KEN 46 The Royal Borough of Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1937 BY JAMES FENTON, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Jas. Truscott 4 Son, Ltd., Printers, Suffolk Lane, London, E.C.4. SUMMARY OF STATISTICS for the Year 1937. Population (estimated) 175,600 Area of borough in acres 2,291 Density of population per acre 77 Number of marriages 2,104 Rateable value £3,381,594 Product of a Id. rate £14,089 Total. M. F. Live births legitimate 1,893 998 895 Birth rate 12.1 illegitimate 232 117 115 Still births ... ... ... 65 35 30 Rate per 1,000 total births 30 Deaths ... ... ... 2,345 1,036 1,309 Death rate (after adjustment) 12.4 Percentage of total deaths occurring in public institutions 59% Deaths from puerperal causes:— Rate per 1,000 total Deaths (live and still) births. Puerperal sepsis 2 0.9 Other puerperal causes 5 2.3 Total 7 3.2 Death rate of infants under one year of age:— All infants per 1,000 births 83 Deaths from measles (all ages) 1 Legitimate infants per 1,000 legitimate live births 71 „ whooping cough (all ages) 5 Illegitimate infants per 1,000 illegitimate live births 181 „ diarrhœa (under 2 years of age) 42 Deaths from phthisis 114 Phthisis death rate 0.65 Deaths from all forms of tuberculosis 130 Tuberculosis death rate 0.74 Deaths from the zymotic diseases 61 Zymotic death rate 0.35 3 Town Hall, Kensington, W.8. 4th May, 1938. 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 1937 on the state of the public health in Kensington. 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 parts 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 1937 has been estimated by the Registrar-General to be 175,600. 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 175,600 North Kensington 92,300 South Kensington 83,300 Wards. St. Charles 30,100 Golborne 21,600 Norland 20,810 Pembridge 19,790 Holland 18,200 Earl's Court 17,850 Queen's Gate 13,950 Redcliffe 21,100 Brompton 12,200 Marriages. During the year, 2,104 marriages were registered, representing a rate of 12.0 marriages per 1,000 of the population. The place of marriage is set out in the following table:— Church of England 772 Roman Catholic Church 332 Nonconformist Church 37 Jewish Church 10 Register Office 953 Total 2,104 Births. The number of births registered was 2,125, after correction for inward and outward transfers; and the birth rate for the borough was 12.1 per 1,000 population. Distributed according to sex and legitimacy the births were as follows:— Male. Female. Total. Legitimate 998 895 1,893 Illegitimate 117 115 232 Totals 1,115 1,010 2,125 4 Table showing the number of births and the birth rates in England and Wales, London, Kensington, and the various wards in the borough in 1937, and the rates for the previous five years:— District. 1937. Birth rates in previous years. No. of births. Birth rate. 1936 1935 1934 1933 1932 England and Wales 610,850 14.9 14.8 14.7 14.8 14.4 15.3 London 55,011 13.3 13.6 13.3 13.2 13.2 14.2 The Borough 2,125 12.1 12.7 12.4 12.3 12.0 12.9 North Kensington 1,572 17.0 17.1 16.6 16.8 16.1 17.3 South Kensington 538 6.5 7.5 7.2 6.6 6.5 7.7 Wards. St. Charles 566 18.8 17.1 16.7 15.4 18.0 19.5 Golborne 473 21.9 20.5 21.5 23.7 21.9 23.6 Norland 294 14.1 17.0 16.4 16.3 13.6 15.9 Pembridge 239 12.1 13.7 11.2 11.6 10.9 7.7 Holland 172 9.5 8.8 8.6 7.3 5.6 8.2 Earl's Court 121 6.8 6.4 6.6 8.3 7.9 9.6 Queen's Gate 65 4.7 7.6 4.9 5.5 5.5 5.7 Redcliffe 126 5.9 7.6 9.5 6.8 6.3 7.2 Brompton 54 4.4 6.8 4.9 4.0 6.7 7.2 Ward unknown 15 ... ... ... ... ... ... 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 1937 12.1 Notification of Births, Public Health (London) Act, 1936, Section 255.—During the year 2,125 live births to Kensington mothers were registered, and of this number 2,010 or 95 per cent, were notified in accordance with the requirements of the Act. The number of still births notified was 65, and the number of births notified as having occurred in Kensington but belonging to other districts was 437. The following table indicates the source of notification and the kinds of births notified: Source of notification. Number of births notified. Still births. Live births. Total births. Number notified by midwives 21 881 902 ,, ,, ,, parents — 7 7 ,, ,, ,, medical practitioners 3 175 178 ,, „ „ other persons 27 510 537 Births in the borough 51 1,573 1,624 Notified from institutions outside the borough 14 437 451 Totals 65 2,010 2,075 6 Percentage of births in Kensington notified during the past five years:— Year. Percentage. 1932 98 1933 94 1934 93 1935 98 1936 99 1937 95 The importance of securing due compliance with legislation in regard to the notification of births 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 1937 was 2,983, 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 2,983 Deaths of residents in public institutions, etc., beyond the borough 460 3,443 Deaths of non-residents in public institutions, etc., within the borough 1,098 Corrected number of deaths belonging to the borough 2,345 The following table shows the number of deaths and the death rates in England and Wales, London, Kensington and the various wards in the borough in 1937, and the rates for the previous five years:— District. 1937 Death rates in previous years. No. of deaths. Death rate. 1936 1935 1934 1933 1932 1931 England and Wales 509,560 12.4 12.1 11.7 11.8 12.3 12.0 12.3 London 50,081 12.3 12.5 11.4 11.9 12.2 12.3 12.4 The Borough 2,345 13.3 12.5 12.1 13.3 12.9 13.6 14.0 North Kensington 1,196 12.9 12.7 12.0 13.7 12.9 13.8 13.8 South Kensington 1,114 13.3 12.1 11.6 12.3 12.6 12.4 13.3 Wards. St. Charles 295 9.8 10.5 14.3 11.4 10.9 12.7 12.5 Golborne 349 16.2 14.8 13.7 16.4 13.9 16.2 14.1 Norland 280 13.5 14.1 11.9 13.9 14.1 14.1 14.2 Pembridge 272 13.7 12.1 12.5 13.8 13.1 12.4 14.2 Holland 283 15.5 12.5 12.3 14.2 13.3 13.4 14.5 Earl's Court 219 12.3 14.1 13.0 12.3 13.1 13.3 14.1 Queen's Gate 175 12.5 9.9 8.8 11.7 11.5 12.6 10.8 Redcliffe 297 14.1 13.2 12.5 11.7 12.7 11.8 15.2 Brompton 140 11.5 8.9 13.5 11.3 11.1 10.5 11.2 Ward unknown 35 ... ... ... ... ... ... ... The following table shows the Kensington death rates since 1896:— Period. Death rate per 1,000 living. 1896-1900 16.4 1901-1905 14.4 1906-1910 13.8 1911-1915 14.3 1916-1920 15.6 1921-1925 13.2 1926-1930 13.5 1931-1935 13.2 1936 12.5 1937 13.3 6 The corrected death rate of 13.3 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 12.4, which should be used when comparing the death rate of Kensington with that of other districts. 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 61 Epidemic influenza 100 Phthisis 114 Other tuberculous diseases 16 Cancer 344 Bronchitis 55 Pneumonia 169 Heart disease 625 Acute and chronic nephritis 52 Puerperal fever 2 Premature birth, etc. 68 Violence (including suicide 40) 133 Old age 23 All other causes 583 2,345 It will be seen that over one-third of the deaths, or 963, were due to diseases of the heart or the organs of respiration. Phthisis, an infectious and preventable disease, caused 114 deaths. The diseases described in the above list as the "principal zymotic diseases" are smallpox, measles, scarlet fever, diphtheria, whooping cough, enteric fever (including fever not otherwise defined) and diarrhoea. Cancer.—Cancer caused 344 deaths, and of this number 322 occurred in persons over the age of 46 years. Carcinoma was the form of cancer to which 315 deaths were attributed; sarcoma and epithelioma were the assigned causes of 9 deaths; 20 deaths were certified as due to cancer or malignant disease without further definition. The parts of the body which were affected in each case are shown in the following table :— Deaths from Cancer, 1937. Parts affected. Sex. Total. Male. Female. Buccal cavity 12 4 16 Lungs 26 19 45 Digestive organs, peritoneum, etc. 72 102 174 Female genital organs — 39 39 Male genito-urinary organs 15 — 15 Breast — 23 23 Skin — 3 3 Other and unspecified organs 7 22 29 Totals 132 212 344 The deaths in the several wards, etc., are set out in the following table :— The Borough 344 North Kensington 159 South Kensington 185 7 Wards. St. Charles 40 Golborne 47 Norland 27 Pembridge 45 Holland 52 Earl's Court 30 Queen's Gate 28 Redcliffe 53 Brompton 22 The number of deaths from this disease was 23 more than in the previous year Table showing the number of deaths in 1937 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 30 - - _ 66 17 25 11 34 4 February 27 — — — 10 8 27 8 16 3 March 27 — 1 1 4 7 27 5 20 — April 24 1 — 2 1 15 22 6 17 1 May 22 — 1 — 2 7 26 2 10 4 June 19 — — — 2 11 41 1 7 5 July 17 1 1 — — 5 25 1 8 7 August 14 — - — — 2 24 — 7 1 September 11 — 1 — 4 6 25 1 6 5 October 9 — 2 9 23 1 4 1 November 6 __ 4 4 30 2 8 7 December 4 1 1 3 15 21 5 19 2 January 1 — - — 2 8 28 12 13 7 Totals 2 5 4 100 114 344 55 169 47 Infant Mortality. During the year 1937 there were 2,125 births and 177 deaths of infants under the age of one year in the borough, which gives an infant mortality rate of 83 per 1,000 births. The corresponding figure for 1936 was 73. The rise in the death-rate has been caused by an increase in the number of deaths of illegitimate children from 24 (15 per cent. of the total deaths) in 1936 to 42 (24 per cent. of total deaths in 1937). The death-rate among legitimate infants is 71 per 1,000 births in 1937, among illegitimate infants it is 181. 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 1937, and the infant death rates for the previous four years:— District. 1937. Infant mortality rates in previous four years. No. of births. No. of deaths of children under 1 year of age. Infant mortality rate. 1936 1935 1934 1933 England and Wales 610,850 34.917 58 59 57 59 64 London 55,011 3,265 60 66 58 67 59 The Borough 2,125 177 83 73 79 93 72 North Kensington 1,572 129 81 79 89 102 80 South Kensington 538 48 89 59 57 75 59 Wards. St. Charles 566 36 64 64 86 115 53 Golborne 473 47 99 94 100 97 89 Norland 294 21 71 104 102 111 117 Pembridge 239 25 105 52 54 73 67 Holland 172 16* 93 62 88 133 85 Earl's Court 121 9 74 103 42 40 55 Queen's Gate 65 4 62 9 29 51 37 Redcliffe 126 17 135 74 69 69 65 Brompton 54 2 37 24 — 40 23 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 52. 8 Infant Mortality Rates, 1896-1937. 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 1937 58 60 83 The number of deaths of Kensington infants occurring in each month during 1937. January 20 February 13 March 21 April 8 May 15 June 15 July 14 August 12 September 9 October 14 November 8 December 28 Causes of, and ages at, deaths of infants under one year of age in Kensington during 1937. Causes of death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total 4 weeks 1—3 months. 3—6 months 6—9 months. 9—12 months. Total infant deaths under 1 year. Common infectious diseases (Chicken Pox 1) (Whooping cough 4) — — — — — 2 1 1 1 5 Pneumonia, bronchitis and other respiratory diseases 1 2 — 1 4 10 17 12 7 50 Diarrhoea — 1 — — 1 12 19 5 2 39 Complications of birth (Atelectasis 6) 8 — — — 8 — — — — 8 (Other complications 2) Congenital malformation 8 2 — 1 11 1 — — — 12 Premature birth 24 3 — 2 29 5 2 — — 36 Atrophy, debility and marasmus — — — — — 3 3 2 — 8 Other diseases:— (Violence 1) 2 1 1 — 4 4 6 3 2 19 (Pyloric stenosis 1) (Meningitis 1) (Influenza 2) (Other conditions 14) ) Totals 43 9 1 4 57 37 48 23 12 177 Death rate in each age period per 1,000 births 20.2 4.2 0.5 1.9 26.8 17.4 22.5 10.9 5.7 83.3 Percentage of total infant deaths occurring in each age period 24.3 5.1 0.6 2.3 32.3 20.9 27.1 14.0 6.7 — 9 Deaths in Quarters of the Year. Disease. 1st. 2nd. 3rd. 4th. Total. Chicken pox — — — 1 1 Whooping cough 1 1 1 1 4 Influenza — — — 2 2 Bronchitis and pneumonia 23 9 4 14 50 Diarrhoea 1 11 8 13 39 Congenital debility, premature birth, malformation and birth injury 18 9 16 13 56 Marasmus 2 2 2 2 8 Other diseases 3 6 4 4 17 54 38 35 50 177 The death-rate among infants during the first month of life (neo-natal period) has risen from 28-2 per cent, of total deaths in 1936 to 32-3 per cent, in 1937. The most frequent cause of death in this group is prematurity, and a large proportion of the infants were illegitimate. Several factors contribute to the high mortality rate among illegitimate infants ; they are concealed pregnancy and lack of ante-natal supervision, the frequency with which attempts to procure abortion are made, and the fact that the mother often works until late in pregnancy and recommences work shortly after confinement which necessitates weaning of the infant. In the group of deaths between one and 12 months, diseases of the respiratory tract (pneumonia and bronchitis) have increased, this being partly due to the influenza epidemic during the early months of the year. The number of deaths from enteritis has remained stationary. The council have continued to direct special attention to the subject and a second intensive educational and publicity campaign was held during the summer months. The existing scheme for treatment of cases of diarrhoea by the district nurses under the direction of Dr. Ronald Carter has continued successfully during the year. Investigations are being made by the council's bacteriologist to increase knowledge of the pathology of the disease. It is noteworthy that in the investigation of all infant deaths from enteritis during the last two years only four babies were found to be wholly breast-fed at the onset of the illness. This emphasises the danger of artificial feeding in an unsatisfactory home environment, and propaganda is constantly directed by the council's staff to influence public opinion on this point. The preventive aspect of medicine is stressed at the sessions held at the welfare centres by the council's medical officers, and this teaching is carried into the homes by the health visiting staff. A special watch is kept for the early signs of rickets or anaemia in the infant and toddler, and the child prone to catarrh receives special attention. The importance of diet, hygiene, proper clothing and fresh air are constantly taught. In regard to the curative side of medicine, 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 practitioners ; a close co-operation also exists between the welfare centres and the baby hospital, the Princess Louise hospital and other children's hospitals serving the borough. The baby clinic, with its auxiliary treatment clinic in Kenley Street, provides advice and treatment for dietetic and allied disorders and treatment of minor ailments for the children of necessitous parents who are referred here from the welfare centres ; massage, artificial sunlight and dental treatment are also given. The number of individual children attending the Kensington infant welfare centres for supervision has increased from 4,803 in 1936 to 4,985 in 1937. Twenty-one infant consultation sessions are held each week by the council's whole-time medical officers who have special experience in the feeding and care of infants and toddlers. Frequent and regular home visiting is carried out by the health visitors. 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. The baby hospital and a children's hospital are situated in the borough. Convalescent homes are available for delicate children. The health services provided by the council are adequate and comprehensive. The principal difficulty in the reduction of the infant death-rate lies in the migrant character of many very poor people who come to live in the north of the borough. The large number of tenement rooms available in the neighbourhood attracts families with insufficient means to rent a small house or flat ; their poverty causes them constantly to move their lodging and makes it difficult for the council's officers to exert a lasting educational influence. 10 Maternal Mortality. There was an unfortunate rise in the maternal mortality rate for the borough from 0.9 per 1,000 in 1936 to 3.3 per 1,000 in 1937, seven women having lost their lives as a result of pregnancy and childbirth during the year. The rate for England and Wales was 3.2. Three of the Kensington deaths occurred among the class who normally seek attention at welfare centres, and four belonged to the well-to-do class. Of the three deaths of women belonging to the class for which provision is made by the council's services, one followed a septic abortion in a widow; the fear of social stigma in this case had caused the patient to conceal her condition and subsequently had prevented her from consenting to admission to hospital until she was dangerously ill. The second case was a woman who had received very careful ante-natal supervision on account of poor health which had occasioned much anxiety to the council's officers ; the mother herself had expressed the conviction that she would not survive the confinement. As a result of the care received during pregnancy the woman's physical health and mental attitude greatly improved, and the labour was normal, the patient saying that she had made a better recovery than she had from her previous confinements. It was arranged that she should receive advice on contraception, and the apparently safe issue of this case was a subject for congratulation when the patient developed an inflamed varicose vein and died suddenly and unexpectedly from an embolism, a month after labour. The third death was from toxaemia of pregnancy and occurred in Yorkshire. This woman had lived in Kensington after she married and had subsequently lived with her mother in the north ; although the death was referred to Kensington the responsibility for her confinement did not rest on the council's services. Both the maternal deaths which occurred in 1936 were above-standard patients and the number of maternal deaths among the well-to-do during 1937 is remarkable when one considers the relatively smaller number of births belonging to this class. The number of deaths among the mothers for whom provision is made by the council was three in about 1,700 births, giving a maternal death rate of 1.8 per 1,000, which is probably near the irreducible minimum, but among the well-to-do class there were 4 deaths in about 400 births, giving a rate of 10 per 1,000. Three of the four deaths were due to toxaemia of pregnancy. An unusually high proportion of pre-eclamptic toxaemia was seen in the council's ante-natal clinics during 1937, and in several cases prompt treatment was necessary in order to save the woman's life. The cause of the condition is still obscure but there seems little to uphold the view that it is a deficiency disease, and the evidence appears to support the old-established theory that it is the mothers on more liberal incomes and diets who are principally affected. Of recent years there has been so little pregnancy toxaemia in the borough that the following figures for 1937, as seen in the ante-natal case records, may be of interest. Forty cases of preeclamptic toxaemia were encountered; fourteen additional cases showed a rise of blood pressure during their pregnancy but although kept under careful supervision did not develop the symptoms or signs of toxaemia and so have not been included in this series. Of the forty cases twenty-four were successfully treated by dietetic measures at home; sixteen were more severe cases and were admitted to hospital for treatment. Of these sixteen cases seven needed an operation for the induction of premature labour on account of the kidney condition; three of the seven infants were stillborn but every mother recovered. One woman, in whose case labour was not artificially induced, had an eclamptic convulsion during labour, but both mother and child eventually did well. The onset of the toxaemic condition was almost invariably heralded by a preliminary rise in the patient's blood pressure before other signs appeared. The necessity for frequent estimations of the blood pressure during the last two months of the pregnancy is urgent since toxaemia is one of the main causes of maternal mortality, and it is of the utmost importance that when midwives are unable to carrv out this test themselves they should refer their patients to an ante-natal clinic. It is satisfactory to report that the midwives employed by the London county council are likely to work in close connection with the clinics and will encourage their patients to make use of the safeguards for their life and health provided by the council's services. Apart from the incidence of toxaemia the routine organisation of the ante-natal clinics has worked smoothly and uneventfully throughout the year. Ante-natal work has become an exact science and the confidence which experience has given to the medical staff when all tests are found normal is imparted to the expectant mother. The importance of this feeling of confidence on her part is difficult to over-estimate. Many of the difficult confinements are not physical but psychological in origin, and it is surprising to note how many labours are rapid and easy when the woman's mind is at rest regarding the normality of her case. Routine Wassermann and Kahn tests carried out in the clinics show a percentage of 1.8 positive cases during 1937 (17 out of 934 tests performed) compared with 2.2 per cent. in 1936. Treatment was arranged for every expectant mother who gave a positive test, and the kind co-operation and assistance of the staff of the special department of the West London hospital has ensured that this treatment is given with the least possible inconvenience and the greatest consideration of the feelings of the mother. One may hope that when this line of treatment becomes general throughout the country it may result in the disappearance of congenital syphilis. A confidential enquiry into the incidence and causation of abortion in the borough was made during the early part of the year, and the report upon this subject (the information in which is being treated as strictly confidential) has been sent for the consideration of the Inter-departmental Committee on Abortion, who invited the medical officer of health and the senior medical officer in the maternity and child welfare department to give evidence before them. 11 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Staff of the Council's Public Health Department. A list of the total staff engaged in the public health department at the end of 1937 will be found in Appendix II, Table V. Bacteriological Work. The council's bacteriological work is carried out at the laboratory at the Princess Louise hospital. The bacteriologist is Dr. Bessie Cadness, who is a part-time officer of the council. She also gives service to the Princess Louise hospital and to another London hospital. The work performed during 1937 was as follows:- Disease suspected. Examinations. Positive. Diphtheria 1,669 22 Scarlet fever 7 2 Tuberculosis 715 79 Typhoid fever. Blood 10 1 ,, Urine 16 — ,, Fæces 99 — ,, Post-mortem material 3 — Paratyphoid 16 — Dysentery (Sonne). Faeces 267 32 Morgan's bacillus 1 1 Gonorrhæa 2 — Syphilis. W.R 1 — Vincent's angina 11 — Ringworm 1 — Meningococcus. Throat 5 — The following examinations were also carried out:- Milk, general test 71 — ,, for tubercle bacilli 21 1 ,, for streptococci 5 5 ,, for dysentery and typhoid 5 — Complete blood count 1 — Urine, complete examination 3 — Test for occult blood 2 — Virulence tests 2 2 Water from public swimming baths 29 — Miscellaneous 9 6 Child Life Protection. At the end of the year there were in the borough 122 foster-mothers, and they had the care of 131 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-six of the foster-children are under the age of five years, and all but twelve, who are seen regularly by private doctors, are in regular attendance at infant welfare centres. The following is a record of the work carried out by the child life protection visitor:— Visits paid to homes 1,361 Special visits paid 219 Children removed voluntarily 161 ,, „ compulsorily — ,, ,, to hospital 20 Deaths reported 3 Cases in which there was cause for complaint 3 Cases recommended for prosecution 1 Foster-mothers added to register 40 ,, ,, removed from register 42 „ ,, on register on 1st January 124 „ „ „ „ 31st December 122 Foster-children ,, ,, „ „ 131 From the above table it will be seen that in three cases there was cause for complaint. Each of these was carefully considered by the maternity and child welfare committee, and in only one case did they recommend proceedings to be taken. Having regard to the conflicting nature of the evidence, it was decided at a later date to withdraw the prosecution. 12 Professional Nursing in the Home. As in past years, the Kensington District Nursing Association continued to carry out professional nursing in the homes of the poor. The number of cases nursed during 1937 was 1,941 and the number of visits paid was 46,646. 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, 1937:— Cases. Visits. Maternity cases 48 934 Miscarriages 16 211 Pneumonia (5 years of age and over) 34 436 ,, (under 5 years of age) 25 456 Ophthalmia neonatorum and other inflammations of the eyes of newly-born children 10 193 Influenza (5 years of age and over) 55 593 „ (under 5 years of age) 3 47 Enteritis and diarrhœa 139 1,408 Tuberculosis (5 years of age and over) 13 1,595 Measles (5 years of age and over) 2 27 ,, (under 5 years of age) 5 39 ,, and pneumonia (5 years of age and over) 34 436 „ ,, (under 5 years of age) 25 456 Whooping cough (5 years of age and over) — — ,, „ (under 5 years of age) 7 168 Chicken-pox (5 years of age and over) — — ,, (under 5 years of age) 1 15 Acute rheumatism 10 178 Puerperal pyrexia 1 4 Scarlet fever 1 3 Pemphigus 2 32 Totals 431 7,231 For the services rendered, the council paid to the association in 1937 a grant of £325. The Princess Beatrice Hospital. The present accommodation is 81 beds. The hospital when completed will provide an additional 49 beds, making a total of 130 beds, a nurses' home, a post-mortem and pathological department, administration offices, etc. The work performed at the hospital during 1937 was as follows:— In-patients. (а) General wards 1,314 (b) Private wards 294 Out-patients. Total number of new out-patients 12,885 ,, ,, ,, out-patients' attendances 62,991 Number of casualties 5,732 Other treatments. Number of operations—major 1,036 minor 833—1,869 Dental cases 2,188 Massage 4,901 Light treatments 1,051 Superficial therapy 1,067 Patients X-rayed 2,601 Ante-natal clinic and maternity ward. Total number of attendances 1,641 Number of patients admitted to maternity ward 318 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 75 beds. The hospital is a recognised training school for nurses. There are X-ray, dental, ophthalmic and massage departments and a fully equipped operating theatre. 