KEN 45 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1936 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 1936. Population (estimated) 176,100 Density of population per acre 76 Rateable value £3,334,408 Total. M. legitimate 1,997 1,058 Live births illegitimate 231 116 Still births 82 49 Deaths 2,201 995 Area of borough in acres 2,291 Number of marriages 2,077 Product of a Id. rate £13,893 F. 939 Birth rate 2.7 115 33 Rate per 1,000 total births 35 1,206 Death rate (after adjustment) 11.7 Percentage of total deaths occurring in public institutions 54% Deaths from puerperal causes:— Rate per 1,000 total Deaths (live and still) births. Puerperal sepsis 1 0.4 Other puerperal causes 1 0.4 Total 2 0.9 Death rate of infants under one year of age:— All infants per 1,000 births 73 Legitimate infants per 1,000 legitimate live births 69 Illegitimate infants per 1,000 illegitimate live births 104 Deaths from phthisis 105 Deaths from all forms of tuberculosis 123 Deaths from the zymotic diseases 97 Deaths from measles (all ages) 26 „ whooping cough (all ages) 13 „ diarrhœa (under 2 years of age) 39 Phthisis death rate 0.59 Tuberculosis death rate 0.70 Zymotic death rate 0.55 3 Town Hall, Kensington, W.8. 18th May, 1937. 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 1936 on the state of the public health in Kensington. Although it is not wise to entertain a feeling of satisfaction in regard to public health work, where there is always room for improvement, or to be too optimistic, it is pardonable to call attention to one or two features in the health of the borough which must be gratifying to all members of the council. For many years the Council have been perturbed by the persistently high infant death rate, and it was this unsatisfactory rate which was responsible more than anything else for the council's decision to appoint whole-time medical officers at the infant welfare centres. Two of these officers began work in 1935, and one in July, 1936. The infant death rate has fallen from 93 in 1934 to 79 in 1935, and to 73 in 1936. Although the figure of 73 for last year is still higher than that for England and Wales and for London, it is at least worthy of note that the fall of 6 points in the Kensington rate in 1936 took place during a year which was generally unsatisfactory in that the rates for England and Wales and for London showed an increase. The rate for England and Wales rose by 2 points, and the rate for London by 8 points. Another rate which has concerned the council is that for maternal mortality, which in past years has been round about 4 ; that is to say, out of every 1,000 births in the borough there have been 4 deaths of mothers resulting from pregnancy or childbirth. In 1934 the council appointed a whole-time ante-natal medical officer with a view to obtaining a reduction in this rate. For a few years before her appointment the Kensington rate averaged 4.4, the rate for England and Wales 4.3 and the rate for London 4.3. In the years following her appointment, the rate for Kensington has averaged 1.5, for England and Wales 4.1, and for London 2.4. In 1934 the Kensington rate was 1.3, in 1935 it was 2.2, and last year it was 0.9. The perfect figure is of course nil, but in human affairs it is impossible to avoid every misfortune, and it is reasonable to say that last year the Kensington figure approached the irreducible minimum. The incidence of diphtheria in Kensington was particularly low in 1936, there being only 142 cases compared with 338 in 1935. The year was one of great housing activity, and particular attention is drawn to page 37, where details of housing work are given. Although it is difficult, or perhaps impossible, to produce statistical evidence of the benefit which has accrued from the efforts which the council have made in housing reform in recent years, it is the experience of all the officers in the public health department who have to deal with housing defects, overcrowding, and so on, that the working-class residents of the borough are living under very much better housing conditions than they were a few years ago. 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 1936 has been estimated by the Registrar-General to be 176,100. 4 From this latter figure, the inhabitants in the different wards of the borough have been estimated to be as shown in the following table:— The Borough 176,100 North Kensington 92,400 South Kensington 83,700 Wards. St. Charles 30,090 Golborne 21,680 Norland 20,830 Pembridge 19,800 Holland 18,400 Earl's Court 17,900 Queen's Gate 14,000 Redcliffe 21,190 Brompton 12,210 Marriages. During the year, 2,077 marriages were registered, representing a rate of 11.7 marriages per 1,000 of the population. The place of marriage is set out in the following: table:— Church of England 749 Roman Catholic Church 326 Nonconformist Church 39 Jewish Church 8 Register Office 955 Total 2,077 Births. The number of births registered was 2,228, after correction for inward and outward transfers ; and the birth rate for the borough was 12-7 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 1,058 939 1,997 Illegitimate 116 115 231 Totals 1,174 1,054 2,228 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various districts in the borough in 1936, and the rates for the previous five years:— District. 1936. Birth rates in previous years. No. of births. Birth rate. 1935 1934 1933 1932 1931 England and Wales 605,292 14.8 14.7 14.8 14.4 15.3 15.8 London 56,273 13.6 13.3 13.2 13.2 14.2 15.0 The Borough 2,228 12.7 12.4 12.3 12.0 12.9 14.2 North Kensington 1,584 17.1 16.6 16.8 16.1 17.3 19.6 South Kensington 629 7.5 7.2 6.6 6.5 7.7 7.8 Wards. St. Charles 513 17.1 16.7 15.4 18.0 19.5 21.6 Golborne 445 20.5 21.5 23.7 21.9 23.6 21.3 Norland 355 17.0 16.4 16.3 13.6 15.9 19.8 Pembridge 271 13.7 11.2 11.6 10.9 7.7 14.3 Holland 162 8.8 8.6 7.3 5.6 8.2 9.1 Earl's Court 116 6.4 6.6 8.3 7.9 9.6 9.2 Queen's Gate 107 7.6 4.9 5.5 5.5 5.7 5.1 Redcliffe 161 7.6 9.5 6.8 6.3 7.2 8.4 Brompton 83 6.8 4.9 4.0 6.7 7.2 5.8 Ward unknown 15 ... ... ... ... ... ... 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 1931-1935 12.6 1936 12.7 Notification of Births Act, 1907—During the year, 2,228 live births to Kensington mothers were registered, and of this number 2,214 or 99 per cent. were notified in accordance with the requirements of the Act. The number of still births notified was 67, and the number of births notified as having occurred in Kensington but belonging to other districts was 564. 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 25 861 886 „ „ „ parents - 19 19 „ „ „ medical practitioners 2 217 219 „ „ „ other persons 19 553 572 Births in the borough 46 1,650 1,696 Notified from institutions outside the borough 21 564 585 Totals 67 2,214 2,281 Percentage of births in Kensington notified during the past five years, in accordance with the Notification of Births Act, 1907:— Year. Percentage. 1932 98 1933 94 1934 93 1935 98 1936 99 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 1936 was 2,961, 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 2,961 Deaths of residents in public institutions, etc., beyond the borough 535 3,496 Deaths of non-residents in public institutions, etc., within the borough 1,295 Corrected number of deaths belonging to the borough 2,201 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 1936, and the rates for the previous five years:— District. 1936 Death rates in previous years. No. of deaths. Death rate. 1935 1934 1933 1932 1931 1930 England and Wales 495,764 121 11.7 11.8 12.3 12.0 12.3 11.4 London 51,142 12.5 11.4 11.9 12.2 12.3 12.4 11.4 The Borough 2,201 12.5 12.1 13.3 12.9 13.6 14.0 12.7 North Kensington 1,173 12.7 12.0 13.7 12.9 13.8 13.8 12.6 South Kensington 1,010 12.1 11.6 12.3 12.6 12.4 13.3 12.5 Wards. St. Charles 317 10.5 14.3 11.4 10.9 12.7 12.5 11.7 Golborne 323 14.8 13.7 16.4 13.9 16.2 14.1 12.3 Norland 294 14.1 11.9 13.9 14.1 14.1 14.2 14.4 Pembridge 239 12.1 12.5 13.8 13.1 12.4 14.2 12.1 Holland 231 12.5 12.3 14.2 13.3 13.4 14.5 12.7 Earl's Court 253 14.1 13.0 12.3 13.1 13.3 14.1 15.0 Queen's Gate 138 9.9 8.8 11.7 11.5 12.6 10.8 11.2 Redcliffe 279 13.2 12.5 11.7 12.7 11.8 15.2 11.1 Brompton 109 8.9 13.5 11.3 11.1 10.5 11.2 11.4 Ward Unknown 18 ... ... ... ... ... ... ... 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 1911-1916 14.3 1916-1920 15.6 1921-1925 13.2 1926-1930 13.5 1931-1935 13.2 1936 12.5 The corrected death rate of 12.5 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 11.7, which should be used when comparing the death rate of Kensington with that of other districts. 7 It will be seen that over one-third of the deaths, or 932, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 105 deaths. The diseases described in the above list as the "principal zymotic diseases" are smallpox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhœa. Cancer.—Cancer caused 321 deaths, and of this number 298 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 14 deaths; 26 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following table:— The parts of the body which were affected in each case are shown in the following table:— Deaths from Cancer, 1936. Parts affected. Sex. Total. Male. Female. Buccal cavity 8 4 12 Lungs 24 22 46 Digestive organs, peritoneum, etc. 64 82 146 Female genital organs - 22 22 Male genito-urinary organs 24 - 24 Breast - 34 34 Skin - 2 2 Other and unspecified organs 12 23 35 Totals 132 189 321 The deaths in the several wards, etc., are set out in the following table:— The Borough 321 North Kensington 152 South Kensington Wards. 168 St. Charles 38 Golborne 30 Norland 43 Pembridge 41 Holland 42 Earl's Court 40 Queen's Gate 24 Redcliffe 41 Brompton 21 Ward unknown 1 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 97 Epidemic influenza 34 Phthisis 105 Other tuberculous diseases 18 Cancer 321 Bronchitis 46 Pneumonia 160 Heart disease 621 Acute and chronic nephritis 57 Puerperal fever 2 Premature birth, etc. 51 Violence (including suicide 29) 105 Old age 22 All other causes 562 2,201 The number of deaths from this disease was 4 more than in the previous year. 8 Table showing the number of deaths in 1936 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 25 — 3 4 3 10 28 10 20 3 February 22 — 4 — 5 9 35 7 19 3 March 21 — 2 1 5 12 20 6 20 5 April 18 2 2 1 1 11 14 2 13 2 May 16 — — — 2 6 27 1 12 4 June 13 — 1 — — 12 30 1 7 2 July 11 — — — — 6 19 2 6 3 August 8 — — 1 — 3 18 — 10 1 September 5 — — — 1 8 18 2 3 3 October 3 — — 1 1 6 28 1 4 6 „ 31 — — 2 4 5 27 2 7 3 November 28 — — — 3 7 27 4 14 3 January 2 — 1 1 9 10 30 8 25 5 Totals 2 13 11 34 105 321 46 160 43 Infant Mortality. During the year 1936 there were 2,228 births and 163 deaths of infants under the age of one year in the borough, which gives an infant mortality rate of 73 per 1,000 births. This marks a decrease on the figure for 1935 (79), which was itself lower than that for 1934 (93). 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 1936, and the infant death rates for the previous four years:— District. 1936. Infant mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infant mortality rate. 1935 1934 1933 1932 England and Wales 605,292 35.712 59 57 59 64 65 London 56,273 3.714 66 58 67 59 66 The Borough 2,228 163 73 79 93 72 98 North Kensington 1,584 126 79 89 102 80 116 South Kensington 629 37 59 57 75 59 54 Wards. St. Charles 513 33 64 86 115 53 109 Golborne 445 42 94 100 97 89 112 Norland 355 37 104 102 111 117 142 Pembridge 271 14 52 54 73 67 120 Holland 162 10* 62 88 133 85 83 Earl's Court 116 12 103 42 40 55 22 Queen's Gate 107 1 9 29 51 37 59 Redcliffe 161 12 74 69 69 65 70 Brompton 83 2 24 - 40 23 32 Ward unknown 15 - - — — — — *This figure includes 7 deaths of infants from the National Children's Adoption Association hostel, which is situated in the Holland ward. In this institution unwanted infants are admitted and kept until they are adopted; they are generally illegitimate and come from all parts of the country. None of the infants from this home who died during the year was a Kensington child, and if these deaths were removed from the statistics the death rate for the Holland ward would be only 18. 9 Infant Mortality Rates, 1896-1936. 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 1931-1935 61 65 83 1936 59 66 73 The number of deaths of Kensington infants occurring in each month during 1936. January 16 February 12 March 26 April 8 May 12 June 9 July 3 August 11 September 10 October 14 November 18 December 24 Causes of, and ages at, deaths of infants under one year of age in Kensington during 1936. 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 nonths. 9—12 months. Total infant deaths under 1 year. Common infectious diseases (Diphtheria 1) (Whooping cough 6) (Measles 6) - - - - - 1 1 5 6 13 Pneumonia, bronchitis and other respiratory diseases 1 - 2 - 3 9 11 7 8 38 Diarrhoea - - 1 - 1 9 13 11 4 38 Complications of birth (Atelectasis 5) (Other complications 7) 10 2 - - 12 - - - - 12 Congenital malformation 6 - - - 6 1 1 1 - 9 Premature birth 19 - 2 - 21 1 - - - 22 Atrophy, debility and marasmus - - - - - 3 4 2 2 11 Other diseases:— (Violence 1) (Pyloric stenosis 1) (Meningitis 1) (Pyelitis 2) (Influenza 1) (Other conditions 14) 1 - 2 - 3 2 7 6 2 20 Totals 37 2 7 - 46 26 37 32 22 163 Death rate in each age period per 1,000 births 16.6 0.8 3.1 - 20.6 11.6 16.6 14.3 9.8 7301 Percentage of total infant deaths occurring in each age period 22.7 1.2 4.3 - 28.2 16.0 22.7 19.6 13.5 - 10 Deaths in Quarters of the Year. Disease. 1st. 2nd. 3rd. 4th. Total. Measles 2 4 - - 6 Whooping cough 3 3 - - 6 Diphtheria - - 1 1 Influenza - - - 2 2 Tuberculosis (not lungs) 2 - - — 2 Bronchitis 1 1 - 2 4 Pneumonia 13 5 - 16 34 Diarrhœa 10 9 6 13 38 Other digestive diseases 1 - 1 2 4 Congenital debility, premature birth, malformation, birth injury 15 6 15 14 50 Violence - 1 - - 1 Other diseases 5 1 1 8 15 Totals 52 30 23 58 163 The deaths occurring during the first month of life (neo-natal deaths) belong to a different category from those occurring after this period. The neo-natal deaths consist principally of cases of malformation, birth injury and prematurity, they include a high percentage of illegitimate infants, most of whom have little chance of survival from birth. Skilled obstetric care at the confinement is already within reach of all Kensington mothers, and the further reduction of the neo-natal death rate is being attempted through the ante-natal services by educating the expectant mother in the importance of the care of her health and the need for a balanced diet in pregnancy, the extra nourishment for necessitous cases provided by the council being of great value in this connection. Prematurity accounts for the largest number of neo-natal deaths ; the ideal to be achieved in this class of case is not so much search for an improved method of treatment of the premature baby as the prevention of prematurity. The percentage of neo-natal deaths to the total infant death rate during 1936 was 28.2, compared with 33.1 in 1935. When the deaths of infants over one month are considered, it should be mentioned that several factors have tended to raise the infant mortality rate in the county during 1936. In the spring there were severe epidemics of measles and whooping cough, and in the latter part of the year there was an epidemic of influenza. All these illnesses have tended to cause an increase in the number of deaths from respiratory disease, and this tendency was increased by the poor summer and lack of sunshine resulting in a lowered resistance to infection. In view of these facts which resulted in the infant death rate for England and Wales and London showing an increase from the preceding year, it is gratifying to note that the rate in Kensington decreased. The appointment of whole-time medical officers for maternity and child welfare work has facilitated administration; and the careful and co-ordinated work of the medical and health visiting staffs, combined with the ancillary services available in Kensington must be tending to raise the general level of health of the infants and young children in the borough. The preventive aspect of medicine is stressed at all the sessions held by the council's medical staff and this teaching is carried into the homes by the women health officers. A special watch is kept for the early signs of rickets or anæmia in the infant and toddler, and the child prone to catarrh receives special attention. The importance of hygiene, proper clothing and fresh air are constantly taught. The deaths from enteritis have diminished since last year. In January, 1936, the council resolved to investigate the high incidence of enteritis amongst children in Kensington and a special sub-committee was appointed, who reviewed the measures taken by the council during the past fifteen years and reported them as being both practical and comprehensive. The sub-committee, while still continuing their investigation, have issued an interim report in which they find from the evidence that most measures calculated to reduce enteritis are already in force in the borough, but since many cases appear to be the result of improper feeding an intensive educational and publicity campaign was recommended and carried out during the year. In addition to this educational campaign a special bacteriological investigation is being carried out. In regard to the curative side, every mother attending an infant welfare centre is advised of the wisdom of having a family doctor and the council's medical officers try to work in constant co-operation with the private medical practitioner. A close co-operation also exists between the welfare centres and the baby clinic, the baby hospital, the Princess Louise hospital, and the other children's hospitals serving the borough. The baby clinic, which acts as the treatment centre for all the welfare institutions in the borough, serves a useful purpose in providing medical attention for the children of necessitous parents; it also provides massage, sunlight and other special treatment when required. The new treatment centre in Kenley Street, which will be opened in 1937, will 11 further increase the facilities whereby North Kensington mothers who cannot afford private medical attention for their children may obtain medical treatment when necessary with the minimum of inconvenience to themselves. The health services for infants and pre-school children in the borough appear indeed both adequate and comprehensive. Twenty-one infant consultation sessions are held each week to supervise the health and upbringing of the normal child ; these sessions are conducted by medical officers, with special experience in the feeding and care of infants and toddlers, who devote their whole time to the council's service. Frequent home visiting is carried out by the council's health visitors assisted by the staff attached to the welfare centres. Milk and cod liver oil are provided free by the council for the children of necessitous parents in order to maintain health. Massage and artificial sunlight treatment are available within close reach of the children's homes ; curative medical treatment is available at the baby clinic, whilst for cases needing in-patient treatment there is a baby hospital and also a children's hospital situated in the borough. Convalescent homes are available for delicate children. One of the difficult problems existing in the borough is presented by the large section of the population which is constantly moving in and out of Kensington and which it is difficult to bring under the influence of the council's officers. With the appointment of two additional health visitors, who commenced work in April, 1937, a systematic search for families belonging to this migrant population will be instituted by house-to-house visiting, and it is hoped that good results will be obtained. Maternal Mortality. There were only two deaths of Kensington women attributable to childbirth during 1936, which represents a maternal death-rate of 0.9 per 1,000 births. This is a record for the borough. The corresponding death-rate for London is 2.1, and for England and Wales 3.6. Both women dying after confinement during the year belonged to the well-to-do class and both were attended by obstetric specialists. No woman belonging to the classes suitable for welfare attention, which represent about 80 per cent. of the total births in Kensington, lost her life as a result of childbirth during the year. It seems justifiable to correlate this gratifying result with the extensive use made by these mothers of the services provided by the council, and the success of the measures adopted is encouraging. Nor is this successful result limited to one year only which might be the result of chance. Three years have now elapsed since the council appointed a whole-time medical officer, who had previously specialised in obstetrics, to be responsible for the conduct of their maternity services under the supervision and direction of the medical officer of health, and it is interesting to compare the maternal mortality rate in the borough during these three years with that of the three years preceding the appointment:— Year. Kensington. London. England and Wales. 1931 6.0 1932 3.8 1933 3.5 average 4.4. 3.8 2.9 3.5 average 3.4. 4.1 4.2 4.5 average 4.3. 1934 1.3 1935 2.2 1936 0.9 average 1.5. 2.7 2.5 2.1 average 2.4. 4.6 4.1 3.6 average 4.1. In the consideration of these figures, the very large increase in the use made of the ante-natal services since the council appointed a whole-time ante-natal medical officer must be remembered, and it would seem justifiable to claim the low mortality rate as an indication of the success of the intensive ante-natal work which has been performed. That careful supervision of the expectant mother can lower the mortality rate by detection and treatment of any abnormality can be seen by examination of the obstetric records of women attending the Kensington ante-natal centres. Among the many hundreds of women who attended during 1936 there were several who had serious and dangerous disease, sometimes unknown to the patient: cases of heart failure, of acute toxaemia, of tuberculosis and so forth, and much time was spent by the council's officers over some of these cases. The patients' husbands were interviewed by the medical officer to obtain their co-operation, the council's services for boarding-out the children were utilised to allow of the mothers' immediate admission to hospital, the hospital staff were consulted personally about the cases, and in each instance the woman's life was saved. The council's ante-natal services would be worth maintaining if it were only for these few cases, but the routine examination of the normal case has in addition a considerable value. By this private consultation in the reassuring atmosphere of the ante-natal centre, the natural fears of the young expectant mother are removed and she is brought under the influence [of the council's officers at a time when she is especially receptive to education in matters of health. The personal contact which is established between the borough ante-natal centres and the mothers living in the district has made the clinics far more valuable as a factor in health education than it is possible for any hospital out-patient department to become, however well equipped and staffed that hospital may be. The council's medical officers and health visitors are in close touch with the mother; they know her home, her family and her circumstances, and can give the individual advice and help 12 which are needed in each case. Special attention is paid to the nutrition of the expectant mother; new ante-natal record cards are in use at the centres on which the diet of the individual mother is recorded; each case is discussed in detail and supplemented by grants of free dinners, milk, adexolin and iron when necessary. In last year's report, attention was drawn to the disquieting prevalence of induced abortion in the borough and the propaganda which was being directed against this practice was mentioned. It is believed that this propaganda has resulted in a diminution in the incidence of abortion during 1936 owing to the increasing knowledge of the dangers of this practice. The importance of post-natal examination is fully recognised in the borough and every woman is advised to attend a post-natal clinic after her confinement, in order that treatment may be obtained for any disability discovered and that it may be assured that the woman's health is in a fit state to stand the strain of a subsequent pregnancy. It appears as if it may now be claimed that the devotion which the council and the maternity and child welfare committee have paid to their maternity services in recent years has resulted in a well co-ordinated scheme of co-operation between the various agencies by which the problem of the care of the expectant mother has been satisfactorily solved. 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 1936 will be found in Appendix II, Table VI. 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 1936 was as follows:— Disease suspected. Examinations. Positive. Diphtheria 1,542 35 Scarlet fever. Nose and throat swabs 38 1 Tuberculosis. Sputum 752 58 ,, Faeces 1 - ,, Urine 1 - Typhoid fever. Blood 10 - ,, Fæces 8 4 Dysentery. Fæces 6 1 Enteritis 1 - Gonorrhœa 7 - Vincent's angina 11 2 Meningococcus. Throat 3 - Faeces from normal infants 45 - Entamoeba histolitica 1 - Ringworm 1 - Cerebro-spinal fluid 1 - Blood count 1 - The following examinations were also carried out:— Milk for general bacteriological examination 60 - ,, for examination for tubercule bacilli 20 1 Water from public swimming baths 26 - Miscellaneous 4 - Child Life Protection. At the end of the year there were in the borough 124 foster-mothers, and they had the care of 166 children under the age of nine years who had been taken for reward. One of the council's health visitors holds the appointment of child life protection visitor, and pays frequent visits to every home where a foster-child is kept. Eighty-five of the foster-children are under the age of five years, and all but eight, who are seen regularly by private doctors, are in regular attendance at infant welfare centres. 13 The following is a record of the work carried out by the child life protection visitor:— Visits paid to homes 1,393 Special visits paid 102 Children removed voluntarily 157 ,, ,, compulsorily - „ „ to hospital 22 Deaths reported 4 Cases in which there was cause for complaint 2 Cases recommended for prosecution 2 Foster-mothers added to register 29 „ „ removed from register 55 ,, ,, on register on 1st January 150 ,, „ „ „ 31st December 124 Foster-children ,, ,, „ ,, 166 From the above table it will be seen that two foster-mothers were recommended for prosecution in 1936. Each had care of a child without having previously notified the local authority as required by section 67 of the Children and Young Persons Act, 1932. In one case the woman admitted that she knew that she should have notified its reception, and the Bench imposed a fine of fifteen shillings and five shillings costs. In the second case a fine of five shillings was imposed. Four deaths of foster-children were reported. In each case inquiries were made, and it is satisfactory to be able to report that there was no occasion for complaint against the foster-mother. 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 1936 was 2,195 and the number of visits paid was 47,114. 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, 1936:— Cases. Visits. Maternity cases 38 727 Miscarriages 15 181 Pneumonia (5 years of age and over) 36 605 „ (under 5 years of age) 15 174 Ophthalmia neonatorum and other inflammations of the eyes of newly-born children 13 201 Influenza (5 years of age and over) 67 568 „ (under 5 years of age) 5 54 Enteritis and diarrhœa 140 1,223 Tuberculosis (5 years of age and over) 23 920 Measles (5 years of age and over) 33 410 „ (under 5 years of age) 114 1,463 ,, and pneumonia (5 years of age and over) 9 156 „ ,, (under 5 years of age) 22 404 Whooping cough (5 years of age and over) 2 14 „ „ (under 5 years of age) 4 86 Chicken-pox (5 years of age and over) 2 14 ,, (under 5 years of age) 7 77 Erysipelas 1 38 Acute rheumatism 7 163 Puerperal pyrexia 2 32 Scarlet fever 1 3 Pemphigus 3 82 Totals 559 7,595 For the services rendered, the council paid to the Association in 1936 a grant of £325. 14 The Princess Beatrice Hospital. The present accommodation is 81 beds. The hospital 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 1930 was as follows:— In-patients. (a) General wards 1,346 (b) Private wards 237 Out-patients. Total number of new out-patients 13,040 „ „ „ out-patients' attendances 62,791 Number of casualties 5,812 Other treatments. Number of operations—major 992 minor 762-1,754 Dental cases 2,197 Massage 4,604 Light treatments 1,298 Superficial therapy 629 Patients X-rayed 2,719 Ante-natal clinic and maternity ward. Total number of attendances 1,452 Number of patients admitted to maternity ward 313 The Princess Louise Kensington Hospital for Children. This institution meets the medical and surgical needs of the children in North Kensington and adjacent districts. In addition to a large out-patient department, there is an in-patient department of 81 beds. The hospital is now a recognised training school for nurses. There are X-ray, dental, ophthalmic and massage departments and a fully equipped operating theatre. The beds are allocated as follows:— General medical 39 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 1936. (a) In-patients. Total number of available beds on 31st December, 1936 81 Average number of available beds during year 75.90 „ „ ,, patients resident daily throughout year 65.85 Number of in-patients in the hospital at beginning of year 60 „ „ ,, admitted during year 1,524 „ „ „ in the hospital at end of year 58 Total number of in-patients 1,584 Average number of days each patient was resident 15.79 Number of patients admitted and discharged during year who were resident for (i) only 1 day 19 (ii) 2 and 3 days 503 (b) Out-patients. Total number of new out-patients 6,075 Total number of out-patients' attendances 42,974 Number of casualty patients among new out-patients 1,598 15 Rheumatism Supervisory Centre. The record of work carried out at the centre during 1936 is as follows:— Number of sessions held 48 Number of individual patients examined— Kensington 285 Hammersmith 37 Other boroughs 44 Total attendances of patients— Kensington 944 Hammersmith 128 Other boroughs 140 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 1936 was as follows:— New cases. Total attendances. Eyes 319 869 Aural 324 625 Minor ailments 1,485 23,548 Dental 1,071 1,730 A school treatment centre has also been established at the baby clinic premises in Tavistock Road, and the record of work for 1936 is as follows:— New cases. Total attendances. Minor ailments 2,791 24,255 Dental 1,936 4,333 Light treatment 264 1,718 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 1936 are as follows:— Cases. Tonsils and adenoids 280 Eyes 441 Dental 624 X-ray 6 Vaccination. There were 2,344 births in 1935 reported to the vaccination officer by the registrars of births. By the 31st December, 1936, 63.2 per cent. of these had been vaccinated. The other 36.8 per cent. are accounted for as follows;- Statutory declarations of objection 16.3 per cent. Died unvaccinated 5.3 ,, Insusceptible of vaccination 0.1 ,, Referred to other districts 8.8 ,, Removed, leaving no trace 5.7 ,, Postponed by medical certificate 0.3 ,, Unaccounted for 0.3 ,, In view of the fact that throughout the country generally only about 36 per cent. of the children born are vaccinated, the Kensington return must be regarded as highly satisfactory. Only 17 per cent. of the children born in Kensington in 1935 remain in the borough unvaccinated. Whilst the percentage of vaccinations is maintained at such a high level, the immunity from smallpox in Kensington should remain correspondingly high. A record of the work in regard to vaccination will be found in Appendix II, Table V. 16 School Medical Service. Sir Frederick Menzies, the county medical officer, has kindly made it possible for me to give the following particulars of the routine medical examination of elementary school children carried out in 1936 in Kensington. Table showing number examined and defects found. Number examined Boys. Girls. Entrants. Age 7. Age 11. Age 14. Entrants. Age 7. Age 11. Age 14. 761 585 654 673 710 595 678 660 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Malnutrition 11 2 7 3 10 5 1 — 3 3 4 2 9 3 1 1 Skin disease 15 8 7 3 6 3 4 2 10 5 7 4 7 7 3 1 Defective teeth — 286 — 173 — 193 — 258 — 274 — 183 — 167 — 210 Enlarged tonsils 89 9 55 7 16 4 15 1 83 7 62 12 35 8 22 4 Adenoids 3 — 2 — 2 2 — — 1 — 1 1 1 1 — Enlarged tonsils and adenoids 40 22 27 9 7 7 6 — 32 20 22 11 8 3 6 1 Other nose and throat defects 18 4 5 2 4 2 3 1 13 2 7 2 6 2 1 — Enlarged glands 108 3 74 7 59 — 46 1 73 5 79 1 49 2 29 — Eye disease 28 17 12 3 9 4 8 4 30 17 16 — 12 4 6 — Vision defects — — — 24 — 69 — 79 — — —— 20 — 62 — 70 Otorrhoea 17 11 8 3 2 2 4 4 12 3 6 3 3 — 2 1 Other ear disease 4 1 6 — 2 1 1 — 7 3 4 — 2 2 2 1 Defective hearing 2 — — — 1 1 2 1 2 1 3 2 2 1 4 — Speech defects 2 — 4 1 4 4 3 1 2 — 3 — — — — — Heart defects 24 1 10 — 6 1 8 2 8 — 9 1 12 — 11 2 Anaemia 13 6 4 — 5 1 9 — 7 1 — — 4 1 2 — Lung defects 30 4 8 1 4 — 3 — 20 3 15 6 2 — 1 — Nervous defects 6 2 4 2 10 2 2 — 12 1 5 — 4 — 2 — Phthisis — — — — 2 — — — — — — — 1 — — — Other T.B. disease — — — — — — — — — — — — — — — — Rickets 25 — 9 — 2 — 7 — 3 1 2 — 4 — 2 — Spinal deformities 1 1 — — 4 1 5 2 2 — 2 2 13 5 18 11 Other deformities 13 2 3 — 12 3 9 — 16 4 7 — 23 3 9 — Other defects 21 8 19 7 18 8 12 6 17 9 12 3 25 14 9 2 Number of children noted for treatment 337 227 272 323 326 239 254 274 * Defects however slight are included under " cases " ; those severe enough to require treatment are shown under *. Table showing the conditions in regard to clothing, nutrition, cleanliness, teeth and vision of the children examined. Age Groups. Number examined. Clothing and boots. Nutrition. Cleanliness of head. Cleanliness of body. Teeth. Vision. Good. Fair. Poor. Good. Average. Below normal. Bad. Clean. Nits. Pediculi. Clean. Dirty. Pediculi. All sound. Less than 4 decayed. Four or more decayed. 