The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1935 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 1935. Population (estimated) 178,300 Area of borough in acres 2,291 Density of population per acre 77 Number of marriages 2,001 Rateable value £3,349,816 Product of a Id. rate £13,957 Total. M. F. Live births {legitimate ... 1,991 998 993 } illegitimate 235 121 114 Birth rate 12.4 Still births 73 39 34 Rate per 1,000 total births 31 Deaths 2,154 953 1,201 Death rate (after adjustment) 11.3 Percentage of total deaths occurring in public institutions 3% Deaths from puerperal causes :— Rate per 1,000 total Deaths (live and still) births. Puerperal sepsis 4 1.7 Other puerperal causes 1 0.4 Total 5 2.2 Death rate of infants under one year of age :— All infants per 1,000 births 79 Deaths from measles (all ages) 0 Legitimate infants per 1,000 legitimate live births 74 „ whooping cough (all ages) 3 Illegitimate infants per 1,000 illegitimate live births 119 „ diarrhœa (under 2 years of age) 57 Deaths from phthisis 78 Phthisis death rate 0.43 Deaths from all forms of tuberculosis 89 Tuberculosis death rate 0.50 Deaths from the zymotic diseases 88 Zymotic death rate 0.49 3 Town Hall, Kensington, W.8. 26th June, 1936. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lord, Ladies and Gentlemen, I have the honour to submit my annual report for 1935 upon the state of the public health in Kensington. The birth rate was 12.4, which is an increase of 0.1 on the previous year, but it is 2.3 below the rate for England and Wales. The death rate of 12.1 is 1.2 lower than the rate for the preceding year. 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 11-3, which is the lowest rate recorded in the history of the borough. The infant death rate has fallen from 93 to 79, but this rate is still above the average for London and for the rest of the country. The year saw great changes in the maternity and child welfare service following the Council's consideration of steps to be taken to deal with this problem of the high infant death rate. The 14 part-time medical officers hitherto employed at the infant welfare centres were replaced by whole-time medical officers who were specially selected by the Council for their experience in maternity and child welfare work. One commenced work on the 1st July, another on the 1st October, and at the end of the year it was decided to appoint a third whole-time medical officer. It is too early yet to show that this change has produced better figures. The maternal death rate of 2.2 is an encouraging one and compares favourably with the figure of 3.93 for England and Wales, and 2.58 for London. The Council's whole-time ante-natal medical officer was engaged in dealing with expectant mothers throughout the year, and, although it would be unwise to ascribe the low rate to her services, it is pleasing to record that she has been able to establish a system of co-operation between doctors, midwives, hospitals and antenatal clinics which cannot have any but the best results. The voluntary workers at the welfare institutions receive considerable encouragement from the high degree of efficiency with which the ante-natal clinics are now conducted. The mild type of smallpox which had been prevalent in London for some time until a few years ago has disappeared and during the past twelve months there was not one notification in the metropolitan area. The year was a favourable one from the point of view of infectious disease. The total number of notifiable acute infectious diseases fell from 1,331 in 1934 to 999. Tuberculosis has happily shown a steady decline since the war, and in several annual reports attention has been called to the low figures recorded. The year 1935 was again one in which the number of notifications, deaths and death rate were lower than experienced in any previous year. The decline taking place in this disease is greater in North Kensington than South Kensington, and the gradual disappearance of this malady, which not long ago was known as the "white man's scourge," is one of the highly satisfactory features in the public health of Kensington. The five years' housing programme initiated in 1933 was pursued with the same vigour as in previous years, and reference to the housing section of this report on page 34 will show that a large amount of work was carried out. The Housing Act of 1935 contained a number of amendments which the Council's recent experience had proved to be desirable and which will be of great assistance in the future conduct of their housing work. Particular attention is called to page 42 where details are given of the overcrowding survey conducted during the year. The presentation of this report affords me an opportunity of expressing my appreciation of the full measure of support which has been accorded to me by the Mayor, the Chairmen and ViceChairmen of the various committees, and all members of the Council. I wish to tender my thanks to the Town Clerk and other chief officers for their support, particularly in regard to the housing activities of the Council which have occupied a considerable amount of time and attention of all officers. The staff of the department have worked loyally 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, 1899, covers an area of 2,291 acres, and is co-extensive with the civil parish and registration district of the same name. The line of demarcation formed by Holland Park Avenue, Notting Hill Gate, and the Bayswater Road divides the borough into approximately equal halves described in previous years and in this report as North and South Kensington respectively. Each of these areas is co-terminous with the parliamentary division of the same name. The borough is further sub-divided into nine wards. North Kensington includes the wards of St. Charles, Golborne, Norland and Pembridge, whilst South Kensington is made up of the five other wards, namely, Holland, Earl's Court, Queen's Gate, Redcliffe and Brompton. Population. The population of the borough as ascertained at the census in 1931 was 180,677 persons; but for the purpose of this report, the population for 1935 has been estimated by the Registrar-General to be 178,300. 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 178,300 North Kensington 94,070 South Kensington 84,230 Wards. St. Charles 30,390 Golborne 22,380 Norlan 21,400 Pembridge 19,900 Holland 18,430 Earl's Court 18,000 Queen's Gate 14,100 Redcliffe 21,340 Brompton 12,360 Marriages. During the year, 2,001 marriages were registered, representing a rate of 11.2 marriages per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 681 Roman Catholic Church 302 Nonconformist Church 42 Jewish Church 8 Register Office 968 Total 2,001 Births. The number of births registered was 2,226, after correction for inward and outward transfers and the birth rate for the borough was 12*4 per 1,000 population. Distributed according to se and legitimacy the births were as follows :— Male. Female. Total. Legitimate 998; 993 1,991 Illegitimate 121 114 235 Totals 1,119 1,107 2,226 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various districts in the borough in 1935, and the rates for the previous five years:— District. 1935. Birth rates in previous years. No. of births. Birth rate. 1934 1933 1932 1931 1930 England and Wales 598,756 14.7 14.8 14.4 15.3 15.8 16.3 London 55,780 13.3 13.2 13.2 14.2 15.0 15.7 The Borough 2,226 12.4 12.3 12.0 12.9 14.2 14.6 North Kensington 1,566 16.6 16.8 16.1 17.3 19.6 19.0 South Kensington 609 7.2 6.6 6.5 7.7 7.8 8.2 Wards. St. Charles 510 16.7 15.4 18.0 19.5 21.6 17.9 Golborne 481 21.5 23.7 21.9 23.6 21.3 21.5 Norland 351 16.4 16.3 13.6 15.9 19.8 22.0 Pembridge 224 11.2 11.6 10.9 7.7 14.3 13.6 Holland 158 8.6 7.3 5.6 8.2 9.1 9.4 Earl's Court 118 6.6 8.3 7.9 9.6 9.2 9.8 Queen's Gate 69 4.9 5.5 5.5 5.7 5.1 5.2 Redcliffe 203 9.5 6.8 6.3 7.2 8.4 9.4 Brompton 61 4.9 4.0 6.7 7.2 5.8 5.3 Ward unknown 51 ... ... ... ... 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 1935 12.4 Notification of Births Act, 1907—During the year, 2,226 live births to Kensington mothers were registered, and of this number 2,175 or 98 per cent, were notified in accordance with the requirements of the Act. The number of still births notified was 66, and the number of births notified as having occurred in Kensington but belonging to other districts was 625. 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 24 817 841 „ „ „ parents -- 24 24 „ ,, „ medical practitioners 1 204 205 „ „ „ other persons 17 505 522 Births in the borough 42 1,550 1,592 Notified from institutions outside the borough 24 625 649 Totals 66 2,175 2,241 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907 Year. Percentage. 1931 97 1632 98 1933 94 1934 93 1935 98 The importance of securing due compliance with the Notification of Births Act cannot be over-estimated, for the information obtained constitutes the starting point of the work of health visitors. Deaths. The number of deaths registered in the borough during 1935 was 2,854, 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 2,854 Deaths of residents in public institutions, etc., beyond the borough 506 3,360 Deaths of non-residents in public institutions, etc , within the borough 1,206 Corrected number of deaths belonging to the borough 2,154 6 The following table shows the number of deaths and the death rates in England and Wales, London, Kensington and the various districts in the borough in 1935, and the rates for the previous five years:— District. 1935 Death rates in previous years. No. of deaths. Death rate. 1934 1933 1932 1931 1930 1929 England and Wales 477,398 11.7 11.8 12.3 12.0 12.3 11.4 13.4 London 47,847 11.4 11.9 12.2 12.3 12.4 11.4 13.8 The Borough 2,154 12.1 13.3 12.9 13.6 14.0 12.7 15.4 North Kensington 1,130 12.0 13.7 12.9 13.8 13.8 12.6 15.4 South Kensington 980 11.6 12.3 12.6 12.4 13.3 12.5 14.5 Wards. St. Charles 317 14.3 11.4 10.9 12.7 12.5 11.7 13.9 Golborne 308 13.7 16.4 13.9 16.2 14.1 12.3 16.0 Norland 255 11.9 13.9 14.1 14.1 14.2 14.4 17.5 Pembridge 250 12.5 13.8 13.1 12.4 14.2 12.1 14.1 Holland 228 12.3 14.2 13.3 13.4 14.5 12.7 14.4 Earl's Court 233 13.0 12.3 13.1 13.3 14.1 15.0 15.9 Queen's Gate 124 8.8 11.7 11.5 12.6 10.8 11.2 12.7 Redcliffe 267 12.5 11.7 12.7 11.8 15.2 11.1 15.7 Brompton 128 13.5 11.3 11.1 10.5 11.2 11.4 12.5 Ward Unknown 44 ... ... ... ... ... ... ... 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 1935 12.1 The corrected death rate of 12-1 is not one which should be compared with those for other districts, for it is necessary that the death rate should be adjusted 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 11.3, which should be used when comparing the death rate of Kensington with those of other districts. Both the corrected death rate and the adjusted death rate are the lowest in the history of the borough 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. 88 Epidemic influenza 31 Phthisis 78 Other tuberculous diseases 11 Cancer 317 Bronchitis 48 Pneumonia 122 Heart disease 612 Acute and chronic nephritis 62 Puerperal fever 4 Premature birth 26 Violence (including suicide 26) 109 Old age 29 All other causes 617 2,154 It will be seen that over one-third of the deaths, or 860, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 78 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 diarrhoea. The following table shows the zymotic death rate for Kensington and London in each of the last five years:— Deaths from principal zymotic diseases per 1,000 persons living. Period. Kensington. London. 1931 0.34 0.33 1932 0.99 0.61 1933 0.49 032 1934 0.88 040 1935 049 027 Cancer.—Cancer caused 317 deaths, and of this number 302 occurred in persons over the age of 45 years. Carcinoma was the form of cancer to which 281 deaths were attributed; sarcoma and epithelioma were the assigned causes of 15 deaths; 21 deaths were certified as due to cancer or malignant disease without further definition. The parts of the bodv which were affected m each case are shown m the following table:— Deaths from Cancer, 1935. Parts affected. Sex. Total. Male. Female. Buccal cavity 7 4 11 Lungs 20 11 31 Digestive organs, peritoneum, etc. 71 92 163 Female genital organs — 31 31 Male genito-urinary organs 16 — 16 Breast — 33 33 Skin — 3 3 Other and unspecified organs.. 8 21 29 Totals 122 195 317 The deaths in the several wards, etc., are set out in the following table:— The Borough 317 North Kensington 150 South Kensington 166 Wards. St. Charles 38 Golborne 30 Norland 39 Pembridge 43 HoUand 37 Earl's Court 41 Queen's Gate 27 Redcliffe 40 Brompton 21 Ward unknown 1 The number of deaths from this disease was 23 less than in the previous year. 8 Table showing the number of deaths in 1935 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 26 — — 3 3 4 24 9 10 5 February 23 — — — 5 5 27 5 10 8 March 23 — — 3 6 3 24 4 24 6 April 20 — — 1 3 8 21 3 14 7 May 18 — — 1 — 6 18 7 7 3 June 16 — — 2 2 4 23 — 10 4 July 13 — — 1 ] 7 26 1 4 4 August 10 — 1 — — 5 22 2 1 3 September 7 — 1 3 — 10 27 1 5 6 October 5 — — 1 1 5 23 1 9 3 November 2 — — — 2 8 25 3 10 5 November 30 — 1 3 3 9 27 2 4 3 December 28 1 — 1 5 4 30 10 14 7 Totals 1 3 19 31 78 317 48 122 64 Infant Mortality. During the year 1935, there were 2,226 births and 175 deaths of infants under the age of one year in the borough. These figures give an infant mortality rate (deaths of infants under twelve months of age to each 1,000 births) of 79. This marks a considerable decrease on the figure for the previous year, which was 93, but it is still higher than the figure for London and for England and Wales. The following table gives the births and the infant death rates in England and Wales, London, Kensington and the various wards of the borough for the year 1935, and the infant death rates for the previous four years :— District. 1935 Infant mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infant mortality rate. 1934 1933 1932 1931 England and Wales 598,756 34,089 57 59 64 65 60 London 55,780 3,229 58 67 59 66 65 The Borough 2,226 175 79 93 72 98 76 North Kensington 1,566 140 89 102 80 116 86 South Kensington 609 35 57 75 59 54 44 Wards. St. Charles 510 44 86 115 53 109 76 Golborne 481 48 100 97 89 112 97 Norland 351 36 102 111 117 142 84 Pembridge 224 .2 54 73 67 120 92 Holland 158 11 88 133 85 83 54 Earl's Court 118 5 42 40 55 22 18 Queen's Gate 69 2 29 51 37 59 59 Redcliffe 203 14 69 69 65 70 67 Brompton 61 — 40 23 32 14 Ward unknown 51 — There is situated within the Holland ward of the borough the National Children's Adoption Association hostel where unwanted children are kept until they are adopted. They are mostly illegitimate and come from poor homes. Three infant deaths occurred in the hostel during the year; not one was a Kensington child; if the deaths were removed from the statistics, the death rate for that ward would be reduced to 69. 9 Infant Mortality Rates, 1896-1935. 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 1935 57 58 79 The number of deaths of Kensington infants occurring in each month during 1935. January 18 February 15 March 19 April 18 May 15 June 8 July 3 August 15 September 12 October 20 November 12 December 20 Causes of, and ages at, deaths of infants under one year of age in Kensington during 1935. Causes of death. Under 1 week. 1—2 weeks. 2—3 weeks. 3—4 weeks. Total 4 weeks. 1—3 months. 3—6 nonths. 6—9 months. 9—12 months. Total infant deaths under 1 year 1. Common infectious diseases (Diphtheria 2) (Whooping cough l)} — — — — — 1 1 1 — 3 2. Digestive diseases 1 — — — 1 — 3 1 — 5 3. Pneumonia, bronchitis and other respiratory diseases — 1 1 1 3 4 11 6 4 28 4. Diarrhoea — — 1 1 2 14 24 10 5 55 5. Complications of birth) (Atelectasis 7) (Other complications 11)} 17 1 — — 18 — — — — 18 6. Congenital malformation 6 1 — — 7 3 2 — — 12 7. Premature birth 19 2 — — 21 5 — — — 26 8. Atrophy, debility and marasmus — — 1 — 1 5 1 1 — 8 9. Other diseases:— (Violence 6) (Pyloric stenosis 2) (Cerebro-spinal meningitis 1) (Pemphigus neonatorum 1) (Cancer 1) (Other conditions 9) 4 — — 1 5 4 7 2 2 20 Totals 47 5 3 3 58 36 49 21 11 175 Death rate in each age period per 1,000 births 21.0 2.2 1.3 1.3 26.0 16.0 22.0 9.0 5.0 79 Percentage of total infant deaths occurring in each age period 26.8 2.8 1.7 1.7 33.1 20.6 28.0 12.0 6.3 10 The council view the high infant mortality rate in the borough with concern and have given much time to the consideration of measures which might help in its reduction. The details of each individual infant death are scrutinised month by month by the maternity and child welfare committee in an attempt to gain possible further elucidation into the causes of the persistently high death rate. In addition to re-organising the medical service, the council have very largely increased the supply of free milk to children up to three years of age, and have decided to grant free cod liver oil or its equivalent whenever necessary. At the end of the year, the maternity and child welfare committee appointed a sub-committee to investigate still more closely the prevalence of enteritis which adds so largely to the high infant death rate. This sub-committee is now engaged on the problem before them. Maternal Mortality. There were five deaths of Kensington women directly associated with childbirth in 1935, representing a maternal death rate of 2.2 per 1,000 births. The corresponding rate for England and Wales is 3.93. Four out of these five were cases of abortion resulting in sepsis and death; only one Kensington woman died after confinement during the year and this death occurred in hospital after a serious operation (Caesarean hysterectomy). The latter patient had attended one of the borough ante-natal clinics when she was six months pregnant and, on account of previous difficult labours, was advised to enter the hospital to which she was promptly referred. She received ante-natal supervision at that hospital and was under the care of the visiting obstetrician during her labour. Despite the unfortunate issue of this case, it is clear that all possible facilities had been employed to render the confinement as safe as possible. The apparent prevalence of induced abortion is a matter for serious concern and an effort has been made by the council's officers with the assistance of the staff of the welfare centres to awaken public opinion to the dangers of this practice. Some progress already has been achieved in this direction and it is hoped that this avoidable cause of maternal mortality and morbidity may soon be greatly diminished. The prevention of difficulty in labour and the improvement of the expectant mother's health and nutrition are sound principles on which to work in securing the reduction of the mortality rate; and the ante-natal service is the most important means to attain this end. The percentage of Kensington women who received ante-natal supervision at the borough centres and at the clinics attached to Queen Charlotte's Hospital and St Mary Abbots Hospital during the year is difficult to calculate with accuracy, as many women attended both borough and hospital clinics, but it is probably about 85 per cent, of the total births; this is a satisfactory figure as many 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 ante-natal work of the borough has been carefully developed and organised and now reaches a high standard. The year's record includes few unusual cases, obstetric abnormalities having been detected and referred for treatment in their early stages, dramatic complications thus being avoided. Out of 17 cases of contracted pelvis only two needed Caesarean section, six being delivered by forceps and the rest having normal confinements. It is interesting to notice in a large proportion of these cases showing definite pelvic contraction that no obstetric interference was necessary; this illustrates the importance of avoiding meddlesome midwifery. The rectification of malpresentations by external version in the clinics has produced good results. Out of 46 cases, 41 were turned successfully and had normal confinements. In five cases of extended breech presentation, version was found to be impossible. These were all referred to hospital; in three of the cases version was successfully performed under an anaesthetic and these patients had subsequent normal confinements ; the two cases in which version was not performed were delivered in hospital, but in spite of skilled attention at birth both babies were stillborn. This result shows the success of version in cases of malpresentation in saving infant life : the 44 babies in which this antenatal manoeuvre had been performed were born alive, whilst the two babies born in the abnormal presentation were stillborn. There has been a number of recorded cases in the clinics of albuminuria of pregnancy, hyperpiesis, pyelitis, heart disease, tuberculosis, and so forth, but of insufficient general interest to warrant a detailed report. All the mothers eventually did well. Six patients were advised with regard to sterility ; two of those who attended for this advice in 1934 have already become pregnant. Many women have also been seen by the council's ante-natal medical officer for various psychical and menopausal disorders and after reassurance were referred to the appropriate agencies for treatment. It must be clearly understood that no medical treatment is carried out in the council's clinics, patients who need curative treatment being referred to private doctors or to hospitals. The council's health services are established for the prevention of illness and not for its cure. Although midwifery forms the essential nucleus of ante-natal work, the latter extends beyond the limits of obstetrics and the ante-natal clinic should be conducted with a view to the future welfare of both mother and child, and not limited to the immediate confinement. Particular attention is paid to the nutrition of the expectant mother in the borough clinics and free dinners, milk, adexolin and iron are granted by the council when necessary. The advantages and practicability of subsequent breastfeeding of the infant are stressed in the interview with each patient. Advice to obtain dental treatment is meeting with an increasing response and the dental sessions attached to the centres are becoming crowded ; the provision of free dentures by the council is proving of much benefit. Not the least important work which is being done in the borough ante-natal clinics is the removal of fear in the pregnant mother, this fear being so common a cause of uterine inertia and difficult labour. The psychical treatment of the pregnant woman is of very great importance and is a recognised factor in preventing those cases of obstetric shock and post-partum haemorrhage which are too frequently a cause of maternal death. 11 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 1935 will be found in Appendix II, Table VII. Bacteriological Work. The council's bacteriological work is 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 work performed by the bacteriologist during 1935 was as follows:— Disease suspected. Examinations. Positive. Diphtheria 1,699 95 ,, (virulence test) 3 1 Tuberculosis (sputum) 338 39 ,, (faeces) 1 — Typhoid fever (blood) 6 1 ,, ,, (faeces) 6 — Dysentery (blood) 6 — „ (fæces) 1 — Gonorrhoea.1 — Scarlet fever (ear) 5 1 Vincent's angina 8 3 The following examinations were also carried out:— Milk (bacterial count) 107 ,, (tubercle bacilli) 25 The number of examinations carried out is up to the average of previous years. In addition to the figures given above, 341 specimens of sputum were examined at the tuberculosis dispensary. Infant Life Protection. At the end of the year there were in the borough 150 foster-mothers, and they had the care of 232 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. Ninety-three of the foster-children are under the age of five years, and all but 7 who are seen regularly by private doctors, are in regular attendance at infant welfare centres. The following is a record of the work carried out by the infant life protection visitor:— Visits paid to homes 1,405 Special visits paid 168 Children removed voluntarily 91 „ ,, compulsorily — ,, „ to hospital 15 Deaths reported 4 Cases in which there was cause for complaint 1 Cases recommended for prosecution 1 Foster-mothers added to register 36 ,, ,, removed from register 47 ,, ,, on register on 1st January 161 ,, „ „ ,, 31st December 150 Foster-children „ ,, „ „ 232 From the above table it will be seen that one foster-mother was recommended for prosecution. She had had the care of a child since August, 1934, but had failed to notify its reception under Section 67 of the Children and Young Persons Act, 1932. The case was dismissed under the Probation of Offenders Act, 1907. Four deaths of foster-children were reported. Two inquests were held and in each case the foster-mother was exonerated from blame. In the other two cases, enquiries were made, and it is satisfactory to be able to report that there was no occasion for complaint against the foster-mothers. 12 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 1935 was 1,885 and the number of visits paid was 45,571. 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, 1935:— Cases. Visits. Maternity cases 51 896 Miscarriages 39 523 Pneumonia (5 years of age and over) 43 785 „ (under 5 years of age) 17 354 Ophthalmia neonatorum and other inflammations of the eyes of newly-born children 28 560 Influenza (5 years of age and over) 39 441 „ (under 5 years of age) 7 90 Enteritis and diarrhoea 72 750 Tuberculosis (5 years of age and over) 24 1,001 „ (under 5 years of age) — — Measles (5 years of age and over) — — „ (under 5 years of age) 3 45 Whooping cough (5 years of age and over) — — „ „ (under 5 years of age) 4 51 Erysipelas 2 14 Acute rheumatism 11 563 Puerperal pyrexia 2 24 Scarlet fever 1 5 Pemphigus 4 76 Totals 347 6,178 For the splendid services rendered, the council paid to the association in 1935 a grant of £325. Midwifery Arrangements. The Queen Charlotte's Hospital authorities maintain a district nurses' home in Ladbroke Grove, North Kensington, and during 1935 members of the staff conducted 541 confinements, of which 516 were in Kensington homes. For some years past a difficulty has been experienced in connection with domiciliary midwifery in South Kensington because the cases arising in poorer homes are widely scattered over the entire southern half of the borough, and there is no area which provides a sufficient number of cases to enable a midwife in private practice to earn a reasonable living. During the course of the year the council resolved to overcome this difficulty by appointing a municipal midwife. This midwife started work in September, and has been provided with quarters at the South Kensington infant welfare centre, 10, Redcliffe Street, which is a most convenient position for her work in South Kensington. It took some little time for her to become known, and she conducted only 4 confinements between the date of her appointment and the end of the year. However, her services have been in greater demand since the end of 1935. She helps at the sessions at the South Kensington centre, and undertakes home visiting in connection with the ante-natal clinics held there. Her appointment supplies a need which had been felt for some time for a midwife who could undertake cases at a charge low enough for the poorer residents of South Kensington. Each case booked is submitted to the Maternity and Child Welfare (Applications) Sub-Committee, who decide the fee to be paid for the midwife's services. The maximum fee is two guineas, and assessments are made according to the family income. St. Mary's Hospital undertake a number of cases in North Kensington in connection with the teaching of medical students, and the maternity nursing of these cases is carried out by the Kensington district nursing association. The council maintain a maternity home with ten beds, the London county council have 71 beds at St. Mary Abbots Hospital for the confinement of poor women, and the Princess Beatrice Hospital in South Kensington has a maternity ward. It will be seen that these facilities, combined with those provided by private doctors and midwives and outlying hospitals, are adequate to the needs of the borough. 