The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1934 BY JAMES FENTON, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Jas. Truscott & Son, Ltd., Printers, Suffolk Lane, London, E.C.4. SUMMARY OF STATISTICS for the Year 1934. Population (estimated) 179,080 Area of borough in acres 2,291 Density of population per acre 78 Number of marriages 2,067 Rateable value £3,343,341 Product of a Id. rate £13.931 Total. M. F. (legitimate 2,005 1,135 1,060 „ Live births legitimate 190 100 90 Blrth rate 12.3 Still births 76 46 30 Rate per 1,000 total births 34 Deaths 2,377 1,011 1,366 Death rate (after adjustment) 12.6 Percentage of total deaths occurring in public institutions . 52% Deaths from puerperal causes :— Rate per 1,000 total Deaths (live and still)births. Puerperal sepsis 2 0.9 Other puerperal causes 1 0.4 Total 3 1.3 Death rate of infants under one year of age :— All infants per 1,000 births 93 Deaths from measles (all ages) 56 Legitimate infants per 1,000 legitimate live births 86 „ whooping cough (all ages) 26 Illegitimate infants per 1,000 illegitimate live births 163 „ diarrhoea (under 2 years of age) . 53 Deaths from phthisis 103 Phthisis death rate 0.58 Deaths from all forms of tuberculosis 118 Tuberculosis death rate 0.66 Deaths from the zymotic diseases 158 Zymotic death rate 0.88 3 Town Hall, Kensington, W.8, 1st May, 1934. To the Mayor, Alderman and Councillors of the Royal Borough of Kensington. My Lord, Ladies and Gentlemen, I have the honour to submit my annual report for 1934 upon the state of the public health in Kensington. The birth rate was 12.3, which is 0.3 above the figure for the previous year, but 2.5 below the rate for England and Wales. The death rate of 13.3 is 0.6 above that for 1933, which was one of the lowest in the history of the borough. This figure, however, cannot be used for comparison with other districts, for it has not been corrected for age and sex distribution of the population. When the necessary adjustment has been made the death rate for Kensington for purposes of comparison becomes 12.5, The infant death rate of 93 was far too high, and has caused the council much anxiety. The recent decision to appoint two whole-time medical officers for infant welfare consultations in place of 14 part-time medical officers was arrived at after considering what, further steps could be taken to improve the maternity and child welfare service, with a view to securing a reduction of this death rate. The maternal death rate of 1.3 compares very favourably indeed with the figure of 4.4 for England and Wales. Although it is not wise to arrive at conclusions from statistics based on comparatively small numbers, it is at least gratifying to know that in the year when the council began to employ a whole-time ante-natal medical officer only three Kensington mothers lost their lives in a total of 2,271 confinements. The figure has never been so low before, and the many voluntary and official workers engaged in maternity and child welfare activities will continue their efforts with enthusiasm, in the hope of maintaining this low rate, and will give every encouragement to the whole-time medical officers, who will shortly begin their campaign against' the high infant death rate. Scarlet fever was prevalent throughout the year, but the disease was mild and there were only three deaths. Diphtheria was at no time epidemic, but the type of the disease now prevailing is severe. The council introduced early in the year a scheme for immunising children against diphtheria. It is a pioneer effort, and relies entirely on close co-operation between the doctors in the borough and the public health department. In less than 12 months from the beginning of the scheme, over 1,600 children have received the benefit of security from an attack of this disease. The epidemic of mild smallpox which has existed in London for a number of years seems to be disappearing. There were in London last year only 146 cases ; Kensington was fortunate to escape entirely. In the last 10 years there have been only 12 cases in the borough, whilst there have been 9,763 in London. The five years housing programme engaged a considerable amount of attention during the year, and reference to page 43 of this report will show that the council achieved more during the year than they had anticipated when the programme was outlined. 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 Act, 1,899, covers an area of 2,291 acres, and is co-extensive with the civil parish and registration district of the same name. The line of demarcation formed by Holland Park Avenue, High Street, Notting Hill Gate, and the Bayswater Road divides the borough into approximately equal halves described in previous years and in this report as North and South Kensington respectively. Each of these areas is co-terminous with the parliamentary division of the same name. The borough is further sub-divided into nine wards. North Kensington includes the wards of St. Charles, Golborne, Norland and Pembridgc, 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 1934 has been estimated by the Registrar-General to be 179,080. 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 179,080 North Kensington 94,506 South Kensington 84,574 Wards. St. Charles 30,391 Golborne 22,580 Norland 21,530 Pembridge 20,005 Holland 18,431 Earl's Court 18,005 Queen's Gate 14,236 Redcliffe 21,442 Brompton 12,460 Marriages. During the year, 2,067 marriages were registered, representing a rate of 11.5 marriages per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 723 Roman Catholic Church 280 Nonconformist Church 45 Jewish Church 14 Register Office 1,005 Total 2,067 Births. The number of births registered was 2,195, after correction for inward and outward transfers; and the birth rate for the borough was 12.3 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,035 970 2,005 Illegitimate 100 90 190 Totals 1,135 1,060 2,195 Table showing the number of births and the birth rates in England and Wales, London Kensington, and the various districts in the borough in 1934, and the rates for the previous five years:— District. 1934. 1933 Birth rates in previous years. 1929 No. of births. Birth rate. 1932 1931 1930 England and Wales 597,642 14.8 14.4 15.3 15.8 16.3 16.3 London 56,853 13.2 13.2 14.2 15.0 15.7 15.7 The Borough 2,195 12.3 12.0 12.9 14.2 14.6 14.4 North Kensington 1,585 16.8 16.1 17.3 19.6 19.0 19.3 South Kensington 557 6.6 6.5 7.7 7.8 8.2 7.7 Wards. St. Charles 468 15.4 18.0 19.5 21.6 17.9 17.9 Golborne 534 23.7 21.9 23.6 21.3 21.5 21.8 Norland 351 16.3 13.6 15.9 19.8 22.0 21.5 Pembridge 232 11.6 10.9 7.7 14.3 13.6 13.3 Holland 135 7.3 5.6 8.2 9.1 9.4 8.2 Earl's Court 149 8.3 7.9 9.6 9.2 9.8 8.7 Queen's Gate 78 5.5 5.5 5.7 5.1 5.2 6.2 Redcliffe 145 6.8 6.3 7.2 8.4 9.4 9.2 Brompton 50 4.0 6.7 7.2 5.8 5.3 5.0 Ward unknown 53 ... ... ... ... ... ... 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 1934 12.3 Notification of Births Act, 1907—During the year, 2,195 live births to Kensington mothers were registered, and of this number 2,028 or 93 per cent. were notified in accordance with the requirements of the Act. The number of stillbirths notified was 84, and the number of births notified as having occurred in Kensington but belonging to other districts was 759. 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 21 871 892 „ „ „ parents - 32 32 „ „ „ medical practitioners 11 286 297 „ „ „ other persons 25 391 416 Births in the borough 57 1,580 1,637 Notified from institutions outside the borough 27 479 506 Totals 84 2,059 2,143 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907:— Year. Percentage. 1930 97 1931 97 1932 98 1933 94 1934 93 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 1934 was 2,848, 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 2,848 Deaths of residents in public institutions, etc., beyond the borough 616 3,464 Deaths of non-residents in public institutions, etc., within the borough 1,087 Corrected number of deaths belonging to the borough 2,377 6 This number of deaths gives a crude death rate of 13.3, but this is not a figure which should be compared with those for other districts, for it is necessary that the death rate should be corrected for age and sex distribution. The proportion of old people to young, and of males to females, varies considerably in different districts. The mortality at the extremes of life is much greater than in the middle period, and at all ages the mortality in females is rather less than in males of corresponding ages. A borough such as Kensington, which has a large proportion of old people amongst its inhabitants, shows a crude death rate which compares unfavourably with that of an industrial borough where the majority of the population consists of young adults, although the conditions of life in the former may actually be very much better than in the latter. Before the death rates of different districts can be compared so as to be of any value in estimating the relative healthiness of the populations, the age and sex distribution must be taken into account. An adjusting factor, based on the age and sex distribution of the population, has been supplied by the Registrar-General, and this, when applied to the Kensington death rate, gives a rate of 12.5, which should be used When comparing the death rate of Kensington with those of other districts. 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 1934, and the rates for the previous five years:— District. 1934 Death rates in previous years. No. of deaths. Death rate. 1933 1932 1931 1930 1929 1928 England and Wales 476,813 11.8 12.3 12.0 12.3 11.4 13.4 11.7 London 51,717 11.9 12.2 12.3 12.4 11.4 13.8 11.6 The Borough 2,377 13.3 12.9 13.6 14.0 12.7 15.4 13.0 North Kensington 1,294 13.7 12.9 13.8 13.8 12.6 15.4 13.4 South Kensington 1,040 12.3 12.6 12.4 13.3 12.5 14.5 12.1 Wards. St. Charles 347 11.4 10.9 12.7 12.5 11.7 13.9 12.0 Golborne 370 16.4 13.9 16.2 14.1 12.3 16.0 13.2 Norland 301 13.9 14.1 14.1 14.2 14.4 17.5 15.3 Pembridge 276 13.8 13.1 12.4 14.2 12.1 14.1 13.4 Holland 261 14.2 13.3 13.4 14.5 12.7 14.4 13.2 Earl's Court 221 12.3 13.1 13.3 14.1 15.0 15.9 13.5 Queen's Gate 166 11.7 11.5 12.6 10.8 11.2 12.7 10.0 Redcliffe 251 11.7 12.7 11.8 15.2 11.1 15.7 12.9 Brompton 141 11.3 11.1 10.5 11.2 11.4 12.5 9.5 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 13.6 1933 12.9 1934 13.3 7 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 158 Epidemic influenza 44 Phthisis 103 Other tuberculous diseases 15 Cancer 340 Bronchitis 54 Pneumonia 176 Heart disease 557 Acute and chronic nephritis 46 Puerperal fever 2 Premature birth 30 Violence (including suicide 43) 136 Old age 26 All other causes 690 2,377 It will be seen that over one-third of the deaths, or 890, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 103 deaths. 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 diarrhœa. 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. 1930 0.62 0.58 1931 0.34 0.33 1932 0.99 0.61 1933 0.49 0.32 1934 0.88 0.40 Cancer.—Cancer caused 340 deaths, and of this number 319 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 290 deaths were attributed; sarcoma and epithelioma were the assigned causes of 14 deaths; 36 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, 1934. Parts affected. Sex. Male. Female. Total. Buccal cavity 8 3 11 Lungs 18 11 29 Digestive organs, peritoneum, etc. 83 106 189 Female genital organs – 29 29 Male genito-urinary organs 12 – 12 Breast - 29 29 Skin 2 1 3 Other and unspecified organs 10 28 38 Totals 133 207 340 The deaths in the several wards, etc., are set out in the following table:— The Borough 340 North Kensington 149 South Kensington 191 Wards. St. Charles 37 Golborne 30 Norland 40 Pembridge 42 Holland 43 Earl's Court 46 Queen's Gate 30 Redclilffe 50 Brompton 20 Ward unknown 2 The number of deaths from this disease was 30 more than in the previous year. 8 Table showing the number of deaths in 1934 from certain diseases of public health importance, arranged in four-weekly periods. Four weeks ending Scarlet fever. Whooping cough. Diphtheria. Influenza. Phthisis. Cancer. Bronchitis. Pneumonia. Diarrhoea and enteritis. January 27 – 2 1 4 10 24 8 28 2 February 24 2 8 2 11 12 27 7 23 6 March 24 2 3 13 10 18 7 27 1 April 21 - – 1 8 12 25 9 20 4 May 19 – 1 1 3 12 18 2 9 7 June 16 – 4 – – 9 36 6 6 10 July 14 – 2 – – 6 25 4 2 August 11 – 2 – – 6 19 – 5 3 September 8 – – – 1 8 33 2 4 1 October 6 – 2 – 1 5 26 1 5 4 November 3 – – 1 1 3 24 1 12 9 December 1 1 1 1 1 8 35 8 21 7 December 29 — 2 4 1 2 30 3 12 3 Totals 3 26 14 44 103 340 54 176 59 Infant Mortality. During the year 1934, there were 2,195 births and 204 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 93. 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 1934, and the infant death rates for the previous four years:— District. 1934 Infant mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infant mortality rate. 1933 1932 1931 1930 England and Wales 597,642 35,018 59 64 65 60 66 London 56,853 3,832 67 59 66 65 64 The Borough 2,195 204 93 72 98 76 69 North Kensington 1,585 162 102 80 116 86 76 South Kensington 557 42 75 59 54 44 55 Wards. St. Charles 468 54 115 53 109 76 64 Golborne 534 52 97 89 112 97 81 Norland 351 39 111 117 142 84 70 Pembridge 232 17 73 67 120 92 96 Holland 135 18 133 85 83 54 84 Earl's Court 149 6 40 55 22 18 46 Queen's Gate 78 4 51 37 59 59 57 Redcliffe 145 10 69 65 70 67 43 Brompton 50 2 40 23 32 14 30 Ward unknown 53 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, 1896-1934. 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 1934 59 67 93 The number of deaths of Kensington infants occurring in each month during 1934. January 23 February 20 March. 19 April 16 May 18 June 22 July 8 August 10 September 13 October 19 November 26 December 10 Causes of, and ages at, deaths of infants under one year of age in Kensington during 1934. 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 11) (Measles 10) (Erysipelas 2) – – – – – 1 6 5 11 23 2. Digestive diseases – – – – – 1 1 1 1 4 3. Pneumonia, bronchitis and other respiratory diseases – 1 – 1 2 13 16 10 10 51 4. Diarrhoea – 1 – 1 2 13 15 10 10 50 5. Complications of birth (Atelectasis 9) (Other complications 2) 11 – – – 11 — — — – 11 6. Congenital malformation 5 – – 1 6 3 2 – – 11 7. Premature birth 24 – 1 2 27 2 1 — – 30 8. Atrophy, debility and marasmus – – – – – 3 3 1 – 7 9. Other diseases:— (Cerebro-spinal meningitis 1) (Convulsions 2) (Violence 9) (Syphilis 1) (Other conditions 4) 7 1 – 1 9 3 4 - 1 17 Totals 47 3 1 6 57 39 48 27 33 204 Death rate in each age period per 1,000 births 21.4 1.4 0.5 2.7 25.9 17.7 21.9 12.3 15.0 93 Percentage of total infant deaths occurring in each age period 23.0 1.5 0.5 2.9 28.0 19.1 23.5 13.2 16.2 10 The high rate of infant mortality in the borough has been a matter of much concern to the council for some years ; they have on various occasions reviewed the maternity and child welfare service with the object of finding and introducing measures for securing an improvement. Towards the end of the year they decided, after consulting the advisory committee to the infant welfare centres, to appoint two whole-time medical officers to conduct the infant welfare sessions in place of the 14 part-time medical officers now engaged on this work. It is hoped that these two doctors will be able to secure a better co-ordination of the maternity and child welfare service with the other medical and social agencies in and near the borough, and bring about that reduction in the infant death rate and that improvement in the health and well-being of the children in the borough which have so long been desired. It is expected that the new whole-time medical officers will take up their duties in the coming autumn. Maternal Mortality. In 1934, there were only three deaths of Kensington women directly associated with childbirth, representing a death rate of 1.3 per 1,000 births. The rate for England and Wales was 4.4. The Kensington death rate is a low one and is a record for the borough, but it could have been lower still as in all three cases death was due to puerperal sepsis. One was a case of abortion ; the other two deaths followed full-term deliveries. One of these was a case of very difficult labour but this might have been prevented by more careful ante-natal supervision and better obstetric technique. Very great attention has been paid during the year to the organisation of the ante-natal service in the borough. The council's ante-natal medical officer is present in her office daily from 9 to 10 a.m. to see expectant mothers from any part of Kensington who need urgent advice. She attends all the ante-natal clinics at the infant welfare centres and the number of ante-natal sessions has been augmented since her appointment. There is now a weekly ante-natal clinic at four of the infant welfare centres ; at the other four a session is held twice a month, but with the rapidly increasing attendances, it seems probable that there will shortly be a weekly session at every centre. In addition to the ante-natal clinics at the infant welfare centres, a weekly evening session is held from 7 to 9 p.m. at the Baby Clinic, No. 92, Tavistock Road, for the benefit of those expectant mothers whose employment prevents them from attending a welfare centre during the day. It is recognised that ante-natal work is not an entity in itself, but is valuable according to the degree of co-operation between (he medical officer in charge of the clinic and the doctor or midwife in charge of the confinement. Every effort, therefore, is being expended to improve the co-ordination between the ante-natal service of the borough and the midwives, doctors and hospitals responsible for the delivery of the patient. A very great improvement in this respect has been obtained since the appointment of the whole-time medical officer who visits the borough maternity home and the maternity ward at St. Mary Abbots Hospital weekly, and who has received most helpful co-operation from both institutions. The obstetric surgeons at Queen Charlotte's Hospital and St. Mary's Hospital have also been ready to assist with hospital treatment whenever required. Most of the Kensington midwives are now co-operating in the ante-natal scheme and send all their patients for medical supervision. In 1934, there were 2,195 births in Kensington and the total number of Kensington women who received ante-natal advice at the borough centres and at the clinics at Queen Charlotte's Hospital and St. Mary Abbots Hospital was approximately 1,848. This represents 85 per cent. of the total births and is a satisfactory figure in view of the fact that a large number of the remaining births occur in better-class families where the mother receives ante-natal care from her own doctor or from a specialist. The expectant mothers are attending the borough ante-natal clinics regularly and follow-up home visits by health visitors are rarely required. Patients are seen once a month until six months pregnant and then at fortnightly intervals until the last month of pregnancy, when they attend each week. Obstetric Work in the Ante-Natal Clinics. The value of the ante-natal clinic does not depend solely upon the obstetric work performed, for its function is to educate the mother in hygiene, to remove her fear of the confinement and to advise her as to any necessary preparations ; however, on inspection of the Kensington case records for 1934, evidence of much useful obstetric work can be found and in several cases it is obvious that the woman's life would have been endangered had she not attended the clinic. A selection of these ante-natal cases is reported to show that the work in the borough is conducted on sound obstetric lines. A.—Constitutional disease complicating pregnancy. (1) A case of chronic nephritis with marked changes in the heart and arteries in a woman of 38. This patient had not realised that her symptoms were of serious import and had come to the clinic to book for the maternity home. She was sent at once to a maternity hospital where it was decided 11 that the risk of allowing the pregnancy to continue was too great and a therapeutic abortion was performed in the hospital, followed by sterilisation by X-rays. The patient made an excellent recovery. (2) A case of chronic nephritis with raised blood pressure in an elderly woman went successfully to full-term under dietetic treatment and both mother and baby did well. (3) A case of severe heart disease (mitral stenosis with failing compensation) was referred to hospital and admitted for treatment. Two months later she had a normal confinement and both mother and baby did well. (4) A case of pulmonary tuberculosis in a young woman, who was being treated by induction of artificial pneumothorax, was seen at one of the clinics. The patient successfully withstood the strain of pregnancy and labour, and is being kept under careful observation; meanwhile, she and the baby are apparently in excellent health. (5) A young woman who had suffered from tubercular peritonitis in childhood had considerable pain throughout her pregnancy from the stretching of old adhesions, but had a normal confinement and made an excellent recovery. (6) A considerable number of patients showed very marked anaemia; this was most common in first pregnancies and in one case was sufficient to cause soreness of the tongue. When met with in the older multiparae it seemed usually connected with poverty and malnutrition, but this was not the case with the younger women. Considerable improvement was obtained in all cases by the administration of iron and sometimes by the addition of liver to the diet; the good effect seemed enhanced when a preparation of vitamins A and D was given in addition. (7) A series of patients who attended the Campden Hill infant welfare centre suffering from debility were given a vitamin A and D preparation during pregnancy and showed a very marked clinical improvement. It appeared also in these cases that the general health was regained more rapidly after the confinement. B.—Diseases associated with pregnancy. Seven cases of pyelitis of pregnancy were met with in the clinics; five of these were sent to their own doctors and two to hospital for treatment. All the mothers did well; one baby was born prematurely and did not survive. C.—Complications of pregnancy. (1) A contracted pelvis was found in seven cases. Five of these were carefully watched, but were allowed to continue to full term; three had a normal though rather prolonged labour; two were delivered by forceps. All these mothers and babies did well. Two cases were treated by premature induction of labour in hospital; in one case the result was entirely successful, but in the second case the baby was stillborn after a difficult forceps delivery ; the mother made a good recovery. In the latter case the induction had been delayed for several weeks after the patient had been sent to hospital. (2) External version for breech presentation was performed in the clinics in 46 cases, 19 of these being primigravidae. All of these women had subsequent normal confinements. In four cases of extended breech presentation in primigravidae version was found to be impossible. These four patients were all referred to hospital where version was again attempted under a general anaesthetic. One case was successfully turned and had a normal confinement; in the other three cases, version was impossible even under anaesthesia. One of the patients had a subsequent spontaneous delivery but the baby was stillborn; the mother made an excellent recovery. The other two cases were delivered by caesarean section and both mothers and babies did well. (3) A transverse lie of the foetus was rectified in eleven cases, all of whom were multiparae; all had subsequent normal confinements. (4) Four cases of hydramnios occurred; in one of these cases an anancephalic foetus was born; in a second case the condition was associated with twin pregnancy and albuminuria. All the mothers did well. (5) Retroversion of the gravid uterus was successfully replaced in one case and the pregnancy continued to full term. (6) Vomiting of pregnancy was excessive in 12 cases, but never necessitated admission to hospital. Many of the cases were associated with domestic worries. (7) Albuminuria of pregnancy was treated in 19 primigravidae and 11 multiparae. In the former class, 15 were cured by diet and four were referred to hospital, where induction of labour was necessary in three cases. Nine of the multiparae were cured by diet and two admitted to hospital; 12 one of the latter had a premature induction of labour and the baby did not survive. All the mothers made good recoveries. (8) Eleven patients (three primigravidæ, eight multiparæ) showed a rise of blood pressure during pregnancy without albuminuria or toxæmic symptoms, the systolic pressure in one case being as high as 180. The three primigravidæ all had small and weakly babies; in one case labour was six weeks premature. The eight multiparæ had normal confinements and healthy babies. The patients were treated by diet but in no case was it thought necessary to consider a premature induction of labour. D.—Miscellaneous. (1) One patient was found to have an abdominal tumour which she had thought to be a pregnancy; this was removed in hospital. (2) Four patients were given advice for sterility and are being kept under observation. (3) Post-natal examinations discovered cases of chronic nephritis, mitral regurgitation, subinvolution, retroflexion, cervicitis, prolapse and breast abscess. There were also numerous cases of debility after the confinement needing medical treatment. It is an undoubted fact that a careful post-natal examination is of very great importance in improving the health of the mothers and it is hoped to extend this work in the future to include every case attending the clinics. From the above record it is clear that, in addition to her work in educating expectant working-class mothers in hygiene and dietetics, which is so essential a part of the public health service, Dr. Russell, the ante-natal medical officer, performed a large amount of valuable obstetric work which certainly made many confinements easier and safer, prevented a good deal of subsequent invalidity, and probably saved the lives of some mothers. 13 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 1934 will be found in Appendix II, Table VII. Bacteriological Work. This was the first year in which the council's work was carried out in the laboratory at the Princess Louise Hospital. The bacteriologist is Dr. Bessie Cadness, who was appointed jointly by the council and the hospital. She gives part-time services to both authorities and is also engaged on the staff of another London hospital. The arrangement has proved satisfactory. The work performed by the bacteriologist during the year 1934 was as follows :— Disease suspected. Examinations. Positive. Diphtheria 1,501 111 „ (virulence test) 10 4 Tuberculosis (sputum) 286 37 Typhoid fever (blood) 5 — „ (urine) 1 — Dysentery 7 — Gonorrhœa 17 2 Scarlet fever (ear) 1 — Vincents angina 1 — The following examinations were also carried out :— Milk (bacterial count) 67 „ (tubercle bacilli) 29 The number of examinations carried out during the year is well up to the average of previous years. In addition to the figures given above, a number of samples from the council's public swimming baths were examined, and the results showed that the water was of a very high degree of purity from a bacteriological point of view ; also, 405 specimens of sputum were examined at the tuberculosis dispensary. Infant Life Protection. At the end of the year there were in the borough 160 foster-mothers, and they had the care of 185 children under the age of nine years who had been taken for reward. One of the council's health visitors holds the appointment of infant life protection visitor, and pays frequent visits to every home where a foster-child is kept. One hundred and twenty of the foster-children are under the age of five years, and all but 10, who are seen regularly by private doctors, are in regular attendance at infant welfare centres. During the year four deaths of foster-children 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 foster-mothers. The following is a record of the work carried out by the infant life protection visitor during 1934 :— Visits paid to homes 1,583 Special visits paid 323 Children removed voluntarily 91 ,, ,, compulsorily — „ ,, to hospital 25 Deaths reported 4 Cases in which there was cause for complaint — Cases recommended for prosecution — Foster-mothers added to register 37 „ ,, removed from register. 13 ,, „ on register on 1st January 136 „ „ ,, „ 31st December 160 Foster-children „ ,, „ 185 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 1934 was 2,246 and the number of visits paid 47,464. 14 The following is a table of cases attended and visits paid by nurses of the association on behalf of the council from the 1st January to the 31st December, 1934:— Cases. Visits. Maternity cases 34 768 Miscarriages 38 409 Pneumonia (5 years of age and over) 39 758 „ (under 5 years of age) 69 1,216 Ophthalmia neonatorum and other inflammations of the eyes of newly-born children 16 247 Influenza (5 years of age and over) 27 296 „ (under 5 years of age) 5 36 Enteritis and diarrhœa 74 608 Tuberculosis (5 years of age and over) 32 1,319 (under 5 years of age) — — Measles (5 years of age and over) 44 603 (under 5 years of age) 140 1,816 Measles and pneumonia (5 years of age and over) 11 260 „ „ (under 5 years of age) 56 1,180 Whooping cough (5 years of age and over) – – „ ,, (under 5 years of age) 8 123 Erysipelas 2 36 Acute rheumatism 4 135 Puerperal pyrexia 1 5 Scarlet fever 2 16 Totals 631 10,287 For the splendid services rendered, the council paid to the association in 1934 a grant of £325. 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 562 confinements, of which 525were 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. Special Legislation in Force Locally. Notification of Zymotic Enteritis. The council resolved in 1924 to make zymotic enteritis or epidemic diarrhcea in infants up to five years of age a notifiable infectious disease. The information thus obtained has made it possible for the council's officers to take effective steps in regard to the prevention and treatment of this disease. This disease is also notifiable in the metropolitan boroughs of Paddington, Fulham, Finsbury, Poplar, Southwark, Deptford, Greenwich and Woolwich. 