diet 46 cases. Dried milk 16 ,, Breast only 16 ,, Cows' milk 28 „ † " Mixed diet " means vegetable soup or gravy and bread, custard or milk pudding at mid.day meal. The other meals consist of cows' milk. District Nursing Association. The district nurses under Miss Eales attended one hundred and four cases of diarrhoea. The nurses paid 923 visits. One child died while the nurse was attending. Eleven cases were sent to hospital and five died. Only four of those who died had routine treatment. One case refused treatment. Results of ten years' treatment by the nurses. The total number of deaths is 34 out of 836 cases. Deaths from vomiting and. diarrhoea, and enteritis. There were 42 deaths from diarrhoea or enteritis (in children under one year) during the year ; eight of them had been notified but did not have routine treatment. Thirty deaths occurred amongst infants who had not been attended by the nurses and had not been notified. (Signed) Ronald Carter. 56 Dysentery.—Six cases of dysentery occurred during the year. One was of the Fiexner variety and five cases were infected with the Sonne organism. Of the Sonne cases, one occurred in the Princess Louise Kensington Hospital for Children, and four in private houses. Three cases occurred in North Kensington and two in South Kensington. Acute Rheumatism.—During the year under review, 62 cases of this disease were notified, 21 of which were removed to hospital for treatment. The sixth annual report on the working of the rheumatism scheme during the period 1st October, 1932, to 30th September, 1933, prepared by the physicians in charge of the centre and the medical officer of health, appears as Appendix I to this report. Other Notifiable Diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no notifiable infectious diseases, other than those to which reference has been made, were notified during the year. Non.Notifiable Diseases. Measles.—There were three deaths from measles in Kensington during the year. The women health officers paid 175 visits to measles patients. Fifty.seven cases were removed to the London county council hospitals. Whooping Cough.—There were 10 deaths from this cause. The deaths in the three preceding years were 36, 10 and 4. The women health officers paid 274 visits to cases of this disease during the year. The number of cases admitted to hospitals from Kensington was 70. 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 provide for the clinics to be opened at the Bab) Clinic at No. 92, Tavistock Road, and at the Kenley Street Minor Ailment Centre. There was no occasion to open a clinic in 1033. 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 1933 is as follows :— Total Scabies— cleansings. Adults 249 School.children 344 Children under five years 84 Common lodging.house cases 1 Verminous conditions— Adults 36 School.children 3,484 „ „ (impetigo and verminous) 25 Children under five years 10 Common lodging.house cases 104 Other conditions— Adults 10 School.children — Common lodging.house cases 3 Total 4,350 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 8,411 articles were so dfealt with and, in addition, 450 blankets and sheets, and 304 articles of night clothing. Of the 3,853 school children cleansed at the medicinal baths in 1933, 350 only were compulsory cases ; the remainder attended voluntarily. Verminous Premises Cleansed. Three hundred and seventy.seven verminous houses were cleansed during the year by landlords in response to notices served under the powers conferred by the London County Council (General Powers) Act, 1922. The council's rat officer, in addition to his duties under the Rats and Mice (Destruction) Act, carries out disinfection of verminous premises in certain cases. The following is a summary of his activities in this direction :— Number of premises visited 107 Number of rooms sprayed 125 57 Disinfection. *SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1933. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Smallpox — — — — Scarlet fever 600 652 631 8,243 Diphtheria 308 327 298 3,543 Enteric fever 10 13 32 351 Paratyphoid fever 3 3 6 84 Measles 72 85 11 103 Consumption 153 181 176 2,110 Cancer 67 69 124 965 Vermin 312 473 140 1,335 Other diseases. 414 462 294 3,739 Totals 1,939 2,265 1,712 20,473 This tables 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 53 tons 3 cwts. 3 qrs. 12 lbs. The number of articles disinfected only was 19,463 and the number disinfected and washed, 1,010. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved in 1933 the washing of 9,445 towels, 236 sheets and 68 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 1933 was 23 tons 12 cwts. 3 qrs. 18 lbs. The number of articles disinfected only was 6,766 and the number disinfected and washed was 2,186. 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 105. The number of private subscribing library books destroyed was 32, and the number disinfected by formalin and returned to the householders was 18. Bacteriological Work. The work performed by the bacteriologist for the council during the year 1933 was as follows :— Disease suspected. Examinations. Positive. Diphtheria 2,061 100 „ (animal inoculations) 3 — Tuberculosis (sputum) 314 31 (ear) 1 — „ (urine) 1 1 Typhoid fever (blood) 12 3 „ (faeces) 28 — „ (urine) 1 — Dysentery (faeces) 27 5 Gonorrhoea 48 2 Ringworm 3 — Cerebro.spinal meningitis 8 — The following examinations were also carried out :— Milk (bacterial count) 55 „ (tubercle bacilli) 29 In addition to these examinations at the Kensington laboratory, 462 specimens of sputum were examined at the tuberculosis dispensary. 