13 The beds are allocated as follows:— General medical 35 Skin 1 General surgical 19 Observation ward 4 Ear, nose and throat 8 Private ward 2 Rheumatism 4 Nursing mothers' ward 1 Eye 1 75 Total The following are figures of work done during 1937. (a) In-patients. Total number of available beds on 31st December, 1937 75 Average number of available beds during year 70.90 „ „ ,, patients resident daily throughout year 56.60 Number of in-patients in the hospital at beginning of year 58 „ „ ,, admitted during year 1,503 „ ,, ,, in the hospital at end of year 54 Total number of in-patients 1,561 Average number of days each patient was resident 13.70 Number of patients admitted and discharged during year who were resident for (i) only 1 day 26 (ii) 2 and 3 days 571 (b) Out-patients. Total number of new out-patients 5,692 Total number of out-patients' attendances 38,719 Number of casualty patients among new out-patients 1,747 Rheumatism Supervisory Centre. The record of work carried out at the centre during 1937 is as follows:— Number of sessions held 48 Number of individual patients examined— Kensington 288 Hammersmith 36 Acton 29 Other boroughs 21 Total attendances of patients— Kensington 924 Hammersmith 157 Acton 114 Other boroughs 61 The average attendance per session of Kensington patients was 19.2. 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 1937 was as follows:— New cases. Total attendances. Eyes 310 831 Aural 209 388 Minor ailments 1,495 18,120 Dental 1,176 2,068 A school treatment centre has also been conducted at the baby clinic premises in Tavistock Road, and the record of work for 1937 is as follows:— New cases. Total attendances. Minor ailments 2,373 21,114 Dental 1,800 4,355 Light treatment 91 900 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 1937 are as follows:— Cases. Tonsils and adenoids 282 Eyes 376 Dental 413 X-ray 1 14 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 1937 in Kensington. Table showing number examined and defects found. Number examined Boys. Girls. Entrants. 824 Age 7. 580 Age 11. 544 Age 14. 699 Entrants. 801 Age 7. 592 Age 11. 569 Age 14. 699 Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Cases. * Malnutrition 7 6 12 6 6 4 4 2 8 5 9 7 4 1 2 — Skin disease 12 9 2 1 6 5 6 4 7 5 6 5 6 4 9 3 Defective teeth — 314 — 209 — 180 — 260 — 319 196 — 175 — 266 Enlarged tonsils 88 7 41 8 20 ' 22 1 85 12 52 11 23 6 21 6 Adenoids 7 5 2 1 2 2 1 — 5 2 4 2 1 1 1 1 Enlarged tonsils and adenoids 28 15 13 10 7 7 4 2 26 17 13 13 2 1 4 3 Other nose and throat defects 5 2 7 3 4 1 5 1 4 1 6 2 2 — 1 — Enlarged glands 86 1 81 4 47 1 48 — 67 2 75 5 42 1 32 1 Eye disease 34 22 15 5 13 4 10 4 26 15 12 4 13 9 10 4 Vision defects — — — 24 — 40 — 56 — — — 31 — 47 — 55 Otorrhoea 8 1 6 1 4 1 3 2 8 5 3 2 6 2 7 6 Other ear disease 5 — — — — — — — 5 1 3 2 2 2 2 — Defective hearing 5 2 4 — 3 1 9 1 1 — 1 6 2 6 3 Speech defects 6 2 4 2 2 1 3 — — — 3 1 2 1 1 — Heart defects 20 — 17 2 11 1 16 1 16 — 11 — 9 — 14 1 Anaemia 7 1 11 4 6 1 13 2 6 2 10 1 7 — 7 2 Lung defects 27 3 11 5 3 — 5 2 21 4 14 3 1 — 1 1 Nervous defects 9 4 5 2 4 1 2 — 3 — 3 — 5 1 — — Phthisis — — 1 — 1 — — — — — — — 1 — — — Other T.B. disease — — — — — — 2 1 1 — — — 1 — — — Rickets 11 1 11 2 4 — 7 — 8 1 3 — 1 — 4 — Spinal deformities 2 — 1 — 7 5 12 7 1 — 5 1 11 10 11 8 Other deformities 13 2 8 2 13 6 19 2 9 1 14 3 15 1 22 2 Other defects 21 8 19 11 17 12 8 3 18 9 18 10 25 10 21 5 Number of children noted for treatment 367 254 238 323 364 256 244 323 * 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. 824 263 558 3 193 599 32 — 821 1 2 822 2 — 462 269 93 — — — Girls 801 297 501 3 197 574 30 — 791 4 6 798 3 — 424 267 110 — — — Age 7. Boys 580 142 438 — 104 437 39 — 580 — — 580 — — 339 209 32 337 191 41 Girls 592 157 431 4 127 433 32 — 588 4 — 592 — — 379 168 45 359 163 62 Age 11. Boys 544 145 396 3 121 396 27 — 544 — — 543 1 — 351 174 19 353 123 65 Girls 569 152 417 — 107 432 30 — 568 1 — 568 1 — 386 171 12 349 131 87 Age 14. Boys 699 183 511 5 148 510 41 — 697 2 — 698 1 — 433 248 18 484 109 101 Girls 699 283 413 3 200 484 15 — 691 4 4 695 3 1 425 263 11 462 129 105 Total 5,308 1,622 3,665 21 1,197 3,865 246 — 5,280 16 12 5,296 11 1 3,199 1,769 340 2,344 846 461 Percentage 30.6 69.0 0.4 22.6 72.8 4.6 99.5 0.3 0.2 99.8 0.2 0.0 60.3 33.3 6.4 64.2 23.2 12.6 London 55.6 44.1 0.3 16.5 77.4 6.1 97.6 2.1 0.3 99.1 0.9 0.0 70.2 26.3 3.5 67.6 19.0 13.4 15 Vaccination. There were 2,399 births in 1936 reported to the vaccination officer by the Kensington Registrars. By the 31st December, 1937, 61.07 per cent. of these had been vaccinated or were insusceptible to vaccination. The other 39.83 per cent, are accounted for as follows:— Statutory declarations of objection 14.34 per cent. Died before vaccination 5.34 „ Referred to other districts 10.88 „ Removed, leaving no trace 7.87 „ Postponed or unaccounted for 0.50 ,, (In addition, by the 31st December, 1937, 226 certificates of successful vaccination had been received in respect of children living in Kensington who were born outside the borough during 1936.) 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 extremely satisfactory. Only 14.84 per cent. of the children born in Kensington in 1936 remained in the borough unvaccinated. Whilst this high percentage of vaccinations is maintained Kensington is reasonably safe from smallpox. Health Propaganda. A programme of health propaganda was conducted by the council's health lecturer throughout the year at the infant welfare institutions. She also lectured to girls' and women's clubs and similar organisations, and at the Princess Louise hospital. In addition to the lectures, educational films were shown at the welfare centres. The "Cinemotor" of the Health and Cleanliness Council visited the poorer districts of the borough during June and health films were shown to about 6,000 people who evinced great interest. The propaganda campaign initiated by the council in 1936 as a means of decreasing the infantile mortality from enteritis was repeated during the summer of 1937. Lectures were given on the protection of food, films were shown dealing with the fly nuisance, and posters and leaflets were distributed throughout the borough. In addition to the above, posters displaying the council's health services have been exhibited 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 Kensington Church Street and the Fox and Lancaster Road elementary schools. It has been arranged for leaflets dealing with the health services to be distributed from the post offices in the borough. The monthly periodical "Better Health" published by the Central Council for Health Education has been given to the mothers at the welfare centres, and left during the home visits of the health visitors. The latter also distribute the booklet "Advice to Mothers" which deals with domestic and personal hygiene and other matters of importance to the young mother. An important and unique event during 1937 was the National Health Campaign, which was opened by a wireless address to the nation by the Prime Minister on the 30th September. This campaign was designed to arouse public interest in the health services of local authorities, and the slogan "Use your Health Services" was introduced for this purpose. All committees of the Kensington borough council accorded their support to the campaign, and every effort was made to ensure its success in the borough. Arrangements were made for large and small posters to be displayed throughout the borough on hoardings and public buildings, and in welfare centres, shops, etc. Attractive leaflets were distributed to the public and appropriately worded bookmarks were given out with all books from the public and private libraries. An outstanding contribution to the campaign was a health exhibition which was held at the premises of Messrs. Derry and Toms, from the 9th to 20th November. It was organised by the Central Council for Health Education in co-operation with the borough council, and was opened by His Worship the Mayor of Kensington, Sir Allan Powell, C.B.E. The exhibition comprised the following stands of local interest:—Public Health Department, Borough Engineer's Department, Kensington Housing Trust, District Nursing Association and British Red Cross Society (Kensington Branch). In addition, there were the following twelve stands of national appeal:—Youth Hostels Association, National Smoke Abatement Society, Eugenics Society, Hospital Savings Association, 16 British Social Hygiene Council, Metropolitan Water Board, Dental Board of the United Kingdom, National Association for the Prevention of Tuberculosis, British Empire Cancer Campaign, Health and Cleanliness Council, National Council for Maternity and Child Welfare and the King's Fund Miniature Hospital. The public health department's stand illustrated many interesting features of the work carried out in Kensington, particularly maternity and child welfare, diphtheria immunisation, disinfestation and disinfection, prevention of acute rheumatism, protection of public food supplies and the administration of the sanitary services. The borough engineer's stand demonstrated the work of his department in connection with street cleansing, street lighting, road surfacing, scavenging, etc. The council's activities, both on the stands of the public health department and of the borough engineer, were fully illustrated by means of interesting models, diagrams and pictures. The exhibition was open from 10 a.m. until 6 p.m. each weekday, and from 10 a.m. until 1 p.m. on Saturdays. Film shows depicting a variety of health subjects proved a great attraction ; classes and demonstrations of the Women's League of Health and Beauty were well attended ; and the Pageantry of Dancing arranged by the Mayfair School of Dancing proved a very popular item. Special lectures on health matters were given by the medical officer of health, the deputy medical officer of health and Dr. Violet Russell. Senior scholars (boys and girls) from the elementary and secondary schools in the borough visited the exhibition in the mornings accompanied by their teachers, and received short lectures at various stands. Mothers from the infant welfare centres were taken in conducted parties, and in some cases the voluntary committees provided coaches and private cars. Parties of students were sent from a number of institutions in and around the borough. The attendance exceeded 10,000. Her Royal Highness, The Princess Louise, Duchess of Argyll, visited the exhibition on Tuesday, 16th November. She was received by His Worship the Mayor, and was much interested in the various exhibits. The health exhibition with its subsidiary attractions, combined with a very interesting air raid precautions exhibition, held in the Town Hall during the first week (November 8th to 13th), had the effect of arousing a considerable amount of interest in regard to many of the council's activities. The result cannot be otherwise than good. It is proposed to repeat the exhibition in the northern part of the borough during 1938. A further item of importance was the publication by the council during the year of a health handbook. This handbook contains valuable information relating to the council's public health, maternity and child welfare, and other services, and particulars of the many voluntary hospitals and societies working in and around the borough. Forty thousand copies were printed and distributed to householders in Kensington. Subscriptions by the Borough Council to Voluntary Health Organisations during 1937. Subscriptions to Hospitals, etc. £ s. d. £ s. d. British Red Cross Society 20 0 0 National Hospital for Diseases of the Heart 5 5 0 Cancer Hospital 5 5 0 Central Council for Health Education 10 10 0 Paddington Green Children's Hospital 5 5 0 Charity Organisation Society 5 0 0 Princess Beatrice Hospital 10 10 0 Chelsea Hospital for Women 5 5 0 Princess Louise Hospital (Rheumatism Supervisory Centre) 300 0 0 Invalid Children's Aid Association 40 0 0 Kensal Gospel and Medical Mission 5 5 0 St. Mary's Hospital 10 10 0 *West London Hospital 10 10 0 Kensington District Nursing Association 5 5 0 Western Ophthalmic Hospital 5 5 0 * An additional grant of £10 10s. Od. was made to this hospital during the year, it being understood that this grant would be a non-recurring one. 17 Payments to Maternity and Child Welfare Institutions. £ s. d. £ s. d. Bramley Road Infant Welfare Centre 360 0 0 Aston Clinton Convalescent Home 9 17 0 Golborne Infant Welfare Centre 530 0 0 Evelyn Convalescent Home 16 16 0 Lancaster Road Infant Welfare Centre 650 0 0 Hambledon Convalescent Home 8 8 0 Wayside Cottage Convalescent Home 53 4 0 South Kensington Infant Welfare Centre 402 0 0 Zachary Merton Convalescent Home 75 0 0 Golborne Day Nursery 197 0 0 Lancaster Road Day Nursery 334 0 0 Association of Infant Welfare and Maternity Centres 8 8 0 St. Clement's Day Nursery 491 0 0 Kensington District Nursing Association 325 0 0 Notting Hill Day Nursery 442 0 0 Baby Hospital 1,650 0 0 Kensington Rescue Association 20 0 0 Princess Louise Hospital 400 0 0 Mutual Registration of Assistance Society 10 0 0 Queen Charlotte's Hospital AnteNatal Clinic 45 0 0 North Kensington Women's Welfare Centre (Gynaecological and Birth Control Clinics) 100 0 0 Queen Charlotte's Hospital (Maternity Home) 1,238 8 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 6,477. The use 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 191. Refuse Removal from Mewsways. Portable containers have been substituted for common dustbins for the storage of house refuse where there are dwellings, stables, and costermongers' stores, and these are proving satisfactory both from a storage and collection point of view. Sewerage and Drainage. Every house in the borough is connected with the water carriage system for the disposal of sewage, and, generally speaking, house drainage in Kensington is very satisfactory. The following table deals with (a) drainage work undertaken voluntarily by owners and supervised by the officers of the public health department, and (b) all drainage work required by notices served under the Public Health (London) Act, and carried out under the supervision of the sanitary inspectors:— Voluntary work. Work under notice. Plans submitted 337 41 Plans approved by the council 337 41 Total reconstruction of drains of premises 97 43 Partial reconstruction of drains of premises 209 65 Repairs to drains by "Economic" method 15 32 Other sanitary works, such as new soil pipes, bath, sinks and lavatory basins 3,816 1,835 18 Sanitary Inspection. The following table shows a summary of the inspections, etc., carried out by the district and housing inspectors during the year:— DESCRIPTION OF WORK. DISTRICT INSPECTORS. Housing Inspectors. Total. 1 2 3 4 5 6 7 Total complaints received 366 468 261 247 236 125 302 226 2,231 Public Health (London) Act, 1936. Complaints received 277 243 255 222 215 125 271 84 1,692 Houses inspected on complaint 277 246 270 222 215 125 271 84 1,710 „ after infectious disease 355 458 118 76 67 65 66 — 1,205 Re-inspections 677 179 1,473 1,425 1,950 686 1,691 155 8,236 By-laws re houses let in lodgings. Complaints received 89 225 6 25 21 — 31 142 539 Houses inspected on complaint 89 225 6 25 21 — 31 142 539 First annual inspection (furnished houses) — — 1 3 — — — — 4 First annual inspection (unfurnished houses) 102 150 96 23 28 — 7 51 457 Re-inspections do. do. 172 683 304 13 42 — 23 178 1,415 Housing Acts. Initial inspections (including preparation or revision of house-tohouse card) 85 82 64 90 106 80 72 278 857 Re-inspections 155 18 34 24 10 30 94 5168 5,533 Underground living rooms. Primary inspections 66 169 40 25 22 — 134 540 996 Re-inspections 82 83 50 64 125 — 172 8253 8,829 Drainage. Applications made 45 66 60 83 184 131 212 39 820 Plans submitted 17 25 20 25 94 68 122 7 378 House drains tested and inspected 47 130 36 49 112 71 141 81 667 Inspections of mews 70 357 5 229 110 170 — 1 942 *„ common lodging houses — — 66 — — — — — 66 †Smoke observations 1 3 — — — — — — 4 Other inspections 616 562 612 455 242 454 446 865 4,252 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 Inspectors. Total 1 2 3 4 5 6 7 Notices issued. Public Health (London) Act, 1936. Intimation notices 242 238 193 70 86 54 109 262 1,254 Statutory notices 26 12 14 3 17 5 11 80 168 Final notices 11 3 2 1 6 2 1 14 40 Summonses issued — — — — 1 — — . 1 Housing Act, 1936. Sect. 9 (Repairs) — — — — — — — 177 177 Sect. 157 (Entry) — — — — — — — 714 714 Removal of manure — — — — 1 — — — 1 Smoke nuisance orders — — — — — — — — — Rent Restrictions Act certificates — 1 — — — — — — 1 Other notices 3 33 3 — — — 1 9 49 Report of waste of water to M.W.B. 13 23 3 10 6 — — 15 70 „ dangerous structures to L.C.C 11 24 7 — 3 — — 9 54 * The common lodging houses for women are inspected by one of the council's women health officers and during the year 1937, eighty inspections were made. † Fifteen smoke observations were made by the inspectors responsible for factories and workshops. 19 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 4 25 19 26 16 23 25 2 140 ,, ,, additions to 15 34 25 15 22 39 46 19 215 Defective drains repaired 1 9 17 14 14 30 23 8 116 House drains cleansed 18 22 12 10 9 15 4 18 108 Water-closets reconstructed 26 53 38 29 54 68 94 13 375 „ repaired 10 13 4 8 14 19 14 98 180 „ new provided 9 11 25 72 108 63 202 13 503 „ supplied with water 9 11 25 72 108 63 202 13 503 Soil pipes ventilated, repaired, etc. 6 15 7 22 29 43 67 3 192 ,, new provided 11 20 23 14 43 24 38 21 194 Ventilating pipes, new provided 6 15 24 18 26 37 16 10 152 Baths, new provided 8 2 37 82 158 163 284 7 761 Sinks, „ „ 23 97 31 43 68 50 64 134 510 Bidets, ,, ,, 4 — 3 5 23 13 11 — 59 Lavatory basins, new provided 15 — 50 198 455 320 512 — 1,550 Waste pipes „ „ 16 79 60 151 157 26 96 119 704 Cisterns cleansed 1 1 7 2 9 5 15 22 62 „ covered 3 4 1 — 5 — 15 9 37 „ abolished — 7 2 — 1 — 1 4 15 Taps fixed on rising main — 64 19 — 5 1 9 149 247 Yards, areas paved, drained, repaired 10 25 35 13 34 13 10 116 256 Dustbins provided 20 17 65 15 79 15 2 51 264 Ashpits abolished 1 2 — 1 2 1 — 7 14 Accumulations of filth, etc., removed 4 31 41 15 15 11 1 118 236 Animals removed — — — — — 1 — 3 4 Overcrowding abated — 1 — — 1 — — 1 3 Indecent occupation abated — — — — — — — 2 2 Underground rooms, illegal occupation discontinued — — — — 1 — 1 9 11 Roofs repaired 20 44 91 24 11 6 4 214 414 Houses provided with water above basement floor — 24 4 1 1 2 — 54 86 Dampness in dwellings remedied 20 22 146 13 10 — 2 156 369 Ventilated food cupboards provided 1 38 — — — — — 139 178 Artificial lighting of staircases provided — 4 — — — — — 19 23 Closing Orders made under Housing Acts— — — — — — — — — — (a) Houses — — — — — — — — — (b) Parts of houses — — — — — — — 202 202 (c) Underground rooms (included in (b) above) — — — — — — — 378 378 Closing Orders determined — — — — — — — 32 32 Repairs of houses completed under the Housing Acts — — — — — — — 147 147 Infectious disease cases removed 240 238 89 59 66 43 42 — 777 Houses disinfected after infectious diseases (including bedding, clothing, etc.) 328 256 95 65 107 45 43 — 939 Rooms in such houses disinfected after infectious disease 338 268 138 78 119 59 53 — 1,053 Houses cleansed under houses let in lodgings by-law 47 39 25 16 9 — 5 60 201 Cleansing of houses not on register 1 1 21 2 6 — 2 5 38 *Verminous houses cleansed (including bedding, clothing, etc.) 50 91 63 18 37 — 2 50 311 *Verminous rooms cleansed in such houses 99 158 86 68 46 — 2 126 585 Dirty bedding cleansed 1 34 21 2 28 — 3 — 89 „ „ destroyed 4 12 1 — 9 — — 1 27 Other sanitary works executed 54 85 12 46 30 — 1 80 308 *These cleansings do not include those which appear on page 59 under the heading of Disinfestation—treatment of verminous dwellings and treatment of slight infestations. 20 Summary of Legal Proceedings taken in 1937. Offence. No. of summonses Magistrate's decision. Allowing dog to deposit its excrement on the public footway. 46 Fines totalling £20 7s. 6d. were imposed in 44 cases; summons dismissed in 2 cases. Breach of by-laws of London county council with respect to the removal of offensive matter. 13 Fines totalling £6 10s. were imposed in 10 cases; summons dismissed in 2 cases; summons dismissed under Probation of Offenders Act, 1907, in one case. Failure to deposit plans in respect of drainage work. 2 Fined £2 in one case; summons dismissed in one case—plans deposited before hearing. Failure to abate nuisance 2 One summons dismissed under Probation of Offenders Act, 1907, on payment of £1 1s. costs; one summons withdrawn—nuisance abated. Smoke Abatement. During the year nineteen special observations were made with a view to ascertaining whether there were any breaches of the smoke provisions of the Public Health Act. No nuisances were discovered which necessitated the service of written intimation notices, although in three cases owners and stokers were advised to adopt better methods of stoking, and burn a more suitable grade of fuel. Mortuary and Chapel of Rest. During the year 128 bodies were deposited in the public mortuary in the following circumstances:— At the request of relations or friends of the deceased 9 At the request of undertakers 35 At the request of coroner 79 By the police 5 128 In 79 cases post-mortem examinations were made under the coroner's warrant. Eighteen 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. The number of bodies deposited during 1937 was only half that for the previous year, and it is to be regretted that more use is not made of the facilities provided. Public Baths and Washhouses. 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 bath with a capacity of 40,000 gallons, (c) a men's second-class bath and (d) a women's second-class bath, each with a capacity of 45,000 gallons. During the summer season (April to September) the four baths were in continuous use. At the end of September the two first-class baths were emptied and cleaned. At the end of October the two second-class baths were emptied and cleaned, the women's second-class bath only being refilled for use during the winter season. Purification of Swimming-bath Water.—The water of the swimming baths is subjected to continuous filtration and chlorination. This has been found to be a satisfactory method of purification if the free chlorine content of the water is kept at about 0.4 parts per million. Although complaints by swimmers as to ill effects of chlorine are rare, an attempt was made towards the end of the year to lower the chlorine content, but as results were not satisfactory from the bacteriological point of view, the previous level is now being maintained. 21 Numbers of Persons using the Swimming Baths.—The number of persons using the baths during 1937 was 131,728 ; this represents an increase of 4,137 over the figure for 1936:— Men 38,111 Women 29,259 L.C.C. Schools— Boys 33,221 Girls 31,137 131,728 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 21 samples being examined. A further twelve samples were taken from the two second-class baths during the winter season. The samples were collected in sterile screw-capped bottles which were filled by a swimmer at the position in the bath indicated in the following table. The samples were obtained from about three feet below the surface of the water. The bottles were then taken immediately for culture of contents to the council's laboratory at the Princess Louise hospital. The following Table gives the site from which the samples were taken and the total cell-count of organisms found in the samples:— Date of taking sample. Site in bath from which sample was taken. Total cell-count of organisms per c.c. of water. Men's First-Class May 7 Deep end 4 June 2 Deep end Sterile. July 7 Deep end Sterile. August 9 Deep end Sterile. September 9 Deep end 3 Women's First-Class May 7 Deep end 8 June 2 Centre Sterile. July 7 Centre Sterile. August 9 Centre Sterile. September 9 Deep end Sterile. Men's Second-Class May 7 Deep end 7 June 2 Centre Sterile. July 7 Deep end Sterile. August 9 Centre Sterile. September 9 Centre 5 October 20 Shallow end 10 October 20 Deep end 4 Women's Second-Class February 26 Deep end Sterile. February 26 Shallow end Sterile. February 26 Centre (surface) Sterile. February 26 Side (surface) Sterile. May 7 Deep end 2 June 2 Deep end Sterile. July 7 Centre Sterile. July 7 Deep end Sterile. August 9 Centre (surface) Sterile. September 9 Deep end 11 October 20 Shallow end Sterile. October 20 Deep end 42 November 26 Deep end Sterile. November 26 Shallow end Sterile. December 22 Shallow end 684 December 22 Deep end 790 Streptococci were absent from all samples, and B. coli from all but the last two. Summary.— During 1937 a total of 131,728 swimmers used the swimming baths. On nine occasions the water in use was subjected to bacteriological examination, a total of 33 samples being taken. Bacteriological examination, on all but the last occasion, showed the samples to be satisfactory. On the last occasion, when the chlorine content of the water had been reduced, the bacteriological count was found to be considerably higher than normal. Conclusions.— The water was found to be satisfactory from the bacteriological point of view, and free from pathogenic organisms, when the free chlorine content of the water was kept at the level of approximately 0.4 parts per million. 22 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 1937 the total number of persons using the slipper baths was 78,807. The total number of bathers using the swimming baths and slipper baths in the last five years are shown in the following table:— Year. Bathers. 1933 235,860 1934 248,606 1935 218,449 1936 207,863 1937 210,535 In the washhouses or laundry department there were 88 washtubs in use in 1937. The number of women using the washtubs in the last five years is as follows:— Year. Washers. 1933 82,715 1934 79,686 1935 73,843 1936 65,537 1937 59,094 There are eight washing-machines, and the number of women who used these during the year was 15,117. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-33. One application was made to the council in 1937 for a certificate of fitness of habitation under these Acts, and this was granted. Canal Boats. The Kensington borough council are vested with authority to enforce the legislation in respect of all canal boats entering the portion of the Grand Junction canal which is within the boundaries of the borough. During 1937, the canal-boats inspector made nine inspections. It was not found necessary to serve any notices 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. In accordance with the powers conferred on them by Section 224 of the Public Health (London) Act, 1936, the borough council can make application to the Court for an order to remove to a hospital, infirmary, institution or other similar place, aged, infirm and physically incapacitated persons living under insanitary conditions. It is provided that the Court may make an Order for a period not exceeding three months, and for such further periods not exceeding three months as may be determined by further Orders. During the year four cases were dealt with. The first was that of an old woman who had been a source of trouble to the council's officers since 1916. She accumulated vast quantities of rubbish in her rooms, which was removed at the council's expense from time to time. She had been removed to hospital on previous occasions, but was temporarily lost sight of after her discharge. When she was rediscovered it was found necessary to apply to the Court for an Order for her removal to hospital; two further applications were made for her detention therein. Before the last of these periods had expired, it was learned that she had been certified to be of unsound mind, and in the circumstances no further action by the council was necessary. The other three cases were those of a man, aged 86, and two women aged 85 and 80. These persons were found to be dirty, verminous and suffering from various chronic diseases. In each case an Order was obtained for removal to St. Mary Abbots Hospital (Institution). 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 232 Total number of visits paid 2,285 Number of poison baits laid during the year 62,790 „ ,, disappeared 58,510 „ ,, removed by the rat officer 4,280 23 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats... ... ... ... ... 13 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 40 Number of sewer defects allowing egress of rats made good 11 Number of premises cleared of rats 137 In contrast to previous years, the prevalence of rats in 1937 was more marked in the southern part of the borough than in the northern. In the last year or two a considerable amount of old property in South Kensington has been demolished, and large buildings erected on the cleared sites. The consequent disturbance of sewers, drains, etc., has been partly responsible for the trouble experienced. The various firms concerned took steps in all cases to combat the rat menace. 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. Forty dead rats were found in sewers, 12 rats were destroyed at Wood Lane depot and 18 rats and mice were killed in private premises. Nuisances from Pigeons. : Section 121 of the Public Health (London) Act, 1936, 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 land on which it is proposed to catch and destroy the birds. The number trapped during last year was 125. Pigeons commonly use the interiors of church towers as roosting places, and with a view to depriving wild pigeons of their homes in Kensington, the openings to all church towers and steeples in the borough known in the past to harbour pigeons have now been wired up. Although some improvement has been secured by the work of the council's officers, the nuisance from pigeons still persists in certain parts of the borough. The birds, most of which roost outside Kensington, come into the borough to feed, and are encouraged to do this by a comparatively small number of persons who continue to place scraps and bread for them in the roadway, on window sills, etc. The council have endeavoured to obtain appropriate legislation to enable them to control this indiscriminate feeding of wild pigeons, but have not been successful. Since the council first started to deal with this problem in 1929, 2,082 pigeons have been destroyed. Fouling of Footpaths by Dogs. It was in 1921 that the council, after prolonged negotiations, succeeded in obtaining a by-law enabling them to deal with the fouling of footpaths by dogs. Modifications of the original by-law have been made in the intervening years, culminating in the present one which was sanctioned by the Home Office in 1936. This by-law differs from any previous one inasmuch as it applies in the case of a dog either on or off the lead. There is, however, 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. During the year under review it was thought that if an extensive campaign was waged for a limited period, some improvement in the condition of the streets of the borough might result. Arrangements were made for eighteen officers of the public health department and a similar number from the borough engineer's department to patrol the streets of the Earls Court and Holland Wards each morning from 7.45 to 9 throughout one week. Only twelve offences in all were detected. The opinion was formed by those on the patrol that much of the fouling of the footways which takes place in the early morning is caused by dogs allowed out of doors unattended. A further campaign for one week was carried out in the early summer, each evening from 9.30 to 10.30. The streets in the same two wards were patrolled, and four offences were detected. As in previous years, the attention of the public was drawn to the by-law by means of handbills, posters and notices posted on lamp-posts and sandbins. Although some improvement in the condition of the streets has been secured, there is room for more. The council have obtained the most stringent by-law the Home Office will approve, and their officers make every effort to see that it is observed. It remains, therefore, for the residents of the borough to co-operate more closely with the council in order to bring about that condition of the streets that all must desire. During the year 46 summonses were issued in respect of offences. Fines totalling £20 7s. 6d. were imposed in 44 cases, and the summons was dismissed in two cases. 24 FACTORIES AND WORKSHOPS. The following table shows the various trades and occupations carried on in registered workshops and factories where men are employed:— Trade or business. Workshops. Factories. Total. Aerated water manufacturers 1 2 3 Bakers 16 53 69 Basket makers 1 — 1 Bedding makers 1 3 4 Blacksmiths 2 1 3 Boot makers and repairers 31 54 85 Builders 56 8 64 Cabinet makers 14 12 26 Carpet repairers 1 — 1 Chromium plating 1 1 2 Coach builders 2 8 10 Cycle repairers 4 1 5 Dentist 1 — 1 Drapery — 5 5 Dressmakers 6 14 20 Dry cleaners 1 16 17 Dyers and cleaners 3 2 5 Electrical apparatus 11 7 18 Electric generating stations — 3 3 Engineering works and motor garages 30 57 87 Firewood choppers 2 2 4 Fretwork 1 1 2 Furriers 6 5 11 Gasworks — 1 1 Glovemakers — 1 1 Hairdressers 1 — 1 Ice-cream manufacturers — 1 1 Instrument makers — 1 1 Invisible menders 1 2 3 Ironmongers 4 — 4 Jewellers 5 5 10 Lampshade makers — 1 1 Laundries 2 39 41 Marine stores 6 - 6 Masons 5 2 7 Metal workers 3 2 5 Paint manufacturers 1 3 4 Photographers 2 — 2 Picture frame makers 7 1 8 Pipe makers — 2 2 Printers — 22 22 Radio repairers 10 4 14 Saddlers 2 — 2 Sausage makers — 25 25 Sign writers 3 1 4 Steam pressers 5 1 6 Sundry businesses 22 21 43 Tailors 78 17 95 Trunk makers 5 — 5 Umbrella makers and repairers 1 1 2 Undertakers 5 3 8 Upholsterers 21 5 26 Watch makers and repairers 4 2 6 Wax figure manufacturers — 2 2 Wheelwrights ~~~ 1 1 Totals 384 421 805 25 Factories and workshops where women are employed.—The following table shows the various trades and occupations carried on in registered workshops and factories where women are employed:— Trade or business. Workshops. Factories. Total. Arts and crafts 7 - 7 Bakers 8 6 14 Basket makers 1 — 1 Bedding makers 2 1 3 Blind makers 3 — 3 Boot makers and repairers — 2 2 Cabinet makers 3 — 3 Cardboard box makers 1 — 1 Chromium plating — 1 1 Corset makers 5 — 5 Drapery 2 5 7 Dressmakers and ladies' tailors 85 10 95 Dry cleaners — 14 14 Dyers and cleaners 2 6 8 Fretwork — 1 1 Electrical apparatus 1 — 1 Embroidery workers 2 — 2 Fine needlework 2 — 2 Florists 8 — 8 Furriers 9 13 22 Glove makers — 1 1 Hairdressers 9 — 9 Instrument makers — 1 1 Invisible menders 3 4 7 Jewellers — 3 3 Lampshade makers 3 1 4 Laundries 20 43 63 Marine stores 3 — 3 Millinery 24 — 24 Pipe makers — 2 2 Printers — 7 7 Sausage makers — 3 3 Steam pressers 3 — 3 Sundry businesses 34 50 84 Tailors 53 17 70 Toy makers — 2 2 Umbrella makers and repairers 1 1 2 Underclothing 2 1 3 Upholsterers 8 2 10 Wax figure manufacturers 1 1 2 Weaving 1 — 1 Totals 306 198 504 Home Work.—Of the 239 outworkers registered, some are employed on premises which^an factories or workshops within the meaning of the Factory and Workshop Act, 1901, others work ir domestic workshops, and the remainder are the genuine " home workers" engaged in theii homes on the work given out to them by various firms and contractors in Kensington and othei districts. The number of outworkers belonging to each of these three classes is shown in the following table:— Outworkers in workshops or factories 48 Outworkers in domestic workshops 3 Outworkers in their own homes 188 Total number of outworkers 239 26 The nature of the work given out to the 188 home workers on the register is as follows:— Tailoring 56 Hand knitting 43 Dressmaking 30 Bootmaking 16 Linen working 12 Drapery 9 Outfitting 7 Fancy goods 7 Sundries 6 Chair caning 2 188 During the year two cases of infectious disease occurred in premises where homework is carried on, but in neither case was the actual homeworker the patient. Appropriate measures were taken, and the homeworkers were kept under observation. It was not found necessary, however, to suspend the issue of the homework. 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) 777 60 - Workshops (including workshop laundries) 1,383 43 — Workplaces (other than outworkers' premises) 239 21 — Totals 2,399 124 — II.—Defects Found. Particulars. Number of defects. Number of prosecutions. Found. Remedied. Referred to H.M. Inspector. Nuisances under the Public Health Act:— Want of cleanliness 87 76 — — Want of ventilation 13 13 1 — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 54 35 3 — Sanitary accommodation:— Insufficient 4 4 — — Unsuitable or defective 33 28 — — Not separate for sexes 3 3 — — Offences under the Factory and Workshop Act:— Illegal occupation of underground bakehouse (S. 101) — — — — Breach of special sanitary requirements for bakehouses (Ss. 97 to 100) - - - - Other offences (excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921) - - - - Totals 194 159 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. 27 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, toddlers clinics, day nurseries, a maternity home, the provision of an obstetric consultant for difficult confinements, dental treatment for mothers and toddlers and the provision of 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 or for their free admission to a day nursery, facilities for the skilled nursing and treatment of cases of puerperal sepsis, and the supply of free milk, dinners and cod liver oil preparations to necessitous cases. On the 1st April, 1937, the Kenley Street and Raymede infant welfare centres and the baby clinic came under the financial control of the council. The transfer of the three institutions was smoothly effected without disturbance to the routine work of the institutions. It is very satisfactory to report that the voluntary committees in each case have continued their association with the centre and give their services in assisting at the sessions and in maintaining the social side of the work which is of much value. The transfer of infant welfare institutions to the council has entailed the addition to the council's staff of a number of nurses with varying experience, qualifications and salaries, who were formerly employed by the voluntary committees. The council have accordingly approved three categories (women health officers, health visitors, and sisters), each with a prescribed salary scale, in which each officer has been graded according to her qualifications. In view of the high infant mortality rate in the borough, it is natural that the care of infants and toddlers has received the constant attention of the maternity and child welfare committee. The council's medical officers supervise the health of infants in the welfare centres, and the health visiting staff visit them frequently at home in order to advise and help in difficulty. The problem of overcrowding in the waiting-rooms at the infant consultation sessions has been satisfactorily solved at some of the centres by the establishment of an appointment system for the mothers, and it seems likely that this innovation will become generally adopted in the future. Special sessions for toddlers are held at four of the welfare centres, and have proved a useful institution. Medical treatment for infant and toddler, when this cannot be obtained from the family doctor, is available at the baby clinic which serves as the treatment centre for the welfare institutions in the borough. The auxiliary treatment centre at the Notting Dale school treatment centre at Kenley Street has proved a great help to the mothers in that area, who found it difficult to take their children to the baby clinic. These two treatment centres, together with the Princess Louise hospital in North Kensington, make it easy to obtain either medical, dental or orthopaedic treatment for the toddler with a minimum of inconvenience to the mother. The arrangement by which the three school treatment centres in North Kensington are also treatment centres for the toddler is a satisfactory one, since continuity of medical treatment in the same premises is obtained from infancy up to school-leaving age. The council's application of their free milk scheme was extended in April in response to Circular 1519 of the Ministry of Health, and no necessitous expectant or nursing mother or child under five years of age is now precluded from a grant of milk if the applications sub-committee consider that it would improve the health of that woman or child. Cod liver oil or similar preparations, and preparations containing iron are also supplied free of charge to necessitous cases on the recommendation of the council's medical officers. The council have attached great importance to the question of providing cheaper milk for all working-class expectant and nursing mothers and pre-school children in the borough and, prior to the issue of the Government's White Paper dealing with their milk policy, they had asked the Metropolitan Boroughs' Standing Joint Committee to enter into further communication with the Milk Marketing Board on this matter. • The ante-natal work in the borough, as organised in 1934, has continued to expand. Co-operation between clinics, doctors, midwives and hospitals is established and is giving excellent results. Owing to the appointment of municipal midwives by the London county council under the Midwives Act, 1936, the borough council did not appoint another midwife on their staff when the Kensington midwife resigned her position during the year. It has been a year of health propaganda—the National Health Campaign has directed public attention to the importance of health, and the educational propaganda of the council's medical officers and health visitors has been constantly directed towards teaching the rules of healthy living and raising the standard of hygiene in the borough. 28 Health Visiting Staff. The council's health visiting staff for the maternity and child welfare scheme consists of seven women health officers and three health visitors. All are general-trained state-registered nurses and qualified health visitors. Within twenty-one days of a birth one of the above officers 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 attend the welfare centre in her district. In all cases the baby, even when attending the centre, is visited at home at least every two months. Special attention is paid to the early recognition of physical defects in the pre-school child and their remedy by treatment. Ante-natal visits are paid to the expectant mother, special attention being paid to first pregnancies. The large floating or migrant population of North Kensington which is continually moving in or out of the borough has rendered it difficult for the health visitors to keep all families under adequate supervision. For the last year the council have arranged for these officers to allot a certain time to the systematic house-to-house visiting of the streets in their area in a search for children who were unknown to them. One hundred and two streets have been visited in this process of combing and 3,574 houses investigated, and an additional 27 infants and 223 toddlers have been brought under supervision by this means. In addition to the routine visiting of expectant mothers, infants and young children and to their work at the welfare centres, the council's health visiting staff investigate cases of still-birth and infantile death ; they visit and report upon cases of ophthalmia neonatorum, puerperal fever and puerperal pyrexia ; they visit and advise the parents on 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 they investigate all applications under the council's scheme for the supply of milk and dinners, home helps and so forth. The work performed by the health visiting staff during 1937 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 No. 9 No. 10 Total. First visits to infants (0-1 year) 61 71 224 235 190 111 140 53 242 221 1,548 Re-visits to infants (0-1 year) 696 519 317 676 601 644 855 439 293 712 5,752 Visits to children between 1 and 5 years 1,121 1,105 860 1,261 1,065 750 1,027 491 673 1,245 9,598 Still-birth enquiries — — 10 7 5 4 2 1 4 9 42 Visits to ophthalmia cases 1 — 1 2 1 — 3 — 3 — 11 Return visits to ophthalmia cases 1 - 7 5 1 - 27 - 1 - 42 Visits to measles cases 1 7 11 2 2 11 26 — 22 22 104 Visits to whooping cough cases 3 4 19 19 16 17 27 3 10 57 175 Visits to puerperal fever cases — — — 1 1 — — — 2 — 4 Visits to puerperal pyrexia cases — — 2 2 4 2 2 — 5 1 18 Visits to enteritis cases 2 2 34 20 6 24 5 — 8 7 108 Infantile death enquiries 2 6 20 17 11 6 12 — 34 23 131 Investigations re milk applications 166 313 458 575 405 341 360 44 878 201 3,741 Ante-natal visits 263 209 286 322 345 260 134 288 135 541 2,783 Half-days at welfare centres 168 160 108 164 159 143 144 151 132 188 1,517 Special visits 290 314 1,071 823 577 623 647 113 714 737 5,909 * These officers commenced health visiting on the 1st April, 1937. The visiting in connection with tuberculosis and factories and workshops is dealt with in the sections of this report dealing with those subjects. 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 29 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 1937 is shown in the following table:— Particulars of work done. Bramley Road. Campden Hill. Dalgarno. (municipal). Golborne. Kenley Street, (municipal). Lancaster Road. Raymede. (municipal). South Kensington. Totals. Births occurring in the area of the centre suitable for welfare attention 258 85 126 113 190 390 310 222 1,694 Sessions at which doctor attended for infant consultations 165 48 91 97 130 185 147 150 1,013 Sessions at which doctor attended for special ante-natal consultations 53 47 52 49 50 97 79 50 437 Individual mothers who attended during the year 776 81 258 447 447 1,006 541 237 3,793 Individual mothers who attended ante-natal sessions during the year 233 75 140 107 151 230 225 99 1,260 Individual children who attended during the year— Children 0 to 1 year 426 93 209 203 264 582 456 241 2,474 „ 1 to 5 years 383 58 274 208 243 559 494 292 2,511 Attendances at centre of mothers for all purposes (excluding the accompanying of children and for the purpose of buying dried milk or other article) 1,912 736 1,050 995 2,400 5,757 2,969 1,171 16,990 Attendances at centre of children for all purposes— Children 0 to 1 year 4,643 1,007 2,235 2,683 2,579 5,561 4,334 151 23,193 „ 1 to 5 years 3,071 763 1,808 2,525 2,559 5,591 2,917 57 19,291 Attendances at dinners— Mothers — — — — — 3,059 — — 3,059 Children — — — — — 834 — — 834 Attendances at doctors' consultations— Ante-natal mothers 995 356 637 404 770 1,291 864 533 5,850 Post-natal mothers — 23 25 76 10 5* 3* 76 218 Children 0 to 1 year 2,361 584 930 1,375 1,432 2,937 1,802 1,866 13,287 „ 1 to 5 years 1,504 399 799 1,117 999 2,488 1,362 1,559 10,227 Average attendances at doctors' consultations— Ante-natal mothers 18 7 12 8 15 13 11 10 — Post-natal mothers — .5 .5 — 1 — — 1 — Children 0 to 1 year 15 12 10 14 11 15 12 12 — „ 1 to 5 years 9 8 6 11 7 13 9 10 — Individual children weighed during the year 808 156 483 411 503 1,141 949 376 4,827 Weighings 7,615 1,759 4,054 4,950 5,079 9,776 7,242 5,448 45,923 First visits paid to— Expectant mothers - - 147 14 24 297 47 - 529 Children 0 to 1 year 12 — 132 — — 198 — — 342 Home visits paid to— Expectant mothers 368 - - 106 81 854 154 236 1,799 Children 0 to 1 year 1,240 — — 510 165 1,860 293 829 4,897 „ 1 to 5 years 1,403 - - 412 269 1,925 347 1,185 5,541 * Post-natal mothers from these centres are now seen at the post-natal clinic at No. 28b, Archer Street. The home visits paid in connection with municipal centres are included in the table of work of the health officers. Those shown in the above table under municipal centres are visits paid by the staff of voluntary committees before the borough council took over the institutions. 30 table showing the dental treatment performed at the centres in 1937. Centre. Patients. Attendances Extractions. Fillings. Dentures. Other treatments. Bramley Road 170 216 316 4 11 57 Campden Hill 7 8 6 2 — 2 Dalgarno 75 241 79 6 19 137 Golborne 44 130 43 — 8 79 Kenley Street 216 254 392 1 13 75 Lancaster Road 243 534 235 35 40 274 Raymede 252 560 240 24 18 278 South Kensington 124 262 139 63 13 120 Totals 1,131 2,205 1,450 135 122 1,022 The council's scheme for the provision of dentures to necessitous expectant and nursing mothers has proved of great value. Midwifery Arrangements. 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 two hundred and sixty expectant mothers attended the welfare centres during the year, with a total of 5,850 attendances ; at the evening clinic 48 sessions were held and 151 women attended, making 449 attendances, with an average attendance of 9-3 at each session. The total numbers attending the council's ante-natal clinics during the year 1937 are therefore 1,411 individual mothers with 6,299 attendances; the corresponding numbers for 1936 were 1,340 and 5,085, and for 1935,1,120 and 4,402. It is satisfactory to note the increasing use which is made of the council's services. 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 three sessions were held during 1937, at which 362 Kensington women attended. There are also ante-natal departments attached to 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 rare instances that a Kensington woman does not obtain ante-natal care. The women attending at the hospital ante-natal departments and at the borough clinics represent approximately 78 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 most of the remaining 22 per cent. The excellent co-operation between the borough council's clinics and the private doctors and midwives, and the 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. Statement of work done during last five years. 1933 1934 1935 1936 1937 Applications for admission 173 206 224 186 197 „ accepted 173 206 224 185 196 „ withdrawn after acceptance 22 17 27 13 12 Women confined during the year 136 158 210 169 174 31 The gross cost of the scheme to the council during 1937 was £1,238 8s. Od. The assessment made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £644 12s. Od. Payments made by patients totalled £633 Os. 6d. London. County Council Hospitals. Hammersmith L.C.C. hospital admits cases from North Kensington into the maternity wards, and a large number of Kensington women make use of this provision. 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 St. Mary Abbots hospital during the year. 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. Private 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 low. Several Kensington midwives retired from practice at the end of the year under the provisions of the Midwives Act, 1936. One midwife previously in private practice is now employed by the London county council. Compensation is paid by the borough council to any private 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 the loss of her fee should not prevent a midwife from sending a Kensington patient for advice. London County Council Midwives. On the 1st January, 1938, the municipal midwives employed by the London county council commenced their duties. Arrangements for co-operation with this new branch of the service promise to be very satisfactory. Hospital Districts. Kensington is especially fortunate in that its northern area is the maternity district of Queen Charlotte's hospital, whose district midwives attended 362 Kensington women in their homes during 1937 ; there is a 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. Post-Natal Examination. In addition to the council's post-natal clinic, weekly post-natal clinics are held 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, 52 sessions were held during 1937, at which 114 individual mothers attended. This number is small, but it represents those cases not 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. On the 1st April, 1937, the borough council, at the request of the voluntary committee, assumed financial control of this institution. It serves as a treatment centre for all the infant welfare centres in the borough, mothers and children being referred there 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 the cases 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 is given by the same staff and in the same premises to children from infancy to school-leaving age. 32 The following are the records for 1937 :— Sessions at which doctors attended for infant consultations 153 Sessions at which doctors attended for mothers'consultations 50 Individual mothers who attended 184 Individual children who attended (old) 261 Individual children who attended (new) 649 Attendances of mothers for all purposes (excluding the accompanying of children) 840 Attendances of children for all purposes 0-1 year 1-5 years 8 550 Seen by doctor at consultations :— Mothers 840 Children 3,548 Average number seen by doctor at consultations :— Mothers 17 Children 23 Individual children weighed 910 Weighings. 