6/6 in both eyes. 6/9 in either or both eyes. 6/12 or worse in either or both eyes. Entrants Boys 761 263 488 10 198 516 43 4 756 5 — 758 3 — 403 231 127 — — — Girls 710 250 454 6 183 504 23 — 701 9 — 705 5 — 357 228 125 — — — Age 7. Boys 585 173 404 8 146 393 45 1 583 2 — 581 4 — 375 159 51 329 186 50 Girls 595 177 415 3 168 400 26 1 587 7 1 591 3 1 382 162 51 315 220 52 Age 11. Boys 654 127 516 11 144 471 39 — 646 8 — 649 5 - 446 187 21 416 130 106 Girls 678 196 475 7 165 478 35 — 666 8 4 674 3 1 503 155 20 388 168 121 Age 14. Boys 673 182 482 9 211 438 24 — 672 1 — 670 3 — 406 237 30 434 116 121 Girls 660 204 454 2 163 478 19 — 647 11 2 656 4 — 446 193 21 443 99 105 Total 5,316 1,572 3,688 56 1,378 3,678 254 6 5,258 51 7 5,284 30 2 3,318 1,552 446 2,325 919 555 Percentage 29.5 69.4 1.1 25.9 69.2 4.9 98.9 1.0 0.1 99.4 0.6 0.0 62.4 29.2 8.4 61.2 24.2 14.6 London 56.4 43.2 0.4 16.6 77.4 6.0 97.5 2.2 0.3 99.2 0.7 0.1 70.5 26.1 3.4 66.2 19.3 14. 5 17 Health Propaganda. The main part of the council's programme of health propaganda was conducted by the health lecturer at the infant welfare institutions. She also lectured at girls' clubs, girl guides meetings, nursery schools, women's meetings of the Salvation Army, and the Lancaster Road Fathers' Council. The subjects dealt with during the year were:— Enteritis—flies; vaccination; model clothes; choosing the right food; preparation for breast feeding; planning diets for the family; wise marketing; bathing the baby; hygiene of pregnancy; management of the nervous child; constipation; prevention of colds and chills; preparation for the newly born baby; nursing in the home; diphtheria immunisation. The health lecturer used the film projector purchased by the council in 1935 on 79 occasions. Films on health subjects were hired or obtained on loan from various organisations, and these proved both interesting and instructive to the mothers. A film called "The Empty Bed," which was purchased by the council in 1935, was also shown periodically at the infant welfare centres, and to audiences at the Argyll Hall, the Town Hall, the Venture in Portobello Road, and the Quest in Clarendon Road, and to parents' associations of some of the London county council elementary schools. In January, 1936, the maternity and child welfare committee appointed a special subcommittee to consider what steps should be taken to decrease the mortality from infantile diarrhoea or enteritis, and at their direction a vigorous propaganda campaign was conducted in the summer. The council purchased a film dealing with the fly nuisance and this was shown at eleven institutions in the borough; 2,000 posters and 20,000 leaflets on the subject of enteritis were distributed throughout the borough through the medium of the welfare institutions, the schools and the council's dustmen; and lantern slides were shown at five cinemas. In addition to the above propaganda, posters displaying the council's health services were exhibited throughout the year at the St. Mary Abbots and St. Charles hospitals, the public libraries, the public baths, and on the frames (which originally belonged to the Empire Marketing Board) at the barracks in Church Street, and the Fox and Lancaster Road elementary schools. In 1928 a monthly periodical, published by the Central Council for Health Education, entitled "Better Health," was issued from the public health department. The object of the publication was to set before the public information relating to health matters in short and interesting articles written by experts. A special issue of the paper was printed for Kensington, a section being reserved for articles of local interest. Two thousand copies of the magazine were distributed each month through various local channels. The publication did not involve any charge on the council, but it was discontinued in 1930 as the printers were unable to secure sufficient advertisements to justify free publication of the journal. The council consider that this publication should be revived, and so provision has been made in their estimates for the year 1937-1938 for the purchase of two thousand copies to be distributed monthly throughout the borough. 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 37. Subscriptions by the Borough Council to Voluntary Health Organisations during 1936. Subscriptions to Hospitals, etc. £ s. d. Cancer Hospital 5 5 0 Central Council for Health Education 10 10 0 Charity Organisation Society 5 0 0 Chelsea Hospital for Women 5 5 0 Invalid Children's Aid Association 40 0 0 Kensal Gospel and Medical Mission 5 5 0 Kensington District Nursing Association 5 5 0 £ s. d. National Hospital for Diseases of the Heart 5 5 0 Paddington Green Children's Hospital 5 5 0 Princess Beatrice Hospital 10 10 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 St. Mary's Hospital 10 10 0 West London Hospital 10 10 0 Western Ophthalmic Hospital 5 5 0 18 Payments to Maternity and Child Welfare Institutions. £ s. d. £ s. d. Bramley Road Infant Welfare Queen Charlotte's Hospital (Maternity Home) 1,198 16 0 Centre 310 14 8 Golborne Infant Welfare Centre 530 0 0 Aston Clinton Convalescent Home 17 15 6 Kenley Street Infant Welfare Centre 261 6 8 Evelyn Convalescent Home 16 16 0 Lancaster Road Infant Welfare Centre 618 19 4 Hambledon Convalescent Home 8 8 0 National Society for Epiletics 1 2 6 Raymede Infant Welfare Centre 324 7 0 Wayside Cottage Convalescent Home 38 0 9 South Kensington Infant Welfare Centre 328 6 8 Association of Infant Welfare and Maternity Centres 8 8 0 Golborne Day Nursery 209 18 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 465 12 0 Kensington Rescue Association 20 0 0 Baby Clinic 618 0 0 Mutual Registration of Assistance Society 10 0 0 Baby Hospital 1,509 10 6 Princess Louise Hospital 400 0 0 North'Kensington Women's Welfare Centre (Gynaecological Clinic) 100 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 throughout the borough by means of trailers drawn by electric tractors. The trailers when full are taken to the disposal points by motor lorries. The council continue to collect refuse in the borough not less frequently than twice weekly. The number of standardised dustbins sold since the council instituted their scheme in 1930 now totals 5,922. 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 158. Refuse Removal from Mewsways. Portable containers have been substituted for common dustbins for the storage of house Tefuse 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 409 81 Plans approved by the council 409 81 Total reconstruction of drains of premises 61 26 Partial reconstruction of drains of premises 211 96 Repairs to drains by " Economic " method 2 17 Other sanitary works, such as new soil pipes, baths, sinks and lavatory basins 4,183 2,024 19 Sanitary Inspection. The following table shows a summary of the inspections,etc. carried out by the district and housing inspectiors during the year:- DESCRIPTION OF WORK. DISTRICT INSPECTORS. Housing Inspectors. Total 1 2 3 4 5 6 7 Total complaints received 444 522 311 305 262 178 316 136 2,474 Public Health (London) Act, 1891 & 1936. Complaints received 141 320 293 278 228 178 270 4 1,712 Houses inspected on complaint 141 320 293 278 228 178 270 4 1,712 „ after infectious disease 212 297 90 14 53 45 65 2 778 Re-inspections 1,610 221 2,736 1,516 2,110 808 1,701 3 10,705 By-laws re houses let in lodgings. Complaints received 303 202 18 27 34 - 46 132 762 Houses inspected on complaint 303 202 18 27 34 - 46 132 762 First annual inspection (furnished houses) - 3 - 5 - - - - 8 First annual inspection (unfurnished houses) 211 155 66 56 56 - 1 1 546 Re-inspections do. do. 1,938 1,284 359 50 521 6 70 285 4,513 Housing Acts. Initial inspections (including preparation or revision of house-tohouse card) 286 176 101 109 100 61 97 178 1,108 Re-inspections 708 299 288 132 25 21 38 3,783 5,294 Underground living rooms. Primary inspections 92 22 137 35 39 3 79 86 493 Re-inspections 957 21 203 118 74 - 151 1,892 3,416 Drainage. Applications made 34 19 88 131 200 187 240 1 900 Plans submitted 29 27 27 41 126 89 143 8 490 House drains tested and inspected 209 143 456 11 76 64 83 7 1,049 Inspections of mews 366 521 15 143 57 187 8 - 1,297 „ canal boats 7 - - - - - - - 7 „ common lodging houses - - 36 - - - - - 36 Smoke observations 16 5 - - - 1 - - 22 Other inspections 1,487 615 795 445 206 588 515 82 4,733 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc., found during the year:— DISTRICT INSPECTORS. Housing Inspec. tors. Total 1 2 3 4 5 6 7 Notices issued. Public Health (London) Act, 1891 & 1936. Intimation notices 295 243 133 110 150 59 144 148 1,282 Statutory notices 21 49 42 4 34 7 9 40 206 Final notices 7 10 8 - 11 1 2 3 42 Summonses issued 1 - - 1 1 - - - 3 Housing Acts. Sect. 17 (1930) (Repairs) 11 12 1 - 1 - - 153 178 Sect. 6 (By-laws) 82 86 4 - 4 - - - 176 Sect. 127 (1925) (Entry) 33 48 4 - 4 - - 617 706 Removal of manure 7 5 - - - - - - 12 Smoke nuisance orders 2 - - - - - - - 2 Rent Restrictions Act certificates 2 - - - - - - - 2 Other notices 35 32 12 - - 5 1 - 85 Report of waste of water to M.W.B. 4 28 11 2 8 3 2 5 63 „ dangerous structures to L.C.C 8 14 10 2 - - - - 34 20 Summary of works completed under the supervision of the district and housing inspectors during the year:— DESCRIPTION OF WORK. DISTRICT INSPECTORS. Housing Inspectors. Total. 1 2 3 4 5 6 7 House drains reconstructed 22 20 34 8 25 3 14 1 127 „ ,, additions to 23 9 88 14 31 8 11 12 196 Defective drains repaired 4 11 39 13 29 32 21 - 149 House drains cleansed 33 25 43 12 12 29 12 8 174 Water-closets reconstructed 23 12 42 13 83 18 81 - 272 ,, repaired 22 20 17 12 47 85 9 1 213 „ new provided 17 21 7 9 139 5 146 35 379 supplied with water 40 15 24 58 145 56 101 - 439 Soil pipes ventilated, repaired, etc. 10 9 23 13 50 14 41 5 165 „ new provided 33 14 20 19 71 14 30 34 235 Ventilating pipes, new provided 25 10 37 10 18 10 28 4 142 Baths, new provided 21 5 31 72 172 83 298 2 684 Sinks, „ „ 83 174 32 50 137 31 92 187 786 Bidets, „ ,, 1 — 5 3 18 3 19 - 49 Lavatory basins, new provided 39 17 53 267 854 510 605 112 2,457 Waste pipes ,, ,, 53 175 62 72 203 21 159 293 1,038 Cisterns cleansed 15 24 11 4 23 3 80 - 160 „ covered 10 22 - 2 9 1 9 - 53 „ abolished 2 13 1 - 1 4 - 7 28 Taps fixed on rising main 19 97 27 - 9 2 9 271 434 Yards, areas paved, drained, repaired 61 54 36 1 79 16 17 68 352 Dustbins provided 100 62 40 16 78 44 4 - 344 Ashpits abolished 5 3 1 - 1 4 - - 14 Accumulations of filth, etc., removed 91 66 23 12 28 14 2 41 277 Animals removed 4 1 - 1 1 - - - 7 Overcrowding abated 4 1 - - - - - - 5 Indecent occupation abated 2 - - - - - - 2 4 Underground rooms, illegal occupation discontinued 1 - - - 6 3 - - 10 Roofs repaired 89 91 61 6 48 10 5 56 366 Houses provided with water above basement floor 13 55 2 3 3 - 1 - 77 Dampness in dwellings remedied 149 75 72 3 20 5 5 - 329 Ventilated food cupboards provided 42 59 11 4 4 - - 71 191 Artificial lighting of staircases provided 3 - 2 - - - - 21 26 Closing Orders made under Housing Acts— (a) Houses - - - - - - - - - (b) Parts of houses - - - - - - - 172 172! (c) Underground rooms (included in lb) above - - - - - - - 334 334 Closing Orders determined - - - - - - - 12 12 Repairs of houses completed under the Housing Acts 12 5 11 3 2 - 3 204 240 Infectious disease cases removed 150 202 93 52 29 11 54 - 583 Houses disinfected after infectious diseases (including bedding, clothing, etc.) 239 245 109 169 107 21 137 - 1,027 Rooms in such houses disinfected after infectious disease 429 247 110 176 126 24 139 - 1,251 Houses cleansed under houses let in lodgings by-laws 95 112 26 3 57 - - 13 306 Cleansing of houses not on register 22 3 20 16 16 2 2 4 85 Verminous houses cleansed (including bedding, clothing, etc.) 164 107 56 64 42 1 32 14 480 Verminous rooms cleansed in such houses 344 236 65 112 51 5 53 26 892 Dirty bedding cleansed 49 24 11 5 33 - 50 - 172 „ „ destroyed 12 3 - 1 1 - - - 17 Other sanitaiy works executed 338 194 14 11 51 - 2 42 652 21 Summary of Legal Proceedings taken in 1936. Offence. No. of summonses. Magistrate's decision. Failure to carry out sanitary repairs 1 Order made requiring works to be carried out within 14 days. Breach of by-laws of L.C.C. with respect to the removal of offensive matter. 24 Fined £1 in four cases; 15s. in five cases; 10s. in five cases; 7s. 6d. in one case; 5s. in one case; summons dismissed under Probation of Offenders Act, 1907, in eight cases. Failure to comply with L.C.C. by-laws in connection with drainage work. 2 Fined £2 in each case. Allowing dog to deposit its excrement on the public footway. 35 Fined £l in one case; 10s. in 32 cases; 5s. in two cases. Smoke Abatement. During the year twenty-two special observations were made with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Acts. Three nuisances were discovered. Written intimation notices resulted in remedies being secured in two instances. Remedies were also obtained in three other cases during 1936 as a result of notices which had been served in the latter part of 1935 Mortuary and Chapel of Rest. During the year 140 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 11 At the request of undertakers 37 At the request of Coroner 85 By the Police 7 140 In 85 cases post-mortem examinations were made under the coroner's warrant. Thirty-seven bodies were deposited in the chapel of rest, Avondale Park. In recent years this building has been redecorated and the furnishings greatly improved with a view to encouraging its use by the poorer persons in Notting Dale who have no satisfactory accommodation for the bodies of dead relations pending the funeral. Whilst the number of bodies deposited during 1936 was greater than in the previous year, it is to be regretted that more use is not made of the facilities provided. Public Baths and Wash-houses. Swimming Baths. Accommodation.—There are at the public baths (a) a men's first-class swimming bath with a capacity of 126,000 gallons, (b) a women's first-class swimming bath with a capacity of 40,000 gallons, (c) a men's second-class bath (45,000 gallons), and (d) a women's second-class bath (45,000 gallons). During the summer season (April to September) the four baths are in continuous use. At the end of September the baths are emptied and cleaned. Only the women's second-class bath is refilled for use during the winter season (October to March). Numbers of Persons using the Swimming Baths.—The number of persons using the baths during 1936 was 127,591 Men 35,627 Women 27,320 L.C.C. Schools— Boys 33,864 Girls 30,780 127,591 22 Purification of Swimming-bath Water.—The water of the swimming baths is subjected to continuous filtration and chlorination. During the year consideration was given to the possible advantage of substituting chloramination as a method of sterilisation of the swimming-bath water, but as will be seen from the bacteriological report which follows, the present method appears to be efficient. It has been decided that no change in method is warranted at present. Bacteriological Examination of Swimming-bath Water.—During the season from April to September samples of water for bacteriological examination were taken from each of the four baths on five occasions, a total of 23 samples being taken. Three further samples were taken in December from the one bath then in use. The samples were obtained in sterile, screw-capped bottles, which were filled by a swimmer at the positions in the bath indicated in the following table. The bottles were then taken immediately for culture to the laboratory of the Princess Louise Hospital. When the test was taken on the 16th September, arrangements were made for the samples to be taken and cultures planted immediately, in order to eliminate any action of free chlorine in the water on bacteria during transit to the laboratory. It will be seen from this report that there is no significant difference between the total cell-counts under the two methods. The following table gives particulars of the condition of water when the samples were taken, the sites from which the samples were taken, and the total cell-counts of organisms found in the samples. Samples were obtained from about 2 feet below the surface of the water, those from the inlet (shallow end) and outlet (deep end) about 6 feet from the grating. The samples taken for direct culture were removed by pipette from near the side of the bath :— Bath. Date of taking sample. Condition of water. Site in bath from which sample was taken. Total cell-count of organisms per c.c. of water. Men's First Class June 3 Still Centre Sterile July 2 Still Centre 3 August 13 Circulating Outlet Sterile August 28 Still Centre Sterile September 16 Still Side 5 Women's First Class June 3 Still Centre 1 July 2 Still Centre Sterile August 13 Circulating Inlet 4 August 13 Circulating Outlet 1 August 28 Still Centre Sterile September 16 Still Side 2 Men's Second Class June 3 Agitated (numerous swimmers). Centre 3 July 2 Agitated (numerous swimmers). Centre 6 August 13 Circulating Inlet 5 August 13 Circulating Outlet 9 August 28 Agitated Centre Sterile September 16 Still Side 9 Women's Second Class June 3 Still Centre Sterile July 2 Agitated (numerous swimmers). Centre 9 August 13 Circulating Inlet 1 August 13 Circulating Outlet 1 August 28 Still Centre Sterile September 16 Still Side Sterile December 3 Still Centre Sterile December 3 Still Inlet Sterile December 3 Still Outlet Sterile B. coli and streptococci were absent from all the samples. 23 Summary.—During 1936 a total of 127,591 swimmers used the swimming baths. On six occasions the water in each bath in use was subjected to bacteriological examination, a total of 26 samples being taken. Bacteriological examination showed all the samples to be free from B. coli and streptococci and the total cell-counts of organisms found were at a satisfactorily low level. Conclusions.—The water of the swimming baths at the Kensington public baths was found to be satisfactory from the bacteriological point of view, and on all occasions was free from pathogenic organisms. Baths and Washhouses. There are thirteen men's and seven women's first-class slipper baths, 34 men's and 20 women's second-class slipper baths, and six special warm baths. During 1936 the total number of persons using the slipper baths was 80,272. The total numbers of bathers using the swimming baths and slipper baths in the last five years are shown in the following table:— Year. Bathers. 1932 232,384 1933 235,860 1934 248,606 1935 218,449 1936 207.863 In the washhouse or laundry department there were 88 washtubs in use in 1936. The numbers of women using the washtubs in the last five years are shown in the following table:— Year. Washers. 1932 89,766 1933 82,715 1934 79,686 1935 73,843 1936 65,537 There are eight washing machines, and the number of women who used these in 1936 was 16,394. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-33. Two applications were made to the council in 1936 for a certificate of fitness of habitation under these acts. One was granted but in the second case it was found that the premises were in a reasonable state of repair and the public health committee decided that a letter should be sent to the applicant to this effect. 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 1936, the canal-boats inspector made seven inspections. Four 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. Removal of Aged, Infirm or Physically Incapacitated Persons. Section 224 of the Public Health (London) Act, 1936, confers on local authorities the same powers regarding aged and infirm persons as they had previously under section 28 of the London County Council (General Powers) Act, 1928. The borough council can make application to the Courts for an order to remove to a hospital, infirmary, institution or other similar place, aged, infirm and physically incapacitated persons living under insanitary conditions. During the year two cases were dealt with. The first was that of an old woman aged 74, who lived alone in two rooms. She was found to be dirty and neglected, and her rooms, bedding and furniture were exceedingly verminous. She was removed to St. Mary Abbots Hospital (Institution) for a period of three months. The second case was a woman of 60 years of age, who occupied a small back room. She was found to be dirty, neglected and suffering from chronic alcoholism; her rooms, bedding and furniture were found to be exceedingly verminous. In this case also an order was obtained for her removal to St. Mary Abbots Hospital (Institution). 24 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. The following table is a record of his work for the year:— Number of individual premises visited by the rat officer on receipt of complaint 223 Total number of visits paid 2,082 Number of poison baits laid during the year 69,040 ,, ,, disappeared 65,470 ,, ,, removed by the rat officer 3,500 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats 6 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 46 Number of sewer defects allowing egress of rats made good 9 Number of premises cleared of rats 153 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. Fifty-six dead rats were found in sewers, 20 rats were destroyed at Wood Lane depot and 36 rats and mice were killed in private premises. Nuisances from Pigeons. Section 121 of the Public Health (London) Act, 1936 (which replaces Section 52 of the London County Council (General Powers) Act, 1927), provides that for the purpose of abating any nuisance caused by pigeons, the council may seize and destroy those in excess of such number as may be considered reasonable. It is necessary, however, in the first place for the council to obtain consent to the measures adopted by them from owners of any building upon which the birds congregate. In previous reports I have stressed the difficulty encountered in the trapping of pigeons owing to the practice of feeding them adopted by a small number of residents. The public health committee have several times considered this aspect of the problem and have made representations with a view to securing legislation to control indiscriminate feeding. No success has attended their efforts in this direction and the large amount of work involved in dealing with the pigeon nuisance has consequently had somewhat disappointing results. In view of the difficulties encountered in trapping, particular attention has been paid in the last few years to the wiring up of church steeples and other places where it was found that pigeons roosted. Five churches have been dealt with in this way, and the number of pigeons has been considerably lessened. It is fairly certain that the majority of the pigeons now seen in Kensington roost outside the borough and come in only to feed. During 1936, 105 pigeons were killed and 40 eggs destroyed. Since June, 1929, when the council started to deal with the problem 1,957 pigeons have been destroyed. Fouling of Footpaths by Dogs. In 1921 the council made a by-law under which it was an offence for any person, in charge of a dog on a lead, to allow it to deposit its excrement on the public footway. The original penalty was a sum not exceeding 40s. but following a deputation from the council to the Home Office in 1933, the Home Secretary modified the by-law by increasing the maximum penalty to £5. Following further representations, the borough council succeeded, in 1936, in obtaining sanction to a wider by-law. Whereas the original by-law applied only to an offence committed by a dog whilst on a lead, the new by-law applies in the case of a dog either on or off a lead. There is a proviso to the effect that a person shall not be liable to be convicted if he satisfies the Court that the fouling by the dog was not due to culpable neglect or default by the person in charge. This new by-law will undoubtedly assist the council's officers in securing a greater improvement in the condition of the streets, for it was found previously that many persons evaded the law by slipping the lead on becoming aware that their dog was about to foul the footway. The attention of the public is drawn to the by-law by means of handbills, posters and notices pasted on lamp posts and sand bins. During the year 35 summonses were issued in respect of offences. Fines of £1 in one case. 10s. in thirty-two cases and 5s. in two cases were imposed. The number of convictions since the first by-law came into operation is 153. 25 FACTORY AND WORKSHOPS. The following table shows the 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 14 63 77 Basket makers 2 — 2 Bedding makers 1 2 3 Blacksmiths 5 2 7 Boot makers and repairers 32 56 88 Builders 60 11 71 Cabinet makers 18 8 26 Carpet repairers 1 — 1 Chromium plating — 1 1 Coach builders 1 7 8 Cycle repairers 3 — 3 Dentist 1 — 1 Drapery — 3 3 Dressmakers 4 — 4 Dry cleaners — 14 14 Dyers and cleaners 1 2 3 Electrical apparatus 9 4 13 Electric generating stations — 3 3 Engineering works and motor garages 19 51 70 Embroidery workers 1 — 1 Firewood choppers 1 2 3 Florists 3 — 3 Fretwork — 2 2 Furriers 2 5 7 Gasworks — 1 1 Glovemakers — 1 1 Hairdressers 4 — 4 Ice-cream manufacturers — 1 1 Instrument makers — 1 1 Invisible menders 1 — 1 Ironmongers 3 — 3 Jewellers 3 7 10 Lampshade makers — 1 1 Laundries 3 36 39 Marine stores 5 — 5 Masons 5 2 7 Metal workers 5 4 9 Paint manufacturers — 1 1 Photographers 4 — 4 Picture frame makers 8 1 9 Pipe makers — 1 1 Printers — 22 22 Radio repairers 10 3 13 Saddlers 1 — 1 Sausage makers — 24 24 Sign writers 2 — 2 Steam pressers 7 — 7 Sundry businesses 27 35 62 Tailors 71 5 76 Trunk makers 5 — 5 Umbrella makers and repairers 1 1 2 Undertakers 5 3 8 Upholsterers 20 6 26 Washing machine manufacturers — 1 1 Watch makers and repairers 6 1 7 Wax figure manufacturers — 1 1 Wheelwrights — 1 1 Totals 374 398 772 26 Factories and workshops where women are employed.—The following table shows the various trades and occupations carried on in registered workshops and factories where women are employed :— Trade or business. Workshops. Factories. Total. Arts and crafts. 4 1 5 Bakers 3 4 7 Basket makers 1 — 1 Bedding makers 1 1 2 Blind makers 2 — 2 Blouse makers 1 — 1 Boot makers and repairers — 1 1 Cabinet makers 2 1 3 Cardboard box makers 1 — 1 Carpet repairers 3 — 3 Chromium plating — 1 1 Corset makers 11 — 11 Drapery — 3 3 Dressmakers and ladies' tailors 182 7 189 Dry cleaners — 9 9 Dyers and cleaners 5 10 15 Fretwork — 2 2 Electrical apparatus 1 — 1 Embroidery workers 2 — 2 Fine needlework 1 — 1 Florists 17 — 17 Furriers 15 10 25 Glove makers — 1 1 Hairdressers 11 —' 11 Instrument makers — 1 1 Invisible menders 4 2 6 Jewellers — 4 4 Knitwear 5 — 5 Lampshade makers 2 1 3 Laundries 22 36 58 Marine stores 1 — 1 Millinery 32 2 34 Photographers 2 — 2 Pipe makers — 1 1 Printers — 6 6 Radio repairers — 1 1 Sausage makers — 1 1 Steam pressers 3 — 3 Sundry businesses 12 15 27 Tailors 58 13 71 Toy makers — 1 1 Umbrella makers and repairers 2 1 3 Underclothing 2 — 2 Upholsterers 11 7 18 Wax figure manufacturers — 1 1 Weaving 2 — 2 Totals 421 144 565 Home Work.—Of the 272 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 68 Outworkers in domestic workshops 38 Outworkers in their own homes 166 Total number of outworkers 272 27 The nature of the work given out to the 166 home workers on the register is as follows :— Tailoring 56 Dressmaking 40 Hand knitting 20 Bootmaking 16 Linen working 12 Outfitting 8 Fancy goods 5 Drapery 4 Blouse making 4 Dyeing and cleaning 1 166 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. 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) 865 66 — Workshops (including workshop laundries) 1,465 58 — Workplaces (other than outworkers' premises) 231 14 — Totals 2,561 138 — II.—Defects Found. Number of defects. Number of prosecutions. Particulars. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Acts :— Want of cleanliness 98 94 2 — Want of ventilation 10 10 — — Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 79 72 2 Sanitary accommodation :— Insufficient 3 1 — — Unsuitable or defective 100 83 Not separate for sexes 6 4 — 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) 4 4 Totals 301 269 4 — III.—Outwork in Unwholesome Premises (Section 108). No case came to my notice during the year of outwork being carried on in unwholesome premises. 28 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, the provision of free dentures for necessitous expectant and nursing mothers, hospital and convalescent treatment for mothers and infants, 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 to necessitous cases. During the year, all the above schemes have been reviewed, and the procedure to be followed by the council's officers in dealing with applications has been revised. It is natural, in view of the high infant mortality rate in the borough that the attention of the council has been focussed on the care of infants and children, and the maternity and child welfare committee have given much thought in attempts to find solutions of the problem. The appointment of an additional whole-time assistant medical officer in May, 1936, has enabled the number of sessions to be increased at the more crowded centres, and has also made possible the institution of toddlers sessions at three of the infant welfare centres. These toddlers sessions are an essential part of a scheme for the more careful supervision of the pre-school child, which was put into operation in 1936. At these special sessions the toddler receives a full medical examination, and the mother is advised in regard to the diet, hygiene and general management of the child of this age. The difficulty of obtaining physical without mental health is recognised and the psychological problems of the mother and child receive careful attention. Particular care is paid to the prevention of illness and deformity, and to obtaining prompt treatment in the early stages of any defect. The benefits of diphtheria immunisation are constantly taught. The council's increased grants of free milk for children up to three years of age (and in special cases to five years), and the grant of cod liver oil or its substitute in necessitous cases have proved of much value to the toddler, and marked improvement has been shown in many cases where the diet was previously deficient. The question of providing cheaper milk for working-class families in the borough has been considered, and the maternity and child welfare committee have been in consultation with the Milk Marketing Board to discuss the possibility of the introduction of such a scheme. There has been an extension of convalescent home treatment during the year, and twice as many pre-school children have been sent for convalescence from the infant welfare centres as in the previous year. Children suffering from repeated infections of the respiratory tract and those recovering from serious illness have received prolonged periods of convalescent treatment with the object of permanently restoring their health ; in all cases improvement, which is sometimes astonishing in degree, has occurred. The advisory committee, which is composed of representatives of the voluntary committees of the welfare institutions, have advocated the introduction of a scheme for the remission of fees for the admission of children of necessitous parents to the day nurseries in the borough in suitable cases. This scheme has been adopted by the council and should produce good results. Particular care is paid by the council's medical officers to the prompt detection and treatment of the defects which are still too frequently found in the child entering school. Cases of anaemia, malnutrition, rickets, orthopaedic defects, dental caries, discharging ears and infected tonsils and adenoids are constantly referred from the welfare centres to the appropriate agency for the purpose. For children unable to afford the services of a private practitioner, the baby clinic, which serves as the treatment centre for all the Kensington infant welfare institutions, has been of the greatest value. Arrangements have been made for an auxiliary treatment centre to be instituted at the Notting Dale school treatment centre at Kenley Street. The three school treatment centres in the borough will now also be treatment centres for the toddler and there will be continuity of medical treatment in the same premises, and in two out of the three centres by the same staff, from infancy up to school-leaving age. There is thus adequate provision in the borough for the medical treatment of the toddler when this is found to be necessary by the council's medical officers and health visitors. The importance of home visiting in the supervision of the health of both infants and pre-school children and in ensuring that any necessary course of treatment is carried out, is recognised by the council. For some time it has been difficult for the health visiting staff to get into contact with all parents of children suitable for welfare attention owing to the large floating population in Kensington. Families in necessitous circumstances are constantly moving in and out of the borough, and it is very difficult for the existing staff of health visitors to keep these families under adequate supervision. The council, after considering the subject, decided, in view of the recommendations in the Minister of Health's circular 1550, to appoint two additional health visitors ; these officers commenced their duties on the 1st April, 1937. In addition to more frequent visiting in order to supervise the pre-school child closely, the new appointments permit of intensive visiting in the congested areas of the northern part of the borough where health education is so vitally important. The ante-natal work as organised in 1934 is progressing satisfactorily, and the attendances during 1936 show an increase over the previous year. Two additional weekly ante-natal sessions were instituted during the year, and eleven clinics are now held each week. The importance of post-natal examination is also recognised, and the gynaecological clinic is a useful ancillary to the service. 