13 Special Legislation in Force Locally. Notification of Zymotic Enteritis. The council resolved in 1924 to make zymotic enteritis or epidemic diarrhoea 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 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 rn respect of 10 breaches. Fines of 20s. in one case and of 10s. in 9 were imposed. < ' • The number of convictions under this by-law during the past 14 years is 118. 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 81 beds. The scheme when completed will provide an additional 57 beds, making a total of 138 beds, a nurses' home, a post-mortem and pathological department, administration offices, etc. The work performed at the hospital during 1935 was as follows:— In-patients. (a) General wards 1,463 (b) Private wards 271 Out-patients. Total number of new out-patients 13,295 „ „ „ out-patients' attendances 60,590 Number of casualties 5,371 Other treatments. Number of operations—major 1,056 minor 933—1,989 Dental cases 2,133 Massage 3,920 Light treatments 1.486 Superficial therapy 189 Actual patients X-rayd 2,971 Ante-natal clinic and maternity ward. Total number of attendances 1,602 Number of patients admitted to maternity ward 298 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. 14 There are X-ray, dental, ophthalmic and massage departments and a fully equipped operating theatre. The beds are allocated as follows:— General medical 39 Skin 1 General surgical 20 Observation ward 4 Ear, nose and throat 9 Private ward 2 Rheumatism 4 Nursing mothers' ward 1 Eye 1 — Total 81 The following are figures of work done during 1935. (a) In-patients. Total number of available beds on 31st December, 1935 81 Average number of available beds during year 76.35 Average number of patients resident daily throughout year 64.57 Number of in-patients in the hospital at beginning of year 56 Number of in-patients admitted during year 1,360 Number of in-patients in the hospital at end of year 60 Average number of days each patient was resident 17.38 Number of patients admitted and discharged during year who were resident for (i) only 1 day 17 (ii) 2 and 3 days 420 (b) Out-patients. Total number of new out-patients 5,284 Total number of out-patients' attendances 47,210 Number of casualty patients among new out-patients 1,644 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 1935 is as follows:— Number of sessions held 48 Number of individual patients examined— Kensington 290 Hammersmith 41 Other boroughs 37 Total attendances of patients— Kensington 1,064 Hammersmith 145 Other boroughs 129 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 there during 1935 was as follows:— New cases. Total attendances. Eye cases 349 978 Aural cases 342 635 Minor ailment cases 1,463 14,982 Dental cases 1,190 1,989 A school treatment centre has also been established at the Baby Clinic premises in Tavistock Road, and the record of work for 1935 is as follows:— New cases. Total attendances. Minor ailment cases 8,396 23,106 Dental cases 1,809 3,724 Light treatment 88 1,799 In addition there is a school treatment centre at the Princess Louise Kensington Hospital for Children, and the particulars of the cases treated there during 1935 are as follows:— Tonsils and adenoids 237 Eyes (new cases) 423 Dental cases 614 X-ray cases 7 15 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 1935 in Kensington. Table showing number examined and defects found. Number examined Boys. Girls. Entrants. 690 Age 7. 561 Age 11. 668 Age 14. 675 Entrants. 746 Age 7. 531 Age 11. 622 Age 14. 739 Cases. • Cases. • Cases. • Cases. * Cases. • Cases. * Cases. • Cases. • Malnutrition 13 5 23 11 15 4 4 2 9 6 10 7 11 6 9 6 Skin disease 11 7 8 6 7 3 2 1 3 1 5 4 1 1 4 3 Defective teeth — 249 — 145 — 197 — 214 — 296 — 141 — 152 — 228 Enlarged tonsils 93 16 63 13 35 4 23 3 119 12 44 9 39 7 38 6 Adenoids 13 8 3 3 4 3 1 — 13 6 4 3 2 2 1 — Enlarged tonsils and adenoids 26 21 7 6 14 10 2 2 21 14 8 4 3 2 1 1 Other nose and throat defects 9 1 6 2 2 — 4 2 13 5 7 5 5 1 5 2 Enlarged glands 92 5 83 1 93 3 65 1 93 5 50 3 59 — 53 1 Eye disease 28 22 13 1 10 2 10 — 29 11 17 4 19 6 13 4 Vision defects — — — 40 — 58 — 81 — — — 39 — 64 — 100 Otorrhoea 13 3 6 2 6 1 4 2 16 4 8 2 13 1 6 3 Other ear disease 4 1 2 1 3 — 3 — 4 — 1 — 1 1 2 — Defective hearing — — 2 2 1 — 1 — 2 1 1 — 2 — 1 — Speech defects 3 1 5 3 3 — 3 1 2 — 3 — 1 — 1 — Heart defects 21 2 11 3 16 — 11 — 17 — 6 2 21 — 18 1 Anaemia 10 2 21 3 15 2 10 1 14 4 7 2 10 1 14 1 Lung defects 31 10 6 3 6 — 4 1 31 4 8 1 9 — 3 — Nervous defects 8 1 9 2 8 1 6 1 5 — 5 1 3 — 5 — Phthisis — — — — 1 — — — — \— — — 3 — — — Other T.B. disease 2 — — — — — — — — — — — — — — — Rickets 13 — 6 1 3 — 1 — 10 — 2 — 4 1 — — Spinal deformities — — 4 2 8 3 10 7 1 — 3 2 10 4 11 4 Other deformities 13 2 19 3 15 1 22 — 12 — 14 2 26 1 25 3 Other defects 27 10 16 8 25 7 16 7 41 18 15 5 29 6 28 8 Number of children noted for treatment 311 218 263 289 345 202 229 327 * 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 Bovs 690 197 480 13 119 541 30 — 690 — — 687 3 — 394 187 109 — — — Girls 746 228 509 9 138 576 32 — 732 13 1 743 3 — 392 191 163 — — — Age 7. Boys 561 177 376 8 83 413 65 — 551 10 — 555 6 — 368 153 40 227 246 80 Girls 531 183 340 8 96 401 33 1 506 16 9 526 5 — 357 124 50 261 186 74 Age 11. Boys 668 198 465 5 107 510 50 1 660 7 1 660 8 — 445 198 25 427 151 90 Girls 622 251 369 2 123 462 37 — 596 23 3 606 15 1 455 149 18 366 150 102 Age 14. Boys 675 184 486 5 201 441 32 1 669 5 1 671 3 1 459 196 20 465 107 102 Girls 739 280 457 2 188 524 27 — 727 12 — 734 5 — 515 203 21 444 169 118 Total 5,232 1,698 3,482 52 1,055 3,868 306 3 5,131 86 15 5,182 48 2 3,385 1,401 446 2,190 1,009 566 Percentage 32.5 66.5 1.0 20.2 73.9 5.9 98.1 1.6 0.3 99.1 0.9 0.0 64.7 26.8 8.5 58.2 26.8 15.0 London 54.2 45.3 0.5 17.4 76.9 5.7 97.2 2.5 0.3 99.0 0.9 0.1 68.9 27.0 4.1 66.4 19.0 14.6 16 Vaccination. There were 2,352 births in 1934 reported to the vaccination officer. By the 31st December, 1935, 67.5 per cent. of these had been vaccinated. The other 32.5 per cent, are accounted for as follows Statutory declarations of objection 15 per cent. Died before vaccination 5 ,, Referred to other boroughs 7 ,, Removed, leaving no trace5 ,, Unaccounted for 0.5 ,, In view of the fact that throughout the country generally only about 37 per cent, of the children born are vaccinated, the Kensington return must be regarded as highly satisfactory. Only 15.5 per cent, of the children born in Kensington in 1934 remain in the borough unvaccinated. Whilst this percentage of vaccinations is maintained at such a high level, the immunity from smallpox in Kensington should remain at a correspondingly high standard. A record of the work of the vaccination officer will be found in Appendix II, Table VI. Health Propaganda. Health propaganda work, as in past years, was conducted by the council's health lecturer at the infant welfare centres and the baby clinic. Lectures were also given at two of the nursery schools in the borough, the Lancaster Road Fathers' Council, girl guide and boy scout groups, the First Feathers Club, and to other organisations. The subject of the health lecturer's talks to most of the organisations has been the council's maternity and child welfare services. In April and May, 1935, there was a fall in the number of children being immunised against diphtheria by the general medical practitioners in the borough, and this was particularly noticeable in regard to school-children. It was felt that if it were possible to obtain the interest of the head teachers, they would be able to assist materially in the council's immunisation scheme. A conference of the head teachers was arranged at the town hall, when His Worship the Mayor took the chair and the medical officer of health explained the council's scheme to the 40 teachers present. Dr. Guy Bousfield, the council's schick testing consultant, showed a film called " The Empty Bed," which deals with diphtheria immunisation. The meeting was a great success and revealed a warm desire for close co-operation. The film impressed the teachers enormously, and they unanimously passed a resolution indicating they were in favour of its being shown to parents, and willingly consented to arrange the distribution of leaflets dealing with the subject. Over 13,000 leaflets were distributed throughout the schools in the borough. A committee of head teachers and representatives of the public health department was formed, and a series of lectures and film displays was arranged for 1936. Following the head teachers' conference, the council purchased a film projector and a copy of the film prepared by Dr. Bousfield. The film was shown in alternate weeks at all the infant welfare centres and the baby clinic. In addition, other films on health subjects, which were lent to the council, were shown at these institutions. The diphtheria film was also shown at many other institutions. It is satisfacory to record that the parents showed a considerable interest in the film and that as a result the number of children immunised against diphtheria showed a steady increase. Early in the year the maternity and child welfare committee decided to advertise the council's maternity and child welfare services, and permission was obtained from the London county council to use the empire marketing board advertisement frames at the Fox school and the Lancaster Road school for the months of June, July and August. Suitable posters were exhibited on these frames and on the empire marketing board frame outside the Kensington barracks, giving the days and times of the consultations at the infant welfare centres, together with information in regard to other maternity and child welfare services. On her first visit to a home after the birth of a child the health visitor delivers a small booklet of about 20 pages entitled " Advice to Mothers," which deals with domestic and personal hygiene and other matters of importance to the young mother. There is also in the public health department a series of leaflets on health questions which are distributed by the staff during their home visits. A record of the work of the health lecturer will be found on page 32. Subscriptions by the Borough Council to Voluntary Health Organisations during 1935. Subscriptions to Hospitals, etc. £ s. d. £ s. d. Cancer Hospital 5 5 0 Paddington Green Children's Hospital Charity Organisation Society 5 0 0 5 5 0 Chelsea Hospital for Women 5 5 0 Princess Beatrice Hospital 10 10 0 Invalid Children's Aid Association 35 0 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 Kensal Gospel and Medical Mission 5 5 0 Kensington District Nursing Association 5 5 0 St. Mary's Hospital 10 10 0 West London Hospital 10 10 0 National Hospital for Diseases of the Heart 5 5 0 Western Ophthalmic Hospital 5 5 0 17 Payments to Maternity and Child Welfare Institutions. £ s. d. £ s. d. Bramley Road Infant Welfare Queen Charlotte's Hospital (Maternity Home) 1,368 18 0 Centre 351 11 8 Campden Hill Infant Welfare Centre 240 0 0 Aston Clinton Convalescent Home 22 15 0 Golborne Infant Welfare Centre 601 13 4 Evelyn Convalescent Home 16 16 0 Kenley Street Infant Welfare Centre 308 15 0 Hambledon Convalescent Home 8 8 0 Littlestone Convalescent Home 9 0 Lancaster Road Infant Welfare Centre 692 14 8 Ranyard Mission Convalescent Home 6 6 0 Raymede Infant Welfare Centre 404 7 0 Wayside Cottage Convalescent Home 70 19 9 South Kensington Infant Welfare Centre 406 14 0 Association of Infant Welfare and Maternity Centres 8 8 0 Golborne Day Nursery 197 0 0 Lancaster Road Day Nursery 323 0 0 Kensington District Nursing Association 325 0 0 St. Clement's Day Nursery 291 0 0 Notting Hill Day Nursery 492 10 0 Kensington Rescue Association 10 0 0 Baby Clinic 669 14 6 Mutual Registration of Assistance Society 10 0 0 Baby Hospital 1,495 10 0 Princess Louise Hospital 400 0 0 North Kensington Women's Welfare Centre (Gynaecological Clinic) 50 0 0 Queen Charlotte's Hospital AnteNatal Clinic 45 0 0 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 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 747, making a total of 4,766 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 113. Refuse Removal from Mewsways. Portable containers have been substituted for common dustbins for the storage of house refuse where there are dwellings, stables, and costermongers' stores, and these are proving satisfactory both from a storage and collection point of view. 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 354 89 Plans approved by the council 354 89 Total reconstruction of drains of premises 59 47 Partial reconstruction of drains of premises 188 103 Repairs to drains by " Economic Method" 15 27 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 4,346 1,769 18 Sanitary Inspection. The following table shows a summary of the inspections, etc., carried out by the male sanitary and housing inspectors during the year:— DESCRIPTION OF WORK. NUMBER OF DISTRICT. Housing Inspectors. Total 1 2 3 4 5 6 7 8 Total complaints received 164 477 508 305 308 206 176 311 59 2,514 Public Health (London) Act, 1891. Complaints received 82 248 132 277 267 182 175 264 13 1,640 Houses inspected on complaint 82 250 132 277 267 182 197 285 13 1,685 ,, after infectious disease 153 313 345 132 47 33 56 73 1,152 Re-inspections 2,774 722 875 2,481 1,776 2,076 1,032 2,578 18 14,332 By-Laws re houses let in lodgings. Complaints received 82 229 376 28 41 24 1 47 46 874 Houses inspected on complaint 82 229 376 28 41 24 1 47 46 874 First annual inspection (furnished houses) 29 5 1 3 1 — — — 39 Re-inspections do. do. — — — — — 6 — — — 6 First annual inspection (unfurnished houses) 50 107 19 15 47 44 6 49 257 594 Re-inspections do. do. 1,304 3,311 1,245 221 318 204 11 100 25 6,739 Housing Act, 1925. Initial inspections (including preparation or revision of house-tohouse card) 744 295 119 81 222 184 24 71 257 1,997 Re-inspections 298 598 349 239 70 5 6 52 5,670 7,287 Underground living rooms. Primary inspections 63 39 66 54 40 1 — 26 39 328 Re-inspections 71 4 186 83 12 — — 50 786 1,192 Drainage. House drains tested and inspected 204 47 57 424 45 113 59 86 185 1,220 Voluntary drainage work. Applications made 25 6 23 72 118 137 144 212 — 737 Plans submitted 5 5 21 25 59 72 89 117 50 443 Inspections of mews 288 358 99 15 38 181 209 42 7 1,237 „ canal boats 6 — — — — — — — — 6 „ common lodging houses — — 67 — — — — — 67 Smoke observations 17 — — — — 2 9 — — 28 Other inspections 545 448 338 468 767 170 478 505 119 3,838 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc., found in the various districts during the year:— NUMBER OF DISTRICT. Housing Inspec. tors. Total 1 2 3 4 5 6 7 8 Notices issued. Public Health (London) Aet, 1891. Intimation notices 150 519 257 176 158 240 77 165 33 1,775 Statutory notices 34 152 35 22 39 62 9 35 1 389 Final notices 7 37 7 10 4 8 — 6 — 79 Summonses issued — — — 2 2 5 — 1 11 21 Housing Acts, 1925 and 1980. Sect. 17 (1930) (Repairs) 3 6 10 8 5 — — — 257 289 Sect. 6 (Bye-laws) — — — — 2 — — — — 2 Sect. 127 (1925) (Entry) 35 74 31 18 11 — — — 961 1,130 Underground room habitation — — — — — — — — 10 10 Removal of manure 3 5 8 — 1 2 — 1 — 20 Smoke nuisance orders — — — — — — — — — — Rent Restrictions Act certificates — — — — — — — — — — Other notices 27 79 16 29 2 1 — 2 13 169 Report of waste of water to M.W.B. 12 16 15 19 4 1 13 2 13 95 „ dangerous structures to L.C.C. 5 8 10 16 2 — 1 — 31 73 19 Summary of works completed under the supervision of the sanitary and housing inspectors during the year:— DESCRIPTION OF WORK. NUMBER OF DISTRICT. Housing Inspectors. Total 1 2 3 4 5 6 7 8 House drains reconstructed 4 1 17 25 6 9 15 23 6 106 ,, ,, additions to 7 6 10 23 13 18 2 26 85 190 Defective drains repaired 7 3 4 26 20 25 19 25 15 143 House drains cleansed 26 8 37 23 23 11 22 10 22 182 Water-closets reconstructed 5 4 21 24 23 58 30 137 65 367 „ repaired 22 7 7 11 32 18 10 9 26 142 „ new provided 20 31 33 16 55 56 48 113 85 447 „ supplied with water 11 8 1 1 34 35 5 198 85 378 Soil pipes ventilated, repaired, &c. 4 5 5 13 17 36 25 47 12 164 ,, new provided 12 13 20 13 25 23 7 37 85 235 Ventilating pipes, new provided 9 10 18 22 11 10 12 24 85 201 Baths, new provided 7 1 20 31 99 97 86 260 — 601 Sinks, „ „ 51 164 67 34 66 79 32 124 497 1,114 Bidets, ,, ,, — — — — 1 1 6 63 — 71 Lavatory basins, new provided 12 2 29 35 307 279 360 800 — 1,824 Waste pipes ,, ,, 24 62 27 40 73 98 19 129 497 969 Cisterns cleansed 3 3 — 4 7 3 5 4 16 45 „ covered 2 5 — 3 3 — 3 4 12 32 „ abolished 1 —— 1 — 1 — 1 — 27 31 Taps fixed on rising main 9 50 — 18 1 — — 3 463 544 Yards, areas paved, drained, repaired 43 79 26 14 35 35 1 24 102 359 Dustbins provided 52 78 26 24 35 42 27 11 49 344 Ashpits abolished 2 — 1 — — — 1 — — 4 Accumulations of filth, &c., removed 30 53 33 18 29 17 17 6 54 257 Animals removed 13 5 3 — 1 — — — — 22 Overcrowding abated 2 6 4 — 1 — — — 65 78 Indecent occupation abated — 8 2 — 1 — — — 6 17 Underground rooms, illegal occupation discontinued — 3 2 — 2 — — 2 193 202 Roofs repaired 61 170 52 31 38 30 22 23 249 676 Houses provided with water above basement floor 10 64 — 1 — 1 — 3 — 79 Dampness in dwellings remedied ... 80 161 68 17 22 20 5 19 30 422 Ventilated food cupboards provided 39 129 8 1 2 — — — 506 685 Artificial lighting of staircases provided 2 — — 1 1 — — — 161 165 Closing Orders made under Housing Acts— (a) Houses — — — — — — — — — — (b) Parts of houses — 4 1 10 3 — — 2 — 20 (c) Underground rooms — — — — — — — — — — Closing Orders determined — — — — — — — — 30 30 Repairs of houses completed under the Housing Acts, 1925 & 1930 3 10 8 3 2 169 195 Infectious disease cases removed 149 130 127 111 80 26 13 52 — 688 Houses disinfected after infectious diseases (including bedding, clothing, &c.) 217 181 162 113 117 75 15 117 — 997 Rooms in such houses disinfected after infectious disease 227 192 169 113 141 79 16 130 — 1,067 Houses cleansed under houses let in lodgings by-laws 110 219 89 19 27 40 — 27 169 700 Cleansing of houses not on register 33 12 6 6 26 15 2 3 — 103 Verminous houses cleansed (including bedding, clothing, &c.) 98 138 57 50 29 23 7 37 88 527 Verminous rooms cleansed in such houses 260 226 88 68 41 29 7 45 185 949 Dirty bedding cleansed 126 132 30 9 7 18 — 38 — 360 „ „ destroyed 6 2 11 5 4 2 — 1 — 31 Other sanitary works executed 295 279 133 2 186 60 — 17 169 1,141 The Shops Act, 1934. This act came into operation on the 31st December, 1934, and requires a closer supervision of all shops than has hitherto been the case. The administration of the act is shared in London between the county council and the metropolitan borough councils, the duty of the latter being limited to the enforcement in all shops of:— (a) suitable and sufficient means of ventilation; (b) „ ,, ,, ,, maintaining a reasonable temperature; (c) „ ,, ,, w.c. accommodation. In order to give effect to the new legislation in Kensington, it was decided to make a complete survey of all shops in the borough and to prepare a card index record on the lines of the one existing in regard to dwelling houses. By the end of the year, 1,245 shops had been inspected and 401 notices served. The following is a summary of the works which have been required:— Provision of additional water closet accommodation 88 Provision of lighting and ventilation to existing water closets 68 Repair of existing water closets 133 Provision of suitable and sufficient means of ventilation to the shop 55 Provision of suitable and sufficient means of maintaining a reasonable temperature in the shop 15 Section 10 (6) of the act provides that a local authority may grant a certificate exempting a shop from the provision of suitable and sufficient water closet accommodation if they are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable that such a certificate should be in force and that suitable and sufficient sanitary accommodation is otherwise conveniently available. Exemption certificates were granted in 35 cases, but in one instance the shop was vacated and the certificate subsequently withdrawn. Shortly after the act came into operation, the council considered the question as to what should be regarded as suitable and sufficient sanitary accommodation where persons of both sexes are employed. It was decided that in those shops where members of both sexes are employed, separate sanitary conveniences for each sex should be required if the number of employees exceeds four; but that if the number is less than four, one sanitary convenience should be regarded as suitable and sufficient, provided that the door of such convenience is fitted with a proper lock or fastener on the internal side and an automatic indicator showing on the external side of the door whether the apartment is engaged or vacant. Where during the course of the inspections under the Shops Act any infringements or contraventions under the Public Health (London) Act, 1891, were observed, the additional requirements were included on the notices served. The following is a summary of the works required in shops under the Public Health (London) Act, 1891:— Drains cleansed 1 Soil pipes, ventilated, repaired 3 Waste pipes, new provided 11 Yards and areas paved, drained, repaired 7 Dustbins provide 2 Accumulations of filth removed 12 Roofs repaired 4 Cleansing 111 20 Summary of Legal Proceedings taken in 1935. Offence. No. of summonses. Magistrate's decision. Failure to carry out sanitary repairs 7 Orders made requiring works to be carried out within 14 days in four cases and within 7 days in one case; fined 5s. and order for work to be carried out within 14 days in one case; fined 40s. and order made for work to be carried out in one case. Failure to comply with by-laws for houses let in lodgings. 4 Fined £1 in four cases. Breach of by-laws of L.C.C. with respect to the removal of offensive matter. 60 Fined £2 in two cases; fined £1 in two cases; fined 10s. in 17 cases; fined 5s. in two cases; in 28 cases, fines amounting to £2410s. were imposed; summons dismissed in 8 cases; and one summons not served. Failure to abate overcrowding 4 Fined £5 in one case; summons dismissed in one case; summons adjourned sine die in two cases. Occupation of underground rooms contrary to closing orders. 8 Fined £1 in one case; fined 10s. in one case; fined 5s. in two cases; fined 2s. 6d. in two cases; summons dismissed in one case and adjourned sine die in one case. Failure to comply with the L.C.C. bylaws in connection with drainage work 8 Fined £1 in two cases; summons withdrawn, works having been carried out, in six cases. Allowing dog to deposit its excrement on the public footway. 10 Fined £1 in one case; fined 10s. in nine cases. Total 101 21 Smoke Abatement. During the year the council's sanitary inspectors made 61 special observations with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. Seven nuisances were discovered. As the primary action taken by the sanitary inspectors resulted in the abatement of the nuisance in three cases, written intimation notices were not served ; in four cases the service of written intimation notices was necessary. Mortuary and Chapel of Rest. During the year 218 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 21 At the request of undertakers 49 At the request of coroner 130 By the police 18 218 In 121 cases, post-mortem examinations were made under the coroner's warrant. Sixteen bodies were deposited in the chapel of rest, Avondale Park. The council bad hoped that this building would prove to be of considerable value to 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 funeral. In recent years the building has been redecorated and the furnishings have been greatly improved, with a view to encouraging people to make more use of the chapel, which is Situated so conveniently for a large number of poor residents. It seems unfortunate that in the past 12 months only 16 bodies were deposited there. 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 slinner 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. 1931 218,158 1932 232,384 1933 235,860 1934 249,606 1935 218,449 In the wash-house or laundry department, there were 88 wash-tubs m use m 1935. The number of women usmg the wash-tubs in the last five years is shown in the following table:— Year. Washers. 1931 90,066 1932 89,766 1933 82,715 1934 79,686 1935 73,843 There are 8 washing machmes, and the number of women using these machines in 1935 was 18,200. 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. All the samples were in accordance with the requirements of the Rag Flock Acts. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-33. One application was made to the council in 1935 for a certificate of fitness for habitation under the acts, and this was not 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 the portion of the Grand Junction Canal which is within the boundaries of the borough. During 1935, the canal-boats inspector made six inspections. No notices were served in respect of the sanitary condition of the boats. No births or deaths occurred on boats whilst lying at the wharves in Kensington, and no cases of infectious disease were reported. 