10,854 Infant and Toddlers' Treatment Clinic. In April, the borough council opened a treatment clinic for infants and toddlers on the premises of the school treatment centre in Kenley Street. The sessions are conducted weekly and the physician-in-charge is Dr. W. A. Hislop. The sessions are being well attended and are proving of great assistance to the council's medical officers conducting the infant consultation sessions at the Bramley Road and Kenley Street infant welfare centres. The following is a record of the work carried out from the 1st April to the 31st December, 1937 :— Sessions held Individual patients treated, 0-1 year 216 „ „ 1-5 years ... 321 Attendances of patients at doctors' consultations 631 Average attendances at doctors'consultations 16 Total attendances for treatment, etc. 1,338 „ patients 0-1 year 750 1-5 years 588 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 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 1937 :— Infants in residence at commencement of the year ... ... 22 Admissions 266 Discharges 249 Deaths 16 Infants in residence at end of the year 23 Average duration of stay in hospital ... ... ... ... 29 days. 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. 33 Massage and Electrical Treatment. The Princess Louise Kensington Hospital for Children. The following is a record of the work conducted thereat during 1937 :— New cases— Under 5 years of age 68 Over 5 years of age 92 160 Discharged— = Under 5 years of age 39 Over 5 years of age 76 115 Transferred to other hospitals because over age 12 Cases treated 286 Treatments given 4,912 The borough council make an annual grant to the authorities of the hospital for this treatment. The Baby Clinic. Record of work during 1937 :— Individual patients treated 221 Treatments given 2,203 Massage treatment for children is also provided at the South Kensington infant welfare centre. Artificial Sunlight Treatment. Artificial sunlight treatment is administered at the baby clinic and hospital. During the year 3,959 treatments were given and the average weekly attendance was 76 ; 160 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 1937, together with the number of cases admitted. Each mother and baby stays in the home for a period of 14 days. Institution. Mothers admitted with babies. Mothers admitted without babies. Evelyn Convalescent Cottage Home, Wargrave, Berkshire 7 2 Hambledon Cottage Home, Surrey 4 — Holiday Cottage, Aston Clinton, Aylesbury, Buckinghamshire 8 1 Wayside Convalescent Home, Sunningdale, Surrey 15 1 Zachary Merton Home, Rustington, Sussex 18 - The Aston Clinton, Wayside and Zachary Merton 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 £175 10s. 6d. In addition, the Invalid Children's Aid Association sent 63 Kensington pre-school children for convalescence, and the council made a grant of £40 to that organisation in respect of this service. Day Nurseries. There are four day nurseries in the borough, namely :— The Golborne Day Nursery. The Lancaster Road Day Nursery. The Notting Hill Day Nursery. The St. Clement's Day Nursery. 34 The following table shows a record of children's attendances at the day nurseries in 1937: Gol- borne. Lancaster Road. Notting Hill. St. Clement's. Totals. Whole-day attendances of children under 3 years of age 4,502 2,235 8,852 2,919 18,508 Whole-day attendances of children over 3 years of age 2,748 3,203 3,138 576 9,665 Total whole-day attendances 7,250 5,438 11,990 3,495 28,173 Charges made for each attendance of a child 8d. 9d. 6d. 1s. — Half-day attendances of children under 3 years of age - - - 555 555 Half-day attendances of children over 3 years of age - - - 109 109 Total half-day attendances — — — 664 664 Charges made for each attendance of a child — — — 6d. — Average daily attendance of children 33 24 54 20 — Day Nursery Scheme. The council have adopted a scheme which was suggested by the advisory committee under which children of necessitous parents may be admitted free of charge to the day nurseries in the borough. This scheme has proved valuable in a limited class of case. Nineteen applications were granted during the year, and the cost to the council was £19 8s. Id. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. During the year 5,580 grants of milk were made by the council's applications sub-committee. One thousand two hundred and nineteen of the grants were in response to new applications, and the remaining 4,361 were renewals of grant. Under the council's scheme, 272,704 pints of fresh milk were granted free of charge at a cost to the council of £3,000 16s. 10d., and 6,763 packets of dried milk were granted free of charge at a cost of /630 6s. 6d. 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 2,181 147 8 8 Campden Hill 789 56 13 8 Dalgarno 531 34 8 5 Golborne 348 24 6 11 Kenley Street 1,330 89 7 4 Lancaster Road 3,582 244 16 4 Raymede 1,634 109 17 4 South Kensington 1,144 86 10 0 Totals 11,539 793 8 8 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. One hundred and twenty-four applications for free dinners were granted ; 30 of these were new applications, and 94 were renewals. The total number of dinners supplied was 4,805 and the cost was £146 13s. 4d. In 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 :— 5,414 pints of milk at a cost of £77 3s. 6d. 117 packets of dried milk at a cost of £8 3s. 6d. 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 eighty-five applications were received for the provision of home helps under the council's scheme. The assistance requested was granted in 162 cases for a period of 14 days each, in two cases for three weeks, in one case for nine days, in five cases for one week; three applicants cancelled their requests, and 12 applications were not granted by the sub-committee. The gross cost of the scheme to the council was £234 14s. 6d. 35 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 usually 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, 23 children were boarded-out at a cost of £26 lis. 2d. Travelling Expenses of Women Breast-feeding Infants Admitted to Hospitals. Two 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 7s. 6d. Health Lecturer. During 1937, the council's health lecturer continued to carry out valuable work in educating mothers in domestic and personal hygiene. She also lectured at many women's and girls' clubs, etc. In addition, she organised in conjunction with the Central Council for Health Education a health exhibition which was held at Messrs. Derry & Toms, Kensington High Street, from the 9th to 20th November. The health lecturer, who was a part-time officer, resigned her appointment at the end of the year after having held the office since 1926. The council have decided to appoint a whole-time officer to conduct educational work in connection with general public health in addition to maternity and child welfare. The following is a record of the lectures given during 1937:— Lectures given. Individual mothers attending. Attendances. Average attendance at lecture. Bramley Road I. W. C. 52 174 491 9.44 Campden Hill „ „ 23 102 348 15.13 Dalgarno „ „ 26 118 391 15.04 Golborne „ „ 26 139 410 15.77 Kenley Street „ „ 35 152 362 10.34 Lancaster Road „ „ 80 266 1,325 16.58 Raymede „ „ 58 284 681 11.74 South Kensington „ 28 140 383 13.68 Baby Clinic 30 173 367 12.23 Other institutions 22 — 685 31.14 Totals 380 1,548 5,443 14.32 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 1937, the attendances of Kensington women at the Telford Road clinic totalled 1,052. The council recognise the good work carried out by the North Kensington women's welfare centre in respect of both birth control advice and gynaecological treatment by making an annual grant of £100. 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 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. There appears no reason why the assumption of financial control of various voluntary institutions by the borough council should interfere in any way with the constitution or work of this committee, for the voluntary committees are still associating themselves with each institution in regard to social work. The advisory committee has always been of great assistance to the council's maternity and child welfare committee in giving advice on matters connected with the institutions, and it is largely owing to the efforts of this body that such smooth running, efficiency and uniformity have been established. It is therefore proposed that two representatives of the voluntary committee of each institution taken over by the council should continue to serve on the advisory committee. The constitution will thus remain the same and it is hoped that the valuable help which has been rendered in the past by this committee will continue in the future. 36 HOUSING. Clearance Areas. Royal Crescent Mews.—This area, situated in the Norland ward, consists of sixteen houses of the cottage type. It was represented to the public health committee on the 21st December, 1937, as a clearance area. Other Areas.—The following table gives particulars of the other 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 1937 (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 proposed to be used for school buildings. (4) Haydens Place, Tavistock Mews. October, 1933. do. 10 29 Premises demolished; four new lock-up garages erected on part of site in 1935. Council acquired remainder in 1937. (5) Silvester Mews October, 1933. Com. Purchase Order. 20 110 Premises demolished; 24 new flats erected by Church Army in 1937, providing accommodation for 150 persons. (6) Gadsden Mews January, 1934. Clearance Order. 14 44 Premises demolished but site not yet developed. (7) Edenham Mews February, 1934. Com. Purchase Order. 10 34 Premises demolished and a Feathers Club being erected on site. (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; 16 new flats erected by Improved Tenements Association in 1937, providing accommodation for 81 persons. (10) Manchester Mews October, 1935. do. 4 25 Premises demolished in 1937 but site not yet developed. (11) Chelsea Grove October, 1935. do. 15 23 Premises demolished in 1937 and site used for erection of garages and studios. (12) Yeomans Row October, 1935. do. 18 155 Premises demolished in 1937 and site being used for 12 new houses. (13) Heathfield Street May, 1936. Com. Purchase Order. 19 67 Order confirmed February, 1937. Property to be demolished and new flats to be erected on site by Aubrey Trust. 37 Compulsory Purchase Orders. The council, in pursuance of their powers to provide housing accommodation for the working classes within the borough, had before 1937 made compulsory purchase orders in respect of five 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 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. Thirty flats have been erected and provide accommodation for 180 persons. (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. Negotiations for acquiring the land proceeded during 1937 and at the end of the year the council were preparing to demolish the existing buildings and to erect 100 working class flats to accommodate 585 persons. (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. Negotiations for acquiring the land proceeded during 1937 and at the end of the year the council were preparing to demolish the existing buildings (together with two houses already in their ownership) and to erect 43 flats to accommodate 256 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. During the year the purchase of the land was completed, the buildings were demolished and at the end of the year contractors were in the process of erecting 60 flats, which will provide accommodation for 354 persons, and two shops. (e) 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 condemned houses in Heathfield Street. In this case objections were lodged and the Minister of Health held a public inquiry on the 15th February, 1937. The order, with slight modification, was confirmed, and at the end of the year negotiations were still proceeding for the acquisition of the properties. It is the council's intention to allow the Aubrey Trust to erect on the site 45 working class flats, providing accommodation for 262 persons. St. Mark's Grove (South Kensington).—On the 2nd March, 1937, the council made a compulsory purchase order in respect of the seven houses in this area. The order was confirmed by the Minister of Health, and negotiations are proceeding for the acquisition of the property. 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 persons, should be dealt with as improvement areas under the Housing Act, 1930. The Housing Act of 1935 abolished improvement area procedure except in those cases where the declaration had been made before that Act received Royal Assent on the 2nd August of that year. On that date three of the areas had been declared, and these were the most important from the point of view of improvement area procedure. The remaining four improvement areas have been absorbed into the council's present housing programme. The following is a summary of the action taken in respect of the three declared areas. (1) Southam Street Improvement Area.—This area was declared in January, 1934, and the by-laws for the abatement of overcrowding and the improvement of housing conditions were confirmed by the Minister of Health in April, 1934. The obligations imposed upon the council to improve this area were completed by 1936, and a concise record of the steps taken is contained in the annual report for that year. 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, and an inspector has been specially engaged for the work. This supervision has a two-fold object, namely, (a) to maintain the improved housing conditions, and (b) to assist owners in keeping their houses in such a state that they can expect some return for the considerable outlay they have been called upon to make. During the year 2,829 inspections were made of the houses in the area, and 253 notices under the Public Health (London) Act, 1936, and the improvement area by-laws were served. In the improvement area by-laws, the council have power to prevent nuisances arising in basement rooms closed for living and sleeping purposes, and owners have been required to wire or board up windows, remove all rubbish and litter, and to remove dirty or verminous wallpaper and woodwork. Routine inspections of the basements are carried out at regular intervals. During the year 1,855 inspections of basement rooms in the area were carried out, and in 141 cases notices under the by-laws were served requiring cleansing works, the removal of rubbish, etc. 38 (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 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 and all the unfit closed basements are now unoccupied. Reconditioning of the houses should have been undertaken in 1936, but in that year a joint sub-committee was appointed to consider proposals for the entire redevelopment of the area, including other houses and land adjoining. At the close of the year the joint sub-committee still had under consideration the redevelopment of the enlarged area. (3) Treverton Street Improvement Area—This area, consisting of 238 houses, was declared an improvement area in May, 1935. The population at that time was 2,449 persons. Considerable difficulty was experienced in obtaining for this area by-laws 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 ; these came into operation on the 1st August, 1936, and they are practically the same as those for the other two improvement areas. The preliminary steps to be taken were the closure of unfit basement dwellings, the rehousing of persons so displaced, and the elimination of overcrowding. Closing orders have been made in respect of 219 underground rooms and undertakings from owners to make the rooms fit for habitation have been accepted in 52 cases. Including both overcrowded families and occupiers of closed basement rooms, there were 227 families (1,025 persons) scheduled for displacement. The following tables show how the families were rehoused:— Basement families. Families. Persons. Number originally occupying 219 basement rooms in respect of which closing orders have been made 114 420 Number rehoused by the council and allied housing associations "outside" the improvement area 29 140 Number rehoused "inside" the area 61 192 Number who found their own accommodation "outside" the area 24 88 Overcrowded non-basement families. Number originally overcrowded in rooms above basement level 113 605 Number rehoused by the council and allied housing associations "outside" the improvement area 42 232 Number rehoused "inside" the area 56 298 Number who found their own accommodation "outside" the area 15 75 The effect of these rehousing operations was that the population was reduced by approximately 20 per cent. Reconditioning of houses under Part II of the Housing Act, 1936. Reconditioning of the houses was commenced in December, 1936, by the service of notices under section 9 of the Housing Act, 1936, and the following table gives a summary of the results obtained up to the end of 1937 :—■ Notices served in 1936 which were outstanding on 1st January, 1937 ... 11 Notices served from 1st January to 31st December, 1937 93 Appeals by owners to the county court against notices — Notices satisfactorily complied with by the owners 50 Notices in respect of which the council carried out the work following default by the owners 2 Notices in respect of which progress was being made by the owners on 31st December, 1937 23 Notices in respect of which the council's contractors were engaged in executing repairs on 31st December, 1937 . 1 Notices in respect of which nothing had been done on 31st December, 1937 (the time allowed had not expired in these cases) ... ... ... 28 During the year four houses in the area were reconditioned by the owners voluntarily. The number of houses remaining to be inspected and dealt with on 31st December, 1937, was 130. At the time of writing (May, 1938) a further thirty-three notices under section 9 of the Housing Act, 1936, have been served. 39 Individual Unfit Houses not Repairable at Reasonable Cost. Section 11—Housing Act, 1936. During the year two houses in Becher Street were represented as unfit for habitation and not repairable at reasonable cost, but as the premises are situated in an area which is likely to be redeveloped as a whole, the question of making demolition orders was deferred for the time being. On 23rd July, 1935, the council made demolition orders in respect of two houses, and the owners subsequently appealed to the county court against the orders. Between making the orders and lodging of the appeals, the Housing Act, 1935, received the Royal Assent and altered the law governing the closing of parts of buildings. This new Act gave an alternative method of dealing with the two houses and accordingly a conference of all the interested parties took place and the hearing of the appeals was adjourned by agreement. Eventually the upper parts of the houses were reconditioned by the owners and the basement underground rooms were closed for human habitation. In 1937 the demolition orders were formally quashed by the county court judge. Individual Unfit Parts of Houses not Repairable at Reasonable Cost. Section 12—Housing Act, 1936. The following table shows the action taken during 1937 in respect of unfit parts of houses :— Outside Inside improvement improvement areas. areas. Closing orders made 184 (348 rooms). 18 (36 rooms). Closing orders determined 23 (43 rooms). 9 (18 rooms). Undertakings by owners not to use for human habitation accepted 3 (5 rooms). — Undertakings by owners to make premises fit accepted. 52 (98 rooms). 5 (10 rooms). Undertakings cancelled—premises having been made fit for habitation 51 (97 rooms). 20 (39 rooms). Cases of default in undertakings to make premises fit for habitation (closing orders made) 5 (10 rooms). 5 (10 rooms). Of the 184 closing orders made outside improvement areas, 183 were in respect of basement dwellings ; the remaining case was in respect of a dwelling above shop premises. Of the 183 basements closed outside improvement areas 60 were empty when the closing orders were made, and in 26 other cases each basement family was able to move to adequate accommodation upstairs in the same house. This left 97 families (372 persons) to be displaced. Of this number 59 families (284 persons) were rehoused by the council, or, through their agency, by the London county council and housing associations. The 18 closing orders made inside improvement areas refer to basements in the Treverton Street improvement area, and an account of the steps taken to secure the vacation of these basements has already been given. For the past two years the council have not had to resort to legal proceedings to enforce closing orders. Individual Unfit Houses Repairable At Reasonable Cost. Section 9—Housing Act, 1936. The following table gives a summary of the action taken and the results obtained during the 12 months ended 31st December, 1937:— Outside improvement areas. Inside improvement areas. Total. Notices served in 1936 which were outstanding on 1st January, 1937 51 11 62 Notices served from 1st January to 31st December, 1937 84 93 177 * Notices withdrawn 5 — 5 Appeals by owners to the county court against notices - - - † Appeals by owners to the county court allowed 1 — 1 Notices satisfactorily complied with by the owners 86 50 136 Notices in respect of which the council carried out the work following default by the owners 9 2 11 Notices in respect of which progress was being made by the owners on 31st December, 1937 19 23 42 Notices in respect of which the council's contractors were engaged in executing repairs on 31st December, 1937 1 1 2 Notices in respect of which nothing had been done on 31st December, 1937 (the time allowed had not expired in these cases) 15 28 43 *Four of the five houses in respect of which the notices were withdrawn were demolished by the owners and a new building has been erected on the cleared site. In the fifth case a second notice was served. †The judge allowed the appeal against the council's notice on a technical point, but the house has subsequently been satisfactorily reconditioned by the owners. 40 From the time the council commenced enforcing the repair of houses by the service of Housing Act notices up to the 31st December, 1937, they have expended £5,487 18s. 2d. in carrying out work following default by owners. Of this sum, £5,075 9s. has been recovered, and the outstanding amount of £412 9s. 2d., with interest, is being collected by instalments. The total expenditure by the council during 1937 in executing repairs was £485 13s. In the past fifteen years 1,610 houses have been repaired under Housing Act procedure. Certificates of Fitness of Houses. Section 51 of the Housing Act, 1936, says that any owner of a house, which is occupied, or of a type suitable for occupation, by persons of the working classes, and in respect of which works of improvement (otherwise than by way of decoration or repair) or structural alterations are proposed to be executed, may submit a list of the proposed works to the council with a request in writing that he be informed whether in the opinion of the council, the house would, after the execution of those works (and other specified works if required), be in all respects fit for human habitation, and would with reasonable care and maintenance remain so fit for a period of at least five years. Where the council are of the opinion mentioned above, the owner is entitled, after executing the works, to a certificate stating that the house is fit for habitation and will remain fit with reasonable care and maintenance for a period not less than five nor more than 10 years. During the year, seven houses were considered under this section of the Act ; in two cases the council decided to grant certificates for periods of six years, and in the remaining five cases the certificates specified periods of five years. Permitted Use of Closed Rooms. During the year applications were received for permission to use 113 closed rooms or parts of houses, and the following table gives a summary of the purposes approved by the council:— Day living rooms 27 Bathrooms 22 Clothes-drying rooms 21 Kitchen-sculleries 20 Dining rooms 10 Storage 8 In connection with business premises 4 Total 112 One application to use a closed room as a kitchen was refused. Overcrowding. 