KEN 47 The Royal Borough or Kensington. THE ANNUAL REPORT ON THE HEALTH OF THE BOROUGH FOR THE YEAR 1938 BY JAMES FENTON, C—B—E—, M—D—, M—R—C—P—, D—P—H—, Medical Officer of Health. 3 as— Truscott & Son, Ltd—, Printers, Suffolk Lane, London, E—C—4— SUMMARY OF STATISTICS for the Year 1938- Population (estimated) 174,100 Area of borough in acres 2,291 Density of population per acre 76 Number of marriages 2,127 Rateable value £3,427,044 Product of a 1d- rate £14-279 Number of inhabited houses 37,519 Total- M- F- Live births legitimate 2,009 1,052 957 Birth rate 12-8 Illegitimate 227 111 116 Still births 62 31 31 Rate per 1,000 total births 27 Deaths 2,049 952 1,097 Death rate (after adjustment) 10-9 Percentage of total deaths occurring in public institutions 56% Deaths from puerperal causes :— Deaths Rate per 1,000 total (live and still) births - Puerperal sepsis 2 0-9 Other puerperal causes 3 1-3 Total 5 2-2 Death rate of infants under one year of age :— All infants per 1,000 births 78 Deaths from measles (all ages) 13 Legitimate infants per 1,000 legitimate live births 73 ,, cancer (all ages) 314 „ whooping cough (all ages) 5 Illegitimate infants per 1,000 illegitimate live births 123 „ diarrhoea (under 2 years of age) 55 Phthisis death rate 0-53 Deaths from phthisis 93 Tuberculosis death rate 0-60 Deaths from all forms of tuberculosis 106 Zymotic death rate 0-43 Deaths from the zymotic diseases 85 3 Town Hall, Kensington, W-8- 4th May, 1939- 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 1938 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 1938 has been estimated by the Registrar-General to be 174,100- 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 174,100 North Kensington 91,600 South Kensington 82,500 Wards St- Charles 30,100 Golborne 21,200 Norland 20,610 Pembridge 19,690 Holland 18,000 Earl's Court 17,750 Queen's Gate 13,750 Redcliffe 21,000 Brompton 12,000 Marriages- During the year, 2,127 marriages were registered, representing a rate of 12-2 marriages per 1,000 of the population- The place of marriage is set out in the following table :— Church of England 756 Roman Catholic Church 398 Nonconformist Church 41 Jewish Church 8 Register Office 924 Total 2,127 Births- The number of births registered was 2,236, after correction for inward and outward transfers and the birth rate for the borough was 12-8 per 1,000 population- Distributed according to se and legitimacy the births were as follows :— Male- Female- Total- Legitimate 1,052 957 2,009 Illegitimate 111 116 227 Totals 1,163 1,073 2,236 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 1938, and the rates for the previous five years:— District- 1938- Birth rates in previous years- No- of births- Birth rate- 1937 1936 1935 1934 1933 England and Wales 621,603 15-1 14-9 14-8 14-7 14-8 14-4 London 64,325 13-4 13-3 13-6 13-3 13 2 13-2 The Borough 2,236 12-8 12-1 12-7 12-4 12-3 12-0 North Kensington 1,617 17-7 17-0 17-1 16-6 16-8 16-1 South Kensington 596 7-2 6-5 7-5 7-2 6-6 6-5 Wards- St- Charles 591 19-6 18-8 17-1 16-7 15-4 18-0 Golborne 487 22-9 21-9 20-5 21-5 23-7 21-9 Norland 295 14-3 14-1 17-0 16-4 16-3 13-6 Pembridge 244 12-4 12-1 13-7 11-2 11-6 10-9 Holland 181 10-1 9-5 8-8 8-6 7-3 5-6 Earl's Court 130 7-3 6-8 6-4 6-6 8-3 7-9 Queen's Gate 70 5-1 4-7 7-6 4-9 5-5 5-5 Redcliffe 151 7-2 5-9 7-6 9-5 6-8 6*3 Brompton 64 5-3 4-4 6-8 4-9 4-0 6-7 Ward unknown 23 --- 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 191 1916-1920 17-2 1921-1925 17-2 1926-1930 14-6 1931-1935 12-6 1936 12-7 1937 12-1 1938 12-8 Notification of Births, Public Health (London) Act, 1936, Section 255-—During the year 2,236 live births to Kensington mothers were registered, and of this number 2,118 or 95 per centwere notified in accordance with the requirements of the Act- The number of still births notified was 63, and the number of births notified as having occurred in Kensington but belonging to other districts was 916 he 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 17 716 733 parents — 8 8 medical practitioners 5 164 169 other persons 28 697 725 Births in the borough 50 1,585 1 635 Notified from institutions outside the borough 13 533 546 Totals 63 2,118 2,181 5 Percentage of births in Kensington notified during the past five years :— Year- Percentage- 1933 94 1934 93 1935 98 1936 99 1937 95 1938 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 1938 was 2,443, 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 personsTotal deaths registered in the borough 2,443 Deaths of residents in public institutions, etc-, beyond the borough 670 3,113 Deaths of non-residents in public institutions, etc-, within the borough 1,064 Corrected number of deaths belonging to the borough 5,049 The following table shows the number of deaths and the death rates in England J or1 Wales, London, Kensington and the various wards in the borough in 1938, and the rat's for the previous five years :— District- 1938 Death rates in previous years- No- of deaths- Death rate- 1937 1936 1935 1934 1933 England and Wales 478,927 11-6 12-4 12-1 11-7 11-8 12-3 London 49,616 114 12-3 12-5 11-4 11-9 12-2 The Borough 2,049 11-7 13-3 12-5 12-1 13-3 12-9 North Kensington 1,091 11-9 12-9 12-7 12-0 13-7 12-9 South Kensington 938 11-2 13-3 12-1 11-6 12-3 12-6 Wards- St- Charles 316 10-5 9-8 10-5 14-3 11-4 10-9 Golborne 274 13-0 16-2 14-8 13-7 16-4 13-9 Norland 258 12-5 13-5 14-1 11-9 13-9 14-1 Pembridge 243 12-3 13-7 12-1 12-5 13-8 13-1 Holland 220 12-2 15-5 12-5 12-3 14-2 13-3 Earl's Court 216 12-2 12-3 14-1 13-0 12-3 13-1 Queen's Gate 131 9-5 12-5 9-9 8-8 11-7 11-5 Redcliffe 239 11-3 14-1 13-2 12-5 11-7 12-7 Brompton 132 11-0 11-5 8-9 13-5 11-3 11-1 Ward unknown 20 --- --- --- --- --- --- 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 1938 11-7 6 The corrected death rate of 11-7 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 10-9, 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 85 Epidemic influenza 13 Phthisis 93 Other tuberculous diseases 13 Cancer 314 Bronchitis 55 Pneumonia 143 Heart disease 563 Acute and chronic nephritis 34 Puerperal fever 2 Premature birth, etc- 66 Violence (including suicide 24) 94 Old age 22 All other causes 552 2,049 It will be seen that over one-third of the deaths, or 854, were due to diseases of the heart or the organs of respiration- Phthisis, an infectious and preventable disease, caused 93 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 314 deaths, and of this number 298 occurred in persons over the age of 45 years a Carcinoma was the form of cancer to which 284 deaths were attributed ; sarcoma and epithelioma were the assigned causes of 8 deaths ; 22 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, 1938- Parts affected- Sex- Total- Male- Female- Buccal cavity 8 2 10 Lungs 17 10 27 Digestive organs, peritoneum, etc- 76 91 167 Female genital organs 30 30 Male genito-urinary organs 25 25 Breast 24 24 Skin 4 4 Other and unspecified organs 8 19 27 Totals 138 176 314 The deaths in the several wards, etc-, are set out in the following table :— The Borough, 314 North Kensington 155 South Kensington 159 7 Wards- St- Charles 48 Golborne 32 Norland 39 Pembridge 36 Holland 32 Earl's Court 38 Queen's Gate 27 Redcliffe 44 Brompton 18 The number of deaths from this disease was 30 fewer than in the previous year Table showing the number of deaths in 1938 from certain diseases of public health importance arranged in four-weekly periods- Four weeks ending Typhoid fever- Whooping cough- Diphtheria- Influenza- Phthisis- Cancer- Bronchitis- Pneumonia- Diarrhoea and enteritis- January 29 ___ 2 10 24 10 21 1 February 26 —- 1 ___ 2 10 25 6 11 3 March 26 1 ___ 3 2 11 25 3 10 7 April 23 — ___ — — 11 29 5 10 5 May 21 ___ 1 — 3 6 19 3 16 2 June 18 — 1 1 