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. This disease is also notifiable in the metropolitan boroughs of Paddington and Holborn, but the Kensington borough council is the only one with a municipal clinic for the supervision of notified cases. 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. Following a deputation from the council to the Home Office in 1933, the Home Secretary modified the by-law by increasing the penalty to £5. Three officers in the public health department make observations under the by-law and during the year summonses were issued in respect of 14 breaches. Fines of 20s. in one case and of 10s. in 12 were imposed; in one case the defendant was cautioned. The number of convictions under this by-law during the past 13 years is 108. 15 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 84 beds. The scheme when completed will provide an additional 54 beds, making a total of 138 beds, a nurses' home, a post-mortem and pathological department, and administration offices, etc. The work performed at the hospital during the year 1934 was as follows:— In-patients. (a) General wards 1,490 (b) Private wards 321 Out-Patients. Total number of new out-patients 13,004 „ „ „ out-patients' attendances 58,437 Number of casualties 4,697 Other Treatments. Number of operations—major 1,089 minor 772—1,861 Dental cases 2,425 Massage 3,557 Light treatments 1,822 Superficial therapy 501 Actual patients X-rayed 2,428 Ante-natal Clinic and Maternity Ward. Total number of attendances 1,594 Number of patients admitted to maternity ward 276 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 81 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 39 General surgical 20 Ear, nose and throat 9 Rheumatism 4 Eye 1 Skin 1 Observation ward 4 Private ward 2 Nursing mothers' ward 1 Total 81 16 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 1934. (a) In-Patients. Total number of available beds on 31st December, 1934 81 Average number of available beds during year 71.26 Average number of patients resident daily throughout year 60.93 Number of in-patients in the hospital at beginning of year 52 Number of in-patients admitted during year 1,307 Number of in-patients in the hospital at end of year 56 Average number of days each patient was resident 17.07 Number of patients admitted and discharged during year who were resident for (i) only 1 day 23 (ii) 2 and 3 days 436 (b) Out-Patients. Total number of new out-patients 8,021 Total number of out-patients' attendances 53,764 Number of casualty patients among new out-patients 1,916 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 1934 is as follows:— Number of sessions held 48 Number of individual patients examined— Kensington 301 Hammersmith 47 Other boroughs 29 Total attendances of patients— Kensington 1,109 Hammersmith 197 Other boroughs 126 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 1934 was as follows:— New cases. Total attendances. Eye cases 423 1,141 Aural cases 335 678 Minor ailment cases 1,515 18,723 Dental cases 1,137 1,978 A school treatment centre has also been established at the Baby Clinic premises in Tavistock Road, and the record of work for the year 1934 is as follows:— New cases. Total attendances. Minor ailment cases 8,383 24,740 Dental cases 1,828 3,615 Light treatment 128 1,644 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 1934 are as follows:— Tonsils and adenoids 313 Eyes (new cases) 385 Dental cases 527 X-ray cases 7 17 School Medical Service. Sir Frederick Menzies, the county medical officer, has kindly made it possible for me to give the following particulars of the routine medical examination of elementary school children carried out in 1934 in Kensington. Table showing number examined and Defects found. Number examined Boys. Girls. Entrants. 916 Age 7. 426 Age 11. 663 Age 14. 852 Entrants. 906 Age 7. 486 Age 11. 762 Age 14. 849 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Malnutrition 7 3 13 2 3 1 3 1 7 2 6 1 9 6 4 2 Skin disease 17 7 2 2 7 5 4 3 6 4 4 2 4 3 3 2 Defective teeth — 404 — 151 — 187 — 296 — 372 — 169 — 207 — 266 Enlarged tonsils 101 14 37 5 19 6 20 6 104 9 41 6 30 3 20 4 Adenoids 9 4 4 4 — - — — 3 — 3 2 1 1 — — Enlarged tonsils and adenoids 42 27 7 3 8 6 5 5 35 24 15 11 3 3 8 8 Other nose and throat defects 10 3 4 1 1 — 3 — 3 2 — — — — 2 — Enlarged glands 101 4 77 3 37 3 29 — 94 6 58 — 45 — 26 — Eye disease 29 16 13 5 12 4 15 4 31 13 14 7 10 3 11 6 Vision defects — — — 15 — 60 — 78 — — — 30 — 71 — 77 Otorrhoea 22 7 4 2 1 - 7 4 25 12 4 1 4 2 5 4 Other ear disease 11 — 3 — 3 2 1 — 8 2 3 — — — — — Defective hearing 1 — 2 2 — — 1 — 2 1 — — 4 3 4 3 Speech defects 8 — 3 — — — 3 1 3 1 2 — — — 1 — Heart defects 16 3 10 — 13 3 11 — 18 - 15 1 16 4 24 6 Anaemia 15 — 11 3 14 2 25 2 10 1 9 — 15 2 11 2 Lung defects 31 9 5 — 5 1 — — 27 8 8 2 8 2 1 1 Nervous defects 5 2 5 1 10 3 7 1 4 — 7 4 6 1 3 1 Phthisis — — — — — — — — — — — 3 — — — Other T.B. disease 1 — 1 — 1 — 1 — — — — — — — — — Rickets 12 1 8 — 4 - 3 1 5 — 2 — 4 — 1 — Spinal deformities 1 — 1 1 15 10 18 11 5 2 3 2 12 6 15 11 Other deformities 19 2 14 2 13 5 10 2 6 1 14 2 25 7 20 6 Other defects 35 16 18 11 27 15 11 5 25 8 16 7 19 9 24 11 Number of children noted for treatment 466 191 273 382 434 224 296 352 * 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 916 364 539 13 289 594 33 — 905 11 — 903 13 — 402 333 181 — — — Girls 906 394 509 3 333 555 18 - 882 22 2 892 14 — 417 325 164 — - - Age 7. Boys 426 220 201 5 75 327 24 - 418 8 — 419 7 - 222 142 62 192 149 43 Girls 486 275 209 2 126 342 18 - 468 17 1 481 5 — 271 155 60 242 164 57 Age 11. Boys 663 280 382 1 146 483 34 - 645 15 3 652 11 — 427 210 26 439 127 93 Girls 762 366 393 3 199 532 31 — 726 35 1 753 9 — 513 216 33 513 162 85 Age 14. Boys 852 334 508 10 237 585 30 — 841 10 1 824 28 — 537 285 30 595 125 128 Girls 849 396 452 1 255 577 17 —- 835 12 2 845 4 — 557 274 18 575 155 119 Total 5,860 2,629 3,193 38 1,660 3,995 205 — 5,720 130 10 5,769 91 — 3,346 1,940 574 2,556 882 525 Percentage 44. 9 54. 5 0. 6 28. 3 68. 2 3 5 97.6 2.2 0.2 98.4 1.6 — 57.1 33.1 9.8 64.5 22.3 13.2 London 53.9 45.5 0 .6 20.5 75.3 4 2 96.9 2.8 0.3 98.9 1.1 0.0 68.8 26.5 4.7 65.3 19.2 15.5 18 Vaccination. There were 2,138 births in 1933 reported to the vaccination officer. By the 31st December, 1934, seventy per cent, of these had been vaccinated. The other thirty per cent, are accounted for as follows :— Statutory declarations of objection 14 per cent. Died before vaccination 6 per cent. Referred to other boroughs 5 per cent. Removed, leaving no trace 4 per cent. Unaccounted for 1 per cent. In view of the fact that throughout the country generally only about thirty-eight per cent, of the children born are vaccinated, the Kensington return must be regarded as highly satisfactory. Only 15 per cent, of the children born in Kensington remain in the borough unvaccinated, and whilst this figure is maintained at such a low level it will be difficult for smallpox to obtain a foothold. A record of the work of the vaccination officer will be found in Appendix II, Table VI. 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, the Women's Co-operative Society, the Women's Conservative and Labour Associations, and other organisations. The report of the health lecturer's work appears on page 34. The council's scheme for diphtheria immunisation has been made a special feature in connection with lectures given by the health lecturer. 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 1934. Subscriptions to Hospitals, etc. £ s. d. £ s. d. Cancer Hospital 5 5 0 Paddington Green Children's Charity Organisation Society 5 0 0 Hospital 5 50 Chelsea Hospital for Women 5 5 0 Princess Beatrice Hospital 10 10 0 Invalid Childrn's Aid Association 30 0 0 Kensal Gospel and Medical Princess Louise Hospital (Rheu- Mission 5 5 0 matism Supervisory Centre) 300 0 0 Kensington District Nursing St. Mary's Hospital 10 10 0 Association 5 5 0 West London Hospital 10 10 0 National Hopital for Diseases of the Heart 5 5 0 Western Ophthalmic Hospital 5 5 0 5 0 Payments to Maternity and Child Welfare Institutions. £ s. d. I s. d. Archer Street Infant Welfare Princess Louise Hospital 400 0 0 Centre 187 0 0 Queen Charlotte's Hospital Ante- Bramley Road Infant Welfare Natal Clinic 45 0 0 Centre 398 18 0 Queen Charlotte's Hospital Campden Hill Infant Welfare (Maternity Home) 1,166 17 0 Centre 240 0 0 Evelyn Convalescent Home 16 16 0 Golborne Infant Welfare Centre 685 0 0 Hambledon Convalescent Home 8 8 0 Kenley Street Infant Welfare Littlestone Convalescent Home 37 16 0 Centre 380 8 0 St. Mary's Convalescent Home 6 0 Lancaster Road Infant Welfare Wayside Cottage Convalescent Centre 614 1 0 Home 31 11 0 Raymede and Sutton Trust Association of Infant Welfare Infant Welfare Centres 540 0 0 and Maternity Centres 8 8 0 South Kensington Infant Welfare Kensington District Nursing Centre 397 13 0 Association 325 0 0 Golborne Day Nursery 197 0 0 Mutual Registration of Assistance Lancaster Road Day Nursery 330 16 0 Society 10 0 0 St. Clement's Day Nursery 291 0 0 North Kensington Women's Wel- Notting Hill Day Nursery 442 6 0 fare Centre (Gynaecological Baby Clinic 618 0 0 Clinic) 20 0 0 Baby Hospital 1,464 9 0 19 SANITARY CIRCUMSTANCES OF THE AREA. Refuse Collection. The collection of house and trade refuse is now being carried out in most districts of the borough by using trailers drawn by motor lorries, and this system will be extended to include the whole of the borough during the present year. The council continue to collect refuse in the borough not less frequently than twice weekly. The number of streets where a daily collection is made has been increased. Since 1st April, 1934, no refuse has been disposed of at Yeading and Harefield, Middlesex; 66 79 per cent. is barged away at Chelsea wharf to a dump beyond Tilbury, Essex, and 33.21 per cent. is disposed of at the destructor installation at Wood Lane depot. The number of standardised dustbins sold during the year was 795, making a total of 4,019 since the council instituted the scheme of standardised dustbins in 1930. The use of a number of dustholes and unsatisfactory refuse receptacles has been further decreased, and the number of portable containers supplied to premises where large quantities of refuse accumulate has been increased to 86. Refuse Removal from Mewsways. The number of portable containers substituted for common dustbins for the storage of house refuse where there are dwellings, stables, and costermongers' stores, now totals 23, and these have proved satisfactory. Sewerage and Drainage. Every house in the borough is connected with the water carriage system for the disposal of sewage, and, generally speaking, house drainage in Kensington is very satisfactory. The following table deals with (a) drainage work undertaken voluntarily by owners and supervised by the officers of the public health department, and (b) all drainage work required by notices served under the Public Health (London) Act, and carried out under the supervision of the sanitary inspectors:— Voluntary work. Work under notice. Plans submitted 319 45 Plans approved by the council 319 45 Total reconstruction of drains of premises 58 31 Partial reconstruction of drains of premises 77 85 Repairs to drains by "Economic Method " 39 33 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 2,725 662 Flooding. On the afternoon of the 24th July there was a sudden heavy rain storm which lasted about an hour. As it appeared probable that the sewers would not be able to carry away all the water quickly enough to prevent flooding of basements, conferences were immediately arranged between officers of the public health and borough engineer's departments, and when the storm ceased all the available sanitary inspectors and health visitors were sent to various parts of the borough to find out the extent of flooding and the need for relief measures. The Mayor (Alderman H. V. Kenyon) at once authorised the expenditure of money from the Mayor's Fund in order that urgent cases might be relieved without delay. Flooding in the southern part of the borough occurred in the basements of 67 houses, but it was not serious, and in many houses was caused by the choking of gullies with leaves or other rubbish. In North Kensington information was obtained that flooding had occurred in 106 houses, but the damage to furniture and bedding was not considerable. Steps were taken at once to alleviate distress by the provision of coal and mattresses, and arrangements were made for mattresses and other bedding affected by the rainwater to be dried at the disinfecting station and the public baths. Every possible assistance was given by the borough engineer's department; and as a result of the Mayor's prompt offer of financial assistance, the sanitary inspectors and health visitors did not find it necessary to seek help from the public assistance officer. 20 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 Inspectors. Grand Total 1 2 3 4 5 6 7 8 9 10 Total complaints received 205 401 252 253 360 163 138 161 220 89 27 2,269 Public Health (London) Act, 1891. Complaints received 94 294 130 148 186 136 132 159 210 89 22 1,600 Houses inspected on complaint 109 294 132 148 186 141 137 162 233 101 19 1,662 „ after infectious disease 187 294 150 166 210 87 57 60 78 33 2 1,324 Re-inspections 2,341 1,095 1,556 2,066 1,057 1,260 1,923 949 1,602 520 9 14,378 By-Laws re houses let in lodgings. Complaints received 111 107 122 105 174 27 6 2 10 — 5 669 Houses inspected on complaint 112 108 124 105 174 27 6 4 10 — 5 675 First annual inspections (furnished houses) 17 — — 10 9 3 — — — — — 39 / Re-inspections do. do. — — — 18 16 41 — — — — — 75 First annual inspections (unfurnished houses) 59 106 101 241 95 32 171 12 71 7 17 912 Re-inspections do. do. 1,715 2,382 982 1,395 1,316 200 457 10 229 1 172 8,859 Housing Acts, 1925 & 1930. Initial inspections (including preparation or revision of house-tohouse card) 303 312 125 190 103 28 243 38 113 8 149 1,612 Re-inspections 34 228 20 122 5 16 2 — 98 2 2,507 3,034 Underground living rooms. Primary inspections 10 67 67 130 136 9 — — 10 2 935 1,366 Re-inspections 30 10 48 361 21 21 — — 20 — 847 1,358 Drainage. House drains tested and inspected 76 49 102 151 50 67 216 35 188 51 63 1,048 Voluntary drainage work. Applications made 17 25 66 59 56 97 166 155 165 170 — 976 Plans submitted 8 4 31 18 12 43 42 63 79 64 — 364 Inspections of workshops 18 33 8 18 49 76 42 59 21 4 — 328 „ factories 26 36 7 41 4 50 6 11 20 1 — 202 „ bakehouses 2 32 11 6 17 29 8 24 18 3 — 150 „ ice cream premises 4 39 8 18 31 23 10 4 5 — — 142 „ other food premises 513 194 122 145 353 325 50 49 26 1 1 1,779 „ mews 173 286 63 12 23 79 270 248 116 90 42 1,402 Smoke observations 30 11 — 7 17 40 1 47 3 3 — 159 Other inspections 401 687 502 326 242 277 285 519 530 140 236 4,145 Canal boats inspections — — — — — — — — — — 12 12 Common lodging house inspections - - - 75 - - - - - - - 75 21 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 Inspectors. Grand Total 1 2 3 4 5 6 7 8 9 10 Kind of notices issued. Public Health (London) Act, 1891. Intimations 283 491 334 213 352 119 218 74 224 23 97 2,428 Statutory notices 45 141 61 42 68 19 32 4 59 7 16 494 Final notices 18 36 22 13 14 3 1 — 28 1 10 146 Summonses issued — 4 5 2 — 1 — — 1 — 8 21 Housing Acts, 1925 and 1930. Sect. 17 (1930) (Repairs) — 2 2 7 6 1 — — — — 68 86 Sec. 127 (1925) (Power of entry) — 9 6 9 26 3 — — 2 — 261 326 Underground room habitation — 3 — — 3 2 — 1 — — 971 980 Removal of manure 2 1 — — — 1 — — — — — 4 Smoke nuisance notices — — — — 2 — — — — — — 2 Rent Restrictions Act certificates — — 1 — 1 — — — — — — 2 Special notices included under Public Health (London) Act, 1891, relating to factories — — — 1 — 9 — — — — — 10 „ workshops — — 1 — — 12 — — — 1 — 14 „ bakehouses — — 1 — — 1 — — 1 — — 3 Other notices 16 53 4 37 4 5 — — 39 1 5 164 Report of waste of water to M.W.B. 5 23 5 12 13 6 2 12 6 3 1 88 „ dangerous structures to L.C.C. 10 4 3 15 23 1 — — 5 — 5 66 Canal boats — — — — — — — — — — 1 1 22 Summary of works completed under the supervision of the sanitary inspectors during the year:- DESCRIPTION OF WORK, &c. NUMBER OF DISTRICT. Housing Inspectors. Grand Total 1 2 3 4 5 6 7 8 9 10 House drains reconstructed 6 7 14 11 10 8 19 3 8 3 - 89 Defective drains repaired 10 7 26 16 9 17 42 17 12 5 1 162 House drains cleansed 26 39 27 56 23 14 12 29 12 7 2 247 Water-closets reconstructed 3 4 42 16 9 14 63 8 27 12 1 199 „ repaired 8 10 14 22 21 38 25 11 27 16 2 194 „ supplied with water 12 9 20 21 1 31 2 2 27 2 2 129 „ new provided 15 46 14 30 14 54 58 58 28 31 — 348 Soil pipes ventilated, repaired, &c. 4 7 6 15 7 18 37 16 26 8 6 150 „ new provided 7 11 18 15 8 13 22 13 20 9 — 136 Baths, new provided 10 — 20 25 12 151 93 104 67 67 — 549 Sinks, „ „ 45 41 70 55 74 75 81 27 63 31 25 587 Lavatory basins, new provided 22 5 10 48 47 282 248 323 196 237 — 1,418 Cisterns cleansed 1 2 5 3 24 6 2 2 1 — 1 47 „ covered — 2 5 — 8 1 2 1 1 — — 20 „ abolished — — 1 — — — 1 — — — — 2 Taps fixed on rising main 7 — 6 12 1 — 1 1 — 1 10 39 Yards, areas paved, drained, repaired 50 40 31 24 30 21 3 3 11 — 43 256 Dustbins provided 47 96 30 28 41 39 15 34 21 1 1 353 Ashpits abolished — — — — — 1 1 1 1 — — 4 Accumulations of filth, &c., removed 42 54 21 14 33 22 4 26 12 4 20 252 Animals removed — 3 3 — 2 2 — 1 1 1 — 13 Overcrowding abated 14 16 2 — 3 2 — — 4 — 184 225 Underground rooms, illegal occupation discontinued 3 — 7 1 2 7 — — — — 935 955 Roofs repaired 44 105 21 33 52 18 33 5 12 2 66 391 Houses provided with water above basement floor 13 16 4 4 — — 9 — — — 1 47 Dampness in dwellings remedied 76 44 29 53 73 6 16 8 27 8 47 387 Demolition and Closing Orders made under Housing Acts— (a) Houses 1 — — — — — — — — — 4 5 (b) Parts of houses — — — — 1 — — 1 — — — 2 (c) Underground rooms — 3 — — 2 2 — — — — 971 978 Closing Orders determined — — — — — — — — — — 3 3 Repairs of houses completed under the Housing Acts, 1925 & 1930 — 1 — — 1 — — — — — 115 117 Infectious disease cases removed 128 149 115 139 111 63 49 22 62 37 — 875 Houses disinfected after infectious diseases (including bedding, clothing, &c.) 216 265 191 169 227 100 165 58 263 79 — 1,733 Rooms in such houses disinfected after infectious disease 217 269 200 177 230 136 167 61 275 96 - 1,828 Houses cleansed under houses let in lodgings by-law 152 200 100 97 175 22 110 1 28 5 18 908 Verminous houses cleansed ing bedding, clothing, &c. 221 115 26 54 74 24 17 29 82 14 6 662 Verminous rooms cleansed in such houses 456 170 28 92 88 24 31 36 95 14 11 1,045 Dirty bedding cleansed 135 14 9 9 15 7 9 — 29 3 — 230 „ „ destroyed 7 2 1 — — 3 — — 4 — — 17 Other sanitary works executed 274 234 46 15 189 77 80 — 39 5 45 1,004 23 Summary of Legal Proceedings taken in 1934. Offence. No. of summonses. Magistrate's decision. Failure to carry out sanitary repairs 9 Orders made requiring works to be carried out within 14 days in four cases and within 7 days in three cases; fined 5s. and order for work to be carried out within 14 days in one case; summons withdrawn, the work having been carried out in one case. Failure to comply with by-laws for houses let in lodgings. 10 Fined £2 in one case; fined £1 in two cases; summonses withdrawn, by-laws having been complied with in five cases; two cases adjourned sine die. Breach of by-laws of L.C.C. with respect to the removal of offensive matter. 26 Fined £2 in two cases; fined £1 in four cases; fined 10s. in sixteen cases; fined 5s. in two cases; summons dismissed with caution in one case and summons dismissed in one case. Failure to abate overcrowding 3 Fined £5 in one case; fined 5s. in one case; summons withdrawn in one case. Occupation of underground rooms contrary to closing orders. 11 Fined £5 in two cases; fined £2 in one case; fined 10s. in two cases; fined 5s. in one case; fined 2s. 6d. in two cases; summons dismissed in one case and adjourned sine die in two cases. Failure to comply with the L.C.C. bylaws in connection with drainage work. 6 Fined £4 in two cases; order made for work to be carried out within 21 days in one case; summons withdrawn, works having been carried out in three cases. Allowing a dog to deposit its excrement on the public footway. 14 Fined £1 in one case; fined 10s. in twelve cases; summons dismissed with caution in one case. Total 79 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. During the year the council's sanitary inspectors made 159 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 in four cases, written intimation notices were not served ; in two cases the service of written intimation notices was necessary. Mortuary and Chapel of Rest. During the year 184 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 17 At the request of undertakers 45 At the request of coroner 121 By the police 11 184 In 115 cases, post-mortem examinations were made under the coroner's warrant. 24 The refrigerating plant for the reception of four bodies, which was installed at the public mortuary in 1933, has proved entirely satisfactory and has secured a marked improvement in hygiene. The appearance of the mortuary chapel has been considerably enhanced by the provision of an altar, curtains, suitable electric light fittings, flower vases, etc. A new rubber floor which has been laid in the chapel still further improves the appearance. Thirty-one bodies were deposited in the Chapel of Rest, Avondale Park. This building is of considerable convenience to those poor persons in Notting Dale who live in perhaps one or two rooms and have no satisfactory accommodation for the bodies of dead relations pending the day of the funeral. Many improvements have been made in the Chapel of Rest. The council redecorated the interior of the building, and a resident of Kensington kindly presented an altar table and pall, flower vases, and mural pictures. 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. 1930 238,262 1931 218,158 1932 232,384 1933 235,860 1934 249,606 In the wash-house or laundry department, there were 88 wash-tubs in use in 1934. The number of women using the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1930 92,381 1931 90,066 1932 89,766 1933 82,715 1934 79,686 There are 8 washing machines, and the number of women using these machines in 1934 was 18,710. Rag Flock Acts, 1911 -28. 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 15.0, 10.5, 10.0 and 7.5 parts of chlorine per 100,000, the limit set by the above acts being 30 parts per 100,000. All the samples were, therefore, in accordance with the requirements of the Rag Flock Acts. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-33. Applications made to the council in 1934 for certificates for fitness for habitation under the Acts totalled three and two certificates were granted. Canal Boats Acts, 1877 and 1884. The Kensington borough council are vested with authority to enforce the Canal Boats Acts and Regulations on all boats entering that portion of the Grand Junction canal which is within the boundaries of the borough. Since March, 1934, the borough council have ceased to use their Kensal Road depot for the disposal of house refuse, and consequently the number of canal boats entering the Kensington wharves has considerably decreased. During 1934 the canal-boats inspector made twelve inspections, all of which were re-inspections. One notice was served upon an owner in respect of the insanitary condition of a cabin. The nuisance was remedied without further action. No births or deaths occurred on boats whilst lying at the wharves in Kensington, and no cases of infectious disease were reported. 25 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 three cases were dealt with. One was that of a woman of 79 years of age who was compulsorily removed in 1929 but had been discharged in April, 1930, and again removed in November, 1933. 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 occasion of the second removal, a large quantity of rubbish was removed, the total weight of which was 3 tons 12 cwt. In February, 1934, the magistrates granted an order for the retention of this woman for a further period of three months. In March, the owner of the house in which the woman resided obtained an order for possession of her room within twenty-eight days. In May, an order was obtained for the woman's retention in St. Mary Abbots Institution for a further three months. She eventually came out of the institution in August. She was not able to occupy her room, and up to the present the sanitary inspector has not been able to trace her. The second case was that of a woman of about 80 years of age. She was ill, and a private doctor was called in who reported the woman's circumstances to a sanitary inspector. There were no relations living nearer than Scotland, and these could not look after her. An order was obtained for her removal to hospital in March, and she died shortly after her admission. The third case was that of a woman, aged 88 years, who lived alone in a basement room. Her room, bed and bedding were infested with bugs ; her sight and mental powers were affected. She had one relation, a nephew living in the country, who could do nothing for her. An order for her removal to hospital was obtained in September, an extension order for three months was granted in January, 1935 ; and the woman is still in hospital. The Rats and Mice (Destruction) Act, 1919. 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 211 Total number of visits paid 2,298 Number of poison baits laid during the year 72,530 „ „ disappeared 66,470 ,, ,, removed by the rat officer 6,060 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 19 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 74 Number of sewer defects allowing egress of rats made good 5 Number of statutory notices served under the Rats and Mice (Destruction) Act, 1919 — Number of premises cleared of rats 188 During the National Rat Week, held in November, special measures of rat destruction were put in hand in the borough council sewers, at the borough council depots and on railway and canal property in the borough. A report of the work done was subsequently published. Nuisances from Pigeons. Section 52 of the London County Council (General Powers) Act, 1927, provides that, for the purpose of abating or mitigating any nuisance, annoyance or damage caused by the congregation at any place in the borough of house doves or pigeons having, or believed by the borough council to have no owner, or of preventing or minimising any such nuisance, annoyance or damage which might, in the opinion of the council, be so caused, the council may seize and destroy or sell any such house doves or pigeons in excess of such number as the council may consider reasonable, and take such steps as they may deem necessary for this purpose. It is necessary, however, in the first place for the council to obtain consent to the measures adopted by them from the person or body in whom the building or land upon which the birds congregate is vested. During the year 1934, 285 pigeons were killed and 103 eggs destroyed. Since June, 1928, when the council first took action under this section, 1,723 pigeons have been destroyed. 26 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 44 35 79 Basket makers 1 — 1 Blacksmiths 12 — 12 Blind makers 1 — 1 Boot makers and repairers 71 16 87 Builders 43 11 54 Cabinet makers 7 3 10 Cigarette makers 3 1 4 Coach builders 11 3 14 Coal wharves 2 — 2 Cooked meat dealers — 2 2 Cycle repairers 7 1 8 Dyers 3 3 6 Electricity generating stations — 4 4 Electric light fitting makers 3 3 6 Firewood choppers 4 3 7 Furriers 4 — 4 Gas works — 2 2 Ice cream manufacturers 4 — 4 Instrument makers — 3 3 Ironmongers 2 — 2 Ladder makers 1 1 2 Lampshade makers 2 — 2 Laundries 4 14 18 Marine stores 1 — 1 Masons 2 1 3 Metal workers 9 5 14 Motor engineers and garages 34 35 69 Motor spirit dealers 5 — 5 Photographers 3 — 3 Piano makers — 1 1 Picture frame makers 3 — 3 Pipe makers — 1 1 Printers 5 7 12 Saddlers 1 — 1 Sausage makers 7 6 13 Sign writers 4 — 4 Steam pressers 4 1 5 Sundry businesses 41 16 57 Sweet manufacturers 3 1 4 Tailors 87 2 89 Timber merchants 2 — 2 Trunk makers 1 — 1 Undertakers 5 1 6 Upholsterers 22 — 22 Washing machine manufacturers — 1 1 Watch makers 7 — 7 Wax figure manufacturers 1 1 2 Wheelwrights - 2 2 Total 476 188 664 27 Factories and workshops where women are employed.—The following table shows the various trades and occupations carried on in registered workshops and factories where women are employed:— Trade or Business. Workshops. Factories. Total. Bakers 1 - 1 Blind makers 1 — 1 Blouse makers 3 — 3 Boot makers and repairers 1 1 2 Corset makers 9 — 9 Dressmakers and ladies' tailors 223 2 225 Dyers 8 1 9 Embroidery workers 1 — 1 Florists 12 — 12 Furriers 12 1 13 Hairdressers 12 — 12 Invisible menders 3 — 3 Jewellers 1 1 2 Knitted goods 1 — 1 Lace workers 3 — 3 Lampshade makers 2 — 2 Laundries 27 42 69 Milliners 33 — 33 Outfitters 5 — 5 Photographers 4 — 4 Picture frame makers 2 — 2 Restaurants 5 — 5 Sundry businesses 38 4 42 Toy makers 1 — 1 Umbrella makers 1 — 1 Upholsterers 7 — 7 Weavers 1 1 1 Total 417 52 469 Home Work.—Of the 180 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, and 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 51 Outworkers in domestic workshops 14 Outworkers in their own homes 115 Total number of outworkers 180 The nature of the work given out to the 115 home workers on the register is as follows:- Tailoring 67 Dressmaking 28 Bootmaking 8 Outfitting 3 Drapery 2 Linen working 2 Fancy goods 1 Blouse making 1 Confectionery 1 Dyeing and cleaning 1 Umbrella making 1 115 28 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 132 „ workshop inspections 715 „ home workers' inspections 300 ,, workplace inspections 33 Home Office Tables. The following tables contain a summary of the inspections made and the defects found and remedied in workshops and factories within the borough where men, women, or young persons are employed:— I.