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 anv room ha vine a floor area of less than 50 sauare feet. Table I. Where a house consists of:— one room 2 units two rooms 3 „ three rooms 5 „ four rooms 7½ „ five rooms 10—with an additional two in respect of each room in excess of five. 41 Table II. Where the floor area of a room is:— 110 sq. ft. or more 2 units 90 sq. ft. or more, but less than 110 sq. ft. 1½ „ 70 sq. ft. or more, but less than 90 sq. ft. 1 „ 50 sq. ft. or more, but less than 70 sq. ft. ½ „ under 50 sq. ft. Nil This standard applies to every house occupied by the working-classes ; but it does not apply in any district until the " appointed day " has been fixed by the Minister of Health. The " appointed day " for Kensington was 1st January, 1937. The overcrowding survey of 1935 revealed in the borough 2,529 overcrowded families. During 1936 the council, aided by the various housing associations operating in the borough and the London county council, made an attempt to reduce the overcrowding, but as the new standard did not operate until 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 before the " appointed day." The number of overcrowded families rehoused in 1936 was 115 (60<>f units) and the number of families overcrowded in the borough at the beginning of 1937 was estimated at 2,428 (11,251 units). On 1st January, 1937, the Minister issued a circular (1591) on the question of the action to be taken by local authorities under the overcrowding provisions of the Housing Act, 1936. The circular stated, inter alia, that " it is the duty of local authorities to see that existing cases of overcrowding are abated as soon as possible, and that no new cases arise . . . the discharge of these duties will call for care and thought in organisation and sympathy and understanding in administration . . . local authorities have by the Act been given considerable powers to secure the abatement of overcrowding ; these powers are there in reserve, but they will play no part in normal administration." During the year the council found no need to resort to legal proceedings, but nevertheless steady progress was made and 450 cases of overcrowding were abated, comprising 2,256$ units. Of these, 339 cases (1,725 units) were rehoused by the council and allied housing associations. The following statement is required to be furnished under the Sanitary Officers (London) Regulations, 1935:— The estimated number of families overcrowded at the end of the year 2,034 (9,234 units). The number of new cases of overcrowding reported ... ... 56 (239$ units). The number of cases of overcrowding relieved ... ... 450 (2,256$ units). 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 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. (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 cm 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 of 1936 authorised the employment of survey assistants up to a total of six for the purpose of measuring rooms in connection with these applications. In 1937, however, it was found necessary to employ only one assistant. The following table shows particulars of the work carried out during 1937 :— Number of applications received 226 Number of houses involved in these applications 1,626 Total number of houses measured 2,645 42 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 2,815. The number of houses cleansed as a result of notices served under the by-laws was 201. During the year the London county council had under consideration the question of amending the by-laws relating to houses let in lodgings, to include provisions for the prevention of nuisances arising from or in a part of a building or an underground room in respect of which a closing order is in force. Similar by-laws have been in force in Kensington improvement areas since 1934, but it was not until the passing of the Housing Act, 1935, that the power to make these by-laws was extended throughout the country. Public Health (London) Act, 1936. The number of written intimation notices served in respect of defects or nuisances in dwellings was 1,254. 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 168 statutory notices and 40 final notices; and one summons was eventually served. The following list shows the major improvements secured :— Houses cleansed 550 House drains reconstructed 140 „ „ additions to 215 Defective drains repaired 116 House drains cleansed. 108 Water closets reconstructed or repaired 555 „ „ (new) provided 503 „ „ supplied with water 503 Soilpipes ventilated, repaired, etc. 192 ,, (new) provided 194 Ventilating pipes (new) provided . 152 Baths (new) provided 761 Sinks (new) provided 510 Lavatory basins (new) provided 1,550 Waste pipes (new) provided 704 Cisterns cleansed, covered, etc. 114 Taps fixed on rising main 247 Yards and areas, paved, drained, repaired 256 Dustbins provided 264 Ashpits abolished . 14 Accumulations of filth, etc., removed 236 Roofs repaired 414 Houses provided with water above basement floor 86 Dampness in dwellings remedied 369 Ventilated food cupboards provided 178 Artificial lighting of staircases provided 23 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 number of rooms to meet their needs. Generally, private owners refuse to let their properties to these families. After careful consideration the borough council concluded that they would have to take special measures to cater for these families. 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. 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, was purchased by agreement. In addition, the council decided to purchase two large houses in St. Charles Square ; one of these was empty and the other contained only two persons ; one was purchased by voluntary agreement, but in the second house it was necessary to make a compulsory purchase order, which was sanctioned by the Minister, after public enquiry, in July, 1937. At the end of the year, the council's contractors were engaged on reconditioning the houses to make them suitable for accommodating large overcrowded families, and they will be ready for occupation early in 1938. 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. 43 The following table shows the licensed common lodging houses and the accommodation available on the 31st December, 1937:— Ward. Name of registered keeper. Address of common lodging house. No. of lodgers for which licensed. Male. Female. Total. Golborne Chesterton, Ada Elizabeth 194, Kensal Road - 49 49 Norland Hankins, Lucy E. 28 & 30, Crescent Street 54 — 54 „ Woodhouse, Jane E. 40, do. - 21 21 Totals 54 70 124 The maximum number of persons allowed to occupy the common lodging house at No. 194, Kensal Road, was fixed in 1936 at 71 women, but when the keeper applied for a renewal of the licence in June, 1937, she intimated that she did not desire to continue to use the annex, and accordingly the maximum number was reduced to 49. Subject to this alteration, the three lodging houses were licensed by the council in June, 1937. Although the three premises can accommodate a total of 124 persons, a recent census, taken at night time, showed only 68 in residence. The premises 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:— No. of houses Situation of properties. or flats. Kenley Street, Seymour King Buildings, 4, Hesketh Place and 6, Runcorn Place ... ... ... ... ... ... ... ... ... ... 120 St. James's Place, Bosworth Road, Sirdar Road, Hesketh Place, Runcorn Place, Walmer Road and Windsor House 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 contributions to the county council, have the right to nominate tenants to 99 county council houses on the Wormholt estate, and 50 houses on other county council estates. Accommodation provided in the Borough by Housing Associations. (a) The Kensington Housing Trust own two freehold houses, 51 leasehold houses, and 257 flats. Of these, a block of 80 flats was built on about one acre of the large Dalgarno Gardens site acquired by the council; the land is leased to the Trust at a peppercorn rent for 999 years. The Trust acquired privately some old houses in Bramley Road, demolished them and erected 40 working-class flats during 1937. (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 1937 the Association completed 16 flats on the cleared site of the Tabernacle Terrace clearance area. (d) Several smaller housing associations such as the Aubrey Trust and the Horace Street Trust, closely associated in management with the Wilsham Trust, own 39 houses and 14 flats. (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 block of 101 flats was erected on approximately one acre of land adjoining the original site. (f) About 5 acres of ground at Dalgarno Gardens acquired by the borough council were 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 a further 128 flats were ready for occupation in February, 1937. (g) The Gas Light and Coke Company, during 1936, erected 68 flats on ground owned by them at the northern end of Ladbroke Grove, and accepted tenants nominated by the council. 44 (h) The council approved a scheme whereby the Church Army should erect 24 maisonettes on the site of the Silvester Mews clearance area. These were completed during 1937. All the property referred to above is for the purpose of accommodating working class 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 1,900 houses or flats in North Kensington, under the control of enlightened management, is a very important factor in the considerable improvement which has taken place in the housing conditions of Kensington. 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 1937 and set out in circular 1650 :— 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) 4,772 (b) Number of inspections made for the purpose 19,956 (ii) (a) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 857 (b) Number of inspections made for the purpose 5,533 (iii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 18 (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 1,431 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 1,086 3. Action under statutory powers during the year :— (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 :— (i) Number of dwelling-houses in respect of which notices were served requiring repairs 177 (ii) Number of dwelling-houses which were rendered fit after service of formal notices (a) By owners 136 (b) By local authority in default of owners 11 (b) Proceedings under Public Health Acts— (i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,254 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 1,254 ('b) By local authority in default of owners Nil (e) Proceedings under sections 11 and 13 of the Housing Act, 1936 :— (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 12 of the Housing Act, 1936— (i) Number of separate tenements or underground rooms in respect of 202 which closing orders were made ... ... ... ... ... (384 rooms) (ii) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms 32 having been rendered fit (51 rooms) 4. Housing Act, 1936, Part IV—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year ... ... 2,034 (ii) Number of families dwelling therein 2,034 (iii) Number of " equivalent " persons dwelling therein 9,234 (b) (i) Number of new cases of overcrowding reported during the year 56 (ii) Number of " equivalent " persons concerned in such cases 239J (c) (i) Number of cases of overcrowding relieved during the year 450 (ii) Number of " equivalent " persons concerned in such cases 2,256£ (d) Number of cases in which dwelling-houses have again become crowded after the local authority have taken steps for the abatement of overcrowding Nil Note.—In obtaining the " number of equivalent persons " children between the ages of one and ten years are counted as " half-persons." Infants under one year of age are not counted. 45 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 1937 twenty-one samples were examined, and one, taken from a road tank arriving at a Kensington dairy, was found to contain the germs of tuberculosis. In accordance with statutory procedure, the result of this examination was sent to the medical officer of health for the county in which the milk was produced. It is worthy of mention that all milk received at the Kensington dairy in question is pasteurised before delivery to the customer, thus reducing the danger of spreading tuberculosis by the consumption of the milk. During the year three samples of milk taken from the dairy after pasteurisation were examined for the presence of tubercle bacilli, and each one gave a negative result. Composition of Milk Samples.—Of the 379 formal samples of milk taken under the Food and Drugs (Adulteration) Act, 1928, in 1937, six 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 1937. 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 14 3•61 8•78 3•62 8•78 3•0 8•5 February 45 3•53 8•74 3•54 8•80 March 28 3•71 8•84 3•71 8•86 April 22 3•54 8•76 3•60 8•75 May 49 3•36 8•81 3•36 8•81 June 36 3•40 8•87 3•42 8•87 July 42 3•50 8•77 3•50 8•77 August 42 3•49 8•73 3•49 8•73 September 25 3•65 8•74 3•05 8•74 Average composition or Normal cow's milk. October 28 3•81 8•81 3•81 8•81 November — — — — — Percentage of milk fat. Percentage of solids not fat. December 48 3•82 8•87 3•82 8•87 379 3•58 8•79 3•59 8•80 3•7 8•9 The following table has been prepared to show the number of samples (formal and informal) 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. 1937. First quarter 6 71 14 91 Second quarter 5 65 35 105 Third quarter 3 99 6 108 Fourth quarter 36 41 2 79 Totals 50 276 57 383 Percentages 13•1 72•1 14•8 100 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." 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. 46 It will be seen that the second quarter of the year produced the largest percentage of samples of poor milk and a very small percentage 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 1937, 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 — 2 2 Added to register 15 2 2 Vacated and removed from register — 3 3 Dairymen with premises outside the borough added to the register — 1 — On register 1st January, 1937 150 173 138 On register 31st December, 1937 165 173 137 (+) Increase. ( —) Decrease + 15 — —1 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 a notice was served upon a registered dairyman, in accordance with the procedure laid down in the act, requiring him to show cause why his name should not be removed from the council's register. The dairyman had been convicted of selling adulterated milk, and his record showed that six of the 32 samples taken from him since 1933 had been found to contain added water. The dairyman and his solicitor appeared before a sub-committee, and were warned that any further conviction in respect of the sale of milk would be followed by the removal of the dairyman's name from the register. 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 462. Sterilisation of Milk Utensils. Article 21 of the Milk and Dairies Order, 1926, requires that every milk vessel, lid or appliance shall after use be thoroughly washed and scalded with boiling water or steam before being used again. When this requirement first came into force, a survey of all Kensington dairies was made ; and where boiling water was not available a notice was served upon the dairyman requiring its provision. Subsequent experience has revealed, however, that boiling water does not afford a practicable means of scalding all utensils, as required by Article 21, and there is little doubt that the only satisfactory way of securing compliance with the Article is by steam scalding. In consequence of this, occupiers of all dairy premises from which outside rounds are operated have been requested to provide steam scalding equipment, and in every case the dairyman has complied with the request. During the latter part of the year the public health committee resolved to regard as unsuitable for retention on the register any milkshop in which milk is sold in bottles filled and closed on the premises, and in which steam scalding equipment has not been provided. This decision was communicated to all dairymen in the borough, and there is reason to hope that during 1938 the sale in Kensington of milk in bottles which have not been scalded by steam will cease. Milk (Special Designations) Order, 1936.—This order revoked an earlier one and reduced the number of designated milks to three, namely, Tuberculin Tested, Accredited and Pasteurised. Tuberculin Tested.—The requirements for this grade are substantially the same as those formerly prescribed for Grade A (Tuberculin Tested) milk. It must be 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. A sample of this milk taken at any time before delivery to the consumer must satisfactorily pass a prescribed methylene blue reduction test and must not contain bacillus coli in one-hundredth of a millilitre. 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 requirements for this grade are similar to those formerly prescribed 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. 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 licences granted in 1937 were as follows :— Principal licences. Supplementary licences. Dealers' licence to bottle and to sell Tuberculin Tested milk 2 — Dealers' licence to sell Tuberculin Tested milk 15 3 Dealers'licence to pasteurise milk 1 — Dealers' licence to sell Pasteurised milk 48 8 (Note.—Supplementary licences enable the holders to sell graded milks in Kensington from premises situated outside the borough.) During the year 12 samples of Tuberculin Tested milk and 53 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, 1936, which are as follows :— Maximum no. of bacteria Standard for Grade. permitted per ml. bacillus coli. Tuberculin Tested No bacterial standard, but must conform Must not be found in to a prescribed methylene blue reduction l/100th ml. test. Pasteurised 100,000 No standard prescribed. The results of the examinations are shown in the following tables:— Tuberculin Tested Milk. Samples collected on Methylene Blue Test. Bacillus Coli. 16th March Satisfactory Absent. „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ ,, „ 26th May „ „ 17th August „ „ „ „ „ „ „ „ „ * Present in 1/100 ml. „ „ „ Absent. „ „ „ „ * In this case a warning letter was sent to the vendor. Pasteurised Milk. Samples collected on Bacteria per ml. Samples collected on Bacteria per ml. 7th January 13,000 21st April 1,700 „ „ 18,100 „ „ 650 „ „ 21,600 11th May 6,100 „ „ 24,000 „ „ 4,100 „ „ 17,200 „ „ 2,400 10th February 18,500 „ „ 11,600 „ „ 28,100 „ „ 960 „ „ 48,000 „ „ 1,280 „ „ 18,200 26th May 1,450 „ „ 4,600 „ „ 2,100 „ „ 52,200 14th July 450 „ „ 30,800 „ „ 1,900 18th February 6,200 „ „ 1,250 „ „ 7,200 „ „ 12,400 24th February 29,200 „ „ 17,500 „ „ 8,900 „ „ 1,090 „ „ 10,800 12th August 2,200 11th March 4,100 „ „ 54,000 „ „ 8,800 „ „ 16,800 „ „ 950 18th October 3,300 „ „ 22,600 „ „ 11,400 „ „ 6,300 „ „ 15,100 „ „ 3,600 „ „ 5,100 21st April 416,000 „ „ 4,800 „ „ 5,100 „ „ 7,500 „ „ 15,400 15th November 8,200 „ „ 7,300 The majority of the results show that these pasteurised milks had a low bacterial content. In only one instance was the count in excess of that laid down in the order. In this case the milk 47 48 was pasteurised on premises outside Kensington, and a letter calling attention to the unsatisfactory result was sent to the medical officer of health of the district in which the premises were situated. A warning letter was also sent to the vendor. 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 satisfactory standard reached in recent years was maintained in 1937. 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 seven samples of ordinary milk were taken at random from Kensington retailers. Four of these were examined by the "plate count "test, and in three cases the number of organisms present did not exceed the permitted number for pasteurised milk; the other sample contained 189,100 bacteria per ml. The remaining three samples were examined by the methylene blue and bacillus coli tests, and proved satisfactory. Phosphatase Test.—The phosphatase test for pasteurised milk was introduced a few years ago, and in 1936 was referred to by the Minister of Health in a circular letter addressed to local authorities. The test is based upon the fact that correct pasteurisation at 145-150° F. destroys one of the enzymes in milk. When a sample of milk is examined, therefore, the presence or absence of that enzyme proves whether or not the milk has been satisfactorily pasteurised. Even relatively small errors in pasteurisation technique are revealed by the test; and, moreover, the addition to pasteurised milk of as small a quantity as 0.3 per cent. of raw milk can be detected. In 1936 the council decided that a number of samples of milk should be examined by the test annually. During 1937, thirty-eight samples were so examined, but two of these were not sold as pasteurised milk, although they had undergone some form of heat treatment. Of the 36 samples of pasteurised milk, 32 passed the test satisfactorily; in three instances the result indicated slight error in pasteurisation technique ; and in one case the milk was reported to be either grossly underheated or raw. The milk in the latter case was stated to be pasteurised in another borough. A letter directing attention to the result of the test was sent to the medical officer of health concerned, as well as to the vendor of the sample. 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 and examines all carcasses immediately afterwards. During the year 22 slaughter-house inspections were made, 57 sheep being slaughtered. 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. There were two licensed slaughter-houses in Kensington during 1936, but in the latter part of that year one closed down. The licence in respect of the remaining one has been renewed for the twelve months ending the 30th June, 1938. 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 satisfies himself that humane methods are applied satisfactorily. The three licences granted by the council to slaughtermen in 1936 were renewed for a further twelve months in 1937. Bakehouses.—There are 80 bakehouses in the borough, and of this number 57 are underground. As a result of 219 inspections which were made during the year, 23 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 1937:— On register Dec. 31,1936. Added to register during 1937. On register Dec. 31.1937. Manufacturers of ice-cream 94 7 101 Storage and sale of ice-cream 153 46 199 Butchers' shops, including premises used for manufacture of sausages and the preservation of meat 103 8 111 Cooked meat shops 80 4 84 Fishmongers' shops—premises used for the purpose of cooking or curing fish (excluding fried fish shops) 19 1 20 Fried fish shops 44 2 46 Totals 493 68 561 49 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 made under this power have been in operation since 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 formerly contained in the London County Council (General Powers) Act, 1908. There were, in addition to the inspection of dairies, etc., mentioned above, 4,153 inspections of food premises during the year. Merchandise Marks Acts, 1887-1926. —Under section 2 of the Act of 1926, Orders in Council may be made prohibiting the sale or exposure for sale in the United Kingdom of imported goods specified, unless such goods bear an indication of origin. Orders which have so far been made in regard to imported foodstuffs relate to honey, fresh apples, currants, sultanas, raisins, eggs in shell, dried eggs, oat products, raw tomatoes, frozen and chilled salmon and sea trout, butter, bacon, ham, poultry, chilled beef, 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 in 193" but no offences were observed. 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. It was not found necessary to take any legal action under this section during 1937. 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 to the council for destruction as trade refuse. The unsound food surrendered and destroyed during the year is shown in the following list :— Bacon (lbs.) 19 Meat, canned (tins) 26 Beef (lbs.) 74 Milk, canned (tins) 8 Caviare (jars) 16 Pigeons 40 Fish, canned (tins) 15 Tomatoes (boxes) 40 Fruit, canned (tins) 567 Turkeys 3 Jam (jars) 6 Vegetables, canned (tins) 123 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. (а) 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 681, of which 21 or 2.9 per cent. were adulterated. (b) Informal Samples.—These are taken without compliance with the strict formalities of the Food and Drugs (Adulteration) Act, 1928, and serve to show the conditions obtaining without disclosing to the vendor the fact that the samples are being taken for analysis. 50 Particulars of formal and informal samples collected are as follows:— Nature of sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Almonds, ground 6 — 4 — Bacon — — 9 — Barley, pearl 1 — — — Brawn — — 7 — Butter 41 — 17 — Cakes, fairy 2 — — — Cakes, sponge 15 — — — Camphorated oil — — 6 — Candied peel 2 — — — Caviare — — 2 1 Cheese 11 — 4 — Cinnamon, ground — — 1 — Cherry ciderette — — 1 — Chicken and ham roll — — 3 — Chinese "chow-chow" — — 1 — Chocolate — — 1 — Cocktail — — 1 — Cocoa 8 — 9 — Coffee 11 — 3 — Coffee and chicory 1 — — — Coffee and chicory extract — — 1 — Coffee extract 2 2 2 2 Corned beef 3 — — — Cream 20 — 9 — Curry powder — — 3 2 Custard powder — — 3 — Dripping — — 4 — Egg substitute — — 1 — Fish paste 6 — 6 — Fish, tinned — — 9 1 Flour — — 3 — Flour, self-raising — — 3 — Friars balsam — — 3 — Fruit flavours — — 1 — Fruit pectin — — 1 — Fruit, tinned — — 11 — Golden syrup — — 3 — Gregory's powder — — 5 — Ham 3 — 3 — Honey 2 — 6 — Icecream 6 — — — Jam 7 4 21 7 Jelly, fruit — — 1 — Lard 20 — 4 — Lemonade powder — — 4 — Lemon curd — — 3 — Lemon squash — — 2 — Liquorice powder — — 3 — Margarine 18 — 7 — Meat paste — 9 — Meat pie — — 4 — Milk 379 6 10 — Milk, condensed — — 11 — Milk foam — — 1 — Milk pudding powder — — 1 — Mincemeat 6 — 3 — Mint sauce — — 1 — Mustard 3 — 7 — Olive oil - — 1 — Peaches, dried — — 1 — Peas, tinned — — 1 — Pepper 3 — — — Protargol — — 1 — 51 Nature of sample. Formal. Informal. Number taken. Number adulterated. Number taken. Number adulterated. Rice 9 — — — Rum butter — — 1 — Sausage roll — — 1 — Sausage meat 3 — — — Sausages 30 2 21 2 Soyolk — — 1 — Suet, shredded 4 — — — Sugar 6 3 9 2 Sweets 6 — 2 — Table cream — — 1 1 Tapioca 1 — — — Tea 10 — 5 1 Tomato puree — — 1 — Vanilla flavouring — — 1 — Vegetables, tinned — — 3 — Vinegar 30 3 17 — Vitacream — — 1 — Whisky 6 1 — — Wine, British — — 13 — Totals 681 21 319 19 The following is a summary of the results of analyses of the 40 adulterated formal and informal samples, together with a record of the action taken by the council:— Article analysed. Nature and amount of adulteration. Action taken. Caviare Contained 18•2 grains of boric acid per lb. Informal sample. Coffee extract Contained 13•9 per cent. of extraneous matter and only 4•2 per cent. of dry coffee extractives. No legal action. „ „ Contained 13•8 per cent. of extraneous matter and only 3•8 per cent. of dry coffee extractives. „ „ „ „ „ „ Informal sample. „ „ „ „ „ „ Curry powder Contained 30 parts of lead per million. „ „ „ „ Contained 24 parts of lead per million. „ „ Fish, tinned Was decomposed and unfit for food. 99 99 Jam (Blackcurrant) Was labelled full fruit standard but contained only 20 per cent. of blackcurrants. 99 99 „ „ „ „ 22 per cent. of blackcurrants. 