22 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 67 years of age who lived alone in two ground floor rooms. She appeared somewhat eccentric and, owing to trouble with her legs, could move about only with difficulty. Her rooms were dirty and she was not able to keep them clean. She was removed to St. Mary Abbots Hospital (Institution) and after she had been there for three months, application was made to the magistrates for her to be detained for a further period of three months ; this was granted. Subsequently she died in the institution. The second case was that of a woman of 93 years, who occupied a front upper room. She was very shaky, and extremely dirty and neglected ; she suffered from a chronic cough and was unable to give herself proper care and attention. Her room was very insanitary, and her bedclothes, which consisted of old coats, were unclean. An order for her removal to hospital was obtained, and she remained there until her death. The third case was that of a woman of 88 years, who lived alone in a first floor front room. The room was dirty and verminous, and the woman was unable to look after herself or keep her room in a habitable condition. An order was obtained for her removal to St. Mary Abbots Hospital (Institution) in October, and she died shortly after admission. 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 2,014 Number of poison baits laid during the year 70,400 „ „ disappeared 66,350 ,, ,, removed by the rat officer 4,050 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 15 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 51 Number of sewer defects allowing egress of rats made good 4 Number of statutory notices served under the Rats and Mice (Destruction) Act, 1919 - Number of premises cleared of rats 162 During the National Rat Week, held in November, special measures of rat destruction were put in hand in the borough council sewers, at the borough council depots and on railway and canal property in the borough. 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. For some time past the destruction of pigeons in the borough has been rendered more difficult because a number of residents habitually feed the birds, thus making trapping more difficult. This aspect of the problem was considered by the public health committee, and on their recommendation the council, in the latter part of 1934, asked the metropolitan boroughs standing joint committee to consider whether any legislation could be obtained which would enable a local authority to take action against any persons feeding wild pigeons after notice had been given by the local authority that such feeding was resulting in a nuisance to the residents in the vicinity. The standing joint committee considered this representation, but decided to take no action thereon as they were of the opinion that any powers acquired for this purpose would be difficult to enforce, and probably ineffective in result. In the latter part of 1935 the council decided to reaffirm their opinion that the local authority should have powers to take action against persons feeding wild pigeons after a warning had been given. During the year 1935, 129 pigeons were killed and 97 eggs destroyed. Since June, 1928, when the council first took action under this section, 1,852 pigeons have been destroyed. 23 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 20 57 77 Basket makers 1 - 1 Blacksmiths 3 1 4 Blind makers 1 - 1 Boot makers and repairers 31 51 82 Builders 58 11 69 Cabinet makers 11 4 15 Cigarette makers - - - Coach builders 1 6 7 Coal wharves 2 - 2 Cooked meat dealers - - - Cycle repairers 3 1 4 Dry cleaners 1 15 16 Dyers - 1 1 Electricity generating stations - 3 3 Electric light fitting makers 4 5 9 Firewood choppers 1 2 3 Furriers 1 8 9 Gas works - 2 2 Ice cream manufacturers - 1 1 Instrument makers - 3 3 Ironmongers 2 - 2 Ladder makers 1 1 2 Lampshade makers - 2 2 Laundries 1 22 23 Marine stores 7 - 7 Masons 6 1 7 Metal workers 5 2 7 Motor engineers and garages 17 50 67 Motor spirit dealers 5 - 5 Photographers 1 - 1 Piano makers - 1 1 Picture frame makers 3 1 4 Pipe makers - 1 1 Printers 2 19 21 Saddlers 1 - 1 Sausage makers - 21 21 Sign writers 2 1 3 Steam pressers 2 - 2 Sundry businesses 38 35 73 Sweet manufacturers - - - Tailors 76 9 85 Timber merchants 1 - 1 Trunk makers 3 - 3 Undertakers 5 3 8 Upholsterers 22 3 25 Washing machine manufacturers - 1 1 Watch makers 9 2 11 Wax figure manufacturers 1 1 2 Wheelwrights - 1 1 Total 348 350 698 24 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 3 2 5 Blind makers 1 — 1 Blouse makers 1 — 1 Boot makers and repairers 2 — 2 Corset makers 9 — 9 Dressmakers and ladies' tailors 253 8 261 Dry cleaners 4 8 12 Dyers 6 3 9 Eembroidery workers 1 — 1 Florists 11 — 11 Furriers 18 5 23 Hairdressers 11 — 11 Invisible menders 2 — 2 Jewellers 1 2 3 Knitted goods 1 — 1 Lace workers 2 — 2 Lampshade makers 3 — 3 Laundries 39 56 95 Milliners 40 — 40 Outfitters 25 — 25 Photographers 5 — 5 Picture frame makers 2 — 2 Restaurants 3 — 3 Sundry businesses 33 10 43 Toy makers 1 — 1 Umbrella makers 1 — 1 Upholsterers 10 — 10 Weavers 1 — 1 Totals 489 94 583 Home Work.—Of the 162 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 39 Outworkers in domestic workshops 10 Outworkers in their own homes 113 Total number of outworkers 162 The nature of the work given out to the 113 home workers on the register is as follows:— Tailoring 54 Dressmaking 31 Bootmaking 9 Outfitting 7 Drapery 2 Linen working 2 Fancy goods 3 Blouse making 2 Dyeing and cleaning 2 Umbrella making 1 113 25 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 130 „ workshop inspections 692 ,, home workers' inspections 323 „ workplace inspections 63 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) 1,117 99 — Workshops (including workshop laundries) 1,785 102 — Workplaces (other than outworkers' premises) 258 14 — Totals 3,160 215 — 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 115 95 - - Want of ventilation Overcrowding 8 4 7 4 - - Want of drainage of floors 3 3 - - Other nuisances 109 82 - - Sanitary accommodation:— Insufficient 7 4 - - Unsuitable or defective 188 146 - - Not separate for sexes 7 3 - - Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) - - - - Breach of special sanitary requirements for bakehouses (Ss. 97 to 100) - - - - Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) 7 4 3 - Totals 448 348 3 - III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. 26 MATERNITY AND CHILD WELFARE SERVICES. Under the council's scheme of maternity and child welfare, complete arrangements are made for the care of expectant and nursing mothers, and children up to five years of age. The scheme includes ante-natal and post-natal clinics, infant consultation sessions, day nurseries, a maternity home, a municipal midwife, the provision of an obstetric consultant for difficult confinements, hospital and convalescent treatment for mothers and young children, home nursing and home helps, arrangements for the boarding-out of children while the mother is in hospital, facilities for the skilled nursing and treatment of cases of puerperal sepsis, and the supply of free milk, dinners and cod liver oil or its equivalent to necessitous cases. During the year the council inaugurated a further scheme for the provision of free dentures for necessitous expectant and nursing mothers. These dentures are supplied at the dental clinics attached to the infant welfare institutions, and the cost of the scheme to the council during 1935 was £203 5s. 10d. The year has been one of considerable expansion in the existing services due to the awakening response of public opinion to the council's propaganda and to the spreading knowledge and appreciation of the facilities offered by the council's health services. The increase in the antenatal work performed in the borough since the council's whole-time medical officer, who was appointed in 1934, has been in charge of the clinics is now apparent. In 1934, the number of individual mothers attending the ante-natal sessions was 692, the total attendances being 2,345 ; the corresponding figures for 1935 are 1,120 and 4,402. It has been necessary to increase the number of ante-natal sessions from 237 in 1934 to 393 in 1935 ; the establishment of a post-natal clinic is an important addition to the service. The popularity of the ante-natal clinics proves more than the wisdom of the council's policy in appointing a whole-time officer to work under the direction of the medical officer of health—it proves the appreciation of the value of the borough ante-natal clinic by the expectant mothers. The latter come voluntarily for advice and education in health and in the upbringing of their children and not to book for confinement. One may claim that the educational side of the health services has made very considerable progress of late years, and in no direction is this more evident than in the ante-natal clinic. With every year the latter widens the scope of its teaching : the preparation for the infant's arrival, hygiene, dietetics, dental treatment, the removal of any septic focus, the treatment of anaemia and malnutrition and, perhaps as important as any of these, the mental treatment of the patient—the removal of those fears of child birth which are present in most young expectant mothers, and their change into a glad expectancy of the coming baby with entire confidence in the normality of the confinement. The high rate of infant mortality in the borough in 1934 determined the council to appoint two whole-time medical officers to conduct the infant consultation sessions in place of the fourteen parttime doctors previously engaged on this work, and in May, 1935, Dr. Helen Buck and Dr. Hilda Davis were appointed to the council's whole-time staff. The attention of these medical officers has been specially directed towards improving the nutrition and consequent resistance to disease of the children attending the welfare centres by attention to diet and education in the simple rules of health. The true function of the clinics as centres of preventive medicine is now established and no medical treatment is carried out, cases in need of such treatment being referred to their own doctors or to hospitals. In this way, the risk of a spread of infection to other children from ill babies brought to the centres is removed and the medical officers are able to concentrate upon their teaching on the maintenance and improvement of health in each infant, which one hopes will cause a definite rise in the general standard of health in Kensington children within the next few years. In order to come into line with the council's scheme, the committee of the baby clinic and hospital have resolved to use the clinic at No. 92, Tavistock Road, as a treatment centre only, to which infants from all the welfare institutions in the borough may be referred, and to send all healthy children attending the clinic to their own welfare centres. This arrangement is proving most satisfactory, and the council's medical officers are receiving very great assistance in their work from the co-operation of the medical staff of the baby clinic and hospital whom they meet in consultation every week. The co-ordination of the various services connected with infant welfare has notably improved since the appointment of the whole-time staff and the council's officers are in frequent communication with the local doctors whose patients attend the clinics and with the hospitals to which any of the children are referred. Very great attention is paid to the quality of the work performed in the clinics and careful and complete examinations are made at regular intervals of every child attending the centre. A certain amount of malnutrition and rickets was evident in a number of the children attending the welfare institutions, and in order to facilitate the treatment of these conditions and to prevent their develop ment in other cases, the council have provided for the free supply of cod liver oil or its equivalent in necessitous cases. The supply of free milk has also been greatly increased. Particular attention is paid by the medical staff to securing early remedial treatment for any orthopaedic deformities found in the children attending the centres. Owing to the time occupied by a thorough examination of each new case and the desire for the advice of the medical officers by an increasing number of mothers, the time taken up by each infant consultation session has greatly increased since the whole-time medical officers were appointed, and at some of the centres the sessions have lasted more than four hours. This is inconvenient for the mothers as well as tiring for the staff, and at the request of the advisory committee, which is composed of representatives of the voluntary committees of the centres, the council have decided to appoint a fourth whole-time medical officer to assist in the maternity and child welfare work in the borough ; this will permit of the establishment of the extra sessions which are needed. In addition to the measures which the council have taken to improve the health of the children in the borough, great attention has been paid to the methods by which the nutrition of the expectant mothers might be improved. Two comprehensive reports on nutrition have been considered by the 27 maternity and child welfare committee and the diet of the poorer expectant mother has been studied with regard to its sufficiency in the essential elements necessary to maintain good health. It was concluded that a perfectly balanced diet should result in improved maternal health at the time of the confinement with a reduction in puerperal sepsis, less subsequent debility and a decrease in the number of artificially fed infants, whilst the physique of the child was likely to be improved and its resistance to rickets and other diseases and infections increased. The various elements in an average diet were discussed and it was decided to supplement the free milk already granted to necessitous expectant mothers by an adequate supply of capsules of a vitamin A and D preparation and of iron when this appears to the medical officers to be desirable. In April, 1935, at the request of the Raymede centre committee, the council assumed financial responsibility and control of the Sutton Trust infant welfare centre which had become too large to be carried on as a branch centre. This arrangement, which was in the first instance a temporary one, was made permanent at the end of nine months as no voluntary committee was formed to undertake the financial administration of the centre. Fortunately, the municipal control of this centre does not entail any severance from the voluntary assistance for which Kensington has always been noted as, although the council will be responsible for the administrative control of the centre, a voluntary committee has been formed, the members of which are assisting at the sessions and continuing to supply the social side of the maternity and child welfare work which is of such great value. The premises which were originally occupied by the Sutton Trust centre having become inadequate for the increasing number of mothers and children attending the sessions, an arrangement has been made by the council by which new and satisfactory accommodation for the infant welfare centre has been obtained in the new community centre building which will very shortly be ready for occupation. Towards the end of 1934, Mrs. Sidney Brown generously presented the freehold premises of No. 28b, Archer Street, and No. 10, Redcliffe Street to the borough council for use in their maternity and child welfare scheme. The former premises are now being employed for ante-natal, postnatal and schick-testing clinics. They also serve as the headquarters of the medical officers engaged in the maternity and child welfare work in the borough, and patients needing advice in cases of emergency can be seen here any day. The premises are convenient of access to all parts of the borough and are proving most suitable for the purposes for which they are employed. The South Kensington infant welfare centre has been transferred to No. 10, Redcliffe Street, from No. 5, Warwick Road, and the new premises are proving much more commodious and better suited to their purpose than the former headquarters of the centre. Midwifery Arrangements. The maternity arrangements in the borough form a comprehensive scheme whereby complete facilities are provided for both hospital and domiciliary care, and every woman is able to obtain the services of a trained midwife at her confinement irrespective of her financial means. Ante-Natal Services. The co-ordinating mechanism of the council's scheme is the ante-natal clinic through which the patient is brought into touch with those services which would be of benefit to her. It is becoming the routine for expectant mothers in Kensington to attend one of the nine ante-natal clinics in the borough at the first sign of pregnancy, and this is a most desirable development. The evening clinic renders it possible for any patient to be under regular ante-natal supervision whilst she is still at work. Education can thus be started at the earliest possible moment and the patient is assisted by expert advice in making the best arrangements for her confinement. Each case is considered on its merits, and a private doctor, midwife, voluntary or London county council hospital or the borough maternity home is recommended according to the circumstances; the only factor considered is the welfare of the patient. The value of this advice by an unbiassed expert, who is assisted by a report on the home conditions, is obvious and the spirit in which the ante-natal service is conducted is becoming appreciated by the local doctors, midwives and hospitals. The co-operation between all of these and the clinics is steadily becoming closer and more harmonious. Hospital Accommodation. The borough council maternity home at Invermead has had a record year with regard to the number of admissions and is increasingly popular with the patients, many of whom are returning to the home for their second confinements. Many women have been admitted to the maternity wards of St. Mary Abbots Hospital and the Princess Beatrice Hospital, which are situated within the borough, and others have been delivered in Queen Charlotte's Hospital, St. Mary's Hospital, St. George's Hospital and other maternity institutions. The borough is well served in respect of easily accessible hospital accommodation, and no difficulty has ever been experienced in securing admission of any patient when this is desirable. Both voluntary and London county council hospitals have co-operated with the borough ante-natal clinics in allowing their patients to be supervised by the ante-natal medical officer, thus sparing these women the long journey to hospital and subsequent wait in a crowded out-patient department, and this is much appreciated by the patients. Ready and helpful assistance in ante-natal treatment has been given by the obstetric staff of Queen Charlotte's Hospital and St. Mary's Hospital whenever requested by the ante-natal medical officer, and the gynaecological clinic at the North Kensington Women's Welfare Centre in Telford Road has proved a most useful ancillary service in the cure of septic conditions before the confinement. 28 Domiciliary Midwifery. The trend of obstetric opinion has tended of late to favour domiciliary midwifery in normal cases, and the council have paid considerable attention to this important subject during the year, with the result that the facilities for confinement at home are now complete, irrespective of the patient's financial means. For patients in comfortable circumstances, the borough is fortunate in its doctors and midwives; skilful obstetric care has been given by Kensington practitioners to patients referred to them from the clinics and the Kensington morbidity rate is low. A panel of private midwives has been formed in North Kensington, who work in co-operation with the borough ante-natal centres, a small subsidy being paid on each case they send to an ante-natal clinic. In addition, the council have decided to pay a sum in compensation to any Kensington midwife whose patient may be referred to hospital by the ante-natal medical officer, so that the fear of a loss of fee will not prevent a midwife from sending her patient for advice. On two occasions during the year it has happened that a midwife's case has needed an anaesthetic for the rectification of a malpresentation during pregnancy for which it was impracticable to obtain the services of a private doctor. In these cases the necessary treatment has been carried out at Queen Charlotte's Hospital, the patient subsequently returning home for a normal confinement and the midwife retaining her case. This linking together of the midwife with the most suitable hospital for each individual case through the medium of the ante-natal clinic, thus forming a complete and co-ordinated midwifery service in the borough, is one of the reasons for the success of the council's ante-natal scheme. Kensington is especially fortunate in that its northern area is served by the maternity district of Queen Charlotte's Hospital, whose midwives attend a large number of women in their own homes and are always ready to attend necessitous cases for a nominal fee or free of charge. The high standard of work of this hospital is of considerable value in keeping down the morbidity rate in the borough. In South Kensington, where the facilities for domiciliary midwifery were insufficient for patients in poor financial circumstances, the council have appointed a whole-time midwife and grant a remission of her fees in necessitous cases. The services of the municipal midwife are also available as a maternity nurse to any Kensington woman who has engaged a doctor for her confinement but cannot afford a nurse's fee in addition ; this should entirely eliminate the employment of the dangerous untrained handywoman and enable any woman, however poor, to have the services of a trained midwife at her confinement. Post-Natal Examination. Arrangements are now being made by the council's women health officers for every woman who does not receive a post-natal examination from her own doctor or midwife to attend the borough post-natal clinic for this purpose. This routine examination after confinement will ensure that treatment is arranged for any condition which may cause difficulty or danger in a subsequent pregnancy and it is hoped that invalidism will thereby be reduced. 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 1935 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) 89 148 328 364 246 233 88 174 1,670 Re-visits to infants (0-1 year) 134 399 564 635 857 992 224 403 4,208 Visits to children between 1 and 5 years 385 848 888 866 1,080 1,003 499 893 6,472 Still-birth enquiries 3 5 10 2 4 6 3 5 38 Visits to ophthalmia cases 2 2 7 2 6 5 — — 24 Return visits to ophthalmia cases 1 5 15 6 9 45 — — 81 Visits to measles cases 13 4 10 9 8 9 15 — 68 Visits to whooping cough cases 17 18 33 14 33 78 52 74 319 Visits to puerperal fever cases — 1 2 2 1 1 — — 7 Visits to puerperal pyrexia cases 3 2 9 12 1 2 2 — 31 Visits to enteritis cases 5 22 27 10 20 7 — — 91 Infantile death enquiries 9 18 25 23 24 21 10 13 143 Investigations re milk applications 310 163 631 621 408 360 141 41 2,675 Ante-natal visits 94 205 188 168 213 94 185 217 1,364 Half-days at welfare centres 104 149 146 116 150 102 67 152 986 Special visits 97 616 673 375 332 196 445 412 3,146 * 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. 29 Infant Welfare Centres. There are eight infant welfare centres; seven centres are conducted by voluntary institutions and one, namely, the Sutton Trust centre, is under municipal control. The work done at these institutions during 1935 is shown in the following table:— Particulars of work done. Bramley Road. Campden Hill. Golborne. Kenley Street. Lancaster Road. Raymede. South Kensington. Sutton Trust. Totals. 1. Number of births occurring in the area of the centre suitable for welfare attention 268 86 173 194 350 347 238 100 1,756 2. Number of sessions at which doctor attended for infant consultations 153 56 115 98 133 150 150 99 954 3. Number of sessions at which doctor attended for special ante-natal consultations 51 38 25 45 43 51 50 43 346 4. Total number of individual mothers who attended during the year 597 164 380 422 1,374 648 430 308 4,323 5. Number of individual mothers who attended ante-natal sessions during the year 137 51 59 156 167 183 140 90 983 6. Total number of individual children who attended during the year— 1. Children 0 to 1 year 396 113 196 282 556 439 279 177 2,438 2. ,, 1 to 5 years 232 83 260 224 473 419 237 236 2,164 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) 1,858 1,084 1,049 2,491 5,700 3,423 2,268 1,126 18,999 8. Total attendances at centre of children for all purposes— 1. Children 0 to 1 year 4,669 1,316 2,438 2,740 4,709 4,539 3,945 1,848 26,204 2. ,, 1 to 5 years 2,908 772 3,217 2,268 5,858 4,380 3,605 2,351 25,359 9. Total attendances at dinners (included in Nos. 7 and 8 above)— 1. Mothers — — — — 3,715 — — — 3,715 2. Children — — — — 1,575 — — — 1,575 10. Total attendances at doctors' consultations— 1. Ante-natal mothers 621 241 193 651 715 722 593 320 4,056 2. Post-natal mothers 242 69 268 257 69 200 410 168 1,683 3. Children 0 to 1 year 2,656 1,066 1,298 1,493 2,421 2,219 2,713 962 14,828 4. ,, 1 to 5 years 1,408 484 1,363 1,202 1,610 2,194 2,019 1,330 11,610 11. Average attendances at doctors' consultations— 1. Ante-natal mothers 12 6 7 15 16 14 11 7 11 2. Post-natal mothers 1 2 1 — 1 3 2 4 2 3. Children 0 to 1 year 17 22 11 15 18 14 18 10 15 4. „ 1 to 5 years 9 10 11 12 12 14 12 13 11 12. Number of individual children weighed during the year 625 196 456 506 1,029 856 510 390 4,568 13. Total weighings 7,206 2,359 5,342 5,001 8,808 8,687 6,738 4,190 48,331 14. Number of first visits paid to— 1. Expectant mothers 70 128 61 124 129 153 — 176 841 2. Children 0 to 1 year 5 867 4 32 356 — — 28 1,292 16. Total number of home visits paid to— 1. Expectant mothers 233 47 97 381 147 403 81 591 1,980 2. Children 0 to 1 year 952 309 443 1,128 1,167 878 806 936 6,619 3. „ 1 to 5 years 645 425 434 1,232 742 940 825 1,625 6,868 30 TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE CENTRES IN 1935. Centre. No. of patients. No. of attendances Extractions. Fillings. Dentures. Other treatments. Bramley Road 36 72 20 4 6 — Campden Hill 15 33 49 5 — 10 Golborne 21 46 18 — — 28 Kenley Street 47 96 40 3 11 29 Lancaster Road 184 452 183 53 23 193 Raymede 250 554 233 19 17 285 South Kensington 119 243 219 73 17 113 Sutton Trust 67 179 98 — 9 72 Totals 739 1,675 860 157 83 730 The Baby Clinic, No. 92, Tavistock Road. For some years past, the baby clinic has been acting both as a treatment centre and as an infant welfare centre, but it was not a welfare centre in the same sense as the other institutions for there was little home visiting. Collective instruction, however, was given by the council's health lecturer. During 1935, less infant welfare work was conducted, and early in 1936 the voluntary committee agreed to cease doing infant welfare work altogether and act purely as a treatment centre to which sick children attending other maternity and child welfare institutions could be sent. The following are the records for 1935 :— Number of sessions at which doctors attended for infant consultations 148 Number of sessions at which doctors attended for special ante-natal and post-natal consultations 49 Total number of individual mothers who attended 261 Total number of individual children who attended (old) 269 (new) 498 Total attendances of mothers for all purposes (excluding the accompanying of children) 1,099 Total attendances of children for all purposes 0-1 years 2,725 1.5 years 8 979 Number seen by doctor at consultations :— 1. Ante-natal mothers 128 2. Post-natal mothers 46 3. Other mothers 87 4. Children 4,570 Average number seen by doctor at consultations :— 1. Mothers 23 2. Children 31 Number of individual children weighed 767 Total weighings 11,704 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 two, which are occupied by Paddington patients, are available for children belonging to the borough. The following is the record for 1935 :— Number of infants in residence at commencement of the year 21 Number of admissions 225 Number of discharges 210 Number of deaths 13 Number in residence at end of the year 23 Average duration of stay in hospital 35 days. Artificial Sunlight Treatment. Artificial sunlight treatment is administered at the baby clinic and hospital. During the year 3,835 treatments were given and the average weekly attendance was 73 ; 245 children were treated. Orthopaedic Treatment. In the course of the routine medical examinations at the infant welfare centres, particular attention has been paid recently to posture and the presence of orthopaedic deformities. 