—Inspections. Premises. Number of Inspections. Written notices. Prosecutions. Factories (including factory laundries) 345 27 - Workshops (including workshop laundries) 1,045 27 — Workplaces (other than outworkers' premises) 243 6 — Total 1,633 60 — 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 58 58 1 -— Want of ventilation 4 3 — — Overcrowding 1 1 — — Want of drainage of floors 4 4 — — Other nuisances 22 22 — — Sanitary accommodation:— Insufficient 3 2 — — Unsuitable or defective 24 23 — — Not separate for sexes 4 4 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) 1 1 _ - Breach of special sanitary requirements for bakehouses (Ss. 97 to 100) _ ___ - - Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) 10 5 5 - Total 131 123 6 — III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. 29 MATERNITY AND CHILD WELFARE. The year was a busy one in the re-organisation of the work of the infant welfare centres. Changes had become necessary owing to a diminution in the number of births suitable for welfare attention in the Archer Street and Campden Hill areas, and the removal of hundreds of families from basements and overcrowded rooms in the Golborne district to the new flats at Dalgarno Gardens. At the end of September, the area hitherto served by the Archer Street centre was handed over to the Lancaster Road centre committee. The Archer Street premises, which were originally the freehold property of Mrs. Sidney Brown and were eventually placed in the hands of trustees, are now being transferred to the borough council, who will thus shortly be in possession of well equipped and appointed premises which will be of considerable value to the maternity and child welfare scheme. The premises are centrally situated on a bus route, thus making them easy of access. When the transfer is completed, the maternity and child welfare committee, with the assistance of the advisory committee, will consider how this magnificent gift can best be used in the interests of the mothers and children of Kensington. During the year, information came to hand that the infant welfare centre on Campden Hill was situated on a site which was required by the London county council for the purposes of erecting a new school. In view of the decreased amount of infant welfare work in this area, it was decided that there would be no justification for establishing a new centre under an independent committee to take the place of the one to be disbanded, and that the work at Campden Hill could well be performed by the South Kensington centre. Arrangements have therefore been made for the Campden Hill area to be linked up with the South Kensington centre area and for the committee of that centre to maintain a branch centre in St. George's Hall, Kensington Place. Towards the end of the year, Mrs. Sidney Brown presented to the council the freehold premises at No. 10, Redcliffe Street, South Kensington, which had been equipped by her to serve as an infant welfare centre. These premises are more suitable than those already occupied by the South Kensington centre committee at No. 5, Warwick Road, and arrangements have been made for that committee to transfer to the new house. Mrs. Sidney Brown's generosity provides South Kensington with much more satisfactory premises for this important work than have hitherto been available. In the early part of 1931 the Raymede infant welfare centre committee established a branch centre at Dalgarno Gardens to serve the needs of those who were then about to occupy the 540 Sutton Trust flats which had recently been erected. At the present time many hundreds of additional flats are being built at Dalgarno Gardens by the Sutton Trust, the Peabody Donation Fund and the Kensington Housing Trust, with the result that there is a considerable increase in the work for the branch centre. The Raymede centre committee have come to the conclusion that this branch centre should be an independent unit with its own committee, and they have asked the borough council to make arrangements for this change to be effected as soon as possible. Under the council's scheme of maternity and child welfare work, complete arrangements are made for the care of expectant and nursing mothers and for children up to five years of age. The scheme includes ante-natal clinics, infant welfare consultations, day nurseries, a maternity home, the provision of an obstetric consultant for difficult cases, hospital and convalescent treatment, home nursing and home helps, facilities for the skilled nursing and treatment of cases of puerperal sepsis, and the supply of extra nourishment in necessitous cases. During the year the council inaugurated a further scheme for the boarding-out of children in order to permit the mother of a family to enter hospital for her confinement where this is necessary for medical reasons, or because the home conditions are unsuitable. The scheme is conducted on the same lines as that for the provision of home helps, and when an application is approved, payment at the rate of 12s. 6d. per week towards the maintenance of each child is made by the council, provided that the services rendered are certified as satisfactory by the medical officer of health. The ante-natal services, which were not being fully utilised by the expectant mothers in the borough, were reorganised during 1934, and a whole-time ante-natal medical officer was appointed and commenced duty on the 1st July. A greatly improved co-ordination between the maternity and child welfare institutions, the maternity hospitals and the local midwives has already been obtained, the attendances at the clinics have increased, and the number of sessions has been augmented. A weekly evening session has been instituted to enable working mothers to obtain medical advice and supervision. 30 Women Health Officers. Eight women health officers are attached to the infant welfare centres serving the borough, and the work performed by these officers during 1934 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 * No. 8 Total. First visits to infants (0-1 year) 354 196 251 314 279 71 167 16 1,648 Re-visits to infants (0-1 year) 487 458 720 742 749 171 471 32 3,830 Visits to children between 1 and 5 years 1,048 976 1,087 781 791 497 945 111 6,236 Still-birth enquiries 6 6 8 3 13 4 8 — 48 Visits to ophthalmia cases 5 3 5 3 10 1 — — 27 Return visits to ophthalmia cases 6 2 15 2 49 8 — — 82 Visits to measles cases 256 241 294 92 365 220 95 1 1,574 Visits to whooping cough cases 44 26 18 7 108 64 37 — 304 Visits to puerperal fever cases 4 — 1 1 1 — — — 7 Visits to puerperal pyrexia cases 7 5 1 1 4 — 2 — 20 Visits to enteritis cases 40 10 7 13 3 3 — 3 79 Infantile death enquiries 35 20 15 34 27 18 20 3 172 Investigations re milk applications 523 141 250 389 262 85 36 35 1,721 Ante-natal visits 178 133 179 149 99 172 222 14 1,146 Half-days at welfare centres 181 146 137 128 165 89 121 22 989 Special visits 489 349 302 348 157 432 388 33 2,498 * This officer also acts as infant life protection visitor. 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. 31 Infant Welfare Centres. There are eight voluntary infant welfare centres and one branch centre in Kensington, and the work done at these institutions during 1934 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. 1st Jan. to 30th Sept. 1. Number of births occurring in the area of the centre suitable for welfare attention 63 283 69 204 172 334 298 224 75 1,722 2. Number of sessions at which doctor attended for infant consultations 34 152 91 148 53 134 150 102 54 918 3. Number of sessions at which doctor attended for special ante-natal consultations 16 50 16 24 26 26 31 30 18 237 4. Total number of individual mothers who attended during the year 283 529 192 461 348 879 550 321 200 3,763 5. Number of individual mothers who attended ante-natal sessions during the year 34 120 41 48 78 103 109 93 66 692 6. Total number of individual children who attended during the year— 1. Children 0 to 1 year 164 364 101 234 237 454 365 210 121 2,250 2. ,, 1 to 5 years 126 209 109 352 197 481 414 206 229 2,323 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) 639 1,843 928 1,588 1,719 4,688 3,086 1,853 969 17,313 8. Total attendances at centre of children for all purposes— 1. Children 0 to 1 year 1,532 4,394 1,026 2,754 2,048 5,362 4,233 2,374 1,213 24,936 2. ,, 1 to 5 years 929 2,647 1,175 4,324 2,017 5,760 4,228 3,049 1,830 25,959 9. Total attendances at dinners (included in Nos. 7 and 8 above)— 1. Mothers — — — 84 — 3,045 — — — 3,129 2. Children — — — — — 2,157 — — — 2,157 10. Total attendances at doctors' consultations— 1. Ante-natal mothers 105 573 124 134 313 359 265 384 88 2,345 2. Post-natal mothers 60 218 34 445 122 258 239 533 241 2,150 3. Children 0 to 1 year 678 2,761 907 1,528 840 2,696 2,331 1,449 615 13,805 4. ,, 1 to 5 years 257 1,388 879 1,733 800 1,413 2,228 1,322 997 11,017 11. Average attendances at doctors' consultations— 1. Ante-natal mothers 7 11 8 6 12 14 8 13 5 10 2. Post-natal mothers 2 1 — 3 2 2 2 5 4 2 3. Children 0 to 1 year 20 18 10 10 16 20 16 14 11 15 4. ,, 1 to 5 years 7 9 10 12 15 11 15 13 18 12 12. Number of individual children weighed during the year 290 573 210 586 434 935 779 416 350 4,573 13. Total weighings 2,268 6,945 2,136 6,576 4,063 8,944 8,286 4,835 2,883 46,936 14. Number of first visits paid to— 1. Expectant mothers 32 57 — 80 135 107 140 — 53 604 2. Children 0 to 1 year — — — — — — — — — — 15. Total number of home visits paid to— 1. Expectant mothers 120 122 55 116 329 107 241 98 55 1,263 2. Children 0 to 1 year 683 729 328 409 1,061 848 743 820 256 5,877 3. „ 1 to 5 years 697 395 446 554 1,167 1,019 707 974 453 6,412 32 TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE CENTRES IN 1934. Centre. No. of patients. No. of attendances Extractions. Fillings. Dentures. Other treatments. Archer Street (1st January —30th September) 74 176 57 21 8 12 Bramley Road 23 56 21 - 4 - Campden Hill 12 26 17 1 1 Golborne 20 43 19 2 22 Kenley Street 19 181 74 - 12 107 Lancaster Road 129 300 102 41 17 151 Raymede and Sutton Trust 239 528 206 27 9 286 South Kensington 69 130 131 9 7 65 Totals 585 1,440 627 98 60 644 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 1934 :— 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 206 Total number of individual children who attended (old) 294 (new) 627 Total attendances of mothers for all purposes (excluding the accompanying of children) 1,469 Total attendances of children for all purposes {0-1year 2,174 {1-5 years 1,210 Number seen by doctor at consultations:— 1. Ante-natal mothers 116 2. Post-natal mothers 549 3. Children 4,673 Average number seen by doctor at consultations :— 1. Ante-natal mothers 2 2. Post-natal mothers 11 3. Children 31 Number of individual children weighed 921 Total weighings 4,673 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 1934 :— Number of infants in residence at commencement of the year 25 Number of admissions during the year 262 Number of discharges during the year 243 Number of deaths during the year 23 Number in residence at end of the year 21 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 4,357 treatments were given and the average weekly attendance was 88 ; 222 children were treated. 33 Message and Electrical Treatment Centre. Massage and electrical treatment is undertaken at the Princess Louise Kensington Hospital for Children, and following is a record of the work conducted thereat during 1934:- New cases— Under 5 years of age 31 Over 5 years of age 117 148 Discharged— Under 5 years of age 40 Over 5 years of age 118 158 Transferred to other hospitals because over age 10 Total cases treated 239 Total treatments given 5,010 The borough council make an annual grant to the authorities of the hospital for this treatment. Massage treatment for children was 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 104. Six hundred and nineteen women attended and of this number 565 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 20 beds, 10 of which are used by Hammersmith borough council patients and 10 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. 1930 1931 1932 1933 1934 No. of applications for admission 164 160 161 173 206 No. of applications accepted 158 156 160 173 206 No. of applications withdrawn after acceptance 14 26 26 22 17 No. of women confined during the year 142 130 128 136 158 The gross cost of the scheme to the council during 1934 was £1,166 17s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £622. Payments made by patients totalled £596. Gynæcological Clinic. The following is a record of the work carried out in the gynaecological clinic at the North Kensington Women's Welfare Centre, No. 12, Telford Road, during the year :— Individual patients examined 250 Kensington patients 100 Total attendances 447 Attendances of Kensington patients 179 The council recognised the good work which had been carried out by the clinic in improving the health of the mothers referred from the infant welfare institutions, and made a grant of £20 to the centre. Day Nurseries. There are four day nurseries in the borough, namely :— The Golborne Day Nursery. The Lancaster Road Day Nursery. The Notting Hill Day Nursery. The St. Clement's Day Nursery. 34 The following table shows a record of children's attendances at the day nurseries in 1934:— Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. 1. Whole-day attendances of children under 3 years of age 5,043 2,276 5,756 1,806 14,881 2. Whole-day attendances of children over 3 years of age 3,414 3,189 1,447 930 8,980 3. Total whole-day attendances 8,457 5,465 7,203 2,736 23,861 4. Charges made for each attendance of a child 8d. 9d. 8d. 1s. — 5. Half-day attendances of children under 3 years of age - - 727 334 1,061 6. Half-day attendances of children over 3 years of age - - 750 160 910 7. Total half-day attendances — — 1,477 494 1,971 8. Charges made for each attendance of a child — — 4d. 6d. — 9. Average daily attendance of children 37.4 24.1 39.4 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 1934, together with the number of cases admitted. Each mother and baby stays in the home for a period of 14 days. Institution. No. of mothers admitted with babies. No. of mothers admitted without babies. St. Mary's Convalescent Home, Birchington-on-Sea, Kent — 2 Evelyn Convalescent Cottage Home, Wargrave. Berkshire 6 4 Hambledon Cottage Home, Surrey 5 Littlestone Convalescent Home, Kent 19 Wayside Convalescent Home, Sunningdale, Surrey 10 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 council have now discontinued sending patients to the Littlestone home. The total cost to the council for convalescent treatment during the year was £106 16s. 3d. Health Lecturer. The council's health lecturer, who was appointed in 1926, has continued to carry out valuable work in educating mothers in domestic and personal hygiene. In addition, she has lectured at many women's and girls' clubs, etc., and from reports received her lectures appear to have been much appreciated. The following is a record of the work of the health lecturer during 1934:— Number of lectures. 1 Number of individual mothers attending. Number of attendances. Average attendance at lecture. Archer Street I. W. C. (1st Jan.-30th Sept.) 25 59 268 10.7 Bramley Road ,, ,, 75 239 810 10.8 Campden Hill ,, ,, 33 104 482 14.6 Golborne „ ,, 37 91 392 10.6 Kenley Street 37 181 561 15.1 Lancaster Road ,, ,, 32 280 810 25.3 Raymede ,, ,, 44 232 880 20.0 South Kensington ,, 52 277 808 15.5 Sutton Trust ,, 37 172 737 19.9 Baby Clinic 43 221 728 16.9 Other institutions 18 - 426 23.7 Totals 433 1,856 6,902 16.0 35 Home Helps. Twenty-six applications were received during the year for the provision of home helps under the council's scheme. The assistance requested was granted in 21 cases for a period of 14 days each ; in one case for one month ; in one case for three weeks ; in one case for one week ; one applicant cancelled her request ; and one application was not granted by the sub-committee. The gross cost of the scheme to the council during the year was £37 10s. Od. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. During the year the council have paid special attention to the means by which the nutrition and health of the poorer mothers and infants in the borough might be improved. The beneficial influence of the free milk grants has been recognised, and in order to encourage more applications from those in need, the normal period of assistance has been extended from six to 12 months, subject to the existing practice whereby each case is periodically reviewed ; the period of each milk grant has also been extended from 28 to 56 days if the case appears to be one in which the circumstances are not likelv to alter. In order to meet the additional expenditure as a result of the council s decisions in regard to extra nourishment, a sum of £1,800 was provided in the estimates. In the year, 2,023 grants of milk were made by the council s applications sub-committee. Six hundred and twenty-five of the grants were in response to new applications, and the remaining 1,398 were renewals of grant. Under the council's scheme, 94,276 pints of fresh milk were granted free of charge at a cost to the council of £1,049 13s. Od. ; 2,023 packets of dried milk were granted free of charge at a cost of £378 19s. 6d. The following table gives particulars of the dried milk supplied at cost price under the council 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 750 53 11 11 Bramley Road 1,480 103 7 4 Campden Hill 214 14 9 2 Golborne 620 43 19 11 Kenley Street 1,056 73 11 5 Lancaster Road 4,014 275 15 8 Raymede 2,311 163 13 10 South Kensington 400 28 8 4 Baby Clinic 288 20 3 4 Totals 11,133 777 11 0 The facilities for the supply of free dinners to expectant and nursing mothers have been improved, and there are now eight dinner centres in North Kensington where these are supplied. The council have also considered it expedient that certain expectant and nursing mothers should receive free dinners in addition to free grants of milk. Forty-nine applications for dinners were granted ; 12 of these were new applications, and 37 were renewals. The cost of the dinners amounted to £27 7s. 6d. The total number of dinners supplied was 1,095. In June, 1932, the council approved of a scheme whereby extra nourishment could be granted by the public assistance authority through the council's maternity and child welfare service to expectant and nursing mothers in receipt of out-door relief. The grants made at the expense of the London county council during the year were as follows :— 700 pints of milk at a cost of £9 15s. 0½d. 25 packets of dried milk at a cost of £1 15s. 5d. In 1934; the county council and the borough council agreed to extend the scheme so that those women attending ante-natal clinics at the county council hospitals who were not in receipt of relief, but were needing extra nourishment, could be assisted by grant of extra nourishment at the expense of the borough council. Help given under this heading is included in the total expenditure of the borough council given above. The council gave consideration to the new scheme of the Milk Marketing Board for supplying milk to schoolchildren at reduced prices, and sent a recommendation to the board asking them to consider extending the scheme so as to cover pre-school children attending maternity and child welfare centres. Birth Control. The question of giving birth control advice to married women has occupied the council's attention on various occasions. In 1931, they decided to 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 conditions upon which advice could be given were strictly medical, social and economic grounds not being accepted. 36 In July, 1934, the council asked the Minister of Health to receive a deputation on the subject of the relaxation of the conditions laid down in the Minister's memorandum 153/M.C.W. The deputation attended the Ministry and were received by the Parliamentary Secretary, Mr. Geoffrey Shakespeare, M.P. They were informed that circular 1408 was being issued and that the Minister thought this would meet the suggestions put forward by the council. The new circular indicates that where a local authority have provided a clinic at which medical advice and treatment are available for married women suffering from gynaecological conditions, and at which contraceptive advice is afforded to married women so suffering in whose cases pregnancy would be detrimental to health, it will be proper also for such advice to be given to married women suffering from such organic diseases as tuberculosis, heart disease, diabetes, chronic nephritis, etc. It also indicates that where such clinics are provided for women suffering from forms of sickness other than gynaecological conditions, the interpretation of the meaning of " sickness " is for the medical officer concerned. I he council thereupon issued the following memorandum to the various infant welfare institutions in the borough:— 1. The Kensington borough council desire to call special attention to the importance of the avoidance of pregnancy by women suffering from organic diseases such as tuberculosis, heart disease, diabetes, chronic nephritis, etc., in which child-bearing is likely to endanger life seriously. They are further of the opinion that there are other forms of sickness, physical and mental, in which pregnancy should be avoided if it is found medically that child-bearing would be detrimental to health. 2. What is or is not medically detrimental to health must be decided by the professional judgment of the medical officers at the infant welfare centres and at the birth control clinic, but the council would specially mention that they have been advised that debility following confinement and the necessity, for health reasons, for the spacing of births may be regarded as medical grounds on which birth control advice may properly be given. 3. When there are medical grounds for giving advice on contraceptive methods to any married woman in attendance at a Kensington infant welfare institution, the patient may be referred to the North Kensington Women's Welfare Centre (birth control clinic), No. 12, Telford Road. A certificate signed by one of the medical officers at the infant welfare institution must be sent to the birth control clinic in respect of each woman so referred. 4. In the case of married women who are unable to pay for birth control advice, the council are prepared to pay to the North Kensington Women's Welfare Centre five shillings in respect of each married woman referred to that association from a Kensington infant welfare centre, on receiving from the association the medical certificate mentioned above, duly endorsed bv the doctor who has given the birth control advice. 5. The certificate will be examined by the medical officer of health, who will satisfy himself that further pregnancy would be detrimental to health and that the patient cannot afford to Dav the fee. 6. The council do not approve of the giving of birth control advice on the premises of anv infant welfare centre in the borough which receives grant from the council. During the year, 15 applications were received and all were granted at a total cost to the council of £3 15s. Od. The council have recently decided to discontinue the payment of the fee of five shillings in respect of each case referred to the birth control clinic and to pay an annual grant of £25. Travelling Expenses of Women Breast-Feeding Infants Admitted to Hospitals. One application was received in 1934 for payment by the borough council of travelling expenses to and from hospital of a woman who was breast-feeding an infant admitted as an in-patient to hospital for treatment. This was granted and the total payment amounted to 3s. Od. 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 body, which co-ordinates the work of the eight infant welfare centres, the four day nurseries, and the baby clinic and hospital. Many matters of importance occupied the attention of this committee in 1934, amongst which were the following :— (a) re-organisation of the free dinner scheme to necessitous expectant and nursing mothers; (b) the appointment of a whole-time ante-natal medical officer and the re-organisation of the ante-natal service; (c) re-allocation of the areas served by various infant welfare centres in the borough ; (d) re-allocation of the work of the Campden Hill centre consequent on its closing down in March. 1935. At the present time, the advisory committee are considering the arrangements to be made as a result of the council's decision to appoint two whole-time medical officers for infant consultation work in place of the part-time doctors at present engaged. The committee have continued to be of great assistance to the council's maternity and child welfare committee, and it is largely owing to the efforts of this body that such smooth running, efficiency and uniformity are obtained in the work of the various voluntary associations engaged in the Kensington maternity and child welfare scheme. 37 HOUSING. During the year the council's sanitary inspectors inspected under the Public Health (London) Act, 1891, and the Housing Acts, 6,764 houses, and the total number of inspections made was 34,468. Public Health (London) Act, 1891. The number of written intimation notices served in respect of defects or nuisances in dwellings was 2,428. In the vast majority of cases the work required was carried out without further action on the part of the council but it was necessary to serve 494 statutory notices and 146 final notices, and 22 summonses were eventually issued. The following is a list of the major improvements secured:— Houses cleansed 1,570 House drains reconstructed 89 Defective drains repaired 162 House drains cleansed 247 Water closets reconstructed, repaired, etc. 393 ,, supplied with water 129 ,, (new) provided 348 Soil pipes ventilated, repaired, etc. 150 ,, (new) provided 136 Baths (new) provided 549 Sinks (new) provided 587 Taps fixed on rising main 39 Cisterns cleansed, covered, etc. 69 Yards, areas, paved, drained, repaired 256 Dustbins provided 353 Ashpits abolished 4 Accumulations of filth, etc., removed 252 Roofs repaired 391 Houses provided with water above basement floor 47 Dampness in dwellings remedied 387 Bylaws for Houses Let in Lodgings. During the year 11 houses were placed on the council s register of houses let in lodgings, and 15 were removed. The total number on the register at the end of the year was 3,155. A systematic and detailed examination of 912 of these houses was made. The total number of inspections of houses let in lodgings during the year was 10,560. (This number is included in the total inspections for the year given above.) Outside improvement areas (which are dealt with later), 21 cases of overcrowding were discovered in houses let in lodgings. Written intimation notices secured an abatement of the overcrowding in every case but four, in which statutory notices were served. It was necessary to take proceedings in three cases. Indecent occupation (persons of the opposite sexes over the age of 12 years not living together as husband and wife, but sleeping in the same bedroom) was found in 12 cases. These cases were remedied by the service of 12 intimation and five statutory notices. The number of houses cleansed under the by-laws for houses let in lodgings was 908. Section 17 of the Housing Act, 1930. Unfit Houses Repairable at Reasonable Cost. The following table gives a summary of the action taken and the results obtained during 1934. These figures are in respect of premises outside improvement areas. Notices served in 1933 which were outstanding on 1st January, 1934 61 Notices served from 1st January to 31st December, 1934 86 Notices of appeal by owners to the county court nil Notices of appeal by owners to the county court outstanding from 1933 1 Section 17 notices withdrawn 1 Notices satisfactorily complied with by the owners 116 Cases in which the council carried out the work in default of owners 1 Cases in which satisfactory progress was being made on 31st December, 1934 14 Notices in respect of which nothing had been done at the end of the year (the time allowed had not expired in these cases) 13 Cases in which the council's contractors were engaged in executing repairs in default of owners at the end of the year 1 Total expenditure of the council in executing repairs during the year £59 6s. 6d. During the past 12 years, 1,114 houses have been reconditioned under Housing Act procedure, and of this number no fewer than 752 have been repaired within the last five years, during which time certain officers of the public health department have concentrated their time entirely upon this class of work. The expenditure incurred by the council in carrying out work in cases where the owners have defaulted has reached the total of £3,356 16s. 6d. Of this sum, £3,289 5s. 6d. has been recovered, and the outstanding amount with interest is now being collected. 