29 On the 4th February, 1936, the council assumed financial responsibility and control of the Sutton Trust infant welfare centre ; on the 6th April the centre was transferred to its present commodious premises leased from the community centre, and the lease of the previous premises was assigned to the Kensington Council of Social Service to be used for handicraft classes. Originally the Sutton Trust centre had served primarily the residents in Sutton Way, but it now serves a larger area, and the council accordingly approved a proposal that the name should be changed to the Dalgarno infant welfare centre. It is very satisfactory that the municipal control of this centre has not entailed any severance from the voluntary committee of the centre who have rendered valuable assistance during the year, both in their help at the sessions and in their conduct of the social and benevolent side of the work ; their ready aid, both material and moral, to any mother attending the centre who is in need of help has been greatly appreciated. Two other voluntary committees (Kenley Street and Raymede) have found it impossible to continue to finance the centres which they had conducted so successfully through their pioneer years, and have requested the council to take over the financial control in order that they might concentrate their time and efforts on the social work which is of so much value and is so essentially the domain of the voluntary worker. The council have acceded to the requests. The baby clinic committee also found in 1936 that they were unable to secure sufficient funds from voluntary sources to maintain satisfactorily both the baby clinic and the baby hospital, and the council have agreed to assume financial control of the former institution which plays a valuable and important part in the council's scheme of maternity and child welfare. Women Health Officers. Eight women health officers are attached to the infant welfare centres serving the borough, and the work of these officers forms the basis of the maternity and child welfare scheme. Within twenty-one days of a birth, the health visitor calls at the home, advises the mother in any difficulty which may have arisen since she left the hospital or was discharged by the midwife, satisfies herself that the baby is receiving proper care and makes an appointment for the mother to take it to the welfare centre in her district. In all cases the baby, even when attending the centre, is visited at home every two months, and the importance of this home visiting is difficult to overestimate. The council's health officers are highly qualified, and all are sanitary inspectors. They have the knowledge and the tact to put things right by a hint when they see errors of hygiene in the management of the home, whilst the mother has an opportunity to ask questions in the privacy of this interview which she might hesitate to asked in a crowded clinic. The health visitor of the present day is a friend of the family, and her influence is greater than it has ever been before. Hygiene in the home is of enormous importance and it is the health visitor who can teach it. In addition to the routine visiting of infants and young children and to their work at the infant consultation sessions, the council's health visitors investigate cases of stillbirth and infantile death ; they visit and report on cases of puerperal fever and puerperal pyrexia ; they visit and advise the parents in cases of infectious disease amongst infants and young children, and help to obtain any necessary treatment ; they arrange for the admission of women to the maternity home and to convalescent homes, and investigate all applications under the council's scheme for the supply of milk and dinners hnms helns boardinp-rmt nf children and sr> forth. The work performed by the council's women health officers during 1936 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) 61 142 346 381 254 201 92 175 1,652 Re-visits to infants (0-1 year) 143 424 669 523 712 891 225 446 4,033 Visits to children between 1 and 5 years 297 748 1,061 698 1,063 735 513 683 5,798 Still-birth enquiries 5 7 10 11 5 4 — 3 45 Visits to ophthalmia cases — — 4 7 2 1 — 2 16 Return visits to ophthalmia cases — — 9 10 3 8 — 1 31 Visits to measles cases 44 222 125 54 218 191 223 230 1,307 Visits to whooping cough cases 10 37 48 13 23 48 98 30 307 Visits to puerperal fever cases — 1 5 6 — — 1 2 15 Visits to puerperal pyrexia cases 1 1 8 6 1 3 2 — 22 Visits to enteritis cases 5 15 32 12 16 12 6 — 98 Infantile death enquiries 5 16 29 27 23 16 11 20 147 Investigations re milk applications 275 282 814 923 509 479 151 91 3,524 Ante-natal visits 85 322 201 204 232 154 210 271 1,679 Half-days at welfare centres 108 136 141 133 154 115 59 128 974 Special visits 61 402 349 401 300 458 507 375 2,853 * This officer also acts as child 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 IV of Appendix II. 30 Infant Welfare Centres. There are seven infant welfare centres of which one (South Kensington) has a branch centre at Campden Hill. Six were conducted by voluntary committees, but on the 1st April, 1937, two of these came under municipal control, and there are now three municipal centres and four under voluntary committees. The council's medical officers conduct both ante-natal and infant consultation sessions at all the infant welfare institutions. The work done at these institutions during 1936 is shown in the following table :— Particulars of work done. Bramley Road. Campden Hill. Dalgarno. Golborne. Kenley Street. Lancaster Road. Raymede. South Kensington. Totals. Births occurring in the area of the centre suitable for welfare attention 262 75 83 160 198 439 350 229 1,796 Sessions at which doctor attended for infant consultations 154 44 105 102 112 166 152 154 989 Sessions at which doctor attended for special ante-natal consultations ... ... 51 42 52 29 51 56 81 51 413 Individual mothers who attended during the year 671 69 222 363 437 1,149 569 289 3,769 Individual mothers who attended ante-natal sessions during the year 200 76 105 85 171 189 247 110 1,183 Individual children who attended during the vear— o J Children 0 to 1 year 411 106 85 251 259 600 469 306 2,487 ,, 1 to 5 years 310 49 247 254 237 493 464 262 2,316 Attendances at centre of mothers for all purposes (excluding the accompanying of children and for the purpose of buying dried milk or other article) ... 2,131 783 964 1,043 2,326 6,950 3,314 1,493 19,004 Attendances at centre of children for all purposes— Children 0 to 1 year 4,141 1,230 1,811 2,024 2,452 4,860 4,770 3,037 24,325 ,, 1 to 5 years 2,792 749 1,654 2,581 2,440 5,137 3,919 3,116 22,388 Attendances at dinners— Mothers — — — 20 — 5,035 — — 5,055 Children — — — — — 1,288 — — 1,288 Attendances at doctors' consultations— Ante-natal mothers 845 224 364 266 776 740 934 482 4,631 Post-natal mothers 245 54 46 112 210 6* 19* 171 863 Children 0 to 1 year 2,363 820 817 1,000 927 2,691 2,045 2,107 12,770 ,, 1 to 5 years 1,375 357 833 1,026 929 1,820 1,737 1,833 9,910 Average attendances at doctors' consultations— Ante-natal mothers 16 5 7 9 15 13 11 9 11 Post-natal mothers 1 1 .9 1 — •1 •2 1 — Children 0 to 1 year 15 18 8 9 12 16 13 13 12 ,, 1 to 5 years 9 8 8 10 10 10 11 12 10 Individual children weighed during the year 721 185 332 505 494 1,093 933 504 4,767 Weighings 6,830 1,970 3,465 4,329 4,852 8,366 8,574 5,719 44,105 First visits paid to— Expectant mothers 71 68 1 122 155 170 587 Children 0 to 1 year 13 — 14 9 37 — — — 73 Home visits paid to— Expectant mothers 354 229 428 54 425 321 474 260 2,545 Children 0 to 1 year 1,246 1,451 1,043 495 1,189 1,525 1,791 1,158 9,898 ,, 1 to 5 years 860 1,140 1,436 435 1,349 1,208 1,954 1,386 9,768 * Post-natal mothers from these centres are now seen at the post-natal clinic at No. 28b, Archer Street. 31 TABLE SHOWING THE DENTAL TREATMENT PERFORMED AT THE CENTRES IN 1936. Centre. Patients. Attendances Extractions. Fillings. Dentures. Other treatments. Bramley Road 48 131 45 4 14 45 Campden Hill 14 37 36 7 4 15 Dalgarno 83 260 77 — 23 160 G-olborne 44 88 28 — 4 56 Kenley Street 61 157 53 1 16 52 Lancaster Road 219 583 238 27 48 152 Raymede 200 425 155 9 22 239 South Kensington 100 241 116 59 12 J 30 Totals 769 1,922 748 107 143 849 The council's scheme for the provision of dentures to necessitous expectant and nursing mothers has proved of great value. The scheme was very popular during the year and 90 mothers were provided with dentures under it. The council provided a sum of £250 in their estimates for the financial year 1935-36, but by December this had been spent and a further sum of £50 was provided to meet outstanding applications. A sum of £500 has been reserved in the estimates for 1937-38 for this service. 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 ante-natal clinic forms the co-ordinating mechanism of the council's scheme and brings the patient into touch with the services which would be of benefit to her. Eleven ante-natal sessions are held weekly, including an evening clinic to provide supervision and help for those women who are obliged to work during the early months of pregnancy. One thousand one hundred and eightythree expectant mothers attended the welfare centres during the year, with a total of 4,631 attendances ; at the evening clinic 48 sessions were held and 157 women attended, making 454 attendances, with an average attendance of 9-4 at each session. The total numbers attending the council's ante-natal clinics during the year 1936 are therefore 1,340 individual mothers with 5,085 attendances; the corresponding numbers for 1935 were 1,120 and 4,402, and for 1934, 692 and 2,345. It is satisfactory to note this increase in the amount of work performed since the appointment of the council's ante-natal medical officer. In addition to the borough council's clinics, two ante-natal sessions are held weekly at the Queen Charlotte's Hospital district ante-natal clinic at No. 240, Ladbroke Grove. One hundred and two sessions were held during 1936, at which 570 women attended, 450 of these being from Kensington. There are also ante-natal departments attached to all the London county council and other hospitals serving the borough. Full use is now being made of the ante-natal services provided by the council, and it is only in very rare instances that a Kensington woman does not obtain ante-natal care. The attendances at the hospital ante-natal departments and at the borough clinics represent approximately 82 per cent, of the total Kensington births, which is a satisfactory figure since the above-standard cases, who would be under the care of a private doctor or specialist, would cover the remaining 18 per cent. The excellent co-operation between the borough council's clinics and the private doctors and midwives, London county council and voluntary hospitals continues and is an essential factor in the success of the maternity scheme. Hospital Accommodation. The hospital accommodation available for Kensington women is ample for the needs of the borough, and no difficulty is experienced in obtaining admission to hospital for any woman who requires it. Kensington Maternity Home. The borough council's maternity home of ten beds is conducted by Queen Charlotte's Hospital at " Invermead," No. 341, Goldhawk Road, Shepherd's Bush. It is a large house situated in pleasant grounds, and in which the nervous young patient receives skilled obstetric care in the reassuring surroundings of a private home. Women entering the home receive their ante-natal supervision from the borough clinics, but are referred once to the home before confinement to be seen by one of the honorary staff attached to Queen Charlotte's Hospital. The same consultant is in charge of the post-natal clinic attached to the home. 32 Statement of work done during last five years. 1932 1933 1934 1935 1936 Applications for admission 161 173 206 224 186 ,, accepted ... 160 173 206 224 185 ,, withdrawn after acceptance 26 22 17 27 13 Women confined during the year 128 136 158 210 169 The gross cost of the scheme to the council during 1936 was £1,198 16s. Od. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £613 13s. Od. Payments made by patients totalled £587 4s. 6d. London County Council Hospitals. Hammersmith L.C.C. Hospital commenced to admit cases from North Kensington into their maternity wards during 1936, and a large number of Kensington women have made use of these facilities ; the co-operation between the borough clinics and the ante-natal department of the hospital has been most satisfactory. St. Mary Abbots L.C.C. Hospital now principally serves South Kensington since the mothers living in the northern part of the borough go to Hammersmith Hospital. A large number of Kensington women have been confined in the hospital during the year. Co-operation with this hospital is also good. Voluntary Hospitals. The Princess Beatrice Hospital, situated within the borough, admits many Kensington women to its maternity ward, and other patients have entered Queen Charlotte's Hospital, St. Mary's Hospital, St. George's Hospital, and other maternity hospitals. All the hospitals serving the borough send lists of the Kensington women booking for their maternity wards to the medical officer of health in order that their patients may receive the benefit of the home visiting carried out by the council's health visiting staff. Domiciliary Midwifery. Privale Doctors and Midwives. For patients in comfortable circumstances the borough is fortunate in its doctors and midwives : skilful obstetric care is given by the Kensington practitioners to patients referred to them from the clinics and the domiciliary morbidity rate is very low. In North Kensington, the establishment of a panel of private midwives who are paid a small subsidy by the council has proved a sound measure, which has facilitated the co-operation between the private midwife and the ante-natal medical officer. In addition to this subsidy, compensation is paid by the council to any midwife booked to attend a Kensington woman if the latter is referred to hospital by the ante-natal medical officer, so that the fear of a loss of her fee does not prevent a midwife from sending a Kensington patient for advice. Municipal Midwife. In the area of South Kensington which is not supplied by any hospital district, the council employ a whole-time midwife whose services are also available as a maternity nurse in any part of the borough for patients unable to pay a nurse's fee in addition to the fee of the doctor. These facilities ought entirely to eliminate the dangerous untrained handywoman. Before the council appointed a midwife there were no facilities in South Kensington for a woman in poor financial circumstances who wished to have her confinement at home. Now every patient has a free choice between home and hospital and the services of a trained midwife are available for every woman in Kensington. In 1936, which was the first year of the midwife's appointment, she attended 18 cases, in eight of which the fee was entirely remitted by the council. She paid 247 ante-natal and post-natal visits to these patients. In the intervals between her cases the midwife, who is a qualified health visitor, assists with the home visiting of mothers and children attending the South Kensington centre. Hospital Districts. Kensington is especially fortunate in that its northern area is the maternity district of Queen Charlotte's Hospital, whose district midwives attended 420 Kensington women in their homes during 1936 ; there was an exceedingly low morbidity rate due to the high standard of work of this hospital. St. Mary's Hospital undertakes a small number of cases in North Kensington in connection with the teaching of medical students, the maternity nursing of these patients being carried out by the Kensington District Nursing Association. 33 Post-Natal Examination. It is satisfactory to report a very large increase in the number of post-natal clinics instituted during 1936. In addition to the council's post-natal clinic, there are now weekly post-natal clinics at the borough maternity home, at all the maternity hospitals and London county council hospitals serving the borough, and at the Queen Charlotte's Hospital district clinic at No. 240, Ladbroke Grove. The importance of a careful routine post-natal examination in diminishing maternal invalidism is now fully recognised and every woman is taught its necessity. At the council's clinic at No. 28b, Archer Street, 49 sessions were held during 1936, at which 280 individual mothers attended, with a total of 300 attendances and an average of 6-1 at each clinic. This number is not large, but it represents these cases which do not come under the care of a private doctor or a hospital, and ensures that post-natal facilities are available for every woman in Kensington. The Baby Clinic, No. 92, Tavistock Road. This institution serves as a treatment centre for all the infant welfare centres in the borough. Mothers and children are referred there from the centres for treatment. Dental work, minor operations, massage, sunlight treatment, etc., are also carried out. Children attend daily for dressings. The medical officers in charge of the baby hospital conduct the sessions at the baby clinic, which renders it easy for any case needing in-patient treatment to obtain it. Under an agreement with the London county council, the treatment of minor defects of schoolchildren is carried out on the premises by the medical staff in charge of pre-school children. Thus, continuous medical treatment by the same staff and in the same premises of children from infancy up to school-leaving age is obtained. On the 1st April, 1937, the borough council, at the request of the voluntary committee, assumed financial control of this institution. The following are the records for 1936:— Sessions at which doctors attended for infant consultations 151 Sessions at which doctors attended for mothers'consultations 50 Individual mothers who attended 191 Individual children who attended (old) 248 Individual children who attended (new) 579 Attendances of mothers for all purposes (excluding the accompanying of children) 989 Attendances of children for all purposes f 0-1 year 1,127 1 1-5 years 9,610 Seen by doctor at consultations :— Mothers 958 Children 4,032 Average number seen by doctor at consultations :— Mothers 19 Children 27 Individual children weighed 827 Weighings 10,737 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 30 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 three medical officers of the council who conduct the infant consultation sessions at the infant welfare centres meet the medical staff of the baby hospital in consultation each week and discuss the treatment and after-care of the Kensington infants in the hospital. The value of this excellent co-operation between those responsible for the preventive treatment and those in charge of the curative treatment of these children is very great. The following is the record for 1936 :— Infants in residence at commencement of the year 23 Admissions 235 Discharges 231 Deaths 5 Infants in residence at end of the year 22 Average duration of stay in hospital 36 days. 34 Orthopaedic Treatment. In the course of the routine medical examination at the infant welfare centres, particular attention has been paid to posture and the presence of orthopaedic deformities. Infants presenting rachitic deformities, are referred to the baby clinic, where they attend for ultra-violet light and massage, the severe cases needing continuous splinting being admitted to the baby hospital. Knock knee and flat foot in the pre-school child 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 1936 :— New cases— Under 5 years of age 75 Over 5 years of age 109 184 Discharged— — Under 6 years of age 49 Over 5 years of age 107 156 Transferred to other hospitals because over age... 4 Cases treated 305 Treatments given 5,651 The borough council make an annual grant to the authorities of the hospital for this treatment. Massage treatment for children is also provided at the baby clinic and the South Kensington infant welfare centre. Artificial Sunlight Treatment. Artificial sunlight treatment is administered at the baby clinic and hospital. During the year 3,880 treatments were given and the average weekly attendance was 74; 311 children were treated. A number of patients were also treated at the Princess Louise Hospital. 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 1936, together with the number of cases admitted. Each mother and baby stays in the home for a period of 14 days. Mothers Mothers Institution. admitted admitted with without babies. babies. Evelyn Convalescent Cottage Home, Wargrave, Berkshire 8 1 Hambledon Cottage Home, Surrey 4 — Holiday Cottage, Aston Clinton, Aylesbury, Buckinghamshire 9 1 Wayside Convalescent Home, Sunningdale, Surrey 9 3 35 The Aston Clinton 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 £81 14s. 9d. In addition, the Invalid Children's Aid Association sent 70 Kensington pre-school children for convalescence and the council made a grant of £40 to that organisation in respect of this service In September last, the council agreed to take a bed in the new Zachary Merton convalescent home which is being erected at Rustington, Sussex. The inclusive charge for one bed for a period of twelve months is £75. The home will be open all the year round and will be available for mothers and infants. It is expected that the home will be opened for the reception of patients in a few months' time. Day Nurseries. There are four day nurseries in the borough, namely :— The Golborne Day Nursery. The Lancaster Road Day Nursery. The Notting Hill Day Nursery. The St. Clement's Day Nursery. The following table shows a record of children's attendances at the day nurseries in 1936 : Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. Whole-day attendances of children under 3 years of age 4,875 2,193 9,027 2,839 18,934 Whole-day attendances of children over 3 years of age 2,523 3,300 3,469 756 10,048 Total whole-day attendances 7,398 5,493 12,496 3,595 28,982 Charges made for each attendance of a child 8d. 9d. 6d. Is. — Half-day attendances of children under 3 years of age 587 587 Half-day attendances of children over 3 years of age 153 153 Total half-day attendances — — 740 740 Charges made for each attendance of a child... — — — 6d. — Average daily attendance of children 32 24-4 55-29 20 — In December last, the maternity and child welfare committee approved of a scheme, which was adopted by the council in January, 1937, for the admission of children of necessitous parents to the above day nurseries at the cost of the council, and a sum of £200 has been placed in the estimates for 1937-38 for this purpose. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. During the past year, the council have paid special attention to the means by which the nutrition and health of the poorer mothers and infants in the borough might be improved. Previously it had been the practice of the maternity and child welfare committee to limit their milk grants to necessitous women in the last three months of pregnancy, nursing mothers, and infants under twelve months of age ; but in January of the year under review they indicated that they were prepared to receive applications from all necessitous expectant and nursing mothers, and children under five years of age. In the year, 4,000 grants of milk were made by the council's applications sub-committee. One thousand and twenty-one of the grants were in response to new applications, and the remaining 2,979 were renewals of grant. Under the council's scheme, 194,352 pints of fresh milk were granted free of charge at a cost to the council of £2,304 13s. Id., and 4,233 packets of dried milk were granted free of charge at a cost of £299 16s. 4d. 36 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. Bramley Road 1,415 96 12 8 Campden Hill 562 40 2 7 Dalgarno 394 26 11 11 Golborne 465 31 1 2 Kenley Street 1,041 70 14 4 Lancaster Road 2,637 175 10 7 Raymede 1,339 93 3 2 South Kensington 773 55 5 6 Baby Clinic 6 8 0 Totals 8,632 589 9 11 There are eight dinner centres in North Kensington where dinners are supplied to expectant and nursing mothers. The council have considered it expedient that certain of these mothers should receive free dinners in addition to free grants of milk. Seventy-two applications for free dinners were granted ; 28 of these were new applications, and 44 were renewals. The total number of dinners supplied was 2,730 and the cost was £84 19s. 4d. 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 :— 6,072 pints of milk at a cost of £84 19s. 3|d. 38 packets of dried milk at a cost of £2 13s. lOd. A scheme of co-operation between the county council and the borough council enables women attending ante-natal clinics at the county council hospitals who are not in receipt of relief, but who are in need of extra nourishment, to be assisted by grant of extra nourishment at the expense of the borough council. Help given in this way is included in the total expenditure of the borough council given above. Home Helps. One hundred and fifty-nine applications were received for the provision of home helps under the council's scheme. The assistance requested was granted in 137 cases for a period of 14 days each, in six cases for one month, in six cases for one week, two applicants cancelled their requests, and eight applications were not granted by the sub-committee. The gross cost of the scheme to the council during the year was £202 5s. Od. 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 child life protection, and the child 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 learn of good homes for children required to be boarded-out During the year, 18 children were boarded-out at a cost of £22 10s. Od. Travelling Expenses of Women Breast-feeding Infants Admitted to Hospitals. Three applications were received for payment by the borough council of travelling expenses to and from hospital of women who were breast-feeding infants admitted as in-patients to hospitals for treatment. These were granted, and the total payments amounted to £1 9s. 4d. 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. 37 The following is a record of the work of the health lecturer during 1936:— Lectures given. Individual mothers attending. Attendances. Average attendance at lecture. Bramley Road I. W. C. 68 364 723 10.6 Campden Hill ,, ,, 33 210 666 16.5 Dalgarno 40 136 628 15.7 Golborne „ „ 30 123 320 10.6 Kenley Street „ „ 47 214 781 16.6 Lancaster Road „ ,, 91 244 1,565 17.2 Raymede „ „ 70 293 879 12.5 South Kensington „ 51 160 501 9.9 Baby Clinic 34 144 471 13.8 Other institutions 23 — 1,186 51.5 Totals 487 1,894 7,720 15.8 Birth Control and Gynaecological Clinics. The council have an agreement with the North Kensington Women's Welfare Centre at No. 12, Telford Road, whereby women attending the infant welfare centres in the borough can in appropriate cases receive birth control advice and gynaecological treatment. The birth control advice is given to married women only, and is based only on medical grounds. During 1936, the attendances of Kensington women at the Telford Road clinic totalled 966. The council recognised the good work which had been carried out by the North Kensington Women's Welfare Centre, and at the beginning of 1936 they increased their grant from £50 to £100. This grant was in respect of both birth control advice and gynaecological treatment. 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. 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. Legislation. The Housing Act of 1936 assembled in appropriate sequence the various parts of the housing code previously distributed in a number of Acts ; and the Public Health (London) Act, 1936, brought into one measure most of the public health legislation in force in the metropolis. These two Acts passed in 1936 contained no new legislation, but they simplified the task of those engaged in the housing work of local authorities. Clearance Areas. During the year the following four new clearance areas were dealt with :— (1) Manchester Mews.—This area, situated in the St. Charles ward, consisted of four mews dwellings hemmed in behind high buildings. A clearance order was made on the 3rd March, 1936. Owners of the properties having lodged objections, the Minister of Health held a public inquiry on the 11th May, 1936, and confirmed the order without modification last September. (2) Chelsea Grove.—This area contains 15 cottages and is situated in the extreme south of the Redcliffe ward. It is set back behind high buildings in Fulham Road. The council made a clearance order on the 3rd March, 1936, and later in that month the owners of the property submitted an ofler not to oppose the clearance order if they were granted an extension of four months of the time in which to secure vacation of the premises. The council agreed to grant this extension and the Minister confirmed the clearance order in September last. 38 (3) Yeoman's Row.—This area consists of 18 houses in the Brompton ward of the borough. The clearance order was made by the council on the 3rd March, 1936, and, no objections being lodged by the owners, the Minister confirmed the council's action in September. (4) Heathfleld Street.—This area, consisting of 19 cottages in the Norland ward of the borough, was declared a clearance area, and a compulsory purchase order was made by the council on the 1st December, 1936. The Minister held a public inquiry on the 15th February, 1937, and subsequently confirmed the order. The following table gives particulars of the clearance areas dealt with since 1930 :— Name of area. Date of declaration. Action taken by council. Number of premises on site. Number of persons originally living on site. Position at end of 1936. (1) Talbot Grove and Mews. December, 1930. Com. Purchase Order. 26 170 Premises demolished and erection of 64 new flats on site completed in 1935 ; 380 persons now accommodated in the new flats. (2) Adair Road, Southam Street. July, 1931 do. 6 113 Premises demolished and 9 new flats erected on site in 1935, providing accommodation for 50 persons. (3) Barker Street July, 1931 Clearance Order. 57 236 Premises demolished ; site to be used for school buildings. (4) Haydens Place, Tavistock Mews. October, 1933. do. 10 29 Premises demolished; and four new lockup garages erected on part of site in 1935. (5) Silvester Mews October, 1933. Com. Purchase Order. 20 110 Premises demolished ; 24 new flats in course of erection and nearing completion. (6) Gadsden Mews January, 1934. Clearance Order. 14 44 Premises demolished but site not yet developed. (7) Edenham Mews February, 1934. Com. Purchast Order. 10 34 Premises demolished but site not yet developed. (8) Bramley Mews February, 1935. Clearance Order. 13 43 Premises demolished but site not yet developed. (9) Tabernacle Terrace July, 1935 do. 7 68 Premises demolished and site to be used for erection of 16 new flats. (10) Manchester Mews October, 1935. do. 4 25 Order confirmed; premises not yet demolished. (11) Chelsea Grove October, 1935. do. 15 23 Order confirmed ; premises not yet demolished. (12) Yeomans Row October, 1935. do. 18 155 Order confirmed ; premises not yet demolished. Plans approved for erection of new houses. (13) Heathfield Street May, 1936 Com. Purchase Order. 19 67 Order confirmed in 1937. 39 Compulsory Purchase Orders. The council, in pursuance of their powers to provide housing accommodation for the working classes within the borough, had before 1936 made compulsory purchase orders in respect of four sites which are not included in the category of clearance areas. Particulars of these sites are as follows :— (a) Kensal Road and West Row.—This site consisting of five premises was made the subject of a compulsory purchase order on the 24th July, 1934. The order was confirmed by the Minister of Health ; the properties were acquired and transferred to the Kensington Housing Trust on condition that the Trust used the site for the purpose of providing working class housing accommodation. A building scheme was approved by the council for the erection of 30 flats to provide accommodation for 180 persons. The new flats were ready for occupation at the end of 1936. (b) Portland Road, Walmer Road and Clarendon Road.—A compulsory purchase order was made on the 8th October, 1935, in respect of this site containing 22 premises. The Minister confirmed the order, and the council have prepared a scheme to erect 100 flats. At the end of the year negotiations were still taking place for the acquisition of the land. (c) Bramley Road and Blechynden Street.—This area containing 11 premises was made the subject of a compulsory purchase order on the 8th October, 1935. The Minister has confirmed the order, and at the end of the year the council were still negotiating for the acquisition of the land. A scheme has been prepared by the council for the provision of 43 flats on this site, augmented by the site of two premises already in the council's ownership. These flats will provide accommodation for 250 persons. (d) South Row and Great Western Terrace.—This area containing 33 cottages was declared for compulsory purchase by the council on the 8th October, 1935. The Minister confirmed the order, and the council have approved a scheme for the erection of 60 flats, which will provide accommodation for 354 persons, and two shops. At the end of 1936 the council were still negotiating for the acquisition of this site. Portland Road and Heathfield Street.