31 The younger children, mainly those presenting rachitic tibial curvature, are referred to the baby clinic, No. 92, Tavistock Road, where they attend for ultra-violet light and massage, the severe cases needing continuous splinting being admitted to the baby hospital. In the 2 to 5 age group, a considerable number of children have been discovered to have varying degrees of knock knee and flat foot. These cases and any congenital deformities needing operative or manipulative treatment are referred to the orthopaedic clinic at the Princess Louise Hospital. From the South Kensington clinics, children needing orthopaedic treatment are referred to the Princess Beatrice Hospital or to the Victoria Hospital for Children, Chelsea. Massage and Electrical Treatment Centre. Massage and electrical treatment is undertaken at the Princess Louise Kensington Hospital for Children, and the following is a record of the work conducted thereat during 1935 :— New cases— Under 5 years of age 49 Over 5 years of age 135 184 Discharged— Under 5 years of age 47 Over 5 years of age 122 169 Transferred to other hospitals because over age 8 Total cases treated 296 Total treatments given 6,045 The borough council make an annual grant of £50 to the authorities of the hospital for this treatment. Massage treatment for children was also provided at the South Kensington infant welfare centre. Borough Council Ante-natal and Post-natal Clinics. In January, the borough council established an evening ante-natal clinic, and the sessions were held at the baby clinic, No. 92, Tavistock Road, on Mondays from 7 to 9 p.m. In June, this clinic was transferred to No. 28b, Archer Street. The evening clinic was inaugurated in order that mothers who, owing to domestic or other reasons, could not attend the afternoon clinics at the welfare centres, might have an opportunity of receiving proper ante-natal care. During the year, 47 sessions were held ; 137 individual mothers attended and made 346 attendances. In addition, five post-natal mothers were seen at these sessions and made six attendances. On the 1st October, 1935, the council established a post-natal clinic at No. 28b, Archer Street on Tuesday afternoons. It is hoped that in time all post-natal mothers attending the welfare centres will attend this clinic in preference to being seen at the ante-natal clinics at the infant welfare centres. From the 1st October to the 31st December, 12 sessions were held ; 36 individual mothers attended and they made 38 attendances. Unless there is some complication needing special attention, it is not necessary for post-natal mothers to attend more than once at the clinic. 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 109. Five hundred and ninety-six women attended, and of this number 500 were Kensington women. Kensington Maternity Home. The borough council maternity home of ten beds 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. Arrangements have been made for women to be admitted to the home to attend a special ante-natal clinic which is held at Invermead on Mondays at 2 p.m. Statement of work done during last five years. 1931 1932 1933 1934 1935 No. of applications for admission 160 161 173 206 224 No. of applications accepted 156 160 173 206 224 No. of applications withdrawn after acceptance 26 26 22 17 27 No. of women confined during the year 130 128 136 158 210 The gross cost of the scheme to the council during 1935 was £1,368 18s. Od. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £639 2s. Od. Payments made by patients totalled £660 0s. 6d. 32 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 Dav Nurserv. The following table shows a record of children's attendances at the day nurseries in 1935:— Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. 1. Whole-day attendances of children under 3 years of age 6,074 2,290 8,868 1,687 18,919 2. Whole-day attendances of children over 3 years of age 2,339 3,057 3,173 1,155 9,724 3. Total whole-day attendances 8,413 5,347 12,041 2,842 28,643 4. Charges made for each attendance of a child 8d. 9d. 8d. 1s. — 5. Half-day attendances of children under 3 years of age — — 134 334 468 6. Half-day attendances of children over 3 years of age — — 67 200 267 7. Total half-day attendances — — 201 534 735 8. Charges made for each attendance of a child — — 4d. 6d. — 9. Average daily attendance of children 37.3 24.4 53.0 18.2 — 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 1935, 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. Evelyn Convalescent Cottage Home, Wargrave, Berkshire 9 6 Hambledon Cottage Home, Surrey 7 7 Holiday Cottage, Aston Clinton, Aylesbury, Buckinghamshire 8 7 Ranyard Mission Convalescent Home, St. Leonards-on-Sea 2 2 Wayside Convalescent Home, Sunningdale, Surrey 24 23 The Aston Clinton, Ranyard Mission and Wayside convalescent homes are open for the reception of patients throughout the year, but the Evelyn and Hambledon homes are closed during the winter months. The total cost to the council for convalescent treatment during the year was £124 10s. 0d. 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 1935:— Number of lectures. Number of individual mothers attending. Number of attendances. Average attendance at lecture. Bramley Road I. W. C. 67 257 779 11.6 Campden Hill ,, ,, 39 136 768 19.7 Golborne „ „ 32 101 292 9.1 Kenley Street ,, ,, 56 171 938 16.8 Lancaster Road „ ,, 59 414 1,249 21.2 Raymede ,, ,, 54 283 1,023 19.0 South Kensington ,, 72 239 1,225 17.0 Sutton Trust „ 47 189 721 15.4 Baby Clinic 39 179 559 14.3 Other institutions 8 - 181 22.6 Totals 473 1,969 7,735 16.4 33 Home Helps. One hundred and twenty-four applications were received for the provision of home helps under the council's scheme. The assistance requested was granted in 100 cases for a period of 14 days each ; in four cases for one month ; in eight cases for three weeks ; in four cases for one week ; in one case for nine days ; four applicants cancelled their requests ; and three applications were not granted by the sub-committee. The gross cost of the scheme to the council during the year was £165 4s. 3d. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. 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 the council have decided to increase their expenditure in this respect. They have provided a sum of £3,500 in their estimates for the financial year 1936-37 to meet the increased demand. A further £300 has been provided in the estimates for the provision of adexolin for mothers and cod liver oil or its equivalent for children. In the year, 3,364 grants of milk were made by the council's applications sub-committee. Nine hundred and fifty-six of the grants were in response to new applications, and the remaining 2,408 were renewals of grant. Under the council's scheme, 160,496 pints of fresh milk were granted free of charge at a cost to the council of £1,917 12s. 0d., and 5,531 packets of dried milk were granted free of charge at a cost of £391 0s. 5d. The following table gives particulars of the dried milk supplied at cost price:— 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 71 5 0 7 Bramley Road 1,142 77 14 8 Campden Hill 500 34 17 7 Golborne 398 28 5 7 Kenley Street 522 36 19 6 Lancaster Road 3,434 241 7 10 Raymede 1,625 114 8 6 South Kensington 542 44 6 1 Sutton Trust 330 22 14 2 Baby Clinic 152 10 6 8 Totals 8,716 616 1 2 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. One hundred and fifty applications for dinners were granted ; 42 of these were new applications, and 108 were renewals. The cost of the dinners amounted to £140. The total number of dinners supplied was 6,600. 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 :— 1,708 pints of milk at a cost of £24 14s. 6£d. 51 packets of dried milk at a cost of £3 15s. Id. 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. Birth Control and Gynaecological Clinics. The council have an arrangement with the North Kensington Women's Welfare Centre at No. 12, Telford Road, whereby women attending the infant welfare centres in the borough can receive birth control advice and gynaecological treatment at the former institution. The birth control advice is given to married women only, and is based on medical requirements only. During 1935, 207 new Kensington patients were given advice at the birth control sessions. The gynaecological treatment is provided for both married and unmarried women, and 117 Kensington patients attended the sessions, their total attendances amounting to 700. The council recognised the good work which had been carried out by the North Kensington Women's Welfare Centre, and at the beginning of 1935 they increased their grant from £25 to £50. This grant was in respect of both birth control advice and gynaecological treatment. 34 Travelling Expenses of Women Breast-feeding Infants Admitted to Hospitals. Five applications were received for payment by the borough council of travelling expenses to and from hospital of women who were breast-feeding infants admitted as in-patients to hospitals for treatment. These were granted, and the total payments amounted to £3 14s. 6d. Boarding-out Children. The council have a scheme under which the children of women staying at home or going to institutions for their confinements can be boarded-out with foster-mothers for a period of about fourteen days. The council are the authority carrying out the work of infant life protection, and the infant life protection visitor is a member of the staff of the public health department. This officer visits the homes of all foster-mothers in the borough to see that the conditions, etc., are satisfactory, and it is thus possible for the council to obtain good homes for children required to be boarded-out. During the year, 14 children were boarded-out at a cost of £27 17s. 6d. 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 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 1935, amongst which were the following :— (a) the appointment of whole-time medical officers to conduct the infant consultation sessions at the infant welfare centres ; (b)re-allocation of the districts of certain infant welfare centres ; (c) scheme for the provision of dentures by the borough council to necessitous expectant and nursing mothers ; (d) domiciliary midwifery service for South Kensington. 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. HOUSING. During the year the council's sanitary inspectors inspected under the Public Health (London) Act, 1891, and the Housing Acts, 6,292 houses, and the total number of inspections made was 34,705. Public Health (London) Act, 1891. The number of written intimation notices served in respect of defects or nuisances in dwellings was 1,775. 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 issue 389 statutory notices and 79 final notices, and 21 summonses were eventually served. The following list shows the major improvements secured :— Houses cleansed 1,073 House drains reconstructed 100 „ „ additions to 105 Defective drains repaired 128 House drains cleansed 160 Water closets reconstructed or repaired 418 „ „ (new) provided 362 „ „ supplied with water 293 Soilpipes ventilated, repaired, etc.152 ,, (new) provided 150 Ventilating pipes (new) provided 116 Baths (new) provided 601 Sinks (new) provided 617 Lavatory basins (new) provided 1,824 Waste pipes (new) provided 472 Cisterns cleansed, covered, etc. 53 Taps fixed on rising main 81 Yards and areas, paved, drained, repaired 257 Dustbins provided 295 Ashpits abolished 4 Accumulations of filth, etc., removed 203 Roofs repaired 427 Houses provided with water above basement floor 79 Dampness in dwellings remedied 392 Ventilated food cupboards provided 179 Artificial lighting of staircases provided 4 35 By-laws for Houses Let in Lodgings. During the year six houses were placed on the council's register of houses let in lodgings; none was removed. The total number on the register at the end of the year was 3,161 and the number of inspections of these houses during the year was 8,252. (This number is included in the total inspections for the year given above.) Outside improvement areas (which are dealt with later), 13 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 and proceedings subsequently taken. 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 11 cases. These cases were remedied by the service of intimation notices. The number of houses cleansed under the by-laws for houses let in lodgings was 700. 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 1935. These figures are in respect of premises outside improvement areas:— Notices served in 1934 which were outstanding on 1st January, 1935 28 Notices served from 1st January to 31st December, 1935 32 Notices of appeal by owners to the county court Nil Section 17 notices withdrawn 7 Notices satisfactorily complied with by the owners 36 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, 1935 11 Notices in respect of which nothing had been done at the end of the year (the time allowed had not expired in these cases) 2 Cases in which the council's contractors were engaged in executing repairs in default of owners at the end of the year 3 Total expenditure of the council in executing repairs during the year £311 From the time the council commenced enforcing the repair of houses by the service of Housing Act notices up to the 31st December, 1935, they have expended £3,767 16s. 6d., in carrying out work in default of owners outside improvement areas. Of this sum, £3,517 2s. 6d. has been recovered, and the outstanding amount of £250 14s., with interest, is being collected in instalments. In the past thirteen years 1,223 houses have been repaired under Housing Act procedure. 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. Apart from improvement area procedure, one demolition order was made during 1934. The house was eventually repaired by the owner at a cost of approximately £400, and during 1935 the council agreed to withdraw the demolition order. Two houses were dealt with in 1935 under Section 19, and in each case the council accepted undertakings from the owner that the house would not be used for human habitation. Action was taken by the council under Section 19 in respect of Nos. 9 and 10, Barandon Street. The freeholders appealed against the demolition orders, but the hearing of the appeal was adjourned and negotiations are in progress. Section 20 of the Housing Act, 1930. Parts of Houses not Repairable at Reasonable Cost. In 20 houses outside improvement areas 33 underground rooms were closed. In three cases the owners gave undertakings to make the basements habitable ; the necessary work was carried out, and the undertakings were subsequently cancelled. Clearance Areas. One clearance area, namely, the Talbot Mews area, was well in hand when the council adopted their five years' programme in May, 1933. This area had on it 25 dwellings holding 170 persons. The council made a compulsory purchase order, and at the end of 1935 the entire re-building programme, comprising 64 new flats, had been completed. There were in the five years' programme, seven clearance areas, comprising 70 houses holding 579 people ; and all are completed or in hand with the exception of the East Mews Road area. During 1935 the chairmen and vice-chairmen of the public health and housing committees had a conference with representatives of the county council in regard to an extension of the five years' programme, and 26 areas were considered as possible clearance areas. Some of these have 36 been, or will be, dealt with in other ways, and at least two are left for consideration by the county council. The representatives of the borough council undertook that the remainder would be considered for action by the borough council. Three of these are already in hand ; two have been represented by me as clearance areas and the third has been included in an area which has been made the subject of a compulsory purchase order. Three areas, where the property is not ripe for clearance but which appear to the council to be suitable for the erection of blocks of flats, have been made the subject of compulsory purchase orders. In two of these cases the borough council propose to erect the new flats, while in the other one the work will be undertaken bv the Kensington housing trust. The following table gives the clearance and compulsory purchase areas in the borough which were in hand or completed during 1935 :— Name of area. Date of declaration. Action taken. No. of premises originally on site. No. of persons originally in occupation. Position at end of 1935. Talbot Grove and Mews Dec., 1930. Com. Purchase Order. 26 170 64 new flats completed by end of 1935, and these provide accommodation for 380 people. Adair Road/Southam Street. July, 1931. do. 6 113 Nine flats completed and occupied by 50 people. Barker Street July, 1931. Clearance Order. 57 236 Buildings demolished but site not yet developed. Haydens Place/Tavistock Mews. Oct., 1933. do. 10 29 Buildings demolished and four lock-up garages erected on part of site. Silvester Mews Oct., 1933. Com. Purchase Order. 20 110 Buildings vacated but not yet demolished. Gadsden Mews Jan., 1934. Clearance Order. 14 44 Buildings demolished and site now vacant. Edenham Mews Feb., 1934. Com. Purchase Order. 10 34 Order confirmed by Minister but buildings not yet demolished. Kensal Road and West Row July, 1934. do. 5 17 Order confirmed. Kensington housing trust to use site to extend their housing accommodation. South Row and Great Western Terrace. Oct., 1934. do. 33 142 Order confirmed but premises not yet acquired. Bramley Road and Blechynden Street. Oct., 1934. do. 11 117 ditto. Portland Road, Walmer Road and Clarendon Road Oct., 1934. do. 22 119 ditto. Bramley Mews Feb., 1935. Clearance Order. 13 43 Clearance order confirmed but buildings not yet vacated. Tabernacle Terrace July, 1935. do. 7 68 Buildings vacated and proposals in hand for erection of 16 flats. Manchester Mews Oct., 1935. do. 4 25 Ministry of Health enquiry held May, 1936—result not yet known. Chelsea Grove Oct., 1935. do. 15 23 Order not yet confirmed by Minister. Yeomans Row Oct., 1935. do. 18 155 ditto. Improvement Areas. The council's five years' programme proposed that seven areas in the borough, containing 910 houses with a population of 12,010, should be dealt with as improvement areas under the Housing Act, 1930. The Act of 1935 abolished improvement area procedure except in those cases where the declaration had already been made before that Act received Royal Assent on the 2nd of August. On that date three of the areas in Kensington had been declared. Other procedure will have to be adopted in dealing with the remaining four improvement areas. Fortunately the three areas declared were the largest and the most important from the point of view of improvement area procedure. 37 The following are particulars of the progress which has been made in the three declared areas. Southam Street Improvement Area. As a measure of administrative convenience, the Ministry of Health divided this area into two but in this report and during the progress of the work they have been dealt with as one with a total population of 5,818 in 410 houses. The declarations were made on the 23rd January, 1934, and the by-laws for the abatement of overcrowding and the improvement of housing conditions were confirmed by the Minister on 27th April, 1934. The public health committee appointed a sub-committee to visit all overcrowded houses and basements within the area in order to decide which families should be transferred to the new accommodation on the Dalgarno Gardens housing estates. After these transfers had taken place, the rooms vacated by the overcrowded families were used for the accommodation of basement tenants who had not been taken out of the area. With a view to securing the best results, a very considerable amount of reshuffling of tenants took place during 1934, and at the end of that year all unsatisfactory basements had been closed and all overcrowding had been abated. In the abatement of overcrowding the by-laws provide that every person remaining in the area, irrespective of age, must have 450 cubic feet of free air space in his sleeping apartment. The number of basement rooms closed was 778, but virtually all the upstairs rooms which had been vacated by overcrowded families were refilled by smaller families. The total number of people transferred from the area to new homes outside was 1,309, and the number transferred from one home to another within the area was 933 ; 493 found other accommodation on their own initiative. The work of improving the condition of the 410 houses in the area remained to be undertaken, and this task commenced in December, 1934. Only four houses were found to be so bad as not to be repairable at reasonable cost ; demolition orders were made and the houses were vacated and demolished. It was ascertained 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 1934. Following a routine inspection of each house, a comprehensive schedule of repairs was prepared and served upon the owner together with a notice requiring him to carry out the necessary work. In addition to general repairs and decorations, the notices required :— (а) Adequate water-closet accommodation ; (б) „ supply of water for domestic use ; (c) „ accommodation for washing clothes ; (d) „ „ storage of food; (it) „ „ preparation and cooking of food ; for the use of and readily accessible to each family. The following is a record of the reconditioning work carried out in this area during 1935 :— Houses cleansed 257 House drains reconstructed 6 „ „ additions to 85 Defective drains repaired 15 House drains cleansed 22 Water closets reconstructed or repaired 91 „ „ (new) provided 85 „ „ supplied with water 85 Soilpipes ventilated, repaired, etc. 12 „ (new) provided 85 Ventilating pipes (new) provided 85 Sinks (new) provided 497 Waste pipes (new) provided 497 Cisterns cleansed, covered, etc. 55 Taps fixed on rising main 463 Yards and areas paved, drained, repaired 102 Dustbins provided 49 Accumulations of filth, etc., removed 54 Roofs repaired 249 Dampness in dwellings remedied 30 Ventilated food cupboards provided 506 Artificial lighting of staircases provided 161 At the end of the year 172 houses had been brought up to the highest standard practicable under improvement area procedure, work was in hand at 109 houses, and 125 houses remained for attention during 1936. The improvement of the area as contemplated in the 1930 Housing Act will probably be completed during 1936 ; but that Act further contemplated that, when once this improvement had been brought about, the houses in these areas should receive more constant and rigid supervision than others. Therefore, as soon as improvement had been completed in any house, that dwelling 38 was placed on a list to be visited regularly (not less than once every two months) by an inspector specially detailed for the purpose. It is contemplated that this close supervision will be exercised for some years, and the object of this is twofold, namely:—(a) to maintain the satisfactory housing conditions which have been secured, and (b) to assist the owner in maintaining his house in such a state that he can expect some reasonable return for the very considerable outlay he has been called upon to make. An interesting development of improvement area procedure in the Southam Street area and one which was not foreseen when the work was originally undertaken was the transfer of houses by sale from private owners to the improved tenements association. By the middle of May, 1936, this association owned 96 of the houses in this area, 42 of which had been bought fairly recently. 