38 This 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 I have received from my colleagues ; I would like to express my gratitude for the assistance they have given. Section 19 of the Housing Act, 1930. Unfit Houses not Repairable at Reasonable Cost. Outside the improvement areas, there was one house in respect of which the council accepted an undertaking that it would not be used for human habitation. At the time of writing this report the owners are preparing a specification of works required to make the house fit, in the hope that the council will allow the undertaking to be withdrawn. An order for demolition was made in respect of another house ; difficulty arose in connection with the ownership, but in due course the problem was solved and the house was sold to a new owner, who has carried out extensive improvements and alterations at a cost of over £300. The house is now fit for occupation and the demolition order has been withdrawn. Section 20 of the Housing Act, 1930. Parts of Rouses not Repairable at Reasonable Cost. In six houses outside improvement areas, seven underground rooms were closed for sleeping purposes. In two cases closing orders were made in respect of separate parts of houses, and in one case an undertaking was given by the owner that a part of a house would not be used for human habitation until it had been rendered fit. Clearance Areas. (1) Corner of Adair Road and Southam Street. The six houses in this area had been demolished before the beginning of 1934. During the course of the year nine flats were built on the cleared site, and these were occupied by October. (2) Barker Street. (3) Haydens Place and Tavistock Mews. (4) Gadsden Mews. (5) Sylvester Mews. During 1934 the council made clearance orders in respect of the first three of the above-mentioned areas, and a compulsory purchase order in respect of the fourth. A Ministry of Health enquiry commenced on the 11th April, 1934, and lasted one week, during which time strenuous opposition was put forward by counsel on behalf of the various owners. In all cases the orders were subsequently confirmed by the Minister without modification. The occupants of the dwellings in these areas have been accommodated in flats owned by the council or the various housing associations, or in houses elsewhere which the tenants found for themselves. All the dwellings are now empty. Demolition is proceeding in the Barker Street area, and it is expected that the houses in the remaining areas will be pulled down shortly. (6) Bramley Mews. This area, which contains 13 dwellings with 45 occupants, was declared to be a clearance area early in 1935, and the Ministry of Health enquiry has not yet been held. (7) Edenham Mews. There are 10 buildings in this area, which provide accommodation for 34 persons. The area was declared to be a clearance area on the 6th February, 1934. The local enquiry was held on the 30th October, 1934, and the compulsory purchase order was confirmed subject to a slight modification of the original declaration whereby No. 10, Edenham Mews, which had not been inhabited for many years, was consequently marked grey on the map instead of red. This is the only case in the council s housing programme where a property marked for demolition has been altered from what is known as a " red " property to a " grey " one, which means that the owner, instead of receiving compensation for site value only, is paid market value. At the time of writing this report (March, 1935) five of the nine dwellings have been vacated. (8) Talbot Mews. The first part of this area was cleared and 20 flats were built and occupied by 117 persons during 1934. The remaining part of the area was cleared by December, 1934, and the erection of 44 more flats is in progress ; they will be ready for occupation during 1935. (The clearance areas mentioned above will ultimately involve the demolition of 112 houses and the displacement of 774 persons. Rebuilding on three of the sites (Adair Road, Sylvester Mews and Talbot Mews) will provide approximately 151 flats with accommodation for 600 to 700 persons.) (9) Kensal Road and West Row. In July, 1934, the council made a compulsory purchase order in respect of five houses on this site. There was no local enquiry, and the order was confirmed by the Minister on the 28th November, 1934. The houses have not yet been vacated. 39 (10) East Mews Road and Manchester Mews. These two small clearance areas, included in the five years programme, have not yet been declared. It is proposed that action will be taken during 1935. Improvement Areas. Southam Street Area. In the declaration of this area, it was found desirable for technical reasons to divide it into halves, which are known as No. 1 and No. 2, but it will be convenient in this report to regard the entire area as one. This area, comprising about 15 acres, is situated in the Golborne ward, which at the 1931 census was the third most densely populated ward in London. The area had a population of 5,818 persons, an average of 16 per house. There were in the area over 400 houses of a similar type, namely, four-storied-basement houses built in terraces. Speaking generally, each house was constructed with seven rooms above ground level, two rooms in the basement, and a common washhouse at the rear of the basement. Water-closet accommodation, water supply and washing accommodation were provided but these conveniences had to be used in common by all the families in a house. There was no provision for storing or preparing food, although cooking appliances, such as gas stoves and fire ranges, were generally adequate. The houses were about 70 years old and had been originally constructed for single-family occupation. They were fast deteriorating on account of the tremendous amount of wear and tear due to the fact that they were let in unfurnished tenements to persons of the poorer working classes with an average of over four families per house. Practically every room was used for living and sleeping purposes. Disrepair and sanitary defects were apparent, but it was practically impossible to improve the conditions with any lasting effect because of excessive usage. The main structures were on the whole fairly good, the streets were wide and well planned, and the area could not have been reasonably dealt with under clearance schemes. The area was declared by the county council to be an improvement area on the 23rd January, 1934, and the improvement area by-laws came into operation on the 27th April, 1934. The by-laws enable the borough council to require 450 cubic feet of air space for every person irrespective of age in a sleeping apartment. In no other part of the country has such a high standard been imposed and it has been tried for the first time in this area on what might be termed an experimental basis. Another interesting feature in regard to the powers applicable to this area is Section 70 of the London County Council (General Powers) Act, 1933, which is known as the " Kensington section " ; it enables the council to close all unfit basements in the area for both living and sleeping purposes, whereas the law applicable to the country as a whole enables these underground rooms to be closed for sleeping purposes only. The operation of these special powers in regard to overcrowding and basement room occupation has been watched with considerable interest by many with a view to their contemplated application in other districts. In the early part of the year, the public health committee appointed a special defective houses sub-committee, the members of which inspected every basement room and investigated all cases of overcrowding within the area. Subsequently, the sub-committee held a large number of meetings at the Town Hall to interview owners, tenants and other interested persons. They recommended the council to make 400 closing orders and to issue notices in every case of overcrowding on the 450 cubic feet standard. It is satisfactory to note that in only five cases have the owners appealed to the county court against the council's closing orders ; three appeals were withdrawn, and in the remaining two the appellants finally agreed to carry out such works as the council specified in order to make the basement rooms fit for human habitation. As a result of their inspection of the houses and their meetings at the Town Hall, the sub-committee scheduled 474 families as requiring improved housing accommodation. These families were divided into two groups :— (i) families to be rehoused " outside " the improvement area, namely, in the new flats or other accommodation at the disposal of the council ; and (ii) families to be rehoused " inside " the area, namely, in the accommodation vacated by some of the families in group (i). In dividing the tenants in this way, the sub-committee had regard to the number in family, cleanliness, arrears of rent and other relevant considerations. The families to be housed outside the improvement area were referred to a housing board which met at the Town Hall and consisted of representatives of the Peabody Donation Fund, the Sutton Dwellings Trust, the Kensington Housing Trust, the Improved Tenements Association, the Aubrey Trust, the Wilsham Trust, the Town Clerk's Department and the Public Health Department. This board nominated the various families for the flats and houses owned by the bodies represented thereon. In July, 1934, the first block of buildings at Dalgarno Gardens was ready and the rehousing of " outside " families from the improvement area began. The council's housing inspectors were notified of every removal to a house owned by the borough council or the allied housing associations, and they immediately got into touch with the owner of the rooms vacated. In the case of basement rooms, the owner was informed that it would be an offence to re-let, and in the case of upstairs rooms vacated on account of overcrowding the owner was asked if he would co-operate with the council by accepting for these vacant rooms smaller families living elsewhere in the area under unsatisfactory conditions. The families selected for rehousing inside the area were visited by the housing inspectors and told of rooms becoming vacant within the area which would be suitable for them. Owners, generally, were very helpful, and upstairs rooms as they became vacant were gradually re-occupied by families from 40 basements and other overcrowded rooms. A constant check on the empty rooms and repeated visits to families were necessary. There were, however, some difficulties. For various reasons many families were loath to leave basements, particularly those occupying rooms at a comparatively low rental and not willing or able to pay a higher rent for upper rooms. Owners and agents were, naturally, asking as high a rent as possible and many families were refused accommodation because they could not pay the required rent. It is provided by Section 8 (4) of the Housing Act, 1930, that if action taken by a local authority results in the removal of a tenant from a controlled house, such a house remains controlled. Owners generally either did not know or did not observe this provision, and the tendency was for the landlord, where a tenant was rehoused by the council, to raise the rent of the rooms vacated. The Housing Act does not give the council authority to take any steps in such cases, but the inspector frequently pointed out the provision of this section to owners and tenants, and some of these difficulties were overcome. It will be seen that, whilst the representatives of the various housing associations and the council's housing managers were engaged in the removal of families recommended for the new flats, the council's housing inspectors were concentrating on the rehousing of families within the area in the rooms becoming vacant. Where housing managers experienced unreasonable refusals, the inspectors brought pressure to bear by the service of notices, with the result that many such families either applied to the council for accommodation or found other rooms for themselves. Some families were regarded by the housing managers as unsuitable for their flats, and such cases reverted to the housing inspectors to rehouse within the area. Difficulty was experienced at one time in obtaining sufficient families living in basement and overcrowded conditions suitable for the new flats, and consequently applications were considered from other tenants living in the areas in order that their vacant rooms might be used for basement and overcrowded tenants. In a few instances families persistently refused to vacate basement rooms after alternative accommodation had been offered, and it was necessary to take legal proceedings to secure compliance with the closing orders. Great care was taken in the rehousing work to adopt what might be called a process of " filteringup." Families were moved direct from the area to new houses only when it was felt that they would be suitable tenants ; in other cases, they were removed to rooms in old houses owned by the borough council and the allied housing associations which had become vacant on the transfer of suitable tenants to the new flats. In other words, families were given the kind of accommodation which seemed to be most suitable for them. One of the chief troubles experienced by the managers and the inspectors was the very difficult families with a low standard of living, who said that they could not find any accommodation for themselves, and whom no landlord would take. Some of these families, as a result of pressure from the inspectors and the owners, eventually moved away, and some were taken by the housing managers. The entire work of rehousing was virtually completed by the end of the year. In addition to the 474 families scheduled for displacement, the housing inspectors dealt with a number of families occupying basement rooms together with upper rooms, who could be satisfactorily accommodated in the latter. These were therefore not recommended for rehousing ; in many cases they were unwilling to vacate the basements, and notices had to be served before they complied with the closing orders. The following statistics show the number of basement rooms vacated by the end of the year and how the families have been dealt with. No. of rooms in respect of which closing orders were made. No. of these rooms vacated. Rooms still to be vacated at the end of year. 778 768 10 Note :—The ten outstanding basement rooms were being made fit by the owners. Families. Persons. No. originally in occupation of the 778 basement rooms in respect of which closing orders have been made 371 1,498 No. rehoused 366 1,471 No. still occupying basement rooms at the end of the year 6 27 The rehousing of the 366 families has been effected in the following ways:— (a) By the council and allied associations outside the area 95 486 (b) Rehoused in vacated rooms inside the improvement area as a result of action by the housing inspectors 167 598 (c) Moved to another part of Kensington as a result of action by the housing inspectors 73 263 (d) Moved out of the borough as a result of action by the housing inspectors 31 124 Total 366 1,471 No. of notices served by the inspectors upon tenants and owners for non-compliance with closing orders respecting basement rooms 213 No. of cases in which legal proceedings have been taken 10 41 Of the 474 families scheduled for displacement from the improvement areas by the defective houses sub-committee 141 were living in rooms above basement level. In addition, three extra cases of overcrowding were discovered by the housing inspectors. By the end of the year, 135 of these cases had been dealt with as follows :— Families. Persons. Total number of overcrowding cases 144 1,001 No. rehoused 135 942 No. of cases outstanding at the end of the year 9 59 (а) No. rehoused by the council and allied associations 74 520 (б) No. rehoused inside the improvement area as a result of action by the housing inspectors 44 316 (c) No. moved to other parts of Kensington as a result of action by the housing inspectors 11 65 (d) No. moved out of the borough as a result of action by the housing inspectors 0 41 135 942 Note :—Of the nine outstanding cases of overcrowding, six were in hand by the housing managers; legal proceedings had been taken in two cases and in one case legal proceedings were pending. No. of notices served by the inspectors upon owners and tenants in respect of overcrowding 133 Statistics showing the reduction of population effected in the Southam Street improvement area :— Persons found to be in the area in the 1933-34 survey 5,818 Persons actually moved out of the area :— (а) Rehoused by the council and allied associations 1,309 (б) Moved away voluntarily 493 1,802 Deduct. Persons known to have moved INTO the area 109 1,693 Estimated number of persons now in the area 4,125 The above figures show a reduction in population since the beginning of 1934 of 29 per cent. Removal of tenants and disinfestation of furniture. In every case where a family was offered better accommodation, the council undertook free of charge, the removal of the furniture which was disinfested during the process of removal. Details of this service will be found on page 61 of this report. Reconditioning and Repair Work. When it was seen in November that there was a prospect of securing the vacation of all unfit basements and overcrowded rooms by the end of the year, the public health committee considered the steps to be taken to obtain reasonably habitable conditions for the 4,125 persons remaining in the area. Only four houses were found to be so bad as not to be repairable at reasonable cost; demolition orders were made, the houses have been vacated, and it is anticipated that they will be pulled down shortly. It was concluded that satisfactory conditions could be secured in the remaining 406 houses by the application of section 17 of the Housing Act, 1930, and the special improvement area by-laws which came into operation during the year. One of these by-laws in particular required careful consideration. It provides that every owner of a house shall provide and maintain :— (a) water-closet accommodation ; (b) a supply of water for domestic use ; (c) accommodation for washing clothes ; (d) accommodation for the storage of food ; (e) accommodation for the preparation and cooking of food ; for every part of the house which is occupied as a separate dwelling, adequate for the use of and readily accessible to each family occupying such part. Water-closet Accommodation. Hitherto the council had enforced throughout the borough one water-closet for every 12 persons. With two exceptions, every house in the area complied with this by-law, and the vast majority of the houses had at least two water-closets. In 138 of the 410 houses the waterclosets were in the back yard. In 164 there was a water-closet in the back yard and one on the ground floor, and in 74 there was a water-closet in the back yard and one on the first floor. As these houses have a basement and three floors above them, the public health committee were satisfied that such accommodation could not in every case be regarded as " readily accessible " to the tenants ; and it was decided to adopt the rule that in houses let to more than one family at least one water-closet above the basement level should be required, in addition to the one or two in the back yard. The position to be selected for this additional water-closet was left to the discretion of officers of the public health department in 42 sultation with owners. In some houses the new accommodation has been provided by cutting off parts of back rooms and forming closets approached from the half-landings, and in other houses the water-closet apartment is being constructed on the back addition roof at approximately first floor level. Supply of Water for Domestic Use. Every house had a water supply in the basement and at least one water tap at the level of the ground floor or higher. The upstairs tap was generally installed on a half-landing of the staircase, with a small angle sink beneath it. This sink, however, was in most cases much too small to be used for washing-up or for preparing food, and was in common use by several families. The inadequacy of water supply for domestic use and the consequent difficulty in satisfactorily preparing food have for some years been one of the great handicaps from which people have suffered in this particular area, and it was decided to require a water tap and sink in the back room on each floor unless the family occupying that room had the use of an adequate water supply and suitable sink in some other readily accessible position. Accommodation for Washing Clothes. In nearly every house there was a washing copper in the washhouse at the rear of the basement. The usual place for drying clothes was the back yard, but it was found that sometimes clothes were dried and aired in the rooms and on staircases and back addition roofs. As it is possible that closed basements may be used for the purpose of washing clothes, it has been decided not to enforce the provision of such accommodation upstairs. Accommodation for Storage of Food. No attempt has been made in the past to secure in these houses properly ventilated food storage accommodation in reasonably cool positions, and it was decided to enforce the provision of a properly ventilated larder for every family. Accommodation for Preparation and Cooking of Food. It was decided to regard the provision of a proper water supply and a suitable sink as adequate accommodation for the preparation of food, and that every family should have a gas cooking stove or a fire cooking range in good repair. The reconditioning work and the improvements referred to above are now being enforced throughout the area, and in some houses the requirements have actually been completed. Whilst the work is in progress the council's officers help the owners in carrying out the work of disinfestation. As the upstairs rooms in the area are of good size and well lighted, the works which are being carried out in the houses, together with the great reduction in the number of people in the area, are bringing about a considerable improvement. It is true that there are no bathrooms and that all the rooms lead on to common passages, and thus the houses remain houses let in lodgings. Nevertheless they do provide satisfactory accommodation at low rents, and the improvement area machinery, as applied in this area, has contributed to the solution of the housing problem in the borough by preserving a large amount of accommodation in houses which are of sound structure, but which had deteriorated as a result of overcrowding and disrepair following heavy usage. Use of Closed Basements. Under the "Kensington section" of the London County Council (General Powers) Act, 1933, it is an offence for any person to use a closed room in an improvement area for any purpose other than one approved by the borough council. During the year the council gave approval in 18 cases, and the following table shows the purposes for which the rooms may be used :— To use basements under shop premises in connection with the businesses 8 To use basements in dwelling houses for the storage of household articles (mainly surplus furniture due to occupiers having to vacate basement rooms) 6 To use basements for washing purposes 2 To use basements as workplaces 2 Withdrawal of Closing Orders. In 18 cases owners of closed basements submitted comprehensive specifications of work required to make the basements comply with the council's regulations and thereby render them fit for habitation. In three cases the work was completed during the year, and the closing orders were determined ; and in 15 cases the work was in hand at the end of the year. Prevention of Nuisances in Closed Basements. The following by-law is included in the improvement area by-laws for preventing nuisances from or in any room which has been closed :— " Where a closing order has been made in pursuance of part II of the Housing Act, 1930, as extended by section 70 of the London County Council (General Powers) Act, 1933, in respect of a room, the occupier shall remove any rubbish or refuse from such room and keep the room clean and wholesome and, in so far as it is necessary for effective cleansing, the owner shall strip off all unclean or unwholesome paper and remove any woodwork infested with vermin or affected by wet or dry rot." An amending by-law, which came into operation on the 1st March, 1935, requires the boarding or wiring up of windows and the removal of lath and plaster partition walls in closed basements. 43 Crescent Street Improvement Area. The general and special powers which apply in the Southam Street area also apply in this area. The declaration was made by the county council on the 24th April, 1934, and the by-laws for the abatement of overcrowding and the improvement of the state of habitability were confirmed by the Minister of Health on the 25th June, 1934. At the date of declaration the area had a population of 1,782 in 129 houses, an average of 138 per house. The defective houses sub-committee inspected every basement and overcrowded tenement during the course of the year. Closing orders were made in respect of 193 basement rooms ; and 148 families, comprising 513 persons, were scheduled for displacement from basements and overcrowded rooms. The council's housing staff spent most of their time on the Southam Street area, but it was possible for them to give some attention to the Crescent Street area. At the end of the year the position in regard to the vacation of basement rooms and the abatement of overcrowding was as follows :— Closure of Basement Rooms. Number of basement rooms in respect of which closing orders had been made 193 Number of basement rooms which had been vacated 167 Number of basement rooms still to be vacated at the end of the year 26 Families. Persons. Number originally occupying the 193 basement rooms 83 302 Number rehoused 69 232 Number remaining to be dealt with at the end of the year 14 70 Abatement of Overcrowding. Families. Persons. Number originally overcrowded 65 351 Number rehoused 49 257 Number remaining to be dealt with at the end of the year 16 94 It is proposed that the reconditioning of unfit houses in this area will be undertaken during the course of 1935. Treverton Street Improvement Area. On the 29th January, 1935, the borough council asked the county council to declare the Treverton Street improvement area, in which there are 238 dwelling houses, accommodating 2,449 persons. If the county council make the declaration, the defective houses sub-committee will commence their inspections at an early date. It has been estimated that about 450 persons will be displaced from the area to relieve overcrowding and in consequence of the closure of basement rooms under the council's special powers. Five Years Programme. This programme was adopted in June, 1933, and from the particulars contained in this report it will be found that by the end of 1934 the council were actually well ahead of schedule in respect of clearance areas ; in fact, only two small areas, namely, East Mews Road with 14 houses and Manchester Mews with four houses, remain for attention. The Southam Street improvement area is well in advance of schedule, and progress in the Crescent Street improvement area is up to schedule. Although the borough council have already asked the county council to declare Treverton Street, this area was actually scheduled for attention in 1936. The programme estimated that 1,660 persons would be removed from unsatisfactory homes in 1934, but actually the figure was over 2,000. The number of persons rehoused in new flats during the year was 1,704, and this number was made up as follows :—the Sutton Trust made available 101 flats for the accommodation of 518 persons; the Peabody Donation Fund opened their first block of 142 flats at Dalgarno Gardens with accommodation for 632 persons ; the Kensington Housing Trust opened Princess Alice House, which contains 80 flats and accommodates 494 persons; and the council, on completion of their flats on the corner of Adair Road and Southam Street, provided accommodation for 60 persons in nine flats. In addition, much accommodation was found for displaced tenants in the existing properties of the council and the various housing associations. 44 Housing Accommodation provided by the Borough Council. The following is a list of the properties owned and managed by the borough council:— No. of houses Situation of properties. 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, Runcorn Place, Walmer Road and Windsor House 103 Southam House 9 Powis Square, Colville Terrace, Elgin Crescent, 85, Ladbroke Grove, 47, Bassett Road and 20a, Adair Road (conversions) 102 St. Quintin Estate (Sec. 1 & 2), and Avondale Park Gardens 116 St. Quintin Estate (Sec. 3, 4 & 5), Threshers Place, etc. 131 Morland House 20 Talbot Grove and Mews 44 (To be completed during 1935.) In addition to the above property within the borough, the council, by virtue of rate contributions to the county council, have the right to nominate tenants to 99 county council houses on the Wormholt estate, and 50 houses on other county council estates. Accommodation provided in the Borough by Housing Associations. The property owned by the voluntary housing associations operating within the borough is shown below :— A.-—The Kensington Housing Trust own two freehold houses, 157 flats and 51 leasehold houses. In October, 1934, a block of 80 flats was completed 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. 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 18 houses and the leaseholds of 15. At the end of the year they held 191 freehold houses, 82 leasehold houses and 36 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 1929 the Sutton Trustees acquired a large building plot of about eight acres in Dalgarno Gardens, and built 540 flats. During 1934 a further 101 flats were erected on approximately one acre of land at Dalgarno Gardens. E.—The Peabody Donation Fund have taken over on a long lease at a nominal rent about five acres of land at Dalgarno Gardens, and are building blocks of flats which will eventually provide accommodation for 1,607 persons. During 1934 a block of 142 flats was erected, and further blocks are to be erected during the next two or three years. G.