58 TUBERCULOSIS. During the year 184 cases of pulmonary tuberculosis and 52 cases of non.pulmonary tuberculosis were notified. The following table shows the number of cases of both forms of the disease notified in the borough and the several wards therein during each year since 1924. District. Years. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. The Borough 314 292 317 252 276 241 260 245 260 236 North Kensington 228 207 227 166 179 156 178 149 174 148 South Kensington 86 85 90 86 97 85 82 96 86 88 Wards. St. Charles 45 52 50 39 48 39 56 49 55 46 Golborne 65 56 69 53 57 41 46 40 48 43 Norland 75 67 59 44 49 43 42 31 42 35 Pembridge 43 32 49 30 25 33 34 29 29 24 Holland 30 27 20 11 25 20 21 17 25 17 Earl's Court 13 18 25 25 20 21 19 23 17 29 Queen's Gate 17 13 15 10 11 7 8 9 8 10 Redcliffe 15 18 22 25 26 25 20 32 24 20 Brompton 11 9 8 15 15 12 14 15 12 12 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 2 — 1 1 1 1 1 — — 2 8 — — — I 5 — — 4 1 — — — 2 10 — 1 1 1 1 2 — — 15 2 15 3 3 8 15 — 1 20 11 19 3 3 12 18 — 2 25 23 29 5 5 12 8 3 — 35 15 15 2 2 12 7 — — 45 18 6 — — 11 4 1 — 55 16 4 1 1 8 3 — 1 65 and upwards 4 4 3 3 1 — — 1 Totals 90 94 25 27 66 58 5 9 † Primary notifications of persons notified during life to be suffering from tuberculosis. 59 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. of 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 17 160 89 1927 178 114 65 74 26 15 140 80 1928 212 107 60 64 25 14 132 74 1929 188 120 68 53 17 10 137 78 1930 202 140 78 58 25 14 165 92 1931 205 127 70 40 21 12 148 82 1932 210 107 58 50 20 11 127 69 1933 184 124 68 52 14 8 138 76 It will be seen that the number of notifications in 1933 was the lowest on record, though the number of deaths, 138, was higher than in the preceding year. Deaths from Tuberculosis in 1933 Allocated to District of Usual Residence of Patients. Pulmonary tuberculosis. Non.pulmonary tuberculosis. The Borough 124 14 North Kensington 77 11 South Kensington 47 3 Wards. St. Charles 21 3 Golborne 22 4 Norland 25 2 Pembridge 9 2 Holland 9 — Earl's Court 13 — Queen's Gate 2 1 Redcliffe 19 1 Brompton 4 1 The places where deaths from tuberculosis occurred are set forth in the following list :— Pulmonary Non.pulmonary tuberculosis. tuberculosis. Patient's home 35 3 St. Mary Abbots Hospital 24 2 St. Charles Hospital 40 7 Princess Louise Kensington Hospital for Children — — Outlying hospitals 12 1 Other places outside the borough 13 1 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations were introduced with a view to :— (1) preventing persons suffering from respiratory tuberculosis entering upon an occupation involving the handling of milk ; and (2) enabling local authorities, in proper cases and with suitable safeguards, to require persons engaged in such occupation to discontinue their work when found to be suffering from the disease in an infective stage. During the year no case occurred which required the attention of the council under these regulations. 60 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 diagnose: made, is shown in the following table :— New Cases. Adults. Children under 15yrs. Total. Males. Females. Males. Females. Examined for first time 225 307 158 137 827 New cases with respiratory tuberculosis 66 72 0 1 139 (16.8 per cent.) New cases with non.respiratory tuberculosis 8 10 8 6 32 ( 3.8 „ ) New cases regarded as " suspects " 7 11 6 3 27 ( 3.2 „ ) New cases not suffering from tuberculosis 164 214 144 127 629 (76.0 „ ) This table shows a diminution of 34 in the number of respiratory cases seen at the dispensary compared with last year. The total number of non.respiratory cases is 4 less than in 1932, being 32 instead of 36. 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 31 respiratory cases and 9 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 35 for 1932. 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 283. The treatment recommended for the cases diagnosed at the dispensary as suffering from tuberculosis, which numbered 171 (pulmonary 139 and non.pulmonary 32), was as follows :— sanatoria, 110 ; domiciliary, 13 ; St. Mary Abbots and other hospitals, 41 ; dispensary, 7. The total number of attendances by patients at the dispensary was 2,271, and 1,608 systematic examinations were made. The number of visits paid by the tuberculosis officer was 111, of which 55 were consultations at home with the doctor in charge of the case. Written reports on cases to public authorities numbered 1,816, and to doctors 433. The total number of sputum examinations was 462 from 360 individual cases. One hundred and nine specimens showed tubercle bacilli to be present, and 353 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, 1933 332 331 161 176 No. of cases notified for the first time during the year 90 94 25 27 No. of cases brought to notice otherwise than by notification 28 22 7 4 No. of cases removed from the register during the year on account of having :— (a) been cured 12 18 24 19 (b) removed from district 53 70 16 21 (c) died 76 64 5 6 (d) been inaccurately diagnosed — — 1 2 No. of cases remaining on the register on 31st December, 1933 309 295 147 159 61 The number of patients on the dispensary register on 31st December, 1933, was 769, whilst at the beginning of the year they numbered 858. A comparison of the dispensary figures with the total number on the notification register (910) shows that the majority of the tuberculosis cases are dealt with through the council's scheme—over 85 per cent.