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. After the sub-committee had completed their inspections in the Southam Street area, they commenced similar work in this area. When the area was declared as an improvement area there were 193 basement rooms in which were 83 families (299 persons). In upstairs rooms there were 65 families (349 persons) living under overcrowded conditions. These one hundred and forty-eight families, comprising 648 persons, were scheduled for displacement. The securing of satisfactory accommodation for these families was completed as far as possible early in 1936, and the action taken is summarised below :— (A) Rehoused Outside the Improvement Area. Families. Persons. (i) by the council and allied housing associations 26 123 (ii) moved out of the area as a result of action by the housing inspector 22 70 48 193 A further 18 families of 69 persons not scheduled for displacement were taken out of the improvement area by the housing managers and the rooms vacated were used to rehouse families " inside " the area. (B) Rehoused Inside the Improvement Area. Families. Persons. (i) rehoused by the improved tenements association 60 256 (ii) rehoused by other private owners by arrangements with the housing inspector 29 119 89 375 These figures leave to be considered 11 families of 80 persons living in overcrowded rooms which were scheduled for displacement. Each case has been considered and each family has been given one or more rooms in addition to their original accommodation, but overcrowding under the 450 cubic feet standard exists. The overcrowding in most of these cases is slight, and, in fact, in three cases overcrowding under the Housing Act, 1935, standard does not exist. Owing to the large numbers in these families and their inability to pay the rents required for four and five rooms it has not yet been able to accommodate them satisfactorily. (The problem of housing accommodation for large families is dealt with in another part of this report.) It should be mentioned that the majority of the properties in the Crescent Street improvement area are in the ownership of the improved tenements association, and of the 148 families scheduled for displacement 119 were tenants of this association. All the basement rooms have now been closed and vacated, and it will be seen that all the families originally scheduled for displacement have now been satisfactorily accommodated with the exception of the 11 families referred to above ; these will be dealt with as soon as there is suitable accommodation available. The time has now arrived when the reconditioning work should be put in hand, but a good deal of thought has been given to the possibility of introducing in this area the new development area procedure laid down in the Housing Act, 1935. Until conclusions have been arrived at, it has been thought wise to postpone the commencement of reconditioning in order to avoid expenditure on houses which might be demolished in a short time if the new machinery were applied. In every case in the Southam Street and Crescent Street improvement areas where the council have offered better accommodation, they have also offered to undertake the removal of the furniture and to secure its disinfestation en route. It was anticipated originally that there might be cases where difficulties would arise ; but the service has become very popular, and it is now quite usual for those who are moving to accommodation not owned by the borough council or the allied housing associations to ask if they can have their effects disinfested before going to the new home. 39 Treverton Street Improvement Area. This area was declared to be an improvement area in May, 1935, at which time there were 2,449 persons living in 238 houses. Considerable difficulty has been experienced in obtaining by-laws necessary to secure improvements in this area similar to those in force in the Southam Street and Crescent Street areas. The Minister of Health came to the conclusion that, as improvement area procedure was abolished by the Housing Act, 1935, he was unable to confirm any new improvement area by-laws. After extensive negotiations between the Ministry of Health, the county council and the borough council, by-laws have been made under section 6 of the Housing Act, 1925, and are now awaiting the approval of the Minister. They are almost identical with those which apply in the two previous improvement areas, with the exception that the overcrowding standard of 450 cubic feet per person is replaced by the new national standard laid down in the 1935 Act. When the by-laws are in operation, the borough council will be able to eliminate overcrowding, to close basements and to secure necessary repairs under Part II of the 1930 Housing Act. Indeed, it is hoped that the improvements to be secured under these somewhat modified powers will be of the same high standard as those obtained in the Southam Street area. New accommodation for rehousing the overcrowded families and persons displaced from basements is being provided in the form of flats by arrangement between the borough council and the Peabody donation fund. 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 133 Morland House 20 Talbot Grove and Mews 44 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. Early in the present year work was commenced on the demolition of some old cottages and the erection of thirty flats on the cleared site. 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 three houses and the leaseholds of four. At the end of the year they held 239 freehold houses, 68 leasehold houses and 27 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. F.—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 year or so. 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. These are now in course of erection and it is expected that they will be completed by June, 1936. 40 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 about 2,300 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 common lodging house at No. 66, St. Anns Road, was closed at the end of the year 1934. Since that time the premises have remained empty, and it is anticipated that they will be demolished and the cleared site used for the erection 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 also closed voluntarily during 1934 ; it has been converted into tenements, which are now occupied. The following table shows the licensed common lodging houses and the accommodation available on the 1st January, 1935 :— The following table shows the licensed common lodging houses and the accommodation available on the 1st January, 1935 :— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed. Male. Female. Total. Golbome Chesterton, Ada Elizabeth 194, Kensal Road - 69 69 Norland Hankins, John W. 28 & 30, Crescent Street 54 - 54 „ Woodhouse, Jane E. 40, do. - 21 21 Totals 54 90 144 In June, 1935, the council renewed the licence in each of the three above cases. Although these three houses are licensed to receive 144 persons, a recent census taken at night time showed only 87 in residence. These three 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. In London there is a demand for flatlets, and for several years the council have been concerned in regard to the proper control of the large number of houses in the borough which are being converted into these one-roomed dwellings. Whilst it is no doubt practicable to erect new blocks of buildings containing flatlets which will prove satisfactory, the council fear that the conversion of existing single-family houses may lead to a number of evils, to which they have already called attention. With a view to securing some control of these dwellings, the council have suggested that they should be provided with legislation, either in the form of sections in a London County Council (General Powers) Act, or in the form of by-laws. The county council, however, have had some difficulty in framing appropriate legislation and have ultimately come to the conclusion that satisfactory results might be obtained by regulating these conversions under the powers contained in the Town Planning Acts. The county council have accordingly expressed their willingness to draw up a code of instructions for the guidance of district surveyors when they are considering plans for conversions. These notes provide as follows :— (1)Arrangements for food storage, dust and refuse.—Each flat should be self-contained and be provided with w.c., bath, kitchen, ventilated food storage and proper arrangements for the storage and removal of dust and refuse. (2) Bathrooms and w.c.'s on half landings.—Favourable consideration will be given to the planning of a bathroom and w.c. on a half landing and not within the flat, only where this position is the sole convenient one and if the general circumstances are otherwise suitable and proper lighting and ventilation are maintained on the staircase. (3) W.c.'s and bathrooms.—W.c.'s should in all cases be provided on external walls and directly ventilated into the open air. Bathrooms should be adequately ventilated into the open air. (4) Size of bedrooms and living rooms.—Living rooms should be not less than 150 square feet in area. In two-roomed flats the bedroom should be not less than 110 square feet, and in flats of three or more rooms one bedroom should be not less than 110 square feet and no bedroom less than 70 square feet in area. 41 (5) Shape and proportion of rooms.—In any alteration of existing planning the shape and proportion of rooms should be considered and, generally, no room should be less than 8 feet wide. (6) Access to rooms.—All rooms should have independent access. (7) Basement rooms.—The conversion of existing underground rooms should be governed generally by existing statutory provisions, and applicants should be informed that they will be required to comply with the borough council's regulations under section 18 of the Housing Act, 1925, as amended by the 7th schedule of the Housing Act, 1935, and with their requirements under the Public Health (London) Act, 1891. All applicants should be asked to supply a scale drawing showing the height of the basement rooms, with relative level of surrounding ground and depth and width of areas. Any proposal to provide sleeping accommodation in a basement will be considered on its merits, but proposals of this kind should be discouraged. (8) External appearance.—This should be varied as little as possible. External access staircases should be avoided, unless required as means of escape where no other means are reasonably possible. Housing Statistics. The Minister of Health each year requires that certain information shall be given in this annual report, and the following are the particulars required by him for 1935 and set out in circular 1492 :— 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) 6,292 (b) Number of inspections made for the purpose 34,705 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,997 (b) Number of inspections made for the purpose 7,287 (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) 4 (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 2,265 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 201 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 289 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 205 (b) By local authority in default of owners 4 B.—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,775 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (а) By owners 1,775 (б) 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 2 (2) Number of dwelling-houses demolished in pursuance of demolition orders Nil (3) Number of dwelling-houses in respect of which undertakings were given that the premises would not be used for human habitation 2 (4) Number of cases in which the undertaking was cancelled, the owner having carried out the necessary work Nil D.—Proceedings under section 20 of the Housing Act, 1930 :— (1) Number of separate tenements or underground rooms in respect of which 20 closing orders were made (33 rooms) 42 (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 be rendered fit for human habitation 3 (6 rooms) 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 Nil (2) Number of dwelling-houses demolished in pursuance of demolition orders 4 (3) Number of separate tenements or underground rooms in respect of which closing orders were made Nil (4) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenement or room having been 30 rendered fit (59 rooms) Overcrowding Survey. Under the Housing Act, 1935, a dwelling house is deemed to be overcrowded when the number of persons sleeping in the house either :— (a) is such that any two of those persons, being ten years old or more, of opposite sexes and not being persons living together as husband and wife, must sleep in the same room ; or (b) is, in relation to the number and floor area of the rooms in the house, in excess of the permitted number of persons as defined in the first schedule of the Act. A child under one year is not counted, and a child between the ages of one and ten years is regarded as half a unit. The following is the schedule referred to under heading (b) :— The expression " the permitted number of persons" means, in relation to any dwelling-house, either— (a) the number specified in the second column of Table I in the annex hereto in relation to a house consisting of the number of rooms of which that house consists ; or, (b)the aggregate for all the rooms in the house obtained by reckoning, for each room therein of the floor area specified in the first column of Table II in the annex hereto, the number specified in the second column of that table in relation to that area, whichever is the less— provided that in computing for the purposes of the said Table I the number of rooms in a house, no regard shall be had to any room having a floor area of less than 50 square feet. Table I. Where a house consists of :— (a) one room 2 (b) two rooms 3 (c) three rooms 5 (d) four rooms 7½ (e) five rooms 10—with an additional two in respect of each room in excess of five. Table II. Where the floor area of a room is :— (a) 110 sq. ft. or more 2 (b) 90 sq. ft. or more, but less than 110 sq. ft 1½ (c) 70 sq. ft. or more, but less than 90 sq. ft.1 (d) 50 sq. ft. or more, but less than 70 sq. ft. ½ (e) under 50 sq. ft. Nil This standard replaces that hitherto in application under by-laws for houses let in lodgings, and, furthermore, it applies to every house occupied by the working-classes ; but it does not apply in any borough until the " appointed day " has been fixed by the Minister, and in the interval the old standards remain in operation. Overcrowding which exists on the " appointed day " cannot be dealt with unless the council have offered the family alternative accommodation, but overcrowding arising for the first time after the " appointed day " becomes a penal offence. With a view to enabling the Minister to know the extent of overcrowding in the country, and to supply information for the use of local authorities in regard to the problem before them, section 1 of the Act requires every local authority to carry out an inspection of their district and to report the result to the Minister, together with their proposals for providing new accommodation to abate the overcrowding. In London the authority to carry out the inspection is each metropolitan borough council, but the London county council is the authority to report the results found for the entire administrative county and to submit comprehensive proposals for the provision of new homes. The survey in Kensington was completed by the end of the year, and indeed it was the first in London to be finished. The results are shown in the table opposite :— 43 Housing Act, 1935.—Overcrowding Survey. Distribution of working-class families in relation to size of family and size of dwelling occupied. Size of family (" equivalent number " of persons). Size of dwelling occupied, in terms of the maximum " equivalent number * of persons permitted to occupy it without causing it to be overcrowded. Totals of families. 0* ½* 1 1½ 2 21 3 3½ 4 4½ 5 5½ 6 7 7 7½ 8 8½ 9 9½ 10 l0½ 11 11½ 12 12½ 13 & over Overcrowded. Not overcrowded. TOTAL. 1 – 12 42 1,368 789 612 339 – 378 16 77 2 140 1 2 • 33 1 12 1 1 19 12 3,840 3,852 U – – – 5 29 17 15 – 3 5 5 – 1 – – – – – – 1 – – – – – – – – 77 77 2 – – 5 69 +489 1,609 1,211 3 1,377 93 331 7 686 12 18 39 173 3 6 86 4 2 30 i 1 – 35 +83 6,208 6,291 21 – – – 28 56 93 1,010 4 465 59 202 1 181 2 2 12 27 – 1 5 – 1 7 – – – – 84 2,072 2,156 3 – – – 12 34 80 1,410 – 947 95 427 7 623 20 38 86 247 6 19 110 9 4 48 2 7 – 60 126 4,174 4 ,300 31 – – – 3 3 203 272 – 207 57 178 4 136 11 11 18 44 4 5 14 – – 7 1 1 – 3 481 703 1,184 4 – – – – 6 240 313 – 64 102 543 18 492 30 56 98 242 – 13 119 8 1 47 1 7 1 48 567 1,894 2,461 4½ – – – – – 73 92 3 11 – 195 3 104 19 14 21 40 3 1 13 3 – 8 1 2 – 3 186 453 639 5½ – – – – 2 48 88 – 19 39 289 10 264 37 38 62 193 13 19 70 13 4 44 – 3 – 55 199 1,112 1,311 5 – – – – – 18 36 – 48 10 104 2 48 18 21 22 38 2 6 13 _ 1 7 – 3 – 5 216 186 402 6 – – – – – 27 21 – 49 15 81 8 29 29 39 97 115 6 13 48 10 1 29 2 1 2 51 201 471 672 6½ – – – – – 10 9 – 18 7 28 5 4 24 36 18 1 3 9 3 1 6 – – – 6 81 123 204 7 – – – – – 3 4 _ 15 3 28 1 12 26 21 56 50 3 4 33 3 2 16 3 1 – 29 92 221 313 7½ – – – – – 2 3 – 7 1 8 2 3 12 8 22 30 5 4 13 2 – 4 – 1 – 5 46 86 132 8 – – – – – 2 3 – 4 – 4 2 19 13 6 – 6 4 4 16 8 – 11 2 1 1 19 71 71 142 8½ – – – – – – 1 – – – 1 – 7 8 5 15 4 – 2 8 1 1 2 – 1 – 2 41 17 58 9 – – – – – – 2 – – – – – 5 1 1 5 4 4 2 11 4 – 2 – – – 10 23 29 52 9½ – – – – – – – – 1 – – – – – 1 – – – – – 1 – – – 1 – 2 6 4 10 10 – – – – – – – – – – – – 2 – – – 4 – – – – – 2 – – – 7 7 9 16 101 – – – – – – – – – – – – 3 – – – – 1 – – – – – – – – 1 5 1 6 11 – – – – – – – – – – – – – – – – – – – – – – – – – – 7 – 7 7 11½ – – – – – – – – – – – – – – – – – – – – – – 1 – – – 2 1 2 3 12 – – – – – – – – – – – – – – – – – – – _ – – – – – 5 – 5 5 12½ – – – – – – – – – – – – – – – – – – – – – – – – – – 1 – 1 1 13 & over. – – – – – – – – – – – – – – – – – – – – – – – – – 1 1 1 1 2 TOTALS OF DWELLINGS OVER-CROWDED – 12 5 112 +110 707 843 15 179 75 254 18 55 60 21 39 14 5 1 1 1 – 1 – – – – +2,529 Not OVER CROWDEO – – 42 1,373 1,298 2,331 3,985 17 3,441 446 2,247 54 2,704 195 282 575 1,256 53 103 581 71 18 271 13 31 4 378 21,767 Total – 12 47 1,485 1,408 3,038 4,828 32 3,820 521 2,501 72 2,759 255 303 614 1,270 58 104 582 72 18 272 13 31 5 378 24,296 * 0 = a dwelling of 1 room under 50 square feet: ½ = a dwelling of 1 room between 50 and 70 square feet. t Including 9 families with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 44 For the purpose of determining the " equivalent number " of persons in a family, a child under one year of age is not counted and a child between the ages of one year and ten years counts as half a person. Only rooms normally used in the locality for sleeping or living purposes are counted as rooms ; thus, sculleries, bathrooms, etc., are not taken into account in determining the permitted number of persons. The table gives a picture of the housing conditions (so far as density is concerned) of the families enumerated in Kensington at the time the survey was taken. The thick black diagonal line in the table separates the overcrowded families from those not overcrowded. The families recorded on the left of the diagonal line are all overcrowded, and the worst cases of overcrowding are those farthest from the line. The families recorded to the right of the line are families not overcrowded, and those near the diagonal line are those whose accommodation is being used to the full extent without being actually overcrowded. The 1931 census revealed that there were in the borough 47,715 private families of all classes, but many of these are provided with ample accommodation, and during the survey it was found necessary to investigate the conditions of only 24,296 families in order to obtain particulars of all actual and suspected cases of overcrowding. It is seen that 2,529 families are living under overcrowded conditions. The following table gives a summary of the survey for each ward :— Ward. Total families investigated. Families overcrowded. Families not overcrowded. North Kensington— St. Charles 8,347 828 7,519 Norland 4,043 546 3,497 Golborne 5,099 766 4,333 Pembridge 2,281 202 2,079 South Kensington— Holland 1,110 45 1,065 Earl's Court 1,084 42 1,042 Queen's Gate 245 7 238 Brompton 195 9 186 Redcliffe 1,892 84 1,808 24,296 2,529 21,767 There were 2,342 overcrowded families out of a total of 19,770 surveyed in North Kensington, and 187 cases out of a total of 4,526 families in South Kensington. The tollowing table gives tne extent ot overcrowding in each metropolitan Dorougn in relation to overcrowding in London as a whole, and the proportion which the " equivalent number " of persons living in overcrowded conditions bears to the estimated total " equivalent population " in each borough :— Metropolitan borough. Number of overcrowded families. Number of " equivalent persons " overcrowded. Proportion of estimated total " equivalent population " in the borough overcrowded. Per cent. Battersea 1,968 10,371 7.4 Bermondsey 3,163 17,042 17.8 Bethnal Green 3,894 20,219 21.7 Camberwell 2,950 15,704 7.1 Chelsea 749 3,661 6.6 Deptford 1,317 6,604 7.1 Finsbury 2,458 12,187 20.5 Fulham 1,795 9,323 6.9 Greenwich 1,091 6,356 7.1 Hackney 2,651 13,600 6.9 Hammersmith 1,728 8,182 6.8 Hampstead 449 2,063 2.4 Holborn 700 3,226 9.4 Islington 6,757 31,941 11.2 Kensington 2,529 11,786 7 0 Lambeth 3,881 19,798 7.5 Lewisham 1,057 6,728 3.3 Paddington 1,998 8,879 6.7 Poplar 4,080 22,386 16.8 St. Marylebone 1,619 7,364 8.4 St. Pancras 4,464 20,712 11.8 Shoreditch 3,898 19,353 23.6 Southwark 4,096 20,478 14.0 Stepney 7,632 38,864 19.7 Stoke Newington 462 2,193 4.6 Wandsworth 1,801 10,333 3.2 Westminster 1,083 5,030 4.2 Woolwich 683 3,606 2.7 Total for County of London (i.e., exclusive of the City of London) 70,953 357,989 9.1 45 Estimate of Total Rehousing Accommodation Required in Kensington. As mentioned earlier, representatives of the borough council conferred with representatives of the county council during the year on the question of extending the council's five years programme ; and subsequently the public health committee embarked upon a campaign for dealing with a number of small clearance areas, which at present give accommodation for 1,163 persons. This work will be spread over several years, and it is estimated that 250 dwellings will be required to rehouse the people to be displaced. The committee have also commenced the task of closing unsatisfactory basements in North Kensington, which are estimated to give accommodation at the present time for 6,000 persons. These clearance areas and basements contain a number of overcrowded families, and when they have been dealt with, not only will unsatisfactory dwellings have been demolished or closed, but a certain amount of overcrowding revealed at the survey will have been abated. There will remain, however, overcrowding in other houses in the borough, and it has been estimated that in order to remedy all overcrowding and to rehouse the families in the clearance areas and unsatisfactory basements approximately 2,000 new dwellings will be required. It will be difficult to provide all this new accommodation within the borough, which is already almost completely built up ; and, whilst the borough council and the Kensington housing associations are providing a considerable number of houses, it will be necessary to look to the London county council to provide a large amount of accommodation outside the borough. The Problem of Large Families with Small Incomes. There are in the borough many families with a large number of small children where, owing to a low wage-earning capacity, the fathers are unable to pay the rent required for an adequate number of rooms. Private owners do not generally care to take such families, and many are so poor and so large that even housing associations hesitate to cater for them. The council have recently given this problem very careful consideration. In North Kensington there are several thousand large tenement houses with good-sized rooms which were intended originally for one family but are now let off in lodgings to two, three, four, five or more families of the working classes. A number of these houses in the poorer districts are gradually approaching the time (ten of fifteen years hence) when they will be ripe for clearance area procedure. The council have decided to acquire voluntarily or by compulsory purchase such of these houses as are necessary and use them for accommodating the very large families which are proving a difficulty in connection with local housing reform. A sum of £10,000 has been included in the estimates for the current year for this purpose. During the course of ten years or so the large families will diminish to manageable dimensions, owing to the children growing up and marrying, and by that time the property may be ready for clearance. Such a measure is thought to be more advantageous to the council than the erection of blocks of new flats for large families. To provide satisfactory accommodation for these families, the flats would have to be larger, and consequently more expensive, than those hitherto built. The era of large families is rapidly disappearing, and neither the council nor private enterprise can be expected to build at considerable cost new blocks of six- or seven-roomed flats to meet what is probably only a temporary difficulty. 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. In the year 1935, twenty-five samples were so taken and one only of these was found to contain tubercle bacilli. The result in this case was communicated to the medical officer of health of the county in which the milk was produced. At a subsequent inspection of the cows at the farm concerned it was found that one cow was suffering from tuberculosis of the udder. This animal was slaughtered under the provisions of the Tuberculosis Order. Composition of Milk Samples.—Of 305 formal samples of milk taken under the Food and Drugs (Adulteration) Act in 1935, eight were certified by the public analyst as adulterated. Four of these contained less than 8'5 per cent, of non-fatty solids, one less than 3 per cent, of fat, whilst the remaining three samples were reported as adulterated owing to the presence in the milk of formaldehyde. These particulars, do not give any indication of the general quality of the milk 46 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 1935. 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 3.61 8.82 3.61 8.82 3 0 8.5 February 34 3.51 8.83 3.51 8.83 March 18 3.66 8.87 3.66 8.87 April 24 3.33 8.78 3.35 8.78 May 32 3.61 8.84 3.61 8.84 June 18 3.59 8.92 3.59 8.92 July ... 27 3.60 8.82 3.60 8.84 August 24 3.61 8.83 3.61' 8.83 September 36 3.84 8.87 3.84 8.87 Average composition of normal cow's milk. October 30 3.79 8.86 3.80 8.98 November 29 3.71 8.90 3.73 8.93 Percentage of milk fat. Percentage of solids not fat. December 15 3.76 8.81 3.80 8.85 305 3.63 8.84 3.64 8.88 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 dining 1935, 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 9 9 Added to register 27 4 4 Vacated and removed from register 13 13 Dairymen with premises outside the borough added to register 6 Dairymen with premises outside the borough removed from the register On register 1st January, 1935 112 174 149 On register 31st December, 1935 139 171 140 (+) Increase. (—) Decrease +27 —3 — 9 The total number of inspections of dairies and milkshops in the borough in 1935 was 521. 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 Order lays down a schedule of fees to be paid by applicants for licences. The licences granted in 1935 were as follows :— Principal *Supplementary- licences. licences. la) Dealers' licence to sell " Certified Milk" 12 1 (b) Dealers' licence to bottle and sell " Grade A (T.T.) Milk "2 — (c) Dealers' licence to sell " Grade A (T.T.) Milk " 18 2 (d) Dealers' licence to sell " Grade A Milk — 1 (e) Dealers' licence to sell " Grade A (Pasteurised) Milk " 1 — (f) Dealers' licence to pasteurise milk 1 — (g) Dealers' licence to sell " Pasteurised Milk " 48 6 • These licences enable the holders to sell graded milks in Kensington from premises situated outside the borough. 47 During the year, 21 samples of " Certified Milk," four of " Grade A (Tuberculin Tested) Milk," and twenty-four 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 on Bacteria per 1 c.c. Coli per l/10th c.c. Sample collected on Bacteria per 1 c.c. Coli per l/10th c.c. *22nd January... 460 Nil. 8th August 8,600 Nil. 12th March 320 11 ,, ,, 30,400 ,, " " 3,300 99 27th 847,000 Present. 