—The council have approved plans of 68 flats to be erected by the Gas Light and Coke Company on land owned by them at the northern end of Ladbroke Grove. The houses owned by the council in the Notting Dale and Kensal Town districts of the Borough, the property owned by the Kensington Housing Trust, the Wilsham Housing Trust, the Improved Tenements Association and the smaller housing associations, are managed by women property managers, who hold frequent conferences and are of great assistance to one another in relieving cases of overcrowding which arise owing to changes in the size of families. The very large amount of housing accommodation, totalling over 2,200 houses or flats in North Kensington, which is now under the control of enlightened management, is a very important factor in the considerable improvement which is taking place in the housing conditions in that part of the borough. Common Lodging Houses. Common lodging houses must be licensed annually, and the 30th June of each year has been fixed by the council as the date of the expiration of each licence. The following table shows the licensed common lodging houses and the accommodation available on the 1st January, 1934:— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed. Male. Female. Total. Golborne Chesterton, Ada Elizabeth 194, Kensal Road - 71 71 Norland Hankins, John W. 28 & 30, Crescent Street 54 - 54 „ Woodhouse, Jane E. 40, do. - 25 25 „ Alexander, Agnes Mary 25 & 27, do. - 43 43 „ Cooper, Sagle 66, St. Ann's Road 66 - 66 Totals 120 139 259 45 In June the council renewed all the licences, except in the case of No. 66, St. Ann's Road, as these premises were in a very bad state of repair. The keeper of this house was invited to appear before the public health committee, and was told that the licence would not be renewed unless he gave an undertaking to carry out a schedule of necessary repairs prepared by the medical officer of health. The keeper stated that he was not able to do the work and that his lease of the premises would expire in December. It was, therefore, decided that the licence should not be renewed, but that no legal action should be taken provided that the premises were closed before the end of the year. This house has now been closed, and the premises have been sold; it is contemplated that the site will be used for a block of flats. The common lodging house for women at Nos. 25 and 27, Crescent Street, which has been maintained by Miss Alexander for several years, was closed voluntarily during the year. There remain in Kensington at the present time only three common lodging houses and, although these are licensed to receive 54 men and 96 women, a recent census taken at night time showed only 82 occupants. It is interesting to recall that in 1923 there were eight common lodging houses in the borough, three for men and five for women. Those for women were all within a stone's throw of each other in the Notting Dale area of the Norland ward. From every point of view it is satisfactory that the number of common lodging houses in Kensington has been so largely reduced, for it is difficult to avoid the conclusion that the presence of many of the men and women who occupied these places constituted .an obstacle to the progress of social reform in the neighbourhood. The three remaining common lodging houses are inspected weekly by officers of the council to ensure that the keepers and their deputies maintain reasonably good conditions and to secure compliance with the council's regulations. Flatlets. The conversion of houses into one-roomed flatlets first came to my notice in the early part of 1933, when application was made for permission to make drainage alterations to certain houses in South Kensington. The plans showed that the owner intended to convert two private-family residences into a number of self-contained one-roomed flatlets. It soon became obvious that the practice was growing, and that the council had inadequate powers to control this type of conversion. The matter was brought to the notice of the improvements committee, who instructed me to prepare a report, with the result that in August, 1933, the council passed the following resolution :— " That representations be made to the London county council and the metropolitan boroughs' standing joint committee, in favour of the promotion of legislation to enable the appropriate local authorities to make and enforce by-laws to control the conversion of houses into flatlets in such a way as to ensure hygienic conditions, and to enable local authorities to secure hygiene and good management during the occupation of the flatlets." The majority of the metropolitan borough councils have expressed themselves in favour of legislation to control these conversions, and their views have been forwarded to the county council, who are now considering the problem. Officers of the county council have visited flatlets in Kensington, and I have had various conferences with them in regard to the extent of the powers required. There is a very definite demand for flatlets, and they undoubtedly serve a useful purpose ; but, when single-family houses are being converted into one-roomed flatlets (sometimes 17., 18 or 19 in one house), it appears desirable that the borough council should have some control over the following (a) Lighting and ventilation of bathrooms. (b) Position and ventilation of water-closets. (c) Accommodation for the storage and cooking of food, and facilities for washing of utensils and disposal of waste water. (d) Storage of refuse. (e) Periodical cleansing of walls and staircases. (J) Keeping of animals. Housing Statistics for 1934. 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 1417 :— 1. Inspection of dwelling-houses during the year :— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 6,764 (b) Number of inspections made for the purpose 34,468 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,612 (b) Number of inspections made for the purpose 3,034 (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. 2,687 46 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 163 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 86 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 116 (b) By local authority in default of owners 1 B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,428 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners 2,428 (b) By local authority in default of owners Nil Outside Improvement Areas. 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 1 (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 1 (4) Number of cases in which the undertaking was cancelled, the owner having carried out the necessary work Nil D.—Proceedings under section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which closing orders were made 9 (2) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit Nil (3) Number of separate tenements in respect of which undertakings were given that the premises would not be used for human habitation 1 Inside Improvement Areas. E.—Proceedings under sections 19 and 20 of the Housing Act, 1930, together with section 70 of the London County Council (General Powers) Act, 1933 :— (1) Number of dwelling houses in respect of which demolition orders were made 4 (2) Number of separate tenements or underground rooms in respect of which closing orders were made 971 (3) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been rendered fit 5 47 FOOD SUPPLY. Milk and Dairies (Consolidation) Act, 1915.—The council have decided that a number of samples of milk shall be taken each year for the purpose of examination for the presence of tubercle bacilli. During 1934, 18 samples were so taken, none of which was found to contain the organism Composition of Milk Samples.—Of 298 formal samples of milk taken under the Food and Drugs (Adulteration) Act in 1934, only two were certified by the public analyst as adulterated, i.e., containing less than three 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 1934. 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•73 8•88 3•73 8•88 3•0 8•5 February 31 3•62 8•83 3•62 8•83 March 38 3•46 8•76 3•50 8•76 April 18 3•64 8•77 3•64 8•77 May 30 3•70 8•85 3•70 8•85 June 24 3•66 8•93 3•66 8•93 July 24 3•96 8•81 3•96 8•81 August 31 3•92 8•81 3•92 8•81 September 18 4•34 8•88 4•34 8•88 Average composition of normal cow's milk. October 24 4•05 8•98 4•05 8•98 November 30 3•80 8•97 3•80 8•97 Percentage of milk fat. Percentage of solids not fat. December 12 3•84 8•91 3•84 8•91 298 3•78 8•86 3•79 8•86 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 three 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 1934, and the number of persons and dairies registered at the end of the year is shown in the following table :— Purveyors of milk in sealed bottles. Dairymen. Dairies and milkshops. Transfers - 24 24 Added to register 27 1 1 Vacated and removed from register — 5 3 Dairymen with premises outside the borough added to register - 15 - Dairymen with premises outside the borough removed from the register - 16 - On register 1st January, 1934 85 179 151 On register 31st December, 1934 112 174 149 (+) Increase. (-) Decrease +27 -5 -2 The total number of inspections of dairies and milkshops in the borough in 1934 was 511. Skimmed Milk. The adulteration of fresh cow's milk with skimmed milk and dried milk has been a. problem which has caused much concern to health officers since the establishment of the Milk Marketing Board in 1933. The board have fixed a price for wholesale milk sent to the London market, with the result that "cut-price" wholesale milk has been eliminated and retail dairymen who previously made considerable profits by purchasing "cut-price" milk have been forced to adopt other methods in order to maintain their former income. 48 Legislation relating to skimmed milk at present in operation is as follows :— Milk and Dairies (Amendment) Act, 1922. Section 4—Prohibition of addition of colouring matter, etc. (1) No person shall add any colouring matter or water or any dried or condensed milk or any fluid reconstituted therefrom or any skimmed milk or separated milk to milk intended for sale, and no person shall, either by himself or by any servant or agent, sell, or offer or expose for sale, any milk to which any such addition has been made. (2) No person either by himself or by any servant or agent shall sell, or offer or expose for sale, as milk any liquid in the making of which dried milk or condensed milk has been used. (3) For the purposes of this section, except as regards the addition of skimmed or separated milk, milk includes skimmed and separated milk. Note.—This Act contains no definition of milk other than that contained in Section 4 (3) quoted above, Milk and Dairies Order, 1926. Article 30. Every person shall cause every churn, vessel or other receptacle used by him for the conveyance of skimmed or separated milk or for containing such milk at any time when it is exposed for sale to be marked with the words "Skimmed Milk" or "Separated Milk" as the case may require, in large and legible type. During the year two cases of improper use of skimmed milk occurred in the borough. In the first it was found that a firm of dairymen was purchasing daily 170 gallons of skimmed milk and mixing it with cream in the proportion of 16 gallons of milk to one of cream before adding the product to 2,000 gallons of fresh milk. The analytical content of the milk was practically unaffected by the addition. Investigation was rendered difficult because the skimmed milk was stored in unmarked churns whilst in the cold store. No action was taken against the firm, for the council were advised (a) that the addition of skimmed milk to cream is not prohibited by the above sectk n, and (b) that the requirements relating to the marking of vessels containing skimmed milk do not apply to such milk when it is not in transit or not exposed for sale. The council concluded that the present legislation in regard to skimmed milk is inadequate,, and a communication was sent to the Ministry of Health, the Association of Municipal Corporations; the Metropolitan Boroughs Standing Joint Committee, and the Milk Marketing Board, urging the desirability of new legislation on the following lines :— 1. That the storage of milk powder on any premises registered under Article 6 of the Milk and Dairies Order, 1926, should be prohibited ; 2. That dealers in skimmed milk should be registered with or licensed by local authorities ; 3. That dealers in skimmed milk should be required to keep accurate records of all consignments of skimmed milk arriving at or leaving the premises ; 4. That appointed officers of a local authority should be empowered to examine records and take samples at any time for the purpose of detecting the fraudulent use of skimmed milk ; 5. That vessels containing skimmed milk should be legibly marked with the words "Skimmed Milk 6. That existing legislation relating to the addition of skimmed milk to milk should be amended so as to provide that milk shall include cream. In the second case, watch was kept on a small wholesale dairy following the delivery to the premises on a Saturday afternoon of an unusually large amount of cream. Shortly after midnight a number of churns suspected to contain skimmed milk arrived at the premises. They were at once examined, and it was found that each churn bore evidence of the removal of a label. The lorry driver, who was afterwards found to be a director of the firm, admitted that the milk was skimmed milk, and stated that he had removed labels bearing the words " skimmed milk " from the churns. In this case, as a result of the vigilance of the council's inspectors, no sophistication was attempted, and on the following day the skimmed milk was taken to a farm in Essex, where it was used as pig food. The cream remained in the dairy for a week, after which it was destroyed because it had turned sour. Proceedings were taken in respect of the conveyance of skimmed milk in unmarked churns, and penalties amounting to £30 were imposed. Milk (Special Designations) Order, 1923.—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 Ordef lays down a schedule of fees to be paid by applicants for licences. The licences granted in 1934 were as follows:— Principal licences. * Supplementary licences. (a) Dealers' licence to sell "Certified Milk" 14 1 (b) Dealers' licence to bottle and sell "Grade A (T.T.) Milk" 2 — (c) Dealers' licence to sell "Grade A (T.T.) Milk" 19 3 (d) Dealers' licence to sell "Grade A Milk" — 1 (e) Dealers' licence to sell "Grade A (Pasteurised) Milk" 1 — (/) Dealers' licence to pasteurise milk 1 — (g) Dealers' licence to sell "Pasteurised Milk" 45 5 * These licences enable the holders to sell graded milks in Kensington from premises situated outside the borough. 49 During the year, 21 samples of "Certified Milk," twelve of " Grade A (Tuberculin Tested) Milk," and twenty-three 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 are shown in the following tables:— " Certified Milk." Sample collected Bacteria per Coli per Sample collected Bacteria per Coli per on 1 c.c. l/10th c.c. on 1 c.c. l/10th c.c. 7th March 2,910 Nil. 24th July 3,400 Nil. 17th April 98 „ „ „ 7,000 „ 530 „ 14th August 3,300 8th May 260 „ „ „ 5,800 „ 630 „ 20th „ 193,000 Present. 29th „ 3,800 „ 30th „ 460 Nil. 20th June 23,000 „ 16th October 410 „ 29,000 „ „ 490 „ „ 26,000 „ 21st November 1,030 „ 24th July 470 „ „ „ 560 „ 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 Bacteria Coli per Sample collected on per 1 c.c. 1/100th c.c. Sample collected on per 1 c.c. l/100th c.c. 20th January 760 Nil. 14th August 27,900 Nil. 7th March 4,080 „ 22nd „ 460 „ 3,550 „ 30th „ 31,000 3,860 „ 16th October 680 17th April 96 „ 21st November 490 „ 8th May 54,000 „ 27th „ 990 " Pasteurised Milk." Sample collected on Bacteria per 1 c.c. Sample collected on Bacteria per 1 c.c. 25th January 2,910 20th June 16,600 7th March 32,380 20th August 240,000 17th April 826,000 22nd „ 1,440 1,030 24th „ 7,200 25th „ Plates un- 16th October 190 countable „ „ 1,900 owing to 21st November 24,500 spreading 27th „ 1,080 organisms. „ „ 2,300 „ „ „ 11th December 77,000 80,000 „ „ 2,300 26th „ 12,000 „ „ 1,630 850 19th June 72,000 „ „ Plates un- countable owing to spreading organisms. The majority of the results show that these designated milks had a very low bacterial content. Indeed, only three showed counts in excess of those laid down in the Order. The council have for some years taken firm action with a view to securing a high degree of purity in designated milks, and it is gratifying to note that the improvement shown in the results for 1933 was maintained in 1934. 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 86 slaughterhouse inspections were made. During 1934, nine beasts and 351 sheep were slaughtered in the borough. 50 Slaughter-houses.—In 1933, the duties relating to the licensing and supervision of slaughterhouses, 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 and extended in October, 1933, by the borough council until the 30th June, 1934, were renewed for 12 months to 30th June, 1935. The premises are kept in a clean 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 provides for the licensing of slaughtermen, and the three licences granted by the council in 1933 were renewed for 12 months to 30th June, 1935. 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 150 inspections which were made during the year, three 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. In 1933 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. At the beginning of 1934 there was available a complete card index record of every registerable shop in the borough. The following is a summary of the alterations made in the council's register of food premises during 1934:— On register Dec. 31, 1933. Added to register during 1934. On register Dec. 31, 1934. Manufacturers of ice-cream 75 7 82 Storage and sale of ice-cream 111 7 118 Butchers' shops, including premises used for manufacture of sausages and the preservation of meat 103 - 103 Cooked meat shops 73 2 75 Fishmongers' shops—premises used for the purpose of cooking or curing fish (excluding fried fish shops) 17 2 19 Fried fish shops 40 2 42 Totals 419 20 439 Under section 6 of the Act, power is given to the London county council to make by-laws in regard to food premises. Draft by-laws were issued at the beginning of the year, and were considered by the borough council. The London county council were informed that the borough council were in favour of the draft by-laws generally, but that they wished consideration to be given to the need for more clear definition of certain requirements. 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 51 the provisions of the London County Council (General Powers) Act, 1908. There were, in addition to the inspection of dairies, etc., mentioned above, 3,233 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. Merchandise Marks (Imported Goods) Chilled beef and frozen mutton and pork, etc. No. 7 Order, 1934. Frequent inspections were made throughout the year to ensure that the requirements of these Orders were observed. 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 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 1934. 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 persons in whose possession the food was at the time of seizure. In only two instances was it found necessary to seize and carry away unsound food, and in. each case a warning was sent to the person concerned. 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 (lb.) 25 ! Canned milk (tins) 67 Bananas (cwt.) 3 ,, vegetables (tins) 173 Beef (stones) 23 Chickens 54 Canned fish (tins) 182 Fish (stones) 30 fruit (tins) 736 Peas (lh.) 112 „ jam (tins) 82 Turkeys 47 „ meat (tins) 62 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 678, of which 12 or 1-8 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. 52 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 3 - - - Apricots, dried 7 - - - Arrowroot 2 - - - Bacon 3 - - - Biscuits, shortbread - - 2 - Bread 6 - - - Bread, wholemeal 3 - - - Butter 50 - 21 - Cake, genoa - - 1 - Cakes, sponge 15 - - - Cheese 23 - 9 - Cheese, cream - - 3 - Chocolate 3 - - - Chocolate sponge mixture - - 1 - Cocoa 5 - - - Coffee 6 - - - Coffee and chicory 2 - - - Cream 17 - 6 - Cream, artificial 1 - - - Cream confectionery:— Cornish cream tarts 1 1 1 1 Cream buns - - 4 1 Cream cakes - - 2 - Cream doughnuts 1 1 2 1 Cream eclairs - - 1 - Cream and jam rolls - - 1 - Cream gâteau - - 1 1 Cream layer cake - - 1 1 Cream sandwich 1 1 7 2 Cream square - - 2 1 French cream sandwich - - 1 1 French cream surprise - - 1 - Fruit and cream flans 1 1 2 1 Peach and cream tart - - 1 1 Scotch cream sandwich - - 1 - Cream, salad - - 1 - Cream, tinned - - 3 - Dripping 3 - - - Figs, dried 2 - - - Flour 2 - 2 - Fruit jelly - - 4 - Fruit, mixed - - 1 - Fruit salad, dried 1 - - - Gin 2 - - - Ginger, ground 3 - - - Grape fruit, tinned - - 1 - Ham 6 - - - Herrings, tinned - - 1 - Honey 3 - 1 - Ice-cream 3 - - - Iodine, tincture of 1 - 1 - Lard 24 - 6 - Lemon curd 6 - - - Lemon squash - - 1 - Lysol - - 1 - Margarine 30 - 14 - Mayonnaise - - 1 - Meat pie - - 1 - Milk 298 2 120 2 Milk, condensed - - 3 - Milk, dried - - 6 - Milk, skimmed 18 - - - Mincemeat 6 - 3 - Mint sauce - - 1 - Nutmeg, ground - - 1 - Oil, camphorated - - 3 - Carried forward 558 6 247 13 53 Nature of Sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Brought forward 558 6 247 13 Ointment, iodine 3 - 1 - Paste, fish 15 - 3 - Paste, meat - - 1 - Peas, tinned - - 3 - Pepper 5 - - - Pork pie - - 2 - Powder, cheese 1 - - - Powder, custard - - 4 - Powder, lemonade 12 - - - Powder, liquorice — — 3 - Prunes, dried 2 — — - Purée, tomato — - 8 7 Rice 6 1 - — Rice, flaked — — 3 — Rice, ground 2 — — — Salts, epsom — — 2 — Salts, glauber — — 2 — Sardines, tinned — - 6 — Sausage, breakfast 3 1 — — Sausage roll — — 1 — Sausages 32 1 9 2 Steak and kidney pie — — 1 — Suet, shredded 3 — 1 — Sulphur, milk of — — 3 — Sweets 4 - 1 — Tea 9 - 1 — Tomatoes, condensed — - 2 2 Tomatoes, tinned — - 2 1 Vinegar 19 3 9 1 "Vitacream" — - 1 — Whisky 4 — — — Wine, British — — 6 — Totals 678 12 322 26 54 The following is a summary of the results of analysis of the 38 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. Cream Confectionery— Cornish cream tarts 27 •28 per cent. of foreign fat in cream portion. No action. „ „ „ 26 „ „ „ Informal sample. Cream buns 20 " " " „ „ Cream doughnuts 28•8 „ „ „ „ „ „ „ „ 25•45 „ „ „ No action. Cream gateau 40•76 „ „ „ Informal sample. „ layer cake 31•61 „ „ „ „ „ Cream sandwich 46•23 „ „ „ „ „ „ „ 38•3 „ „ „ „ „ „ „ 36•27 „ „ „ Proceedings. Fined £2 and £10 costs. Cream square 29•3 „ „ „ Informal sample. French cream sandwich 21•39 „ „ „ „ „ Fruit and cream flans 36•6 „ „ „ „ „ „ „ „ „ 34•85 „ ,, „ No action. Peach and cream tart 27•7 ,, „ „ Informal sample Milk 6 per cent. of required fat deficient. „ „ „ 6 „ „ „ Vendor cautioned. „ 4 „ „ „ „ „ „ 2 „ „ „ Informal sample. Tomato purée 5.2 grains of tin per lb. „ „ „ 4.1 „ „ „ „ „ „ 3.5 „ „ „ „ „ „ 2.8 „ „ „ „ „ „ 2.4 „ „ „ „ „ „ 2.2 „ „ „ „ „ „ 1.5 „ „ „ „ Rice 7 grains of extraneous mineral matter per lb. No action. * Sausages 425 parts of sulphur dioxide per million Vendor cautioned. * „ 343 „ „ „ Informal sample. * „ 41 „ „ „ „ „ * Sausage (breakfast) 137•3 „ „ „ No action. Tomatoes, condensed 5•2 grains of tin per lb. Informal sample. „ „ 2•6 ,, ,, „ „ Tomatoes, tinned 1•7 „ „ „ „ Vinegar 20 per cent. of required acetic acid deficient. Proceedings. Fined £1 and 10s. 6d. costs. „ 17 „ „ „ Proceedings. Fined 10s. and 10s. 6d. costs. „ 7 „ „ „ Informal sample. „ 1 „ „ „ Vendor cautioned. The total number of prosecutions under the Food and Drugs (Adulteration) Act was three, the fines and costs amounting to £14 11s. 0d. Cream Confectionery.—During the year a number of samples of cream confectionery were examined, and in 46 per cent, of these it was found that the filling was a substance other than cream. Proceedings were taken in one case, where a cream sandwich contained a filling in which 84 percent. of the fat was foreign fat (i.e., other than butter fat). A conviction was obtained and a penalty imposed. The public health committee, as a result of this conviction, decided that the trade should be informed that proceedings would not be recommended in respect of cream confectionery sold under a description which included the word "cream" if the filling contained no foreign fat and had the composition of dairy cream to which not more than 25 per cent. of stabilising, sweetening, or flavouring substances had been added, provided that such additions were not in contravention of any legal requirement. 55 The Public Health (Condensed Milk) Regulations, 1923-27, and the Public Health (Dried Milk) Regulations, 1923-27.—During the year, three samples of condensed milk and six of dried milk were taken, and each was found to comply with the regulations in every respect. Food Poisoning.—Section 7 of the London County Council (General Powers) Act, 1932, requires every doctor 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, 334 cases were notified in London. The number notified in Kensington was 23 ; there were 18 in the Golborne ward, four in the St. Charles ward, and one in the Brompton ward. It will be observed that with one exception, all the Kensington cases occurred in the northern part of the borough, where the majority of the poorer residents live. In the one case in South Kensington, the patient lived in a mews dwelling. In one case the illness proved fatal. The patient was a woman who ate some sausages and the following morning fell ill with diarrhoea and sickness. She was worse the following day, and a doctor was called in. As her condition was more serious the next day, she was removed to hospital, where she died a few hours later. A post-mortem examination showed that death was due to food poisoning. The sausages suspected were bought in a neighbouring borough, and the circumstances were notified to the medical officer of health concerned. An analysis was made of the foods suspected of causing the illness in the notified cases, and resulted as follows:— Food causing illness. No. of cases. Breakfast sausage 1 Faggots 1 Fish 5 Fish or meat paste 3 Fruit 1 Lobster patty 1 Meat pie 2 Mushrooms 1 Pork 3 Pressed beef 1 Sausages 3 Tinned peas and sausages 1 A number of articles of food were submitted to the bacteriologist for examination, but in no case was a report received regarding the presence of any of the salmonella group of organisms. 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 ; with the exception of the fatal case, the illness was invariably mild. Pharmacy and Poisons Act, 1933.—This Act, which has for its object closer control over the sale of poisons and poisonous substances than has hitherto been the case, was passed in 1933 and will come into operation on the "appointed day," which has not yet been fixed. Part 2 of the Act provides for the preparation of a list of poisons divided into two parts, part 1 of which will contain the names of those poisons which may not be sold except by a person who is an "authorised seller" and part 2, the names of those poisons which may not be sold except by an "authorised seller" or a person whose name appears in the register of a local authority. During the year there was issued a draft poisons list in which those poisons usually regarded as deadly were given in part 1 and those usually contained in substances used for agricultural, horticultural, industrial and sanitary purposes in part 2. Inspectors approved by the Pharmaceutical Society will enforce the law in regard to part 1 poisons ; but it will be the duty of the council to keep a register of persons selling part 2 poisons, to carry out inspections of the premises concerned, and to enforce the requirements relating to the proper marking and storage of the poisons. For this purpose the medical officer of health and the food inspector have been appointed inspectors under the Act. 56 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 1930-34. 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. 1930 4 411 329 32 68 11 8 24 221 3 2 1 99 3 3 80 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 1934 — 549 360 7 80 10 4 20 177 2 2 2 56 4 5 52 1,331 Cases of mistaken diagnosis are excluded from the above table. ‡ Acute rheumatism in children under 16 years of age became notifiable in Kensington on 1st October, 1927. It is also notifiable in Paddington and Holborn. * 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 1934, arranged in Four-Weekly Periods (1st January, 1934, to 29th December, 1934). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Acute rheumatism. Cerebro spinal meiiingitis. Dysentery. Enteritis. Polio myelitis. Total. January 27 - 50 25 - 3 - - 1 31 - 9 - - 2 - 121 February 24 - 41 13 — 6 1 - — 34 — 9 2 106 March 24 - 38 22 - 6 1 1 i 28 - 7 - - 2 - 106 April 21 - 54 20 — 7 1 1 2 20 - 1 1 - 2 - 109 May 19 - 41 28 1 6 1 - 2 10 - 8 - - 1 — 98 June 16 - 40 41 — 4 2 - 2 4 - 2 — - 13 - 108 July 14 — 45 20 1 3 — - 1 3 - 4 - - 3 - 80 August 11 - 42 23 — 7 1 1 2 5 — 1 1 2 4 - 89 September 8 - 33 6 1 3 — - 1 1 - 2 — — 10 1 58 October 6 - 39 38 1 13 2 1 1 8 - 4 — 1 6 — 115 November 3 - 54 38 1 6 — - — 11 - 5 — 2 4 1 122 December 1 - 42 36 1 10 1 - 7 12 1 1 — — 2 — 113 " 29 - 30 50 1 6 - - - 10 1 3 - - 3 — 104 Totals - 549 360 7 80 10 4 20 177 2 56 4 5 52 2 1,329 Cases of mistaken diagnosis are excluded from the above table. 57 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 78 of this report. Smallpox.—During 1934, there was a large decrease in the number of smallpox cases notified in London. One hundred and forty-six cases occurred in the metropolitan area, as compared with 534 in the previous year. Thirteen of the 29 metropolitan boroughs were affected. There was only one death from this disease in London during the year. One case of smallpox was notified in the borough during the year, but the notification was subsequently withdrawn as the patient was found to be suffering from chicken pox. 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 72. Scarlet Fever.—The number of cases notified during the year was 578, of which 541 were removed to hospital. Twenty-nine 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 1934:— District. Period No. 1 Period No. 2 Period No. 3 Period No. 4 Period No. 5 Period No. 6 Period No. 7 Period No. 8 Period No. 9 Period No. 10 Period No. 11 Period No. 12 Period No. 13 London 1,771 1,415 1,440 1,372 1,469 1,348 1,324 1,312 980 1,434 1,667 1,575 1,294 The Borough 50 41 38 54 41 40 45 42 33 39 54 42 30 North Kensington 33 24 26 39 27 33 35 36 21 33 34 29 23 South Kensington Wards. 