1 3 24 6 12 7 July 16 — ___ 3 — 6 18 1 8 5 August 13 — ___ ___ — 4 20 3 9 5 September 10 — ___ ___ 3 26 2 5 2 October 8 ___ - 1 5 27 2 9 5 November 5 — ___ — 2 8 27 3 11 3 December 3 — ___ — — 9 22 4 11 7 31 — 1 1 — 7 28 7 11 7 Totals 1 4 8 13 93 314 55 143 59 Infant Mortality- During the year 1938 there were 2,236 births and 175 deaths of infants under the age of one year in the borough, which gives an infant mortality rate of 78 per 1,000 births- The corresponding figure for 1937 was 83- The death-rate among legitimate infants was 73 per 1,000 births in 1938, among illegitimate infants it was 123- 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 1938, and the infant death rates for the previous four years :— District- 1938- Infant mortality rates in previous four years No- of births- No- of deaths of children under year of age- Infant mortality rate- 1937 1936 1935 1934 England and Wales 621,603 32,473 53 58 59 57 59 London 64,325 3,746 57 60 66 58 67 The Borough 2,236 175 78 83 73 78 93 North Kensington 1,617 144 89 81 79 89 102 South Kensington 596 31 52 89 59 57 75 Wards- St- Charles 591 45 76 64 64 86 115 Golborne 487 46 94 99 94 100 97 Norland 295 32 108 71 104 102 111 Pembridge 244 21 86 105 52 54 73 Holland 181 8 44 93 62 88 133 Earl's Court 130 4 31 74 103 42 40 Queen's Gate 70 2 29 62 9 29 51 Redcliffe 151 13 86 135 74 69 69 Brompton 64 4 62 37 24 — 40 Ward unknown 23 — — — — — — 8 Infant Mortality Rates, 1896—1938. 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 1938 53 57 78 The number of deaths of Kensington infants occurring in each month during 1938. January 23 February 15 March 23 April 13 May 12 June 15 July 13 August 12 September 12 October 9 November 10 December 18 Causes of, and ages at, deaths of infants under one year of age in Kensington during 1938. 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 — — — — — — 1 — 4 5 (Measles 3) (Whooping cough 2) Pneumonia, bronchitis and other respiratory diseases 1 — — 1 2 14 19 6 3 44 Diarrhoea — — — — — 11 24 8 7 50 Complications of birth (Atelectasis 6) (Other complications 9) 13 1 1 — 15 — — — — 15 Congenital malformation 6 1 7 2 1 — 10 Premature birth 23 4 1 2 30 30 Atrophy, debility and marasmus 2 1 — — 3 3 3 — — 9 Other diseases :— (Violence 1) (Otitis media 2) (Meningitis 1) 2 1 — — 3 3 3 1 2 12 (Tub— meningitis 1) (Syphilis 1) (Other conditions 6) Totals 47 8 2 3 60 33 51 15 16 175 Death rate in each age period per 1,000 births 21.0 3.6 0.9 1.3 26.8 14.8 22.8 6.7 7.2 78.2 Percentage of total infant deaths occurring in each age period 26.9 4.6 1.1 1.7 34.3 18.8 29.1 8.6 9.1 '9 Deaths in Quarters of the Year. Disease. 1st. 2nd. 3rd. 4th. Total. Measles 2 1 3 Whooping cough — 1 — 1 2 Bronchitis and pneumonia 19 7 9 9 44 Diarrhoea 15 10 13 12 50 Congenital debility, prematurity, mal. formation and birth injury, marasmus 23 18 12 11 64 Tuberculous meningitis — 1 — — 1 Syphilis — — — 1 1 Violence 1 — — — 1 Other diseases 1 2 3 3 9 61 40 37 37 175 The council have shown deep concern in regard to the high infant death rate in the borough, and the circumstances of every infant death are examined in detail by the maternity and child welfare committee. Although the total number of deaths is lower than in 1937, the number of infants who died in the first four weeks of life, or neo.natal period, shows a relative increase from 32.3 per cent. of the total deaths in 1937 to 34.3 in 1938. Twelve of these 60 neo.natal deaths occurred in the well.to.do classes. Of the 48 deaths of infants belonging to the class for which provision is mainly made by the council's services it is noteworthy that in a quarter of the number (12 cases) there was absence or gross inadequacy of pre.natal supervision owing to the mother's neglect to take advantage of the facilities provided by the council. When it is appreciated that the number of women attending the hospital pre.natal department and borough clinics represents over 80 per cent. of the total Kensington births and that those cases under the care of a private doctor or specialist would account for the remainder, this high infant death rate among the few cases who did not receive supervision during pregnancy emphasizes the value of pre.natal care. In several of the cases receiving adequate supervision the feebleness of the infant which resulted in death was consequent upon severe illness of the mother which resulted in the premature termination of the pregnancy either spontaneously or by induction of labour. In the group of deaths between one and twelve months of age the death rate from enteritis remains very high, although in some cases the intestinal symptoms were secondary to disease of the respiratory tract. The council have continued to direct special attention to this subject, and intensive propaganda in the form of leaflets, posters, lectures and films was renewed during the summer months. Further investigations have been made by the council's bacteriologist on the nature of the intestinal contents of a series of bottle.fed babies, and an attempt made to reproduce the conditions present in breast.fed infants by certain dietary additions, but these have met with inconclusive results. On January 5th, 1938, a meeting of the Kensington Medical Society was convened under the chairmanship of the medical officer of health in order to consider the problem of the high infant mortality rate in the borough. All the council's medical officers, a number of the London county council's medical superintendents and medical officers, several consultants in children's diseases and a large number of Kensington medical practitioners were present. The conference aroused such interest that it was followed by a second meeting on March 8th when the discussion and interchange of views was completed. The conclusions arrived at may be summarised as follows :— (1) That mortality from enteritis occurs almost entirely among infants who are artificially fed. (2) That breast.feeding of infants is of the utmost importance. (3) That, if possible, a baby with enteritis should be nursed in its own home and not admitted to hospital on account of the risk of infection to other infants. (The meeting learned with satisfaction of the council's decision to make an extra grant to the Kensington District Nursing Association to permit of free home nursing facilities for infants attended by medical practitioners at home.) (4) That propaganda against flies and in favour of cleanliness in the home is of great value. Tribute was paid to the expert skill and valuable work carried out by Dr. Ronald Carter, the council's specialist for enteritis, whose report for the year 1938 appears on page 63. In summing up the discussion the medical officer of health pointed out that the council were already working on the lines suggested at the meeting in their attempt to lower the infant mortality rate. 10 It is generally recognised that catarrhal diseases, both respiratory and intestinal, are more prone to occur and most likely to prove fatal in infants whose diet is faulty and nutrition poor. It is the constant endeavour of the council's medical officers and health visitors to improve the nutritional condition of these children by advice on feeding, hygiene, proper clothing and fresh air. A comprehensive report on rickets in Kensington children was submitted to the council in July by the assistant medical officers who conduct the infant welfare sessions. In this report the importance of instruction regarding the essential elements of diet for children was stressed and the value of codliver oil in the prevention of rickets emphasised. Codliver oil and its equivalent preparations are granted free of charge by the council in necessitous cases. The number of individual children attending the Kensington infant welfare centres for supervision has increased from 4,985 in 1937 to 5,497 in 1938. Twenty 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 ; regular home visiting is carried out by the health visitors. Milk and codliver oil are provided free by the council for children of necessitous parents. 