—an increase over last year. 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 40 X-ray examinations were conducted at a total cost of £14 12s. 6d. Home Visiting. The number of home visits paid in 1933 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 20 28 22 33 1 32 29 165 Re-visits 177 205 163 196 4 327 210 1,282 Non-pulmonary. First visits 7 12 5 6 — 10 — 40 Re-visits 50 118 114 91 1 218 76 668 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. Whenever possible, desirable alterations are pointed out and urged upon the family. Reports are also made upon sanitary defects and special economic and other difficulties, and efforts are made to deal with them. These visits are additional to those made by the Charity Organisation Society and the Invalid Children's Aid Association, who undertake the weekly collection of any assessment made in connection with treatment in residential institutions under the London county council's tuberculosis scheme. The following table, giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1933 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 12 5 2 — — — — — — — 19 2 — 11 7 9 6 6 1 — — — 40 3 1 9 4 7 7 3 2 1 1 — 35 4 — 2 7 4 4 2 — — — — 19 5 — 1 3 4 2 3 — — — — 13 6 — — 1 — 1 — — — — — 2 128 62 This total falls 43 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 nine years:— 1925. Amount of room space per occupant 0.55 1926. ditto. 0.58 1927. ditto. 0.59 1928. ditto. 0.61 1929. ditto. 0.67 1930. ditto. 0.73 1931. ditto. 0.70 1932. ditto. 0.67 1933. ditto. 0.77 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 his 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 667 contacts traced by the dispensary service in 1933. Of these, 418 were examined one or more times by the tuberculosis officer, 70 were examined by their own doctors or had been recently examined at school, while 129 refused examination or failed to attend after three appointments had been given them. There were 50 cases having no contacts—mainly domestic servants. These figures show an encouraging increase in the number of contacts seen at the dispensary despite the marked reduction in the number of notified cases. 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 1933. The work at the dispensary during the year is shown in the following table :— Dentist's attendances at the dispensary 52 Number of individual patients treated 44 Patients' attendances 121 Number of fillings 4 Number of extractions 110 Number of dentures arranged for 9 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 1933 the council undertook to pay for the treatment in 32 cases at a cost of £182 14s. The corresponding figures for 1932 were 25 and £165 18s. 6d. Home Nursing. The cases of tuberculosis attended and the visits paid by the nurses of the Kensington District Nursing Association during the past five years are shown in the following table :— Year. Cases. ... Visits. 1929 ... 28 ... 1,327 1930 ... 18 ... 946 1931 ... 16 ... 394 1932 ... 30 ... 1,094 1933 ... 23 ... 1,259 The nurses carry out their work splendidly and are very much appreciated by the poor. 63 Supply of Extra Nourishment to Tuberculous Persons. Three persons received extra nourishment during the year. The total amount supplied was 84 pints of milk and 84 new laid eggs, at a cost to the council of £1 10s. 1½d. 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. The work of the care committee has been considerably increased under the scheme introduced by the London county council last April of referring all cases admitted to the council's general hospitals to the care committee for assessing. There has also been a marked increase in the number of visits paid in connection with the collection of payments. During 1932 there were 216 cases assessed and 529 reviewed, whereas in the last nine months of 1933, covering the period of the new arrangement, the corresponding figures were 337 and 625. The members of the care committee have devoted considerable time and attention to the care and after-care work; and attendances at the meetings numbered 50 more than during 1932. 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 1933 and at the end of the year 3 patients from Kensington were in regular attendance and a favourable report was received of their work. There are at present a few 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 19 patients to whom bedsteads and bedding are being loaned. In 13 of these the assistance was given for the first time during the past 12 months, the articles issued being as follows :— Bedsteads ... 8 Mattresses ... 11 Bolsters ... 0 Pillows ... 22 Pillow-slips ... 24 Sheets ... 33 Blankets ... 18 Quilts ... 11 Mattress covers 12 The total stock of bedding, etc., on loan on 31st December, 1933, was :— Bedsteads ... 13 Mattresses ... 17 Bolsters ... 1 Pillows ... 27 Pillow slips ... 36 Sheets ... 63 Blankets ... 31 Quilts ... 16 Mattress covers 17 64 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 176 Number of rooms disinfected 181 Bacteriological Examinations. Specimens of sputum submitted by medical practitioners for bacteriological examination at the expense of the council:— Examined at the council's laboratory 314 Examined by the tuberculosis officer 462 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. SIXTH ANNUAL REPORT ON THE KENSINGTON RHEUMATISM SCHEME (October 1st, 1932—September 30th, 1933) BY JAMES FENTON, M.D., D.P.H., JANET K. AITKEN, M.D., M.R.C.P., and LUCY E. ELLIOTT, M.B., B.S., M.R.C.S., L.R.C.P. PART I. General by JAMES FENTON, M.D., D.P.H. The sixth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was completed on the 30th September, 1933. 