17 17 12 15 14 7 10 6 12 6 10 13 7 St. Charles 8 5 11 10 13 10 5 18 6 15 23 15 10 Golborne 10 8 6 11 7 12 16 13 8 9 15 10 2 Norland 10 7 7 9 6 7 10 2 3 4 3 2 8 Pembridge 5 4 2 9 1 4 4 3 4 5 3 2 3 Holland 4 3 3 2 3 1 6 1 3 — 5 1 — Earl's Court 4 5 — 1 2 3 — 3 6 6 2 4 2 Queen's Gate 1 4 3 9 5 2 — — — — 1 — 1 Redcliffe 4 3 5 2 2 1 3 1 3 — 1 5 2 Brompton 4 2 1 1 2 — 1 1 — — 1 3 2 Cases of mistaken diagnosis are excluded from the above table. The number of cases was 68 fewer than in the previous year, and the disease remained mild in type. There were three deaths during the year, and in the three preceding years the number was one, three and one respectively. There were 44 instances where more than one case occurred in the same house. Ten of the 549 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. During the year, it was necessary for application to be made to the West London Police Court for orders for the compulsory removal of two cases of scarlet fever to hospital. In one instance, the family occupied part of a basement flat, the remaining two rooms being occupied by members of another family. In the other instance, the house was let in lodgings to members of four families. Every persuasive effort was made by the council's officers to induce the parents to allow the patients to go to hospital, but these failed and, as the home conditions were conducive to the spread of infection, it was essential in the public interest that a magistrate's order for removal should be obtained. It is interesting to record that these are the only two cases over a period of many years where the officers of the public health department have found it necessary to apply to a magistrate for power to secure removal. As a preventive measure, the 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 £1 15s. 3d. was incurred in respect of this service. Diphtheria.—Three hundred and eighty-four cases of diphtheria were notified during the year, 383 of which were removed to hospital. 58 Twenty-four patients notified as suffering from diphtheria were found after admission to hospital not to be suffering from any infectious disease at all, with the result that they were returned home. The following table shows the number of cases notified in the various wards in each four-weekly period during 1934:— District. Period No. 1 Period No. 2 Period No. 3 Period No. 4 Period No. 5 Period No. 6 Period No. 7 Period No. 8 Period No. 9 Period No. 10 Period No. 11 Period No. 12 Period No. 13 London 921 834 775 759 897 847 847 823 708 921 1,198 1,122 1,239 The Borough 25 13 22 20 28 41 20 23 6 38 38 36 50 North Kensington 23 12 20 15 26 35 17 21 4 36 34 33 46 South Kensington Wards. 2 1 2 5 2 6 3 2 2 2 4 3 4 St. Charles 8 1 6 4 11 16 3 4 3 14 18 8 27 Golborne 10 5 6 7 6 9 4 5 — 9 3 9 5 Norland 4 2 4 2 8 6 9 10 1 10 10 13 8 Pembridge 1 4 4 2 1 4 1 2 — 3 3 3 6 Holland 1 1 — — 1 2 1 — — — 2 3 1 Earl's Court — — — 1 1 — — — — — — — — Queen's Gate — — — 4 — 1 1 2 — 1 — — 1 Redcliffe — — — — — — 1 — 2 1 — — 1 Brompton 1 — 2 — — 3 — — — — 2 — 1 Cases of mistaken diagnosis are excluded from the above table. There were 26 instances where more than one case occurred in the same house. The number of Kensington deaths was 14, representing a case mortality of 4 per cent. In the three preceding years the deaths were 22, 29 and 7. During the year, 1,501 throat swabs were examined at the council's laboratory at Princess Louise Hospital, and of these 111 gave a positive result. There were no " return " cases reported during the year. Four cases of diphtheria were reported from St. Mary Abbots Hospital, five from St. Charles Hospital, one from the Kensington Institution, and five from the Princess Louise Kensington Hospital for Children. Under the Anti-toxin Order, 1910, the council are empowered to supply diphtheria antitoxin for administration to patients who are too poor to pay, and on signing the necessary declaration that the patient cannot afford specific treatment, a medical man can obtain a free supply from Mr. Evans, chemist, at No. 135, Ladbroke Grove, W.11, Mr. W. Reeves, chemist, at No. 81, Cornwall Road, W.11, or from the public health department at the town hall. The anti-toxin is obtainable at all hours of the day and night from Mr. Evans' and Mr. Reeves' premises, and during office hours from the town hall. When the town hall is closed, applications for anti-toxin can be made to Mr. Britton, an officer of the department, who lives at No. 1, Hornton Place, Hornton Street (only a few yards from the town hall). The council loan syringes with portable sterilizers to doctors for the purpose of administering the anti-toxin. Medical men administering the council's anti-toxin to poor persons are, on application to the medical officer of health, paid a fee of 5s. per patient treated. In 1934 the borough council supplied 276,000 units of anti-toxin for 36 patients at a cost of £22 12s. 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 1934 was £6 5s. 0d. The council introduced during 1934 a scheme whereby medical practitioners can immunise poor patients against diphtheria in return for a fee of 10s. paid by the council in respect of each patient. Particulars of this scheme appear on page 64 of this report. Enteric Fever.—Seven cases of this disease were notified; two were removed to hospital and four to nursing homes. The cases notified in the three preceding years were 11, 14 and 16. There were no deaths from this disease as against two and one in the preceding years. Four cases were notified from the southern division of the borough and three came from North Kensington. In two cases there was evidence that the disease had been contracted abroad; one contracted the disease during a visit to the country ; but the remaining four had not been out of London for some time prior to their illness. Erysipelas.—Eighty cases were notified during the year, 52 of which were removed to hospital. There were eight deaths from this cause, the deaths in the three preceding years being ten, seven and three. 59 Ophthalmia Neonatorum.—The following table gives particulars of ophthalmia cases notified in 1934 and the results of treatment:— Case. No. Cases. Vision unimpaired. Vision impaired. Total blindness. Death. Notified. Treated. At home. In hospital. 1 Feb. 8 Yes - Yes - - - 2 Mar. 13 Yes — Yes — — — 3 „ 27 — Yes Yes — — — 4 May 10 — Yes Yes — — — 5 June 8 Yes — Yes — — — 6 „ 14 Yes — Yes — — — 7 July 26 Yes — Yes — — — 8 Sept. 20 Yes — Yes — — — 9 „ 26 — Yes Yes — — — 10 Nov. 20 — Yes Yes — — — From the above table, it will be seen that all the cases recovered without any injury to sight. Puerperal Fever.—During the year, four cases of this disease were notified. Three were confined at home, subsequently removed to Queen Charlotte's Hospital and recovered; one was confined at home, subsequently removed to the North-Western Fever Hospital and recovered. Puerperal Pyrexia.—Twenty cases of puerperal pyrexia were notified during the year. Nine occurred in hospitals to which the patients had been removed prior to their confinements, and 11 in the homes of the patients. Of the 11 confined at home, seven were subsequently removed to hospital for treatment, whilst the remaining four received attention in their own homes. None of the notified cases of puerperal pyrexia proved fatal. In 1926, 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 722, which suggested that notification should be supplemented, when necessary, by facilities for assistance in diagnosis and for the treatment of patients who are not able to secure adequate treatment for themselves. The council have appointed Dr. A. Morris Johns, a consultant at Queen Charlotte's Hospital, to the position of consulting gynaecologist and obstetrician and, in addition, Dr. Morris Johns from the 1st January to the 30th June conducted the 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 or obstetrician and one guinea for each enquiry into a maternal death. Since the 1st July, however, the council's ante-natal medical officer has conducted the enquiries into maternal deaths. Malaria.—Two cases of this disease were notified during the year, and investigations revealed that in each case the disease had been contracted abroad. Encephalitis Lethargica.—In 1934, there were two cases reported in Kensington. The patients were males aged 25 and 13 years respectively. The cases were notified on the 22nd February and 12th September, and both are still under treatment. Poliomyelitis and Polio-Encephalitis.—Two cases of poliomyelitis or polio-encephalitis were notified to the public health department during the year. One was an adult aged 35 years and the other a child aged 5 years. The former died and the latter recovered. Cerebro-Spinal Meningitis.—There were four cases of this disease notified during the year ; particulars are subjoined:— No. Sex. Age. Date of notification. Result. 1 F. 28 years. February 10th. Recovered. 2 F. 26 years. „ 21st. do. 3 F. 2 years. April 6th. Died. 4 F. 47 years. July 28th. do. Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia but the oniy kinds notifiable are acute primary pneumonia and influenzal pneumonia. One hundred and 60 seventy-seven notifications were received, 147 patients being certified as suffering from acute primary pneumonia and 30 from influenzal pneumonia. The number of deaths from pneumonia during the year was 176, and 44 deaths were certified to be due to influenza. Zymotic Enteritis or Summer Diarrhœa.—During the year, 52 cases of zymotic enteritis were notified, and there were 50 deaths of children under the age of one year from diarrhoea or enteritis. Forty-three of the deaths occurred amongst infants who had not been notified. In 1924, the borough council adopted a scheme for the control and treatment of zymotic enteritis or summer diarrhoea. From 1924 until the year under review, the scheme was in operation for the summer months only, but during the past year the scheme operated from the 1st January to the 31st December. 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:— Zymotic Enteritis Scheme, 1934. The council's scheme for the treatment of zymotic enteritis in the home during the period, 1st January to 31st December, has worked smoothly. During the summer I saw a few isolated cases of infective enteritis with high temperatures, but the great majority of cases were caused by dietetic disorders. I saw 35 cases in their own homes, and paid 160 visits. No case proved fatal in the home. I sent four cases to hospital ; these babies were suffering from toxæmia and could not be treated at home. One of them had attended a welfare centre fairly regularly and was a well nourished child, and I cannot understand how she developed the illness. She ultimately died in hospital. This was the only death that occurred. The patient had a temperature of 105° F., there was no illness amongst the rest of the family, and the mother was intelligent and clean. Several cases of diarrhoea in breast-fed infants were referred to me by local doctors. In these cases malted milk was not necessary, and as there was no vomiting, breast feeding was continued ; the mothers, however, were convinced that their breast milk did not agree with the infant. I was able to assure them that they were wrong. All these cases recovered and breast feeding was continued. The treatment comprised washing out the colon and giving a dose of castor oil. During the year I saw no case of dysentery or paratyphoid. District Nursing Association. No death occurred whilst the nurses were in attendance. Thirteen cases were referred to hospitals. The nurses attended 76 cases from the 1st January to the 31st December, and paid 615 visists. I think the council's scheme has worked well during the year as a result of the whole-hearted co-operation between the council's health officers, the staffs of the infant welfare centres, and the district nurses. (Signed) Ronald Carter. Dysentery.—Five cases of dysentery were notified during the year. Three were of the amoebic type and two cases were infected with the Sonne organism. Two of the cases of amoebic dysentery were contracted abroad. Both the Sonne cases occurred in private houses and were removed to St. Charles Hospital. Acute Rheumatism.—During the year under review, 56 cases of this disease were notified, 19 of which were removed to hospital for treatment. The sixth annual report on the working of the rheumatism scheme during the period 1st October, 1933, to 30th September, 1934, 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 56 deaths from measles in Kensington during the year. The women health officers paid 1,574 visits to measles patients. Five hundred and eleven cases were removed to the London county council hospitals. In the early part of the year, measles was epidemic in London and prevalent in the borough. With the object of reducing the mortality and mitigating the complications associated with measles epidemics by the prompt removal of cases to hospital, the London county council and the several metropolitan borough councils have adopted a scheme of co-operation which is put into force during epidemic periods. The scheme was applied early in the year and, as the borough council health visitors found it impossible to visit all the cases of measles occurring, the council appointed a trained hospital nurse temporarily to assist. The scheme worked very satisfactorily. Whooping Cough.—There were 26 deaths from this cause. The deaths in the three preceding years were 10, 36 and 10. The women health officers paid 304 visits to cases of this disease during the year. The number of cases admitted to hospitals from Kensington was 91. 61 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 £100 has been provided in the council's estimates. The arrangements provide for the clinics to be opened at the Baby Clinic at No. 92, Tavistock Road, and at the Kenley Street minor ailment centre. There was no occasion to open a clinic in 1934. Cleansing of Verminous Persons. The cleansing of verminous persons is carried out at the medicinal baths, Blechvnden Mews. The record of work done during 1934 is as follows:— Scabies— Total cleansings. Adults 320 School-children 491 Children under five years 83 Common lodging-house cases 1 Verminous conditions— Adults 53 School-children 3,485 „ „ (impetigo and vermin) 250 Children under five years 9 Common lodging-house cases 16 Other conditions— Adults 28 School-children 1 Common lodging-house cases 1 Total 4,737 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 10,549 articles were so dealt with and, in addition, 599 blankets and sheets, and 347 articles of night clothing. Of the 4,227 school children cleansed at the medicinal baths in 1934, 277 only were compulsory cases ; the remainder attended voluntarily. Verminous Premises Cleansed. Six hundred and sixty-two 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 120 Number of rooms sprayed 136 Disinfestation. During the course of inspection of houses which have been represented as unhealthy in various parts of the country, it was found that the number infested with bugs was very large. Indeed, it has been estimated that over 75 per cent. of the old working-class dwellings in London are infested, and in some areas the percentage is higher than this. Once bugs are established it is an extremely difficult task to dislodge them, for they often lay their eggs in the most inaccessible places. Consequently, none of the fumigants usually employed for disinfection is of much use in exterminating bugs. In view of the intensive action contemplated in clearance and improvement area procedure, it became a matter of urgency to discover a method of disinfestation which would give satisfactory results. The Prevention of Transference of Vermin from Old Bug-Infested Houses to New Housing Estates. Reports of experiments with hydrocyanic acid gas which had been carried out in various parts of the country led the council to approach the Imperial Chemical Industries for expert advice on the use of this gas. Hydrocyanic acid is a colourless liquid which is a compound of carbon, hydrogen and nitrogen. It evaporates at 26° C. (78'8° F.) and gives off a light, penetrative gas. This gas, in a concentration of from two to three per cent. by volume, will kill bugs and their eggs in a very short time. Unfortunately, it is extremely dangerous to human life, for only a few breaths are required to cause death. Because of its high toxicity, it was necessary to adopt a scheme for its use which would be safe. Such a scheme was formulated by Imperial Chemical Industries, and it involved the provision of vans in which the furniture of families could be fumigated en route from 62 the old homes to the new. A new disinfestation depot was built at Wood Lane in the same grounds as the disinfecting station, and two vans, built to the specification of Imperial Chemical Industries, were purchased. The vans are a modification of the type used by railway companies for their door-to-door transport service, and are of all-welded steel construction, with a sliding door on one side. There is a recess at one end, and in this recess are placed the vaporiser (which is in effect an electric kettle) in which the cyanide is boiled, and an outlet to an exhaust fan. In the vans there are electric gastight tubular heaters, for it has been found that the gas is more effective when applied in a heated compartment. The necessary electric connections are made at the recess. The vans, which are 14 ft. by 6 ft. 6 in. by 6 ft. 8 in., are placed on chassis conforming to the latest traffic regulations for road vehicles. In order to ensure safety, the vans are made to withstand great pressure. The station consists of a dutch barn constructed over a concreted site. At one end of the barn there is a 9-in. pipe connection to a fan and a tall chimney, with 3-in. pipe connections and valves to each van. There is also the electric switchboard which carries the current to the vans for heating purposes. In the middle of the barn there are rails on to which the vans are rolled for fumigation. When the loaded vans arrive at the station, the bedding is removed and is taken to the steam disinfector for treatment. The tight-fitting door is then closed and the heaters in the van are switched on. The vaporiser is filled with the requisite amount of cyanide and is heated by an electric hot plate fitted under its base. The cyanide evaporates completely in about 15 minutes and the gas is conducted straight to the interior of the van, which is allowed to retain its charge for two hours. At the end of this time an outlet-valve is opened and the exhaust fan is set in motion, thus sucking the gas in the van up a chimney into the open air. The van is cleared of a dangerous concentration of gas and the door is opened. Chemical tests are applied to prove the absence of gas. The compartment is then allowed to air naturally for some time before the furniture is conveyed to the new home. The collection, fumigation and subsequent clearance and delivery take about eight hours. It is essential that only skilled men should handle this gas, and therefore one sanitary inspector and two members of the disinfecting staff were sent to the cyanide plant of Imperial Chemical Industries at Billingham, Stockton-on-Tees, where they underwent a comprehensive course of instruction in the handling of hydrocyanic acid, van fumigation, first aid, and the use of resuscitation apparatus. During fumigation, two trained men are always present, and they work under the supervision of the sanitary inspector. A man is never allowed to be alone during the application of the gas or when the doors of the van are being opened. From the first week in July to the end of the year the furniture of nearly 400 families was fumigated in connection with clearance and improvement area procedure, and it is significant that only four of the loads were found to be entirely free from vermin. All the effects of every family moving to a new dwelling are fumigated. Tenants are given notice of removal some weeks before the scheduled date, so that they can wash the furniture, thus facilitating the work, and make other necessary preparations. There has been no difficulty in getting the tenants to co-operate in the scheme ; the fact that their furniture is removed free of charge is undoubtedly a great encouragement. On the day appointed for removal the van reaches the old home early in the morning, and the men collect everything the family wish to take to their new home. The furniture is delivered clean in the afternoon, so that there is the minimum of inconvenience to the people concerned. During the year there were only six claims for damages, and these were met by a total payment of 35s. The cost of fumigation, including transport charges, insurance, etc., is approximately £3 per load. It should be pointed out, however, that in many cases the effects of two families are fumigated in one van, and the cost per family is therefore less than £3. The system of van fumigation has been highly successful, and up to the present there has been no recurrence of vermin in the new homes. It may be interesting to note that there is an arrangement whereby people who wish to buy second-hand furniture, etc., may have such articles fumigated before taking them to new homes. The response to this arrangement has been very encouraging, and it is evident that people, when given a clean start in a new home, are anxious to live up to a standard which is considerably higher than their former one. The Treatment of Verminous Dwellings. The question of fumigating verminous dwellings is beset with difficulties. Several houses have been treated with hydrocyanic acid gas. One experiment of great interest may be mentioned, namely, the fumigation of Hope Cottage, Alderson's Yard, Kensal Road, early in 1934. This house, which is entirely detached, was treated with hydrocyanic acid gas by a new method. Arrangements were made to accommodate the tenants elsewhere for a day and a night, and they left their home by 9 a.m. The house was securely sealed except for two windows and the front door. Through these windows hot air was pumped by the Dreymura Tubit drying system. A uniform temperature of 100° F. was reached in a short time. Hydrocyanic acid was then placed in the rooms in the form of Zyklon B, which is a granular diatomaceous earth impregnated with cyanide. The gas is given off as soon as the earth is exposed to the air. Immediately the gas was released the hot-air supply was shut off and the sealing of the house was completed. The house was left under the gas for four hours, after which all windows were opened and the heating apparatus was again put into operation. 63 Chemical tests were made at intervals, and it was found that the air in the house was clear of the gas in about hours. The hot air was then applied to the bedding and upholstered articles, and after a short time tests proved that these could be used without danger. The kill of bugs was enormous and constant inspections throughout the summer proved that all eggs had been rendered sterile. This experiment showed that a house fumigated in this manner could be slept in the same night. The test was carried out in a detached house, and it led one to the view that it is not yet safe to apply the method to the terrace type of house generally found in Kensington ; cracks in party walls and chimney connections may result in a dangerous leakage from one house to its neighbour. Close co-operation with the Natural History Museum has resulted in many experimental fumigations with various chemicals, and although the perfect insecticide, suitable for use in dilapidated houses, has not yet been discovered, an exceptionally high degree of success has been obtained. Experimental work was commenced with crude orthodichlorbenzene. This chemical is sufficiently toxic to kill bugs, but it is not volatile enough to reach minute cracks and crevices, where the eggs are deposited. The advice of the government chemist was sought, and he suggested several substances which might be used in conjunction with orthodichlorbenzene. Some flats at Sutton Dwellings were treated with mixtures of orthodichlorbenzene and (a) methylene chloride and (b) carbon tetrachloride. These mixtures were highly successful. Unfortunately, their cost is rather high, and the presence of methylene chloride produced acute physical discomfort in all persons present when this mixture was used. It has been impossible so far to obtain a suitable filter for a gas mask in order to neutralise methylene chloride, and its use as a fumigant has therefore been discontinued. Two substances, when mixed with orthodichlorbenzene, have proved to be extremely satisfactory. Orthodichlorbenzene and methylated spirit mixed in equal volume give a fumigant which is toxic and highly volatile. When applied with a pressure spray, a particularly strong concentration of gas is given off in a short time. This mixture is not suitable for furnished rooms, however, for it has the effect of spoiling polished surfaces. A mixture of orthodichlorbenzene and white paraffin oil gives equally good results and has the advantage of being non-staining. It is 98 per cent, efficient, and is now used in Kensington as a routine spray in verminous rooms. Other experiments have been undertaken, and some are still in hand ; and it is hoped to evolve a formula which will be cheap and completely effective. Interest m the disinfestation depot and in the experiments in fumigating dwellings has been considerable from the beginning. Representatives from government departments, medical officers of health from as far afield as Sweden, and sanitary inspectors and other officers in large numbers from all over the country have visited Kensington and have gone away impressed by the work that is being carried on. Statement of work done in connection with disinfestation. Period 1st July to 31st December, 1934. Number of families' furniture removed and treated with hydrocyanic acid gas 399 Weight of furniture estimated at 600 tons. Weight of bedding disinfected by steam 43 tons, 14 cwt., 1 qr., 21 lb. Number of articles stoved :— Mattresses and flock beds 1,820 Bolsters and pillows 2,925 Blankets and sheets 2,270 Sundries 2,237 Total 9,252 articles. Number of houses treated with orthodichlorbenzene and other chemicals 157 ,, ,, ,, hydrocyanic acid gas 41 In addition to the above, 437 houses were treated with sulphur during the course of the vear. Disinfection after Infectious Diseases, etc. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1934. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles fected. Smallpox 4 6 1 68 Scarlet fever 561 628 652 8,593 Diphtheria 350 365 350 4,826 Enteric fever 6 8 16 269 Measles 556 609 43 529 Consumption 178 214 190 1,762 Cancer 48 56 114 867 Other diseases 357 413 286 2,937 Totals 2,060 2,299 1,652 19,851 This table does not include the work carried out at Wood Lane on behalf of the Paddington borough council. 64 The total weight of the bedding, clothing, etc., of Kensington residents disinfected was 53 tons 10 cwts. The number of articles disinfected only was 18,926 and the number disinfected and washed, 925. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved in 1934 the washing of 10,745 towels, 247 sheets and 76 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 pavment per annum is to be £600. The weight of Paddington articles disinfected in 1934 was 21 tons 7 cwt. 1 qr. 2 lb. The number of articles disinfected only was 7,322 and the number disinfected and washed was 2,059. 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 125. The number of private subscribing library books destroyed was 34, and the number disinfected by formalin and returned to the householders was 22. Disinfection at a Local Public Institution. During a temporary breakdown of the disinfecting plant at St. Mary Abbots Hospital the council were able to assist the hospital authorities. From the 19th March to the 26th April the council collected from the hospital, disinfected and returned 332 mattresses, 354 pillows and 389 blankets, a total of 1.075 articles weighing 9 tons 19 cwt. Diphtheria Immunisation. Diphtheria, with its persistently high incidence and mortality, has for too long constituted a grave menace, particularly to the child population. It is essentially a disease of children under the age of fifteen years. About 60,000 cases are notified annually in England and Wales, and the average number of deaths each year is approximately 3,000. It has been estimated that 10 per cent, of the children born each year will suffer from diphtheria before they reach the age of fifteen years. It kills an average of 80 to 90 children out of every 1,000 attacked. The following table shows the number of cases and deaths in Kensington during the past six years:— Year. Cases. Deaths. 