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. An important 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. Maternal Mortality. There were five deaths resulting from pregnancy and childbirth among Kensington women during 1938, which gives a maternal mortality rate for the borough of 2.2 per 1,000. The rate for England and Wales was 2.97. Three of the Kensington deaths occurred among the well.to.do class, two of them following operation for Caesarean section. The death rate is again much higher in above.standard cases than among the class for which provision is made by the council's services. The maternal death.rates in the two classes are about 10 per 1,000 and 1.1 per 1,000 respectively. There were only two deaths of women belonging to the class who normally seek attention at welfare centres ; one was a case of haemorrhage occurring in a booked hospital case, where the hospital authorities had been responsible for pre.natal supervision ; and the other, although referred to Kensington, occurred in Durham where the patient had stayed with her mother during her pregnancy. It will be seen that in neither of these cases could the maternal death have been prevented by the council's services. Record attendances were made at the council's pre.natal clinics during the year, and careful routine supervision continued to prove its value by the discovery of cases where it was necessary to arrange for special obstetric care during the confinement. In some of these cases the woman was unaware of pre.existent heart disease ; in others there was unsuspected pelvic contraction ; in a third class of case a high blood pressure without other symptons was a warning that prompt treatment was necessary in order to prevent the onset of toxaemia. Admission to hospital was arranged whenever it seemed desirable for the safety of the mother, and all these women made good recoveries. Routine Wasserman and Kahn tests carried out in the clinics show a percentage of 1.6 positive cases during 1938 (15 out of 928 tests performed) compared with 1.8 per cent. in 1937 and 2.2 per cent. in 1936. An advantage resulting from the earlier attendance of women at the pre.natal clinics is that this test can be carried out in the early months of the pregnancy when, if found positive, treatment of the mother is almost certain to save the child from being born with a congenital syphilitic infection. The kind co.operation and assistance of the special departments of the West London hospital and St. Mary's hospital has ensured that this treatment of the mother is given with the least possible inconvenience and the greatest consideration for her feelings. 11 GENERAL PROVISION OF HEALTH SERVICES FOR THE AREA. Particulars of the Staff of the Public Health Department at the end of 1938 (as required by Ministry of Health Circular 1728). Year of Medical Officer of Health. Appointment. James Fenton, C.B.E., 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 Medical Officers, Maternity and Child Welfare. Medical Officer in charge. Violet I. Russell, M.D., M.R.C.O.G. 1934 Assistant Medical Officers. Helen R. Buck, M.B., D.R.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.H1936 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. Bousfield, M.D. (Schick.testing clinic) 1934 Hilary Ledgerwood, M.B., B.A.O. (Baby clinic) 1937 William A. Hislop, M.B., Ch.B (Baby clinic) 1937 Edith K. Budden, M.D. (Baby clinic) 1937 Hugh A. Burt, M.B., M.R.C.S., L.R.C.P. (Chronic rheumatism clinic) 1938 Richard H. Dobbs, M.B., M.R.C.P., M.R.C.S. (Whooping cough clinic) 1938 Other Part.time Officers. Mrs. W. Murch, L.D.S., R.C.S. (Dentist at baby clinic) 1937 H. Wilson Jones, L.D.S., R.C.S. (Dentist at Raymede infant welfare centre) 1937 H. Graham.Scott, M.R.C.S., L.R.C.P. (Anaesthetist at Raymede infant welfare centre) 1937 A. Dreaper, L.D.S. (Dentist at Kenley Street infant welfare centre) 1937 Edward V. Slaughter, M.R.C.S., L.R.C.P. (Anaesthetist at Kenley Street infant welfare centre) 1937 J. Salter, L.D.S. (Dentist at Lancaster Road infant welfare centre) 1938 S. D. Adams, M.D. (Anaesthetist at Lancaster Road infant welfare centre) 1938 Public Vaccinators. Basil Hood, M.R.C.S., L.R.C.P. (St. Charles hospital) 1930 James Carver, M.B., F.R.C.S., L.R.C.P. (St. Mary Abbots hospital) 1932 Harold P. Widdup, M.B., Ch.B. (North Kensington) 1936 Eric L. Ivens, M.R.C.S., L.R.C.P. (South Kensington) 1937 Clerical Staff. James H. Wilson (Chief clerk and vaccination officer) 1900 Francis W. Gascoyne 1919 Derek P. Roberts 1934 John S. Russell 1923 Reginald C. Charlton 1935 Denis C. Page1925 George W. Churcher 1935 Ronald F. Rogers1931 Charles E. Mallett 1936 Victor R. Minter 1932 John G. Hopgood 1938 Miss Marion Southwell 1938 James G. Pope (temporary) 1936 Edward J. Simmons (temporary) 1938 Miss Pauline Dobson (temporary) 1938 Miss Joan R. Mead (temporary) 1938 12 Sanitary Inspectors. ¶†Henry W. Walters (Senior inspector) 1925 ¶†Cecil R. Webb 1925 ¶§Ronald V. Coombs 1932 ¶§John S. Wheeler 1930 §Arthur L. Vague 1934 ¶§Donald J. Hunt 1931 ¶§Thomas A. Wilson 1934 x ::¶f§Frederick G. Bishop ¶§Maurice Cottrell 1934 (Food inspector) 1931 §Ronald D. Callis 1934 ¶§James Clancey 1935 § Joseph L. Coombs (temporary) 1938 §Ivor G. Heycock (temporary) 1938 Women Sanitary Inspectors. ‡†Miss W. H. E. Whitbread (Senior woman sanitary inspector) 1920 ‡†Miss E. M. Law (Child life protection officer) 1921 Air Raid Precautions Staff. §Dennis C. Draper (sanitary inspector) 1935 ¶§Wilfred F. Troughton (sanitary inspector) 1938 John H. Gillett (clerk) 1938 Kenneth Griffin (clerk) 1938 Women Health Officers and Health Visitors. Superintendent. ‡†Miss K. M. Roe 1926 Health Officers. †Mrs. V. A. Ross 1921 J§Miss W. E. Cockram 1932 ‡§Miss E. Mogridge 1929 J § Miss G. H. Bryant (Propaganda ‡§Miss I. Brady 1931 officer) 1936 ‡§Miss D. I. Grigg 1937 ‡ Miss C. Mead 1937 Health Visitors. ‡Miss M. A. S. Batty 1937 ‡Miss M. Cook 1938 ‡§Miss D. Grand 1937 ‡Miss R. Maguire 1938 ‡Miss E. Axtens 1938 Other Officers, etc. Miss A. E. Haycock (Tuberculosis dispensary nurse) 1922 Miss H. M. Barber (Sister, 304, Westbourne Grove) 1935 Miss W. Hutchison (Sister-in-charge, Baby Clinic) 1937 Miss E. Hill (Dispenser, Baby Clinic) 1937 Miss R. Currie (Sister-in-charge, Lancaster Road Day Nursery) 1938 Miss Thruston (Nursery nurse, Lancaster Road Day Nursery) 1938 Miss J. Bell (Nursery nurse, Lancaster Road Day Nursery) 1938 Miss Moody (Masseuse, Baby Clinic) 1937 Miss F. M. Reeves (Assistant welfare sister, Raymede infant welfare centre) 1937 M iss Caton (Secretary, Rheumatism Supervisory Centre) 1933 Arthur C. Britton (Mortuary keeper) 1930 Albert Nunn (Chief disinfector) 1906 George Harris (Disinfector) 1914 Walter Strong (Disinfector) 1928 Ernest Manning (Disinfector) 1931 Frank Nunn (Disinfector) 1934 James Noble (Disinfector) 1937 Walter Bruce (Disinfector) 1938 A. V. Boddington (Superintendent, medicinal baths) 1929 Charles H. Coombs (Drain.testing assistant) 1927 Reginald G. Weedon (Drain.testing assistant) 1937 Mr. and Mrs. W. Whale (Caretakers, Tuberculosis Dispensary) 1932 Edmund Hagley (Caretaker, clearing house) 1937 † 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 ; they are also qualified Health Visitors. 