—On the 1st December, 1936, the council made a compulsory purchase order in respect of 25 premises in Portland Road and Walmer Road, and added the 19 houses in Heathfield Street, which were declared a clearance area in May, 1936. In this case two owners objected to the council's action. The Minister held a public inquiry on the 15th February, 1937. If the order is confirmed it is the council's intention to allow the Aubrey Trust to erect working class flats on the site. Improvement Areas. The council's five years housing programme, adopted in 1933, 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 the Act received Royal Assent on the 2nd August of that year. On that date three of the areas had been declared, and it is fortunate that these were the most important from the point of view of improvement area procedure. Other steps will have to be adopted in deeding with the remaining four improvement areas. (1) Southam Street Improvement Area.—As a measure of administrative convenience, the Minister divided this area into two parts, but in this report and during the progress of the work they have been dealt with as one. The declarations were made in January, 1934, and the by-laws for the abatement of overcrowding and the improvement of housing conditions were confirmed by the Minister in April, 1934. During 1936, the obligations imposed upon the council to improve this area were completed, and it will be of interest to submit a concise record of the steps the council have taken. Description oj area in 1934. The area, comprising about 15 acres, was a black spot in the Golborne ward; it contained 410 premises with a population of 5,818 persons. The average number of separate families per house was over four. The Golborne ward as a whole was the third most densely populated ward in London and the improvement area itself had as great a density as 390 persons to the acre. The majority of the 410 premises consisted of tenement houses of the four-storied basement type, built in long terraces. Generally, each house contained seven rooms above ground level, two rooms in the basement and a common washhouse at the rear of the basement. The water closet accommodation, judged by the standard of one convenience to every twelve persons, was generally sufficient, but was usually found in the rear yard at basement level. This meant that all the occupiers, except basement tenants, had to descend one, two or three flights of unlighted stairs by night or by day to reach the apartments. In every house there was one sink situated in the basement washhouse for the common use of all families. The only other water supply was usually a tap situated on one of the landings or on the back addition roof. The washhouse in nearly every case contained one copper for the common use of all the families in the house. Cooking accommodation, in the form of gas stoves and fire ranges, was generally adequate but there was practically no food storage accommodation. It will be seen, therefore, that the people in this area enjoyed very limited domestic comforts. 40 The houses had been built about 70 years previously for single-family occupation ; but practically every room was being used for both living and sleeping purposes and the dwellings were fast deteriorating on account of the tremendous amount of wear and tear. Disrepair and sanitary defects were common, but the main structures were, on the whole, fairly good. The streets are wide and well planned and the area could not have been reasonably dealt with under clearance procedure. An unsatisfactory feature was the bad condition of basement rooms which were unfit owing to lack of air space and proper ventilation, darkness and dampness. Power to deal with the area. The Housing Act, 1930, provided a solution to the problem of dealing with areas such as this where rapid deterioration was taking place, but where immediate demolition was not practicable ; but the council were not entirely satisfied with the new powers and they induced the London county council to promote special legislation to enable them to close completely the unsatisfactory basements. These special powers were obtained in the London County Council (General Powers) Act, 1933. The council concluded that they had three primary obligations to fulfil in connection with this area, namely :— (1) closure of unsatisfactory basements ; (2) abatement of overcrowding ; (3) reconditioning of the houses under Part II of the Housing Act, 1930. There is a fourth duty, namely, the enforcement of improvement area by-laws to maintain a proper standard of accommodation ; this duty will remain as long as the area is an improvement area. Closure of basements and abatement of overcrowding. The first steps were to decrease the number of people in the area, eliminate overcrowding and thus reduce the heavy wear and tear on the property. With this view in mind, the council acquired the vacant Dalgarno Gardens building site of ten acres in North Kensington and made arrangements with housing associations for the immediate erection of 323 flats for the working classes. By December, 1934, the 778 basement rooms were closed and vacated ; early in 1935 the rehousing of overcrowded families was completed. The result was that 1,802 persons were moved out of the area, giving a reduction in population of 29 per cent. In connection with this work, the council decided to prevent bug infestation of the new flats, and the now well-known procedure of disinfesting by hydrocyanic acid gas the furniture of families removed from old vermin infested houses to new flats was made a routine practice. During the operations undertaken in vacating basements and abating overcrowding, the furniture of 399 families was treated in this way. No fee was asked from these families. Reconditioning of the houses. In December, 1934, the council commenced the task of securing the repair and improvement of the houses. Four houses were found not to be repairable at reasonable cost. Demolition orders were made and the premises were vacated and demolished during 1935. The remaining houses were brought up to a satisfactory standard of habitability by the application of Section 17 of the Housing Act, 1930, and the special improvement area by-laws. Every house was surveyed, a comprehensive schedule of repairs prepared in each case, and 373 notices were served requiring the execution of the necessary work. The cost of reconditioning in individual houses varied from £30 to over £200 and it is estimated that an average of /90 per house has been spent in this process. The following is a record of the principal works carried out:— Houses cleansed (including disinfestation) 373 New sinks, with water supply, fixed 1,139 Ventilated food cupboards provided 1,158 House drains reconstructed 15 Additions made to house drains 173 Defective drains repaired 25 Water closets reconstructed or repaired 185 New water closets provided 143 New soil or ventilating pipes provided 143 Artificial lighting of staircases provided 354 Yards and areas paved or repaired 312 Accumulations of rubbish, etc., removed... 288 Roofs repaired 475 External painting provided 217 In 16 cases, the council completed the requirements of the Section 17 notices in default of the owners at an expense of £868 15s. 9d. Of this amount, £246 13s. 2d. has already been recovered and the remainder, with interest, is being collected through the rents. The improvement of the area as contemplated three years ago is now completed. Prevention of nuisances in closed basement rooms. In the improvement area by-laws, the council have powers to prevent nuisances arising in closed basement rooms and owners have been required to wire or board up the windows, remove all rubbish and litter, and to remove dirty or verminous wall paper and woodwork. Routine inspections of the basements are carried out once every two months and it is interesting to report that only on rare occasions are unsatisfactory conditions found. 41 Use of closed basement rooms. The council have control over the use of closed basement rooms and have sanctioned their use in 34 cases for the following purposes :— Storage of surplus furniture 12 Temporary storage of builder's materials 8 Storage of empty boxes, etc., in shop premises 11 Washing and drying of clothes 3 In some of the houses owned by the Improved Tenements Association the basement floors have been concreted and the rooms converted into bathrooms. In 39 houses, the basement rooms have, at considerable expense, been made fit for habitation and the closing orders have been determined. Maintenance of the standard attained. The Housing Act, 1930, contemplated that, when once the improvement had been brought about, the area should receive constant and rigid supervision in order to maintain the high standard achieved. Therefore, as soon as reconditioning of a house was completed, it was placed upon a list to be visited regularly by an inspector detailed for the purpose. This supervision has a two-fold object, namely, (a) to maintain the improved housing conditions, and (b) to assist the owner in keeping his house in such a state that he can expect some return for the considerable outlay he has been called upon to make. (2) Crescent Street Improvement Area.—This area consisting of 129 premises with a population of 1,782 persons was declared to be an improvement area in April, 1934. The by-laws for the abatement of overcrowding and the improvement of the houses were confirmed by the Minister of Health in June, 1934. During 1935 the council closed 193 unfit basement rooms in this area for living and sleeping purposes, and displaced therefrom 82 families comprising 299 persons. In addition there were 65 families of 349 persons living under overcrowded conditions in rooms above basement level. All these 147 families have been satisfactorily rehoused with one or two exceptions, and all the unfit closed basements are now unoccupied. Reconditioning of the houses should have been undertaken in 1936, but the council, in conjunction with a housing association, are considering whether this area can be entirely redeveloped. (3) Treverton Street Improvement Area.—This area was declared to be an improvement area in May, 1935. Considerable difficulty was experienced in obtaining by-laws necessary to secure improvements in this area, similar to those in force in the Southam Street and Crescent Street improvement areas. After negotiations between the Ministry of Health, the county council and the borough council, special new by-laws were made under the Housing Act, 1935, and were confirmed by the Minister on the 22nd July last. They are almost identical to 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. The by-laws came into operation on the 1st August, 1936, and the council have practically the same powers to deal with the Treverton Street area as they have in their other improvement areas. The first steps to be taken were the closure of unfit basement dwellings, the rehousing of persons so displaced, and the elimination of overcrowding. In 1936 the council dealt with the unfit basement dwellings in this area, and during the year closing orders were made in respect of 183 basement rooms ; in addition, the council accepted undertakings from owners to make 42 basement rooms fit for habitation. Including both overcrowded families and occupiers of closed basement rooms, there were 227 families (1,025 persons) scheduled for rehousing. The new flats to accommodate the displaced families were provided at Dalgarno Gardens by the Peabody Donation Fund, but they were not completed until December with the result that very few families were rehoused from the area in 1936. As it is not desirable to undertake reconditioning of the premises until the overcrowding has been abated, the former task was not commenced until the last month of the year when notices were served under section 17 of the Housing Act, 1930, in respect of eleven premises. At the time of writing (April, 1937) rehousing and reconditioning are proceeding rapidly. Individual Unfit Houses Not Repairable At Reasonable Cost. Section 19—Housing Act, 1930 (now Section 11—Housing Act, 1936). No houses were dealt with under this heading during the year. In the previous year, however, demolition orders were made in respect of two premises, but the owners appealed to the County Court The hearing was adjourned with a view to the owners arranging for the houses to be reconditioned At the end of 1936 the two houses (with the exception of the basements) had been repaired and made fit for habitation. Individual Unfit Parts of Houses Not Repairable At Reasonable Cost. Section 20—Housing Act, 1930 (now Section 12—Housing Act, 1936). In addition to the action taken in closing unfit parts of houses (basements) in improvement areas, 207 parts of houses, mostly underground rooms in basements, were represented as unfit and not repairable at reasonable cost. (Of these, 11 were special South Kensington cases arising out of town planning applications.) 42 The following table shows the action taken during 1936 in respect of unfit parts of houses :— Outside improvement areas. Inside improvement areas. (a) Closing orders made 80 (152 rooms) 92 (183 rooms) (b) Closing orders determined 5 (10 rooms) 7 (14 rooms) (c) Undertakings by owners not to use for human habitation accepted 2 (4 rooms) (d) Undertakings by owners to make premises fit accepted 32 (63 rooms) 22 (42 rooms) (e) Undertakings cancelled—premises having been made fit for habitation 9 (18 rooms) 1 (2 rooms) (J) Cases of default in undertakings to make premises fit for habitation (closing orders made) 2 (4 rooms) The 92 closing orders made inside improvement areas refer to basements in Treverton Street improvement area, and an account of the steps taken to secure the vacation of these basements has already been given. Of the 80 closing orders made in respect of parts of houses outside improvement areas, 79 were in respect of basement dwellings, the remaining case was in respect of a room on the first floor without natural lighting or ventilation. Of the 79 basements outside improvement areas closed last year, 23 were empty when the closing orders were made, and in 8 other cases the basement families were able to move to adequate accommodation upstairs in the same house. This left 48 families (202 persons) to be displaced. Of this number 21 families (104 persons) were rehoused by the council, or, through their agency, by the London county council and housing associations ; and 6 families (23 persons) are still living in the basements. These 6 families who have not left the closed basements have been offered and refused alternative accommodation. For the past two years the council have not had to resort to legal proceedings to enforce closing orders, but it may be that such will have to be taken in one or two of these six remaining cases during 1937. Individual Unfit Houses Repairable At Reasonable Cost. Section 17—Housing Act, 1930 (now Section 9—Housing Act, 1936). The following table gives a summary of the action taken and the results obtained during the 12 months pnripri 31st December. 1936 :— Outside improvement areas. Inside improvement areas. Totals. Notices served in 1935 which were outstanding on 1st January, 1936 ... 16 109 125 Notices served from 1st January, to 31st December, 1936 84 94 178 Appeals by owners to the County Court against notices 1 — 1 Notices withdrawn — — — Notices satisfactorily complied with by the owners 42 175 217 Notices in respect of which the council carried out the work in default of the owners 6 17 23 Notices in respect of which progress was being made by the owners on 31st December, 1936 23 9 32 Notices in respect of which the council's contractors were engaged in executing repairs at the end of the year 2 — 2 Notices in respect of which nothing had been done at the end of the year (the time allowed had not expired in these cases) 26 2 28 From the time the council commenced enforcing the repair of houses by the service of Housing Act notices up to the 31st December, 1936, they have expended £5,002 5s. 2d. in carrying out work in default of owners. Of this sum, £4,287 15s. 5d. has been recovered, and the outstanding amount of £738 15s. 6d. with interest, is being collected in instalments. The total expenditure by the council during 1936 in executing repairs was £1,234 8s. 8d. In the past fourteen years, 1,463 houses have been repaired under Housing Act procedure. 43 Underground Room Regulations. Section 18 of the Housing Act, 1925 (now section 12 (2) of the Housing Act, 1936) states that a room, the surface of the floor of which is more than 3 feet below the surface of the street adjoining or more than 3 feet below the surface of any ground within 9 feet of the room shall be deemed to be unfit for habitation if either— (a) the average height of the room from floor to ceiling is not at least 7 feet ; or (b) the room does not comply with regulations made by the local authority for securing proper ventilation and lighting, and protection against dampness and effluvia. The regulations in force at the beginning of 1936 had been made by the council under the Housing and Town Planning Act, 1909, and had not been revised since 1913. As recent Acts have amended the law in regard to underground rooms, the council decided to revise their underground room regulations, and a new set was submitted to the Minister of Healtfy during the year. He gave his approval in September last, and copies are now available at the Town Hall for owners who are interested. Town Planning Applications—Underground Rooms. During the year the London county council, being the town planning authority for the metropolis, commenced to make it a condition of approval to the conversion of existing houses into flats, etc., that the borough council must be satisfied in regard to the proposed use of underground rooms. Eleven applications arose in which underground rooms were found not to comply with the regulations. All these cases were in respect of large well-constructed houses in South Kensington where to a great extent the subsoil is of gravel, sand, or other normally dry material. Notwithstanding the absence of evidence of dampness it was decided that the rooms should be closed unless they fully complied with the council's underground room regulations. Upon the application of the owners, however, permission was granted in some cases to use the rooms for prescribed domestic purposes. Uvercrowding. Under the Housing Act, 1936, 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 fifth 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 n (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 44 in any borough until the " appointed day " has been fixed by the Minister, and in the interval the old standards remain in operation. The " appointed day " has not been fixed for the country as a whole, but it is determined for each area by the Minister after he has considered the housing resources of the local authority for that area, and the number of cases of overcrowding found in the district by the survey undertaken in the latter part of 1935. In Kensington the overcrowding survey revealed the existence of 2,529 cases of overcrowding under the new standard, and in May, 1936, the council appointed a small deputation to confer with the London county council with a view to obtaining some definite indication of the latter's proposals for meeting the demand for housing accommodation which will be occasioned by the abatement of this amount of overcrowding. Following this conference, the county council, as the authority for framing proposals for the provision of new houses for the abatement of overcrowding under the Housing Act, intimated that they would support the proposal that the " appointed day " for Kensington should be 1st January, 1937. Accordingly, an appropriate application was made to the Minister, and in due course the " appointed day " was fixed for the 1st January, 1937. Overcrowding which exists on the " appointed day " is not an offence unless alternative accommodation is refused, but overcrowding arising for the first time after this day is illegal. The following table shows the amount of overcrowding existing in each ward of the borough at the beginning of 1936 as revealed by the overcrowding survey. 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. During the year the council, aided by the various housing associations operating in the borough and the London county council, have made an attempt to reduce the overcrowding, but as the new standard did not operate until the 1st January, 1937, efforts were confined to overcrowding existing in borough council property and houses owned by the associations. This limitation was necessary, because, if the council abated overcrowding in privately-owned houses, they had no adequate power to prevent a recurrence until after the " appointed day." As a result of this precaution no case has come to notice of a house being decrowded and subsequently becoming overcrowded. The following statement is required to be furnished under the Sanitary Officers (London) Regulations, 1935 :— (a) the estimated number of families overcrowded at the end of the year 2,428 (11,251 units) (b) the number of new cases of overcrowding reported 14 (71£ units) (c) the number of cases of overcrowding relieved 115 (606f units) (d) the number of cases in which dwelling houses in respect of which the local authority have taken steps for the abatement of overcrowding have again become overcrowded) Nil As far as Kensington is concerned, Section 6 of the Housing Act, 1935, (now Section 62 of the Housing Act, 1936) provided that within six months of 1st July, 1936, every rent book or similar document used in connection with a " dwelling house " must contain the following information :— (1) After the 1st day of January, 1937, an occupier who causes or permits his dwelling to be overcrowded is liable to prosecution for an offence under the Housing Act, 1936, and, if convicted, to a fine not exceeding five pounds. Any part of a house which is occupied by a separate family is a " dwelling." (2) A dwelling is overcrowded if the number of persons sleeping in it is more than the " permitted number," or is such that two or more of those persons, being ten years old or over, of opposite sexes (not being persons living together as husband and wife) must sleep in the same room. (3) The " permitted number " for the dwelling to which this (Rent Book) ( ) relates is persons. In counting the number of persons each child under ten years of age counts as half a person, and a child of less than one year is not counted at all. 45 (4) The Act contains special provisions relating to overcrowding already existing on the above-mentioned date or which is due to a child attaining the age of either one or ten years after that date, or which is due to exceptional circumstances. Full information about these special provisions and all provisions as to overcrowding can be obtained free on application to the borough council, whose address is Town Hall, Kensington, W. 8. The Act provides that the council shall, upon application of either the landlord or occupier, give in writing the permitted number of persons in respect of the " dwelling house " owned or occupied by the applicant. In order to deal with the maximum number of applications from owners for " permitted numbers," the council during the summer authorised the employment of survey assistants up to a total of six for the purpose of measuring rooms in connection with these applications. During the year, however, it was found necessary to employ only two of these assistants. The following table shows particulars of the work they had carried out up to 31st December, 1936 :— (a) Number of applications received 80 (b) Number of houses involved in these applications 2,593 (c) Total number of houses measured 1,214 By-laws for Houses let in Lodgings. The total number of houses let in lodgings on the register at the end of the year was 3,161, and the number of inspections of these houses during the year was 5,829. The number of houses cleansed as a result of notices served under the by-laws was 360. Until the passing of the Housing Act, 1935, overcrowding and indecent occupation (i.e., persons of opposite sexes over the age of twelve years not living together as man and wife but sleeping in the same bedroom) in houses let in lodgings was controlled by the by-laws made under section 6 of the 1925 Act. The Housing Act, 1935, however, repealed, as from the " appointed day," by-laws in respect of overcrowding and indecent occupation, and substituted the new national overcrowding standard mentioned earlier. Public Health (London) Act, 1936. The number of written intimation notices served in respect of defects or nuisances in dwellings was 1,282. 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 206 statutory notices and 42 final notices; and three summonses were eventually served. The following list shows the major improvements secured:— Houses cleansed 871 House drains reconstructed 127 „ ,, additions to 196 Defective drains repaired 149 House drains cleansed 174 Water closets reconstructed or repaired 485 „ „ (new) provided 379 „ „ supplied with water 439 Soilpipes ventilated, repaired, etc. 165 „ (new) provided 235 Ventilating pipes (new) provided 142 Baths (new) provided 684 Sinks (new) provided 786 Lavatory basins (new) provided 2,457 Waste pipes (new) provided 1,038 Cisterns cleansed, covered, etc. 241 Taps fixed on rising main 434 Yards and areas, paved, drained, repaired 352 Dustbins provided 344 Ashpits abolished 14 Accumulations of filth, etc., removed 277 Roofs repaired 366 Houses provided with water above basement floor 77 Dampness in dwellings remedied 329 Ventilated food cupboards provided 191 Artificial lighting of staircases provided 26 Rehousing of Large Families with Small Incomes. During the overcrowding survey of the borough in 1935 it was found that there was a number of families with a large number of small children who, owing to low family incomes, would be unable to pay an economic rent for the requisite number of rooms to meet their needs. Generally, private owners refuse to let their properties to these families—even some housing associations hesitate to provide accommodation for them. After careful consideration the borough council concluded that they would have to take special measures to cater for these families. 46 The council in the first place considered the possibility of purchasing a number of large tenement houses and letting each one to a large family. For this purpose they included in their estimates for 1935-1936 a sum of £10,000. Several hundreds of these houses were surveyed in blocks and groups but the amount of available vacant accommodation was so small as not to warrant the expenditure. Accordingly attention was given to the acquisition of empty properties. A group of seven houses in Princes Road and Pottery Lane, which were practically unoccupied, were surveyed and the council decided to acquire them. In addition two large houses in St. Charles Square, one empty and the other containing only two persons, were surveyed and the council here again decided to purchase them. These houses will eventually provide suitable accommodation for very large and poor families. This procedure is thought to be more advantageous to the council than the erection of blocks of new flats for large families. To provide satisfactory accommodation, the flats would have to be large, 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 problem. Common Lodging Houses. Common lodging houses must be licensed annually, and the 30th June of each year has been fixed by the council as the date of the expiration of each licence. The following table shows the licensed common lodging houses and the accommodation available on the 1st January, 1936 :— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed. Male. Female. Total. Golborne Norland m Chesterton, Ada Elizabeth 194, Kensal Road ____ 71 71 Hankins, John W. 28 & 30, Crescent Street 54 — 54 Woodhouse, Jane E. 40, do — 21 21 Totals 54 92 146 In June, 1936, the council renewed the licence in each of the three above cases. Although these three houses are licensed to receive 146 persons, a recent census taken at night time showed only 82 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. Housing Accommodation provided by the Borough Council. The following is a list of the properties owned and managed by the borough council:— Situation of properties. No. of houses or flats. Kenley Street, Seymour King Buildings, 4, Hesketh Place and 6, Runcorn Place 120 St. James's Place, Bosworth Road, Sirdar Road, Hesketh Place, Runcorn Place, Walmer Road and Windsor House 95 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 contributionsto 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. 47 Accommodation provided in the Borough by Housing Associations. (a) The Kensington Housing Trust own 2 freehold houses, 51 leasehold houses, and 187 flats. Of these, a block of 80 flats was built on about one acre of the large Dalgamo Gardens site acquired by the council; the land is leased to the Trust at a peppercorn rent for 999 years. During 1936, 5 premises in West Row, acquired compulsorily under the Housing Act, 1930, were demolished and the Trust have erected 30 flats on the site. These flats were ready for occupation at the end of the year. In addition the Trust have acquired privately some old houses in Bramley Road, and at the end of the year had demolished them and were erecting 40 working class flats. (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 own 304 houses in Kensington, and hold ground rents in respect of 31 houses. During 1936, the Association prepared a scheme to erect 16 flats on the cleared site of the Tabernacle Terrace clearance area. (d) Several smaller housing associations such as the Aubrey Trust and Horace Street Trust, closely associated in management with the Wilsham Trust, own 39 houses and 14 flats. The Aubrey Trust have approached the borough council with a scheme for building 50 working class flats on the site of the Heathfield Street and Portland Road compulsory purchase order, referred to on page 39. 1 (e) In 1929 the Sutton Trustees acquired a large building site of about 8 acres in Dalgarno Gardens, and built 540 flats. During 1934 a further 101 flats were erected on approximately one acre of land adjoining the original site. (f) About 5 acres of the ground at Dalgarno Gardens acquired by the borough council was leased in 1933 to the Peabody Donation Fund at a nominal rent, on condition that the Peabody Trustees erected working class flats for Kensington people. During 1934 a block of 142 flats was completed and at the end of 1936 a further 128 flats were ready for occupation. (g) The Gas Light and Coke Company have, during the year, erected 68 flats on ground owned by them at the northern end of Ladbroke Grove and, subject to subsidy being paid in respect of these flats, the company have agreed to accept tenants nominated by the council. (h) The council approved a scheme whereby the Church Army should erect 24 maisonettes on the site of the Silvester Mews clearance area. At the end of the year these flats were in the course of erection, and they will be ready for occupation during 1937. All the property referred to above is for the purpose of accommodating Kensington workingclass families. The various property managers concerned work in close co-operation with the borough council's officers in the task of rehousing families from condemned houses, unfit basements and overcrowded homes. This very large amount of housing accommodation, totalling approximately 1,620 houses or flats in North Kensington, under the control of enlightened management, is available for the working-class population of the borough, and is a very important factor in the considerable improvement which has taken place in the housing conditions of Kensington. Central System of Hot Water Supply in New Flats. The Kensington Housing Trust when building their block of 80 flats on the Dalgarno Gardens site in October, 1934, installed a system of central hot water supply whereby each flat is constantly supplied with hot water from robot boilers contained in a separate boiler house. The average weekly cost to the Trust per flat is about Is. 7d., whilst the tenants are charged amounts varying from Is. to Is. 6d. per week according to the size of the flat. In July, 1936, the borough council considered the advisability of providing a similar system in their new flats to be erected on the South Row and Great Western Terrace site. It was estimated that the rents of these flats would, if this system were installed, be increased by an average amount of approximately 2s. 2|d. per week. Whilst there are certain factors which detract from the desirability of providing a central hot water system, the council decided that in the new South Row and Great Western Terrace flats they would make provision for such a system. Estimate of Total Rehousing Accommodation required in Kensington. During the year the council considered the question of the amount of new accommodation which will be required to deal with the clearance areas, unfit basements and overcrowding still awaiting attention. The following table shows the estimated number of families to be displaced as the result of completing the council's existing housing programme :— Improvement areas 92 Clearance areas or closing orders 222 Overcrowding procedure—Housing Act, 1936 737 Closing of unfit basements 1,425 Total 2,476 Experience has shown (i) that a proportion of the basement dwellings will be made lit by the owners and will be available for rehousing, and (ii) that a number of families prefer to find their own accommodation rather than to accept that offered by the council. It was considered that a reasonable allowance to make under (i) is 8 per cent, or 114 of the 1,425 basements affected, and 48 under (ii) 10 per cent. of the total of 2,476, less the overcrowding figure of 737 in which this allowance has already been made, viz., 174 families. In this way the total displacement figure of 2,476 may be reduced to 2,188, and this latter figure may be taken to represent the number of new dwellings required during the next few years. The council and the housing associations already have in hand plans involving a net provision estimated at 503 dwellings. The deduction of the 503 dwellings to be provided in this way from the total requirements of 2,188 leaves 1,685 new dwellings still to be found, as shown in the following table:— Total gross displacements 2,476 Less estimate of basements made fit 114 And estimate of families finding own accommodation 174 288 Total net displacements 2,188 Less net provision already planned by borough council and housing associations 503 Total estimated new requirements 1,685 The council on the 21st July, 1936, approved the estimate of 1,685 as the number of new dwellings, apart from those already planned by the council and the housing associations, required to complete the council's existing housing programme. 