99 99 „ „ „ „ „ „ „ „ „ „ 27 per cent. of blackcurrants. „ „ „ „ „ „ Vendor cautioned. „ „ „ „ 21 per cent. of blackcurrants. „ „ „ „ „ „ „ „ „ „ „ „ 20 per cent. of blackcurrants. „ „ 52 Article analysed. Nature and amount of adulteration. Action taken. Jam (Blackcurrant) Was labelled lower fruit standard but contained only 16 per cent. of blackcurrants. Informal sample. „ „ „ ,, 11 per cent. of blackcurrants. ,, ,, „ „ ,, ,, 11 per cent. of blackcurrants. ,, ,, Milk 30 per cent. deficient in fat Proceedings. Fined £1 and 10s. 6d. costs. „ 11 „ „ „ Proceedings. Fined £5 and £1 1s. costs. „ 7 per cent. extraneous water No legal action. „ 5•3 „ „ „ Proceedings. Fined £10. „ 5 per cent. extraneous water and 5•2 per cent. deficient in fat. Vendor cautioned. „ 3•3 per cent. extraneous water ,, ,, Sausages 320 parts of sulphur dioxide per million. Informal sample. „ 250 „ „ „ Vendor cautioned. „ 137 ,, „ ,, ,, ,, „ 64 „ „ „ Informal sample. Sugar, demerara 0•5 grain of lead per lb. No legal action was taken but these results were communicated to the Ministry of Health. „ „ „ „ „ „ „ „ „ „ „ „ „ 0•75 „ „ „ Table cream Consisted only of flavoured custard powder. Informal sample. Tea Sold as tannin free but contained 14 per cent. of tannin. ,, ,, Vinegar 7 per cent . deficient in acetic acid Vendor cautioned. „ Consisted entirely of artificial vinegar. ,, ,, „ „ „ „ ,, ,, Whisky 41•2 degrees under proof Proceedings. Fined £3 and £2 costs. The number of prosecutions under the Food and Drugs (Adulteration) Act was four. The fines and costs, amounted to £22 11s. 6d. Misleading and Deceptive Labelling.—During the year under review numerous cases of false or misleading labelling of foodstuffs were adversely commented upon by the public analyst. The following extracts from the analyst's reports for 1937 indicate a few of the various types of misleading descriptions met with :— Cherry Ciderette.—"This article consisted merely of a coloured and artificially flavoured beverage of the mineral water type and probably owed nothing to either cherries or cider." Milk Foam.—"The 'milk foam' consisted of an artificially coloured and flavoured kind of sherbet powder, mainly sodium bicarbonate, tartaric acid and sugar. The label on this was to my mind, as masterly in deception as any I have seen." Tea.—" One sample of tea was found to be quite an ordinary kind of tea, with a tannin content of 14 per cent., but bore the following false and deceptive label:— ' Health tea. No free tannin. No indigestion. Truly digestive as the injurious free tannin is eliminated by the process of manufacture Table Cream.—" A sample sold as' table cream ' consisted not of cream but of a vanillaflavoured custard powder. The name ' table cream ' is applied to cream of rather low fat content, just as is the term ' coffee cream,' and the dairy trade may be said to have established a right to the use of such a name. Its application to a custard powder is, to my mind, wholly unwarrantable ; it is calculated to mislead the purchaser and is a particularly glaring example of deceptive labelling." Vinegar.—" Twenty vinegars were reported genuine, but attention was directed in my reports upon two of them to the fact that the labels were not satisfactory. One bore the words 4 vinegar ' in large print and ' non-brewed ' in small print. As vinegar is essentially a brewed article, I am of the opinion that this name is merely a contradiction in terms. The other bore a label having the words ' pure table vinegar ' in large type and the word ' synthetic ' in very small characters, the latter apparently having been applied by means of a rubber stamp. In this case I expressed the opinion that, since the small overprinting was easily capable of being overlooked by any ordinary purchaser, this label was deceptive." 53 The Public Health (Condensed Milk) Regulations, 1923-27, and the Public Health (Dried Milk) Regulations, 1923-27.—During the year, eleven 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. The number of entries in the council's list on the 31st December, 1937, was 211 ; 204 of these were in respect of persons who had applied for renewal of their registration for the twelve months ending 30th April, 1938, and the remainder were new registrations. The Shops Act, 1934. This act requires a closer supervision of all shops than had hitherto been the case. Administration is divided 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 1936, 2,992 shops had been inspected. During 1937, a further 376 shops were inspected and 156 notices were served. The following is a summarv of the works which have been required:— 1935 1936 1937 Provision of additional water closet accommodation 88 25 16 Provision of lighting and ventilation to existing water closets 68 24 13 Repair of existing water closets 133 93 34 Provision of suitable and sufficient means of ventilation to the shop 55 38 13 Provision of suitable and sufficient means of maintaining a reasonable temperature in the shop 15 46 12 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. Thirty-four exemption certificates were granted in 1935, fifteen in 1936, and a further six in 1937. 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 following is a summary of the works required in shops under the Public Health Act:— 1935 1936 1937 Drains cleansed 1 6 12 Soil pipes, ventilating pipes, repaired 3 1 3 Waste pipes repaired 11 17 17 Yards and areas paved, drained, repaired 7 5 25 Dustbins provided 2 3 36 Accumulations of filth removed 12 22 40 Roofs repaired 4 10 19 Cleansing 111 79 117 54 THE PREVENTION OF, AND CONTROL OVER, INFECTIOUS DISEASE. Notifiable Infectious Diseases. The following diseases are compulsorily notifiable in Kensington:— Acute encephalitis lethargica. Influenzal pneumonia. Acute polio-encephalitis. Malaria. Acute polio-myelitis. Membranous croup. Acute primary pneumonia. Ophthalmia neonatorum. Acute rheumatism. Plague. Anthrax. Puerperal fever. Cerebro-spinal fever. Puerperal pyrexia. Cholera. Relapsing fever. Continued fever. Scarlatina or scarlet fever. Diphtheria Smallpox. Dysentery. Tuberculosis. Erysipelas. Typhoid or enteric fever. Glanders. Typhus fever. Hydrophobia. Zymotic enteritis. Table showing Notifications of certain Infectious Diseases received in 1933-37. 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. 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 59 999 1936 — 289 142 8 66 12 13 21 177 2 — 3 48 6 7 78 872 1937 — 233 193 14 72 8 11 35 216 3 — 8 52 3 64 84 996 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 during the year, arranged in Four-Weekly Periods (2nd January, 1937, to 1st January, 1938). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. sipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Malaria. Encephalitis lethargica. Polio myelitis. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Total. January 30 - 16 18 - 7 - 2 1 73 - - - 5 2 7 2 133 February 27 - 31 20 1 5 - 2 2 21 - - 2 6 - 1 2 93 March 27 - 23 36 - 7 l - 2 11 1 - - 5 - - 2 88 April 24 - 26 22 - 10 - - 1 12 - - - 3 - - 5 79 May 22 — 16 19 1 8 1 — 2 15 - — - 3 1 - 5 71 June 19 — 19 15 - 8 2 — 2 14 - - — 1 - - 12 73 July 17 - 15 12 3 2 2 1 3 9 - - 1 5 - - 6 59 August 14 - 13 6 - 4 1 - 3 6 - - - 1 - - 9 43 September 11 - 13 7 3 5 - 2 3 8 1 - 1 5 - 1 5 54 October 9 - 15 11 - 2 - 2 3 2 - - 3 2 - 4 12 56 November 6 - 16 6 1 2 - 1 6 5 - - - 7 - 7 15 66 December 4 - 18 14 4 6 - 1 3 15 1 - 1 7 - 27 5 102 January 1 — 12 7 1 6 1 — 4 25 — - — 2 - 17 4 79 Totals — 233 193 14 72 8 11 35 216 3 - 8 52 3 64 84 996 Cases of mistaken diagnosis are excluded from the above table. 55 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 1937. 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. Pem bridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 2. 2 to 3. 3 to 4. 1 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 233 — 7 19 23 31 67 29 14 35 2 5 1 77 38 30 29 18 13 5 14 9 228 2 Diphtheria (including membranous croup) 193 6 16 21 21 24 55 16 11 17 3 3 — 68 45 30 26 7 2 6 5 4 190 4 Enteric fever 14 — — — 1 — — 2 3 4 2 2 — 2 — 6 1 2 1 1 1 — 12 2 Puerperal fever 11 — — — — — — — — 8 3 — — 2 3 3 2 — — 1 — — 11 2 Puerperal pyrexia 35 — — — — — — — 4 26 4 1 — 8 7 4 3 5 2 — 6 — 33 — Primary pneumonia 140 16 6 16 6 9 13 8 8 17 9 21 11 20 69 16 5 7 9 3 8 3 80 47 Influenzal pneumonia 76 2 2 3 1 1 1 — 7 17 6 21 15 12 31 3 8 5 5 3 6 3 39 36 Dysentery 64 6 4 6 10 8 16 4 3 6 1 — — 31 10 10 2 6 2 — 2 1 57 1 Erysipelas 72 1 — 1 1 — 2 5 4 12 13 22 11 18 13 12 2 8 6 7 5 1 46 3 Encephalitis lethargica — — — — — — — — — — — — — — — — — — — — — — — 1 Cerebro-spinal meningitis 3 1 1 — — — — — 1 — — — — — — — 2 — 1 — — — 3 3 Polio-myelitis and polio-encephalitis 8 — 2 1 3 - 1 1 - - - - - - 2 - 1 2 - 1 2 — 6 1 Pulmonary tuberculosis 202 — 1 1 — 1 4 3 21 100 19 44 8 48 27 26 22 19 19 9 27 5 190 114 Other forms of tuberculosis 51 2 3 3 1 1 10 10 3 11 2 3 2 17 10 11 3 5 2 — 3 — 50 16 Ophthalmia neonatorum 8 8 — — — — — — — — — — — 1 2 2 1 — — — 1 1 5 — Malaria 3 — — — — — — — — 1 2 — — — — 1 — — — — 1 1 3 — *Enteritis (diarrhoea) 84 50 24 7 3 — — — — — — — - 21 32 14 1 3 1 4 7 1 32 47 † Acute rheumatism 52 — — — — 1 24 24 3 — — — — 21 18 7 3 — — 1 1 1 14 — Totals 1,249 92 66 78 70 76 193 102 82 254 66 122 48 346 307 175 111 87 63 41 89 30 999 279 * Notifiable only in children under the age of 5 years. † ,, ,, ,, ,, ,, 16 ,, Cases of mistaken diagnosis are excluded from the above table. Smallpox.—During 1937 no case of smallpox occurred in London, and nobody who had been recently in contact with this disease came to live in Kensington. Scarlet Fever.—The number of cases notified was 251, but after observation in hospital 18 were found not to be suffering from scarlet fever. It will be seen from the first table on the previous page that there has been a decline in the incidence of this disease since 1933, and the number of notifications received during 1937 is only 38 per cent. of those received during 1933. The character of the disease was generally mild, and the mortality rate was 0.9. Of the total number of cases notified, 246 were removed to hospital. Three 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 three 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. Diphtheria.—-Two hundred and twenty cases of diphtheria were notified. Two hundred and seventeen patients were removed to hospital, but 27 of these were subsequently found not to be suffering from diphtheria and were returned home after the acute illness had subsided. There were 14 instances where more than one case occurred in the same house. The number of deaths from diphtheria was four, which represents a case mortality of 2.0. In the three preceding years the deaths were 29, 19 and 11, the respective case mortality rates being 4, 6 and 7.7. 56 During the year 1,669 throat swabs were examined at the council's laboratory at Princess Louise hospital, and 22 of these showed the presence of the diphtheria bacillus. Nine cases of diphtheria were reported from St. Mary Abbots hospital, 66 from St. Charles hospital, and 21 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. 11, or from the public health department at the town hall. The antitoxin is obtainable at all hours of the day and night from Mr. Evans's and Mr. Reeves's premises, and during office hours from the town hall. When the town hall is closed, applications for antitoxin can be made to Mr. Britton, an officer of the department, who lives at No. 1, Hornton Place, 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 1937 the borough council supplied 116,000 units of anti-toxin for 11 patients at a cost of £7 8s. Od. 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 1937. From the introduction of the scheme in 1934 to the end of 1937 the number of children immunised has been 3,557. 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 93, of which number 58 gave a positive reaction. The number of children who were presented for Schick testing after having received immunising inoculations totalled 523 ; of this number 453 proved negative, 36 remained positive, and 34 failed to reattend for the reading. It is unfortunate that the total number of children immunised during the year was only 614, 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 spoke on this subject at welfare centres, clubs and so on ; the council have purchased a diphtheria immunisation film which the health lecturer showed as often as possible; and all members of the staff were constantly bringing the advantages of this preventive measure to the notice of parents with whom they came in contact. Enteric Fever.—Fourteen cases of this disease were notified, five being in South Kensington and nine in North Kensington. Twelve of the patients were removed to hospital. There was a small outbreak of five cases, and two of the patients died. These five cases occurred in two tenement houses in North Kensington and the number of intimate contacts was 41. As the opportunity for spreading the disease in these two houses was considerable, the most thorough measures to prevent such spread were taken. This included the prophylactic inoculation of 37 contacts with Felix's anti-typhoid serum in order to confer passive immunity and immediate protection. This is the first time that this serum has been used for such a purpose, although it has been in use in the actual treatment of typhoid fever in different parts of the world during the last three years. No case occurred among those who were thus protected. Of the remaining cases one occurred in a nurse who had been in professional attendance on a case of enteric fever contracted in the Croydon area, where there had been an epidemic. The other eight cases were all of the sporadic type. The two deaths mentioned above were the only ones to occur during the year. Erysipelas.—Seventy-two cases were notified, 46 of these being removed to hospital. There were 3 deaths from this disease, as compared with 7, 3 and 5 in the three preceding years. 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. 1937 1 Feb. 23 — Yes Yes — — — 2 May 8 Yes — Moved away to another borough 3 May 21 — Yes Yes — — — 4 June 11 Yes — Yes — — — 5 June 29 — Yes Yes — — — 6 June 29 — Yes Yes — — — 7 July 22 — Yes Yes — — — 8 Dec. 13 Yes — Yes — — — 57 From the above table, it will be seen that seven cases recovered without any injury to sight ; and one case moved to another area before treatment had been completed. Puerperal Fever.—Eleven cases of this disease were notified and all were removed to hospital. In nine instances the patient recovered, and there were two deaths. Puerperal Pyrexia.—Thirty-five cases of this disease were notified, 27 of the patients being confined in hospital and eight in their own homes. Six of the eight 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, Dr. 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. Two hundred and sixteen notifications were received during the year, 140 patients being certified as suffering from acute primary pneumonia and 76 from influenzal pneumonia. The number of deaths from pneumonia was 169, and 100 deaths were certified to be due to influenza. Malaria.—Three cases of this disease were notified ; investigations revealed that in two instances the disease had been contracted abroad, and in the third case malaria had been induced for therapeutic purposes. Acute Rheumatism.—Fifty-two cases were notified. The ninth annual report on the working of the rheumatism scheme during the period 1st October, 1936, to 30th September, 1937, prepared by the medical officer of health and the physician in charge of the rheumatism centre, appears as appendix I to this report. Cerebro-spinal Meningitis.—Three cases of this disease were notified, two of the patients being females aged 4 months and 14 months, and the other a male aged 18 years. Two of the patients left Kensington, and it is not known whether they recovered completely. The third patient died. Dysentery.—Sixty-four cases of dysentery were notified. One was of the amoebic type and the rest were bacillary in origin. The majority of these cases were due to the Sonne bacillus. There has been an increased incidence of dysentery due to this type of organism during the year. Many of the cases notified followed bacteriological examinations of the faeces in very slight cases of diarrhoea in children. These examinations were performed at the request of medical practitioners who had been notified that a number of Sonne dysentery cases had occurred, and been asked to be on the look out. In addition a number of persons harbouring the Sonne bacillus, who gave no history of intestinal upset, were discovered as a result of examinations of the faeces of contacts. It seems probable that there are many carriers among the normal healthy population, and in other years some cases of mild Sonne dysentery have probably gone unrecognised. The cases were of a mild type but there was one death. Zymotic Enteritis or Summer Diarrhoea.—Eighty-four 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 47 deaths certified as due to diarrhoea, etc., and of these there were 39 children under one year of age. Ten 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 four 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 84 notified during the year 30 were classed as severe and 54 as mild. Fifty-one cases occurred in infants under one year of age, and 33 in infants aged one year and over. In seven instances there were 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 :— " During the year 1937 I attended 65 cases in their own homes and paid 550 visits. Two cases were removed to hospital and there died ; these were the only deaths that occurred amongst the cases I attended. I was consulted from time to time by doctors in the borough in regard to cases which showed unusual symptoms. I saw a few cases of real zymotic enteritis with high temperatures, but these all responded to treatment and were kept at home. A considerable number of cases of diarrhoea and vomiting occurred amongst infants who were being weaned too rapidly owing to their mothers having to go out to work. The mothers did not allow sufficient time for satisfactory weaning to take place. 58 A number of artificially fed infants were over-fed, particularly those having dried milk. Some of them put on a pound in weight weekly. Cases of vomiting occurred where the child was not ill and did not require routine treatment, but had contracted a ' habit of vomiting ' ; some of these were cured by giving drugs, and others by allowing them to suck Nestles milk from a spoon, this was followed in two and a half hours by giving the patient a bottle of water. The increase in the number of cases attended by myself is partly due to the doctors at welfare centres requesting me to examine cases of dyspepsia with slight vomiting and diarrhoea. I think this is a good rule to adopt as these patients are easily cured. The majority of cases of diarrhoea and vomiting were due to dietetic causes. I have worked in close co-operation with the Council's medical officers, and when I have ceased attending cases I invariably forward to them my notes. 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 139 cases, the total number of visits paid being 1,408. Seventeen of the cases did not respond to home nursing, and these were admitted to hospital, where four died. Since 1924, 1,351 cases have been attended by the nurses, and the total number of deaths amongst these is 50, making a case mortality rate of 3 7 per cent. Poliomyelitis and Polio-encephalitis.—Nine cases of this disease were notified during the year, four of the patients being females aged If, 4, 5 and 6½ years and five males aged 1, 2, 2½, 3 and 11 years. In one case the diagnosis was not confirmed; six cases are still receiving treatment, and two 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.—There was one death from measles in Kensington. The women health officers paid 104 visits to measles patients. One hundred and six cases were removed to the London county council hospitals. Whooping cough.—There were five deaths from this cause. The deaths in the three preceding years were 36, 3 and 13. The women health officers paid 175 visits to cases of this disease. The number of cases admitted to hospitals from Kensington was 92. 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 1937. 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 88 249 56 56 — — 6 12 Other boroughs 138 374 13 13 — — 3 8 School Children. Kensington 184 532 3,318 3,318 199 790 — — Other boroughs 104 291 519 519 13 62 — — Children under 5. Kensington 21 56 18 18 — — — — Other boroughs 10 30 2 4 — — — — Lodging-house cases — — 139 139 — — 456 456 Totals 545 1,532 4,065 4,067 212 852 465 476 59 The total number of persons cleansed during the year was 5,287 ; the total cleansings numbered 6,927. This shows a considerable increase over the figures for the previous year, which were 4,029 and 5,658 respectively. 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 16,031 articles were so dealt with and, in addition, 449 blankets and sheets, and 357 articles of night clothing. Of the 4,337 school-children cleansed at the medicinal baths, 534 were compulsory cases ; the remainder attended voluntarily. Disinfestation. The activities of the public health department in regard to disinfestation may be divided into two branches. The first is the treatment of vermin-infested houses, and the second the treatment of verminous furniture. Treatment of Verminous Dwellings. For some time past the officers of the department have been actively engaged in the search for 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 a highly effective method of treatment has been evolved with the use of a substance known as washed heavy naphtha. This substance is a complex mixture of aromatic hydrocarbons with their associated bodies, and the major constituents are pseudocumene, mesitylene, tetramethyl-benzene, cumarone and indene ; small amounts of naphthalene, thiopen and methylpyridenes are also present. The constituent, or mixture of constituents, which is lethal to the bed-bug is not at present known. Pathological tests carried out at the University College Medical School indicate that danger to man from the use of the substance is not to be apprehended. Washed heavy naphtha is simple to apply, and the method adopted for house fumigation is briefly as follows :—The house is pre-heated by means of portable primus stoves. The windows, fire-places, etc., are sealed with a stout paper. Then, in order to counteract any loss of vapour by diffusion through the fabric of the structure of the dwelling and by absorption in building materials, screens of cotton fabric are fixed right round the rooms of the dwelling. Furniture is brought away from the walls and the whole of the cotton fabric thoroughly wetted with the naphtha, which is applied with a knapsack spray. The house is kept sealed for 24 hours, and then ventilated. The rate of desorption of the vapour is rapid, and the rooms are fit for habitation after being ventilated for a few hours. The number of premises treated with naphtha during 1937 was 373, the total number of rooms being 1,069. Ninety-four borough council houses were treated with naphtha. The results appear to be satisfactory, and only in 27 cases was a second application necessary. These failures occurred chiefly in the early days, while the technique was being perfected. The council's clearing house at Seymour King Buildings was used to re-house temporarily families displaced while their houses were being treated with naphtha. Altogether, 101 families were temporarily re-housed in this way. The treatment of slight infestations. The council do all in their power to help persons who find that their houses are slightly buginfested, and the council's workmen treat such premises either by burning sulphur or, more frequently, by applying a light contact spray. In some cases a small spray apparatus charged with insecticide is loaned to poor persons, and instruction is given in its use. During the year 494 premises were treated with sulphur or with a light spray, 832 rooms in these premises being affected; and 1,024 articles were taken to Wood Lane to be treated in the steam disinfectors. 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 condemned houses to houses hitherto free. To avoid this possibility all infested houses are disinfested by thorough application of " Keritox " 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 ensure that all the hydrogen cyanide has been extracted, after which the furniture and bedding are transferred to the new home. The entire process 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 ; this is done because it has been found difficult to render these articles entirely free from all traces of hydrogen cyanide in four hours. 60 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 frequently ask 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 is 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 of furniture carried out during the year. Number of families whose furniture was transferred by the council from old to new homes 541 Number of loads treated with hydrogen cyanide 505 The weight of furniture removed and treated with hydrogen cyanide was 638 tons 15 cwts. The bedding in connection with the above removals weighed 48 tons 18 cwt. 0 qr. 20 lbs., and this was treated by steam at the council's disinfecting station. The articles treated by steam were as follows:— Mattresses and flock beds 1,956 Bolsters and pillows 3,440 Quilts 830 Blankets and sheets 2,393 Sundries 1,709 10,328 The following table gives the bodies for whom removals were undertaken during the year :— Kensington Borough Council 65 Kensington Housing Trust 123 Peabody Donation Fund 140 Sutton Trust 95 Improved Tenements Association 44 Aubrey Trust 3 Capitol Housing Trust 46 Church Army 24 Charity Organisation Society 1 During the past few years the council have entered into contracts with 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. During 1937, however, the council were too busily engaged with removals in their own area to be able to allow much use of the disinfestation service by the authorities mentioned above. Foot Holborn families and one family from St. Marylebone were moved; these removals comprised six loads of furniture. The weight of the furniture removed for these boroughs was 5 tons 15 cwt.; and 76 articles, weighing 6 cwt. 0 qr. 27 lb., were treated by steam at the council's disinfecting station. Inspections and re-inspections of premises. The officer in charge of disinfestation, in addition to supervising the work outlined above, paid 2,030 visits during the year and served 25 notices. He also spent a considerable amount of time in research work. Disinfection after Infectious Diseases, etc. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1937. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Scarlet fever 252 277 288 4,419 Diphtheria 181 191 188 2,473 Typhoid fever 25 87 33 2,217 Para-typhoid fever 6 6 8 49 Measles 109 117 9 111 Consumption 187 211 206 1,793 Cancer 44 56 60 439 Other diseases 647 739 541 6,458 Totals 1,451 1,684 1,333 17,969 This table does not include the work carried out at Wood Lane on behalf of the Paddington borough council. 61 The total weight of the bedding, clothing, etc., of Kensington residents disinfected was 34 tons 18 cwt. 3 qr. 2 lb. The number of articles disinfected only was 16,856 and the number disinfected and washed, 1,103. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved the washing of 10,658 towels, 354 sheets and 188 other articles. The Paddington authority have 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 is 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 7 cwt. 3qrs. 19 lb. The number of articles disinfected only was 6,447 and the number disinfected and washed was 1,761. 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 88. The number of private subscribing library books destroyed was 50, and the number disinfected by formalin and returned to the householders was 19. 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 of the records of the borough bacteriologist, who examines a large number of specimens of sputum, etc., for general practitioners. It was recorded in last year's report that a survey of the records over a series of years appeared to show a greater percentage of cases coming to light as a result of a study of the death returns than had been the case in previous years. Whilst in 1937 there was still a large number of cases first brought to the notice of the medical officer of health after death, the majority of these cases were actually persons of no fixed abode who had received treatment for tuberculosis in other parts of the country and had been admitted to hospitals in Kensington within a short period prior to their death. The returns do not show that there is any delay upon the part of the medical practitioners with regard to diagnosis and notification of cases under their care. Indeed, the increasing number of cases sent to the dispensary for examination with a view to diagnosis and found to be non-tubercular seems to point to a greater realisation upon the part of the general practitioners for the need of all the facilities which are available at the tuberculosis dispensary for the investigation of their cases. 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 bv the council. The following table shows the number of cases of tuberculosis in the various parts of the borough on the 31st December, 1937, and the number of cases notified for the first time during the year :— Cases in the borough on 31st December, 1937. New cases notified during 1937. The Borough 690 236 North Kensington 458 151 South Kensington 232 85 Wards. St. Charles 168 60 Golborne 125 33 Norland 96 33 Pembridge 69 25 Holland 46 23 Earls Court 47 19 Queens Gate 24 9 Redcliffe 88 30 Brompton 27 4 62 During 1937 there was again an increase in the number of new cases notified as compared with 1936, and the following graph shows the general trend since 1926. 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 - - 1 1 - 2 1 1 1-5 3 — 6 2 — - 1 1 5-15 5 1 5 13 - - 2 - 15-25 22 38 1 7 5 8 - 1 25-35 29 25 2 0 14 15 1 1 35-45 9 10 1 1 7 8 1 1 45-55 16 6 1 — 12 7 1 - 55-65 11 6 1 1 12 8 2 1 65 and over 4 4 1 1 8 8 — 1 Totals 99 90 19 28 58 56 9 7 When the above table is compared with last year's figures, it shows there has been a definite increase in the number of new cases in the male age groups 15-25 and 25-35 years. In the females there is also an increase in the age group 15—25 years. There is no doubt that this increase in the number of notifications is partly accounted for by the more thorough investigation of illness, with the result that many cases hitherto undiagnosed are being found, by the application of modern methods, to be tuberculous; and partly by the epidemic of influenza in the early part of the year which brought new cases to our notice. Contact examination also brings to light a certain number of cases, especially in the latter years of life, which would probably have otherwise remained unrecognised. The discovery of these cases, although increasing the number of notifications, brings to light reservoirs of infection from which the younger members of the community may be infected ; it makes it possible for the patients to be segregated and so removes the risk of infection to others. 63 The following table shows the sources of the new notifications during the year:— Cases. Brompton Hospital 27 St. Charles Hospital 26 St. Mary Abbots Hospital 16 Hospitals and sanatoria other than above 70 Total cases notified by hospitals 139 General practitioners 85 Tuberculosis officer 12 It will be noted that 59 per cent. of the cases are notified from hospitals or allied institutions. In the case of Brompton Hospital, however, from which 27 primary notifications were received during the year, most of these cases were sent by medical practitioners to the out-patient department for diagnosis or were admitted to the wards from the tuberculosis dispensary as observation cases. 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, 1937 235 255 96 88 674 Cases notified for the first time during the year 100 89 19 28 236 Cases brought to notice otherwise than by notification 46 44 12 8 110 Cases removed from the register during the year on account of having:— (a) recovered from the disease 12 15 16 16 59 (b) removed from district, lost sight of, etc. 47 56 16 19 138 (c) died 57 60 10 6 133 Cases remaining on the register on 31st December, 1937 265 257 85 83 690 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. 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. 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 1937 114 65 16 9 130 74 During the year there has been a slight increase in the number of deaths registered as compared with 1936. The influenza epidemic at the beginning of the year, which has already been noted, seems to have been a major factor in bringing this about, but there is no reason to believe that the 64 gradual fall which has been occurring steadily for many years will not continue. The age group which has shown the least decline in latter years is the female age group 25-35 years. This is an observation which is general throughout the country and appears to be due to the change in the habits of women of this age. More are in employment during the day than used to be the case, and the still fashionable slim figure, and consequent reduction in diet of the individual in order to attain this, is no doubt a factor in the failure of this age to show the fall which has occurred in the other age groups. Deaths from Tuberculosis in 1937 Allocated to District of Usual Residence of Patients. Respiratory tuberculosis. Non-respiratory tuberculosis. The Borough 114 16 North Kensington 73 9 South Kensington 37 7 No fixed abode 4 - Wards. St. Charles 29 3 Golborne 15 3 Norland 17 2 Pembridge 12 1 Holland 7 2 Earl's Court 10 2 Queen's Gate 4 2 Redcliffe 12 1 Brompton 4 — The places where the deaths from tuberculosis occurred are set forth in the following list:— Respiratory tuberculosis. Non-respiratory tuberculosis. Patient's home 29 3 St. Mary Abbots Hospital 6 2 St. Charles Hospital 37 — Brompton Hospital 4 — Other institutions 38 11 Seventy-six 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 Brompton Hospital, 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 tuberculosis health officers visit all notified cases at frequent intervals. Some notified cases do not require or desire public medical treatment, and in these 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 85 per cent. of all cases notified. 65 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 1937 1937 Previous to 1937 1937 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. 12 11 9 — 20 - - - - - 10 1 2 3 16 - - - - - F. 10 4 8 — 12 — — — — — 2 1 2 4 9 — — — — — Children 7 - - - - - - - - - 7 4 2 11 24 - - - - - Disease not arrested Adults M. 14 8 72 9 89 20 13 27 1 41 5 — — 1 6 1 — — 1 2 F. 32 13 67 14 94 21 15 19 1 35 7 3 3 3 16 2 2 3 4 11 Children 7 5 1 — 6 7 1 1 — 2 20 6 3 7 36 7 4 2 11 24 Condition not ascertained during the year 6 4 3 — 7 - - - - - - - - 2 2 - - - - - Total on dispensary register at 31st December, 1937 88 45 160 23 228 48 29 47 2 78 51 15 12 31 109 10 6 5 16 37 (b) Not now on dispensary register and reasons for removal therefrom Discharged as recovered Adults M. 168 25 5 — 30 — — — - — 8 1 1 11 21 - - - - - F. 303 20 13 — . 33 — — — - — 18 10 2 17 47 — — — — — Children 407 3 — — 3 — — — - — 42 18 9 223 292 - - - - - Lost sight of, or otherwise removed from dispensary register 1716 310 239 62 611 15 2 11 1 14 140 62 33 228 463 1 1 2 5 9 Dead Adults M. 158 91 228 349 668 1 — 2 9 11 5 2 5 1 13 1 — — — 1 F. 231 123 183 215 521 2 1 1 10 12 4 5 2 1 12 — — — — — Children 74 13 5 8 26 2 — — - — 6 3 4 15 28 1 1 1 — 3 Total written off dispensary register 3057 585 673 634 1892 20 3 14 20 37 223 101 57 499 880 3 2 3 5 13 Grand totals 3145 630 833 657 2120 68 32 61 22 115 274 116 68 527 985 13 8 8 21 50 66 Of the cases entered on the dispensary register previous to 1937, 38 were removed as recovered and 49 owing to the death of the patient during the year. Of the cases arising during 1937, 32 or 13 per cent. died before the end of the year. The dispensary is also a centre for reference of doubtful cases for investigation, and the majority of the new cases were referred by general practitioners ; others were sent by school medical officers and the various charitable institutions. A certain number, who had no private doctor, came of their own accord. 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 220 361 119 126 826 New cases with respiratory tuberculosis 79 82 9 3 173 New cases with non-respiratory tuberculosis 6 13 13 17 49 New cases still under observation 1 4 — - 5 New cases diagnosed as nontuberculous 134 262 97 106 599 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 715 specimens of sputum, etc., were examined. In recent years the diagnosis and control of the disease has been measured with greater accuracy owing to advances in radiography. X-ray facilities are provided by arrangement with the London county council, at St. Mary Abbot's hospital and St. Charles hospital, and during the year 768 radiological examinations were made. There has been a considerable increase in the use of radiological methods during the year as compared with 1936 when 516 X-rays were carried out and a still greater increase as compared with 1935 when 190 such examinations were made. The X-ray films are sent from the two hospitals to the dispensary where they are interpreted by the tuberculosis officer in conjunction with his clinical findings in each case, as this is an arrangement which is generally recognised as more valuable than the separate opinion of a radiologist who has not the benefit of being able to correlate the results of the physical and radiological examinations. A large number of the cases coming to the dispensary are ultimately diagnosed as non-tubercular and are referred back to their own doctors or to other institutions for further investigation and appropriate treatment. During the year 75 cases were added to the dispensary register because of their removal into the borough, as compared with 68 cases in 1936; whilst 110 cases were removed from the register because of their transfer out of the district. This tendency to migration has already been noted as a difficulty in maintaining the supervision of the cases and of their home contacts in this area. The examination of contacts has been one of the important functions of the dispensary service since its commencement. A contact is a person who has been living or working in close association with a known case of tuberculosis, but who does not necessarily manifest symptoms. The growth of the school medical service and of the infant welfare branch of the public health department 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 at 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. It was ascertained that there existed 454 contacts of the new cases arising in 1937, and of these 237 were examined at the dispensary, 42 by their own doctors, 6 by school medical officers, 20 by medical officers at infant welfare centres and 15 at various hospitals; 134 or 34 per cent. failed to undergo an appropriate examination. Of the total number of contacts examined at the dispensary during the year 7 were found to be suffering from tuberculous disease. During the year 3,395 visits were paid by the women health officers. Since 1st April, 1937, two whole-time tuberculosis health visitors have been assigned to this work instead of as in the past 67 each health visitor of the council having a district in which she was responsible for the whole of the health services. The new arrangement allows the two health officers to specialise in the tuberculosis visiting and leads to a greater interest in the tuberculosis service than was possible under the former arrangement when the visitor had so many other calls upon her time. It also allows closer co-operation between these visitors and the tuberculosis officer who accompanies them on many of their visits. The number of home visits has increased as a consequence of the change from 2,324 in 1936 to 3,395 in 1937. 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 1937. The following table shows the work carried out during the year :— Number of patients treated 13 Number of extractions 12 Patients'attendances 62 Number of dentures 10 Number of fillings 1 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 in this category is the refills necessary with artificial pneumothorax treatment. This treatment entails the collapse of the affected lung by introducing air into the pleural cavity and thus enables the lung to be temporarily put out of action and rested until firm healing has taken place, when the lung is once more allowed to re-expand and function in a normal manner. Air has to be introduced in this fashion at intervals of approximately once a fortnight, to maintain the collapse. Most of the patients attend Brompton hospital for their refills, 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. During the year 34 patients were undergoing this treatment and received 659 refills. Gold Therapy. Sanocrysin treatment is frequently used in certain cases which are unsuitable for collapse therapy or in patients who have had one lung collapsed and whose other lung shows infiltration. It enables the clinician to treat the disease in the contralateral lung whilst the collapsed lung is healing. The council accept financial responsibility for the cost of this treatment in out-patients. Artificial Light Treatment. Artificial light therapy is available for any cases which will benefit by it. The cost of such treatment is borne by the council. Housing. Tuberculosis has always been associated with bad housing conditions ; and, with the general improvement in the housing standards, there has been a concurrent reduction in the incidence of the disease. When tuberculous persons are found to be living in unsuitable conditions, and especially where there is any difficulty in the patient having a room to himself, every endeavour is made to re-house the family. These families are referred either to the council's housing department or to the London county council for alternative accommodation, and preferential treatment is given to them. Bed and Bedding. The council provide 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, the object being to provide the patient with a separate bed and bedroom as this 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 1937, 39 patients had assistance under this heading for varying periods. The following is a list of the articles lent :— Bedsteads 29 Mattresses and covers 30 Pillow-slips 61 Pillows 59 Blankets 77 Sheets 94 Quilts 29 On 31st December, 1937, the following articles of bedding were on loan to 19 patients :— Bedsteads 14 Mattresses and covers 14 Pillow-slips 32 Pillows 29 Blankets 38 Sheets 40 Quilts 16 68 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. Patients awaiting admission to a sanatorium, or who have some intercurrent disease lowering their resistance, also require extra nourishment. During the year 89 patients received grants of nourishment for varying periods. Residential Treatment. There has been no financial obligation on the patients or their dependents 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. In addition the number of beds available has increased and the variety of hospitals, sanatoria and colonies has assisted in encouraging the patients to remain for longer periods under treatment, this being essential even in the early stages of the disease. Methods of treatment have also improved in recent years and 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, 1937, 140 patients on the dispensary register were undergoing residential treatment in hospitals, sanatoria or colonies. During the year, 301 cases were admitted, 228 cases were discharged and 60 died in institutions. Of the patients discharged, 95 had been in hospital under three months, 85 three to six months, 36 six to twelve months, and 12 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. 1933 23 1,259 1934 32 1,319 1935 24 1,001 1936 23 920 1937 13 1,595 The nurses carry out their work splendidly and are very much appreciated. Care Committee. In 1922 the council established a tuberculosis care committee, whose primary duty is to undertake the care and after-care of patients suffering from tuberculosis. Prior to July, 1934, a considerable portion of the work of the committee was the assessment of patients undergoing residential treatment, but from that date assessments were abolished. The council appreciate the co-operation of the representatives of the voluntary associations in their work of supervising the after-care of tuberculous persons. General. Eighty-five per cent, of the cases of tuberculosis in Kensington are dealt with under the council's scheme ; 66 per cent, of those persons who came 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. I have the honour to be, My Lord, Ladies and Gentlemen, Your obedient Servant, JAMES FENTON, Medical Officer of Health. 69 APPENDIX I. TENTH ANNUAL REPORT on THE KENSINGTON RHEUMATISM SCHEME (1st October, 1936—30th September, 1937) by JAMES FENTON, M.D., M.R.C.P., D.P.H., and JANET K. AITKEN, M.D., M.R.C.P. PART I. General by JAMES FENTON, M.D., M.R.C.P., D.P.H. The tenth year of work at the rheumatism centre of the Royal Borough of Kensington was completed on the 30th September, 1937. The functions of this centre are to assist in the early diagnosis of rheumatism in children (the early treatment of this disease being of paramount importance), and also to compile statistics with a view to determining etiological factors and thereby assist in the prevention of rheumatism. 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 and 1933. On the 1st October, 1936, the Minister of Health made new regulations for a further period of three years. The regulations define acute rheumatism as denoting the following conditions, occurring separately or together, in a child under the age of sixteen years :— (a) Rheumatic pains or arthritis, if accompanied by a rise in temperature; (b) Rheumatic chorea; (e) Rheumatic carditis. Response to Notification. Detailed particulars in regard to notification over a period of 10 years are given below:— Year. NUMBER OF NOTIFICATIONS BY— Total number of notifications. Total number of patients notified during 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 1936-37 10 27 8 12 57 30 Totals 142 329 75 150 696 405 Incidence of the disease. It will be seen from the above table, that there has been a marked increase in the number of notifications received during the past year, compared with that for the preceding two years, but a study of the table will show that this increase has occurred at regular three-yearly intervals over the ten-year period. It coincides with the years in which new regulations have been made by the Minister of Health and may be attributed to the fact that in these years reminders in regard to notification have been sent to all medical practitioners in the borough. These reminders invariably result in increased notification, particularly from school medical officers and from medical officers of institutions to whom these local regulations are not familiar. 70 Epidemiology. As in previous years, an effort has been made, both at home visits and at the supervisory centre, to ascertain factors in the causation of the disease. Particular attention has, during the year, been paid to the question of diet. Details of this investigation will be found in part II of this report. Co-operation of the public. During the National Health Campaign, which opened in September last, great stress was laid on the necessity for co-operation on the part of the public in order that the fullest use might be made of the various health services. In this connection, it is pleasing to be able to report that the parents of rheumatic children are taking increasing advantage of the facilities for diagnosis and treatment provided at the supervisory centre. In the past, they have brought their children to the centre only when asked to do so, but recently, many, realising the importance of intercurrent symptoms, have returned before the date appointed, thus helping to prevent the serious consequences which, in this disease, so often result-from neglect of minor symptoms. Residential treatment of rheumatism. Hospital accommodation. Four beds are reserved at the Princess Louise hospital for the treatment of rheumatism, and extra beds are available when required. In addition, cases are admitted for treatment to other hospitals in the borough. Convalescent homes. Adequate facilities for convalescence have again been available ; the necessary arrangements being made through the Invalid Children's Aid Association, or under the London county council's rheumatism scheme. Report on the Social Work of the Centre by Mrs. G. JACOBSON., Honorary Secretary. The staff of the centre cpnsists of one paid part-time social worker—Miss Hilda Caton—who is in charge of the social work; one honorary secretary—Mrs. Gerald Jacobson ; three voluntary workers—Miss Dudley Baxter, Miss Greer and Miss Reitlinger; and another voluntary worker—Miss Hazel Kahn—who is in charge of the filing of case papers, entering up of weights and temperatures, etc., at the centre on the days that the children attend. One of the questions most frequently asked by visitors to the Kensington rheumatism supervisory centre is " Why is such a large staff needed to run the centre ? " The answer can be stated briefly—" The centre attempts to deal with every phase of the rheumatic child's life." There is a large amount of home visiting to be performed. All first visits to children notified to be suffering from acute rheumatism are paid by the council's health visitors, but the remainder are paid by the staff of the rheumatism supervisory centre. Altogether 895 visits were paid to families in Kensington during 1937. The visits paid may be divided into the following categories :— 1. Visits paid to inform the parents that the child is due to attend the centre. It is one of the aims of the centre that every mother should be visited before bringing her child for examination, so that the situation may be discussed, and valuable information may be obtained which would not be ascertained if the mother was not interviewed until in the presence of the doctor. 2. Visits paid when home treatment has been ordered by the physician. Frequently a rheumatic child is ordered to spend a week in bed, or just resting at home. It is the visitor's duty to see that the child is not made use of by the parents to run errands, and to do the housework or shopping—an unfortunate occurrence which has been discovered several times. 3. Visits paid to investigate social conditions. The centre attempts to inv estigate the social conditions of every family that comes under its care. Much has been done with the assistance of the public health department to remove families from damp and overcrowded homes to better conditions where therheumatic child will have a chance. The social workers are also responsible in many cases for assisting the parents to get extra nourishment for these children—i.e., dinners at school, milk, etc. 4. Visits paid in regard to convalescence, tonsillectomies, etc. In cases where these have been advised. visits to the home are necessary to make arrangements with the parents. Another duty undertaken by the visitors may be best described as that of " liaison officer." Amongst others, school teachers and school care committees send children to the centre—these children may need special care at school, and yet not be ill enough to warrant sending them to a special school for physically defective children. It is the visitors work to make contacts with the school-teachers, and so enlist their sympathy and help in dealing with these cases, explaining the need for extra rest during the day, and why they must not do drill, play games, swim, etc. Another branch of the work done by the centre is to find suitable work for cardiac cases. In many cases contact has been made with the local labour exchanges, explaining the need for finding sedentary work. Much time is spent discussing with the parents the future of these children, and the best way of setting about the difficult task of finding suitable work. In some cases the centre has been instrumental in getting children apprenticed. Although the centre is open to children up to the age of 16, it is often difficult to get them to attend once they have commenced work, as they are afraid of losing their employment through taking time off. These patients are in their adolescent stage—one of the most important in their lives—when serious breakdowns are liable to occur unless checked by supervision. The visitor discusses with the parents the child's state of health, and is often able to notice early signs of trouble and get the mother to use her influence in making the child take the necessary time off to attend the centre. At 16 years of age the child leaves our care, but whenever possible the physician in charge of the centre communicates with the panel doctor and transfers all details of the case to him. In this report no mention has been made of the work done in dealing with cases attending the centre from other boroughs. As no visits are paid by our workers outside the Kensington area, all following up, etc., has to be done by correspondence, which takes up a considerable amount of time. There is much secretarial work to be carried out in dealing with cases. All work done has to be recorded on special case sheets, which are kept apart from the medical records. These are invaluable in checking up past events in the family life. 71 PART II. The Work of the Centre by JANET K. AITKEN, M.D., M.R.C.P., In the ten vears 1927-37 during which the centre has been in existence, 2,448 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. 