13 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 1938 was as follows :— Disease suspected. Examinations. Positive. Diphtheria 2,006 26 Scarlet fever 25 7 Tuberculosis 762 57 Typhoid fever. Blood 14 1 „ Urine 3 — ,, Faeces 151 — Paratyphoid Blood 3 — „ Urine 145 — „ "Faeces 229 — Dysentery (Sonne). Fæces 275 18 Gonorrhoea 1 — Syphilis. W.R. 1 — Vincent's angina 3 — Ringworm 1 — Meningococcus. Throat 2 — The following examinations were also carried out :— Milk, general test 127 ,, for tubercle bacilli 11 „ for typhoid 2 Complete blood count 1 Test for occult blood 1 Virulence tests 5 Water from public swimming baths 64 Water from wells, etc. 45 Miscellaneous 15 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, 1938:— Cases. Visits. Maternity cases 37 731 Miscarriages 20 194 Pneumonia (5 years of age and over) 19 345 „ (under 5 years of age) 12 198 Ophthalmia neonatorum and other inflammations of the eyes of newly-born children 7 88 Influenza (5 years of age and over) 27 227 „ (under 5 years of age) — — Enteritis and diarrhoea 130 1,134 Tuberculosis (5 years of age and over) 24 1,644 Measles (5 years of age and over) — — „ (under 5 years of age) 128 1,384 ,, and pneumonia (5 years of age and over) — — „ „ (under 5 years of age) 9 120 Whooping cough (5 years of age and over) — — ,, „ (under 5 years of age) 5 81 Chicken-pox (5 years of age and over) — — ,, (under 5 years of age) 3 44 Acute rheumatism 15 280 Puerperal pyrexia 10 176 Scarlet fever — — Pemphigus 2 34 Totals 448 6,680 For the services rendered, the council paid to the association in 1938 a grant of £375. 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 1938 was 2,822 and the number of visits paid was 48,395. 14 The Princess Beatrice Hospital- The present accommodation is 85 beds- The hospital when completed will provide an additional 50 beds, making a total of 135 beds, a nurses home, a post-mortem and pathological department, administration offices, etc- The work performed at the hospital during 1938 was as follows :— In-patients. (a) General wards 1,286 (b) Private wards 296 Out-patients. Total number of new out-patients 11,414 „ „ „ out-patients' attendances 61,034 Number of casualties 4,900 Other treatments. Number of operations—major 968 minor 672—1,640 Dental cases 2,390 Massage 3,134 Light treatments 1,371 Superficial therapy 1,045 Patients X-rayed 2,800 Ante-natal clinic and maternity ward. Total number of attendances 1,368 Number of patients admitted to maternity ward 271 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, orthopaedic and massage departments and a fully equipped operating theatre. 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 Total 75 The following are figures of work done during 1938. (a) In-patients. Total number of available beds on 31st December, 1938 75 Average number of available beds during year 70.81 „ „ ,, patients resident daily throughout year 55.71 Number of in-patients in the hospital at beginning of year 54 „ ,, „ admitted during year 1,558 „ „ „ in the hospital at end of year 37 Total number of in-patients 1,466 Average number of days each patient was resident 12.90 Number of patients admitted and discharged during year who were resident for (i) only 1 day 28 (ii) 2 and 3 days 583 (b) Out-patients. Total number of new out-patients 7,027 Total number of out-patients' attendances 39,104 Number of casualty patients among new out-patients 1,854 Rheumatism Supervisory Centre. The record of work carried out at the centre during 1938 is as follows:— Number of sessions held 49 Number of individual patients examined — Kensington 289 Hammersmith 39 Acton 28 Other boroughs 20 15 Total attendances of patients— Kensington 1,068 Hammersmith 124 Acton 94 Other boroughs 77 The average attendance per session of Kensington patients was 21.7. 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 1938 was as follows:— New cases. Total attendances. Eyes 333 866 Aural 128 243 Minor ailments 1,190 16,502 Dental 1,443 2,218 A school treatment centre has also been conducted at the baby clinic premises in Tavistock Road, and the record of work for 1938 is as follows :— New cases. Total attendances. Minor ailments 1,941 18,962 Dental 1,715 4,492 Light treatment, massage, etc. 84 1,094 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 1938 are as follows:— Cases. Tonsils and adenoids 563 Eves 512 Dental 1,015 X-ray 12 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 1938 in Kensington. Table showing number examined and defects found- Number examined Boys- Girls- Entrants697 Age 7611 Age 11- 579 Age 14- 557 Entrants697 Age 7- 595 Age 11- 586 Age 14- 610 Cases- • Cases- • Cases- • Cases- • Cases- • Cases- • Cases- • Cases • Malnutrition 8 4 14 10 12 4 2 10 3 4 3 10 5 1 1 Skin disease 11 6 8 4 3 2 6 4 8 2 6 2 6 6 — — Defective teeth — 263 — 231 — 207 — 219 — 256 — 224 — 173 — 197 Enlarged tonsils 107 12 50 8 24 7 19 2 98 13 70 9 34 7 21 5 Adenoids 11 8 7 6 3 3 1 — 5 1 2 1 1 — — — Enlarged tonsils and adenoids 20 16 17 12 6 4 1 1 22 12 9 6 1 1 1 Other nose and throat defects 18 8 13 4 4 2 4 2 12 1 9 5 8 3 1 — Enlarged glands 119 10 122 4 84 3 47 — 91 5 110 5 68 1 27 2 Eye disease 27 13 20 9 7 2 7 3 26 18 16 6 10 3 11 2 Vision defects 36 — 51 — 65 — — — 30 — 52 — 52 Otorrhoea 10 2 11 6 7 — 4 — 16 4 9 2 3 — 2 — Other ear disease 10 5 2 — 2 — — — 3 — 1 1 4 3 — — Defective hearing 1 — 8 2 1 — 4 2 4 1 — 1 7 3 4 Speech defects 2 — 5 1 2 1 3 1 2 — 3 1 — ] 1 Heart defects 16 17 2 8 — 11 — 17 1 7 — 15 3 10 1 Anaemia 8 2 13 1 8 1 5 2 8 3 5 1 3 1 5 — Lung defects 33 7 13 1 6 — 4 — 30 9 17 6 7 1 2 — Nervous defects 3 1 6 2 11 3 4 2 6 1 10 3 8 3 — — Phthisis 1 — — — — — — — 1 — 2 — 2 — — — Other T.B. disease 1 — — — 1 — — — — — — — — — — — Rickets 13 3 8 — 3 — 6 — 5 1 3 — 2 — 3 Spinal deformities 2 2 1 15 11 2 1 4 3 8 3 7 6 14 Other deformities 11 2 23 5 14 — 17 3 15 5 22 5 36 9 9 1 Other defects 25 11 28 19 18 3 7 5 40 19 18 6 23 11 7 2 Number of children noted for treatment 317 301 270 268 304 279 245 242 *Defects however slight are included under " cases " ; those severe enough to require treatment are shown under*- 16 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 697 230 462 5 178 479 39 1 696 1 — 695 2 — 389 234 74 — — — Girls 697 212 480 5 167 494 36 — 690 4 3 693 3 1 404 216 77 — — — Age 7. Boys 611 127 481 3 98 463 49 1 611 — — 610 1 — 360 188 63 328 193 73 Girls 595 148 444 3 137 425 33 — 591 2 593 2 — 349 180 66 310 204 70 Age 11 Boys 579 153 423 3 113 432 34 — 578 1 — 576 2 1 362 189 28 419 96 64 Girls 586 170 414 2 133 427 26 — 582 2 2 584 2 — 407 164 15 364 135 87 Age 14 Boys 557 128 428 1 150 387 20 —- 554 3 — 556 1 — 337 204 16 379 83 92 Girls 510 171 337 2 124 367 18 1 504 4 2 510 — — 312 189 9 338 86 86 Total 4.832 1,339 3,469 24 1,100 3,474 255 3 4,806 17 9 4,817 13 2 2,920 1,564 348 2,138 797 472 Percentage 27.7 71.8 0.5 22.7 71.9 5.3 0.1 99 5 0.3 0.2 99.7 0.3 0.1 60.4 32.4 7.2 62.8 23.4 13.8 London 54.6 45.1 0.3 16.2 77.2 6.6 97.7 2.0 0.3 98.7 1.2 0.1 70.2 26.3 3.5 67.8 19.0 13.2 Vaccination- There were 2,302 births in 1937 reported to the vaccination officer by the Kensington registrars- By the 31st December, 1938, 58.17 per cent. of these had been vaccinated or were insusceptible to vaccination- The other 41.83 per cent, are accounted for as follows:— Statutory declarations of objection 12.90 per cent. Died before vaccination 6.26 „ Referred to other districts 14.39 „ Removed, leaving no trace 7.94 Postponed or unaccounted for 0.34 (In addition, by the 31st December, 1938, 340 certificates of successful vaccination had been received in respect of children living in Kensington who were born outside the borough during 1937-) In view of the fact that throughout the country generally only about 35 per cent. of the children born are vaccinated, the Kensington return must be regarded as extremely satisfactory- Only 13.24 per cent. of the children born in Kensington in 1937 