30th April 104,000 Present. ,, ,, 5,500 ,, *15th May 6,000 Nil. 30th September 9,600 Nil. 28th „ 4,200 ,, ,, ,, 3,400 ,, 29th June 440 ,, ,, ,, 1,900 ,, ,, ,, 13,000 ,, 30th October 740 ,, 23rd July 3,500 ,, ,, ,, 2,230 ,, ,, ,, 17,000 Present. ,, ,, 1,900 ,, ,, ,, 2,090 Nil. The above results, except those marked with an asterisk, were forwarded to the Minister of Health at whose request the samples were taken. " Grade A (Tuberculin Tested) Milk." Sample collected on Bacteria Coli per per 1 c.c. l/100th c.c. Sample collected on Bacteria Coli per per 1 c.c. l/100th c.c. 22nd January ... 230 Nil. 19th June 3,100 Nil. 12th March 620 „ 30th October ... 2,600 " Pasteurised Milk." Sample collected on Bacteria per 1 c.c. Sample collected on Bacteria per 1 c.c. 22nd January ... 890 26th March 2,400 ,, ,, 360 28th 6,500 14th February 14,100 9th April 7,200 99 99 17,800 10th „ 7,600 99 99 ... . 1,130 16th „ 13,500 99 99 1,270 9t 99 10,600 99 tt 1,950 19th June 3,200 12th March 12,500 8th August 69,000 22nd ,, 11,200 13th 12,600 ,, ,, 10,600 ,, ,, 28,000 ,, ,, 31,200 3rd September 35,000 26th „ 3,820 30th 86,000 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 recent years was maintained in 1935. Bacteriological Examination of other Milk.—No bacteriological standards exist for milk which is not sold under a special designation, but as a matter of interest and in order to ascertain the degree of purity of " ordinary " milk sold in the borough, a number of samples were taken at random from Kensington retailers. Of the 53 samples so taken, 30 contained less than 30,000 bacteria per c.c., 19 others less than 100,000 per c.c., whilst in two cases only was the maximum number of organisms permitted in Grade A (T.T.) milk (i.e., 200,000) exceeded. These results are very satisfactory and are doubtless due to the widespread practice among London wholesalers of pasteurising all their milk supplies before passing them on to retailers. In this connection it is significant that the only sample found to contain tubercle bacilli in the borough during the year was one known to have been sold without being pasteurised. 48 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 carcasses immediately afterwards. During the year 43 slaughterhouse inspections were made. During 1935 nine beasts and 153 sheep were slaughtered in the borough. 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 in respect of the two Kensington slaughter-houses in 1934 were renewed for twelve months to 30th June, 1936. 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 respeect 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 1934, were renewed for 12 months to 30th June, 1936. 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 80 bakehouses in the borough, and of this number 57 are underground. As a result of 273 inspections which were made during the year, 34 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. The following is a summary of the alterations made in the council's register of food premises during 1935 :— On register Dec. 31, 1934. Added to register during 1935. On register Dec. 31. 1935. Manufacturers of ice-cream 82 6 88 Storage and sale of ice-cream 118 14 132 Butchers' shops, including premises used for manufactu of sausages and the preservation of meat 103 103 Cooked meat shops 75 75 Fishmongers' shops—premises used for the purpose cooking or curing fish (excluding fried fish shops) 19 19 Fried fish shops 42 42 Totals 439 20 459 Under section 6 of the Act, power is given to the London county council to make by-laws in regard to food premises but so far none has been issued. Inspection of Food Premises.—In addition to the premises dealt with above, other places in the borough where food is prepared or exposed for sale are required to be kept in accordance with the provisions of the London County Council (General Powers) Act, 1908. There were, in addition to the inspection of dairies, etc., mentioned above, 2,576 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. Orders which have so far been made in regard to imported foodstuffs relate to honey, fresh apples, currants, sultanas, raisins, eggs in shell, dried eggs, oat products, raw tomatoes, frozen and chilled salmon and sea trout, butter, bacon, ham, poultry, chilled beef and frozen mutton and pork. 49 Frequent inspections were made throughout the year to ensure that the requirements of these Orders were observed. In one instance, one of the council's inspectors saw seventeen turkeys exposed for sale on a stall, five of which bore show tickets marked with the word " English." Upon examination all the birds were found to be of foreign origin and in each case the " indication of origin " disc had been removed. The proprietor stated that he had not removed the discs, but when his store was examined discs marked " foreign " were found in the dustbin. Proceedings were taken and fines amounting to £6 were imposed. In several other instances imported tomatoes exposed for sale were not properly marked and notices were served 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 were made but no offences were observed in 1935. 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. Particulars of offences occurring in Kensington during the past year together with the results of action taken are as follows:— Offence. Action taken. Exposing for sale unsound figs Proceedings. Fined £2. „ „ „ chickens ,, ,, £10 and £l Is. Od. costs. Depositing ,, ,, ,, ... ... Trader cautioned. 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 :— Beef (lbs.) 180 Grouse 60 Chickens 7 Meat (stones) 125 Fish (lbs.) 28 Meat, tinned (tins) 22 Fish roe (lbs.) 40 Milk, tinned (tins) 18 Fish, tinned (tins) 38 Pears (lbs.) 352 Fruit, bottled (bottles) 101 Potatoes (cwts.) 87 Fruit, tinned (tins) 648 Tomatoes (lbs.) 84 Grapes (boxes) 7 Vegetables, tinned (tins) 49 Greengages (lbs.) 50 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 644, of which 22 or 3- 4 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. 50 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 12 _ Arrowroot 2 — — Bacon 3 — — Beef, pressed — — 1 Brawn 6 — 2 Bread and butter — — 1 Butter 37 — 14 Cakes 6 — 1 Cakes, fish — — 2 Cakes, sponge 9 — — Cheese 27 — 6 Cherries, glace — — 1 Cocoa 7 — 3 Coffee 13 — 1 Cordial, fruit — — 3 Cornflour — — 1 Crab, dressed, tinned — — 1 Cream 13 — 6 Cream, confectionery o 2 13 4 Cream, butter — — 1 — Dripping 13 1 7 — Essence, coffee and chicory — — 1 — Figs, dried — — 1 — Fish, tinned 3 1 8 2 Flour 3 — 1 — Fruit, dried 6 — — — Fruits, crystallised — — 1 — Gin 2 1 — — Ginger, ground — — 3 — Ginger, preserved — — 1 — Ham 3 — — — Honey — — 8 — Ice-cream 6 — — — Iodine — — 1 1 Iodine ointment, stainless L 1 3 2 Iodine paint — 1 — Iodine pencil — 1 1 Iodine, solution of — 1 1 Iodine, spirit of — 2 1 Jam — 4 — Jelly, glycerine and rose — 1 — Lamb, loin of — 1 — Lard 17 — 8 — Lardex — — 1 — Lemon barley — — 1 — Lemon curd — — 9 — Margarine 13 — 6 — Marmalade — 1 — Meat — 1 — Meat, minced 5 — 3 — Mincemeat — — 6 — Milk 305 8 109 4 Milk, condensed — — 9 — Mustard 6 — — — Mustard, prepared — — 2 — Oil, olive — — 2 — Paste, fish 15 — 13 — Paste, meat — — 1 — Peas, tinned — — 3 — Peel, candied — — 3 — Pepper 3 — 1 — Pie, meat — — 2 — Pork — — 4 — Powder, gregory 2 — — — Powder, lemonade 6 — — — Powder, liquorice — — 3 — Powder, soap — — 1 — Prawns — — 1 — " Preservative " — — 1 — Prunes — — 4 — Carried forward 547 14 298 16 51 Nature of Sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Brought forward 547 14 298 16 Rice 6 — — — Roes, herring — — 1 — Sago 1 — 1 — Sardines — — 3 — Sausage roll — — 1 — Sausages 35 2 17 3 Saveloys — — 1 — Semolina — — 2 — Sponge mixture — — 1 — Suet, shredded 6 — — — Sugar, icing — — 3 — Sugar, pudding — — 1 — Sulphur, milk of — — 3 — Sweets 6 — 3 — Tapioca 6 — — — Tea 2 — — — Tomato, condensed — — 3 — Tomato puree — — 1 — Vermicelli, egg — — 1 — Vinegar 25 6 11 2 Vinegar, malt 6 — — — Whisky 4 — 3 — Wine — — 2 — Totals 644 22 356 21 52 The following is a summary of the results of analysis of the 43 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— Cream slices The filling was not cream Proceedings. Summons with drawn. ,, ,, ,, ,, Informal sample. Cream doughnuts ,, ,, Proceedings. Summons withdrawn. ,, ,, ,, ,, Informal sample. Cream-filled chocolate slices ,, ,, ,, ,, Cream layer cake ,, ,, ,, ,, Dripping 4.3 per cent, of water Vendor cautioned. Fish, tinned 65 parts of formaldehyde per million. Proceedings. Fined £2 and 10s. 6d. costs. ,, ,, ,, Informal sample. ,, 10 parts of lead, and 150 parts of tin per million. ,, ,, Gin 37.8 degrees under proof Proceedings. Summons dismissed on payment of £1 Is. costs. Iodine Consisted of a 1.75 per cent. solution of iodine. Informal sample. Iodine ointment, stainless 66 per cent,.deficient of iodine Proceedings. Summons dismissed on payment of 5s. costs. II II 60 Informal sample. II II 12 „ ,, ,, ll ll Iodine pencil 20 „ ll ll Iodine, solution of 80 per cent deficient in both iodine and potassium iodide and 50 per cent, deficient in alcohol. ll ll Iodine, spirit of Prepared wholly or partly with mineralised methylated spirit. ll ll Milk 50 per cent, deficient of fat ll ,, ,, ,, ,, ,, ,, ,, ,, ,, Vendor cautioned. If ,, 8 „ added water Informal sample. II 8 ,, ,, ll ll II ,, 3.7,, ,, Vendor cautioned. „ 3*6 „ I, ,, ,, ,, ,, 3.0 „ ,, ,, II ,, ,, ,, ,, ,, ,, 2 parts of formaldehyde per million. Proceedings. Fined £2 and £3 3s. costs. ,, 3 parts of formaldehyde per million and 1 per cent, added water. Proceedings. Fined £2. ,, 3 parts of formaldehyde per million. No action. Sausages Presence of preservative not declared. Vendor cautioned. ,, II II II ll ,, II II Informal samples. ,, II ll ll ll „ ll ll ll ll Vinegar 54 per cent, of required acetic acid deficient. Proceedings. Fined £1 and 10s. 6d. costs. 42.5 Proceedings. Dismissed on payment of 14s. costs. ,, 26.5 ,, Proceedings. Fined 5s. and 10s. 6d. costs. ,, 136 II II II II II 13 Informal sample. ,, 3.75 „ |,, Vendor cautioned. ,, 3.75 „ ll ll ,, 1 Informal sapmle. The total number of prosecutions under the Food Druges (Adullteration) Act, was eleven the fine and costs amounting to £1415s. 53 The addition of preservatives to milk has been prohibited throughout the country since 1912 and the instances reported above are the first contraventions discovered in Kensington for many years. Two of the samples were taken the same day from different vendors, but subsequent enquiries revealed that the vendor of one had been supplied by the vendor of the other. Two days later another sample was obtained from the latter vendor and this was also found to contain formaldehyde. On this occasion the sampling officer inspected the premises and found a bottle containing fluid which upon analysis proved to be a solution of formaldehyde. The proceedings taken are indicated above. The Public Health (Condensed Milk) Regulations, 1923-27, and the Public Health (Dried Milk) Regulations, 1923-27.—During the year, nine samples of condensed milk were taken, and each was found to comply with the regulations in every respect. No samples of dried milk were examined. Food Poisonimg.—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, 490 cases were notified in London. The number notified in Kensington was 23 ; there were 15 in the Golborne ward, six in the St. Charles ward, and two in the Norland ward. It will be observed that all the Kensington cases occurred in the northern part of the borough, where the majority of the poorer residents live. Not a single case was reported from South Kensington. 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. Egg 1 Fish 6 Fish paste 2 Ham 2 Ham, tinned 1 Ice-cream 1 Meat pie 1 Pork and pork preparations 5 Pressed beef 1 Salmon, tinned 1 Sausages 1 Saveloy . 1 It is also worthy of mention that in every case the illness was a mild one, and the patient recovered in a day or two. There was no outbreak of food poisoning in the borough and many of the cases notified must be regarded as suspicious rather than as actual cases of food poisoning. Pharmacy and Poisons Act, 1933.—This Act which has for its object the closer control over the sale of poisons and poisonous substances than was formerly the case, was passed in 1933 to come into operation on the " appointed day." An Order in Council, dated 6th June, 1935, fixes this day as 1st January, 1936, in respect of certain provisions and 1st May following in respect of the remainder. The Act prescribes the preparation by a Poisons Board of a poisons list divided into two parts and called part 1 and part 2. Part 1 contains the names of those poisons usually known as deadly and which in future may be sold only by registered pharmacists, and part 2 contains those commonly in use for domestic, horticultural, agricultural and sanitary purposes and which may be sold not only by registered pharmacists but also by traders whose names are entered in a local authority's list of persons entitled to sell such poisons. The Act also provides that rules must be made by the Secretary of State ; these rules have been made and come into operation on the 1st May, 1936. It will be the duty of the council to enforce the new requirements so far as they relate to the sale of part 2 poisons and for this purpose they have appointed the medical officer of health, the deputy medical officer of health and the food inspector as inspectors under the Act. 54 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 1931-35. Year. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. P. m'itis 3c polioence phalitis. JAcute rheumatism. Cerebro spinal meningitis. Dysentery. •Enteritis. Total. 1931 2 385 222 16 61 13 8 61 253 I I 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 1935 — 304 338 7 63 11 7 30 136 5 2 1 28 2 6 39 999 Cases of mistaken diagnosis are excluded from the above table. + Acute rheumatism in children under 16 years of age became notifiable in Kensington in 1927. It is also notifiable in Paddington and Holborn. * Zymotic enteritis in children under 5 years of age became notifiable in Kensington in 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 1935, arranged in Four-Weekly Periods (1st January, 1935, to 29th December, 1935). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Polio myelitis. Total. January 26 25 46 1 8 3 1 3 9 - 4 - - 2 I 103 February 23 — 22 28 5 1 2 7 14 1 2 1 2 2 87 March 23 — 24 37 4 2 16 1 3 1 88 April 20 — 26 36 1 2 1 1 3 20 4 5 99 May 18 — 17 27 6 3 12 1 1 5 72 June 15 — 18 20 5 1 1 8 2 1 5 61 July 13 — 11 17 — 2 — 2 5 3 10 50 August 10 16 20 2 6 1 1 5 1 6 58 September 7 — 14 16 5 1 3 2 12 __ 53 October 5 — 30 24 1 3 2 3 8 1 5 77 November 2 — 32 24 1 2 1 1 10 1 1 3 3 79 30 — 41 23 1 4 1 2 4 1 3 2 — 82 December 28 — 28 20 — 11 1 — 23 1 3 1 1 1 — 90 Totals — 304 338 7 63 11 7 30 136 5 2 28 2 6 59 1 999 Cases of mistaken diagnosis are excluded from the above table. 55 A table, showing the numbers of cases of infectious disease notified in the various age periods, notified in the various wards, and admitted to hospital, and the deaths from these diseases during the year, will be found in Appendix II on page 72 of this report. Smallpox.—No case of smallpox occurred in London. At various times during the year there were 23 persons in Kensington who had been in contact with cases of smallpox in other parts of the country or on board ships. These contacts were kept under daily observation until all possibility of the development of the disease had disappeared. Scarlet Fever.—The number of cases notified was 331, of which 312 were removed to hospital. Twenty-seven 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 :— 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 1,081 964 897 873 762 975 641 709 627 821 1,064 1,010 857 The Borough 25 22 24 26 17 18 11 16 14 30 32 42 28 North Kensington 20 13 19 19 9 10 8 11 10 26 29 30 25 South Kensington Wards. 5 9 5 7 8 8 3 5 4 4 3 12 3 St. Charles 13 3 6 6 3 5 3 4 6 9 13 12 10 Golborne 2 4 7 9 2 3 1 1 — 9 1 5 3 Norland 2 3 1 4 3 — 3 5 4 6 5 9 6 Pembridge 3 3 5 — 1 2 1 1 — 2 10 4 6 Holland — — 1 2 2 1 — 1 1 2 — 1 — Earl's Court 1 5 2 2 2 1 — 1 — — 1 4 — Queen's Gate 2 o — 2 — — — 1 — — 2 Redcliffe 1 2 1 — 3 3 1 2 3 1 — 5 — Brompton 1 2 1 1 1 1 2 1 2 1 1 Cases of mistaken diagnosis are excluded from the above table. The number of cases was 247 fewer than in the previous year, and the disease remained mild in type. There was one death, and in the three preceding years the numbers were three, one and three respectively. There were 24 instances where more than one case occurred in the same house. Five of the 304 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 five, with a view to ascertaining the source of infection. 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, but during the year no expenditure was incurred in respect of this service. Diphtheria.—Three hundred and sixty-seven cases of diphtheria were notified, 364 of which were removed to hospital. Twenty-nine patients notified as suffering from diphtheria were found after admission to hospital not to be suffering from any infectious disease at all, with the result that they were returned home. Ihe loilowmg table snows tne number ot cases notinea in tne various wards in each four-weekly period :— 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 1,149 1,005 829 761 669 541 505 544 474 706 776 813 639 The Borough 46 28 37 36 27 20 17 20 16 24 24 23 20 North Kensington 39 22 35 32 24 16 17 19 16 22 23 22 16 South Kensington Wards. 7 6 2 4 3 4 1 2 1 1 4 St. Charles 17 10 12 16 10 12 7 10 10 11 7 13 9 Golborne 8 6 11 7 5 — 4 2 4 5 8 5 3 Norland 10 3 10 6 4 4 4 6 2 3 5 4 4 Pembridge 4 3 2 3 5 — 2 1 — 3 3 — Holland 4 1 1 1 2 — — — — 1 — — — Earl's Court 1 1 1 2 — 1 1 — — — — 1 Queen's Gate 2 1 — — 1 3 — — — — 1 — — Redcliffe — 2 — 1 — — — — 1 — 1 1 Brompton 1 2 Cases of mistaken diagnosis are excluded from the above table. 56 There were 34 instances where more than one case occurred in the same house. The number of Kensington deaths was 19, representing a case mortality of 6 per cent. In the preceding years the deaths were 14, 22 and 29. During the year, 1,699 throat swabs were examined at the council's laboratory at Princess Louise Hospital, and of these 95 gave a positive result. There were no " return " cases reported. Three cases of diphtheria were reported from St. Mary Abbots Hospital, 46 from St. Charles Hospital, four from the Kensington Institution, and 17 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 doctor 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 antitoxin is obtainable at all hours of the day and night from Mr. Evans's and Mr. Reeves's premises, and during office hours from the town hall. When the town hall is closed, applications for antitoxin can be made to Mr. Britton, an officer of the department, who lives at No. 1, Hornton Place, Horrnton Street (only a few yards from the town hall). The council lend 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 1935 the borough council supplied 520,000 units of anti-toxin for 41 patients at a cost of £31 19s. 6d. The borough council undertake to supply toxoid-antitoxin for the Schick test and immunisation to any doctor 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 is obtained. During 1934 the council introduced a scheme whereby doctors can immunise poor patients against diphtheria in return for a fee of 10s. paid by the council in respect of each patient, and full details of the scheme appeared in my report for that year. Particulars of the work carried out during 1935 appear on page 60 of this report. Enteric Fever.—Seven cases of this disease were notified ; five were removed to hospital and two to nursing homes. The cases notified in the three preceding years were 7, 11 and 14. There was one death from this disease as against none and two in the preceding years. Five cases were notified from South Kensington and two from North Kensington. In two cases there was evidence that the disease had been contracted abroad ; two contracted the disease during a visit to the country ; but the remaining three had not been out of Lodnon for some time prior to their illness. Erysipelas.—Sixty-three cases were notified, 32 of which were removed to hospital. There were three deaths from this cause, the deaths in the three preceding years being eight, ten and seven. Ophthalmia Neonatorum.—-The following table gives particulars of ophthalmia cases notified and the results of treatment:— Case No. Cases. Vision unimpaired. Vision impaired. Total blindness. Death. Notified. Treated. At home. In hospital. 1934 1 Dec. 31 — Yes Yes — — — 2 Dec. 31 Yes — Yes — — — 1935 3 Jan. 3 — Yes Yes — — — 4 Feb. 6 Yes — Yes — — — 5 Mar. 29 Yes — Yes — — — 6 Aug. 7 — Yes Yes — — — 7 Sept. 17 Yes — Yes — — — 8 Oct. 3 Yes — Yes — — — 9 Oct. 11 Yes Yes — — — 10 Nov. 23 Yes Yes — — — 11 Dec. 9 Yes Still under treatment From the above table, it will be seen that ten cases recovered without any injury to sight ; and one case is still under treatment. 57 Puerperal Fever.—Seven cases of this disease were notified. Two were confined at home, were subsequently removed to the North-Western Hospital, and recovered ; one was confined at home, was subsequently removed to Queen Charlotte's Hospital, and recovered ; one was confined in Paddington Hospital, and recovered ; one was confined in St. George's Hospital, and recovered ; one was confined in the Elizabeth Garrett Anderson Hospital, and recovered ; and one was confined in St. Mary Abbots Hospital, and died. Puerperal Pyrexia.—Thirty cases of puerperal pyrexia were notified. Twenty-one occurred in hospitals to which the patients had been removed prior to their confinements, and nine in the homes of the patients. Of the nine confined at home, six were subsequently removed to hospital for treatment, and the remaining three 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 specialist at Queen Charlotte's Hospital, to the position of consulting gynaecologist and obstetrician. For these services, Dr. Morris Johns receives a fee of three guineas for each case attended by him on behalf of the council as gynaecologist or obstetrician. Malaria.—Five cases of this disease were notified, and investigations revealed that in each case the disease had been contracted abroad. Encephalitis Lethargica.—There were two cases reported in Kensington. The patients were males aged 67 and 4| years. The cases were notified on the 30th September and 25th October, and both are still under treatment. Poliomyelitis and Polio-Encephalitis.—One case of poliomyelitis was notified to the public health department. The patient was a male aged 3| years, who recovered after treatment at home. Cerebro-spinal Meningitis.—There were two cases of this disease notified; particulars are subjoined :— No. Sex. Age. Date of notification. Result. 1 Male 31 February 16 Died. 2 Male 5 months December 28 Died. Pneumonia and Influenzal Pneumonia.—There are many forms of pneumonia, but the only kinds notifiable are acute primary pneumonia and influenzal pneumonia. One hundred and thirty-six notifications were received, 97 patients being certified as suffering from acute primary pneumonia and 39 from influenzal pneumonia. The number of deaths from pneumonia was 122, and 31 deaths were certified to be due to influenza. Zymotic Enteritis or Summer Diarrhcea.—Fifty-nine cases of zymotic enteritis were notified, and there were 55 deaths of children under the age of one year from diarrhcea or enteritis. Forty-five 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 diarrhcea. From 1924 until 1934, the scheme was in operation for the summer months only, but during the past two years it 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 :— Zymotic Enteritis Scheme, 1935. Infective enteritis occurred in a few isolated cases in which the temperature was high, but the majority of cases were caused by dietectic disorders and catarrhal conditions associated with nasal catarrh as the primary cause, the intestines being affected secondarily ; a few cases were asosciated with bronchial catarrh. I attended 38 cases in their homes and paid 175 visits. I sent one case to hospital; it ultimately developed pneumonia and died. This was the only death that occurred. There were no cases with blood and mucus in the stools. I saw no cases of dysentery. In a considerable number of young infants which were being fed on artificial food, the amount of food given was excessive in relation to their age and weight. This was particularly so when dried milk was given. In many instances great care had to be exercised in adjusting the diet to the child's requirements. 58 District Nursing Association. The nurses attended 72 cases and paid 750 visits. They sent 5 cases into hospital; one died (referred to above) and four recovered. No death occurred in the home while the nurses were in attendance. The full routine treatment was carried out in 38 cases. Rectal washouts were given in 29 cases. Eight doctors availed themselves of the nurses' assistance in their cases. Health Visitors' Notes. There were 59 notifications during the year. The severe cases numbered 29, and those which had a mild attack numbered 30. There were 38 infants under one year of age, and 21 aged one year and over. Infection in Families. Two cases of diarrhoea occurred in each of two families. In all the other notifications, the patient was the only case in the family. In three instances two cases occurred in the same house. Diet. In the majority of cases, the food which was most frequently associated with diarrhoea was ordinary fluid cows' milk. (Signed) Ronald Carter. Dysentery.—Six cases of dysentery were notified. Three were of the amoebic type and three were infected with the Sonne organism. Two of the cases of amoebic dysentery were contracted abroad. Two of the Sonne cases occurred in private houses and were treated at home ; the third case was contracted in hospital. Acute Rheumatism.—Twenty-eight cases were notified. During the year 31 children suffering from this disease were removed to hospital for treatment. The seventh annual report on the working of the rheumatism scheme during the period 1st October, 1934, to 30th September, 1935, 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. Non-notifiable Diseases. Measles.—There were no deaths from measles in Kensington. The women health officers paid 68 visits to measles patients. Thirty-seven cases were removed to the London county council hospitals. Whooping cough.—There were three deaths from this cause. The deaths in the three preceding years were 26, 10 and 36. The women health officers paid 319 visits to cases of this disease. The number of cases admitted to hospitals from Kensington was 117. In 1930, the council authorised the medical officer of health to open special whooping cough clinics if the disease appeared in epidemic form in the borough, and for this purpose a sum of £100 has been provided in the council's estimates each year. 