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 1936 and set out in circular 1561:— 1. Inspection of dwelling houses during the year:— (i) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 5,092 (b) Number of inspections made for the purpose 25,804 (ii) [a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 1,108 (b) Number of inspections made for the purpose 5,294 (iii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (iv) 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 1,460 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 976 3. Action under statutory powers during the year:— (a) Proceedings under sections 17, 18 and 23 of the Housing Act, 1930 :— (i) Number of dwelling-houses in respect of which notices were served requiring repairs 178 (ii) Number of dwelling-houses which were rendered fit after service of formal notices (a) By owners 217 (b) By local authority in default of owners 23 (b) Proceedings under Public Health Acts— (i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,282 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 1,282 (b) By local authority in default of owners Nil (c) Proceedings under sections 19 and 21 of the Housing Act, 1930:— (i) Number of dwelling-houses in respect of which demolition orders were made Nil (ii) Number of dwelling-houses demolished in pursuance of demolition orders Nil (d) Proceedings under section 20 of the Housing Act, 1930— (i) Number of separate tenements or underground rooms in respect of which closing orders were made 172 (ii) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 12 49 4. Housing Act, 1935. Overcrowding:— (а) (i) Number of dwellings overcrowded at the end of the year 2,428 (ii) „ „ families dwelling therein 2,428 (iii) ,, „ "equivalent " persons dwelling therein 11,251 (b) Number of new cases of overcrowding reported during the year 14 (c) (i) Number of cases of overcrowding relieved during the year 115 (ii) „ ,, " equivalent" persons concerned in such cases 606½ (d) Number of cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil Note—The " number of equivalent persons " is obtained by counting children between the ages-of one and ten years as " half-persons." 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 1936 twenty samples were so taken, and only one was found to contain tubercle bacilli. The sample in this case was taken from a road tank arriving in Kensington. The result of the examination was communicated to the medical officer of health of the county in which the milk was produced, when it was found that 48 farms were implicated. The total number of cows examined was 1,027, of which seven were found to be diseased and were slaughtered. Composition of Milk Samples.—Of the 367 formal samples of milk taken under the Food and Drugs (Adulteration) Act, 1928, in 1936, ten were found to be adulterated. This statement does not give any indication of the general quality of the milk supplied in the borough, and it will therefore be interesting to note from the following table the average composition of the samples taken :— Average composition of formal milk samples taken in 1936. 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 24 3.66 8.76 3.66 8.83 3 0 8.5 February 37 3.60 8.87 3.62 8.87 March 24 3.56 8.88 3.56 8.88 April 24 3.42 8.85 3.47 8.84 May 38 3.47 8.83 3.47 8.83 June 26 3.46 8.88 3.46 8.88 July 37 3.53 8.72 3.53 8.76 August 30 3.45 8.71 3.46 8.73 September 28 3.63 8.80 3.63 8.80 Average composition or normal cow's milk. October 31 3.89 8.82 3.90 8.84 November 35 3.68 8.87 3.68 8.87 Percentage of milk fat. Percentage of solids not fat. December 33 3.91 8.87 3.91 8.87 367 3.64 8.82 3.65 8.83 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. 50 The following table has been prepared to show the number of samples of good, fair and poor quality milk, all of genuine composition, taken during each quarter of the year :— Classification of genuine milk samples according to quality. Period. Good quality. Fair quality. Poor quality. Total. 1936. First quarter 15 64 3 82 Second quarter 9 51 26 86 Third quarter 15 62 14 91 Fourth quarter 75 21 2 98 Totals 114 198 45 357 Percentages 31.9 55.5 12.6 — Note : The classification of milk according to quality is based on the butter fat content, the standards adopted being :— 3*8 per cent, butter fat and over—" Good." Over 3-4 per cent, but under 3-8 per cent.—" Fair." Over 3 per cent, but under 3*4 per cent.—" Poor." It will be seen that the second quarter of the year produced the largest number of samples of poor milk and the smallest number of good milk, whilst the reverse took place in the fourth quarter. This experience is common throughout the country. Milk and Dairies (Amendment) Act, 1922, and Milk and Dairies Order, 1926.—A summary of the alterations made in the register of dairymen and dairies during 1936, 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 ... 7 7 Added to register 11 1 — Vacated and removed from register — 3 2 Dairymen with premises outside the borough added to the register ... 1 ... On register 1st January, 1936 139 174 140 On register 31st December, 1936 150 173 138 (+) Increase. (—) Decrease +11 —1 —2 Under the Milk and Dairies (Amendment) Act, 1922, a local authority may refuse to register a person or may remove a person's name from the register of purveyors of milk if, in their opinion, the sale of milk by him is likely to endanger the public health. During the year one application for registration was refused. The applicant, who desired to trade in Kensington from premises outside, had previously been registered as a purveyor of milk within the borough. His methods of distribution and his record were equally unsatisfactory, and a notice was served under section 2 of the act requiring him to appear before the council to show cause why they should not refuse to register him. The applicant failed to appear, and the necessary resolution refusing registration was passed in his absence. Routine inspections of all premises on the council's register of dairies are made from time to time, and the number of such inspections made during the year was 565. Milk (Special Designations) Orders, 1923 and 1936.—On the 1st June the Milk (Special Designations) Order, 1936, came into operation. This order revokes the earlier one and reduces the number of designated milks to three, namely, Tuberculin Tested, Accredited and Pasteurised. Tuberculin Tested.—The conditions for this grade are substantially the same as those formerly prescribed for Grade A (Tuberculin Tested) milk. It is raw milk from cows which have passed a veterinary examination and a tuberculin test, and it may be bottled on the farm or at a licensed bottling establishment. Until the 31st December, 1936, a sample of this milk taken at any time before delivery to the consumer was required to contain not more than 200,000 bacteria per millilitre and no bacillus cohform in one-hundredth of a millilitre. After the date mentioned a prescribed methylene blue reduction test for cleanliness is substituted for the bacteria plate test. The milk may be pasteurised, in which case it must be described as Tuberculin Tested Milk (Pasteurised), and must not contain more than 30,000 bacteria per millilitre. If it is bottled on the farm the word " Certified " may be added to its designation. Accredited.—The conditions for this grade are similar to those prescribed in the order of 1923 for Grade A milk. It is raw milk from cows which have passed a veterinary examination, and may be bottled on the farm or at a licensed bottling establishment. It must satisfy the same bacteriological tests as are prescribed for raw Tuberculin Tested milk. 51 Pasteurised.—This designation is applicable where Accredited milk or ungraded milk is pasteurised in accordance with the requirements of the order. The conditions imposed are the same as in the order of 1923, except that there are additional requirements with regard to thermometers and temperature records. During pasteurisation the milk must be retained at a temperature of 145-150 degrees Fahrenheit for a period of at least 30 minutes. The new order provided that licences granted before the 1st June, 1936, under the revoked order should continue in operation until the end of the year, a licence to sell milk as Certified or Grade A (Tuberculin Tested) being deemed to be a licence to use the designation Tuberculin Tested, and a licence to sell milk as Grade A beiner deemed to be one to use the designation Accredited. The licences granted in 1936 were as follows :— Principal licences. * Supplementary licences. (a) Dealers' licence to sell Certified milk 13 1 (b) Dealers' licence to bottle and sell Grade A (T.T.) milk 2 — (c) Dealers' licence to sell Grade A (T.T.) milk 16 1 (d) Dealers' licence to sell Grade A (Pasteurised) milk 1 — (e) Dealers' licence to pasteurise milk 1 — (f) Dealers' licence to sell Pasteurised milk 46 7 * These licences enable the holders to sell graded milks in Kensington from premises situated outside the borough. During the year, 11 samples of Certified milk, five of Grade A (Tuberculin Tested) milk, and thirty-eight 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, 1923, which are as follows:— Special grade of milk. Maximum number of bacteria permitted per c.c Standard for bacillus coli. Certified milk 30,000 Must not be found in onetenth c.c. Grade A (Tuberculin Tested) milk 200,000 Must not be found in onehundredth c.c. Pasteurised milk 100,000 No standard 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. 26th March 98,000 Nil. 14th July 5,500 Nil. „ „ 10,800 „ 4th August 3,450 „ 28th April 1,080 „ 11th „ 410 „ 14th July 11,200 „ „ „ 74,000 „ „ „ 3,200 „ 18th „ 6,200 „ „ „ 6,200 „ „ The above results, except that 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 per 1 c.c. Coli per l/100th c.c. Sample collected on Bacteria per 1 c.c. Coli per l/100th c.c. 27th February 14,100 Nil. 12th August 546,000 Present. 3rd March 9,600 „, „ „ 3,600 „ 14th July 13,900 „ Pasteurised Milk. Sample collected on Bacteria per 1 c.c. Sample collected on Bacteria per 1 c.c. 18th February 13,600 4th August 59,000 3rd March 3,300 12th 8,800 „ „ 1,440 12th 1,700 „ „ 8,400 8th September 2,600 „ „ 1,600 „ „ 4,800 26th 32,000 „ „ 72,600 „ „ 44,000 „ „ 4,280,000 28th April 12,500 „ „ 3,000 25,000 15th 12,100 30th June 990 „ „ 66,000 „ „ 1,610 „ „ 16,100 „ „ 2,700 21st October 5,400 „ „ 2,500 „ „ 4,600 15th July 9,600 „ „ 6,600 6,506 5th December 710 „ „ 95,000 „ „ 860 „ „ 3,400 „ „ 560 „ „ 1,010 „ „ 890 4th August 17,000 „ „ 950 52 The majority of the results show that these designated milks had a very low bacterial content. Indeed, only four 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 1936. 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 six samples of ordinary milk were taken at random from Kensington retailers. Four of these contained less than 30,000 bacteria per c.c. and could be regarded as satisfactory milks ; the other two, however, each contained approximately 500,000 bacteria per c.c. 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 27 slaughterhouse inspections were made. During 1936 five beasts and 89 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. The licences granted in respect of the two Kensington slaughter-houses in 1935 were renewed for twelve months to 30th June, 1937. 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.—This act provides for the humane slaughtering of animals by means of mechanically operated instruments, and the council's food inspector makes inspections to satisfy himself that humane methods are applied satisfactorily. The three licences granted by the council to slaughtermen in 1935 were renewed for a further twelve months in 1936. Bakehouses.—There are 80 bakehouses in the borough, and of this number 57 are underground. As a result of 272 inspections which were made during the year, 38 notices were served for the cleansing of walls and ceilings. Registration of Food Premises.-The provisions relating to the registration of food premises formerly contained in the London County Council (General Powers) Act, 1932, now form part of the Public Health (London) Act; 1936. The premises which are required to be registered are those 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 1936:— On register Dec. 31, 1935. Added to register during 1936. On register Dec. 31, 1936. Manufacturers of ice-cream 88 6 94 Storage and sale of ice-cream 132 21 153 Butchers' shops, including premises, used for manufacture of sausages and the preservation of meat 103 - 103 Cooked meat shops 75 5 80 Fishmongers' shops—premises used for the purpose of cooking or curing fish (excluding fried fish shops) 19 - 19 Fried fish shops 42 2 44 Totals 459 34 493 Under section 183 of the Public Health (London) Act, 1936, power is given to the London county council to make by-laws for promoting sanitary and cleanly conditions in the manufacture, preparation, storage, transport, and exposure for sale of any article intended to be sold for human consumption. By-laws have now been made and operate from the 1st January, 1937. 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 Public Health (London) Act, 1936, which re-enacts similar provisions contained in the London County Council (General Powers) Act, 1908. There were, in addition to the inspection of dairies, etc., mentioned above, 1,932 inspections of food premises during the year. 53 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, frozen mutton and pork, malt products, maize, starch, salt, boneless beef and veal, salted beef and pork and edible offals. Frequent inspections were made throughout the year to ensure that the requirements of these orders were observed. In several instances imported tomatoes exposed for sale were not properly marked and cautions were given 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 1936. 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 180 of the Public Health (London) Act, 1936, 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 bacon „ „ „ „ „ „ „ „ „ „ pigs trotters Proceedings. Fined £21. Dismissed under Probation of Offenders Act. „ „ „ Trader cautioned. Under the provisions of subsection 8 of section 180 of the Public Health (London) Act, 1936, any persons having in their possession food intended for sale which is diseased or unsound, or unfit for human consumption, may surrender it tp the council for destruction as trade refuse. The unsound food surrendered and destroved during the vear is shown in the following list:— Beef (lbs.) 273 Chicken 1 Farinaceous substances (pkts.) 28 Fish (lbs.) 84 Fish, tinned (tins) 53 Fruit, tinned (tins) 456 Meat, tinned (tins) 24 Milk, tinned (tins) 15 Pickles (bottles) 3 Pigs heads 5 Pigs trotter 1 Rabbits 210 Salad cream (bottles) 60 Soup, tinned (tins) 2 Turkeys 5 Vegetables, tinned (tins) 92 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 664, of which 30 or 4- 5 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. 54 Particulars of formal and informal samples collected are as follows:— Nature of sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Almond blend 2 2 — — Almonds, ground 5 — 5 — Almonds, ground, imitation 1 — — — Arrowroot 3 — — — Apricots, dried 4 — 2 — Asparagus, tinned — — 3 — Bacon — — 3 — Baking powder — — 1 — Beef, minced — — 3 — Bloater spread — — 1 — Butter 47 — 15 — Cake — — 1 — Cakes, sponge 9 — — — Caviare — — 3 — Cheese 16 — 6 — Cheese, cream — — 1 1 Chocolate coffee cream walnuts — — 1 1 Chocolate drops — — 1 — Chocolate slices, cream filled — — 1 1 Cinnamon, ground 2 — — — Cocoa 7 — 3 — Coffee 3 — 4 — Coffee and chicory 1 — 1 — Colouring liquid — — 1 — Colouring paste 1 1 2 2 "Cookeen" — — 1 — Cornflour — — 2 — Crab, tinned — — 4 — Cream 15 — 1 — Cream, tinned 1 1 10 2 Dates, pasteurised — — 1 — Dripping 13 — — — Drugs and medical preparations— Figs, compound syrup of — — 3 — Iodine, tincture of — — 3 1 Oil, camphorated — — 4 - Ointment, carbolic 3 2 9 8 Ointment, iodine — — 1 — Powders, grey 6 4 7 4 Powders, seidlitz — — 3 — Fish paste 18 — 6 — Fruit pectin — — 1 — Fruit, tinned — — 6 — Fruits, crystallised — — 1 — Gin 1 — — — Ginger, ground 1 — — — Ham — — 3 — Honey — — 6 — Icecream 7 — — — Jam 3 3 12 4 Jelly, fruit — — 2 — Lard 21 — — — Lemon cheese — — 6 — Lemonade crystals — — 2 — Liver, calves' 1 — — — Margarine 21 — 6 — Meat pie — — 4 — Milk 367 10 68 3 Milk, condensed — — 9 — Milk, separated 4 — — — "Milket" — — 1 — Mincemeat 3 — 3 — Mint sauce — — 1 — Oil, cottonseed — — 1 — Oil, olive — — 3 — 55 Nature of sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Pastry, puff — — 1 — Peas, tinned — — 5 — Peel, candied 1 — —' — Pepper — — 6 — Prunes 2 — — — Rice 3 — 2 — Roes, tinned — — 1 — Salmon, cutlet — — 1 — Salmon, smoked 1 1 4 1 Sardines, tinned — — 12 4 Sausages 24 1 12 1 Semolina — — 4 — Suet, shredded 2 2 2 — Sugar, demarara — — 3 — Sweets 6 1 9 2 Tea 7 — 3 — Tomatoes, tinned — — 12 — "Trex" — — 1 — Vinegar, malt 4 — 1 — Vinegar, table — — 2 2 Vinegar, wood 11 1 6 — Whisky 5 1 1 1 Wines 12 — — — Totals 664 30 336 38 The following is a summary of the results of analyses of the 68 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. Almond blend Contained 20 per cent, of sugar and 33 per cent, of wheat starch. No action. „ „ „ „ „ „ Cheese, cream Contained only 31 per cent, of fat. Informal sample. Chocolate coffee cream walnuts The filling was not cream Letter sent to vendor. Chocolate slices—cream filled „ „ „ Informal sample. Colouring paste (damson blue) Contained 360 parts of lead per million. „ „ „ „ (apple green) Contained 100 parts of lead per million. „ „ ,, „ (damson blue) Contained 540 parts of lead per million. Proceedings. Vendor fined £5 and £10 costs. Cream, tinned described as highly concentrated rich cream. Contained only 20.1 per cent. of fat. Informal sample. „ „ Contained only 22.6 per cent. of fat. „ „ „ „ Contained only 19.4 per cent. of fat. Proceedings. Summons dismissed on warranty defence. Drugs— Iodine, tincture of 16 per cent. deficient in iodine and 26 per cent. excess of pot. iodide. Informal sample. Ointment, carbolic 53 per cent. deficient in phenol „ „ „ „ 47 „ „ „ „ „ „ „ 46 „ „ „ Proceedings. Summons adjourned sine die. „ „ 46 „ ,, „ Informal sample. „ „ 25 „ „ „ Vendor cautioned. „ „ 20 „ „ „ Informal sample. „ „ 14 „ „ „ „ „ „ „ 7 „ „ „ „ „ „ „ 6 „ „ „ „ „ „ „ 6 „ „ „ „ „ 56 Article analysed. Nature and amount of adulteration. Action taken. Drugs— Powders, grey 90 per cent, deficient in mercury Informal sample. „ „ 84 „ „ „ Proceedings. Summons withdrawn. „ „ 68 „ „ „ „ „ „ „ 62 „ „ „ Informal sample. „ „ 56 „ „ „ „ „ „ „ 52 ,, ,, ,, Proceedings. Summons dismissed, £21 costs against the council. „ „ 43 ,, ,, ,, Proceedings. Summons withdrawn. „ „ 38 ,, ,, ,, Informal sample. Jam, blackcurrant 56 per cent, deficient in blackcurrants. Proceedings. Summons dismissed on warranty defence. ,, ,, 50 ,, ,, ,, Informal sample. ,, ,, 40 ,, ,, ,, Proceedings. Summons dismissed on warranty defence. ,, ,, 40 „ „ ,, No action. ,, ,, 33 ,, ,, ,, Informal sample. Jam, raspberry 45 „ „ raspberries. ,, ,, ,, ,, 18 „ ,, ,, ,, ,, Milk 7 per cent, deficient in fat Proceedings. Summons dismissed on payment of 10s. 6d. costs. ,, 5 ,, ,, ,, Vendor cautioned. ,, 3 ,, ,, ,, ,, ,, ,, 2 ,, ,, ,, Informal sample. ,, 14 per cent, extraneous water ,, ,, ,, 6 ,, ,, ,, Proceedings. Summons dismissed on payment of 10s. 6d. costs. ,, 6 ,, ,, ,, ,, ,, ,, ,, 3 ,, ,, ,, Vendor cautioned. ,, 2 ,, ,, ,, ,, ,, ,, 2 ,, ,, ,, ,, ,, ,, 2 ,, ,, ,, ,, ,, ,, 2 ,, ,, ,, ,, ,, ,, 1 ,, ,, ,, Informal sample. Salmon, smoked 660 parts of hydroxy-benzoic acid and 80 parts of formaldehyde per million. Proceedings. Fined £2 and 10s. 6d .costs. ,, ,, ,, ,, ,, Informal sample. Sardines, tinned 12 parts of lead per million ,, ,, ,, ,, 10 ,, ,, ,, ,, ,, ,, ,, 10 ,, ,, ,, ,, ,, ,, ,, 5 ,, ,, ,, ,, ,, Sausages Presence of preservative not declared. ,, ,, ,, ,, ,, ,, Vendor cautioned. Suet, shredded Contained only 81 percent, of fat. ,, ,, ,, ,, ,, ,, 77 ,, ,, ,, ,, Sweets— Crystallised orchard fruits Consisted of flavoured jellies and contained no fruit. ,, ,, White chocolate Contained no fat-free cocoa matter. ,, ,, ,, ,, ,, ,, „ ,, ,, Vinegar, table Consisted of artificial vinegar ,, ,, ,, ,, ,, ,, „ ,, ,, ,, wood 14 per cent, deficient in acetic acid. Proceedings. Summons dismissed on payment of 10s. 6d. costs. Whisky 72 degrees under proof Informal sample. ,, 38.8,, ,, „ Proceedings. Fined £14 and £1 costs. 57 The total number of prosecutions under the Food and Drugs (Adulteration) Act was fifteen. The fines and costs, after deducting the costs given against the council, amounted to £13 2s. The Misleading and Deceptive Labelling of Food.—On various occasions during the year, notably in connection with jam, cream confectionery, sweets and vinegar, attention has been directed to misleading and deceptive labelling. This practice appears to be on the increase, and there can be little doubt that trade competition, the absence of fixed standards of composition for various articles of food, and the absence of adequate legal requirements regarding the labelling of such articles are responsible. A number of provisions relating to labelling are contained in the Food and Drugs (Adulteration) Act, 1928, but for the following reasons they are not of great value :— (a) Section 30 of the Act provides that a person who wilfully gives a label with any article of food or drug sold by him which falsely describes the article sold shall be guilty of an offence. The value of this provision is limited by the word " wilfully," for it has been held in the High Court that in order to secure a conviction the prosecutor must satisfy the Court that the vendor had wilfully given a label knowing it to be false. It is a matter of difficulty to prove this guilty knowledge on the part of the vendor, and consequently very few proceedings are likely to prove successful. (b) Sections 3 and 4 of the Act contain requirements regarding the labelling of compounds and, in view of the bearing which these sections have upon the problem, it may be well to quote them here :— " 3. Provision as to sale of compounds.—If any person sells any compound article of food, or any compounded drug, which is not composed of ingredients in accordance with the demand of the purchaser, he shall be guilty of an offence." " 4. Protection from liability where article properly labelled:— (1) No person shall be guilty of any such offence as aforesaid in respect of the sale of an article of food or a drug mixed with any ingredient or material not injurious to health, and not intended fraudulently to increase its bulk, weight or measure, or to conceal its inferior quality, if at the time of delivering the article of food or drug he supplies to the person receiving it a notice, by a label distinctly and legibly written or printed on or with the article or drug, to the effect that it is mixed." Section 4 does not indicate what shall constitute a proper label other than that it shall be "distinctly and legibly written or printed on or with the article or drug". As a result, manufacturers, when labelling their products, have introduced ingenious devices to secure the protection afforded by this section, in place of a frank declaration which might be detrimental to their sales. These ingenious declarations are sometimes printed in letters so small as to be almost unreadable except at very close sight, or in a colour calculated to render them hardly noticeable, or in a position on the label where they are least likely to catch the eye of the purchaser. Examples have been observed where all of these devices have been incorporated in the same label. The use of contradictory statements on the same label is also frequently encountered; such descriptions as "Wood table vinegar," "Rich concentrated tinned cream—contains 25 per cent, of butter fat" and "British sherry " are examples. Attention might also be drawn to what may be termed the "collateral advertisement," which may be in the form of a newspaper advertisement, a handbill or a radio broadcast. No legislation exists at present to control this form of advertising, and there are many instances where, although the labels attached to the actual foodstuffs are in order, the advertisement makes extravagant and unjustifiable claims for the article in question. The seriousness lies in the fact that a person is frequently led to purchase an article by the claims made in the advertisement, little or no attention being paid to the actual label attached to the goods. The legal provisions to which reference has been made are identical with those contained in the repealed Sale of Food and Drugs Act, 1875, and have thus been in operation for more than sixty years. During this period the knowledge of food chemistry has increased rapidly, and it has been freely drawn upon by those whose business and financial interests are bound up with food manufacture. As a result, many kinds of manufactured foods unthought of or impossible of manufacture sixty years ago have now been placed on the market. The keenest competition exists among manufacturers, many of whom, unfettered by any legal standards of composition for these articles, have introduced cheaper substitutes for normal ingredients or have reduced the amount of such ingredients, thereby being able to sell at lower prices. These variations in the composition of foodstuffs are not always adequately disclosed to the purchaser. This practice may be looked at from two points of view : firstly, that of the purchaser who is prejudiced, and secondly, that of the honest trader over whom the unscrupulous trader can enjoy an unfair advantage. The following is a review of the council's recent experience in regard to articles sold in Kensington under misleading descriptions. (a) Jam. Originally jam consisted of fruit plus sugar, but keenness of competition amongst manufacturers to secure the "lion's share" of the trade led to the substitution of such cheaper substances as apple 58 pulp, pectin and fruit juices for a percentage of the named fruit, with a consequent lowering of the general standard of the jams placed on the market. The jam manufacturers apparently became alarmed at the chaotic position which they themselves had created, and in 1931, the Food Manufacturers' Federation, after consulting the Society of Public Analysts and other Analytical Chemists, prescribed standards for first and second quality jams. These standards specify the minimum fruit content to be permitted in the various types of jam, and the manner in which the jams should be labelled. The minimum percentage of named fruit in jams of first quality is as follows:— Cherry, rhubarb 45% Strawberry 42% Red gooseberry, greengage, victoria plum, red plum, apricot, peach 40% Raspberry, damson, blackberry, loganberry 38% Redcurrant, green gooseberry, green or golden plum 35% Blackcurrant 30% In all varieties of second quality jams the minimum fruit content required is 20 per cent. In the case of jams conforming to the standards for first quality, no declaration of added fruit juice is required, but with second quality jams the name of the fruit must be accompanied by the words " With other fruit juice " in letters of the same size as the name of the fruit. A correct example of labelling for first quality jams is as follows:— STRAWBERRY. FULL FRUIT STANDARD. This jam is guaranteed to conform to the agreed Full Fruit Standard of the Food Manufacturers' Federation. A correct example of labelling for second quality jams is as follows:— STRAWBERRY WITH OTHER FRUIT JUICE. LOWER FRUIT STANDARD. This jam is guaranteed to conform to the agreed Lower Fruit Standard of the Food Manufacturers' Federation. These standards of the Food Manufacturers' Federation have been widely adopted by manufacturers throughout the country, and the terms "Full Fruit Standard" and "Lower Fruit Standard " have become well recognised. Recently instances have been noted where manufacturers of low quality jams have labelled their products "Full Fruit Standard " but have omitted any reference to the Food Manufacturers' Federation. As an example of ingenious deception, the following label, attached to a jar of low standard blackcurrant jam, is worthy of special mention :— BLACKCURRANT. FULL FRUIT STANDARD. This jam is guaranteed to conform to the agreed Full Fruit Standard of the Food Manufacturers' Federation. And other fruit juices. Although fruit juice is permitted in jam of the full fruit standard, its presence need not be declared. The finished jam, however, must have the minimum fruit content laid down for first quality jam; in the case of blackcurrant this is 30 per cent. The jam to which the above label was attached contained only 20 per cent, of fruit, which is the minimum quantity permitted in second quality jam. It would probably be the contention of the manufacturer that the form of wording adopted gives notice that the full fruit standard has been lowered by the addition of other fruit 59 juices, but it is unlikely that many members of the public would place this interpretation on the labeL Having regard to its analytical content, this jam should have been labelled:— BLACKCURRANT WITH OTHER FRUIT JUICE. LOWER FRUIT STANDARD. This jam is guaranteed to conform to the agreed Lower Fruit Standard of the Food Manufacturers' Federation. The public health committee decided that these misrepresentations in regard to jam should be brought to the notice of the Food Manufacturers' Federation. (b) Tinned Cream. Fresh dairy cream has an average butter fat content of 50 per cent. Many samples of tinned cream have been examined by the council's public analyst, and in no case has the butter fat content exceeded 25 per cent. ; it is in fact contended by the canning industry that technical difficulties render impracticable the canning of cream having a higher butter fat content. Notwithstanding that the samples of tinned cream taken in Kensington had a butter fat content not exceeding onehalf of that normally found in fresh dairy cream, many of them bore labels making such extravagant statements as "Rich cream," "A highly concentrated rich dairy cream," "In richness and in taste equals fresh cream." Instances of contradictory statements on labels have also been encountered, and the following is a typical example:—" Rich dairy cream—butter fat 25 per cent." Legal proceedings were taken against the vendor of one sample of tinned cream which was described as "A highly concentrated rich dairy cream," but was found to contain only 19 per cent, of butter fat. The defendant successfully pleaded a warranty defence and the summons was dismissed. Legal technicalities, mention of which is made later, prevented the council from taking any action against the person who gave the warranty. (c) Cream Confectionery. During 1934 the public health committee had before them a number of reports dealing with samples described as cream confectionery, in some of which the cream portion was found to contain fats other than butter fat. Proceedings were taken against one confectioner for selling a cream sandwich the cream portion of which contained 84 per cent, of foreign fat, and a conviction was recorded. Further samples procured in different parts of the borough showed that the use of synthetic cream in this type of confectionery was quite common ; and the committee decided that a letter should be sent to all vendors of cream confectionery in Kensington informing them that a cream filling would be regarded as genuine only if it contained no foreign fat and had the composition of dairy cream to which not more than 25 per cent, of stabilising, flavouring or sweetening substances had been added, provided that such additions were not in contravention of any existing legal requirements. This action by the committee at first proved effective, and the majority of samples of cream confectionery taken subsequently were reported by the public analyst as genuine. In due course, however, two further instances arose in which the fillings were found to contain foreign fat. Proceedings were instituted, but before the hearing of the summonses adverse decisions were given in similar cases elsewhere in London, and it was decided not to proceed with the Kensington prosecutions. It is of interest to record that, as a result of the committee's action a firm of caterers with several depots in Kensington substituted the word "creamy" for "cream" in their descriptions of the article in question. The present position is far from satisfactory, for in recent months the council's officers have had to rely on persuasive rather than corrective methods to check this misuse of the word "cream." Although there is at present little cause for complaint in shops situated in the better class areas of the borough, many shops in the poorer parts are still selling articles of confectionery under descriptions which include the word "cream" when the fillings of such articles do not consist of cream. Towards the end of the year, a box of chocolate slices was purchased from a shop-keeper. On the top of the box was a picture of a dairymaid, and the words "Dairy Maid" were printed in large type ; also in prominent type were the words "Cream filled." Upon examination these chocolate slices were found to consist of a number of small chocolate-coated sponge cakes through the centre of which was a white cream-like substance; the fat portion of this cream-like substance consisted of fat other than butter fat. 60 (d) Vinegar. Most of the vinegar sold in this country for domestic purposes is either malt vinegar or artificial vinegar. The former is derived wholly from malted barley or other cereals and is sometimes sold under the designation "Table vinegar." Artificial vinegar consists of acetic acid and water coloured by the addition of caramel. Artificial vinegar is seldom sold as such ; it is usual to describe it as "Wood vinegar," probably because acetic acid is sometimes derived from the distillation of wood. During 1935 several samples sold as "Table vinegar" were found upon analysis to be artificial vinegar, whilst a number of samples of artificial vinegar were sold under labels describing them as "Wood table vinegar." From what has been said above it will be appreciated that "wood" and "table" constitute a contradiction. The public health committee had before them a report on the subject of vinegar in March, 1935, and they decided:— (i) That where artificial vinegar is sold as "Table vinegar" proceedings should be taken against the vendor; (ii) That where artificial vinegar is sold as "Wood table vinegar" a letter should be sent to the vendor in the first place and proceedings taken subsequently if the letter does not have the desired effect; and (iii) That vendors should be informed by circular that where vinegar is demanded it will be regarded as an offence if artificial vinegar is supplied. Since these decisions were put into effect, the sale of artificial vinegar as table vinegar in Kensington has ceased, although there is recent evidence that the old misleading terms are coming into use again. (e) Sweets. Crystallised Orchard Fruits—Crystallised and glace fruits are imported chiefly from France, especially for the Christmas trade. They are sold in small flat wooden and cardboard boxes and are rather expensive. During the past year it has been observed that many grocers are selling a sweet-meat consisting of flavoured jellies (but containing no fruit) in boxes similar, both as regards shape and labelling, to those in which genuine crystallised fruits are sold. There is nothing on the labels to indicate the true nature of the contents of the boxes, and there is little doubt that many members of the public purchase these articles in the belief that they are buying crystallised fruits. This type of misrepresentation was brought to the notice of the public health committee, and in accordance with their instructions a letter has been sent to Kensington traders notifying them that after the 1st April, 1937, proceedings will be taken in all cases where sweetmeats are sold as crystallised fruits. White Milk Chocolate—Another type of wrongly labelled confectionery which has been offered for sale in local shops is that described as "White milk chocolate." This article is prepared wholly from milk, cocoa fat and sugar, and is devoid of fat-free cocoa matter, an essential ingredient of chocolate. Cocoa fat is a constituent of the cocoa bean and is extracted before cocoa is manufactured ; it is almost a waste product. Two samples of white milk chocolate were reported during the year, and warning letters were sent to the vendors. (f) Wines. "Sherry," "Tarragona" and "Port" are words which should be used exclusively in respect of wines imported from certain foreign countries, and therefore the descriptions "British Sherry," " British Tarragona " and " British Port " each constitute a contradiction in words. An important decision regarding labels containing contradictory words was given in the High Court. A wine merchant was prosecuted for selling as "Fine British Tarragona" a wine which was found to consist of 85 per cent, of British wine made from imported raisins and 15 per cent, of wine imported from Tarragona. In the lower court the magistrate dismissed the summons, as he considered that the label truly described the contents of the bottle ; but on appeal it was held that the label was a false one, as it assumed too high a standard of knowledge in the public, who might not see anything antagonistic in the words "British" and "Tarragona." (g) Drugs. Iodine Preparations.