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. On the 1st October, 1933, the Minister of Health made new Regulations for a further period of three years. The regulations, like their predecessors of 1927 and 1930, define acute rheumatism as denoting the following conditions, occurring separately or together in a child under the age of sixteen years :— (а) rheumatic pains or arthritis, if accompanied by a rise of temperature ; (б) rheumatic chorea ; (c) rheumatic carditis. Response to Notification. Detailed particulars in regard to notification are given below :— 1927-28. 1928-29. 1929-30. 1930-31. 1931-32. 1932-33. 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. 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 6 6 supervisory centre. Private medical practitioners. 53 63 40 33 32 36 28 31 21 12 43 18 School medical officers. 28 1 20 12 1 2 Hospitals and institutions. 46 27 31 17 7 7 Totals 159 95 105 70 95 48 66 40 41 24 58 24 It will be seen that for the first time since the opening of the clinic there has been an increase in the number of cases notified, and this is probably due to the reminders in regard to notification which were sent to medical practitioners during the course of the year. In previous reports it has been stated that the steady decline in the number of cases notified is partly due 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. Thus, there was an accumulation of patients to be notified in the first year or two. The percentage of attendances of the notified cases at the centre has fallen this year. There is often a delay between the notification and attendance. If an acute case is under the care of the general practitioner, it will not attend for supervision until the acute phase is over ; the attendance may therefore come into the next year's figures. Also, a certain number of cases are now sent straight to Queen Mary's Hospital, Carshalton, and the delay between the notification and the supervisory attendance may be still more prolonged. It will be noted that a much higher proportion of the cases this year has been notified by general practitioners, therefore it will not be wise to comment on this fall in attendances until the statistics for the next year are available. 66 PART II. The Work of the Centre by JANET K. AITKEN, M.D., M.R.C.P. and LUCY ELEANOR ELLIOTT, M.B., B.S., M.R.C.S., L.R.C.P. In the six years 1927-33 during which the centre has been in existence, 1,463 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 1932-33 Kensington 128 177 266 290 Hammersmith 35 40 47 51 Other boroughs 10 17 12 20 173 234 325 361 — — During the year 1932-33, 48 sessions have been held at the Princess Louise Hospital, and the average attendance has risen from 25-4 in 1931-32 to 28 in 1932-33 ; the total number of attendances during this year has risen from 1,254 to 1,344. Average attendance per session of Kensington patients 22 „ „ „ „ „ other „ 6 28 The total number of attendances of patients during 1932-33 is as follows :— Kensington Notified cases... (a) New 24 (b) Old 340 Unnotified cases (a) New 64 (b) Old 628 Hammersmith (a) New 23 (b) Old 211 Hounslow (a) New — (b) Old 8 Paddington (a) New 6 (b) Old 18 Ealing (a) New — (b) Old 3 Various boroughs (a) New 4 (b) Old 15 1,344 The new Kensington cases in 1932-33 were recommended to attend the clinic from the following sources :— Invalid Children's Aid Association 19 School medical officers 27 Princess Louise Hospital 11 Other hospitals and institutions — Private practitioners 5 Notifications... 17 Public health department 1 Parents 8 88 The disposal of cases which attended the centre may be summarised as follows :— Tonsillectomy at Princess Louise Hospital 19 Admission to Princess Louise Hospital 26 Admission to St. Mary Abbots Hospital 1 Admission to other hospitals 2 Special schools 4 Special heart homes— 1. Carshalton 3 2. West Wickham — 3. Lancing 1 Convalescent homes 21 Referred to massage department for special chest expansion exercises 5 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. An electrocardiograph has now been installed at Princess Louise Hospital and is used for the cases attending the clinic. Already it has been extremely useful, especially in noting the progress of cases as to whether there is an improvement or the reverse according to the tracings. Its value in diagnosis will gradually increase as the tracings of individual cases are compared. 67 Mrs. Jacobson, the honorary secretary of the clinic, has learned to take the electrocardiograms and the physicians wish to express their thanks to her for her most valuable aid. It would have been impossible for the physicians to have taken more than a very limited number of tracings without her assistance owing to the large attendance at the weekly sessions. Clinical Report. In the Fifth Annual Report, the result of an investigation into the value of tonsillectomy in the treatment of juvenile rheumatism was given. The conclusions were as follows :— (a) There is some evidence suggesting that preliminary tonsillectomy, in 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. (b) The progress of the disease is the most satisfactory in cases who have healthy tonsils. (c) 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. It has been suggested by various authorities that tonsillectomy is apt to precipitate an attack of juvenile rheumatism, especially of chorea. It was decided to investigate this point. The number of cases who have had tonsillectomy and in whom we should know the immediate history is 114, of which 24 are cases of chorea. The history of three children who had an attack of rheumatism within six months of tonsillectomy has been carefully investigated. There is also one doubtful case. 1. There are no children who had juvenile arthritic rheumatism for the first time within six months of tonsillectomy. 