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 1935. Cleansing of Verminous Persons. The cleansing of verminous persons is carried out at the medicinal baths, Blechynden Mews. The record of work done is as follows :— Scabies— Total cleansings. Adults 315 School-children 502 Children under five years 123 Common lodging-house cases 1 Verminous conditions— Adults 48 School-children 3,233 „ „ (impetigo and vermin) 685 Children under five years 13 Common lodging-house cases 73 Other conditions— Adults 8 School-children — Common lodging-house cases 100 Total 5,101 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 11,931 articles were so dealt with and, in addition, 653 blankets and sheets, and 353 articles of night clothing. Of the 4,420 school children cleansed at the medicinal baths, only 438 were compulsory cases ; the remainder attended voluntarily. 59 Disinfestation. Disinfestation of furniture, etc., with hydrocyanic acid gas. In the last annual report there was a detailed description of the steps taken by the council to prevent the transference of vermin from old bug-infested houses to new housing estates. The method adopted in the borough is as follows :—Specially constructed steel vans, built to the specification of Imperial Chemical Industries, Ltd., are used. These are of welded steel with sliding doors bolted in position, and are fitted with electrical heaters, hydrocyanic acid vaporisers, and connections to exhaust duct and chimney at the disinfecting station at Wood Lane. All persons who are allocated flats under the rehousing scheme are notified that fumigation of all their effects must be carried out before they take up occupation of their new home. At least a week's notice is given of the date and time of removal. On the appointed day the council's van arrives at the old house at about 8 a.m., when all furniture and effects which the people decide to have removed to the new house are loaded on to the vehicle. The van goes to the council's Wood Lane depot, where all bedding is removed and taken to the steam disinfecting station to be treated by steam, after which hydrocyanic acid is introduced into the van. The van remains charged with the gas for two hours, and is then ventilated for at least four hours, after which the contents are chemically tested for residual gas. As soon as they have been pronounced clear the steamed bedding is loaded and all effects are taken to the new house. It has been found desirable, in order to avoid any possibility of accident, to retain all upholstered articles overnight in a warm, well-ventilated room, and return them to the owners the next day. During 1935 the disinfestation work has been fairly heavy. One hundred and thirty-eight loads of furniture from Kensington families were treated at the Wood Lane disinfesting station, and in addition a good deal of work has been done for neighbouring boroughs (Marylebone, Fulham and Hammersmith) with whom the council made formal agreements for disinfestation of furniture in connection with slum-clearance schemes. A charge of three guineas was made to these boroughs for each load of furniture dealt with. The numbers of loads disinfested under the agreements were— Marylebone 107, Hammersmith five, and Fulham one. In addition, 11 loads were treated for the Islington and Finsbury Housing Association. The Treatment of Verminous Dwellings. The year's work in fumigating verminous dwellings has been beset with difficulties. Hydrocyanic acid gas is an unsuitable fumigant for houses, but fumigation with orthodichlorbenzene achieved a high degree of success. It was found that orthodichlorbenzene possessed certain advantages which made it a most useful fumigant. The contact effect of orthodichlorbenzene at all stages of life of the bed-bug is very great ; the vapour of orthodichlorbenzene kills eggs, nymphs and adult bed-bugs in positions where no ordinary contact sprays can reach them ; orthodichlorbenzene vapour possesses the remarkable effect of causing bugs to bolt from their hiding places into the open, and so be killed more quickly. During the year, however, queries were raised by the government chemist and others as to the effect of orthodichlorbenzene on operators and persons who inhabit rooms immediately after fumigation with the substance, with the result that its use has been suspended pending the results of further research. It may be said here that fumigations with orthodichlorbenzene were a complete success in Kensington, as may be instanced by the results on one housing estate alone, where vermin infestation of nearly 70 per cent, was reduced to less than 3 per cent. in 12 months. Operators employed by the council have always been adequately protected from fumes by gas masks, and treated premises have generally not been occupied until they have been ventilated for at least 18 hours. The council's officers are at present working hard to try to evolve a formula which will enable the disinfestation of verminous dwellings to be carried out safely and successfully. The number of verminous premises treated with orthodichlorbenzene, sulphur and other chemicals during the year was 783, the total number of rooms being 1,181. In addition to this work, which is carried out by the disinfecting staff, 527 verminous houses were cleansed by landlords in response to notices served under the London County Council (General Powers) Act, 1922. The following is a summary of the disinfestation work carried out :— No. of families whose furniture was removed and treated with hydrocyanic acid 393 No. of Kensington cases 159 „ St. Marylebone cases 213 „ Hammersmith cases 5 „ Fulham cases 1 „ Islington and Finsbury cases 15 Weight of furniture so treated 269 tons 18 cwt. Weight of bedding disinfected by steam 24 tons 19 cwt. 1 qr. 24 lb. No. of articles treated in steam disinfector 5,269 Mattresses and flock beds 932 Bolsters and pillows 1,448 Blankets and sheets 1,267 Sundries 1,662 60 Premises. Rooms. No. of houses treated with orthodichlorbenzene and other chemicals 238 437 No. of houses treated with sulphur 505 744 Bedding and clothing removed to Wood Lane and disinfested by steam in connection with the sulphur treatment of rooms Disinfestations 183 Articles 2,489 Disinfection after Infectious Diseases, etc. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1935. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Smallpox — — — — Scarlet fever 335 382 395 6,326 Diphtheria 324 335 327 3,924 Enteric fever 8 8 47 718 Measles 52 54 12 159 Consumption 184 229 196 1,791 Cancer 52 57 106 1,010 Other diseases 372 402- 319 3,357 Totals 1,327 1,467 1,402 17,285 This table does not include the work carried out at Wood Lane on behalf of the Paddington borough council. The total weight of the bedding, clothing, etc., of Kensington residents disinfected was 45 tons 19 cwt. 2 qr. 10 lb. The number of articles disinfected only was 18,969 and the number disinfected and washed, 805. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved the washing of 11,547 towels, 357 sheets and 169 other articles. The Paddington authority have entered into an agreement with the council for the disinfection of all articles removed from Paddington homes to be performed at the Kensington disinfecting station. As the Paddington council require certain of the articles to be washed after disinfection the charge was fixed at 20s. per cwt. of articles dealt with, but there is a proviso in the agreement that the minimum payment per annum is to be £600. The weight of Paddington articles disinfected was 17 tons 15 cwt. 3 qr. 12 lb. The number of articles disinfected only was 6,304 and the number disinfected and washed was 1,564. 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 by the officers of the public health department was 131. The number of private subscribing library books destroyed was 32, and the number disinfected by formalin and returned to the householders was 25. Diphtheria Immunisation. The council's diphtheria immunisation scheme, under which doctors practising in the borough carry out immunisation of children on behalf of the council, worked successfully during 1935. It was found necessary during the year to make a slight modification in the scheme, for it came to notice that cases occurred where doctors had given one or two injections but were unable to give the third, as a result of the removal of the patient to another district, or for some other reason. In order that doctors should not be out of pocket to the extent of the cost of the injections given, the council authorised payment for the material used in partially immunised cases, provided that the doctors had used their best efforts to give the three doses. During 1935, 1,476 children were immunised. From the beginning of the cheme on the 1st May, 1934, to the 31st December, 1935, 2,318 children have been immunised. Under the scheme, a schick testing clinic is conducted by Dr. Guy W. J. Bousfield at No. 28b, Archer Street on Friday mornings. A Schick test to ascertain whether the child is susceptible to diphtheria or not is performed when desired on children prior to immunisation and during the year the total number of children attending for pre-immunisation schick tests was 149. Seventy-nine gave positive reactions, 66 were negative, and 4 failed tojreattend for the reading. Every effort is made to schick test all children who have been immunised, and 1,442 children attended for this purpose. A negative test was obtained in 1,373 children, 11 remained positive, and 58 failed to reattend for the reading. These results are satisfactory as less than one per cent, were found positive after receiving one course of immunising injections. 61 TUBERCULOSIS. In August, 1935, Dr. A. W. K. Picard, assistant medical officer of health and tuberculosis officer, retired. He was appointed in 1921. During his term of office, he must have gained much satisfaction in noting the steadily decreasing incidence of such a devastating disease. This decrease is still continuing, and the following table shows the age and sex distribution of the cases notified and the deaths from all forms of this disease during the year :— Age periods. New cases. Deaths. Pulmonary. Non-pulmonary Pulmonary. Non-pulmonary M. F. M. F. M. F. M. F. Under 1 — — 1 — 1 — — — 1-5 — 1 3 2 — — — 1 5-10 1 — 4 3 — — — 1 10-15 1 1 2 — — — 1 — 15-20 7 9 1 — 2 1 — — 20-25 12 11 1 1 3 6 1 — 25-35 21 23 1 4 14 9 1 — 35-45 16 14 — 3 10 7 1 — 45-55 20 4 — 1 8 4 — 1 55-65 7 3 2 — 5 2 — 1 65 and over 4 1 — 1 4 2 1 2 Totals 89 67 15 15 47 31 5 6 Primary notifications of persons notified during life to be suffering from tuberculosis. There has been during the year a very definite decrease in pulmonary forms in females, and also a definite fall in the non-pulmonary forms in both sexes—the decrease is evident both in new cases and in deaths from the disease. The following table shows the incidence of the disease in the borough during the year :— Pulmonary. Non-pulmonary. Males. Females. Males. Females. No. of cases on the register of notifications on 1st January, 1935 329 319 156 165 = 969 No. of cases notified for the first time during the year 89 67 15 15 = 186 No. of cases brought to notice otherwise than by notification 24 17 6 7 = 54 No. of cases removed from the register during the year on account of having :— (a) been cured 11 20 22 21 = 74 (b) removed from district 94 77 28 34 = 233 (c) died 46 34 4 4 = 88 (d) been inaccurately diagnosed 13 13 6 3 = 35 No. of cases remaining on the register on 31st December, 1935 278 259 117 125 = 779 The following table shows over the past ten years the incidence of the disease, as registered by notifications of cases, and deaths :— Year. Pulmonary tuberculosis. Non-pulmonary 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. 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 1935 156 78 44 30 11 6 89 50 62 The following table shows the number of cases of all forms of the disease notified in the borough and the several wards therein during each year since 1926. District. Years. 1926. 1927. 1928. 1929. 1930. 1931. 1932. 1933. 1934. 1936. The Borough 317 252 276 241 260 245 260 236 229 186 North Kensington 227 166 179 156 178 149 174 148 142 112 South Kensington 90 86 97 85 82 96 86 88 87 74 Wards. St. Charles 50 39 48 39 56 49 55 46 48 40 Golborne 69 53 57 41 46 40 48 43 41 17 Norland 59 44 49 43 42 31 42 35 29 28 Pembridge 49 30 25 33 34 29 29 24 24 27 Holland 20 11 25 20 21 17 25 17 17 23 Earl's Court 25 25 20 21 19 23 17 29 21 11 Queen's Gate 15 10 11 7 8 9 8 10 12 9 Redcliffe 22 25 26 25 20 32 24 20 24 22 Brompton 8 15 15 12 14 15 12 12 13 9 The fall in the incidence of the disease is chiefly noted in the northern part of the borough where the number of cases has fallen by 50 per cent. during the ten years as compared with 18 per cent. in South Kensington. This is all the more pleasing as North Kensington is the area where the majority of the population is of the working classes and where the factors stated to be conducive to the incidence and spread of the disease are more prevalent. It is noteworthy that during the past decade a fall of 73 per cent. is noted in deaths from nonpulmonary forms as compared with a fall of 39 per cent. in pulmonary forms. The incidence of the non-pulmonary forms is chiefly in the younger sections of the population and much credit for this decrease must be given to the valuable work of the maternity and child welfare and school medical officers in the borough. Not only was the number of notifications in 1935 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 1935 Allocated to District of Usual Residence of Patients. Pulmonary tuberculosis. Non-pulmonary tuberculosis. The Borough 78 11 North Kensington 47 9 South Kensington 31 2 Wards. St. Charles 18 2 Golborne 6 3 Norland 15 1 Pembridge 8 3 Holland 8 1 Earl's Court 7 — Queen's Gate 2 — Redcliffe 8 1 Brompton 6 — The places where deaths from tuberculosis occurred are set forth in the following list Pulmonary tuberculosis. Non-pulmonary tuberculosis. Patient's home 19 — St. Mary Abbots Hospital 16 1 St. Charles Hospital 27 5 Princess Beatrice Hospital 1 Brompton Hospital 3 — Outlying hospitals 9 — Other places outside the borough 3 5 63 Public Health (Prevention of Tuberculosis) Regulations, 1925.—These regulations were introduced with a view to :— (1) preventing persons suffering from pulmonary 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. 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 is shown in the following table:— Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for first time 181 247 123 103 654 New cases with pulmonary tuberculosis 68 57 5 2 132 (20.2 per cent.) New cases with non-pulmonary tuberculosis 3 8 9 2 22 (3.35 „ ) New cases still under observation 2 6 4 2 14(2.15 „ ) New cases diagnosed as nontuberculous 108 176 105 97 486 (74.3 „ ) There was a decrease of 12 in the number of pulmonary cases seen at the dispensary compared with the preceding year. The total number of non-pulmonary cases is 17 less than in 1934, being 22 instead of 39. There were 26 pulmonary cases and 8 non-pulmonary cases added to the dispensary register upon removal into the borough of patients from other districts, making 34 cases as compared with a total of 55 in 1934. 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 213. The treatment recommended for the cases diagnosed at the dispensary as suffering from tuberculosis, which numbered 154 (pulmonary 132 and non-pulmonary 22), was as follows :—institutional (hospitals, sanatoria or colonies) 141 ; domiciliary 9 ; dispensary supervision 4. The total number of attendances by patients at tne dispensary was 1,879. Tne number of visits paid by the tuberculosis officer was 66, of which 22 were consultations with the doctor in charge of the case. The total number of sputum examinations was 341, from 268 individual cases. Sixty-four specimens showed tubercle bacilli to be present, and 277 gave negative results. 64 An analysis of the register of the patients under dispensary supervision is shown in the following table:— Condition at the time of the last record made during the year to which the return relates Pulmonary Non-pulmonary Previous to 1935 1935 Previous to 1935 1935 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Bones and joints Abdominal Other organs Peripheral glands Total Bones and joints Abdominal Other organs Peripheral glands Total Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on dispensary register on 31st December. Disease arrested Adults M. 10 7 9 — 16 — — — — — 4 1 — — 5 — — — — — F. 14 1 4 — 5 — — — — — 1 2 — 1 4 — — — — — Children 6 — — — — — — — — — 7 1 — 14 22 — — — — — Disease not arrested Adults M. 24 32 56 11 99 18 9 21 4 34 9 — 1 4 14 2 — — — 2 F. 32 25 46 6 77 13 12 19 2 33 8 3 3 2 16 3 1 2 2 8 Children 15 3 1 — 4 3 1 1 — 2 18 10 4 31 63 4 — 1 4 9 Condition not ascertained during the year 21 7 6 4 17 — — — — — 18 10 4 12 44 — — — — — Total on dispensary register at 31st December, 1935 122 75 122 21 218 34 22 41 6 69 65 27 12 64 168 9 1 3 6 19 (b) Not now on dispensary register and reasons for removal therefrom Discharged as recovered Adults M. 4 — 1 — 1 — — — — — 1 — — 1 2 — — — — F. 9 2 2 — 4 — — — — — 3 — — — 3 — — — — — Children 9 — — — — — — — — — 5 5 1 19 30 — — — — — Lost sight of, or otherwise removed from dispensary register 68 27 32 8 67 9 — 4 — 4 17 11 6 23 57 — — — 1 1 Dead Adults M. 6 3 13 11 27 4 3 1 2 6 — — — — — — — 1 — 1 F. 1 4 9 9 22 1 1 2 2 5 — — — — — — — — — — Children — — — — — — — — — — — — — 1 1 — — 1 — 1 Total written off dispensary register during 1935 97 36 57 28 121 14 4 7 4 15 26 16 7 44 93 — — 2 1 3 Grand totals 219 111 179 49 339 48 26 48 10 84 91 43 19 108 261 9 1 5 7 22 65 X-Ray Diagnosis. Prior to 1932, x-ray examination work in connection with the diagnosis of tuberculosis was conducted free of charge at St. Mary Abbots Hospital, but in that year 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 examination, 7s. 6d. for the first photograph taken, and 2s. 6d. for each subsequent one. During the year, 119 x-ray examinations were conducted at the hospital at a total cost of 44 12s. 6d. During 1935, more use has been made of the x-ray facilities provided. They have enabled the tuberculosis officer to reach a diagnosis earlier and thus in cases where no definite evidence of the disease could be ascertained, the patients have been relieved of a considerable amount of anxiety. Home Visiting. The number of home visits paid by the council's women health officers during the year was 2,166. In addition to these, the various voluntary organisations represented on the after-care committee visit the homes when so desired by the after-care committee, but unnecessary duplication of visiting is avoided. 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 patient under observation has failed to keep an appointment, he is visited at home by a woman health officer, who gives him a definite appointment to attend at the dispensary. If he fails to keep this appointment further visits are paid for the same purpose and the patient's medical adviser is informed at an early date. Examination and Systematic Supervision of Home Contacts. There were 547 contacts traced by the dispensary service in 1935. Of these, 296 were examined one or more times by the tuberculosis officer, 90 were examined by their own doctors or had been recently examined at school, and 77 refused examination or failed to attend after three appointments had been given them. Eighty-four 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 1935. The work at the dispensary during the year is shown in the following table:— Dentist's attendances at the dispensary 52 Number of fillings 1 Number of individual patients treated... 39 Number of extractions 69 Patients' attendances 100 Number of dentures arranged for 14 Artificial Pneumothorax Treatment. In February, 1935, the London county council informed the metropolitan borough councils that facilities for the provision of artificial pneumothorax treatment could be made available at a number of their general hospitals, the refills to be provided at the request of the tuberculosis officer at a charge of 10s. 6d. per refill. The borough council decided to avail themselves of these facilities, but during the year the majority of the Kensington patients received refills at Brompton Hospital. Other cases which received the initial artificial pneumothorax treatment whilst resident in institutions returned to the same institutions for subsequent refills after discharge to their homes. In 1935 artificial pneumothorax treatment was provided in 20 cases at a cost of £126 10s. 6d. Home Nursing. The cases of tuberculosis attended and the visits paid by the nurses of the Kensington district nursing association during the past five years are shown in the following table:— Year. Cases. Visits. 1931 16 394 1932 30 1,094 1933 23 1,259 1934 32 1,319 1935 24 1.001 The nurses carry out their work splendidly and are very much appreciated by the poor. Supply of Extra Nourishment to Tuberculous Persons. Ten persons received extra nourishment during the year. The cost to the council for milk and eggs supplied was £4 19s. 6d. 66 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. Prior to July, 1934, a considerable portion of the work of the committee was the assessment of patients undergoing institutional treatment, but with the abolition of assessments by the county council the care committee have been able 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 1935, and at the end of the year two patients from Kensington were in regular attendance. 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 Bedding for Home Isolation. When it is found necessary to enable a patient to be isolated in his home and thus prevent the spread of infection, the council lend bedsteads and bedding for use in the home. In 1935, 31 patients had assistance under this heading for varying periods. The following is a list of the articles lent :— Bedsteads 24 Pillow-slips 64 Blankets 63 Quilts 29 Mattresses and covers ... ... ... 29 Pillows ... ... 60 Sheets ... ... ... 92 On the 31st December. 1935. the following articles of bedding were out on loan to 15 patients:— Bedsteads 12 Pillow-slips ... ... ... ... 32 Blankets 31 Quilts 14 Mattresses and covers 14 Pillows ... ... ... ... ... 29 Sheets 45 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 doctors. The following table shows the number of disinfections carried out during the year :— Cases where bedding, etc., was disinfected by steam ... 196 Number of rooms disinfected 229 Bacteriological Examinations. Specimens of sputum submitted by medical practitioners for bacteriological examination at the expense of the council:— Examined at the council's laboratory 339 Examined by the tuberculosis officer 341 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. 67 APPENDIX I. EIGHTH ANNUAL REPORT on THE KENSINGTON RHEUMATISM SCHEME (1st October, 1934—30th September, 1935) by JAMES FENTON, M.D., M.R.C.P., D.P.H., JANET K. AITKEN, M.D., M.R.C.P., and ALBERTINE L. WINNER, M.D., M.R.C.P. PART I. General by JAMES FENTON, M.D., M.R.C.P., D.P.H. The eighth year of work at the rheumatism supervisory centre of the Royal Borough of Kensington was completed on the 30th September, 1935. 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 1934-35 4 22 4 1 31 17 Totals 118 257 74 144 593 350 Dr. Lucy Elliott, the honorary assistant physician at the rheumatism centre, tendered her resignation in November, and the borough council appointed Dr. Albertine L. Winner in her place. Dr. Elliott had performed excellent work at the centre, and the rheumatism sub-committee were very sorry to lose her services. 68 PART II. The Work of the Centre by JANET K. AITKEN, M.D., M.R.C.P., and ALBERTINE L. WINNER, M.D., M.R.C.P. In the eight years 1927-35 during which the centre has been in existence, 1,707 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. Total new and old cases attending the centre during the last five years. 1930-31 1931-32 1932-33 1933-34 1934-35 Kensington 177 266 290 311 296 Hammersmith 40 47 51 45 39 Other borough 17 12 20 35 40 234 325 361 391 375 During the year 1934-35, 48 sessions have been held at the Princess Louise Hospital. Average attendance per session of Kensington patients 21.5 „ „ „ „ other „ 5.6 27. 1 The total number of attendances of patients during 1934-35 is as follows:— Kensington Notified cases (a) New 19 (b) Old 381 Unnotified cases (a) New 64 (b) Old 580 Hammersmith (a) New 10 (b) Old 124 Paddington (a) New 4 (b) Old 32 Ealing (a) New 5 (b) Old 32 Various boroughs (a) New 5 (b) Old 58 1,314 The new Kensington cases in 1934-35 were recommended to attend the clinic from the following sources :— Invalid Children's Aid Association 5 School medical officers 25 Princess Louise Hospital ... 17 Private doctors 12 Notifications 8 Parents 13 Infant welfare centres 3 • 83 The disposal of cases which attended the centre and which needed special treatment may be summarised as follows :— Tonsillectomy at Princess Louise Hospital 2 Admission to Princess Louise Hospital 27 Admission to other hospitals 4 Special schools 6 Special heart homes 4 Convalescent homes 28 Referred to massage department for special chest expansion exercises 7 78 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. 69 Clinical Report. During the year a study was made of a special series of cases with particular reference to the information obtained from the electrocardiograms. Thirty-five of these cases were children suffering from various manifestations of acute rheumatism, and, as a control, 35 cases with no clinical abnormality and, as far as could be detected, no abnormal cardiac condition. The following table shows the results in tabular form obtained from this investigation. Cases 1 to 35 are children definitely suffering from rheumatism, and cases 36 to 70 are the results obtained from those children used as a control. The electrocardiographics curve is empirically lettered P, Q, R, S, T. Abbreviations used in the following table :— Sl.L.A.D. = Slight left axis deviation. R.A.D. = Right axis deviation. M.S. = Mitral stenosis. A.R. = Aortic regurgitation. E.C. = Electrocardiogram. Electrocardiograms in Mitral Stenosis. Name. Sex. Presect age. First attack. First seen. MS. first noted. A.R. Date of E.C. Time of E.C. after M.S. first noted. Age at E.C. Active rheumatic carditis at date of E.C. Deviation. P waves. E.C. 1. J.A. M 13 1930 1.35 1935 0 1935 0 12 Act Sl.L.A.D. PI flat 2. H.A. M 12 1931 0.31 1935 0 1935 0 11 0 — — — 3. G.B. F 10 ? 3.33 1934 0 1934 0 8 0 — PI flat — 4. M.B. F 12 ?1930 5.34 1934 0 1935 1 11 0 PI, 2, 3 flat 5. E.C. F 13 1933 1.33 1933 0 1934 1 11 0 — — — 6. F.D. F 16 1929 3.29 1931 + 1935 4 15 0 SI.R.A.D. PI, 2, 3 flat P—R+ 1 extra ventricular systole. M.S. first. 7. L.F. M 18 1929 1.29 1930 + 1934 4 16 0 L.A.D. PI, 2, 3 notched. R-R+? 8. V.F. F 9 ? 8.29 1930 + 1935 5 8 0 — P2+ M.S. first. 9. H.G. M 15 1928 1.28 1934 0 1934 0 13 0 — R—T++ Low voltage. 10. P.G. F 10 1933 1.35 1934 + 1935 1 10 0 — All flat ? 11. R.G. M 12 1928 8.30 1930 0 1936 6 12 0 — All flat R 1 notched. 