1929 326 11 1930 329 13 1931 222 7 1932 415 29 1933 295 22 1934 360 14 Of the 360 cases which occurred in 1934, 359 were admitted to fever hospitals. It has been estimated that the cost to London ratepayers of the nursing and isolation of each case averages £25, and thus the total cost of the 359 cases in 1934 was approximately£9,000. The heavy toll of sickness and death, even when the disease is not in epidemic form, stands out in contrast to that of everv other infectious disease except measles. Diphtheria is not a disease of modern times ; it was first described in 1748, and in 1894 it was discovered to be due to a germ. This germ grows in the throat of the infected person and produces a poison, the diphtheria toxin, which is absorbed into the system and causes the damage. The treatment of individual sunerers from diphtheria has been very considerably improved in recent years, with the result that the death rate amongst those attacked has been reduced from over 30 per cent, to under 10 per cent. ; but, notwithstanding this progress, the disease itself has proved an increasingly difficult problem. Indeed, the ordinary public health measures for preventing the spread of infection (notification, isolation, the swabbing of contacts, and disinfection) have proved to be far from successful. In 1923 over 40,000 cases were notified in England and Wales; in 1930, there were over 72,000. Measures for the prevention of diphtheria call, therefore, for close and earnest attention. It can be stated definitely that, if the public will co-operate with the medical profession in securing immunisation against diphtheria, not only can sickness and deaths be reduced enormously, but there can also be a great saving of the ratepayers' money now being spent on fever hospital nursing and isolation. Furthermore, school life and education would not be interfered with so 65 much as at present, for the patients are mostly school children and they must remain in hospital for a period of approximately six weeks. The Ministry of Health, in 1932, issued an official circular which states, "It is, therefore, desirable that attention should be paid to the advantages of diphtheria immunisation, and where practicable, to offer to the parents or guardians of children over one year of age necessary facilities for protection." Early in the year the council gave careful consideration to the need for introducing a method of active immunisation against diphtheria in Kensington, and after prolonged negotiation with the Kensington division of the British Medical Association they evolved a scheme under which the work of immunising Kensington children would be undertaken by local doctors on behalf of the council. The scheme provided that the council should, subject to the conditions mentioned below, pay a fee of 10s. to a doctor who immunises a Kensington child against the disease :— (a) The medical practitioner's name must be on a panel prepared by the medical officer of health. (b) The council will not pay a fee in respect of any child under the age of one year or over the age of twelve years. (c) The council will not pay a fee unless the medical officer of health is satisfied that the parent or guardian cannot reasonably be expected to afford a private fee for this treatment. (If the wage-earner of the family is entitled to national health insurance medical benefit, or has an income which would entitle him to benefit if he were insurable, or is unemployed, the medical officer of health will generally regard the case as one for which the council should pay ; but where the familyis in better circumstances, the medical officer of health will, unless there are exceptional conditions, regard the family as one able to pay a private fee to the doctor.) (d) Before immunising a child, the medical practitioner must obtain the written consent of the parent or guardian. (e) The child must be given three immunising injections at weekly intervals. (/) In order to facilitate the working of the scheme in the early stages, it has been decided to use only one brand of immunising material—that issued by Messrs. Burroughs, Wellcome and Co. When further experience has been obtained, it may be possible to extend approval to the products of other firms. (g) Each dose of the immunising agent must be contained in a separate sealed glass ampoule. In no circumstances will the council pay a fee in respect of the immunisation of a child by a preparation from a container holding more than one dose. (h) The medical practitioner will enter the particulars of each immunising dose on a record card provided by the council. When this record card is completed and returned to the public health department, the medical officer of health will, in appropriate cases, forward particulars to the borough treasurer in order that the fees due may be paid each quarter. (i) In every case the medical practitioner must place before the parent or guardian the significance of the Schick test and advise that this should be applied to children over five years of age. If the parent or guardian decides to forego the Schick test before immunisation, it may be omitted. The medical practitioner must urge in every case that the Schick test should be applied three months after the immunising injections have been given. (j) If the parent or guardian desires the Schick test to be performed before immunisation, the medical practitioner must refer the child to the council's immunisation expert. The medical practitioner will also endeavour to arrange for every child to visit the immunisation expert at the first opportunity after the expiry of three months from the last injection. (k) The technique to be employed in connection with diphtheria immunisation work must be that prescribed by the council's immunisation expert. (/) The fee of ten shillings to be paid by the council in respect of each child immunised in accordance with these rules will be the limit of the council's liability in connection with diphtheria immunisation, and the cost of purchasing the immunising agent must be borne by the medical practitioner, who will also be responsible for any subsequent medical attention necessary and for any other liability which may result. (m) The medical officer of health may examine any child before, during or after the administration of the immunising doses, and all records kept by the medical practitioners in respect of diphtheria immunisation must be open to his inspection. The council appointed an expert in diphtheria immunisation work (Dr. Guy W. J. Bousfield) who prescribes the technique to be followed in those cases for which the council are prepared to pay a fee. He also undertakes all Schick testing which may be necessary. He attends at the tuberculosis dispensary in Ladbroke Grove from 2 to 4 p.m. each Friday. When a doctor or a parent wishes to have a child Schick tested, the patient is sent to the expert on one Friday and the test is carried out ; the interpretation of the test is undertaken on the following Friday. Doctors may consult the expert at his clinic when he is in attendance, or privately at any other time bv appointment. Most children under one year of age are immune to diphtheria, and it is therefore not considered necessary to immunise them. After the age of 12 years the risk of contracting the disease diminishes rapidly, and the council do not pay fees in respect of persons over this age. In these circumstances, if a doctor wishes to immunise infants under one year or persons over 12 years of age, it is necessary for him to arrange for a private fee to be paid for his services and for the services of the immunisation expert, if desired. As the majority of children between the ages of one and five years are susceptible to diphtheria, there is no need to apply the Schick test, and immunisation can be recommended immediately (except in the case of those who have had diphtheria). If the Schick test applied after the immunising injections have been given proves positive, the expert advises the doctor to give further injections, and on the production of evidence that 66 these have been given, the council pay an additional fee of ten shillings, subject to the limitation of liability indicated under heading (l) above. The council, by means of the usual health propaganda channels, have brought to the notice of Kensington residents the fact that diphtheria can be prevented, and have urged those who desire security for their children to apply to their family doctor. After the council had adopted the scheme outlined above, doctors in the borough were invited to join the immunisation panel; and 64 names now appear thereon. The scheme was put into operation on the 1st May, 1934, and has proved very successful. In the early days it was found that a number of children sent for the preliminary Schick test gave a negative result and therefore did not need to be immunised, with the result that the doctors who sent them did not receive any fee. If the doctors had not gone to the trouble of persuading the parents to take their children to the Schick testing clinic, but had immediately undertaken immunisation, they would have received a fee of ten shillings for each child. It is desirable that, as far as possible, children over five years of age should be Schick tested before immunisation, and that doctors should be induced to encourage parents to take their children to the clinic for this test. It appeared, however, that the more successful doctors were in their persuasive efforts, the fewer were the cases in which they could receive fees ; to meet this difficulty, the council on the 26th June, 1934, resolved that a fee of 2s. 6d. should be paid to a doctor in respect of each child sent by him to the clinic for a pre-immunisation Schick test if it proved to be negative. Towards the end of the year a few cases came to notice where a doctor had given one or two injections and, for some reason beyond his control, found it impossible to give the remainder. It seems unfortunate that a doctor should be out of pocket to the extent of several shillings as a result of his efforts to co-operate with the council in this branch of preventive medicine, but the council took the view in the early days that it is undesirable that there should be in the community a number of partially immunised children who might develop diphtheria and thus bring discredit on the scheme. For this reason the council decided that they would pay only when the three doses had been given. Nevertheless, at the end of the year they recognised the hardship caused to individual doctors, and they decided that if a doctor is unable to complete the treatment of a patient through circumstances beyond his control they would defray the cost of the immunising material already used by him. The following are particulars of the work done under the scheme from its commencement on the 1st May to the end of the year. Total attendances of children at Schick testing clinic 384 Number of children primarily Schick tested 105 Positive 69 Negative 36 Number of children finally Schick tested 287 Positive 3 Negative 284 Number of children finally Schick tested but not primarily tested 267 Number of children who failed to attend for reading after Schick testing 12 Number of children immunised during the year by general medical practitioners 842 £ s. d. Fees paid to these practitioners 421 0 0 Negative cases—36 at 2s. 6d. 4 10 0 Total fees paid £425 10 0 Judging by the difficulty experienced in persuading the public to accept diphtheria immunisation for their children in many other areas of this country, it was contemplated that not more than 500 children would be immunised in Kensington in the first twelve months. As 842 were immunised during the eight months of 1934 that the scheme was in operation, the result must be considered satisfactory. The doctors in the borough are co-operating enthusiastically with the council in this scheme which is a pioneer one of its kind. At the time of writing (April, 1935), the total number of children immunised has reached well over 1,600, and similar schemes are now being introduced in other areas. 67 TUBERCULOSIS. The number of notifications received during the year was 229, which is the lowest figure recorded since the introduction of notification in 1912. The pulmonary cases notified totalled 182, and the non-pulmonary, 47. 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 1925. District. Years. 1925. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. The Borough 292 317 252 276 241 260 245 260 236 229 North Kensington 207 227 166 179 156 178 149 174 148 142 South Kensington 85 90 86 97 85 82 96 86 88 87 Wards. St. Charles 52 50 39 48 39 56 49 55 46 48 Golborne 56 69 53 57 41 46 40 48 43 41 Norland 67 59 44 49 43 42 31 42 35 29 Pembridge 32 49 30 25 33 34 29 29 24 24 Holland 27 20 11 25 20 21 17 25 17 17 Earl's Court 18 25 25 20 21 19 23 17 29 21 Queen's Gate 13 15 10 11 7 8 9 8 10 12 Redcliffe 18 22 25 26 25 20 32 24 20 24 Brompton 9 8 15 15 12 14 15 12 12 13 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 — 1 5 1 1 1 5 1 3 1 1 1 10 1 6 7 1 - - 15 6 16 3 4 2 5 - - 20 11 20 1 l 7 8 2 3 25 16 34 4 l 12 10 1 2 35 15 11 1 l 7 7 — 1 45 17 12 2 2 14 8 1 1 55 7 5 — 3 9 3 — — 65 and upwards 5 4 1 — 5 3 1 — Totals 78 104 26 21 58 45 6 9 Primary notifications of persons notified during life to be suffering from tuberculosis. 68 The following table shows the number of notifications of pulmonary and non-pulmonary tuberculosis received since 1923, 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. 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 1934 182 103 58 47 15 8 118 66 Not only was the number of notifications in 1934 the lowest on record, but also the number of deaths was lower than in any previous year in the history of the borough. Deaths from Tuberculosis in 1934 Allocated to District of Usual Residence of Patients. Pulmonary tuberculosis. Non-pulmonary tuberculosis. The Borough 103 15 North Kensington 73 8 South Kensington Wards. 30 7 St. Charles 26 1 Golborne 21 4 Norland 14 1 Pembridge 12 2 Holland 8 1 Earl's Court 6 1 Queen's Gate 4 1 Redcliffe 8 — Brompton 4 4 The places where deaths from tuberculosis occurred are set forth in the following list:— Pulmonary tuberculosis. Non-pulmonary tuberculosis. Patient's home 29 2 St. Mary Abbots Hospital 14 4 St. Charles Hospital 31 2 Outlying hospitals 16 5 Other places outside the borough 13 2 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations were introduced with a view to:— (1) preventing persons suffering from respiratory tuberculosis entering upon an occupation involving the handling of milk ; and (2) enabling local authorities, in proper cases and with suitable safeguards, to require persons engaged in such occupation to discontinue their work when found to be suffering from the disease in an infective stage. During the year no case occurred which required the attention of the council under these regulations. 69 THE COUNCIL'S SCHEME FOR THE PREVENTION AND TREATMENT OF TUBERCULOSIS. Dispensary Diagnosis and Treatment. The number of new cases seen at the dispensary during the year, with the original diagnoses made, is shown in the following table:— Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 204 328 156 150 838 New cases with respiratory tuberculosis 59 83 0 2 144 (17·2 per cent.) New cases with non-respiratory tuberculosis 9 9 12 9 39 ( 4·6 „ ) New cases regarded as "suspects" 4 11 11 3 29 ( 3·4 „ ) New cases not suffering from tuberculosis 132 225 133 136 626 (74·8 „ ) This table shows an increase of 5 in the number of respiratory cases seen at the dispensary compared with last year. The total number of non-respiratory cases is 7 more than in 1933, being 39 instead of 32. The " suspects " are those cases remaining on the books at the end of the year whose diagnosis has not been completed, and do not represent, as in former years, the total number of "suspect" cases dealt with during the year. There were in addition 41 respiratory cases and 14 non-respiratory cases added to the dispensary register during the year upon removal into the borough of patients from other districts, making 55 cases as compared with a total of 40 in 1933. Cases came to the dispensary on 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 293. The treatment recommended for the cases diagnosed at the dispensary as suffering from tuberculosis, which numbered 183 (pulmonary 144 and non-pulmonary, 39), was as follows sanatoria, 129 ; domiciliary 14 ; St. Mary Abbots and other hospitals, 38 ; dispensary, 2. The total number of attendances by patients at the dispensary was 1,968, and 1,342 systematic examinations were made. The number of visits paid by the tuberculosis officer was 134, of which 71 were consultations with the doctor in charge of the case. Written reports on cases to public authorities numbered 1,797 and to doctors, 422. The total number of sputum examinations was 405, from 347 individual cases. Ninety specimens showed tubercle bacilli to be present, and 315 gave negative results. Records. An analysis of the tuberculosis notification 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, 1934 309 295 147 159 No. of cases notified for the first time during the year 78 104 26 21 No. of cases brought to notice otherwise than by notification 34 20 8 10 No. of cases removed from the register during the year on account of having:— (a) been cured 2 0 1 2 (b) removed from district 25 47 19 15 (c) died 64 50 4 8 (d) been inaccurately diagnosed 1 3 1 0 No. of cases remaining on the register on 31st December, 1934 329 319 156 165 70 The number of patients on the dispensary register on 31st December, 1934, was 814. At the beginning of the year they numbered 769. A comparison of the dispensary figures with the total number on the notification register (969) shows that the majority of the tuberculosis cases are dealt with through the council's scheme—over 84 per cent. Residential Institutional Treatment, Light Treatment, X-ray Diagnosis, etc. Prior to the 1st April, 1932, X-ray examination work in connection with the diagnosis of tuberculous patients was conducted free of charge at St. Mary Abbots Hospital, but on that date a new agreement was entered into between the borough council and the London county council whereby the latter body undertake this work at a cost of 7s. 6d. for each X-ray examination, 7s. 6d. for the first photograph taken and 2s. 6d. for each subsequent one. As the council's tuberculosis officer visits St. Mary Abbots Hospital by arrangement at least once a week, and is able to see the patients under X-ray examination, a photograph is not always necessary ; thus the expenditure incurred by the council for this service is limited. During the year 75 X-ray examinations were conducted at a total cost of £27 5s. Od. Home Visiting. The number of home visits paid in 1934 by the council's women health officers is shown in the following table:— Women Health Officers. TOTAL. No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Tuberculosis. Pulmonary. First visits 26 20 22 13 6 34 32 153 Re-visits 178 220 150 94 24 333 187 1,186 Non-pulmonary. First visits 5 19 8 9 1 5 5 52 Re-visits 93 136 105 54 6 109 82 585 These visits are additional to those made by the Charity Organisation Society and the Invalid Children's Aid Association. 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. The following table, giving the number of rooms occupied by the families of definite cases of tuberculosis diagnosed in 1934 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 10 3 1 2 - - - - - - 16 2 2 6 16 8 6 2 1 2 — — 43 3 — 10 12 11 5 7 2 1 — 1 49 4 — 1 4 1 3 7 1 2 1 — 20 5 — — 1 2 3 3 — — 1 — 10 6 — — - 1 1 - 1 — — 2 5 143 71 This total falls 40 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 ten years:— Year. Rooms per occupant. 1925 0·55 1926 0·58 1927 0·59 1928 0·61 1929 0·67 1930 0·73 1931 0·70 1932 0·67 1933 0·77 1934 0·70 The Following-up of Patients in Cases of Doubtful Diagnosis. Patients often do not realise the importance of allowing the tuberculosis officer to complete his diagnosis. When a " suspect " has failed to keep an appointment, he is visited at home by a woman health officer, who gives him a definite appointment with the tuberculosis officer at the dispensary so that he will not be kept waiting. If he fails to keep 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 611 contacts traced by the dispensary service in 1934. Of these, 387 were examined one or more times by the tuberculosis officer, 111 were examined by their own doctors or had been recently examined at school, and 113 refused examination or failed to attend after three appointments had been given them. Eighty-nine of the patients notified during the year had no home contacts. 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 1934. The work at the dispensary during the year is shown in the following table:— Dentist's attendances at the dispensary 52 Number of fillings 9 Number of individual patients treated 47 Number of extractions 50 Patients' attendances 125 Number of dentures arranged for 9 Artificial Pneumothorax Treatment. In 1934 the council undertook to pay for the treatment in 26 cases at a cost of £134 18s. 6d. The corresponding figures for 1933 were 32 and £182 14s. Od. 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. 1930 18 946 1931 16 394 1932 30 1,094 1933 23 1,259 1934 32 1,319 The nurses carry out their work splendidly and are very much appreciated by the poor. Supply of Extra Nourishment to Tuberculous Persons. Eight persons received extra nourishment during the year. The total amount supplied was 84 pints of milk and 84 new laid eggs, at a cost to the council of £1 10s. l£d. Arrangements for Care and After Care. In 1922 the council established a tuberculosis care committee, whose primary duty is to undertake the care and after care of patients in the borough suffering from tuberculosis. The care committee have also carried out the assessment of patients admitted to London county council sanatoria, and this duty has constituted a considerable portion of their work. In July, 1934, the county council resolved that in future no contributions should be required from patients, or persons legally responsible for them, towards the cost of the residential treatment of tuberculosis (except in respect of dentures provided during treatment), or towards the cost of the 72 boarding-out of children under the County of London (Tuberculosis) Regulations, 1930. The abolition of assessments towards the cost of residential treatment has allowed the care committee to devote more time to the task for which they were originally established. The committee meet at the town hall, and their meetings are well attended. 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 induced employers to hold open the positions of men about to undergo sanatorium treatment. Handicrafts Class. 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 1934, and at the end of the year three patients from Kensington were in regular attendance and a favourable report of their work was received. There are at present a few vacancies in the class. The Kensington borough council disinfect all gloves made by exposing them to formalin vapour, which has been shown by experiment to be effective as a sterilizer without injuring the texture or colour of the gloves. Provision of Shelters at the Homes of Patients. The council are prepared to loan shelters and they keep several in readiness at their Wood Lane depot, but at the present time none is in use. Provision of Bedding for Home Isolation. At the present time there are 15 patients to whom bedsteads and bedding are being loaned. In six of these the assistance was given for the first time during the past 12 months, the articles issued being as follows :— Bedsteads 5 Mattresses 6 Bolsters 0 Pillows 12 Pillow-slips 17 Sheets 20 Blankets 12 Quilts 8 Mattress covers 6 The total stock of bedding, etc., on loan on 31st December, 1934, was :— Bedsteads 11 Mattresses 15 Bolsters 0 Pillows 29 Pillow slips 35 Sheets 45 Blankets 31 Quilts 15 Mattress covers 15 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 190 Number of rooms disinfected 214 Bacteriological Examinations. Specimens of sputum submitted by medical practitioners for bacteriological examination at the cpense of the council:— Examined at the council's laboratory 313 Examined by the tuberculosis officer 405 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. 73 APPENDIX I. SEVENTH ANNUAL REPORT on THE KENSINGTON RHEUMATISM SCHEME (1st October, 1933—30th September, 1934) BY JAMES FENTON, M.D., M.R.C.P., D.P.H., JANET K. AITKEN, M.D., M.R.C.P., and LUCY E. ELLIOTT, M.B., B.S. PART I. General by JAMES FENTON, M.D., M.R.C.P., D.P.H. The seventh year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was completed on the 30th September, 1934. 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 :— (a) rheumatic pains or arthritis, if accompanied by a rise of temperature; (b) rheumatic chorea ; (c) rheumatic carditis. Response to notification. Detailed particulars in regard to notification are given below:— Year. No. of notifications. Total number of notifications. Total number of patients notified in the year who attended the centre. Medical officers at rheumatism supervisory centre. Private doctors. School medical officers. Hospitals and other institutions. 1927-28 32 53 28 46 159 95 1928-29 37 40 1 27 105 70 1929-30 12 32 20 31 95 48 1930-31 9 28 12 17 66 40 1931-32 12 21 1 7 41 24 1932-33 6 43 2 7 58 24 1933-34 6 18 6 8 38 32 Totals 114 235 70 143 562 333 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. In the seven years 1927-34 during which the centre has been in existence, 1,600 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. Cases attending the centre. 1929-30 1930-31 1931-32 1932-33 1933-34 Kensington 128 177 266 290 311 Hammersmith 35 40 47 51 45 Other boroughs 10 17 12 20 35 173 234 325 361 391 74 During the year 1933-34, 48 sessions have been held at the Princess Louise Hospital, and the average attendance has risen from 28 in 1932-33 to 30.9 in 1933-34 ; the total number of attendances during this year has risen from 1,344 to 1,467. Average attendance per session of Kensington patients 23.9 ,, ,, ,, other „ 7. 0 30.9 The total number of attendances of patients during 1933-34 is as follows:— Kensington Notified cases (a) New 41 (b) Old 439 Unnotified cases (a) New 65 (b) Old 578 Hammersmith (a) New 17 (b) Old 195 Paddington (a) New 7 (b) Old 54 Ealing (a) New 2 (b) Old 20 Various boroughs (a) New 5 (b) Old 44 1,467 The new Kensington cases in 1932-33 were recommended to attend the clinic from the following sources:— Invalid Children's Aid Association 8 School medical officers 37 Princess Louise Hospital 12 Other hospitals and institutions 4 Private practitioners 16 Notifications 21 Parents 8 106 The disposal of cases which attended the centre may be summarised as follows:— Tonsillectomy at Princess Louise Hospital 13 Admission to Princess Louise Hospital 30 Admission to other hospitals 6 Special schools 6 Special heart homes— 1. Carshalton 5 2. West Wickham — 3. Lancing — Convalescent homes 30 Referred to massage department for special chest expansion exercises 8 Cases which were admitted to Princess Louise 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. Clinical Report. An investigation into the progress and possible significance of certain basal murmurs. It has been found, in examining children at the centre with reference to the presence or absence of organic heart disease, that the significance of basal cardiac murmurs is often in doubt. The insignificant basal murmur is mentioned in text books. It is described as a soft systolic murmur, variable in position, often in the second left intercostal space, and it is not associated with any sign of organic heart disease. Such a murmur may be described as physiological, the child being apparently quite healthy, or as functional or haemic, it being associated with anaemia or other debilitating condition. A clear description of the aetiology of such murmurs is not given, nor does there seem to be anv agreement as to the existence of anv definite aetiological factor. Such insignificant murmurs are often found. In examining healthy school children it was found that in the prone position, after exercise, a murmur could be heard in 60 per cent, of the children ; but a difficulty often occurs when basal murmurs are first heard in deciding into which category, functional or organic, such murmurs should be placed. For this reason an investigation was undertaken during the year. The following is an analysis of 51 cases in which there is a basal systolic murmur. In all these cases the murmurs are so similar in character, although they may vary slightly in intensity, that it is not possible to differentiate them by auscultation only. 75 (Abbreviations used in the following tables:— L.=lying. S.=standing. E.=expiration. I.=inspiration. T.A.=tricuspid area. A.A.=aortic area. P.A.=pulmonary area. >=greater than. Physiolog.=physiological.) GROUP I.—Basal murmur with no other signs of carditis. A.—Basal murmur unchanging—no history of juvenile rheumatism. Case. Site. Posture. Persistence after first heard. Electrocardiogram. Remarks. P.H. Maximum P.A., T.A. and A.A. L. only. E. > I. 1 year. Physiolog. Pain over heart. E.S. Maximum T.A. L. only. E. only. 4 years. ,, Pain over heart—relieved strapping. B.W. Maximum T.A., P.A. S. and L. E. and I. 10 months ,, E.B. T.A. S. > L. 3 years. ,, Later murmurs heard as loud in prone position. R.F. Maximum T.A., P. A. and A. A. L. > S. E. > I. 3 ,, ,, Sister definite congenital lesion. D.F. ,, ,, ,, 4 „ ,, ,, ,, ,, ,, D.S. Maximum T.A., P.A. ,, 1 year. ,, History of scarlet fever. B.—Basal murmur not present when first seen—no history of juvenile rheumatism. J.B. T.A. L. and S. 8 months. Physiolog. Developed 3 months after first seen. W.G. Maximum T.A., P.A. L. > S. 1½ years. ,, Developed 3 years after first seen. M.B. T.A. and P.A. S. > L. 10 months Developed 8 months after first seen. K.T. „ L. and S. 11 ,, Physiolog. ,, ,, ,, ,, C.—Murmur unchanging—history of juvenile rheumatism, but no evidence of carditis since attending centre. G.W. Maximum T.A., P.A. and A.A. L. only at first. 2½ years. Physiolog. History of acute attack. E.C. T.A., P.A. and A.A. S. and L. E. > I. ,, ,, History of arthritic attack. P.O. T.A. and P.A. L. only. E. only. 3 Physiolog.,except T, small. History of pains. No acute attack. J.G. Maximum T.A., P.A. L. > S. E. > I. 1½ ,, Physiolog. History of acute attack 3 months before first seen. E.P. T.A. L. only. E. only. 1 year. ,, History of pains only. L.H. Maximum P.A., A.A. and T.A. L. > S. 2½ years. ,, History of chorea. G.P. Maximum T.A., P.A. and A.A. S. > L. E. > I. 10 months ,, Long history of pains. R.H. ,, ,, L. only. E. > I. 3 years. ,, History of pains. A.L. Maximum T.A., A.A. and P.A. L. > S. E. > I. 2 „ - History of pains for 4 years. D.—Murmur not heard when first seen—history of juvenile rheumatism, but no evidence of carditis since attending centre. L.E. T.A. soft. L. only. E. only. First heard last visit. Physiolog. History of chorea. L.R. T.A. L. only. 1 year. ,, Developed 4 years after first seen. History of chorea. K.H. ,, L. and S. No. Heard for 2 months - Developed 6 months after history of chorea. C.S. Maximum T.A., P.A. L. only. only. 6 months. Physiolog. Developed 2 years after history of chorea. D.F. ,, ,, S. and L. 9 ,, ,, Developed 2½ years after history of chorea. GROUP II.—Basal murmur preceding other signs of carditis. A.—Basal murmur unchanging—no history of juvenile rheumatism. Case. Site. Posture. Persistence after first heard. Electrocardiogram. Remarks. D.H. Maximum T.A., P.A. and A.A. S. and L. 3 years. Physiolog. No pains or arthritis, but attacks of pyrexia with heart enlarged and tachycardia. Now well. C.B. ,, ,, ,, 1 year. ,, Developed mitral incompetence with no evidence of rheumatism. B.—Basal murmur not heard when first seen—no history of juvenile rheumatism. No cases. 76 C.