2. There are two children who had chorea for the first time within six months of tonsillectomy, and one doubtful case. Case 1. Onset of chorea four months after tonsillectomy. Case 2. Choreic movements noted five days after tonsillectomy. Case 3. In this case, the notes are not absolutely clear. It is thought, however, that the tonsillectomy took place after the onset of chorea. Unfortunately, it has not been possible to trace the case. 3. There is one child who had a relapse of arthritic juvenile rheumatism four months after tonsillectomy. 4. There are no children who had second attacks of chorea within six months of tonsillectomy. The two cases in which attacks occurred four months after tonsillectomy can hardly be attributed to the operation. The only case therefore that might be said to have been precipitated by tonsillectomy is the case of chorea which is said to have begun within five days after the operation. It could, of course, be argued that this is too early a response for the tonsillectomy to have been the cause, and it is also possible that the chorea was present to a mild degree when the tonsillectomy was performed. A child is admitted for the operation, and it is naturally nervous, and the definite choreic characteristics of the movements are not noted until a later date. From these investigations, therefore, there is no definite evidence in support of the theory that tonsillectomy is likely to precipitate attacks of juvenile rheumatism. Although the cases supervised at the clinic and the number of attendances have increased this year, it was thought that the number of acute cases seemed to be diminishing. Investigations have, therefore, been carried out to ascertain whether this was correct. In Table 1 only cases which are definitely diagnosed as juvenile rheumatism have been included in the figures and only the new cases coming to the clinic have been compared. Table 1. Definite new rheumatic cases seen. Year. Acute. Non-acute. 1928 Number. 5 Percentage. 20% Number. 20 Percentage. 81% 1929 9 31% 20 69% 1930 8 30% 19 70% 1931 12 30% 28 70% 1932 15 42% 21 58% 1933 11 31% 24 69% In this comparison, it will be seen that the percentages do not vary very much; indeed, in the years 1929, 1930, 1931 and 1933, they are almost identical. There is, however, a fallacy in these statistics. All doubtful cases of juvenile rheumatism have been omitted. In the earlier years, cases which would have been classified as doubtful at the time have since been proved by continual observation to be true cases of rheumatism by the occurrence of an acute or sub-acute attack. They have, therefore, been included in these figures. The observation of doubtful cases of the later years has not been continued over a long period, and it is certain that a number of these will in future years prove to be rheumatic and should therefore be included in this table as nonacute cases. It is possible, therefore, that the percentage of acute to non-acute new cases may be diminishing, although it is unlikely that the change is very marked. 68 Table II. New cases seen. Year. Total. Rheumatic cases. Non-rheumatic or doubtful. Percentage of rheumatic cases to all new cases. Acute. Non-acute. Total. 1928 175 24 151 2.8% 10.8% 13.6% 1929 121 29 92 7.4% 16.8% 24.2% 1930 172 27 145 5.0% 11.0% 16.0% 1931 179 40 139 7.0% 15.6% 22.6% 1932 129 36 93 11.6% 16.2% 27.8% 1933 121 35 86 9.0% 19.9% 28.9% Table II shows the percentage of acute and non-acute rheumatic cases to the total number of the new cases seen (Kensington only). It will be seen that the total percentage of rheumatic cases has risen from 13.6% to 28.9%. For the reasons explained above, where it is suggested that the non-acute cases are really higher than the figures shown in the later years, the rise is probably still more marked than the table indicates. Although the total number of new rheumatic cases seen has risen from 24 in 1928 to 35 in 1933, this is not such a large increase as the percentage increase of rheumatic cases to the total number of new cases seen, which suggests that juvenile rheumatism as a clinical entity is being more clearly recognised by the authorities which seiid cases to the clinic. APPENDIX II. Table I. Vital Statistics of Whole District for 1933 and previous Years. Year. 1 Population estimated to middle ot each year. 2 Births. Total deaths registered in the district. Transferable deaths Net deaths belonging to the district Uncorrected number. 3 Net. of nonresidents registered in the district. 8 of residents not registered in the district. 9 Under 1 year of age. At all ages. Number. 4 Rate.* 5 Number. 6 Rate.* 7 Number. 10 Rate per 1,000 net births. 11 Number. 13 Rate.