12. L.H. F 14 1927 1.28 1931 0 1934 3 12 0 R.A.D. PI & 3 flat — r 1933 2 12 0 SI.R.A.D. A11 P waves flat — 13. O.H. M 15 1930 3.31 1931 0 1935 4 14 0 — \l936 5 15 0 14. S.H. F 14 1927 6.29 1929 0 1933 4 11 0 PI flat 15. P.J. M 13 1932 1.33 1934 0 1935 1 12 0 — 16. J.L. M 12 1932 10.32 1932 + 1934 2 10 0 R.A.D. — M.S. first. + + + 17. M.L. F 12 1934 1.34 1934 + 1935 1 12 0 PI small P2 flat R 1 notched. A.R. first. 18. J.L. M 15 1934 12.34 1934 0 1934 0 13 0 Sl.L.A.D. — — 19. T.M. M 12 1929 9.29 1931 0 1935 4 11 0 — — Low voltage. 20. E.P. F 11 1931 — 1933 0 — — — — — — P—R+ Low voltage. 21. M.P. F 16 1935 1.35 1934 0 1935 1 15 Act — PI & P3 flat P—R+. Low voltage. 22. M.S. F Died 1933 10.33 1933 0 1934 1 6 0 R.A.D. + + R.A.D. — T2 & T3++. 23. F.W. F 13 1928 8.29 1932 + 1934 2 11 0 PI & P2 notched. P3 inverted PI flat Tl flat, T2 & 3+ + . M.S. first. Q.R.S. notched. 24. L.W. F 12 1934 3.34 1934 0 1934 0 10 0 SI.R.A.D. 25. E.W. F 12 1926 6.33 1933 + 1936 3 12 0 L.A.D. P2 flat ? + + P3 notched. 26. A.A. F 15 ? 6.30 1930 + 1934 4 13 0 — M.S. first. 27. C.B. M 11 1932 3.32 1936 0?p 1936 0 11 0 L.A.D. — T2 & R1 notched. 28. M.D. F 13 1934 1.35 1935 0 1935 0 12 0 — — — 29. J.G. F 11 1930 1930 1933 0 1933 0 8 0 SI.R.A.D. PI & 3 flat P—R+. 30. J.P. M 11 ? 1933 1934 0?p 1934 0 9 0 Sl.L.A.D. P2 + R—R+. 31. R.R. M 8 1934 1936 1936 0 1936 0 8 0 — All notched T2 + . 32. A.S. F 12 1932 1933 1932 + ?p 1933 1 9 0 SI.R.A.D. All flat P—R+. M.S. first. 33. D.W. F 14 1930 1931 1931 0 1934 3 12 0 SI.R.A.D. P2 + + Pl notched P2 small P3 flat 34. J.W. M 13 1928 1935 1935 0 1935 0 12 0 35. R.B. M 12 1931 1934 1934 0 1936 2 12 0 — All small T2+. 70 35 control cases with no murmurs and no active carditis. Some have had a mild attack of myocarditis. Name. Sex. Age at E.C. Deviation. P Waves. 36 S.E. F 10 P 2 flat 37 A.A. F 9* R.A.D. P 3 flat 38 G.B. F 11 SI. R.A.D. P 3 flat 39 J.B. F — SI. R.A.D. P 2 & P 3 flat 40 G.B. F 14 — — 41 E.B. 14 R.A.D. P 3 flat 42 M.B. F 9 L.A.D. P 2+ 43 V.C. M 12 SI. L.A.D. P 1 flat Q,R,S, 3 notched. 44 D.C. F 14 — P 1 flat C T 2 flat, T 3 inverted (R 1 & R 3 notched. 45 A.C. M 8 R.A.D. — — 46 A.C. M 13 — P 2 flat, P 3 inverted — 47 W.C. M 12 — — — 48 T.C. M 14 SI. R.A.D. P 1 flat — 49 F.C. M 7 SI. L.A.D. P 3 flat — 50 M.C. F 12 — — — 51 E.C. F 13 — — P — R + 52 R.C. M 8 — — — 53 H.C. M 10 — — — 54 F.D. F 11 — P 3 biphasic P — R full. 55 W.D. M 9 L.A.D. — — 56 D.D. F 3 SI. R.A.D. P 1 flat — 57 G.D. M 7 — P 3 flat — 58 M.D. F 12 P 3 inverted — 59 P.D. F 12 — P 1, 2, 3 flat T waves small. 60 L.D. M 5 — — — 61 L.E. M 13 — P 3 inverted — 62 E.E. F 12 — P 3 inverted — 63 F.F. F 10 R.A.D. P 3 flat T 3 inverted. 64 H.F. F 11 — P 3 flat T 3 flat. 65 R.F. M 9 — P 1 & P 3 flat T 3 inverted. 66 D.G. F 13 — — P — R full. 67 P.G. F 12 — — P — R full. 68 I.G. F 13 — P 3 flat P — R full. T 3 flat. 69 J.C. F 11 SI. R.A.D. — — 70 M.F. F 13 — ~~— Of the cases definitely suffering from rheumatic manifestations, in 23 mitral stenosis is the only lesion (apart from myocarditis), in 10 there is associated aortic incompetence, and in 3 there is a pericardial involvement in addition to the valvular lesions. One case had all three lesions. In 5 of the cases of mitral stenosis, the electrocardiogram shows no deviation and no abnormality. In the control series, 6 cases are likewise normal. I. Pure Mitral Stenosis. 23 cases. A. Deviation. No deviation 15 L.A.D 2 R.A.D 6 In a good many cases, the time which elapsed between the onset of mitral stenosis and the date of the electrocardiogram was not known, or was of short duration. In four cases, however, at least four years elapsed and no right deviation was noted. One of the cases of L.A.D. had active rheumatic carditis when the E.C. was taken. In only one of the six cases of R.A.D. was this really marked. B. P Waves. All P waves normal ... ... 9 P 2+ 1 P 1 flat or very small 10 P 2 „ 4 P 3 8 P 3 inverted 1 All 3 notched 1 P 1 notched ... ... ... ... 1 It will be seen therefore that in only one case is the P wave enlarged, and in only two cases are the P waves notched. C. Conduction. P — R prolonged ... ... ... ... ... 3 (two having very low voltage curves) R — T markedly prolonged ... ... ... ... 1 D. Q.R.S. Wave. R 1 notched 1 E. T Waves. T 2 was increased ... 3 II. Mitral Stenosis and Aortic Disease. 10 cases. A. Deviation. No deviation ... 4 L.A.D 2 R.A.D 4 71 In six cases the mitral definitely preceded the aortic lesion ; these include the 4 cases of R.A.D. and 2 with no deviation. In three both lesions were present when first seen ; two have a L.A.D. and the other none. In one the aortic lesion probably preceded the mitral lesion ; this has no deviation. B. P Waves. All P waves normal 2 P 1 flat 4 P 2 + 1 P 2 flat or very small 5 P 3 3 P 3 inverted 1 All notched 1 P 1 and 2 notched 1 P 3 notched 1 In this group also, in one case only is a P wave enlarged, in three cases the P waves are notched. C. Conduction. P — R prolonged 3 D. Q.R.S. Wave. R 1 notched 3 E. T Waves. T 1 flat 1 T 2 and 3 + 1 Mitral Stenosis and Pericarditis. A. Deviation. L.A.D 2 R.A.D 1 The case of R.A.D. is the one which has aortic disease as well. B. P Waves. All normal 1 P 2 + 1 All flat 1 C. Conduction. P — R + 2 P — R normal 1 D. Q.R.S. Wave. R 1 notched 1 E. T Waves. T 2 -4- 1 Control Cases. 35 cases with no murmur and no active carditis. Some have had a mild attack of myocarditis. A. Deviation. No deviation 22 L.A.D 4 R.A.D 9 B. P Waves. All P waves normal ... ... ... ... ... 12 P 2 + 1 P 1 flat or very small 6 P 2 „ „ 4 P 3 12 Inverted or biphasic 5 The small P 3 can hardly be described as abnormal. C. Conduction. P — R prolonged 5 D. Q.R.S. Wave. Q.R.S. 1 notched ... ... ... ... ... 1 Q.R.S. 3 notched 2 (not abnormal) E. T Waves. T 1 flat or very small... ... ... 1 T 2 „ „ 2 T 3 2 T 3 inverted 3 Discussion. In adult cases it is generally held that the electrocardiogram in patients with mitral stenosis is often characteristic. There is, fairly commonly, R.A.D., and the P waves are either increased or abnormal in form. It will be seen, however, that in the 35 children's cases analysed there is no such common change in deviation. There is R.A.D. in 11 cases out of the 35, but it must be remembered that R.A.D. is not considered abnormal in children, and in the control cases there are 9. The P waves are enlarged or notched in 8 cases out of 35, whereas in the control cases only one case shows enlargement. In two cases only, both R.A.D. and abnormal P waves occur together. Conclusion. There are no definite characteristic changes in the electrocardiograms of cases of mitral stenosis in children. The only alteration that is found with any frequency is an enlarged or notched P wave. The control patients show this change in 2 8 per cent, of the cases. The mitral stenosis patients show this change in 23 per cent, of the cases; but where mitral stenosis is the only lesion, in 13 per cent, of the cases only. It would seem, therefore, that an abnormal P wave is associated with cardiac lesions in children, but the difference between 2-8 per cent, and 13 per cent., though suggestive, is not sufficient to indicate that abnormal P waves are characteristic of mitral stenosis in children. 72 APPENDIX II. TABLE I. Vital statistics of whole district for 1935 and previous years. Year. Population estimated to middle of each year. Births. Total deaths registered in the district. Transferable deaths Net deaths belonging to the district Uncorrected number. Net of nonresidents registered in the district. of residents not registered in the district. Under 1 year of age. At all ages. Number. Rate.* Number. Rate." Number. Rate per 1,000 net births. Number. Rate.* 1 3 3 4 S 6 7 8 9 10 11 13 13 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 1935 178,300 2,344 2,226 12.4 2,854 15.9 1,206 506 175 79 2,154 12.1 * Rates calculated Der 1.000 of estimated Donulation. At Census of 1931. Area of district in acres (exclusive of area covered by water) 2,291 Total population at all ages ... ... 180,677 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 1935. Notifiable Disease. Number of cases notified. Total cases notified in each ward. Cases admitted to hospital. Total deaths. At all ages At ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. .. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. | 35 to 45. 45 to 65. 65 and over. Small pox Scarlet fever 304 2 15 21 25 32 99 48 22 29 6 5 — 93 47 51 38 11 19 9 22 14 285 1 Diphtheria (including membranous croup) 338 12 12 23 44 49 109 33 15 30 6 4 i 144 68 65 26 10 8 8 6 3 335 19 Enteric fever 7 — — — — — 1 — — 5 — 1 — — — 1 1 1 1 2 1 — 7 1 Puerperal fever 7 — — — — — — — — 5 2 — — 3 1 1 1 — — — 1 — 4 4 Puerperal pyrexia 30 1 22 7 — — 6 9 2 7 1 2 — 3 — 6 1 Primary pneumonia 97 4 11 9 10 2 15 5 5 9 4 15 8 14 55 7 7 3 3 2 4 2 40 9 Influenzal pneumonia 39 — — 1 — — 2 2 2 7 7 10 8 5 19 7 2 1 2 3 — — 18 12 Dysentery 6 — — — — 2 — — — 3 — 1 — 1 2 — 1 — 1 1 — — 4 — Erysipelas 63 2 — 1 — — 3 3 1 6 9 23 15 9 16 8 8 4 3 2 8 5 32 3 Encephalitis lethargica 2 1 1 2 5 Cerebro-spinal meningitis 2 1 1 1 1 • 2 3 Polio-myelitis and polio-encephalitis 1 Pulmonary tuberculosis 156 — — 1 — — 1 2 16 67 30 34 5 33 11 27 18 19 11 8 21 8 132 78 Other forms of tuberculosis 30 1 1 — 1 3 7 2 1 7 3 3 1 8 6 2 8 4 — 1 — 1 22 11 Ophthalmia neonatorum 11 11 5 3 3 6 — Malaria 5 — — — — — — — — 4 — 1 — — — — — 1 3 — 1 — 5 — *Enteritis (diarrhoea) 59 38 12 7 1 1 15 34 7 3 24 64 †Acute rheumatism. 28 — — — 1 1 6 18 2 — — — — 11 3 9 2 1 1 — 1 — 31 5 Totals 1185 71 51 63 83 91 243 113 65 195 74 97 39 348 275 190 123 58 54 36 68 33 955 216 * Notifiable only in children under the age of 5 years. t 16 „ Cases of mistaken diagnosis are excluded from the above table. 73 TABLE III. Causes of Death at Different Periods of Life in 1935. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 75 and upwards ALL CAUSES M. 953 110 6 8 12 29 33 37 85 174 228 231 F. 1,201 65 13 12 11 22 36 56 100 156 307 423 Typhoid and paratyphoid fevers M. ... ... ... ... ... ... ... ... ... ... ... ... F. 1 ... ... ... ... 1 ... ... ... ... ... ... Measles M. ... ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Scarlet fever M. 1 ... 1 ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Whooping cough M. 1 ... ... 1 ... ... ... ... ... ... ... ... F. 2 ... 1 ... ... ... ... ... ... ... ... ... Diphtheria M. 7 2 ... 3 2 ... ... ... ... ... ... ... F. 12 ... ... 6 4 1 ... ... 1 ... ... ... Influenza M. 10 ... ... ... ... ... ... 1 3 1 2 3 F. 21 ... ... ... 1 2 ... 3 2 1 6 6 Encephalitis lethargica M. 3 ... ... ... ... ... 1 ... ... 2 ... ... F. 2 ... ... ... ... ... 1 ... ... ... 1 ... Cerebro-spinal fever M. 2 1 ... ... ... 1 ... ... ... ... ... ... F. 1 ... ... ... ... 1 ... ... ... ... ... ... Tuberculosis of respiratory tem M. 47 1 ... ... ... 5 14 9 8 6 4 ... F. 31 ... ... ... ... 7 7 7 4 4 1 1 Other tuberculous diseases M. 6 ... ... ... 1 3 ... ... ... 1 1 ... F. 5 ... 1 1 ... ... ... 1 1 ... 1 ... Syphilis M. 3 ... ... ... ... ... ... ... 3 ... ... ... F. 1 ... ... ... ... ... ... ... 1 ... ... ... General paralysis of the insane, tabes dorsalis M. 5 ... ... ... ... ... ... 1 1 1 2 ... F. 1 ... ... ... ... ... ... ... ... 1 ... ... Cancer, malignant disease M. 122 ... ... ... ... ... 2 1 13 37 42 27 F. 195 1 ... ... ... ... ... 10 31 45 66 42 Diabetes M. 14 ... ... ... 1 ... ... ... 1 2 7 3 F. 19 ... ... ... ... ... 1 l 2 5 8 2 Cerebral haemorrhage, etc. M. 23 ... ... ... ... ... ... l 2 8 8 4 F. 46 ... ... ... ... ... ... ... 1 8 18 19 Heart disease M. 242 ... ... ... 1 1 2 4 13 55 70 96 F. 370 1 ... ... ... 1 4 4 17 33 99 211 Aneurysm M. 6 ... ... ... ... 1 ... 2 ... 1 1 1 F. 4 ... ... ... ... ... ... ... 1 2 ... 1 Other circulatory diseases M. 50 1 ... ... ... ... ... ... 4 10 15 20 F. 77 ... ... ... ... ... ... 1 6 8 21 41 Bronchitis M. 25 4 ... 1 ... 1 ... 1 ... S 6 9 F. 23 4 ... ... ... ... 2 ... ... 2 7 8 Pneumonia (all forms) M. 60 14 4 1 1 2 ... 1 5 11 8 13 F. 62 6 4 1 1 ... 1 4 6 10 12 18 Other respiratory diseases M. 16 ... ... ... ... 3 ... 1 ... 5 4 3 F. 17 ... ... 1 ... ... 2 2 2 1 3 6 Peptic ulcer M. 14 ... ... ... ... 1 1 ... 4 4 4 ... F. 5 ... ... ... ... ... 1 1 1 2 ... Diarrhœa, etc. M. 32 32 ... ... ... ... ... ... ... ... ... ... F. 32 23 2 ... ... 1 ... 1 1 1 2 1 Appendicitis M. 11 ... ... ... ... ... ... 1 3 4 2 1 F. 17 ... ... 2 3 1 1 1 4 4 1 Cirrhosis of liver M. 8 ... ... ... ... ... ... 5 2 1 ... F. 5 ... ... ... ... ... 1 ... 2 1 ... 1 Other diseases of liver, etc. M. 5 ... ... ... ... ... ... ... 2 ... 2 1 F. 10 1 ... ... ... ... 1 1 2 4 1 ... Other digestive diseases M. 23 3 ... ... ... 1 2 2 3 1 4 7 F. 33 2 ... ... ... ... ... 3 4 7 7 10 Acute and chronic nephritis M. 26 ... ... ... ... ... 3 ... 1 4 12 6 F. 36 ... ... ... 1 ... 1 4 3 5 11 11 Puerperal sepsis F. 4 ... ... ... ... ... 3 1 ... ... ... ... Other puerperal causes F. 1 ... ... ... ... ... ... 1 ... ... ... ... Congenital debility, premature birth, malformation, etc. M. 42 41 ... ... ... ... ... 1 ... ... ... ... F. 25 23 1 1 ... ... ... ... ... ... ... ... Senility M. 9 ... ... ... ... ... ... ... ... 1 1 7 F. 20 ... ... ... ... ... ... ... ... ... 1 19 Suicide M. 13 ... ... ... ... 1 ... 2 4 2 4 ... F. 13 ... ... ... ... 1 1 ... 5 1 2 3 Other violence M. 47 5 ... I 4 7 6 4 1 6 4 9 F. 36 1 2 2 1 1 3 3 1 3 12 7 Other defined diseases M. 80 6 1 1 2 2 2 5 9 7 24 21 F. 74 2 2 ... 1 3 6 7 7 9 22 15 Causes ill-defined, or unknown M. ... ... ... ... ... ... ... ... ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... 74 TABLE IV. Infant Mortality during the Year 1935. Net Deaths from stated Causes, at Various Ages under One Year of Age. Cause of death. Under 1 week. 1-2 weeks. 2-3 weeks'. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under one year. All causes. Certified 41 4 5 3 53 32 45 23 11 164 Uncertified 5 ... ... ... 5 2 1 2 1 11 Measles ... ... ... ... ... ... ... ... ... ... Whooping-cough ... ... ... ... ... ... ... 1 ... 1 Diphtheria. ... ... ... ... ... 1 ... ... 2 Influenza ... ... ... ... ... ... ... . . . . . . ... Encephalitis lethargica ... ... ... ... ... ... ... ... ... ... Cerebro spinal meningitis ... ... ... ... ... ... . . . . . . 1 Acute tuberculosis. ... ... ... ... ... 1 ... ... ... 1 Other tuberculous diseases ... ... ... ... ... ... ... ... ... ... Bronchitis ... ... ... ... 1 2 3 2 ... 8 Pneumonia ... 1 ... ... 2 2 8 4 4 20 Other respiratory diseases ... ... ... ... ... ... ... ... ... ... Diarrhoea, etc. ... ... ... ... 2 14 24 10 5 55 Complications of birth 17 1 ... ... 18 ... ... ... ... 18 Malformation 6 1 ... ... 7 3 2 ... ... 12 Premature birth 19 2 ... ... 21 5 ... ... ... 26 Deaths from violence 4 ... ... ... 4 1 1 ... ... 6 Atrophy, debility and marasmus ... ... ... ... 1 5 1 1 ... 8 Digestive diseases 1 ... ... ... 1 ... 3 1 ... 5 Other diseases ... ... ... 1 1 2 5 2 2 12 Totals 47 5 3 3 58 36 49 21 11 175 Net births in the year of legitimate, 1,991. illegitimate, 235. Net deaths in the year of legitimate infants, 147. illegitimate infants, 28. 75 TABLE V. The Work of the Women Health Officers for the Year 1935. HEALTH OFFICERS. total *1 2 3 4 5 6 7 8 Child Welfare- First visits to infants (0-1 year) 89 148 328 364 246 233 88 174 1,670 Return visits to infants (0-1 year) 34 399 564 635 857 992 224 403 4,108 Total visits to children (1-5 years) 85 848 888 866 1,080 1,003 499 893 6,162 Stillbirth enquiries 3 5 10 2 4 6 3 5 38 Visits to ophthalmia cases 2 2 7 2 6 5 — — 24 Return visits to ophthalmia cases 1 5 15 6 9 45 — — 81 Visits to measles cases 13 4 10 9 8 9 15 — 68 Visits to whooping cough cases. 17 18 33 14 33 78 52 74 319 Visits to puerperal fever cases — 1 2 2 1 1 — — 7 Visits to puerperal pyrexia cases 3 2 9 12 1 2 2 — 31 Visits to enteritis cases 5 22 27 10 20 7 — — 91 Infantile death enquiries 9 18 25 23 24 21 10 13 143 Milk investigations 310 163 631 621 408 360 141 41 2,675 Ante-natal visits 94 205 188 168 213 94 185 217 1,364 Half-days at welfare centres 104 149 146 116 150 102 67 152 986 Special visits 97 616 673 375 332 196 445 412 3,146 Tuberculosis— Pulmonary—First visits — 11 14 3 16 16 33 30 123 Re-visits — 200 265 3 133 131 394 248 1,374 Non-Pulmonary—First visits — 4 7 — 6 _ 10 3 30 Re-visits — 115 118 — 126 42 150 88 639 Rheumatism— First visits to cases notified — — 8 — 3 10 5 1 27 Common Lodging Houses— Inspections — 13 — — 2 52 — — 67 Factories and Workshops Act- Inspections of factories ... — 13 2 — 79 — 22 14 130 Inspections of workshops... — 13 10 — 35 28 478 128 692 Inspections of outworkers' premises — 6 37 — 15 36 210 19 323 Inspections of other workplaces 24 1 25 Total Visits 866 2,980 4,017 3,231 3,807 3,469 3,057 2,916 24,343 Notices issued under the Public Health Act— Intimation notices — — — — — — 2 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 11. 76 TABLE VI. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1934. DATE. 1934. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth list sheets. Number of these births duly entered in columns 1, 2, 4, and 5 of the vaccination register (birth list sheets), viz. : Number of these births which are not entered in the vaccination register, on account (as shown by report book) of Total number of certificates of successful vaccination received during the calendar year, 1935. Column I. successfully vaccinated Column II. Column V. dead, unvaccinated. Postponement by medical certificate. Removal to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Insusceptible of vaccination Certificate of conscientious objection. 1st January to 31st Dec. North 914 636 1 160 35 — 13 63 6 1,874 South 1,438 945 3 199 88 1 130 68 4 Total 2,352 1,581 4 359 123 1 143 131 10 77 TABLE VII. Particulars of the Staff of the Public Health Department at the end of 1935 (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 Deputy Medical Officer of Health and Tuberculosis Officer. John W. Hunter, M.D., Ch.B., B.Hy., D.P.H. 1935 Assistant Medical Officers, Maternity and Child Welfare. Violet I. Russell, M.D., M.C.O.G. 1934 Helen R. Buck, M.B., D.C.O.G. 1935 Hilda M. Davis, M.B., D.P.H. 1935 Consultant Medical Officers (Part-time). Hugh R. Carter, M.D. (Treatment of zymotic enteritis) 1924 Janet K. Aitken, M.D. (Rheumatism supervisory centre) 1930 Alun Morris Johns, M.D. (Consultant gynaecologist and obstetrician) 1932 Bessie H. E. Cadness, M.B. (Bacteriologist) 1934 Guy W. J. Bousfield, M.D., M.B. (Schick testing clinic) 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) 1932 Clerical Staff. James H. Wilson (Chief clerk Beatrice J. Fenton 1930 and vaccination officer) 1900 Ronald F. Rogers 1931 Francis W. Gascoyn 1919 Derek P. Roberts (Temporary) 1934 John S. Russell 1923 Eric R. Hundy ( ,, ) 1934 Denis C. Page 1925 Reginald C. Charlton 1935 Francis T. Pearce 1929 George W. Churcher (Temporary) 1935 Victor R. Minter 1932 Sanitary Inspectors. *George W. McQuinn (Senior §Arthur L. Vague 1934 inspector) 1901 §Thomas A. Wilson 1934 tJohn McDermid 1920 §Maurice Cottrell 1934 Henry W. Walters (Food §Ronald D. Callis (Temporary) 1934 inspector). 1925 § James Clancey ( ,, ) 1935 Cecil R. Webb 1925 §Dennis C. Draper ( ,, ) 1935 §John S. Wheeler 1930 §James R. Baily ( ,, ) 1935 §Donald J. Hunt 1931 §Stanley W. Simpson- Frederick G. Bishop 1931 Scott ( „ ) 1935 §Ronald V. Coombs 1932 Women Health Officers. Miss W. H. E. Whitbread ... 1920 Miss P. Bing 1930 Mrs. V. A. Ross 1921 §Miss B. I. Brady (Infant Life Miss E. M. Law 1922 protection visitor) 1931 Miss K. M. Roe 1926 §Miss W. E. Cockram 1932 §Miss E. Mogridge 1929 Other Officers. Miss A. E. Haycock (Tuberculosis dispensary nurse) 1922 Miss G. F. Lucas (Municipal midwife) 1935 Miss H. M. Barber (Nurse-in-charge, Archer Street clinic) 1935 Miss E. J. Upton (Nurse-in-charge, Dalgarno centre) 1935 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 Joipt 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 are qualified health visitors. 78 INDEX. page Advisory committee 34 After-care of tuberculous patients 66 Aged, infirm and physically incapacitated persons, removal of 22 Agricultural Produce (Grading and Marking) Act 49 Analysis of tuberculosis register 64 Ante-natal clinic (Queen Charlotte's Hospital) 31 ,, ,, (Borough Council) 31 „ work 10 & 27 Anti-toxin (diphtheria) 56 Artificial Cream Act 49 „ pneumothorax treatment 65 „ sunlight 30 Baby clinic 30 „ hospital 30 Bacteriological examinations (infectious disease and milk) 11 & 47 Bacteriological examinations (tuberculosis) 11 & 66 Bakehouses 48 Basement rooms 37, 38, 39 & 41 Baths and washhouses 21 Bedding for tuberculous patients 66 Birth control 33 Births 4 „ in wards and rates 4 ,, notified 5 Boarding out of children 34 Canal Boats Acts 21 Cancer 7 Care of tuberculous patients. 66 Cerebro-spinal meningitis 57 Chapel of Rest 21 Cleansing station 58 Clearance areas 35 Closing orders 37 to 41 Common lodging houses 40 Convalescent homes 32 Crescent Street improvement area 38 Day nurseries 32 Deaths 5 „ , causes of 7 „ from certain diseases 8 ,, from cancer 7 „ from tuberculosis 61&62 ,, in wards and rates 6 Defects (housing) remedied 19 & 41 Dental treatment at infant welfare centres 30 „ ,, for tuberculous patients 65 Diarrhoea (summer) 13 & 57 Diphtheria 55 ,, immunisation 60 Disinfection (infectious disease) 60 ,, (tuberculosis) 66 Disinfestation by HCN 59 Dispensary diagnosis and treatment of tuberculosis 63 Dog nuisances 13 „ (proceedings) 13 & 20 Drainage and sewerage 17 Dwelling-house inspection 18 & 41 Dysentery 58 page Electrical treatment 31 Employment of tuberculous patients 66 Encephalitis lethargica 57 Enteric fever 56 Erysipelas 56 Extra nourishment for expectant and nursing mothers and their infants ... 33 Extra nourishment for tuberculous patients 65 Factories and workshops 23 Flatlets 40 Following-up of tuberculous patients 65 Food,'inspection and supervision 45 Food and Drugs (Adulteration) Act 49 ,, „ (proceedings) 52 Food premises, inspection 48 „ „ registration 48 ,, poisoning 53 „ supply 45 ,, unsound 49 Foster-children 11 Fouling of footpaths by dogs 13 Grants to maternity and child welfare institutions 17 Gynaecological clinic 33 Handicrafts class for tuberculous patients... 66 Health lecturer 16 & 32 ,, propaganda 16 ,, services (general) 11 ,, visitors 28 & 75 Home contacts of tuberculosis 65 ,, helps 33 ,, nursing (general) 12 ,, nursing of tuberculous patients 65 ,, Office tables (factories and workshops) 25 ,, visiting of tuberculous patients ... 65 ,, workers 24 Houses let in lodgings 35 Housing 34 Housing Act, 1930 35 ,, accommodation owned by Council 39 „ accommodation provided by associations 39 ,, action under statutory powers 18 & 34 ,, , five years programme 35 ,, statistics 41 Hydrocyanic acid gas disinfestation 59 Ice cream 48 Improved Tenements Association 39 Improvement areas 36 Increase of Rent and Mortgage Interest (Restrictions) Acts 21 Indecent occupation 35 Infant consultations at infant welfare centres 29 ,, life protection 11 ,, mortality 8 „ ,, , death rates 9 „ ,, , causes of deaths 9 „ ,, , deaths each month 9 „ „ , deaths in wards 8 79 INDEX—continued. page Infant welfare centres 29 Infectious diseases 54 Introduction 3 Invermead 31 Kensington District Nursing Association 12 ,, Housing Trust 39 Lectures, health 16 & 32 Legal proceedings, food and drugs 52 ,, sanitary administration 20 Legislation, local 13 Light treatment at baby clinic and hospital 30 London County Council (General Powers) Act, 1927 22 London County Council (General Powers) Act, 1928 22 London County Council (General Powers) Act, 1932 48 Malaria 57 Marriages 4 Massage 31 Maternal mortality 10 Maternity and child welfare 26 „ home 31 Measles 58 Medicinal baths 58 Merchandise Marks Acts 48 Midwifery 12 & 27 Milk (bacteriological examination) 11 Milk and Dairies (Amendment) Act 46 „ „ (Consolidation) Act ... 45 „ ,, Order 46 Milk (Special Designations) Order 46 Milk supplied in Kensington 45 Mortuary 21 Non-notifiable infectious diseases 58 Notifiable ,, 54 Notifications of Births Act 5 Notifications of infectious diseases since 1931 54 ,, tuberculosis (age and sex distribution) 61 Notifications of tuberculosis (deaths and death rates) 61 Notifications of tuberculosis (in wards) 62 Nursing (professional) in the home 12 Obstetric work 10 Ophthalmia neonatorum 56 Orthopaedic treatment 30 Outworkers 24 Overcrowding survey 42 Peabody Donation Fund 39 Pharmacy and Poisons Act 53 Pigeons, nuisances from 22 Pneumonia and influenzal pneumonia 57 Pneumothorax treatment of tuberculous patients 65 Poliomyelitis and polioencephalitis 57 Population 3 Post-natal clinic (Borough Council) 31 Prevention of infectious disease 54 Princess Beatrice Hospital 13 Princess Louise Hospital 13 Proceedings under Food and Drugs (Adulteration) Act 52 page Proceedings under Housing Act, 1930 20 & 41 „ ,, Public Health Acts (housing) 20 & 41 „ „ Public Health (London) Act 20 ,, ,, Public Health (unsound food) 49 Propaganda (health) 16 Public Health (Condensed Milk) Regulations 53 ,, ,, (Dried Milk) Regulations 53 ,, ,, (London) Act notices served 18 & 41 ,, ,, (Meat) Regulations 48 ,, ,, (Prevention of Tuberculosis) Regulations 63 Puerperal fever and pyrexia 57 Queen Charlotte's Hospital ante-natal clinic 31 Rag Flock Acts 21 Rats and Mice (Destruction) Act 22 Reconditioning and repair work 37 Refuse collection and removal 17 Registration of food premises 48 ,, houses let in lodgings 35 Rent Restrictions Acts 21 Rheumatism in children 13, 14, 58 & 67 „ supervisory centre 14 & 67 Samples, adulterated 52 ,, formal 50 ,, informal 50 Sanitary circumstances of the area 17 ,, inspection 18 „ notices 18 ,, works completed 19 Scarlet fever 55 Schick test 60 School medical service 15 ,, treatment centres 14 Sewerage and drainage 17 Shops Act, 1934 20 Slaughterhouses 48 Slaughter of Animals Act 48 Smallpox 55 Smoke abatement 21 Southam Street improvement area 37 Sputum flasks 66 Staff 77 Statistics, summary of 2 vital 3&72 Subscriptions to hospitals, voluntary health organisations, etc. 16 Sutton Dwellings Trust 39 Travelling expenses of women breast-feeding infants 34 Treverton Street improvement area ... 39 Tuberculosis 61 Tuberculosis register, analysis of 64 Typhoid and paratyphoid fever 56 Underground rooms 37, 38, 39 & 41 Unsound food 49 Vaccination 16 „ Officer's return 76 80 INDEX—continued. page Verminous furniture disinfected by HCN 59 „ persons cleansed 58 ,, premises cleansed 59 Vital statistics 3&72 Washhouses 21 Whooping cough 58 Wilsham Housing Trust 39 Women health officers 28 & 75 Workshops 23 X-ray diagnosis of tuberculosis 65 Zymotic enteritis 13 & 57 „ death rate 7 APPENDIX I. page Eighth annual report of the Kensington rheumatism scheme 67 APPENDIX II. Causes of death at different periods of life in 1935 (Table III) 73 Infant mortality during 1935 (Table IV) 74 Infectious disease cases notified during 1935 (age periods, number admitted to hospital, and total deaths) (Table II) 72 Staff of public health department (Table VII) 77 Vaccination officer's return for 1934 (Table VI) 76 Vital statistics for 1935 and five preceding years (Table I) 72 Work of women health officers for 1935 (Table V) 75