remained in the borough unvaccinated. Whilst this high percentage of vaccinations is maintained Kensington is reasonably safe from smallpox. Health Propaganda- In December, 1937, the health lecturer who had for some thirteen years been employed by the council to carry out propaganda work resigned. This officer had been employed part-time only, but the council decided after careful consideration that the vacancy should be filled by a whole-time official- The newly appointed officer did not commence her duties until July of the following year, and the health propaganda work was carried out in the interval by various other officers of the public health department- The National Health Campaign, which was inaugurated by the Prime Minister in September, 1937, continued during the first three months of 1938. During the whole period of the campaign, large and small posters were 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 public and private library books. In addition to the above, posters dealing with various aspects of public health were displayed throughout the year on the eleven frames owned by the council and which originally belonged to the Empire Marketing Board. There is little doubt that this intensive campaign did much to stimulate public interest in the council's health services. The borough council's campaign, instituted in 1936 with a view to decreasing the infant mortality from enteritis, again operated during the summer months, when posters and leaflets were displayed on public buildings, at infant welfare centres and on the council's vehicles, sandbins, etc. Leaflets were supplied to the county council schools, and these were distributed to school-children. 17 As in previous years, 2,000 copies of " Better Health " were distributed each month to mothers at the welfare institutions, and copies of the booklet " Advice to Mothers " were given out by the health visitors both at the welfare centres and in the course of home visits. The booklet is particularly useful in supplementing the advice given by the council's medical officers and health visitors at the infant welfare centres, and by the propaganda officer in the course of her lectures. A special leaflet, designed to encourage breast feeding, was prepared and distributed. Propaganda regarding diphtheria immunisation was considerably extended during the year. Special birthday cards were printed and one of these is now sent to each child on its first birthday. Particulars of the council's scheme for diphtheria immunisation are set out on the back of the card, and in order to follow up the message of the birthday card, a specially compiled letter is sent to the parents if after six months it is found that the child has not been immunised. As mentioned elsewhere in this report, a new diphtheria immunisation clinic was established during the year at No. 304, Westbourne Grove, W.ll, and leaflets were prepared and distributed drawing the attention of residents to it- The propaganda officer gave talks on diphtheria immunisation at the infant welfare centres and other institutions, and these were illustrated whenever possible by means of the council's diphtheria film entitled " The Empty Bed." A revised edition of the council's handbook of the health services in the borough was printed and distributed to 40,000 householders. During the latter part of the year, preparation was being made for the health exhibition which was held at the Argyll Halls on the 7th to 9th February, 1939. The record of the lectures given by the propaganda officer will be found on page 26 of this report. Subscriptions by the Borough Council to Voluntary Health Organisations during 1938. 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 15 15 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 Empire Rheumatism Council 200 0 0 Invalid Children's Aid Association 65 0 0 St- Mary's Hospital 10 10 0 Kensal Gospel and Medical Mission 5 5 0 West London Hospital 10 10 0 Kensington District Nursing Association 5 5 0 Western Ophthalmic Hospital 5 5 0 Payments to Maternity and Child Welfare Institutions- £ s. d. £ s. d. Bramley Road Infant Welfare Centre 441 5 0 Hambledon Convalescent Home 8 8 0 Wayside Cottage Convalescent Home 13 2 9 Golborne Infant Welfare Centre 530 0 0 South Kensington Infant Welfare Centre 390 0 0 Zachary Merton Convalescent Home 75 0 0 Golborne Day Nursery 197 0 0 Association of Infant Welfare and Maternity Centres 8 8 0 St. Clement's Day Nursery 391 0 0 Notting Hill Day Nursery 449 13 0 Kensington District Nursing Association 375 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) 1,157 13 0 Evelyn Convalescent Home 16 16 0 18 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 pre-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, 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. Facilities exist for obtaining gynaecological and birth control advice for suitable cases- The borough council have decided to make use of the emergency obstetrical service of the London county council for dealing with obstetric emergencies in cases where patients cannot be removed to hospital without undue risk. The service provides an obstetrician, midwife and appropriate equipment ; it can be used by any doctor attending a maternity case, and can be obtained by telephoning the London county council. The emergency unit is dispatched to the patient's home by ambulance. On the 1st April, 1938, the council assumed control of the Lancaster Road infant welfare centre and day nursery at the request of the voluntary committee of the centre- It is satisfactory to report that this committee, as in the case of all other voluntary committees connected with centres now under municipal control, have continued their association with the centre and rendered excellent service in assisting at the centre sessions and maintaining the social side of the work, which is of so much value. The management of the day nursery has involved the transfer to the council's staff of a number of domestic servants, who have received readjustments in wages as prescribed by the scheme of the Joint Industrial Council. The transfer of the Lancaster Road centre and day nursery was smoothly accomplished without interference with the routine work of the institution. In December, 1938, the voluntary committee of the Bramley Road infant welfare centre asked the council to assume control of the centre from 1st April, 1939, owing to their inability to collect the additional income which will be required for the maintenance of the new centre when this is built. Happily, the voluntary committee intend to continue their valuable social work at the centre, which was among the first established in the country. The supervision of the large number of health visitors, welfare sisters, nurses, caretakers, cleaners and domestic staff who have been added to the council's staff during recent years by the transfer of voluntary centres, and the need for co-ordinating the work of these institutions, rendered it necessary in the interests of efficiency to appoint an officer for this purpose, and in May Miss K. M. Roe, one of the council's senior women health officers, was appointed as superintendent health visitor to carry out these supervisory duties. Since 1919 the council have supplied extra nourishment, principally milk, free or at cost price to necessitous expectant and nursing mothers and children under five years of age. The expenditure on this service has increased from £374 in 1920 to £4,130 in 1937. During the year the council subjected the scheme to careful scrutiny and finally decided to substitute dried milk for liquid milk for a provisional period of six months- Dried milk is more easily digestible by infants and, whilst