* 13 1928 ‡ 178.400B 2,184 2,559 14.3 2,477 13.8 694 543 213 83 2,326 130 1929 178.200D ‡176.000B 2,139 2,544 14.4 2,889 16.4 733 552 213 84 2,708 15.4 1930 175.800D 176,000 2,154 2,580 14.7 2,401 13.6 749 590 177 69 2,242 12.7 1931 174,800 2,111 2,485 14.2 2,646 15.1 716 525 188 76 2,455 14.0 1932 183,500 2,245 2,362 12.9 2,930 15.4 937 497 232 98 2,490 13.6 1933 181,100 2,138 2,165 12.0 2,833 15.6 1,033 536 157 72 2,336 12.9 * Rates calculated per 1,000 of estimated population. ‡ B. Population as estimated by the Registrar-General for the calculation of birth rate. D. ,, ,, „ „ „ „ „ death rate. At Census of 1931. Area of district in acres (exclusive of area covered by water) 2,291 Total population at all ages 183,893 Total families or separate occupiers 47,713 69 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 1933. 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 — — — — — — — — — — — — — — — — — — — — — — — — Scarlet fever 617 4 22 47 59 56 214 95 32 64 15 8 1 164 120 126 58 47 23 31 31 17 628 1 Diphtheria (including membranous croup 295 13 16 19 25 35 113 45 12 13 1 3 — 84 80 65 29 11 1 11 9 5 325 22 Enteric fever 11 — — — 1 — 5 2 — 1 — 1 1 2 1 3 — 2 — 1 1 1 5 2 Puerperal fever 10 — — — — — — — — 8 2 — — 2 4 — 2 — — 1 1 — 8 3 Puerperal pyrexia 49 — — — — — — — 1 42 5 1 — 12 12 8 3 4 4 3 3 — 43 5 Primary pneumonia 151 9 15 13 15 7 15 11 6 16 16 18 11 26 84 18 10 4 2 — 7 — 61 29 Influenzal pneumonia 57 — 1 2 2 — 2 2 4 14 7 17 6 8 20 13 4 1 4 1 4 2 30 45 Dysentery 6 — — 1 — — 3 — — — — 2 — 1 — 2 — 2 — — 1 — 4 1 Erysipelas 97 1 — — — 2 3 4 5 21 15 32 14 17 17 20 10 2 9 8 11 3 76 10 Encephalitis lethargica — — — — — — — — — — — — — — — — — — — — — — — 1 Cerebro-spinal meningitis 5 4 — 1 — — — — — — — — — 1 3 — — 1 — — — — 5 2 Polio-myelitis and polio-encephalitis 1 — — — 1 — — — — — — — — — 1 — — — — — — — 1 — Pulmonary tuberculosis 184 2 — — — — — 1 17 82 30 44 8 36 41 20 19 7 29 10 15 7 163 124 Other forms of tuberculosis 52 2 10 — — — 5 2 6 18 4 2 3 10 2 15 5 10 — — 5 5 28 14 Ophthalmia neonatorum 6 6 — — — — — — — — — — — 3 1 2 — — — — — — 2 — Malaria 1 — — — — — — — — — — 1 — — — — 1 — — — — — — — *Enteritis (diarrhoea) 106 59 27 13 6 1 — — — — — — — 25 46 33 1 — 1 — — — 31 52 † Acute rheumatism 62 — — — 3 3 22 32 2 — — — — 25 11 13 7 1 2 1 2 — 21 5 Totals 1710 100 91 96 112 104 382 194 84 279 95 129 44 416 443 338 149 92 75 67 90 40 1431 316 • Notifiable only in children under the age of 5 years. † ,, ,, ,, ,, ,,1 ,, Cases of mistaken diagnosis are excluded from the above table. 70 Table III. Causes of Death at Different Periods of Life in 1933. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and upwards ALL CAUSES M. 1,025 95 12 12 21 31 40 49 114 184 266 201 f. 1,311 62 11 21 17 40 61 70 133 195 290 411 Typhoid and paratyphoid fevers M. 1 ... ... ... ... ... 1 ... ... ... ... ... f. 1 ... ... ... ... ... ... ... ... ... 1 ... Measles M. 1 ... 1 ... ... ... ... ... ... ... ... ... f. 2 ... ... 2 ... ... ... ... ... ... ... ... Scarlet fever M. 1 ... 1 ... ... ... ... ... ... ... ... ... f. ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough M. 4 1 1 1 1 ... ... ... ... ... ... ... f. 6 3 3 ... ... ... ... ... ... ... ... ... Diphtheria M. 11 1 1 3 6 ... ... ... ... ... ... ... f. 11 ... ... 6 5 ... ... ... ... ... ... ... Influenza M. 34 ... ... 1 ... 2 2 1 6 7 9 6 f. 58 ... ... 1 1 3 2 5 7 10 10 19 Encephalitis lethargica M. 1 ... ... ... ... ... ... ... ... ... ... 1 f. ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal fever M. 2 1 1 ... ... ... ... ... ... ... ... ... f. ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of respiratory system M. 66 1 ... ... 1 8 12 12 12 11 8 1 f. 58 1 ... ... 2 15 18 8 7 4 3 ... Other tuberculous diseases M. 5 1 ... ... ... ... ... 3 ... 1 ... ... f. 9 1 1 2 ... 1 2 ... ... 1 1 ... Syphilis M. 4 ... ... ... ... ... ... ... 2 1 1 ... f. 3 1 ... ... ... ... ... ... 1 1 ... ... General paralysis of the insane, tabes dorsalis M. 6 ... ... ... ... ... ... 1 2 2 1 ... f. ... ... ... ... ... ... ... ... ... ... ... ... Cancer, malignant disease M. 124 ... ... 1 ... ... 3 3 19 39 41 18 f. 186 ... ... 1 2 ... 3 11 28 57 54 30 Diabetes M. 9 ... 1 ... ... ... ... ... 1 3 3 1 f. 14 ... ... ... ... ... ... ... ... 4 5 5 Cerebral haemorrhage, etc. M. 28 ... ... ... ... ... ... 2 2 9 8 7 f. 41 ... ... ... ... ... ... 1 4 3 16 17 Heart disease M. 223 ... ... ... 2 2 3 2 18 27 93 76 f. 365 ... ... ... 1 3 2 10 26 30 96 197 Aneurysm M. 8 ... ... ... ... 1 ... 1 4 1 1 ... f. 8 ... ... ... ... ... ... 3 ... ... 4 1 Other circulatory diseases M. 43 ... ... ... ... ... ... 1 5 7 19 11 f. 75 ... ... ... ... ... ... 4 13 28 30 Bronchitis M. 41 1 ... ... ... ... 1 ... 4 6 13 16 f. 32 2 ... ... ... ... 1 1 1 7 4 16 Pneumonia (all forms) M. 87 9 5 1 ... 1 4 6 14 18 14 15 f. 104 10 5 6 ... 3 5 5 11 16 16 27 Other respiratory diseases M. 15 ... ... ... 1 ... ... 2 1 5 5 1 f. 9 ... ... ... 1 ... ... ... 1 3 2 2 Peptic ulcer M. 12 ... ... ... ... ... ... ... 3 5 2 2 f. 12 ... ... ... ... ... ... 1 2 3 4 2 Diarrhœa, etc. M. 30 30 ... ... ... ... ... ... ... ... ... ... f. 22 12 1 1 ... ... 2 ... ... 1 1 4 Appendicitis M. 7 ... ... 1 ... 1 ... ... ... 3 2 ... f. 5 ... ... ... 1 ... ... ... ... 2 1 1 Cirrhosis of liver M. 6 ... ... ... ... ... 1 ... 2 ... 2 1 f. 5 ... ... ... ... ... ... ... 1 3 1 ... Other diseases of liver, etc. M. 4 ... ... ... ... ... ... ... ... 4 ... ... f. 8 ... ... ... ... ... ... 1 ... 2 2 3 Other digestive diseases M. 19 2 ... ... ... 2 ... ... 2 4 6 3 f. 26 ... ... ... 1 ... 2 2 8 4 4 5 Acute and chronic nephritis M. 22 ... ... ... 1 1 2 ... 1 9 4 4 f. 33 ... ... ... ... 1 3 5 4 5 5 10 Puerperal sepsis f. 3 ... ... ... ... 1 1 1 ... ... ... ... Other puerperal causes F. 5 ... ... ... ... 