—Several samples of iodine preparations have been purchased in Kensington and the labels used to describe the article have been misleading. It will suffice if one typical case is quoted. A sample was sold in a bottle bearing two labels, one on each side of the bottle. On one label were the words "Iodine Paint" ("Iodine" in large 61 letters and " Paint " in small), " Price Is. 3d.," and in small type at the bottom of the label " Not to be taken." The other label bore the words " Makers guarantee—Does not contain colouring matter. Is made from spirits and iodine. Resublimed B.P. For external use only." Although the price marked on the bottle was Is. 3d., the actual purchase price was 2d. This sample proved to be a weak solution of iodine, whereas iodine paint is a compound preparation and should contain the ingredients laid down in the Pharmaceutical Codex. Grey Powder.—This is a British Pharmacopoeia preparation consisting of specified quantitties of mercury and chalk, and is frequently prescribed for children. During the year several samples were examined, and eight of them were found not to conform to the requirements of the British Pharmacopoeia. Prosecutions were undertaken in respect of four samples, and all were down for hearing on the same day. The first case was heard at great length, and the Bench dismissed the summons and gave 20 guineas costs against the council; the remaining three summonses were thereupon withdrawn. It was contended on behalf of the defendants that a grey powder purchased in a chemist's shop need not necessarily conform to the British Pharmacopoeia standard and that a chemist might add a diluent without giving notice of such addition to the purchaser. It is significant that, notwithstanding the decision of the Bench, within one week of the hearing one of the defendants altered the labels used by him in connection with the sale of grey powders so as to give notice that the powders contained an ingredient not specified in the British Pharmacopoeia. A brief reference has already been made to the difficulty of taking action under section 30 of the Food and Drugs (Adulteration) Act, 1928. In certain instances, however, where a label is misleading and the purchaser is prejudiced by the article he receives, it might be possible to prosecute successfully under section 2 of the Act. This section provides that no person shall sell to the prejudice of the purchaser any article of food or drug which is not of the nature or substance or quality of the article demanded. In the absence of definite standards, prosecutions under this section arising from deceptive labelling entail considerable risk, and doubtless many local authorities have hesitated to take this risk, in the knowledge that failure to secure a conviction would give impetus to the very practice they were endeavouring to stop. Another difficulty arises from the fact that retailers purchase many of the foods they sell in tins or packets which are sealed and labelled by the manufacturer. The retailer, therefore, unable to guarantee such articles himself, obtains a written warranty from the firm supplying him, and it is reasonably certain that most summonses against retailers would be dismissed as a result of what is known as a " warranty defence." It is true that proceedings might then be taken against the person supplying the warranty, but by reason of the Summary Jurisdiction Act, 1848, such proceedings must be taken within six months of the date of the warranty. In two recent cases in Kensington where a summons against a retailer was dismissed on a warranty defence it was found impossible to proceed against the wholesaler because more than six months had elapsed since the date of his warranty. A large variety of foodstuffs, particularly those in tins, remain in saleable condition for a year or more, and it is quite likely that cases similar to these two will arise in the future. In 1931 a departmental committee was set up to enquire into the working of the law as to the composition and description of articles of food other than milk, and to report what alterations in the law or its administration appeared desirable. The work of this committee was suspended later in that year on account of the economic crisis, and when it was resumed two years later the terms of reference were amended as follows :— " To consider whether it is desirable that the law relating to the composition and description of articles of food should be altered so as to enable definitions or standards to be prescribed or declarations of composition to be required, for articles of food other than liquid milk ; and if so to recommend what alterations of the law are required." The Committee completed its work in 1934, and the following are extracts from its report :— " Our answer to the question which we are asked to report upon is that it is desirable that the law relating to the composition and description of articles of food should be altered so as to enable definitions or standards to be prescribed, or declarations of composition to be required, for articles of food other than liquid milk." " At the same time we wish to state that in our opinion the case for the extension of standards or definitions to all articles of food is not made out. We consider that in a large number of cases the housewife to-day gets an article of the nature, substance, and quality she demands and that she would not be benefited by a multitude of standards, definitions or declarations of composition. We are satisfied, however, that in some cases standards or declarations of composition or definitions of some kind are necessary for the protection of the consumer." 62 " We think the main thing to be aimed at is that the public, when buying any important article of food, should know what they are getting. A considerable amount of elasticity must be allowed in the preparation of many articles, and we should recommend that the power to fix standards or definitions should only be used where it is shown that it is necessary for the protection of the public health (including nutrition) or the protection of the pocket of the consumer." " A number of our witnesses have complained of the misleading nature of some food advertisements and food labels. We are satisfied that these complaints are well founded. The Food Manufacturers' Federation, Patent and Proprietary Foods Section, put the following recommendation before us :— " ' It is our opinion that any attempt to control by statute statements about the composition of food will be stultified unless it is legally enacted that, for purposes of evidences as to the nature, quality and substance demanded of a food specific claims made in advertisements shall be deemed to be part of the package label. Though it is theoretically true that the purchaser is expected to examine the label of a product before he completes its purchase, it is a matter of common knowledge that the vast majority of purchasers do not do so. The description on which they have been induced to buy the product is in a large number of cases only that contained in the advertisements, and we hold very strongly that progress in the standardisation and description of food will be seriously hampered until this matter is dealt with.' " We agree with the principle of this recommendation." It will be seen that the departmental committee were, with limitations, in favour of the fixing of food standards and the prescribing of labels, but no measures have yet been introduced to give effect to the committee's recommendations. Some success has been obtained in Kensington by the issue of circular letters to traders, particularly with regard to cream confectionery and vinegar, and experience has shown that traders generally are only too anxious to co-operate with the council in their endeavours to safeguard the interests of the consumer. Unfortunately, however, there are in every area a few traders who are not influenced by appeals from the local authority, and the present position of the law makes it difficult to take action against them. Their practice enables them to compete unfairly with other traders, and tends to induce a form of competition which is not to the advantage of the consumer. Moreover, action taken by the Kensington borough council constitutes a source of grievance to retailers in this borough, for their competitors in other areas may not be subjected to the same restrictions. It is therefore too much to hope that local authorities can, without the assistance of further legislation, tackle successfully all the problems referred to. 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. Pharmacy and Poisons Act, 1933.—This act and the rules made thereunder, both of which came into operation during 1936, have for their object the closer control of the sale of poisons and poisonous substances. The act provides for 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 these may now be sold only by registered pharmacists. Part 2 contains the names of those poisons commonly in use for domestic, horticultural, agricultural and sanitary purposes ; these may be sold, not only by registered pharmacists, but also by traders whose names are entered in a list kept by the local authority. Entries in such list are for a period not exceeding twelve months and terminating on a date fixed by the local authority. When the council considered the act and rules, they decided that all entries in their list should be in respect of the twelve months commencing on the 1st May of each year. It is the duty of the council to enforce the new requirements so far as they relate to the sale of part 2 poisons (except by pharmacists, who are supervised by the Pharmaceutical Society), 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. In accordance with the decision of the public health committee, application forms for registration, together with an explanatory leaflet were circulated to those traders in the borough likely to be affected. Upon receipt of the application form duly completed an abridged copy of the poisons rules was sent to each applicant; his premises were subsequently inspected in order to ascertain whether he should be registered and also whether he was familiar with the new requirements. During the year 210 applications for entry in the council's list were received, and in every instance the application was granted. 63 The Shops Act, 1934. This act came into operation on the 31st December, 1934, and requires a closer supervision of all shops than had 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 1935, 1,245 shops had been inspected. During 1936, a further 1,747 shops were inspected and 222 notices were served. The following is a summary of the works which have been required :— 1935. 1936. Provision of additional water closet accommodation 88 25 Provision of lighting and ventilation to existing water closets 68 24 Repair of existing water closets 133 93 Provision of suitable and sufficient means of ventilation to the shop 55 38 Provision of suitable and sufficient means of maintaining a reasonable temperature in the shop 15 46 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. During 1935, 34 exemption certificates were granted and a further 15 were granted in 1936. 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 Act were observed, the additional requirements were included on the notices served. the notices served. The following is a summary of the works required in shops under the PubJ Health Act:— 1935. 1936. Drains cleansed 1 6 Soil pipes, ventilating pipes, repaired 3 1 Waste pipes repaired 11 17 Yards and areas paved, drained, repaired 7 5 Dustbins provided 2 3 Accumulations of filth removed 12 22 Roofs repaired 4 10 Cleansing 111 79 64 THE PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notifiable Infectious Diseases. The following diseases are compulsorily notifiable in Kensington:— Acute encephalitis lethargica. Acute polio-encephalitis. Acute polio-myelitis. Acute primary pneumonia. Acute rheumatism. Anthrax. Cerebro-spinal fever. Cholera. Continued fever. Diphtheria. Dysentery. Erysipelas. Glanders. Hydrophobia. Influenzal pneumonia. Malaria (not induced). Membranous croup. Ophthalmia neonatorum. Plague. Puerperal fever. Puerperal pyrexia. Relapsing fever. Scarlatina or scarlet fever. Smallpox. Tuberculosis. Typhoid or enteric fever. Typhus fever. Zymotic enteritis. Table showing Notifications of certain Infectious Diseases received in 1932-36. Year. Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. P.m'itis & polioence phalitis. ‡ Acute rheumatism. Cerebro spinal meningitis. Dysentery. *Enteritis. Total. 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 1,330 1935 — 304 338 7 63 11 7 30 136 5 2 1 28 2 6 39 999 1936 — 289 142 8 66 12 13 21 177 2 — 3 48 6 7 78 872 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 1936, arranged in Four-Weekly Periods (29th December, 1935 to 2nd January, 1937). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. Erysipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. Polio myelitis. Acute rheumatism. Cerebro spinal meningitis. Dysentcry. Enteritis. Total. January 25 - 15 14 1 9 - 3 1 16 - - 1 7 1 1 1 70 February 22 - 29 12 1 3 - - - 13 — - - 2 - - 9 69 March 21 - 23 10 - 7 2 — 1 17 — - - - - - 3 63 April 18 - 23 12 2 4 — 1 2 7 — - - 4 2 - 2 69 May 16 - 29 17 — 9 2 1 2 9 — - 1 2 — - 3 75 June 13 - 37 12 — 6 1 1 1 8 - - - 4 — 1 9 80 July 11 - 31 13 — 3 3 — 3 8 1 - - 1 - 1 6 70 August 8 - 15 11 2 1 - - 3 9 — - - 3 - - 6 50 September 5 - 14 5 - 4 - 2 2 5 - - - 1 - - 6 39 October 3 - 12 7 1 5 1 - 3 7 - - - 4 1 - 12 53 31 - 11 10 1 3 1 2 1 19 1 - 1 7 - 1 6 64 November 28 - 29 8 — 7 2 3 1 24 — - - 11 - 3 11 99 January 2 - 21 11 — 5 — — 1 35 — - - 2 2 — 4 81 Totals — 289 142 8 66 12 13 21 177 2 — 3 48 6 7 78 872 Cases of mistaken diagnosis are excluded from the above table. 65 Table showing the number of cases of infectious disease notified in the various age periods and wards; the number admitted to hospital; and the total deaths from these diseases in 1936. 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. Smallpox - - - - - - - - - - - - - - - - - - - - - - - - Scarlet fever 289 3 21 14 26 26 90 36 19 40 8 4 2 84 52 50 33 19 18 12 11 10 274 2 Diphtheria (including membranous croup) 142 4 11 11 18 18 42 13 10 12 - 3 - 47 28 23 13 6 7 3 11 4 141 11 Enteric fever 8 — — 1 — — 1 1 - 2 1 2 — 1 1 1 — 1 2 1 - 1 5 2 Puerperal fever 13 — — — - — — - 2 9 - — — 2 4 - 4 — — 1 2 — 11 1 Puerperal pyrexia 21 - - - - - - - 4 15 2 — — 4 3 4 6 2 — 1 1 — 20 1 Primary pneumonia 143 16 18 9 11 10 10 7 5 9 7 28 13 22 71 12 9 5 8 3 10 3 65 160 Influenzal pneumonia 34 1 — 2 — — 4 — — 9 5 9 4 2 14 3 8 1 - 1 4 1 12 34 Dysentery 7 — 1 1 — — 2 — — 1 1 1 — — 1 — — 1 2 — — 3 7 — Erysipelas 66 — — 2 — — 1 3 7 10 10 23 10 17 11 6 7 8 6 3 5 3 35 5 Encephalitis lethargica - - - - - - - - - - - - - - - - - - - - - - - 2 Cerebro-spinal meningitis 6 1 1 — — — — 2 1 — — 1 — 2 1 — — 1 — — 1 1 6 2 Polio-myelitis and polio-encephalitis 3 - - - - - - - 2 - - 1 - - - - 2 - - 1 - - 2 — Pulmonary tuberculosis 174 - - - - - 2 3 6 90 24 33 16 39 23 19 27 9 17 15 16 9 102 105 Other forms of tuberculosis 34 — 1 1 — 2 6 2 4 14 1 2 1 9 6 5 1 3 4 2 4 — 26 18 Ophthalmia neonatorum 12 12 - - - - - - - - - - - 1 2 2 4 — — — — 3 8 - Malaria 2 - - - - - - - - 1 - 1 - - - - - 1 1 - - - 1 — *Enteritis (diarrhoea) 78 40 22 4 4 2 - - - - - - - 20 28 14 5 8 1 — 2 — 46 43 †Acute rheumatism 48 — — — — 1 20 26 1 — — — — 13 11 16 6 — 1 1 — — 16 10 Totals 1080 83 75 45 59 59 178 93 61 212 61 108 46 263 256 155 125 65 67 44 67 38 777 396 * Notifiable only in children under the age of 5 years. † „ „ „ „ „ 16 „ Cases of mistaken diagnosis are excluded from the above table. Smallpox.—During 1936 no case of smallpox occurred in London. Nine persons who had been in contact with this disease on board ship came to live in Kensington immediately after disembarkation. They were kept under daily observation by the department in order that prompt isolation and treatment might be secured in the event of the development of smallpox. Scarlet Fever.—The number of cases notified was 309, but after observation in hospital 20 were found not to be suffering from scarlet fever. The decline in the incidence of the disease noted in the previous year was maintained in 1936. The character of the disease was generally mild, and the mortality rate was low, there being only 2 deaths. Of the total number of cases notified, 294 were removed to hospital. Eight of the notified cases were patients in the same house as persons who had within the previous 28 days returned from hospital after having been treated for scarlet fever. In each of these eight cases a careful investigation was made with a view to ascertaining the source of infection, and necessary steps were taken to prevent any further spread. 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. By means of this test it can be ascertained which contacts are likely to develop the disease. If the test gives a positive result, an injection of scarlet fever anti-toxin will give a passive immunity lasting sufficiently long to tide the patient over the incubation period. No expenditure was incurred on this during the year. Diphtheria.—One hundred and seventy-seven cases of diphtheria were notified. One hundred and seventy-six patients were removed to hospital, but 35 of these were subsequently found not to be suffering from diphtheria and were returned home after the acute illness had subsided. 66 There were, in 1936,196 cases fewer than in 1935. There were 12 instances where more than one case occurred in the same house. The number of deaths from diphtheria was 11, which represents a case mortality of 7-7. In the three preceding years the deaths were 22, 29 and 19, the respective case mortality rates being 7, 4 and 6. During the year 1,542 throat swabs were examined at the council's laboratory at Princess Louise Hospital, and 35 of these showed the presence of the diphtheria bacillus. Eight cases of diphtheria were reported from St. Mary Abbots Hospital, ten from St. Charles Hospital, and three from Princess Louise Hospital. 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.ll, 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, Hornton 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 1936 the borough council supplied 402,000 units of anti-toxin for 36 patients at a cost of £25 16s. 6d. Diphtheria Immunisation. The arrangement, under which doctors practising in the borough carry out immunisation of children on behalf, and at the cost, of the council, continued in operation throughout 1936. From the introduction of the scheme in 1934 to the end of 1936 the number of children immunised has been 2,943. Dr. Guy Bousfield continued throughout the year to hold a schick-testing clinic at No. 28b, Archer Street. The total number of children attending for pre-immunisation Schick tests was 164, of which number 91 gave a positive reaction. The number of children who were presented for Schick testing after having received immunising inoculations totalled 702; of this number 675 proved negative, 27 remained positive, and 36 failed to reattend for the reading. It is unfortunate that the total number of children immunised during the year was only 600, which represents approximately only one-fourth of the children born in the borough during that period. Considerable efforts have been made to bring the value of diphtheria immunisation to the notice of the public. The health lecturer frequently speaks on this subject at welfare centres, clubs and so on ; the council have purchased a diphtheria immunisation film which the health lecturer shows as often as possible ; and all members of the staff are constantly bringing the advantages of this preventive measure to the notice of parents with whom they come in contact. Enteric Fever.—-Eight cases of this disease were notified, five being in South Kensington and three in North Kensington. Four of the patients were removed to hospital and one to a nursing home. The cases notified in the three preceding years were 11, 14 and 8. There were 2 deaths from the disease during the year. In two cases there was evidence that the disease had been contracted outside London, but in the remaining six the patients had not been out of the metropolis for some time prior to their illness. Erysipelas.—Sixty-six cases were notified, 35 of these being removed to hospital. There were 5 deaths from this disease, as compared with 10, 7 and 3 in the three preceding vears. 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. 1936 1 Mar. 3 Yes — Yes — — — 2 Mar. 18 — Yes Yes — — — 3 Apr. 21 — Yes Yes — — — 4 May 12 — Yes Yes — — — 5 May 18 — Yes Still under treatment — — — 6 June 17 Yes — Yes — — — 7 June 30 — Yes Yes — — — 8 July 4 Yes — Yes — — — 9 Sept. 5 Yes — Yes — — — 10 Oct. 23 — Yes Yes — — — 11 Nov. 7 — Yes Yes — — — 12 Nov. 12 — Yes Yes — — — From the above table, it will be seen that eleven cases recovered without any injury to sight; and one case is still under treatment. 67 Puerperal Fever.—Thirteen cases of this disease were notified ; six were confined at home, six in hospital and one in a nursing home. Four of the cases confined at home were subsequently removed to hospital. In every instance the patient recovered. Puerperal Pyrexia.—Twenty-one cases of this disease were notified, 17 of the patients being confined in hospital and four in their own homes. Three of the four confined at home were subsequently removed to hospital for treatment. None of the notified cases proved fatal. The council, as suggested by the Minister of Health, have provided facilities for expert assistance in diagnosis and treatment for patients who are unable to secure this for themselves. In this connection, l3r. A. Morris Johns, a specialist at Queen Charlotte's Hospital, was appointed to the position of consulting gynaecologist and obstetrician some years ago. His services are available to any general practitioner or midwife on request. 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 seventyseven notifications were received during the year, 143 patients being certified as suffering from acute primary pneumonia and 34 from influenzal pneumonia. The number of deaths from pneumonia was 160, and 34 deaths were certified to be due to influenza. Malaria.—Two cases of this disease were notified and investigations revealed that in each instance the disease had been contracted abroad. Acute Rheumatism.—Forty-eight cases were notified. The eighth annual report on the working of the rheumatism scheme during the period 1st October, 1935, to 30th September, 1936, prepared by the medical officer of health and the physicians in charge of the rheumatism centre, appears as appendix I to this report. Cerebro-spinal Meningitis.—Six cases of this disease were notified, four of the patients being females aged 1, 12, 19 and 54 years, and two males aged 1 and 10 years. Three of the female patients died and the fourth was still under treatment at the end of the year. With regard to the two male patients, the one aged 10 completely recovered, and the other moved out of the district before full recovery. Dysentery.—Seven cases of dysentery were notified. Two were of the amoebic type, and the infection was contracted abroad. The remaining five patients suffered from bacillary dysentery, the infecting organism being the sonne bacillus. Four of the cases of bacillary dysentery were removed to hospital for treatment, and the remaining one to a nursing home. There were no deaths from the disease. Zymotic Enteritis or Summer Diarrhoea.—Seventy-eight cases of zymotic enteritis were notified. In considering the value to be attached to this figure two points must be remembered. First, the disease is notifiable only in children under five years of age. Second, zymotic or infective enteritis is sometimes difficult to distinguish from enteritis following errors in diet and other forms of this disease which may not be infective ; doctors frequently notify enteritis, whether it be of the zymotic variety or not, to be on the safe side, or in order that the facilities offered by the council shall be made available in the treatment of the patient. There were 43 deaths certified as due to diarrhoea, etc., and of these there were 36 children under one year of age. Thirteen of the children under five dying of diarrhoea had been notified. In 1924 the council adopted a scheme for the control and treatment of zymotic enteritis. From 1924 until 1934, the scheme was in operation for the summer months only, but during the past three years it operated from the 1st January to the 31st December. All cases of notified enteritis are visited by the health visitors, and of the 78 notified during the year 32 were classed as severe and 46 as mild. Forty-six cases occurred in infants under one year of age, and 32 in infants aged one year and over. In only one instance was there more than one case in the same family. The council retain the part-time services of Dr. Ronald Carter, who has made a special study of zymotic enteritis, for the treatment in their own homes of cases not attended by other doctors. The following are extracts from a report by Dr. Carter on his work during the year :— " I attended 58 cases in their own homes and paid 452 visits. I took three cases to hospital and they all died ; these were the only deaths that occurred amongst the cases that I attended. One of these cases was hopelessly ill when I was called in." "Several doctors in the neighbourhood consulted me in regard to cases. One case that I saw in consultation was that of a breast-fed child with blood and mucous in the stools. The doctor and parent were seriously considering stopping breast feeding; the child completely recovered with treatment without having its food changed." "A considerable number of artificially fed infants under five months were being given an amount of food which they could not digest, this was particularly the case when dried milk was given. These cases require very careful readjustment of their diet." "During the last year there has been a considerable increase in the number of cases dealt with under the council's scheme. The doctors at the welfare centres have requested the nurses to attend those suffering from early symptoms of dyspepsia with only slight diarrhoea and vomiting, but which were not suffering from enteritis. The results have been excellent, and I strongly approve of this endeavour of the council's medical officers to prevent enteritis developing." "I have worked in close co-operation with the council's medical officers and when attending cases I invariably forward them notes on the cases when I have ceased attending." 68 "I was asked to see a breast-fed child two months old who was attending an infant welfare centre, and who was not doing well, and was vomiting. The vomiting turned out to be due to an abscess in the middle ear. The child died in hospital and at the post-mortem the suppuration in the ear was the only abnormality found ; this case was not included in the enteritis deaths. This is the only breast-fed infant that I have seen die during the last twelve years." " In the majority of cases the food most frequently associated with vomiting and diarrhoea was ordinary fluid cow's milk." In addition to the services of Dr. Carter, the council have an arrangement with the district nursing association for the services of nurses to be available for the home treatment of diarrhoea. During the year the nurses attended 140 cases, the total number of visits paid being 1,223. Twentythree of the cases did not respond to home nursing, and these were admitted to hospital, where five of them died. In 27 cases the services of the district nurses were requisitioned by local practitioners. Full routine treatment was carried out in 91 cases, and in 49 rectal washouts were given. Since 1924, 1,212 cases have been attended by the nurses, and the total number of deaths amongst these is 46, making a case mortality rate of 3-8 per cent. Poliomyelitis and Polio-encephalitis.—Three cases of poliomyelitis were notified during the year. The patients were females aged 16, 18 and 45 years, and all recovered after treatment. Other notifiable diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no other notifiable infectious disease was notified. Non-notifiable Diseases. Measles.—In the latter part of 1935 measles became epidemic throughout London, and it remained prevalent in the borough until the summer of 1936. From the 1st November, 1935, to the 1st August, 1936, 1,794 cases of measles, of which 568 were admitted to hospital, were brought to the notice of the department. There were 24 deaths from the disease in Kensington during the epidemic and 26 deaths throughout the year under review. The London county council and the borough council have adopted a scheme of co-operation, which is put into force during epidemic periods, with the object of mitigating complications and reducing the mortality. The scheme was applied early in the year, and the county council provided increased hospital accommodation for the treatment of those suffering from measles. In addition, the borough council appointed a trained nurse to carry out the home visiting of cases to ensure that the patients received proper care and attention. In all she paid 795 visits during the spring of 1936. Whooping Cough.—There were 13 deaths from this cause. The deaths in the three preceding years were 10, 36 and 3. The women health officers paid 307 visits to cases of this disease. The number of cases admitted to hospital from Kensington was 101. In 1930, the borough 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 1936. 