having almost all the advantages of liquid milk, is much less likely to become contaminated in the home, and so less likely to give rise to enteritis- The large amount of milk now distributed by the council makes the purchase of bulk milk possible in the dried form, which will permit of an increase in the number of grants made without a corresponding increase in expenditure. The change from liquid milk supplied by the dairies to dried milk distributed from the welfare centres has necessitated certain alterations in procedure and administration- The forms of application for milk grants have been revised, and two additional junior clerks appointed to order the stores of dried milk each week, and to undertake the duty of distributing the milk at the welfare centres. The erection of a new health centre on the site of the Raymede infant welfare centre and adjoining properties was approved in principle by the council during the year- This building will centralise a number of maternity and child welfare and other health services now accommodated as separate units in various buildings in North Kensington. During September, when it was seen that most of the council's staff would be required for duty at the first-aid posts should an emergency arise, arrangements were made, with the help of the advisory committee, for the voluntary committees of all the welfare centres to help to carry on a skeleton maternity and child welfare service among the non-evacuated population. Happily, the need for this did not arise, but credit is due to the voluntary helpers who made it possible during the crisis to carry on the work at every centre under war conditions. 19 Health-Visiting Staff. The council's health-visiting staff for the maternity and child welfare scheme consists of eleven health officers. 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. Pre-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 two years 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. 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 1938 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 No. 11 Totals. First visits to infants (0—1 year) 121 45 218 284 138 120 186 96 95 107 221 1,631 Re-visits to infants (0-1 year) 947 462 462 577 649 742 539 1,173 7»J 739 588 7,675 Visits to children between 1 and 6 years 1,955 1,419 957 1,293 792 1,056 599 1,594 775 799 896 12,135 Still-birth enquiries 3 1 5 6 3 4 4 — 4 5 — 35 Visits to ophthalmia cases 2 — 3 — — 1 1 2 1 2 12 Return visits to ohthalmia cases 4 — 6 — — 2 1 6 19 Visits to measles cases 90 118 81 130 23 47 32 1 34 69 137 762 Visits to whooping cough cases 57 27 36 79 82 23 57 44 49 34 15 503 Visits to puerperal fever cases 1 — — — _ 1 1 — 1 — 4 Visits to puerperal pyrexia cases — — 1 3 2 3 2 4 2 3 20 Visits to enteritis cases 1 5 5 18 10 8 6 15 7 2 4 81 Infantile death enquiries 8 6 17 16 8 11 17 4 14 10 24 135 Investigations re milk applications 223 214 687 392 319 261 574 441 228 177 227 3,743 Pre-natal visits 310 180 342 230 347 341 179 583 346 255 410 3,523 Half-days at welfare centres 151 157 106 176 181 133 172 285 211 169 173 1,914 Special visits 417 196 377 817 693 267 703 214 391 474 443 4,992 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. Four were conducted by voluntary committees, but on the 1st April, 1938, one of these came under municipal control, and there are now four municipal centies and three under voluntary committees. The council's medical officers conduct both pre-natal and infant consultation sessions at all the infant welfare institutions. 20 The work done at these institutions during 1938 is shown in the following table Particulars of work done. Bramley Road. Campden Hill. Dalgarno. (municipal). Golborne. Kenley Street. (municipal). Lancaster Road. (municipal) Raymede. (municipal). South Kensington. Totals. Births occurring in the area of the centre suitable for welfare attention 292 95 160 243 140 325 289 242 1,786 Sessions at which doctor attended for infant consultations 154 49 96 103 123 174 137 131 967 Sessions at which doctor attended for special pre-natal consultations 51 44 51 48 50 79 71 50 444 Individual mothers who attended during the year 766 70 163 533 151 1,107 404 203 3,397 Individual mothers who attended pre-natal sessions during the year 277 70 137 142 151 219 233 126 1,355 Individual children who attended during the year— Children 0 to 1 year 417 115 243 235 238 519 438 321 2,526 ,, 1 to 5 years 393 83 289 394 192 888 442 290 2,971 Attendances at centre of mothers for- all purposes (excluding the accompanying of children and for the purpose of buying dried milk or other article) 1,771 273 1,297 1,072 888 3,997 1,974 1,114 12,386 Attendances at centre of children for all purposes— Children 0 to 1 year 4,358 1,301 2,341 2,379 2,545 5,582 3,749 3,829 26,084 ,, 1 to 5 years 2,808 736 1,899 2,688 1,754 3,575 2,235 2,534 18,229 Attendances at dinners— Mothers —— —— —— —— —— 1,683 —— —— 1,683 Children —— —— —— —— —— —— —— —— —— Attendances at doctors' consultations— Pre-natal mothers 1,329 273 638 486 775 979 1,031 616 6,127 ♦Post-natal mothers 1 3 16 23 3 —— 8 16 70 Children 0 to 1 year 1,998 644 1,035 1,238 1,211 2,416 1,765 1,834 12,141 1 to 5 years 1,375 358 1,021 1,212 956 1,950 1,165 1,296 9,333 Average attendances at doctors' consultations— Pre-natal mothers 26 6.1 12.2 10.0 15.5 12.4 14.5 12.3 —— •Post-natal mothers —— —— 0.3 —— 0.6 —— 0.1 0.3 —— Children 0 to 1 year 14 13.1 10.7 12. 9.8 13.9 12.8 14.0 —— „ 1 to 5 years 8.9 7.3 10.6 11.7 7.8 11.2 8.5 9.8 —— Individual children weighed dur- ing the year 810 196 532 629 430 983 880 548 5,008 Weighings 6,976 2,007 4,398 4,767 4,394 8,322 5,851 5,510 42,225 Home visits paid by staff of voluntary committee to— Expectant mothers 400 —— —— 171 —— †252 —— 270 1,093 2,709 Children 0 to 1 year 1,014 —— —— 358 —— †518 —— 819 ,, 1 to 5 years 1,332 —— —— 243 —— †596 —— 1,040 3,211 * Post-natal cases are now seen at the post-natal clinic at No. 304, Westbourne Grove, W.ll. †Lancaster Road infant welfare centre was taken over by the borough council on April 1st, 1938. The figures are in respect of visits paid by the staff of the voluntary committee during the first three months of the year. , The home visits paid in connection with municipal centres are included in the table of work of the health officers- 21 table showing the dental treatment performed at the centres in 1938. Centre- Patients. Attendances Extractions. Fillings. Dentures. Other treatments. Bramley Road 49 210 280 2 11 137 Campden Hill 6 12 21 4 —— 4 Dalgarno 53 185 61 8 12 104 Golborne 31 135 46 2 6 81 Kenley Street 71 297 501 10 14 191 Lancaster Road 196 528 186 10 44 181 Raymede 137 561 195 24 24 318 South Kensington 75 213 107 15 9 24 Totals 618 2,141 1,397 75 120 1,040 [Note.—In addition, 137 pre-school children, who had been referred to the baby clinic from infant welfare centres for medical treatment, received dental treatment thereat. The mothers of 106 children referred to the baby clinic for medical treatment received dental treatment whilst attending with their infants ; dentures were provided in 30 cases.] The council's scheme for the provision of dentures to necessitous expectant and nursing' mothers has proved of great value. Midwifery Arrangements. Pre-Natal Services. The pre-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. It is upon the clinic that the important duty devolves of advising each woman whether institutional or domiciliary confinement is preferable in her case, thus relieving unnecessary overcrowding of hospital wards whilst ensuring admission for those who require it. Nine pre-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 three hundred and fifty-five expectant mothers attended the infant welfare centres during the year, with a total of 6,127 attendances ; at the evening clinic 48 sessions were held and 134 women attended, making 456 attendances, with an average of 9.5 at each session. The total numbers attending the council's pre-natal clinics during the year 1938 are therefore 1,489 individual mothers with 6,583 attendances; the corresponding numbers for 1937 were 1,411 and 6,209, and for 1936, 1,340 and 5,085. 