1 3 1 ... ... ... Congenital debility, premature birth, malformations, etc. M. 45 43 1 1 ... ... ... ... ... ... ... ... F. 30 29 1 ... ... ... ... ... ... ... ... ... Senility M. 11 ... ... ... ... ... ... ... ... ... 4 7 F 20 ... ... ... ... ... ... ... ... ... 3 17 Suicide M. 26 ... ... ... ... 3 2 7 4 3 4 3 F. 24 ... ... ... ... 2 3 3 10 6 ... ... Other violence M. 37 3 ... ... 4 5 2 2 ... 5 5 11 F. 50 ... ... 2 1 6 5 2 4 8 9 13 Other defined diseases M. 91 2 ... 3 5 5 7 6 12 14 21 16 F. 86 3 ... ... 2 4 9 10 14 12 20 12 Causes ill-defined, or unknown M. 1 ... ... ... ... ... ... ... ... ... ... 1 F. ... ... ... ... ... ... ... ... ... ... ... ... 71 Table IV. INFANT MORTALITY DURING THE YEAR 1933. 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 causes. Certified 41 8 6 5 60 20 24 19 21 144 Uncertified 7 1 1 ... 9 2 2 ... ... 13 Measles ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... 1 1 2 4 Diphtheria ... ... ... ... ... ... 1 ... ... 1 Influenza ... ... ... ... ... ... ... ... ... ... Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... Cerebro spinal meningitis ... ... ... ... ... ... ... 1 ... 1 Tuberculosis of respiratory system ... ... ... ... ... ... 1 1 ... 2 Other tuberculous diseases ... ... ... ... ... ... 1 1 ... 2 Bronchitis ... ... ... ... ... 2 ... 1 ... 3 Pneumonia 1 1 2 ... 4 1 2 4 8 19 Other respiratory diseases ... ... ... ... ... ... ... ... ... ... Diarrhoea, etc. ... ... ... ... 1 8 16 9 8 42 Congenital debility 10 1 1 ... 12 ... ... ... ... 12 Malformation 5 1 1 1 8 1 ... ... 1 10 Premature birth 31 3 ... 1 35 1 ... ... ... 36 Deaths from violence 1 ... ... ... 1 1 1 ... ... 3 Atrophy, debility and marasmus ... 2 2 ... 4 7 2 ... 1 14 Other digestive diseases ... ... ... ... ... ... 1 1 ... 2 Other diseases ... 1 1 2 4 1 ... ... 1 6 Totals 48 9 7 5 69 22 26 19 21 157 Net births in the year of legitimate, 1,964. illegitimate, 201. Net deaths in the year of legitimate infants, 134. illegitimate infants, 23. 72 Table V. The Work of the Women Health Officers for the Year 1933. HEALTH OFFICERS.. Total. 1 2 3 4 5 6 7 Child Welfare- First visits to infants (0-1 year) 337 207 226 258 370 77 171 1,646 Return visits to infants (0-1 year) 416 474 732 519 900 179 540 3,760 Total visits to children (1-5 years) 900 1,104 1,380 673 830 538 898 6,323 Stillbirth enquiries 12 6 6 7 13 1 — 45 Visits to ophthalmia cases 17 4 8 5 13 — — 47 Return visits to ophthalmia cases 16 9 10 5 67 — — 107 Visits to measles cases 36 11 23 3 94 7 1 175 Visits to whooping cough cases 57 18 49 10 91 25 24 274 Visits to puerperal fever cases 5 4 2 1 — — 1 13 Visits to puerperal pyrexia cases 19 6 2 9 9 4 — 49 Visits to enteritis cases 65 34 59 17 21 2 1 199 Infantile death enquiries 19 21 12 22 32 6 11 123 Milk investigations 324 73 119 494 284 77 48 1,419 Ante-natal visits 155 208 158 171 99 136 141 1,068 Half-days at welfare centres 187 146 132 119 205 101 119 1,009 Special visits 390 333 298 295 162 545 407 2,430 Tuberculosis— Pulmonary—First visits 20 28 22 33 1 32 29 165 Re-visits 177 205 163 196 4 327 210 1,282 Non-Pulmonary—First visits 7 12 5 6 — 10 — 40 Re-visits 50 118 114 91 1 218 76 668 Rheumatism- First visits to cases notified 16 5 13 9 12 4 4 63 Common Lodging Houses— Inspections — 13 — — 42 — — 55 Factories and Workshops Act— Inspections of factories 1 32 35 1 10 11 4 94 Inspections of workshops 12 15 17 7 55 375 169 650 Inspections of outworkers' premises 21 5 8 14 47 176 29 300 Inspections of other workplaces — — — 4 — 13 7 24 Total Visits 3,259 3,091 3,593 2,969 3,362 2,864 2,890 22,028 Notices issued under the Public Health Act— Intimation notices — — — — — 1 3 4 Statutory notices — — — — — — — — Final notices — — — — — — — — Summonses — — — — — — — — 73 Table VI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1932. date. Registration sub-districts comprised in vaccination officer's district. 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 Number of births returned in birth list sheets. Column I. successfully vaccinated Column II. 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. Total number of certificates of successful vaccination received during the calendar year, 1933. 1932. Insusceptible of vaccination Certificate of conscientious objection. Column V. dead, unvaccinated. Postponement by medical certificate. 1st January to 31st Dec. North 1,282 904 3 212 76 3 35 34 15 1,921 South 983 723 11 81 60 4 56 34 14 Total 2,265 1,627 14 293 136 7 91 68 29 74 TABLE VII. PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1933 (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 Greer 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 Dennis C. Draper ( „ ) 1933 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 §Leonard R. Hundy ( ,, ) 1933 Vaccination Officer. James H. Wilson 1933 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 (Infant Life Protection Visitor) 1931 ‡§Miss W. E. Cockram 1932 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. Combs 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. 75 INDEX. PAGE Advisory committee 34 Acute rheumatism 56 „ „ Appendix 1 65 Agricultural Produce (Grading and Marking) Act, 1928 47 Ambulance facilities 15 Areas, clearance and improvement 38 Artificial Cream Act, 1929 48 „ pneumothorax treatment 62 „ sunlight treatment 30 Baby Clinic 30 „ Hospital 30 Bacteriological examination (tuberculosis) 64 „ work (infectious disease) 57 Bakehouses 46 Basement rooms 35 Baths and washhouses 23 Bedding for home isolation of tuberculous patients 63 Births 4 „ notified (table) 5 Birth control 33 Birth rate decline (table) 5 Births, wards and rates (table) 4 Building schemes (suggested) 38 ,, „ (approved) 38 Canal Boats Acts, 1877 & 1884 23 Cancer 7 Care and after-care of tuberculous patients 63 Cerebro-spinal meningitis 54 Chapel of rest 22 Clearance areas 36 & 38 Common lodging houses 41 Convalescent homes 32 Day nurseries 31 Deaths 5 „ causes of 6 „ from certain diseases (table) 8 „ from cancer (table) 7 „ wards and rates (table) 6 „ from tuberculosis, in wards (table) 59 Dental treatment at infant welfare centres 30 „ „ for tuberculous patients... 