— Basal murmur unchanging—previous history of juvenile rheumatism. Case. Site. Posture. Persistence after first heard. Electrocardiogram. Remarks. P.H. Maximum T.A., P.A. L. and S. E. > I 3 years. Physiolog. Arthritis when first seen, and well since, but developed localised apical murmur. JP. T.A. and P.A. L. only. E. > I. 1½ ,, Slight left axis deviation and delay in conducttion. Mitral incompetence developed after sub-acute attack. E.B. Maximum T.A., P.A. and A.A. L. > S. E. > I. 2 „ Physiolog. No further evidence of rheumatism, but mitral incompetence developed. D.—Basal murmur not heard when first seen—previous history of juvenile rheumatism. S.R. Maximum T.A., P.A. and A.A. S. and L. E. > I. 20 months First diastole short, T, deeply inverted second physiolog. History of acute attack 6 months before. Well 1 year. Then sub-acute attack followed 7 months later by mitral incompetence. J.W. T.A. only. L. only. E. and I. No. Heard for 6 months. Left axis deviation and P, sharply inverted. History of acute attack. Nil since. GROUP III.—Basal murmur following other signs of carditis noted at centre. N.B.—All these cases therefore have history of juvenile rheumatism before onset of murmur, which was not present when first seen. Case. Site. Posture. Persistence after first heard. Electrocardiogram. Remarks. D.H. T.A. S. and L. 8 months. First very short diastole. Later physiolog. Tachycardia and slight enlargement. Murmur developed 10 months later. Patient very well. W.N. Maximum T.A., P.A. and A.A. L. only. 2 years. P—R= 12 min. Active carditis. Basal murmur developed 1 year later. Later mitral incompetence without further rheumatism. W.H. P.A. and A.A. ,, 1½ ,, T, very small. Murmur developed 1½ years after acute attack. T.D. Maximum T.A., P.A. and A.A. E. > I. 1½ ,, - Active carditis 2 years before basal murmur heard. Second attack after murmur developed, with transitory apical murmur. E.W. T.A. and P.A. L. > S. 2 ,, Left axis deviation. Acute carditis 1 year before basal murmur developed. D.W. ,, ,, S. and L. 2 ,, Left axis deviation, low voltage. Acute carditis 1 year before basal murmur heard. A.B. Maximum T.A., P.A. and A.A. Only after exercise E. > I. 6 months. Full P—R. Acute carditis 4 years before basal murmur heard. D.G. T.A. and P.A. L. only. E > I. 1 year. Full P—R. Short diastole. No acute attack. Prolonged conduction noted before basal murmur. GROUP IV.—Basal murmur coincident with other signs of carditis. Case. Site. Posture. Persistence after first heard. cardiogram Remarks. G.B. P.A., T.A. and A.A. L. only. 1 year. Delayed conduction. Later, physiolog. Acute carditis when first seen. No mitral lesion persists. P.B. Maximum T.A., A.A. L. only. E. > I. 2½ years. - Acute attack with apical murmur 6 months before. Later apical localised murmur only. R.B. P.A. L. > S. 1 year. - Acute carditis and chorea. Later no apical murmur. S.C. Maximum T.A., P.A. L. > S. E. > L. 3 years. Physiolog. During attack when first seen localised apical murmur, heart not enlarged. Later conducted. No further attacks. C.D. Maximum T.A., P.A. and A.A. ,, 1½ ,, Very abnormal. Doctor gave history of acute attack with pericardial friction. F.D. ,, ,, L. and S. E. > I. 2 „ — History of chorea, apical murmur, later conducted. R.L. T.A. L. and S. 20 months Delay in conduction. History of pain and apical murmur. Disappeared later. L.L. Maximum T.A., P.A. L. > S. E. > I. 5 years. Physiolog. Since pneumonia at 2 years, history of heart trouble. Feverish attacks and pains. A.S. P.A. L. and S. 1½ ,, Low voltage curve. Mitral incompetence. E.T. Maximum T.A., P.A. L. > S. E. > I. 1 year. Physiolog. ,, ,, I.H. T.A. and P.A. L. only. 2 years. — Conducted apical murmur. Later localised. N.B.—(1) By rheumatic pains we mean pains which are present at rest as well as when walking. They are often in the arms or back of neck as well as in the legs, and no other cause can be found for the pains. (2) Where acute or active carditis is mentioned, there has been some definite sign of cardiac involvement ; if enlargement, it is often by clinical tests only, for it has not been possible to screen in the upright position until lately. 77 It will be noted that the patients have been divided into groups on clinical considerations other than the character of the murmur, which is similar in all groups. It was thought that the murmurs in the various groups might be differentiated from each other on clinical grounds, such as whether they were localised or diffuse, or confined to any given posture of the patient, but this did not prove to be the case. It will be seen that localised murmurs and murmurs which are heard in the prone position only are to be found in most of the groups. Localised murmurs. Group. Cases IA 1 IB 1 IC 1 ID 3 III 1 IV 3 Murmurs heard in prone position only. Group. Cases. IA 2 IC 3 ID 2 IIC 3 IID 2 III 3 IV 3 Group IA may all be congenital murmurs ; the murmurs were present when the patients were first seen, they have persisted, and there is no history of juvenile rheumatism and no development of signs of carditis. In the cases of R.F. and D.F. a diagnosis of congenital septal defect is considered to be extremely probable, because these two patients are sisters and there is a third sister, N.F., who has a murmur which is exactly similar in position and distribution, but louder and rougher, and which indicates, we think, an obvious congenital defect. In two cases it will be noted that there is a history of temporary pain over the praecordium ; in neither is there any marked bony depression over the heart, the murmur is not heard in the standing position, is loudest in expiration, and is persistent after the pain is relieved ; a mechanical endocardial cause is not suggested. On the other hand, there are many cases in the following groups which, had they been seen at one consultation only, would be indistinguishable from the cases in Group IA. For example, all cases in Group IB, had they been seen for the first time after the murmur developed, would have appeared to be the same in type, and yet they are not congenital. (The only one which might be a possible exception is M.B., whose murmur is best heard in the standing position.) Similarly, in Group IC the murmurs are not distinguishable and it is only the history of juvenile rheumatism (without a history of carditis) which in any case makes a congenital origin for the murmur doubtful. Cases Group ID also, had the patients been seen only when the murmur was present, would have resembled those in IA except for the history. There is no reason, however, why a history of juvenile rheumatism should not be superimposed on a congenital case. In these cases in Group IA, which are not definitely thought to be due to a slight congenital abnormality, the murmurs may have no significance and may be disregarded in considering the child's future activities, but physiological and haemic murmurs are not usually so persistent, and a comparison with the other groups here again leads to difficulties in diagnosis. In Group IIA, C.B. when first seen was a similar case to those in IA, yet with no history of juvenile rheumatism; mitral incompetence has developed; while D.H., if seen now for the first time, would not be distinguishable, the parent would give no rheumatic history, although the bouts of tachycardia and pyrexia which were present may have been rheumatic in origin. In Group IC the murmurs are similar to those in IA, there are no other signs of carditis, the murmur has persisted although the average observation time is less than in Group IA, but there is a history of juvenile rheumatism in this group. One hesitates to describe a murmur as physiological when there is this history. For example, in Group IIC, E.B. had a history of rheumatism, and P.H. of rheumatic pains, when first seen, but they had no evidence of carditis beyond the basal murmur, and yet later, without any further evidence of a rheumatic attack, they both developed apical murmurs, one conducted towards the axilla. In Group IID the case of S.R., had she been seen for the first time after the development of the basal murmur, when the electrocardiogram was physiological, and before the development of the apical murmur, would have been similar to those in Group IC, and yet a mitral incompetence developed. Had the case of J.W. been seen during the phase when the basal murmur was present, it is only the abnormality of the electrocardiogram which would have distinguished it from those in IC. In Group III, active or acute carditis has preceded the onset of the basal murmur in all cases, and yet in all of them there are periods in which, had the case been seen for a short time only, they might have been placed in Group IC, although in some the electrocardiogram would have revealed some cardiac damage. In Group IV, G.B., R.B., C.D., R.L. and L.L. are similar cases. Summary. (1) In the cases analysed, murmurs cannot be assessed from a consideration of their localisation or of the posture of the patient in which they can be heard. Diagnosis and prognosis are therefore not assisted by this investigation. (2) In view of the fact that a number of these cases of basal murmurs, with no other signs of cardiac involvement, subsequently develop a carditis, it would appear that these murmurs should not immediately be dismissed as necessarily of no significance, especially if there is a history, which suggests even mild juvenile rheumatism. The honorary secretary, Mrs. Jacobson, has continued her valuable assistance in the work of taking electrocardiograms and supervising and helping in the extensive social work of the centre. In addition, regular and helpful assistance in filing and giving out case papers has been rendered by Mrs. Bluck, and in home visiting by Miss Reitlinger, Miss Grier and Miss Dudley Baxter. The officers of the council are grateful for their invaluable assistance. 78 APPENDIX II. TABLE I. Vital statistics of whole district for 1934 and previous years. Year. 1 Population estimated to middle of 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. 12 Rate.* 13 1929 ‡176,000B 175,800D 2,139 2,544 14.4 2,889 16.4 733 552 213 84 2,708 15.4 1930 176,000 2,154 2,580 14.7 2,401 13.6 749 590 177 69 2,242 12.7 1931 174,800 2,111 2,485 14.2 2,646 15.1 716 525 188 76 2,455 14.0 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 1934 179,080 2,305 2,195 12.3 2,848 15.9 1,087 616 204 93 2,377 13.3 * 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 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 1934. Notifiable Disease. Number of cases notified. Total cases notified in each ward. Cases admitted to hospital. Total deaths. At ages.— Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. At all ages 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. Smallpox — — — — — — — — — — — — — — — — — — — — — — — Recheck881 Scarlet fever 549 7 25 35 45 62 178 78 36 64 10 8 1 149 127 78 49 32 38 26 32 18 512 3 Diphtheria (including membranous croup) 360 13 27 29 42 49 128 35 9 19 5 4 1 123 78 87 34 12 2 10 5 9 359 14 Enteric fever 7 — — — — — — 2 1 2 — 1 1 — — 2 1 1 2 — — 1 6 — Puerperal fever 4 — — — — — — — — 4 — — — 1 1 2 — — — — — — 4 2 Puerperal pyrexia 20 — — — — — — — — 18 2 — — 6 6 2 3 — 1 1 1 — 7 1 Primary pneumonia 147 18 23 17 15 8 13 1 3 19 4 16 10 23 81 12 12 3 6 2 5 3 60 3& Influenzal pneumonia 30 1 1 1 — 2 — — 2 6 4 8 5 2 20 1 3 — — 1 2 1 18 23 Dysentery 5 — — — 1 — 1 — — 1 1 1 — — — — 2 2 1 — — — 5 1 Erysipelas 80 2 1 1 1 1 2 1 — 18 11 23 19 16 23 14 5 9 5 2 4 2 52 8 Encephalitis lethargica 2 — — — — — — 1 — 1 — — — 1 — — — — — — 1 — 2 5 Cerebro-spinal meningitis 4 — — 1 — — — — — 2 — 1 — — — 1 — — 2 — — 1 1 5 Polio-myelitis and polio-encephalitis 2 — — — — — 1 — — — 1 — — — 1 — — — — — — 1 1 1 Pulmonary tuberculosis 182 — — 1 — — 1 1 22 81 26 41 9 40 28 21 20 14 19 11 18 11 141 103 Other forms of tuberculosis 47 — 1 1 2 1 4 14 7 7 3 6 1 8 13 8 4 3 2 1 6 2 34 15 Ophthalmia neonatorum 10 10 — — — — — — — — — — — — 1 7 1 1 — — — — 3 — Malaria 2 — — — — — — — — 1 — 1 — — — — — 1 — — 1 — 1 — *Enteritis (diarrhœa) 52 31 16 4 1 — — — — — — — — 18 17 11 4 1 1 — — — 18 59 † Acute rheumatism 56 — — — 1 — 23 29 3 — — — — 19 15 11 6 3 1 — 1 — 19 7 Totals * Notifiable only in children under the age of 5 years. † „ 16 Cases of mistaken diagnosis are excluded from the above table. 79 TABLE III. Causes of Death at Different Periods of Life in 1934. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 6 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. 1,011 104 30 21 14 31 36 50 100 202 212 211 f. 1,366 100 37 30 22 27 53 60 117 164 308 448 Typhoid and paratyphoid fevers m. ... ... ... ... ... ... ... ... ... ... ... ... f. ... ... ... ... ... ... ... ... ... ... ... ... Measles m. 23 4 9 10 ... ... ... ... ... ... ... ... f. 33 6 19 8 ... ... ... ... ... ... ... ... Scarlet fever m. 2 ... ... 2 ... ... ... ... ... ... ... ... f. 1 ... ... 1 ... ... ... ... ... ... ... ... Whooping cough m. 11 6 4 1 ... ... ... ... ... ... ... ... f. 15 5 5 5 ... ... ... ... ... ... ... ... Diphtheria m. 3 ... 2 ... 1 ... ... ... ... ... ... ... f. 11 ... 1 6 4 ... ... ... ... ... ... ... Influenza m. 7 ... ... ... ... ... ... 1 ... 3 1 2 f. 37 ... ... ... ... 2 ... ... 2 7 13 13 Encephalitis lethargica m. 1 ... ... ... ... 1 ... ... ... ... ... ... f. 4 ... ... ... ... ... 1 ... 2 ... 1 ... Cerebro-spinal fever m. 1 1 ... ... ... ... ... ... ... ... ... ... f. 4 ... ... 1 ... ... 1 ... 1 1 ... ... Tuberculosis of respiratory sys- tem m. 52 ... ... ... 1 7 11 7 11 10 4 1 f. 51 ... ... ... l 14 14 8 8 3 2 1 Other tuberculous diseases m. 7 ... 1 ... ... 2 2 ... 1 ... 1 ... f. 8 ... ... 2 1 2 ... 1 ... 1 1 ... Syphilis m. 4 1 ... ... ... ... ... ... 1 1 1 ... f. 1 ... ... ... ... 1 ... ... ... ... ... ... General paralysis of the insane, tabes dorsalis m. 1 ... ... ... ... ... ... ... ... 1 ... ... f. 2 ... ... ... ... ... 1 ... 1 ... ... ... Cancer, malignant disease M. 128 ... ... ... ... 2 1 4 20 36 38 27 f. 212 ... ... ... ... 1 5 8 40 53 58 47 Diabetes M. 10 ... ... ... ... ... ... 1 1 4 2 2 f. 13 ... ... ... ... ... ... ... 3 2 4 4 Cerebral hæmorrhage, etc. M. 33 ... ... ... ... ... ... 2 3 6 9 13 f. 46 ... ... ... ... ... 1 ... 3 9 14 19 Heart disease m. 231 ... ... ... l 4 2 5 8 60 72 79 f. 326 ... ... ... l 3 4 9 14 35 93 167 Aneurysm m. 6 ... ... ... ... ... ... ... ... 3 2 1 f. 2 ... ... ... ... ... ... ... ... 2 ... ... Other circulatory diseases M. 50 ... ... ... ... ... 1 ... 6 11 14 18 f. 109 ... ... ... ... ... ... 2 2 9 37 59 Bronchitis m. 25 5 1 ... ... ... 1 2 4 1 4 7 f. 29 3 ... ... l ... ... ... 1 3 6 15 Pneumonia (all forms) M. 85 26 9 5 l 1 2 4 8 8 7 14 f. 91 17 9 3 ... ... 3 4 5 8 11 31 Other respiratory diseases M. 9 ... • •• ... 1 ... ... ... ... 3 1 4 f. 13 ... ... ... 1 ... 1 ... 2 1 1 7 Peptic ulcer M. 18 ... ... ... ... ... 1 1 5 5 5 1 f. 10 ... ... ... ... ... 1 2 2 1 4 ... Diarrhœa, etc. M. 32 26 2 ... ... l ... ... ... ... 1 2 f. 27 24 1 ... ... ... ... 1 ... ... 1 ... Appendicitis M. 6 ... ... ... ... l ... 1 1 ... 2 1 f. 10 ... ... ... 1 ... ... 1 2 ... 5 1 Cirrhosis of liver M. 10 ... ... ... ... ... ... 2 3 2 3 ... F. 3 ... ... ... ... ... ... ... ... 2 1 ... Other diseases of liver, etc. M. 1 ... ... ... ... ... ... ... ... ... ... 1 F. 12 ... ... ... ... 1 ... ... 2 2 3 4 Other digestive diseases M. 13 2 ... ... ... ... ... ... 1 5 4 1 F. 38 2 ... 1 2 ... 4 3 3 3 8 12 Acute and chronic nephritis M. 28 ... ... ... ... ... 1 ... 1 7 8 11 F. 18 ... ... ... 1 1 2 ... 1 2 3 8 Puerperal sepsis F. 2 ... ... ... ... ... 1 1 ... ... ... ... Other puerperal causes F. 1 ... ... ... ... ... ... 1 ... ... ... ... Congenital debility, premature birth, malformation, etc. M. 28 27 1 ... ... ... ... ... ... ... ... ... F. 32 31 ... ... 1 ... ... ... ... ... ... ... Senility M. 6 ... ... ... ... ... ... ... ... ... ... 6 F. 20 ... ... ... ... ... ... ... ... ... 4 16 Suicide M. 25 ... ... ... ... 2 1 5 6 8 3 ... F. 18 ... ... ... ... ... 2 5 3 5 3 ... Other violence M. 47 2 ... 1 5 4 7 6 5 8 5 4 F. 46 7 1 ... ... ... 2 3 4 2 6 21 Other defined diseases M. 108 4 1 2 4 6 6 9 15 20 25 16 F. 118 5 1 3 8 2 10 11 16 13 28 21 Causes ill-defined, or unknown M. ... ... ... ... ••• ... ... ... ... ... ... ... F. 3 ... ... ... ... ... ... ... ... ... 1 2 80 TABLE IV. Infant Mortality during the Year 1934. 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 39 3 1 4 47 35 46 26 33 187 Uncertified 8 ... ... 2 10 4 2 1 ... 17 Measles ... ... ... ... ... ... 1 1 8 10 Whooping-cough ... ... ... ... ... 1 4 3 3 11 Diphtheria ... ... ... ... ... ... ... ... ... ... Influenza ... ... ... ... ... ... ... ... ... ... Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... Cerebro spinal meningitis ... ... ... ... ... ... 1 ... ... 1 Tuberculosis of respiratory system ... ... ... ... ... ... ... ... ... ... Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... ... 2 4 2 ... 8 Pneumonia ... 1 ... 1 2 11 12 8 10 43 Other respiratory diseases ... ... ... ... ... ... ... ... ... ... Diarrhœa, etc. ... 1 ... 1 2 13 15 10 10 50 Complications of birth 11 ... ... ... 11 ... ... ... ... 11 Malformation 5 ... ... 1 6 3 2 ... ... 11 Premature birth 24 ... 1 2 27 2 1 ... ... 30 Deaths from violence 6 ... ... 1 7 2 ... ... ... 9 Atrophy, debility and marasmus ... ... ... ... ... 3 3 1 ... 7 Other digestive diseases ... ... ... ... ... 1 1 1 1 4 Other diseases 1 1 ... ... 2 1 4 1 1 9 Totals 47 3 1 6 57 39 48 27 33 204 Net births in the f legitimate, 2,005. year of -< (illegitimate, 190. Net deaths in the C legitimate infants, 173. year of -j (.illegitimate infants, 31. 81 TABLE V. The Work of the Women Health Officers for the Year 1934. HEALTH OFFICER TOTAL 1 2 3 4 5 6 7 *8 Child Welfare— First visits to infants (0-1 year) 354 196 251 314 279 71 167 16 1,648 Return visits to infants (0-1 year) 487 458 720 742 749 171 471 32 3,830 Total visits to children (1-5 years) 1,048 976 1,087 781 791 497 945 111 6,236 Stillbirth enquiries 6 6 8 3 13 4 8 — 48 Visits to ophthalmia cases 5 3 5 3 10 1 — — 27 Return visits to ophthalmia cases 6 2 15 2 49 8 — — 82 Visits to measles cases 256 241 294 92 365 220 95 1 1,574 Visits to whooping cough cases 44 26 18 7 108 64 37 — 304 Visits to puerperal fever cases 4 — 1 1 1 - - — 7 Visits to puerperal pyrexia cases 7 5 1 1 4 - 2 — 20 Visits to enteritis cases 40 10 7 13 3 3 — 3 79 Infantile death enquiries 35 20 15 34 27 18 20 3 172 Milk investigations 523 141 250 389 262 85 36 35 1,721 Ante-natal visits 178 133 179 149 99 172 222 14 1,146 Half-days at welfare centres 181 146 137 128 165 89 121 22 989 Special visits 489 349 302 348 157 432 388 33 2,498 Tuberculosis— Pulmonary—First visits 26 20 22 13 6 34 32 — 153 Re-visits 178 220 150 94 24 333 187 — 1,186 Non-Pulmonary—First visits 5 19 8 9 1 5 5 — 52 Re-visits 93 136 105 54 6 109 82 — 585 Rheumatism- First visits to cases notified 16 10 5 5 13 6 2 — 57 Common Lodging Houses — Inspections - 17 2 — 71 — — — 90 Factories and Workshops Act- Inspections of factories 2 30 78 — - 19 3 — 132 Inspections of workshops 13 11 39 4 18 475 155 — 715 Inspections of outworkers' premises 33 5 6 25 49 155 27 — 300 Inspections of other workplaces - - - - - 20 13 — 33 Total Visits 4,029 3,180 3,705 3,211 3,270 2,991 3,028 270 23,684 Notices issued under the Public Health Act— Intimation notices - - - - - 1 1 — 2 Statutory notices - - - - - - - - - Final notices - - - - - - - - - Summonses - - - - - - - - - •This woman health officer is also responsible for the duties of infant life protection visitor under the Children Act, 1908, and the Children and Young Persons Act, 1932, and particulars of her work appear on page 13. TABLE VI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1933. DATE. 1933. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth list sheets. Number of these births duly entered in columns 1, 2, 4, and 5 of the vaccination register (birth list sheets), viz. : Number of these births which are not entered in the vaccination register, on account (as shown by report book) of Column I. successfully vaccinated Column II. Column V. dead, unvaccinated. Postponement by medical certificate. Removal to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Total number of certificates of successful vaccinatior received during the calendar year, 1934. Insusceptible of vaccination Certificate of conscientious objection. 1st January to 31st Dec. North 947 670 3 162 52 — 14 44 2 2,013 South 1,191 814 7 136 70 3 95 54 12 Total 2,138 1,484 10 298 122 3 109 98 14 82 83 Particulars of the Staff of the Public Health Department at the end of 1934 (as required by Ministry of Health Circular 359). Year of Appointment. Medical Officer of Health and Administrative Tuberculosis Officer. James Fenton, M.D., M.R.C.P., D.P.H. 1920 Assistant Medical Officer of Health and Tuberculosis Officer. A. W. K. Picard, M.D 1922 Assistant Medical Officer, Maternity and Child Welfare. Violet I. Russell, M.D., M.C.O.G 1934 Consultant Medical Officers (Part-time). Hugh R. Carter, M.D. (Treatment of zymotic enteritis) 1924 Janet K. Aitken, M.D. (Rheumatism supervisory centre) 1927 Alun Morris Johns, M.D. (Consultant gynaecologist and obstetrician) 1932 Bessie H. E. Cadness, M.B. (Bacteriologist) 1934 Public Vaccinators. Owen W. Roberts, M.R.C.S., L.R.C.P. (North Kensington district) 1930 Greer A. Henderson, L.R.C.P.I., L.R.C.S.I. (South Kensington district) 1930 Basil Hood, M.R.C.S., L.R.C.P. (St. Charles Hospital) 1930 James Carver, M.B., F.R.C.S. (St. Mary Abbots Hospital) Clerical Staff. 1932 James H. Wilson (Chief clerk and Vaccination Officer) 1900 Francis W. Gascoyne 1919 John S. Russell 1923 Denis C. Page 1925 Francis T. Pearce 1929 Victor R. Minter 1932 Dennis C. Draper 1933 Beatrice J. Fenton (Temporary) 1930 Ronald F. Rogers (,,) 1931 Derek P. Roberts (,,) 1934 Eric R. Hundy (,,) 1934 Sanitary Inspectors. *Thomas Cutting (Senior Inspector) 1900 *George W. McQuinn 1901 †John McDermid 1920 ¶†Tit Henry W. Walters (Food inspector) 1925 ¶†Cecil R. Webb 1925 ¶§John S. Wheeler 1930 ¶§Donald J. Hunt 1931 ¶§Frederick G. Bishop 1931 ¶§Ronald V. Coombs 1932 §Arthur L. Vague 1934 ¶§Thomas A. Wilson 1934 §George N. Topping (Temporary) 1934 §Maurice Cottrell („) 1934 §Ronald D. Callis (,,) 1934 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 Other Officers. Mrs. M. Hayman (Health lecturer) 1926 Miss Caton (Secretary, rheumatism supervisory centre) 1933 Arthur C. Britton (Mortuary keeper) 1930 Albert Nunn (Chief disinfector) 1906 George Harris (Disinfector) 1914 William Taylor (,,) 1926 Walter Strong (,,) 1928 Ernest Manning (,,) 1931 Frank Nunn (Temporary disinfector) 1934 A. V. Boddington (Superintendent of medicinal baths) 1929 Walter E. Weedon (Rat officer) 1926 William J. Clancy (Drain-testing assistant) 1903 Charles H. Coombs (,, „) 1927 Mr. and Mrs. W. Whale (Caretakers, tuberculosis dispensary) 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. ::Smoke Inspector's Certificate. All the Women Health Officers have undergone 3 years general hospital training, and have secured the certificate of general nursing proficiency, and (except Miss Haycock) are qualified health visitors. 84 INDEX. PAGE Advisory committee 36 Acute rheumatism 14, 60 & 73 After-care of tuberculous patients 71 Aged, removal of infirm and physically incapacitated persons 25 Agricultural Produce (Grading and Marking) Act 51 Ante-natal clinic (Queen Charlotte's Hospital) 33 „ medical officer 10 „ work 10 & 29 Anti-toxin (diphtheria) 58 Artificial Cream Act 51 „ pneumothorax treatment 71 „ sunlight 32 Aubrey Trust 39 Baby clinic 32 „ hospital 32 Bacteriological examinations (infectious disease and milk) 13 Bacteriological examinations (swimming- bath water) 13 Bacteriological examinations (tuberculosis) 13 & 72 Bakehouses 50 Basement rooms 40, 42 & 43 Baths and washhouses 24 Bedding for tuberculous patients 72 Birth control 35 Births 4 „ notified 5 Butchers' shops 50 Canal Boats Acts 24 Cancer 7 Care of tuberculous patients 71 Cerebro-spinal meningitis 59 Chapel of Rest 23 Cleansing station 61 Clearance areas 38 Closing orders 40, 42 & 43 Common lodging houses 44 Convalescent homes 34 Cream confectionery 54 Day nurseries 33 Deaths 5 „ , causes of 7 „ from certain diseases 8 ,, from cancer 7 „ from tuberculosis 68 „ in wards and rates 6 Defects (housing) remedied 22 & 37 Dental treatment at infant welfare centres 32 „ ,, for tuberculous patients. 71 Diarrhoea (summer) 14 & 60 Diphtheria 57 „ immunisation 64 Disinfection (infectious disease) 63 ,, (tuberculosis) 72 Disinfestation by HCN 41 & 61 Dispensary diagnosis and treatment of tuberculosis 69 Dog nuisances 14 „ „ (proceedings) 14 & 23 Drainage and sewerage 19 Dwelling-house inspection 20 & 37 Dysentery 60 PAGE Electrical treatment 33 Employment of tuberculous patients ... 72 Encephalitis lethargica 59 Enteric fever 58 Erysipelas 58 Extra nourishment for expectant and nursing mothers and their infants ... 35 Extra nourishment for tuberculous patients 71 Factories and workshops 26 Flatlets 45 Flooding 19 Following-up of tuberculous patients 71 Food, inspection and supervision 47 Food and'Drugs (Adulteration) Act 51 „ „ (proceedings) 54 Food premises, inspection 50 „ „ registration 50 „ poisoning 55 ,, storage, preparation and cooking accommodation 42 „ supply 47 ,, unsound 51 Foster-children 13 Fouling of footpaths by dogs 14 & 23 Fried fish shops 50 Grants to maternity and child welfare institutions 18 Gynaecological clinic 33 Handicrafts class for tuberculous patients 72 Health lecturer 18 & 34 ,, propaganda 18 ,, services (general) 13 ,, visitors 30 & 81 Home contacts of tuberculosis 71 ,, helps 35 „ nursing (general) 13 ,, nursing of tuberculous patients 71 ,, Office tables (factories and workshops) 26 „ visiting of tuberculous patients 70 „ workers 27 Hospital (general) 15 Houses let in lodgings 37 Housing 37 accommodation owned by Council 44 „ accommodation provided by associations 44 „ action under statutory powers 21, 37 & 38 „ , five years programme 43 „ statistics 45 Hydrocyanic acid gas disinfestation 41 & 61 Ice cream 50 Improved Tenements Association 39 & 44 Improvement areas 39 Increase of Rent and Mortgage Interest (Restrictions) Acts 24 Indecent occupation 37 Infant consultations at infant welfare centres 10 & 31 „ life protection 13 „ mortality 8 „ „ , death rates 9 „ „ , causes of deaths 9 „ „ , deaths each month 9 „ „ , deaths in wards 8 85 INDEX—continued. page Infant welfare centres 31 Infectious diseases 56 Introduction 3 Invermead ... 33 Kensington District Nursing Association ... 13 ,, Housing Trust 39, 43 & 44 Lectures, health 18 & 34 Legal proceedings, food and drugs 54 „ ,, sanitary administration 23 Legislation, local 14 Light treatment at baby clinic and hospital 32 ,, ,, for tuberculous patients ... 70 London County Council (General Powers) Act, 1927 25 London County Council (General Powers) Act, 1928 25 London County Council (General Powers) Act, 1932 50 & 55 London County Council (General Powers) Act, 1933 39 Malaria 59 Marriages 4 Massage 33 Maternal mortality 10 Maternity and child welfare 29 „ home 33 Measles 60 Medicinal baths 61 Merchandise Marks Acts 51 Midwifery 14 Milk (bacteriological examination) 13 Milk and Dairies (Amendment) Act 47 „ „ (Consolidation) Act 47 „ „ Order 47 Milk (Special Designations) Order 48 Milk supplied in Kensington 47 Mortuary 23 Non-notifiable infectious diseases 60 Notifiable ,, ,, 56 Notifications of Births Act 5 Notifications of infectious diseases since 1930 56 ,, tuberculosis (age and sex distribution) 67 Notifications of tuberculosis (deaths and death rates) 68 Notifications of tuberculosis (in wards) 67 Nursing (professional) in the home 13 Obstetric work 10 Ophthalmia neonatorum 59 Outworkers 27 Overcrowding. 37, 41 & 43 Peabody Donation Fund 39, 43 & 44 Pharmacy and Poisons Act 55 Pigeons, nuisances from 25 Pneumonia and influenzal pneumonia 59 Pneumothorax treatment of tuberculous patients 71 Poliomyelitis and polioencephalitis 59 Population 3 Prevention of infectious disease 56 Princess Beatrice Hospital 15 Princess Louise Hospital 15 Proceedings under Food and Drugs (Adulteration) Act 54 page Proceedings under Housing Act, 1930 21, 38 & 46 „ „ Public Health Acts (housing) ... 21 & 37 „ ,, Public Health (London) Act 23 „ „ Public Health (unsound food) 51 Propaganda (health) 18 Public Health (Condensed Milk) Regulations 55 „ „ (Dried Milk) Regulations ... 55 „ ,, (London) Act notices served 21 & 37 ,, ,, (Meat) Regulations 49 „ „ (Prevention of Tuberculosis) Regulations 68 Puerperal fever ancj pyrexia 59 Queen Charlotte's Hospital ante-natal clinic 33 Rag Flock Acts 24 Rats and Mice (Destruction) Act 25 Reconditioning and repair work 41 Refuse collection and removal 19 Registration of food premises 50 „ houses let in lodgings 37 Rent Restrictions Acts 24 Residential institutional treatment of tuberculosis 70 Rheumatism in children 14, 60 & 73 ,, supervisory centre 16 & 73 Samples, adulterated 54 „ formal 51 „ informal 51 Sanitary circumstances of the area 19 „ inspection 20 „ notices 21 „ works completed 22 Scarlet fever 57 Schick test 58 & 65 School medical service 17 „ treatment centres 16 Sewerage and drainage 19 Shelters for tuberculous patients 72 Skimmed milk 47 Slaughterhouses 50 Slaughter of Animals Act 50 Smallpox 57 Smoke abatement 23 Sputum flasks 72 Staff 83 Statistics, summary of 2 vital 3 & 78 Subscriptions to hospitals, etc 18 Sutton Dwellings Trust 39, 43 & 44 Swimming-bath water (bacteriological examination) 13 Travelling expenses of women breast-feeding infants 36 Tuberculosis 67 Typhoid and paratyphoid fever 58 Underground rooms 40, 42 & 43 Unsound food 51 Vaccination 18 „ Officer's return 82 86 INDEX—continued. page Verminous furniture disinfested by HCN 41 & 61 „ persons cleansed 61 ,, premises cleansed 61 Vital statistics 3 & 78 Washhouses 24 Washing accommodation 42 Water-closet accommodation 41 Water supply for domestic use 42 Whooping cough 60 Wilsham Housing Trust 39 & 44 Women health officers 30 & 81 Workshops 26 v X-ray diagnosis of tuberculosis 70 Zymotic enteritis 14 & 60 „ death rate 7 APPENDIX I. page Seventh annual report of the Kensington rheumatism scheme 73 APPENDIX II. Causes of death at different periods of life in 1934 (Table III) 79 Infant mortality during 1934 (Table IV) ... 80 Infectious disease cases notified during 1934 (age periods, number admitted to hospital, and total deaths) (Table II) 78 Staff of public health department (Table VII) 83 Vaccination officer's return for 1933 (Table VI) 82 Vital statistics for 1934 and five preceding years (Table jl) 78 Work of women health officers for 1934 (Table V) 81