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 pre-natal sessions are held weekly at the Queen Charlotte's hospital district pre-natal clinic at No. 240, Ladbroke Grove. One hundred and two sessions were held during 1938, at which 430 Kensington women attended. There are also pre-natal departments attached to the London county council and other hospitals serving the borough. Full use is now being made of the pre-natal services provided by the council, and it is only in rare instances that a Kensington woman does not obtain pre-natal care. The excellent co-operation between the borough council's clinics and midwives or hospitals in charge of the women's confinement continues, and is an essential factor in the success of the maternity scheme. Hospital Accommodation. The hospital accommodation available for Kensington women has been sufficient for the needs of the borough, and no difficulty has been experienced in obtaining admission to hospital for any woman who required 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 pre-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. 22 Statement of work done during last five years. 1934 1935 1936 1937 1938 Applications for admission 206 224 186 197 162 ,, accepted 206 224 185 196 162 ,, withdrawn after acceptance 17 27 13 13 19 Women confined during the year 158 210 169 169 146 The gross cost of the scheme to the council during 1938 was £1,155 12s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £529 2s- Od- Payments made by patients totalled £633 Os. 6d. London County Council Hospitals. Kensington patients are admitted to St- Mary Abbots, Hammersmith and Paddington L.C.C hospitals, and a large number of Kensington women make use of this accommodation. The county council, in order to establish a closer link between the borough council's clinics and St- Mary Abbots hospital, have appointed the four medical officers concerned with the council's maternity and child welfare scheme as honorary officers of the hospital. 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. During the course of the year the two private midwives remaining in Kensington retired from practice, and, apart from the cases attended by doctors, domiciliary midwifery is now conducted by midwives of the London county council and of Queen Charlotte's hospital in the northern area of the borough A small number of cases are undertaken by St- Mary's hospital in connection with the teaching of medical students, the maternity nursing of these patients being carried out by the Kensington District Nursing Association- Excellent work has been carried out, and co-operation with the ante-natal clinics has been most satisfactory. Post-Natal Examination. In addition to le council's post-natal clinic, weekly post-natal clinics are held at the borough materuty 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. 304, West bourne Grove, 50 sessions were held during 1938, at which 74 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. His institution 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 tne 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. 23 The following are the records for 1938 :— Sessions at which doctors attended for infant consultations 163 Sessions at which doctors attended for mothers' consultations 50 Individual mothers who attended 234 Individual children who attended (old) 371 Individual children who attended (new) 608 Attendances of mothers for all purposes (excluding the accompanying of children) 964 Attendances of children for all purposes 0-1 year 1,316 1-5 years 8,615 been by doctor at consultations :— Mothers 964 Children 3,662 Average number seen by doctor at consultations :— Mothers 19 Children 25 Individual children weighed 979 Weighings 3,650 Infant and Toddlers' Treatment Clinic. In April, 1937, 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 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 during 1938 :— Sessions held 46 Individual patients treated, 0-1 year 250 „ „ 1-5 years 428 Attendances of patients at doctors' consultations 1,027 Average attendances at doctors' consultations 22 Total attendances for treatment, etc. 1,099 „ „ patients 0-1 year 452 „ „ „ 1-5 years 647 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. following is the record for 1938 :— Infants in residence at commencement of the year 23 Admissions 249 Discharges 241 Deaths 7 Infants in residence at end of the year 24 Average duration of stay in hospital 31 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. 24 Massage and Electrical Treatment. The Princess Louise Kensington Hospital for Children. The following is a record of the work conducted thereat during 1938 :— New cases— Under 5 years of age 67 Over 5 years of age 119 186 Discharged— — Under 5 years of age 55 Over 5 years of age 89 114 Transferred to other hospitals because over age 11 Cases treated 322 Treatments given 6,193 The borough council make an annual grant to the authorities of the hospital for this treatment. The Baby Clinic. Record of work during 1938 :— Individual patients treated 290 Treatments given 2,451 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 1,853 treatments were given, and the average weekly attendance was 80 ; one hundred and twenty 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 1938, 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 3 2 Hambledon Cottage Home, Surrey 3 — Wayside Convalescent Home, Sunningdale, Surrey 5 1 Zaohary Merton Home, Rustington, Sussex 28 — ihe Wayside and Zachary Merton convalescent homes are open for the reception of patients tliroughout the year, but the Evelyn and Hambledon homes are closed during the winter months. Ihe total cost to the council for convalescent treatment during the year was £132 18s. 9d. in addition, the Invalid Children's Aid Association sent 69 Kensington pre-school children for convalescence, and the council made a grant of £45 to that organisation in respect of this service. 25 Day Nurseries. The following table shows a record of children's attendances at the day nurseries in 1938 : Golborne. Lancaster Road. Notting Hill. St. Clement's. Totals. Whole-day attendances of children under 3 years of age 4,811 1,458 9,101 2,978 18,348 Whole-day attendances of children over 3 years of age 2,392 2,851 3,225 576 9,044 Total whole-day attendances 7,203 4,309 12,326 3,554 27,392 Charges made for each attendance of a child 8d. 9d. 8d. 1s. — Half-day attendances of children under 3 years of age — — — 466 466 Half-day attendances of children over 3 years of age — — — 103 103 Total half-day attendances — — — 569 569 Charges made for each attendance of a child — — — 6d. — Average daily attendance of children 32 20 54 19 — 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. Forty-four applications were granted during the year, and the cost to the council was £71 18s. 11d. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. In November, 1938, the council, in their scheme for the supply of extra nourishment for expectant and nursing mothers and infants, substituted dried milk for liquid milk. During the year 5,438 grants of milk were made by the applications sub-committee. One thousand three hundred and eighteen of the grants were in response to new applications, and the remaining 4,120 were renewals of grant. Under the council's scheme, 236,048 pints of fresh milk were granted free of charge at a cost to the council of £2,893 11s. 8d., and 11,203 packets of dried milk were granted free of charge at a cost of £786 13s. 2d. 