62 Diarrhoea, summer 55 Diphtheria 52 Disinfection 57 „ (tuberculosis) 64 Dispensary diagnosis and treatment of tuberculosis 60 Dog nuisances 13 Doubtful diagnosis of tuberculosis 62 Drainage 18 Dwelling housed, inspection of 43 Dysentery 56 Employment of tuberculous patients 63 Encephalitis lethargica 54 Enteric fever 53 Electrical treatment 31 Erysipelas 53 Extra nourishment for expectant and nursing mothers and their infants 33 Extra nourishment for tuberculous patients 63 Factories and workshops 25 Fitness of houses 42 Following-up of tuberculous patients 62 PAGE Food, inspection and supervision of 43 Food and Drugs (Adulteration) Act, 1928 48 ,, ,, ,, ,, (proceedings under) 50 Food premises, inspection of 47 „ „ registration of 46 „ poisoning 50 „ supply 43 „ unsound 48 Fouling of footpaths by dogs 13 General provision of health services in area 12 Grants to maternity and child welfare institutions 17 Gynaecological clinic 31 Handicrafts class for tuberculous patients 63 Health lecturer 32 „ propaganda 17 Home contacts of tuberculosis 62 ,, helps 33 „ Office tables (Factory and Workshops) 27 „ nursing of tuberculous patients 62 „ visiting „ „ 61 Hospital, general 14 Houses let in lodgings 43 Housing 34 „ accommodation owned by council 40 ,, accommodation provided by housing associations 40 „ action under statutory powers 42 „ five years' programme 36 „ statistics 43 Ice cream 46 Improvement areas 36 & 39 Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-1933 23 Indecent occupation 35 & 41 Infant consultations at welfare centres 29 Infant life protection 12 Infant mortality— 8 Deaths, causes of 10 ,, each month (table) 9 „ in wards (table) 8 Infant mortality rates (table) 9 Infant welfare centres 29 Infectious disease 51 ,, ,, cases in four-weekly periods (table) 51 Introduction 3 Kensington District Nursing Association 13 Legal proceedings (sanitary administration) 22 Legislation (local) 13 Light treatment for tuberculosis 61 London County Council (General Powers) Act, 1932 46 & 50 Malaria 54 Marriages 4 Massage 31 Maternal mortality 11 Maternity and child welfare 28 76 INDEX—continued. PAGE Maternity home 31 Measles 56 Medicinal baths 56 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 45 Milk supplied in Kensington 43 Mortuary 22 Non-notifiable diseases 56 Notifiable infectious diseases 51 Notification of Births Act, 1907 5 Notifications of infectious diseases 1929 to 1933 (table) 51 Notifications of tuberculosis, age and sex distribution 58 Notifications of tuberculosis, deaths and death rates since 1922 (table) 59 Notifications of tuberculosis in wards since 1924 (table) 58 Nursing (professional) in the home 13 Ophthalmia neonatorum 54 Outworkers 26 Overcrowding 35 & 41 Pigeons, nuisance from 24 Pneumonia and influenzal pneumonia 55 Pneumothorax treatment for tuberculosis 62 Population 3 Poliomyelitis and polio-encephalitis 54 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, health 17 Public Health (Condensed Milk) Regulations, 1923-1927 50 „ ,, (Dried Milk) Regulations, 1923-1927 50 „ „ (Meat) Regulations, 1924 46 „ ,, (Prevention of Tuberculosis) Regulations, 1925 59 Puerperal fever 54 „ pyrexia 54 Queen Charlotte's Hospital ante-natal clinic 31 Rag Flock Acts, 1911-1928 23 Rats and Mice (Destruction) Act, 1919 24 Records (tuberculosis) 60 Refuse collection 18 ,, removal from mews 18 Registration of houses let in lodgings 43 „ food premises 46 Remedy of defects without service of notices 43 Removal of aged, infirm or physically incapacitated persons 24 Residential institutional treatment of tuberculosis 61 Rheumatism supervisory centre 15 PAGE Samples adulterated (table) 50 „ formal (table) 49 „ informal (table) 49 Sanitary circumstances of the area 18 „ inspection 19 Inspections made (table) 19 Legal proceedings (table) 22 Notices issued (table) 20 Works completed (table) 21 Scarlet fever 52 School medical service 16 School treatment centres 15 Sewerage and drainage 18 Shelters (tuberculosis) 63 Slaughterhouses 46 Slaughter of Animals Act, 1933 46 Smallpox 52 Smoke abatement 22 Sputum flasks 64 Statistics, summary of 2 „ vital 3 Subscriptions to hospitals, etc. 17 Travelling expenses of women breast-feeding infants 34 Tuberculosis 58 „ new cases (table) 58 Underground rooms 34 Unsound food 48 Vaccination officer 12 Verminous persons, cleansing of 56 ,, premises cleansed 56 Vital statistics 3 Whooping cough 56 Women health officers 28 Work done at infant welfare centres (table) 29 X-ray diagnosis of tuberculosis 61 Zymotic enteritis 55 ,, death rate (table) 7 APPENDIX I. Sixth annual report on the Kensington rheumatism scheme 65 APPENDIX II. Causes of death at different periods of life in 1933 (Table III) 70 Infant mortality during 1933 (Table IV) 71 Infectious disease, cases notified during 1933 (Table II) 69 Staff of pub he health department (Table VII) 74 Vaccination officer's return for 1932-1933 (Table VI) 73 Vital statistics for 1933 and previous years (Table I) 68 Work of women health officers for 1933 (Table V) 72