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. Vermin. Impetigo. Other conditions. Persons. Cleansings. Persons. Cleansings. Persons. Cleansings. Persons. Cleansings. Adults. Kensington 71 190 38 40 — — 6 8 Other boroughs 61 176 12 15 — - 1 3 School Children. Kensington 105 299 2,632 3,306 108 366 1 1 Other boroughs 47 135 424 492 24 71 — — Children under 5. Kensington 11 25 9 9 - — — — Other boroughs 23 66 2 2 — — — — Lodging-house cases — — 97 97 — — 357 357 Totals 318 891 3,214 3,961 132 437 361 369 69 The total number of persons cleansed during the year was 4,029 ; the total cleansings numbered 5,658. 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 11,012 articles were so dealt with and, in addition, 453 blankets and sheets, and 272 articles of night clothing. Of the 3,341 school-children cleansed at the medicinal baths, 735 were compulsory cases ; the remainder attended voluntarily. Disinfestation. The disinfestation of verminous houses and the furniture of families moving from old properties to new housing estates is a branch of the work which has grown enormously in recent years ; and with that growth there has been made considerable advance in the methods of attack against the bed-bug. Vermin infestation of the borough council's properties. Inspection of a number of fiats under the ownership of one of the housing associations showed a high degree of infestation with vermin, and suggested the importance of a routine inspection of the properties owned by the borough council and occupied by the poorest members of the community. In this routine inspection there were omitted the council's converted properties in Elgin Crescent, Powis Square and Colville Terrace, and also the new flats at Talbot Grove House and Southam House, which are known to be free from vermin. The number of dwellings inspected was 307 and the majority of them are very old properties which have been in the council's possession since before the war. When it was reported that 62 per cent, of these 307 dwellings were infested with vermin, the council decided to instigate systematic fumigation of their properties. To enable this to be done, the housing committee placed at the disposal of the public health committee twelve flats in Seymour King Buildings, which can be used as clearing houses to provide accommodation for families for a night or two during the time their homes are being disinfested. The twelve flats have been redecorated, furnished and equipped in a simple but comfortable manner, and each one is ready for occupation at a moment's notice. Every necessity, including beds, bed-linen, crockery, heating, lighting, cooking facilities, hot water system, etc., is available. These clearing houses will enable the council to disinfest about 300 dwellings a year. When the problem of infestation of the council's own property has been solved, these clearing houses will enable the council to assist the housing associations and even private owners in ridding their premises of vermin. Treatment of Verminous Dwellings. During the year officers of the public health department have endeavoured to discover a method of house disinfestation which would be cheap and successful, but safer than the application of hydrogen cyanide. Various substances have been experimentally applied, and that which appears to be most successful is heavy naphtha, which was tried at the suggestion of the Government Chemist. At the date of writing about 250 premises have been fumigated with heavy naphtha or pseudocumene (a purified form of heavy naphtha) and the results appear to be very good. Experience is being gained in the methods of application, times of exposure, dosage, etc., and there are reasonable grounds for hoping that a safe and successful fumigant has been found. It will be wise, however, to defer a final opinion until the end of the summer, when an inspection will be made of the houses treated. The number of verminous premises treated with orthodichlorbenzene, heavy naphtha, pseudocumene, sulphur and other chemicals during the year was 693, the total number of rooms being 1,348. These disinfestations were carried out by the council's disinfestation staff, and, in addition, owners cleansed 519 verminous premises in response to notices served under the Public Health Acts. Treatment of houses to be demolished. When houses are demolished the woodwork frequently finds its way, either as firewood or for repair purposes, into other houses, and thus vermin may be carried unsuspectingly from slum houses to properties hitherto free. To avoid this possibility all condemned houses are disinfested with orthodichlorbenzene prior to demolition. The Disinfestation of Furniture, etc., with Hydrogen Cyanide. The method introduced in the borough in 1934 to prevent the transference of vermin from old vermin-infested houses to new housing estates continued in operation throughout the year. All families who are allocated flats under rehousing schemes are notified that fumigation of their furniture must be carried out before they can take up occupation of their new homes. On the day of removal a specially constructed steel van arrives at the old home about 8 a.m. when all furniture and effects are loaded into the vehicle, which then goes to the council's Wood Lane depot. Bedding is removed from the van for disinfection by steam, after which hydrogen cyanide is applied to the contents left in the van. The gas remains in contact with the furniture for two hours and the process of extraction is then put into operation for four hours. Tests are made to make sure that all the hydrogen cyanide has been extracted, after which the furniture and bedding are transferred to the new home. The entire procedure of removal and fumigation is completed during the same day so that the family experience no inconvenience. There is an exception, however, in the case of upholstered articles, which are retained overnight in a warm, well-ventilated room; 70 this is done because it has been found difficult to render these articles entirely free from all traces of hydrogen cyanide in four hours. This work of disinfestation with hydrogen cyanide is carried out by the council's own skilled operators, who were trained at the Imperial Chemical Industries works at Billingham. It is interesting to observe that this service is not one which is shunned by the working classes ; it has become exceedingly popular, and working-class families voluntarily removing from one address to another in the borough are in the habit of asking the council to move their furniture and disinfest it en route. The council's stipulation that no family shall enjoy a new home under a housing scheme unless their effects have been disinfested has been a wise one, for it means that all families, whether they think their furniture is verminous or not, are treated alike. It is further interesting to note that furniture coming from condemned houses, even though it looks clean and has been cared for by a reasonably clean housewife, is more frequently infested than is thought either by the general public or by the housewife herself. Summary of disinfestation carried out during the year. The council have entered into contracts with the St. Marylebone, Fulham, Hammersmith, Willesden and Holborn councils to remove and disinfest the effects of families moving from condemned houses in those areas to new housing estates. The Kensington council make a charge of £3 7s. 6d. for each load of furniture dealt with. The following is a summary of the work of disinfestation carried out by the council's officers during the year:— Kensington Dwellings. Premises. Rooms. Houses treated with heavy naphtha 78 154 „ „ „ pseudocumene 99 300 „ „ „ sulphur and Kensington insecticide 516 894 Bedding and clothing removed to Wood Lane and disinfested by steam in connection with the disiniestation of rooms:— Disinfestations 165 Articles 1,534 Furniture in transit from Old to New Homes. Kensington. Marylebone. Willesden. Fulham. Holborn. Hammersmith. Number of families removed 257 91 72 24 5 1 Number of loads treated 219 50 69 18 10 1 Total number of families 450 ,, „ loads 367 The weight of furniture removed and treated by hydrogen cyanide was 432 tons 9 cwts., comprised as follows:— Tons. Cwts. Qrs. Kensington 254 13 3 Marylebone 49 7 0 Willesden 90 10 2 Fulham 24 12 0 Holborn 12 5 3 Hammersmith 1 0 0 The bedding in connection with the above removals weighed 35 tons 5 cwts. 1 qr. 15 lb., and this was treated by steam at the council's disinfecting station. The articles treated by steam were as follows:— Mattresses and flock beds 1,447 Bolsters and pillows 2,429 Quilts 718 Blankets and sheets 1,739 Sundries 1,737 8,070 71 Disinfection after Infectious Diseases, etc. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1936. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Scarlet fever 305 341 346 4,683 Diphtheria 137 146 142 1,911 Enteric fever 9 12 30 552 Measles 554 586 76 1,143 Consumption 174 203 179 1,755 Cancer 37 43 89 711 Other diseases 413 459 360 4,142 Totals 1,629 1,790 1,222 14,897 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 40 tons 18 cwt. 0 qr. 15 lb. The number of articles disinfected only was 15,388 and the number disinfected and washed, 1,043. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved the washing of 10,048 towels, 369 sheets and 190 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 19 tons 4 cwt. 0 qrs. 4 lb. The number of articles disinfected only was 6,148 and the number disinfected and washed was 1,748. 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 109. The number of private subscribing library books destroyed was 47, and the number disinfected by formalin and returned to the householders was 24. TUBERCULOSIS. In accordance with the Public Health (Tuberculosis) Regulations, 1930, which rescinded the regulations issued in 1912, 1921 and 1924, and consolidated their provisions with minor amendments, all forms of tuberculous disease must be notified to the medical officer of health. The information obtained from the system of notification is supplemented in the public health department by a study of the death returns and an examination of the records of the borough bacteriologist, who examines a large number of specimens of sputum, etc., for general practitioners. From a survey of the records over a series of years it appears that a greater percentage of cases is first coming to light as a result of a study of the death returns than was the case several years ago, and as a consequence, the work of prevention and treatment of the disease is being hampered. This is a matter which has frequently been brought to the notice of medical practitioners in the borough. When the bacteriologist finds tubercle bacilli in a specimen submitted by a practitioner, a letter is sent to the doctor if a notification is not received in the course of a few days and in addition to being asked to notify the case, the medical practitioner is informed of the facilities for treatment offered by the council. The following table shows the number of cases of tuberculosis in the various parts of the borough on the 31st December, 1936, and the number of cases notified for the first time during the year:— Cases in the borough on 31st December, 1936. New cases notified during 1936. The Borough 674 208 North Kensington 475 130 South Kensington 199 78 Wards. St. Charles 169 49 Golborne 110 29 Norland 113 24 Pembridge 83 28 Holland 37 12 Earls Court 38 20 Queens Gate 20 17 Redcliffe 79 20 Brompton 25 9 72 During 1936 there was an increase in the number of new cases compared with 1935. The general tendency, however, is for a gradual fall as shown in the following graph :— The following table gives the age and sex distribution of the cases notified for the first time during the year, and the age and sex distribution of the deaths during the year:— New cases. Deaths. Respiratory. Non-respiratory Respiratory. Non-respiratory M. F. M. F. M. F. M. F. 0-1 - - - - - - 2 - 1-5 — — 1 3 — — 2 1 5-15 — 5 6 2 — — — 1 15-25 8 35 4 4 11 11 1 2 25-35 21 32 4 6 12 8 1 2 35-45 11 13 1 — 11 4 1 1 45-55 15 6 — 1 17 6 3 — 55-65 8 4 1 — 10 3 — — 65 and over 6 10 — 1 6 6 — 1 Totals 69 105 17 17 67 38 10 8 Although there has been a fall in the recorded incidence of the disease in the male population and in certain age groups of the female population, the above table, when compared with last year's figures, shows that there has been a definite increase in the number of new cases in the female age groups 15-25 years, 25-35 years, and 65 years and over. Furthermore, although there has been a very gratifying decrease in the number of notifications during the post-war period, there appears to be a tendency for an increasing number of those received to be in respect of persons in the older age groups. This is partly accounted for by the more thorough investigation of illness, with the result that many cases hitherto diagnosed as bronchitis are being found, by the application of modern methods, to be tuberculous. Thus, this apparent tendency for tuberculosis to be more prevalent in the later years of life may not be entirely real; and the figures may probably be regarded as satisfactory because they show that a number of hitherto undiagnosed cases, which may be reservoirs of infection for younger members of the community, are now receiving attention under the council's tuberculosis service. 73 The following table shows the sources of the new notifications during the year:— Cases. Brompton Hospital 28 St. Charles Hospital 24 St. Mary Abbots Hospital 16 St. Mary's Hospital 14 Hospitals and sanatoria other than above 46 Total cases notified by hospitals 128 General practitioners 74 Tuberculosis officer 6 It will be noted that 61 per cent, of the cases are notified from hospitals or allied institutions. It might, therefore, be inferred that there is a tendency for practitioners to delay notification until a definite diagnosis has been proved, or that the patients fail to obtain medical advice until hospital treatment is necessary. The following table shows the number of cases added to and the number removed from the notification register during the year:— Respiratory. Non-respiratory. Totals. Males. Females. Males. Females. Cases on the register of notifications on 1st January, 1936 278 259 117 125 779 Cases notified for the first time during the year 69 105 17 17 208 Cases brought to notice otherwise than by notification 52 29 9 13 103 Cases removed from the register during the year on account of having:— (a) recovered from the disease 19 31 19 29 98 (b) removed from district 64 49 17 25 155 (c) died 73 46 4 8 131 (d) been inaccurately diagnosed 8 12 7 5 32 Cases remaining on the register on 31st December, 1936 235 255 96 88 674 One of the characteristics of the population in North Kensington is that it is nomadic. This is apparently growing and it causes considerable difficulty in keeping the patients and their family contacts under supervision. Deaths.—During the year there has been an increase over 1935 in the number of deaths registered. It must be remembered, however, that the returns for 1935 were exceptionally low. Years. Respiratory tuberculosis. Non-respiratory tuberculosis. Tuberculosis (all forms). Deaths. Deaths per 100,000 persons living. Deaths. Deaths per 100,000 persons living. Deaths. Deaths per 100,000 persons living. 1927 114 65 26 15 140 80 1928 107 60 25 14 132 74 1929 120 68 17 10 137 78 1930 140 78 25 14 165 92 1931 127 70 21 12 148 82 1932 107 58 20 11 127 69 1933 124 58 14 8 138 76 1934 103 58 15 8 118 66 1935 78 44 11 6 89 50 1936 105 59 18 10 123 69 The increase in the mortality rate is mainly in the male population in the age groups of 15-25 and 45 years and over, and in the female population in the age groups of 15-25 and over 45 years. Thirty-five of the deaths from tuberculosis during the year had not been notified previous to death and 22 of these occurred in hospital, that is, 28'5 per cent, of the total deaths from tuberculosis were not previously notified. 74 Deaths from Tuberculosis in 1936 Allocated to District of Usual Residence of Patients. Respiratory tuberculosis. Non-respiratory tuberculosis. The Borough 105 18 North Kensington 65 11 South Kensington 31 6 No fixed abode 9 1 Wards. St. Charles 28 6 Golborne 20 2 Norland 8 2 Pembridge 9 1 Holland 9 1 Earl's Court 2 2 Queen's Gate 3 — Redcliffe 11 1 Brompton 6 2 The places where the deaths from tuberculosis occurred are set forth in the following list:— Respiratory tuberculosis. Non -respiratory tuberculosis. Patient's home 25 1 St. Mary Abbots Hospital 11 2 St. Charles Hospital 42 6 Brompton Hospital 5 — Other institutions 22 9 Eighty per cent, of the deaths occurred whilst the patients were undergoing residential treatment. The Prevention and Treatment of Tuberculosis. In the prevention and treatment of tuberculosis there is close co-operation between the London county council and the borough council, the latter providing the dispensary service and the former the residential treatment. In 1921 the borough council took over the duties of the North Kensington Voluntary Dispensary committee, which had been in operation since 1909. In 1923 the dispensary service for South Kensington, carried out by the Brompton Hospital Authorities, was discontinued, as it was found difficult to co-ordinate the preventive work carried out by the borough council from two dispensaries. The services of the tuberculosis officer are available at the dispensary or at home consultations and the council's women health officers visit all notified cases at frequent intervals. A number of cases notified each year do not require or desire public medical treatment, and in these cases the medical practitioner is communicated with and requested to supply information regarding the patient, his environment, and what form of treatment he is receiving. This request is acceded to in practically all cases, and a report is received every year on the patient's progress. All statutory notified cases do not come under the tuberculosis scheme for treatment and supervision, and only those cases receiving public medical treatment and supervision are entered on the dispensary register, but it is gratifying to note that this register contains 80 per cent, of all cases notified. 75 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 Respiratory Non-respiratory Previous to 1936 1936 Previous to 1936 1936 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. 6 8 11 3 22 - - - - - 5 1 2 2 10 - - - - - F. 12 5 5 — 10 - - - - - 3 — 1 3 7 — — 1 — 1 Children 7 1 — — 1 — — — - — 7 3 2 14 26 - - - - - Disease not arrested Adults M. 18 10 59 9 78 12 10 22 2 34 9 — — 1 10 — — 1 3 4 F. 20 13 61 11 85 24 3 28 2 33 7 1 3 1 12 2 4 1 3 10 Children 11 3 1 — 4 3 1 — — 1 24 7 3 13 47 1 1 1 4 7 Condition not ascertained during the year 7 4 4 1 9 - - - - - 1 1 1 3 6 - - - - - Total on dispensary register at 31st December, 1936 81 44 141 24 209 39 14 50 4 68 56 13 12 37 118 3 5 4 10 22 (b) Not now on dispensary register and reasons for removal therefrom Discharged as recovered Adults M. 166 22 2 — 24 - - - - - 6 1 1 10 18 - - - - - F. 298 18 11 — 29 - - - - - 17 9 2 17 45 - - - - - Children 405 2 — - 2 - - - - - 37 18 7 216 278 - - - - - Lost sight of, or otherwise removed from dispensary register 1683 302 204 59 565 12 2 1 — 3 132 59 30 218 439 — — — 2 2 Dead Adults M. 156 86 217 337 640 — 1 2 3 6 4 2 5 1 12 1 — — — 1 F. 226 121 169 199 489 3 1 1 6 8 4 5 2 1 12 - - - - - Children 74 13 5 8 26 - - - - - 5 3 3 14 25 — — 1 — 1 Total written off dispensary register 3008 565 608 603 1776 15 4 4 9 17 205 97 51 480 833 1 — 1 2 4 Grand totals 3089 609 749 672 1985 54 18 54 13 85 261 110 62 514 947 4 5 5 12 26 76 Of the cases entered on the dispensary register previous to 1936, 90 were removed as recovered, and 52 owing to the death of the patient during the year. Of the cases arising during 1936, 19 or 15 per cent., died within twelve months of coming under the scheme. The dispensary is a centre for reference of doubtful cases for investigation, and a number of cases came to it during the year on their own accord, or were referred by medical practitioners or by the various agencies in the area. The following table shows the new cases sent up to the dispensary during the year, classified according to their ultimate diagnosis:— Adults. Children under 15 yrs. Total. Males. Females. Males. Females. Examined for the first time 181 295 81 96 653 New cases with respiratory tuberculosis 57 77 _ 5 139 New cases with non-respiratory tuberculosis 5 11 6 4 26 New cases still under observation 6 4 1 5 16 New cases diagnosed as nontuberculous 113 203 74 82 472 In the diagnosis and supervision of the disease there are, in addition to clinical investigation, certain laboratory facilities for the examination of specimens. These are carried out at the council's laboratory, and during the year 472 specimens of sputum, etc., were examined. In recent years the diagnosis and control of the disease has been measured with greater accuracy owing to the advances in radiography. X-ray facilities are provided by arrangements with the London county council, at St. Mary Abbots and St. Charles Hospitals, and during the year 516 radiological examinations were made. There has been an increase in the use of the radiological methods during the year as compared with 1935, when 190 X-ray examinations were carried out. The X-ray films are sent from the two hospitals to the dispensary where they are interpreted by the tuberculosis officer in conjunction with the clinical findings in each case. Where the interpretation is carried out by the tuberculosis officer the charge to the borough council has been reduced to 2s. 6d. as compared with 7s. 6d. in previous years. It is now a well-recognised fact that it would be entirely wrong to discharge patients from the dispensary, or to give a definite opinion of the progress of a case, without having an X-ray investigation. A large number of the cases coming to the dispensary are ultimately diagnosed as nontuberculous and are referred back to their own doctors or referred to other institutions for further investigation and appropriate treatment. During the year 68 cases were added to the dispensary register because of their removal into the borough, as compared with 34 cases in 1935, whilst 75 cases were removed from the register because of their transfer out of the district. This characteristic of the population in this area has already been noted as a difficulty in maintaining the supervision of the cases and of their home contacts. The examination of contacts of known cases of tuberculosis has been one of the important functions of the dispensary service since its commencement. A contact is a person who has been living in contact with a known case of tuberculosis, but need not necessarily manifest symptoms. The growth of the school medical section and of the infant welfare branch of the public health service has been a decided asset in keeping the child population under supervision, including the child contacts of known cases of tuberculosis. As a result of the knowledge that their children have been examined at school or a welfare centre it is occasionally difficult to persuade the parents to bring the children to the dispensary for a special examination, but on the other hand, the school and infant welfare medical officers readily refer doubtful cases, especially contacts, to the tuberculosis officer for investigation. There is no doubt that the efficiency of these services is to some extent responsible for the reduction in the incidence of the disease in the child population. There is a very useful part to be played by the dispensary service in the examination of contacts, who are young adults and persons in the older age groups. Great difficulty is found in persuading the young adults to submit to this examination when they consider themselves fit and well, but many visit their respective medical practitioners under the insurance acts. It was ascertained that there existed 366 contacts of the new cases arising in 1936, and of these, 150 were examined at the dispensary ; 51 by their own doctors ; 11 by school medical officers; 16 by medical officers at infant welfare centres, and 10 at various hospitals ; 128, or 35 per cent.. 77 failed to undergo an appropriate examination during the year. Of the total number of contacts, examined at the dispensary during the year, only one was found to be suffering from tuberculosis. During the year 2,314 home visits were paid by the women health officers. In addition to these, members of the various voluntary organisations represented on the care committee visit the homes when so desired by the care committee, but unnecessary duplication of visiting is avoided. Ancillary Services. Dental Treatment. 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 1936. The following table shows the work carried out during the year :— Number of patients treated 66 Number of extractions 98 Patients' attendances 160 Number of dentures 18 Number of fillings 1 Every case receiving dentures is reported to the care committee who assess the patient's contribution towards the cost, but in most cases it is not possible to make any assessment. Artificial Pneumothorax Treatment. When patients return home after a period of institutional treatment a certain number require specific forms of therapy to be continued. The most common form of specific therapy in this category is the refills necessary with artificial pneumothorax treatment. Most of the patients are dealt with at Brompton Hospital, but arrangements are entered into with other hospitals when there is some difficulty about time and travelling. The borough council accept financial responsibility for the cost of this treatment at the rate of 10s. 6d. per refill. During the year 19 patients were undergoing this treatment and received 309 refills. Specific Gold Therapy. One patient received a course of sanocrysin treatment during the year, whilst attending Brompton Hospital as an out-patient. The cost was borne by the council. Artificial Light Therapy. Artificial light therapy is of benefit in cases of tuberculous disease of the skin, and during the year one patient received light baths at St. John's Hospital, for lupus of the face. The cost was borne by the council. Housing. Tuberculosis has always been associated with bad housing conditions ; but with the general improvement in the housing standards, there has been a concurrent reduction in the incidence of the disease. In spite of the general standard being raised, there is still something to be desired in the housing of many of the tuberculous cases. There are several difficulties, the main one being that the majority of cases are living in bad housing conditions by reason of the family economic position. Better accommodation is difficult to obtain for any family in a strained financial position due to a chronic debilitating condition like tuberculosis, especially when many families capable of paying higher rents and with good prospects are demanding better housing. These tuberculous families are, however, referred either to the London county council or to the borough council's housing department, and preferential treatment is given. Bed and Bedding. The council provides a service of decided value which temporarily alleviates border-line housing conditions by the loaning of bed and bedding. This encourages the home isolation of the patient and is a factor in preventing the spread of infection in the home. This service is of great benefit while the patient is awaiting residential treatment, or in cases where the family are awaiting the provision of better housing accommodation. In 1936, 30 patients had assistance under this heading for varying periods. The following is a list of the articles lent :— Bedsteads 22 Mattresses and covers 24 Pillow-slips 55 Pillows 51 Blankets 60 Sheets 77 Quilts 25 On 31st December, 1936, the following articles of bedding were on loan to 22 patients :— Bedsteads 13 Mattresses and covers 15 Pillow-slips 36 Pillows 35 Blankets 43 Sheets 55 Quilts 17 Extra Nourishment. It is well known that the nutrition of the tuberculous patient must be adequately maintained after undergoing residential treatment, so that he can derive full benefit from the convalescence. 78 Patients awaiting admission to sanatorium, or where some intercurrent disease may have lowered their resistance, also require extra nourishment. During the year 51 patients received grants of extra nourishment for varying periods. Residential Treatment. There has been no financial obligation on the patients or their dependants in respect of residential treatment provided by the London county council since 1934, and thus a larger number of patients are willing to participate in the benefits. The number of beds available has increased and the variety of hospitals, sanatoria and colonies available has assisted in encouraging the patients to avail themselves of longer periods of treatment, which are so essential even in the early stages of the disease. In addition, the methods of treatment have improved in recent years. All this has meant that fewer patients are discharged in a condition which necessitates home nursing by persons not fully realising the dangers of infection. On 1st January, 1936, 141 patients on the dispensary register were undergoing residential treatment in hospitals, sanatoria or colonies. During the year 232 cases were admitted, 174 discharged and 59 died in institutions. Of the patients discharged, 63 remained under three months, 81 three to six months, 28 six to twelve months, and 41 over twelve months. 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. 1932 30 1,094 1933 23 1,259 1934 32 1,319 1935 24 1,001 1936 23 920 The nurses carry out their work splendidly and are very much appreciated. Care Committee. The tuberculosis care committee was established by the council in 1922 as an adjunct to the other services. Their function is to investigate the social and economic interests of the families both while the patient is undergoing treatment and after discharge. The committee is composed of representatives of the various voluntary organisations in the district, and others interested in tuberculosis, including representatives of the Charity Organisation Society, the Invalid Children's Aid Association, the United Services Fund, the local Public Assistance Committee, the London Insurance Committee, the school care committee, together with members of the borough council. They help in connection with propaganda in the anti-tuberculosis campaign, the provision of financial or other material assistance when such is deemed necessary, and in obtaining suitable employment for patients. Since their inception they have been doing good work in a very difficult task. The obtaining of suitable employment for the tuberculous patient is a difficulty. In a few cases the patient has refused to attend the dispensary or has requested that no enquiries should be made, in case the employers, as in many cases they unfortunately do, take the view opposite to the vital needs and interests of the patient, when an ample supply of labour is at their disposal. Prior to 1934, a considerable part of the work was in the assessment of patients undergoing residental treatment but this has now been abolished. The committee meet once a month and investigate applications for (1) the supply of extra nourishment, bed and bedding, (2) the provision of clothing by the London county council for patients undergoing residential treatment, when this cannot be obtained from voluntary sources, and (3) the boarding-out of children by the London county council where tuberculosis exists in the family. General. Eighty per cent, of the cases of tuberculosis in Kensington are dealt with under the council's scheme ; 65 per cent, of those persons who come in close contact with cases of tuberculosis are medically examined and, if necessary, supervised under the council's scheme ; the proportion of beds available in London county council hospitals, etc., for Kensington patients is 120 to every 100 deaths from this disease. These figures show that an efficient campaign against tuberculosis is being conducted. Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations were introduced with a view to :— (a) preventing persons suffering from pulmonary tuberculosis entering upon an occupation involving the handling of milk ; and (b) 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 the regulations. 79 APPENDIX I. NINTH ANNUAL REPORT on THE KENSINGTON RHEUMATISM SCHEME (1st October, 1935—30th September, 1936) 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. In 1927, the Minister of Health made regulations under which acute rheumatism became a notifiable disease in Kensington for a period of three years; similar regulations were made in 1930, 1933 and 1936. These regulations defined 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 in temperature ; (b) Rheumatic chorea; (c) Rheumatic carditis. By the end of September, 1936, notification had been in force for nine years, and the following table shows the notifications received and their source :— Year. NUMBER OF NOTIFICATIONS BY— Total number of notifications. Total number of patients notified in the year who attended the rheumatism supervisory centre. Medical officers at rheumatism supervisory centre. Private practitioners. 