1932-33 1933-34 1934-35 1935-36 1936-37 Kensington 290 311 296 285 288 Hammersmith 51 45 39 37 36 Other boroughs 20 35 40 45 50 361 391 375 367 374 During the year 1936-37, 48 sessions have been held at the Princess Louise hospital. Average attendance per session of Kensington patients 19.2 „ „ „ „ other „ 6.9 26.1 The total number of attendances of patients was :— Kensington Notified cases (a) New 28 (b) Old 301 Unnotified cases (a) New 64 (b) Old 531 Hammersmith (a) New 17 (b) Old 140 Paddington (a) New 2 (b) Old 31 Acton (a) New 12 (b) Old 102 Other boroughs (a) New 3 (b) Old 25 l,256 The new Kensington cases were recommended to attend the clinic from the following sources:— Invalid Children's Aid Association 4 School medical officers 23 Princess Louise hospital 13 Private doctors 15 Home visiting after notification 10 Parents 12 Infant welfare centres 9 Tuberculosis dispensary 6 92 The disposal of cases which attended the centre and which needed special treatment may be summarised as follows:— Tonsillectomy at Princess Louise hospital 6 ,, other hospitals 3 Admission to Princess Louise hospital 31 Special schools ' 3 Convalescent homes 27 Referred to massage department for special chest expansion exercises 4 74 Clinical Report. It has been stated that the rheumatic child is one who has a taste for acid foods, particularly vinegar, and it has been demonstrated that Vitamin C (ascorbic acid) is reduced in the rheumatoid and juvenile types of rheumatism. It was decided therefore, before trying in any way to amplify or modify the usual food intake of these children, to investigate the diets of some of those attending the clinic. A questionnaire was drawn up, and Mrs. Jacobson and Miss Kahn, honorary social workers at the clinic, undertook to interview the children. Ninety children were chosen at randon (35 boys and 55 girls), the choice depending on whether the investigator had time to put her questions to the children, and mothers time to wait while the children were questioned. All suffered from juvenile rheumatism or were potential rheumatics suffering from pains suggestive of early rheumatism. The mothers were not present at the interview, as it was thought that their ideas as to what a child should have might colour the replies given. Plenty of time was taken, so that the child might be at ease, and reply naturally and truthfully. 72 The questionnaire was based on the following points :— 1. Details of the day's meals. 2. Favourite type of food. 3. Likes and dislikes, with special reference to meat, vegetables, condiments, milk, sugar and sweets. The day's meals.—Only two children stated that they did not sit down to take their meals. Sixty-four children had four meals a day (breakfast, dinner, tea and supper) ; twenty-six had no supper, and of these only two had more than porridge or bread and butter for breakfast, and only two had anything beyond bread and butter and cake for tea. In these cases food was poor in quality as well as quantity probably owing to lack of means. The following table shows details of the day's meals :— Breakfast. Dinner. Tea. Supper Bread 66 (2 rolls) 19 87 28 Toast 12 — 6 — Fried bread 4 — — — Biscuits 3 — — 7 Cake — — 64 2 Porridge, cornflakes, shredded wheat 33 — — 2 Meat — 49 2 — Sausage 1 8 1 — Rabbit — 2 — — Bacon and ham 9 — — — Meat pie and stew — — — 3 Fish — 10 3 — Fish and chips — 8 — 8 Sardines 1 — — — Eggs 19 10 6 — Vegetables (other than potatoes) — 50 2 — Potatoes 1 68 1 — Chips — 3 1 4 Milk pudding — 14 — — Other puddings — 17 — — Fruit 1 7 — 3 Butter 52 9 58 19 Dripping — — 1 — Jam 12 — 47 2 Syrup and honey — — 5 — Marmite — — 1 — Cheese 1 — 1 6 Cream 1 2 1 — Tea 65 28 71 7 Cocoa 13 2 1 22 Milk 7 7 5 15 Coffee 1 1 — — Oxo or bovril 2 — — 2 Ovaltine — — — 1 Soup — 3 — 2 Favourite type of food.—The following table shows the favourite type of food:— Boys. Girls. Total. Fruit 7 16 23 Meat 6 17 23 Eggs 5 7 12 Fish 2 7 10 Fish and chips 1 — Puddings 5 2 7 Vegetables 2 2 4 Cakes 2 1 3 Steak and kidney pudding — 1 1 Sausages 1 — 1 Cheese 1 — 1 Chips — 1 1 Shredded wheat 1 — 1 Porridge 1 — 1 Honey — 1 1 Bread 1 — 1 35 55 90 73 Likes and dislikes.—The following table shows details in regard to foods liked by boys and girls:— Boys. Girls. Total. Meat 29 50 79 Chicken only 1 (aged 9) Lean meat only 1 (aged 11) 1 (aged 13) Except steak and sausage — 1 (aged 11) Vegetables 32 44 76 Only potatoes 1 (aged 11) 4 (aged 8, 12, 13 & 13) Not greens 1 (aged 14) 4 (aged 9, 9, 11 & 13) Not potatoes 1 (aged 10) 1 (aged 10) *Condiments 19 30 49 Especially vinegar 8 5 Only vinegar and pepper 1 1 Only pepper — 1 Not mustard 2 6 Not vinegar or mustard — 1 Not pepper or salt 1 — Milk.—All liked it except two, both girls of 13. Sitgar.—All liked it except three two boys aged 9 and 11, and one girl aged 11. **Sweets 32 51 83 Occasionally 2 3 5 When eaten-— Any time 9 11 20 After dinner 5 10 15 Before school 6 5 11 After school 4 17 21 Not often 6 8 14 Not allowed 1 1 2 *Condiments.—The children were asked about all the condiments in turn, no particular stress being laid on vinegar. Forty-nine children stated that they liked condiments, and fifteen had a special preference for vinegar. This would seem to be a very high proportion if one did not know that vinegar is very commonly taken by people of this class. Also, the proportion is markedly higher in boys than in girls—nine boys and six girls, that is, 20 per cent, against 11 per cent. It is perhaps an unusually high result, but no great importance is attached to it. **Sweets.—When questioned about sweets, 83 children stated that they had them frequently and five occasionally. The children appeared to eat them at any time during the day, both before and after meals. Comments.—Although twenty-three children stated that fruit was their favourite food, very little fruit appears to have been given in their diet. For breakfast only one had fruit, for dinner only seven, for tea none, and for supper three. As oranges should be a very important item in the diet of rheumatic children, owing to the known shortage of vitamin C in this type of case, this is obviously a serious defect. Apart from instructing the parents in this respect, it Should be fairly easy to get the children's assistance in remedying this deficiency. It will be noted that nearly all of them like sweets and have them almost daily. It is a common custom to give the child a halfpenny or penny to spend on the way to school, and this is almost always spent on sweets ; with encouragement the child could be taught to spend this on fruit. Only three named cake as a favourite, and yet sixty-four children had stated that they had cake for tea. It is probable that this cake would not be of a very nourishing type, and it may be possible to persuade the mother to substitute fruit in some cases, especially as the children do not seem to like cake very much. Twenty-three children gave meat as their favourite dish, and it appears that the vast majority do have meat daily. Only thirty-one stated that they had puddings for dinner. This is probably due to lack of energy on the parents' part in cooking suitable puddings ; similarly, fish and chips, popular for supper, are probably bought ready cooked. No differentiation was made between butter and margarine, because the children did not know which they had. A great deal of tea is drunk, some children having it with every meal. Sixty-five have it for breakfast, twenty-eight for dinner, seventy-one for tea, and seven for supper ; a little milk and sugar is taken with the tea, but more nourishing beverages might be substituted. Two points have emerged which rather surprised the investigators. A few years ago when some enquiries were made about diet, it was often said that children would not eat greens ; in this investigation, however, seventy-six out of ninety said that they liked vegetables, and only five said that they disliked greens. Every endeavour has been made to impress on parents the importance of this item of diet. The second point was that only two children did not like milk. These were both girls of thirteen years of age. It is certain that the same replies would not have been given two or three years ago, and this satisfactory result is probably due to the fact that children are now given milk at school. They are hungry, are encouraged by their masters and mistresses to drink it, and have found that by taking milk they have come to like it. 74 APPENDIX II. TABLE 1. Vital statistics of whole district for 1937 and previous years. Year. 1 Population estimated to middle of each year. 2 Births. Total deaths registered in the district. Transferable deaths Net deaths belonging to the district Uncorrected number. 3 Net. of nonresidents registered in the district. 8 of residents not registered in the district. 9 Under 1 year of age. At all ages. Number. 4 Rate.* 5 Number. 6 Rate.* 7 Number. 10 Rate per 1,000 net births. 11 Number. 12 Rate.* 13 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 1937 175,600 2,296 2,125 12.1 2,983 17.0 1,098 460 177 83 2,345 13.3 *Rates calculated per 1,000 of estimated population. At Census of 1931. Area of district in acres (exclusive of area covered by water) 2,291 Total population at all ages 180,677 Total families or separate occupiers 47,713 75 TABLE II Causes of death at Different Periods of life in 1937. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 16 years. 15 and under 25 years. 25 and under 35 years. 35 and under 45 years. 45 and under 55 years. 55 and under 65 years. 65 and under 75 years. 76 and upwards all causes M. 1,036 108 11 8 11 33 47 49 101 193 254 221 F. 1,309 69 10 7 12 26 49 59 107 205 296 469 Typhoid and paratyphoid fevers M. 1 .. .. .. .. .. .. .. 1 .. .. .. F. 1 .. .. .. .. .. .. .. 1 .. .. .. Measles M. 1 .. .. .. 1 .. .. .. .. .. .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Scarlet fever M. 1 .. .. 1 .. .. .. .. .. .. .. .. F. 1 .. .. 1 .. .. .. .. .. .. .. .. Whooping cough M. 3 2 1 .. .. .. .. .. .. .. .. .. F. 2 2 .. .. .. .. .. .. .. .. .. .. Diphtheria M. .. .. .. .. .. .. .. .. .. .. .. .. F. 4 .. .. 2 1 .. .. .. 1 .. .. .. Influenza M. 31 1 .. .. .. 4 1 3 7 2 8 5 F. 69 l .. .. .. .. 2 5 5 11 14 31 Encephalitis lethargica M. 1 .. .. .. .. .. .. .. .. 1 .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever M. .. .. .. .. .. .. .. .. .. .. .. .. F. 3 1 1 .. .. 1 .. .. .. .. .. .. Tuberculosis of respiratory tem M. 58 .. .. .. .. 5 14 7 12 12 7 1 F. 56 2 .. .. .. 8 15 8 7 8 7 1 Other tuberculous diseases M. 9 l 1 2 .. 1 1 1 2 .. .. .. F. 7 1 l .. 1 1 1 .. 1 1 .. .. Syphilis M. 8 .. .. .. .. .. 1 1 1 4 1 .. F .. .. .. .. .. .. .. .. . . . . . . . . General paralysis of the insane, tabes dorsalis M. 6 .. .. .. .. . . 1 .. 3 .. 2 .. F. 1 .. .. .. .. .. .. .. .. 1 .. .. Cancer, malignant disease M. 130 .. .. 2 .. 1 1 1 14 42 43 26 F. 214 .. .. .. 1 2 3 10 39 55 51 53 Diabetes M. 7 .. .. .. .. .. .. .. .. 2 3 2 F. 20 .. .. .. .. 1 .. .. 1 5 8 5 Cerebral haemorrhage, etc. M. 35 .. .. .. .. .. .. .. 2 9 10 14 F. 58 .. .. .. .. .. .. 2 5 9 17 25 Heart disease M. 241 .. .. .. .. 2 .. 3 18 47 85 86 F. 384 .. .. .. 1 4 5 8 18 36 114 198 Aneurysm M 8 .. .. .. .. .. .. .. 2 2 1 3 F. 7 .. .. .. .. .. .. 2 2 1 1 1 Other circulatory diseases M. 40 .. .. .. .. .. .. 1 5 4 13 17 F. 78 .. .. .. .. .. .. 1 3 13 23 38 Bronchitis M. 23 5 .. .. .. .. .. .. 3 4 6 5 F. 32 2 .. .. .. . .. .. 3 4 2 21 Pneumonia (all forms) M. 97 23 5 .. 1 2 3 12 7 16 16 12 F. 72 16 3 1 .. 1 5 5 4 8 11 18 Other respiratory diseases M. 12 .. .. l .. .. 1 1 .. 2 4 3 F. 11 .. .. .. .. .. 1 2 .. 2 1 5 Peptic ulcer M. 13 .. .. .. .. .. .. 1 1 7 4 .. F. 12 .. .. .. .. .. 1 .. .. 5 3 3 Diarrhoea, etc. M. 31 26 2 .. .. .. .. .. .. .. 1 2 F. 16 13 1 .. .. .. .. 2 .. .. .. .. Appendicitis M. 11 .. .. .. 1 1 1 3 .. 4 1 .. F. 9 .. .. 1 l l .. .. .. 2 3 1 Cirrhosis of liver M. 9 .. .. .. .. .. .. 2 3 2 1 1 F. 2 .. .. .. .. .. 1 .. .. .. 1 .. Other diseases of liver, etc. M. 6 .. .. .. .. .. 1 .. .. 1 3 1 F. 8 .. .. .. .. .. .. .. 1 2 2 3 Other digestive diseases M. 18 3 .. .. .. .. 2 1 3 2 3 4 F. 23 3 1 .. 1 .. 1 1 1 2 6 7 Acute and chronic nephritis M. 30 .. .. .. l 1 .. .. 2 9 11 6 F. 22 .. .. .. .. l .. 2 2 6 5 6 Puerperal sepsis F. 2 .. .. .. .. 1 .. 1 .. .. .. .. Other puerperal causes F. 5 . .. .. .. .. 5 .. .. .. .. .. Congenital debility, premature birth, malformation, etc. M. 41 41 .. .. .. .. .. .. .. .. .. .. F. 27 26 .. .. 1 .. .. .. .. .. .. .. Senility M. 7 .. .. .. .. .. .. .. .. .. 1 6 F. 16 .. .. .. .. .. .. .. .. .. .. 16 Suicide M. 23 .. .. .. .. 2 6 2 2 5 5 1 F. 17 .. .. .. .. 1 4 1 4 5 .. 2 Other violence M. 53 .. 2 1 4 9 7 5 5 7 5 8 F. 40 1 .. 2 1 .. .. 4 2 8 9 13 Other defined diseases M. 80 6 .. l 3 5 7 5 7 9 19 18 F. 88 1 2 .. 4 4 5 5 7 21 18 21 Causes ill-defined, or unknown M. 2 .. .. .. .. .. .. .. 1 .. 1 .. F. 2 .. 1 .. .. .. .. .. .. .. .. 1 76 TABLE III. Infant Mortality during the Year 1937. Net Deaths from stated Causes, at Various Ages under One Year of Age. Cause or Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. ft-9 months. 0-12 months. - Total deaths under one year. All causes. Certified .. 40 9 1 4 54 35 44 23 12 168 Uncertified 3 .. .. .. 3 2 4 .. .. 9 Measles .. .. .. .. .. .. .. .. .. .. Whooping-cough .. .. .. .. . . 2 1 .. 1 4 Chicken pox .. .. .. .. .. .. .. 1 .. 1 Influenza .. .. .. .. .. .. .. 1 1 2 Meningitis .. .. .. .. .. .. 1 .. .. 1 Acute tuberculosis .. .. .. .. .. .. 1 .. 1 2 Other tuberculous diseases .. .. .. .. .. 1 .. .. 1 2 Bronchitis .. .. .. .. .. 2 3 2 .. 7 Pneumonia 1 2 .. 1 4 8 13 9 5 39 Other respiratory diseases .. .. . . .. .. .. .. .. .. .. Diarrhoea, etc. .. 1 .. .. 1 12 19 5 2 39 Complications of birth 8 .. .. .. 8 .. .. .. .. 8 Malformation 8 2 .. 1 11 1 .. .. '.. 12 Premature birth ... 24 3 .. 2 29 5 2 .. .. 36 Deaths from violence 1 .. .. .. 1 .. .. .. .. 1 Atrophy, debility and marasmus .. .. .. .. .. 3 3 2 .. 8 Other diseases 1 1 1 .. 3 3 5 3 1 15 Totals 43 9 1 4 57 37 48 23 12 177 Net births in the legitimate, 1,893 year of illegitimate, 232 Net deaths in the legitimate, 135 year of illegitimate, 42. 77 TABLE IV. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1936. DATE. 1936. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth list sheets. Number of these births duly entered in columns 1, 2, 4, and 5 of the vaccination register (birth list sheets), viz. : Number of these births which are not entered in the vaccination register, on account (as shown by report book) of Column i. successfully vaccinated Column ii. Column v. dead, unvaccinated. Postponement by medical certificate. Removal to other districts and notified to vaccination officers of the districts. Removal to places unknown, or which cannot be reached, and cases not having been found. Not accounted for. Total number of certificates of successful Vaccination received during the calendar year, 1937. Insusceptible of vaccination Certificate of conscientious objection. 1st January to 31st Dec. North 779 514 3 129 35 1 6 86 5 1,855 South 1,620 940 8 215 93 2 255 103 4 Total 2,399 1,454 11 344 128 3 261 189 9 78 TABLE V. Particulars of the Staff of the Public Health Department at the end of 1937 (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. Charles P. Hay, M.D., M.R.C.P. (Edin.), D.P.H. 1937 Assistant Medical Officers, Maternity and Child Welfare. Violet I. Russell, M.D., M.C.O.G. (Medical officer in charge) 1934 Helen R. Buck, M.B., D.C.O.G. 1935 Hilda M. Davis, M.D., 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., (Schick testing clinic) 1934 Public Vaccinators. 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 Eric L. Ivens, M.R.C.S., L.R.C.P. (South Kensington district) 1937 Clerical Staff. James H. Wilson (Chief clerk and vaccination officer) 1900 Derek P. Roberts 1934 Reginald C. Charlton 1935 Francis W. Gascoyne 1919 Betty C. Tucker 1937 John S. Russell 1923 George W. Churcher (Temporary) 1935 Denis C. Page 1925 Charles E. Mallett ( ,, ) 1936 Francis T. Pearce 1929 James G. Pope ( ,, ) 1936 Ronald F. Rogers 1931 Herbert C. E. Gatehouse ( ,, ) 1937 Victor R. Minter 1932 Sanitary Inspectors. *George W. MeQuinn (Senior inspector) 1901 ¶§Ronald V. Coombs, B.A. 1932 §Arthur L. Vague 1934 †John McDermid 1920 ¶§Thomas A. Wilson 1934 ¶†Henry W. Walters (Food inspector) 1925 §Maurice Cottrell 1934 ¶†Cecil R. Webb 1925 §Ronald D. Callis (Temporary) 1934 ¶§John S. Wheeler 1930 ¶§James Clancey 1935 ¶§Donald J. Hunt 1931 §Dennis C. Draper (Temporary) 1935 *::¶§Frederick G. Bishop 1931 ¶§Charles R. Cox ( ,, ) 1937 Women Health Officers. ‡†Miss W. H. E. Whitbread 1920 ‡§Miss B. I. Brady 1931 †Mrs. V. A. Ross 1921 ‡§Miss W. E. Cockram 1932 ‡†Miss E. M. Law 1922 ‡Miss M. Flambert 1936 ‡†Miss K. M. Roe 1926 ‡Miss G. H. Bryant 1936 ‡§Miss E. Mogridge 1929 ‡§Miss D. I. Grigg 1937 Health Visitors. ‡Miss M. Batty 1937 ‡Miss C. Mead 1937 ‡Miss D. Grand 1937 Other Officers. Miss A. E. Haycock (Tuberculosis dispensary nurse) 1922 Miss H. M. Barber (Child life protection officer) 1935 Miss W. Hutchison (Sister-in-charge, baby clinic) 1937 Miss E. Hill (Dispenser, baby clinic) 1937 Mrs. M. E. Goadby (Masseuse, baby clinic) 1937 Miss F. M. Reeves (Assistant, Raymede infants' welfare centre) 1937 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 Walter Strong ( „ ) 1928 Ernest Manning ( ,, ) 1931 Frank Nunn ( „ ) 1934 James Noble ( ,, ) 1937 A. V. Boddington (Superintendent of medicinal baths) 1929 Walter E. Weedon (Rat officer) 1926 Charles H. Coombs (Drain-testing assistant) 1927 Reginald G. Weedon ( „ „ ) 1937 Mr. and Mrs. W. Whale (Caretakers, tuberculosis dispensary) 1932 Edmund Hagley (Caretaker, clearing house) 1937 * Certificate of the Royal Sanitary Institute, f Certificate of the London Sanitary Inspectors Examination Board. J 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 and Health Visitors have undergone 3 years' general hospital training, and have secured the certificate of general nursing proficiency. The Women Health Officers are also qualified Health Visitors. 79 INDEX. PAGE Advisory committee 35 After-care of tuberculous patients 68 Aged, infirm and physically incapacitated persons, removal of 22 Agricultural Produce (Grading and Marking) Act 49 Analysis of tuberculosis register 65 Ante-natal services 10 & 30 Anti-toxin (diphtheria) 56 Artificial Cream Act 49 ,, light therapy 67 ,, pneumothorax treatment 67 ,, sunlight 33 Baby clinic 31 ,, hospital 32 Bacteriological examinations (infectious disease and milk) 11 & 47 Bacteriological examinations (tuberculosis) 11 & 66 Bakehouses 48 Basement rooms 38&39 Baths and washhouses 20 & 22 Bedding for tuberculous patients 67 Birth control 35 Births 3 ,, in wards and rates 4 ,, notified 4 Boarding out of children 35 Canal Boats 22 Cancer 6 Care of tuberculous patients 68 Cerebro-spinal meningitis 57 Certificates of fitness of houses 40 Chapel of rest 20 Child life protection 11 Cleansing station 58 Clearance areas 36 Closing orders 39 Common lodging houses 42 Compulsory purchase orders 37 Convalescent homes 33 Crescent Street improvement area 38 Day nurseries 33 Day nursery scheme 34 Deaths 5 ,, , causes of 6 ,, from certain diseases 7 ,, from cancer 6 ,, from tuberculosis 63 ,, in wards and rates 5 Defects (housing) remedied 19 Dental treatment at infant welfare centres 30 ,, „ for tuberculous patients 67 Diarrhoea (summer) 57 Diphtheria 55 ,, immunisation 56 Disinfection (infectious disease) 60 Disinfestation by HCN 59 Dispensary diagnosis and treatment of tuberculosis 64 Dog nuisances 23 Drainage and sewerage 17 Dwelling-house inspection 18 Dysentery 57 page Electrical treatment 33 Employment of tuberculous patients 68 Enteric fever 56 Erysipelas 56 Extra nourishment for expectant and nursing mothers and their infants 34 Extra nourishment for tuberculous patients 68 Factories and workshops 24 Food, inspection and supervision 4-5 Food, misleading and deceptive labelling 52 Food and Drugs (Adulteration) Act 49 & 51 ,, ,, (proceedings) 51 Food premises, inspection 49 ,, ,, registration 48 „ supply 45 ,, unsound 49 Foster-children 11 Fouling of footpaths by dogs 23 Gold therapy 67 Grants to maternity and child welfare institutions 17 Gynaecological clinic 35 Health lecturer 15 & 35 „ propaganda 15 ,, services (general) 11 „ visitors 28 Home contacts of tuberculosis 66 ,, helps 34 „ nursing (general) 12 ,, nursing of tuberculous patients 68 ,, Office tables (factories and workshops) 26 ,, visiting of tuberculous patients 66 ,, workers 25 Houses let in lodgings 42 Housing 36 Housing Act 36 & 39 ,, accommodation provided by council 43 ,, accommodation provided by associations 43 ,, action under statutory powers 18 & 42 ,, , five years programme 37 ,, statistics 44 Hydrocyanic acid gas disinfestation 59 Ice cream 48 Improved Tenements Association 43 Improvement areas 37 Increase of Rent and Mortgage Interest (Restrictions) Acts 22 Indecent occupation 40 Infant and toddlers' treatment clinic 32 Infant consultations at infant welfare centres 29 ,, mortality 7 ,, ,, , death rates 8 ,, ,, , causes of deaths 8 ,, ,, , deaths each month 8 ,, ,, , deaths in wards 7 ,, ,, , deaths in quarters 9 Infant welfare centres 28 Infectious diseases 54 Invermead 30 80 INDEX—continued. page Kensington District Nursing Association 12 „ Housing Trust 43 Labelling of food 52 Lectures, health 15 & 35 Legal proceedings, food and drugs 51 ,, „ sanitary administration 20 Light treatment at baby clinic and hospital 33 Malaria 57 Marriages 3 Massage 33 Maternity mortality 10 Maternity and child welfare 27 „ home 30 Measles 58 Medicinal baths 58 Merchandise Marks Acts 49 Midwifery arrangements 30 Widwives Act, 1936 31 Milk (bacteriological examination) 11 & 47 Milk and Dairies (Amendment) Act 46 ,, ,, (Consolidation) Act 45 „ ,, Orders 46 Milk (Special Designation) Order 46 Milk supplied in Kensington 45 Mortuary 20 Non-notifiable infectious diseases 58 Notifiable ,, ,, 54 Notifications, age periods, deaths and admissions to hospital table 55 ,, of infectious diseases since 1933 54 „ „ births 4 „ ,, tuberculosis (age and sex distribution) 62 ,, tuberculosis (deaths and death rates) 63 „ „ tuberculosis (in wards) 61 Nursing (professional) in the home 12 Obstetric work 10 Ophthalmia neonatorum 56 Orthopaedic treatment 32 Outworkers 25 Overcrowding 40 Peabody Donation Fund 43 Permitted use of closed rooms 40 Pharmacy and Poisons Act 53 Phosphatase test (milk) 48 Pigeons, nuisances from 23 Pneumonia and influenzal pneumonia 57 Pneumothorax treatment of tuberculous patients 67 Poliomyelitis and polioencephalitis 58 Population 3 Post-natal examination 31 Prevention of infectious disease 54 Princess Beatrice Hospital 12 Princess Louise Hospital 12 Proceedings under Food and Drugs (Adulteration) Act 51 page Proceedings under Housing Act 20 & 44 ,, ,, Public Health Acts (housing) 20&44 ,, „ Public Health (London) Act (General) 20 ,, „ Public Health (London) Act (unsound food) 51 Propaganda (health) 15 Public Health (Condensed Milk) Regulations 53 . ,, ,, (Dried Milk) Regulations 53 ,, ,, (London) Act notices served 18 & 42 ,, ,, (Meat) Regulations 48 ,, ,, (Prevention of Tuberculosis) Regulations 68 Puerperal fever and pyrexia 57 Queen Charlotte's Hospital ante-natal clinic 30 Rats and Mice (Destruction) Act 22 Reconditioning and repair work 39 Refuse collection and removal 17 Registration of food premises 48 ,, houses let in lodgings 42 Rehousing accommodation 42 Rent Restrictions Acts 22 Rheumatism in children 13, 57 & 69 ,, supervisory centre 13 & 69 Samples, adulterated 51 ,, formal 50 ,, informal 50 Sanitary circumstances of the area 17 ,, inspection 18 ,, notices 18 „ works completed 19 Scarlet fever 55 Schick test 56 School medical service 14 ,, treatment centres 13 Sewerage and drainage 17 Shops Act, 1934 53 Slaughterhouses 48 Slaughter of Animals Act 48 Smallpox 55 Smoke abatement 20 Southam Street improvement area 37 Staff 78 Statistics, summary of 2 ,, vital 3 & 74 Subscriptions to hospitals, voluntary health organisations, etc. 16 & 17 Sutton Dwellings Trust 43 Swimming baths 20 ,, bath water, purification of 20 ,, „ bacteriological examination of 21 Travelling expenses of women breast-feeding infants 35 Treverton Street improvement area 38 Tuberculosis 61 ,, prevention and treatment 64 Tuberculosis register, analysis of 65 Typhoid and paratyphoid fever 56 Underground rooms 38 & 39 Unsound food 49 81 INDEX—continued. PAGE Vaccination 15 ,, officer's return 77 Verminous furniture disinfected by HCN 59 ,, persons cleansed 58 ,, premises cleansed 59 Vital statistics 3 & 74 Washhouses 20 & 22 Whooping cough 58 Wilsham Housing Trust 43 Women health officers 28 Workshops 24 X-ray diagnosis of tuberculosis Zymotic enteritis 57 „ death rate 2 PAGE APPENDIX I. Tenth annual report of the Kensington rheumatism scheme 69 APPENDIX II. Causes of death at different periods of life in 1937 (Table II) 75 Infant mortality during 1937 (Table III) 76 Staff of public health department (Table V) 78 Vaccination officer's return for 1936 (Table IV) 77 Vital statistics for 1937 and five preceding years (Table I) 74