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 33 10 26 81 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 11 43 6 3 63 32 1934-35 4 22 4 1 31 17 1935-36 9 19 3 4 35 25 Totals 132 302 67 138 639 375 (a) Notification by medical officers at the rheumatism supervisory centre. A number of possible sufferers from acute rheumatism are referred to the supervisory centre by other departments of Princess Louise Hospital (at which institution the centre is established), school medical officers and various health workers, such as the Invalid Children's Aid Association and school visitors ; these are examined and duly notified if a positive diagnosis is made. (b) Notification by private practitioners. It will be seen that the percentage of the notifications received from private practitioners has been fairly constant throughout the period the disease has been notifiable. It would thus appear that there is a satisfactory response from this source. There are, however, a number of children who are suffering from rheumatism, but in whose cases a prolonged observation is required to make a diagnosis. Parents are often unwilling or cannot afford to pay a private practitioner for a long period of observation, and so the doctor has no chance of arriving at a final opinion satisfactory to himself. Thus, a number of cases escape notification ; and, in addition, there are others which escape notification because they are frequently changing doctors, which may make it difficult for any one to make up his mind about the case. New doctors are not likely to notify cases, for the regulations are local, and they may not be aware of them. The public health department attempts to counteract these difficulties by periodically circularising all the doctors known to be practising in the borough. They are not only reminded of their duty to notify cases, but are also informed that children may be observed over long periods at the supervisory centre. (c) Notification by school medical officers. Notifications from this source have, except in the first few years, been low. It should not be inferred, however, that this indicates failure to obtain adequate supervision and treatment for rheumatic school children. 80 Cases needing supervision are often referred by the school medical officers to the rheumatism supervisory centre at Princess Louise Hospital, whilst others are referred to the London county council clinic at Shepherd's Bush. School doctors often arrange the direct admission to appropriate institutions of children needing urgent treatment. (d) Notification from hospitals. Notwithstanding the fact that frequent reminders as to duties in regard to notification are sent to hospitals, notifications from this source have been very few. This is probably due to frequent changes in the resident medical staff; the new doctors may not be aware that the disease is notifiable in this borough. Conclusions. 1. Statistics. (a) Incidence of the disease. The statistics of the past nine years show that the annual number of notifications has decreased. It is by no means certain, however, that the incidence of the disease has lessened in a like degree. There has been a decrease in the severity of the lesions associated with the disease, particularly in lesions of the heart, which, in many instances in the past, were due to neglect of early symptoms. (b) Epidemiology. The relation between poverty and the incidence of the disease has been confirmed, as has also the familiar character of the disease. Throughout the period under consideration, by far the greater proportion of cases has occurred in the northern part of the borough—that is, in the poorer and more crowded districts. The disease has been found to be most prevalent in streets where the basement type of house predominates. Recently, many of the basements have been closed for human habitation, and it will be interesting to observe in the future what effect, if any, this measure will have on the incidence of the disease. During the past year investigations were carried out to ascertain whether there was any connection between diet (e.g., certain types of food) and the occurrence of rheumatism, but no new fact of importance was discovered. 2. The value of notification. Notification of rheumatism has proved to be of definite value. This was particularly so in the early days, but now that the activities of the supervisory centre are well known, it is probable that supervision of cases could be carried out almost equally well without preliminary notification. Of the 35 cases notified during the past year, 25 attended the centre, and nine were under the care of a private practitioner or under supervision in an institution. In regard to the 25 cases attending the centre, it is impossible to state definitely how far their attendance depended upon notification, but it can be stated with a fair amount of certainty that at least 80 per cent. would have done so. It is therefore obvious that the centre is no longer dependent upon notification as a means of obtaining material. This is further confirmed by the number of cases (shown in Part II of this report) referred to the centre from other boroughs in which the disease is not notifiable. Residential treatment of rheumatism. Hospital accommodation. Eight beds are available at the Princess Louise hospital for the treatment of rheumatism, and it is not difficult to obtain beds at other institutions for cases of juvenile rheumatism. Convalescent homes. Since the early days of notification, facilities for convalescent home treatment have greatly increased. In an earlier report it was stated that " the period of waiting has been excessive, the accommodation for the residential treatment of rheumatic children being quite inadequate." Fortunately, this is no longer true, and there is little, if any, delay in getting cases away. In the past year, 19 children were sent for convalescent treatment from the supervisory centre, nine through the Invalid Children's Aid Association, and 10 under the London county council rheumatism scheme. The latter has been particularly useful, as under it arrangements are made to send rheumatic children to convalescent homes for the summer holidays. Many of these children attend special schools and are under careful supervision during term-time ; if these children remained at home during the long summer holidays, it is probable that a good deal of the benefit gained from previous treatment and supervision would be lost. PART II. The Work of the Centre by JANET K. A IT KEN, M.D., M.R.C.P., and ALBERTINE L. WINNER, M.D., M.R.C.P. In the nine years 1927-36 during which the centre has been in existence, 2,074 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. 1931-32 1932-33 1933-34 1934-35 1936-36 Kensington 266 290 311 296 285 Hammersmith 47 51 45 39 37 Other boroughs 12 20 35 40 45 325 361 391 375 367 81 During the year 1935-36, 48 sessions have been held at the Princess Louise hospital. Average attendance per session of Kensington patients 19.7 „ „ „ „ other „ 5.6 25.3 The total number of attendances of patients was :— Kensington Notified cases (a) New 22 (6) Old 326 Unnotified cases (a) New 51 (b) Old 545 Hammersmith (a) New 8 (b) Old 120 Paddington (a) New 4 (b) Old 34 Acton (a) New 14 (b) Old 54 Other boroughs (a) New 4 (b) Old 30 1,212 The new Kensington cases were recommended to attend the clinic from the following sources :— Invalid Children's Aid Association 5 School medical officers . 23 Princess Louise hospital 16 Private doctors 5 Home visiting after notification 5 Parents 15 Infant welfare centres 3 Tuberculosis dispensary 1 73 The disposal of cases which attended the centre and which needed special treatment may be summarised as follows :— Tonsillectomy at Princess Louise hospital 10 Admission to Princess Louise hospital 9 Admission to St. Charles hospital 1 Special schools 5 Convalescent homes 19 Referred to massage department for special chest expansion exercises 2 46 Record of the progress of 104 cases which have attended the centre during a period of five years or more. From the records we have been able to collect 104 cases which have been supervised under the scheme for a period of five years or more. The records of these 104 cases are, for the purpose of this investigation, continuous and complete ; they are unselected. A few cases which have been seen over a period of five years have not been included, as the recorded information was incomplete for various reasons. The number may be considered small in relation to the total dealt with by the scheme, but over a period of five years, children fail to continue to attend the clinic for a variety of reasons : they may remove from the district; parents may refuse to avail themselves of the scheme, especially when the child is not obviously ill; they reach the age of 14 and go to work or reach the age of 16 and become beyond the age limit of the scheme. The cases are divided into three groups :— (1) In this group there are children sent to the clinic who may have pains suggesting rheumatism but who have not had a definite rise of temperature, acute arthritis, cardiac involvement, or chorea. That is to say they have not manifested a syndrome sufficient to justify classification under the notification regulations. Twenty-six cases are in this category. (a) Fourteen cases.—These cases were brought to the clinic on account of pains simulating rheumatism. They never developed any sign or symptom suggesting cardiac involvement. (b) Twelve cases.—These cases, in addition to their initial symptoms, manifested at times cardiac murmurs or extra systoles, but in no case during the period of observation was there any evidence of damage to the heart. (2) In this group there are seven cases in which the initial symptoms, which were not sufficiently definite to be notifiable when first seen, developed to such an extent that they became notifiable. Two developed acute rheumatic fever with a cardiac lesion, and in five it was decided during the period of observation, although they had had no acute attack, that there was definite evidence of rheumatic carditis. (3) In this group all the cases were notifiable when first seen ; there are 71 cases. 82 (a) Thirteen cases.—These had arthritis and fever or chorea, but no murmur or other abnormality of the heart was demonstrated during the five or more years under observation. (b) Seven cases.—These had arthritis and fever or chorea, and during the period of observation they developed various types of slight abnormalities of the heart, variable and not at any time thought to indicate cardiac damage. (c) One case.—Similar to those in group (b), but the basal murmur did not vary during the five years. (d) Fourteen cases.—In all these cases there had been at one time or another evidence of definite cardiac involvement—enlargement of the heart, apical systolic murmurs, or pericardial rub. When last examined, however, these signs had disappeared, and no evidence of any cardiac abnormality could be detected, (d) Eight cases.—In these there was evidence of heart disease when first seen, and this remained stationary, showing no further cardiac damage, although during the five years of observation two had an attack of chorea and three had a second attack of acute rheumatism. Five of these cases have mitral incompetence, and three mitral stenosis. (f) Six cases (two of these cases are also included in group (d)).—These are of interest, as they had a cardiac lesion, but had no symptoms suggesting juvenile rheumatism. (g) Twelve cases.—These cases, although notifiable, had no evidence of carditis when first seen, but they developed lesions at a later date. When last seen five had mitral regurgitation, five had mitral stenosis, and two had a double lesion—mitral stenosis and aortic incompetence. Of these twelve cases, two when first seen were beginning an attack of acute juvenile rheumatism. Four developed lesions without any evidence of an acute attack, and six had further attacks of chorea or acute rheumatism. (h) Twelve cases.—These cases had definite evidence of. cardiac involvement when first seen and during the period of observation the heart was further damaged. Five had no intermediate acute attack, but the signs of mitral incompetence changed to those of mitral stenosis, and seven had acute exacerbations, five developing aortic regurgitations as well as mitral stenosis. Summary. (1) Twenty-six cases (25 per cent.) have not become notifiable during the five years or more that they have been under supervision. Twenty-one of these cases, although they had no definite arthritis or fever and were not notifiable, had rheumatic pains at times during the period under observation and were therefore potential cases of juvenile rheumatism. That 21 or 20 per cent., who were unnotifiable and had rheumatic pains on and off during the five or more years, did not develop an acute attack, may be largely due to the care that had been taken. These supervised children, if the pains are definite and their general health is not altogether satisfactory, are frequently sent to bed for a week or more at home ; the district nurse attends night and morning to take pulse and temperature, and appropriate treatment is advised. The social worker attends, wherever possible, to see that the instructions are carried out. With this arrangement it has been found, on many occasions, that the pains subside and the general health improves. It is justifiable to conclude that a certain number of acute attacks have been prevented by this method, especially as in some of the cases the pains had been present for some weeks before the child was brought to the centre, and the symptoms had shown no tendency to improve until this treatment was adopted. Also the fact that the parents, usually the mother, but occasionally the father, grandparent or other relative have been trained to bring these children to the centre and keep them under regular supervision for five years in the absence of any acute illness, is significant evidence of the educational value of the centre. There is no doubt that the centre and the public medical service have trained the parents to realise the possible seriousness of the " growing pains " which used to be considered so lightly. Such educational work is not the least important part of the centre's responsibility. (2) Only seven cases which were not notifiable when first seen have developed cardiac lesions. (3) Of the nineteen patients with chorea, only ten have a cardiac lesion. We have noticed that an increasing number of children are sent up to the centre by schoolmasters and schoolmistresses who have observed suspicious movements of face and limbs and told the parents to obtain advice. Sometimes a diagnosis of chorea is made, and sometimes the movements are only nervous habits ; the latter type of case can be referred, if necessary, to the child guidance clinic. Children with even mild chorea and no evidence of carditis are usually sent for institutional treatment as they do not progress well in the home. In hospital their symptoms quickly subside, but it has been found that they must not be allowed to return to their ordinary activities too soon or the movements will recur. Convalescent treatment is therefore advised, although the parents will sometimes refuse to permit this owing to the expense involved. (4) Twenty-one cases (20 per cent. of the whole) developed mitral stenosis or aortic regurgitation, or both : of these only eleven (50 per cent.) had an acute arthritic attack. Four had chorea, and six had neither chorea nor acute arthritic attack; three of these, however, had been in-patients in hospital for sub-acute rheumatism or carditis more than two years before the mitral stenosis was noted, so that it is probable that the real onset of the cardiac lesion was at that time. (5) Six cases with cardiac lesions had no rheumatic symptoms, that is to say that they had no reported rheumatic pains or arthritis. It may be that the pains occurred at an early age when the child could not easily explain or remember his symptoms, and the parent was not observant, but in these cases no such historv could be obtained. (6) Thirty-five notifiable cases (33 per cent.) had no organic lesion when last seen. Of these, fourteen cases originally had a definite cardiac lesion and have apparently recovered completely. It must be noted that at the end of the period of observation sixty-one, or 58 per cent., of the cases have no demonstrable cardiac lesion. Twenty-six of these were potential rheumatics, nine had had chorea, twenty-six had had rheumatic fever, and no less than fourteen had haa clinical evidence of cardiac damage at some stage of their illness. Permanent cardiac damage is, of course, the consequence most to be feared in cases of juvenile rheumatism, owing to the serious invalidism it may entail, with premature death. This high rate of freedom from cardiac damage may be ascribed in part to the preventive measures already described, in part to early diagnosis at the centre, and consequent hospitilisation or care in the home of all cases of definite juvenile rheumatism, and in part possibly to the arrangements made at the centre for convalescent treatment for debilitated children. On the whole, therefore, the analysis of these cases would seem to be very satisfactory and an indication of the prophylactic value of the supervisory centre. 83 APPENDIX II. TABLE I. Vital statistics of whole district for 1936 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 Number. Rate.* 1 2 3 4 6 6 7 8 9 10 11 12 13 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 1936 176,100 2,399 2,228 12.7 2,961 16.8 1,295 535 163 73 2,201 12.5 ♦Rates calculated per 1,000 of estimated population. At Census of 1931. Area of district in acres (exclusive of Total population at all ages 180,677 area covered by water) 2,291 Total families or separate occupiers 47,713 84 TABLE II. Causes of Death at Different Periods of Life in 1936. 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 66 years. 65 and under 76 years. 76 and upward ALL CAUSES M. 995 99 19 9 11 30 38 38 109 195 237 210 F. 1,206 64 23 19 17 23 32 53 92 160 269 454 Typhoid and paratyphoid fevers M. 2 ... ... ... ... ... 1 1 ... ... ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Measles M. 12 4 5 o 2 1 ... ... ... ... ... ... ... F. 14 2 7 5 ... ... ... ... ... ... ... ... Scarlet fever M. ... ... ... ... ... ... ... ... ... ... ... ... F. 2 ... 1 ... 1 ... ... ... ... ... ... Whooping cough M. 7 4 1 2 ... ... ... ... ... ... ... F. 6 2 2 2 ... ... ... ... ... ... ... Diphtheria M. 3 1 ... 2 ... ... ... ... ... ... ... ... F. 8 ... 1 3 3 1 ... ... ... ... ... ... Influenza M. 10 1 ... ... ... ... ... ... 1 3 3 2 F. 24 1 1 ... 1 ... ... 2 ... 4 7 8 Encephalitis lethargica M. 2 ... ... ... 1 ... ... ... ... 1 ... ... F. ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal fever M. ... ... ... ... ... ... ... ... ... ... ... ... F. 2 l ... ... ... ... ... 1 ... ... ... Tuberculosis of respiratory sys- tem M. 67 ... ... ... ... 11 12 12 18 9 4 1 F. 38 ... ... ... ... 11 8 5 6 2 4 2 Other tuberculous diseases M. 10 2 ... 1 ... 1 2 1 3 ... ... ... F. 8 ... 1 ... 2 1 2 1 ... ... 1 ... Syphilis M. 7 1 ... ... ... ... ... ... 1 2 2 1 F. 1 ... ... ... ... ... ... ... ... ... 1 General paralysis of the insane, r tabes dorsalis M. 5 ... ... ... ... ... ... 1 2 1 ... 1 F. 1 ... ... ... ... ... ... 1 ... ... ... ... Cancer, malignant disease M. 129 ... l ... ... ... 3 1 23 35 41 25 F. 192 ... ... ... ... ... 4 18 28 42 47 51 Diabetes M. 10 ... ... ... ... 1 ... 1 ... ... 7 1 F. 22 ... ... ... ... ... ... ... 5 1 10 6 Cerebral haemorrhage, etc. M. 33 ... ... ... ... ... ... 1 8 12 12 F. 51 ... ... ... ... ... ... 1 3 6 18 23 Heart disease M. 266 ... l ... ... 2 ... 4 17 54 99 89 F. 355 ... ... ... 1 1 3 9 14 41 90 196 Aneurysm M. 11 ... ... ... ... ... ... ... 2 5 1 3 F. 5 ... ... ... ... ... 1 ... 2 1 1 Other circulatory diseases M. 34 ... ... ... ... ... 1 ... 2 10 8 13 F. 78 ... ... ... ... ... ... 2 3 9 24 40 Bronchitis M. 26 3 ... ... ... ... ... 2 4 8 3 6 F. 20 1 ... ... ... ... 1 2 4 12 Pneumonia (all forms) M. 89 21 7 1 ... 3 2 5 10 15 14 11 F. 71 13 4 5 2 ... 1 2 ... 7 16 21 Other respiratory diseases M. 9 ... ... ... ... ... ... 1 2 4 1 1 F. 5 ... ... ... ... ... ... ... ... ... 1 4 Peptic ulcer M. 11 ... ... ... ... ... ... 3 4 2 2 F. 12 ... ... ... ... ... 1 ... 6 3 1 1 Diarrhoea, etc. M. 21 19 ... ... ... ... ... ... ... ... 1 1 F. 22 19 1 ... ... ... 1 ... ... ... ... 1 Appendicitis M. 6 ... ... ... ... ... 1 ... 2 1 1 1 F. 5 ... ... ... 1 1 ... ... ... 2 1 ... Cirrhosis of liver M. 6 ... ... ... ... ... ... 1 2 3 ... ... F. 5 ... ... ... ... ... ... ... ... 3 2 ... Other diseases of liver, etc. M. 2 ... ... ... ... ... ... ... ... 1 1 ... F. 12 ... ... ... ... ... ... 1 3 1 3 4 Other digestive diseases M. 25 3 ... ... 2 1 1 4 5 6 3 F. 26 1 2 ... ... ... 1 1 ... 8 4 9 Acute and chronic nephritis M. 25 ... ... ... ... 1 2 ... 2 7 7 6 F. 32 ... ... 1 ... ... 2 3 7 5 14 Puerperal sepsis F. 1 ... ... ... ... 1 ... ... ... ... ... ... Other puerperal causes F. 1 ... ... ... ... ... 1 ... ... ... ... ... Congenital debility, premature birth, malformation, etc. M. 30 30 ... ... ... ... ... ... ... ... ... ... F. 21 20 ... 1 ... ... ... ... ... ... ... ... Senility M. 3 ... ... ... ... ... ... ... ... 1 2 F. 19 ... ... ... ... ... ... ... 3 16 Suicide M. 16 ... ... ... ... 2 5 2 1 4 2 ... F. 13 ... ... ... ... ... 2 1 2 4 3 1 Other violence M. 34 1 1 1 5 6 5 1 2 2 5 5 F. 42 ... 2 ... 1 4 2 1 2 5 7 18 Other defined diseases M. 84 9 3 ... 4 1 3 4 7 13 16 24 F. 91 5 ... 2 5 1 6 5 15 11 17 24 Causes ill-defined, or unknown M. ... ... ... ... ... ... ... ... ... ... ... ... F. 1 ... ... ... ... ... ... ... ... ... ... 1 85 TABLE III. Infant Mortality during the Year 1936. 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 30 2 5 .. 37 21 35 30 21 144 Uncertified 7 .. 2 .. 9 5 2 2 1 19 Measles .. .. .. .. .. .. .. 2 4 6 Whooping-cough .. .. .. .. .. .. 1 3 2 6 Diphtheria .. .. .. .. .. 1 .. .. .. 1 Influenza .. •• .. .. .. 1 1 .. .. 2 Meningitis .. .. .. .. .. .. 1 .. .. 1 Acute tuberculosis .. .. .. .. .. .. .. .. .. .. Other tuberculous diseases .. .. .. .. .. . . . . 1 1 2 Bronchitis .. .. .. .. .. 2 .. .. 2 4 Pneumonia .1 .. .. .. 3 7 11 7 6 34 Other respiratory diseases .. .. .. .. .. .. .. .. .. .. Diarrhoea, etc. .. .. 1 .. 1 9 13 11 4 38 Complications of birth 10 2 .. .. 12 .. .. .. .. 12 Malformation 6 .. .. .. 6 1 1 1 .. 9 Premature birth 19 .. 2 .. 21 1 .. .. .. 22 Deaths from violence .. .. .. .. .. 1 .. .. .. 1 Atrophy, debility and marasmus .. .. .. .. .. 3 4 2 2 11 Other diseases 1 .. 2 .. 3 .. 5 5 1 14 Totals 37 2 7 .. 46 26 37 32 22 163 Net births in the legitimate, 1,997 Net deaths in the legitimate infants, 139 year of year of illegitimate, 231 illegitimate infants, 24. 86 TABLE IV. The Work of the Women Health Officers for the Year 1936. HEALTH OFFICERS. total *1 2 3 4 5 6 7 8 Child Welfare- First visits to infants (0-1 year) 61 142 346 381 254 201 92 175 1,652 Return visits to infants (0-1 year) 143 424 669 523 712 891 225 446 4,033 Total visits to children (1-5 years) 297 748 1,061 698 1,063 735 513 683 5,798 Stillbirth enquiries 5 7 10 11 5 4 — 3 45 Visits to ophthalmia cases — — 4 7 2 1 — 2 16 Return visits to ophthalmia cases — — 9 10 3 8 — 1 31 Visits to measles cases 44 222 125 54 218 191 223 230 1,307 Visits to whooping cough cases 10 37 48 13 23 48 98 30 307 Visits to puerperal fever cases — 1 5 6 — — 1 2 15 Visits to puerperal pyrexia cases 1 1 8 6 1 3 2 — 22 Visits to enteritis cases 5 15 32 12 16 12 6 — 98 Infantile death enquiries 5 16 29 27 23 16 11 20 147 Milk investigations 275 282 814 923 509 479 151 91 3,524 Ante-natal visits 85 322 201 204 232 154 210 271 1,679 Half-days at welfare centres 108 136 141 133 154 115 59 128 974 Special visits 61 402 349 401 300 458 507 375 2,853 Tuberculosis— Pulmonary—First visits — 24 24 2 14 14 38 24 140 Re-visits 189 320 3 167 166 460 280 1,585 Non-Pulmonary—First visits 3 7 — 4 — 4 5 23 Re-visits — 74 131 — 86 41 161 83 576 Rheumatism— First visits to cases notified — 1 9 1 8 15 13 2 49 Common Lodging Houses- Inspections 1 22 — — — 47 — — 70 Factories and Workshops Act- Inspections of factories — 24 2 — 80 — 55 32 193 Inspections of workshops — 6 16 — 33 12 442 156 665 Inspections of outworkers' premises — 16 49 — 13 22 306 33 439 Inspections of other workplaces — — 1 — — — 33 7 41 Total Visits 1,101 3,114 4,410 3,415 3,920 3,633 3,610 3,079 26,282 Notices issued under the Public Health Act- Intimation notices — 1 1 — — — 13 5 20 Statutory notices Final notices Summonses *This woman health officer is also responsible for the duties of child life protection visitor under the Public Health (London) Act, 1936, and particulars of her work appear on page 13. 87 TABLE V. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1935. DATE. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth list sheets. Number of these births duly entered in columns 1, 2, 4, and 5 of the vaccination register (birth list sheets), viz. : Number of these births which are not entered in the vaccination register, on account (as shown by report book) of Total number of certificates of successful vaccination received during the calendar year, 1936. 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. 1935. Insusceptible of vaccination Certificate of conscientious objection. 1st January to 31st Dec. North 831 572 — 148 44 — 6 55 6 1,835 South 1,513 910 2 233 80 6 202 79 1 Total 2,344 1,482 2 381 124 6 208 134 7 88 TABLE VI. Particulars of the Staff of the Public Health Department at the end of 1936 (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 Joan Goodger, M.R.C.S., L.R.C.P., D.P.H 1936 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. 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 Harold P. Widdup, M.B., Ch.B. (North Kensington district) 1936 Clerical Staff. James H. Wilson (Chief clerk Ronald F. Rogers 1931 and vaccination officer) 1900 Derek P. Roberts 1934 Francis W. Gascoyne 1919 Reginald C. Charlton 1935 John S. Russell 1923 Eric R. Hundy (Temporary) 1934 Denis C. Page 1925 George W. Churcher( „ ) 1935 Francis T. Pearce 1929 Charles E. Mallett ( ,, ) 1936 Victor R. Minter 1932 James G. Pope ( ,, ) 1936 Beatrice J. Fenton 1930 Charles R. Cox ( „ ) 1936 Sanitary Inspectors. George W. McQuinn (Senior §Frederick G. Bishop 1931 inspector) 1901 §Ronald V. Coombs, B.A. 1932 john McDermid 1920 §Arthur L. Vague 1934 Henry W. Walters (Food §Thomas A. Wilson 1934 inspector) 1925 §Maurice Cottrell 1934 Cecil R. Web 1925 §Ronald D. Callis (Temporary) 1934 John S. Wheeler 1930 james Clancey ( ,, ) 1935 Donald J. Hunt 1931 §Dennis C. Draper ( „ ) 1935 Women Health Officers. Miss W. H. E. Whitbread 1920 Miss P. Bing 1930 Mrs. V. A. Ross 1921 §Miss B. I. Brady (Child 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 M. Flambert (Nurse-in-charge, Dalgarno centre) (Temporary) 1936 Mrs. M. Hayman (Health lecturer) 1926 Miss Caton (Secretary, rheumatism supervisory centre) 1933 Arthur C. Britton (Mortuary keeper) 1930 Albert Nunn (Chief disinfector) 1906 George Harris (Disinfector) 1914 William Taylor ( „ ) 1926 Walter Strong ( „ ) 1928 Ernest Manning ( „ ) 1931 Frank Nunn (Temporary disinfector) 1934 A. V. Boddington (Superintendent of medicinal baths) 1929 Walter E. Weedon (Rat officer) 1926 William J. Clancy (Drain-testing assistant) 1903 Charles H. Coombs 1927 Mr. and Mrs. W. Whale (Caretakers, tuberculosis dispensary) 1932 * Certificate of the Royal Sanitary Institute. Certificate of the London Sanitary Inspectors Examination Board. Certified Midwife. Certificate for Meat and other Foods. §Certificate of the Royal Sanitary Institute and Sanitary Inspectors Examination Joint Board. ::Smoke Inspector's Certificate. x Certificate in Sanitary Science as applied to Buildings and Public Works. 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. 89 INDEX. page Advisory committee 37 After-care of tuberculous patients 78 Aged, infirm and physically incapacitated persons, removal of 23 Agricultural Produce (Grading and Marking) Act 53 Analysis of tuberculosis registe 75 Ante-natal services 11 & 31 Anti-toxin (diphtheria) 66 Artificial Cream Act 53 ,, light therapy 77 pneumothorax treatment 77 ,, sunlight 34 Baby clinic 33 . ,, hospital 33 Bacteriological examinations (infectious disease and milk) 12 & 51 Bacteriological examinations (tuberculosis) 12 & 52 Bakehouses 52 Basement rooms 47 Baths and washhouses 21 & 23 Bedding for tuberculous patients 77 Birth control 37 Births 4 ,, in wards and rates 4 ,, notified 5 Boarding out of children 36 Canal Boats Acts 23 Cancer 7 Care of tuberculous patients 78 Cerebro-spinal meningitis 67 Chapel of Rest 21 Child life protection 12 Cleansing station 68 Clearance areas 37 Closing orders 40 Common lodging houses 46 Compulsory purchase orders 39 Convalescent homes 34 Crescent Street improvement area 41 Day nurseries 35 Deaths 5 ,, , causes of 7 ,, from certain diseases 8 ,, from cancer 7 ,, from tuberculosis 73 ,, in wards and rates 6 Defects (housing) remedied 20 Dental treatment at infant welfare centres 31 ,, ,, for tuberculous patients 77 Diarrhoea (summer) 67 Diphtheria 65 ,, immunisation 66 Disinfection (infectious disease) 71 Disinfestation by HCN 69 Dispensary diagnosis and treatment of tuberculosis 74 Dog nuisances 24 Drainage and sewerage IS Dwelling-house inspection 19 Dysentery 67 page Electrical treatment 34 Employment of tuberculous patients 78 Enteric fever 66 Erysipelas 66 Extra nourishment for expectant and nursing mothers and their infants 35 Extra nourishment for tuberculous patients 77 Factories and workshops 25 Food, inspection and supervision 49 Food and Drugs (Adulteration) Act 49 & 53 ,, ,, (proceedings) 55 Food premises, inspection 52 ,, ,, registration 52 ,, supply 49 ,, unsound 53 Foster-children 12 Fouling of footpaths by dogs 24 Gold therapy 77 Grants to maternity and child welfare institutions 18 Gynaeological clinic 37 Health lecturer 17 & 36 ,, propaganda 17 ,, services (general) 12 , ,, visitors 29 & 86 Home contacts of tuberculosis 76 ,, helps 36 „ nursing (general) 13 ,, nursing of tuberculous patients ... 78 Office tables (factories and workshops) 27 ,, visiting of tuberculous patients ... 77 workers 26 Hot water supply to flats 47 Houses let in lodgings 45 Housing 37 Housing Act 37 & 41 ,, accommodation provided by council 46 ,, accommodation provided by associations 47 ,, action under statutory powers 19 & 45 ,, , five years programme 39 ,, statistics 48 Hydrocyanic acid gas disinfestation 69 Ice cream 52 Improved Tenements Association 47 Improvement areas 39 Increase of Rent and Mortgage Interest (Restrictions) Acts 23 Indecent occupation 43 Infant consultations at infant welfare centres 30 ,, mortality 8 ,, ,, , death rates 9 ,, ,, , causes of deaths 9 ,, ,, , deaths each month 9 ,, ,, , deaths m wards 8 ,, ,, , deaths in quarters 10 Infant welfare centres 30 Infectious diseases 64 Introduction 3 Invermead 31 90 INDEX—continued. page Kensington District Nursing Association 13 „ Housing Trust 47 Labelling of food 57 Lectures, health 17 & 36 Legal proceedings, food and drugs 55 ,, ,, sanitary administration 21 Light treatment at baby clinic and hospital 34 London County Council (General Powers) Act, 1927 24 London County Council (General Powers) Act, 1928 23 London County Council (General Powers) Act, 1932 52 Malaria 67 Marriages 4 Massage 34 Maternity mortality 11 Maternity and child welfare 28 ,, home 31 Measles 68 Medicinal baths 68 Merchandise Marks Acts 53 Midwifery arrangements 31 Milk (bacteriological examination) 12 & 52 Milk and Dairies (Amendment) Act 50 ,, ,, (Consolidation) Act 49 ,, „ Orders 50 Milk (Special Designation) Order 50 Milk supplied in Kensington 49 Mortuary 21 Non-notifiable infectious diseases 68 Notifiable ,, ,, 64 Notifications, age periods, deaths and admissions to hospital table 65 of infectious diseases since 1932 64 „ ,, Births Act 5 ,, „ tuberculosis (age and sex distribution) 72 ,, ., tuberculosis (deaths and death rates) 73 ,, ,, tuberculosis (in wards) 71 Nursing (professional) in the home ... 13 Obstetric work 11 Ophthalmia neonatorum 66 Orthopaedic treatment 34 Outworkers 26 Overcrowding 43 Peabody Donation Fund 47 Pharmacy and Poisons Act 62 Pigeons, nuisances from 24 Pneumonia and influenzal pneumonia 67 Pneumothorax treatment of tuberculous patients 77 Poliomyelitis and polioencephalitis 68 Population 3 Post-natal clinic (borough council) 33 Prevention of infectious disease 64 Princess Beatrice Hospital 14 Princess Louise Hospital 14 Proceedings under Food and Drugs (Adulteration) Act 55 page Proceedings under Housing Act 21 & 48 ,, ,, Public Health Acts (housing) ... 21 & 48 ,, ,, Public Health (London) Act (General) 21 ,, Public Health (London) Act (unsound food) ... 53 Propaganda (health) 17 Public Health (Condensed Milk) Regulations 62 ,, ,, (Dried Milk) Regulations 62 ,, ,, (London) Act notices served 19 & 45 ,, (Meat) Regulations 52 ,, (Prevention of Tuberculosis) Regulations 78 Puerperal fever and pyrexia 67 Queen Charlotte's Hospital ante-natal clinic 31 Rats and Mice (Destruction) Act 24 Reconditioning and repair work 40 Refuse collection and removal 18 Registration of food premises 52 ,, houses let in lodgings 45 Rehousing accommodation 45 & 47 Rent Restrictions Acts 23 Rheumatism in children 15, 67 & 79 ,, supervisory centre ... 15 & 79 Samples, adulterated 54 ,, formal 54 „ informal 54 Sanitary circumstances of the area,, inspection 19 „ notices 19 „ works completed 20 Scarlet fever 65 Schick test 66 School medical service 16 „ treatment centres 15 Sewerage and drainage 18 Shops Act, 1934 63 Slaughterhouses 52 Slaughter of Animals Act 52 Smallpox65 Smoke abatement 21 Southam Street improvement area ... 39 Staff 88 Statistics, summary of 2 ,, vital 3 & 83 Subscriptions to hospitals, voluntary health organisations, etc. 17 & 18 Sutton Dwellings Trust 47 Swimming baths 21 „ bath water, purification of 22 ,, ,, bacteriological examination of 22 Travelling expenses of women breast-feeding infants 36 Treverton Street improvement area 41 Tuberculosis 71 ,, prevention and treatment 74 Tuberculosis register, analysis of 75 Typhoid and paratyphoid fever 66 Underground rooms 43 Unsound food 53 91 INDEX—continued. page Vaccination 15 ,, officer's return 87 Verminous furniture disinfected by HCN 69 ,, persons cleansed 68 ,, premises cleansed 69 Vital statistics 3 & 83 Washhouses 21 & 23 Whooping cough 68 Wilsham Housing Trust 47 Women health officers 29 & 86 Workshops 25 X-ray diagnosis of tuberculosis 76 Zymotic enteritis 67 „ death rate 7 page APPENDIX I. Ninth annual report of the Kensington rheumatism scheme 79 APPENDIX II. Causes of death at different periods of life in 1936 (Table II) 84 Infant mortality during 1936 (Table III) 85 Staff of public health department (Table VI) 88 Vaccination officer's return for 1935 (Table V) 87 Vital statistics for 1936 and five preceding years (Table I) 83 Work of women health officers for 1936 (Table IV) 86