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. No. of 7-pint packets sold. Value of milk sold. £ s. d. Bramley Road 2,003 9 136 12 11 Campden Hill 728 29 60 5 8 Dalgarno 950 17 72 2 8 Golborne 961 19 67 17 8 Kenley Street 1,150 1 77 19 2 Lancaster Road 2,991 20 206 16 4 Raymede 2,006 17 109 17 4 South Kensington 1,308 8 86 10 0 Totals 12,097 120 818 1 9 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-nine applications for free dinners were granted ; 54 of these were new applications, and 75 were renewals. The total number of dinners supplied was 5,786 and the cost was £146 8s. 6d. 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 :— 5,508 pints of milk at a cost of £75 13s. 9d. 140 packets of dried milk at a cost of £9 16s. 8d. A scheme of co-operation between the county council and the borough council enalbles 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. 26 Home Helps. One hundred and seventy-two applications were received for the provision of home helps under the council's scheme. The assistance was granted in 133 cases for a period of 14 days each, in four cases for a month, in three cases for three weeks, in one case for 16 days, in one case for 13 days, and in two cases for one week ; six applicants cancelled their requests and 22 applications were not granted. The gross cost of the scheme to the council was £213 19s. 4d. Boarding-out of 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 £27 13s. 2d. Travelling Expenses of Women Breast-feeding Infants Admitted to Hospitals. Nine 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 £4 1s. 0d. Health Lecturer. The part-time health lecturer who had been working in the borough for some years left at the end of 1937. The council gave careful attention to the question of filling the vacancy, and decided to appoint a whole-time propaganda officer. The officer appointed is a general hospital-trained nurse, a certified midwife, certificated health visitor and qualified sanitary inspector. She commenced her duties in the second half of the year, and the following is a record of the lectures given up to the end of December :— Lectures given. Individual mothers attending. Attendances. Average attendance at lecture. Bramley Road I. W. C. 12 98 178 14.83 Campden Hill ,, „ 11 99 260 23.54 Dalgarno ,, „ 12 61 145 12.08 Golborne „ „ 11 50 95 8.63 Kenley Street „ „ 11 43 113 10.18 Lancaster Road „ „ 11 67 123 11.18 Raymede ,, ,, 12 104 217 18.08 South Kensington ,, 11 61 121 11.0 Baby Clinic 1 14 14 14.0 Other institutions 3 — 90 30.0 Totals 95 597 1,356 14.27 Birth Control and Gynaecological Clinics. The council have an agreement with the North Kensington women's welfare centre at No. 12, felford Road, whereby women attending the infant welfare centres in the borough can, in appropriate cases, receive birth control advice and gynaecological treatment. During 1938, the attendances of Kensington women at the Telford Road clinic totalled 1,344. 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. Child Life Protection. At the end of the year there were in the borough 106 foster-mothers, and they had the care of 109 children under the age of nine years who had been taken for reward. One of the council's health officers holds the appointment of child life protection visitor, and pays frequent visits to every home where a foster-child is kept. Seventy-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. 27 The following is a record of the work carried out by the child life protection visitor :— Visits paid to homes 1,597 Special visits paid 401 Children removed voluntarily 153 „ „ compulsorily — ,, „ to hospital 25 Deaths reported 7 Cases in which there was cause for complaint 1 Cases recommended for prosecution — Foster-mothers added to register 54 ,, ,, removed from register 70 ,, ,, on register on 1st January 122 ,, ,, „ ,, 31st December 106 Foster-children „ „ „ „ 109 From the above table it will be seen that in only one case was there cause for complaint. After careful consideration by the maternity and child welfare committee it was decided to send a warning to the foster-mother concerned. The Advisory Committee to the Borough Maternity and Child Welfare Committee. The advisory committee was established in 1920. The voluntary 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. The control of various voluntary institutions by the borough council has not interfered in any way with the constitution or work of this committee, for the voluntary committees still remain attached to the institutions and carry on the social and ancillary work. The advisory committee have 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. As mentioned on page 18, the advisory committee rendered valuable help to the council during the September crisis in maintaining a skeleton maternity and child welfare service at the infant welfare institutions. 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 6,581. Various arrangements have been introduced for improving the systems of storing refuse, and the number of portable containers supplied to premises where large quantities of refuse accumulate has been increased from 191 to 288. 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 ansupervised 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 295 33 Plans approved by the council 295 33 Total reconstruction of drains of premises 71 24 Partial reconstruction of drains of premises 228 59 Repairs to drains by "Economic" method 16 27 Other sanitary works, such as new soil pipes, bath sinks and lavatory basins 3,429 1,623 28 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 INSPECTIONS, Etc. ward. Housing Inspectors. Total St. Charles. Golborne. Norland. Pembridge. Holland. Earls Ct. & Queens Gt. Brompton & Redcliffc 1 2 3 4 6 6 7 Total complaints received 412 582 341 447 175 206 284 352 2,799 Public Health (London) Act, 1936. Complaints received 361 375 284 418 163 204 256 73 2,134 Houses inspected on complaint 360 392 284 415 161 229 266 75 2,182 „ after infectious disease 216 161 91 55 25 54 75 10 687 Re-inspections 1,391 459 1,486 981 502 1,339 1,794 159 8,111 Inspections of mews 194 305 128 129 28 86 7 3 880 Smoke observations 3 5 19 2 — 29 Other inspections 1,073 1,141 512 589 187 680 699 1,076 5,957 By-laws re. houses let in lodgings. Complaints received 51 207 57 29 12 2 28 279 665 Houses inspected on complaint ... 51 207 57 29 12 2 29 282 669 First annual inspection (unfurnished houses) 159 96 275 306 251 134 220 583 2,024 Re-inspections do. do. 617 841 645 415 412 246 352 2,351 5,879 Housing Acts. Initial inspections (including preparation or revision of house-tohouse card) 192 108 266 220 82 138 279 830 2,115 Re-inspections 54 143 99 106 48 197 240 6,337 7,224 Underground living rooms. Primary inspections 159 108 196 294 44 226 169 648 1,844 Re-inspections 115 105 208 426 168 287 346 7,376 9,031 Drainage. Applications made 47 63 101 155 104 145 185 73 873 Plans submitted 15 22 17 33 63 79 89 10 328 House drains tested and inspected 241 268 406 223 53 142 57 222 1,612 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc., found during the year:— DESCRIPTION OF INSPECTIONS, Etc. ward. Housing Inspectors. Total St. Charles. Golborne. Norland. Pernbridge. Holland. Earls Ct. & Queens Gt. Brompton & Redcliffc 1 2 3 4 5 6 7 Notices issued. Public Health (London) Aet, 1936. Intimation notices 337 330 266 339 213 184 286 422 2,377 Statutory notices 52 89 83 25 42 43 38 90 462 Final notices 10 19 20 4 5 7 13 19 97 Summonses issued 3 3 10 2 — 2 — 15 35 Housing Act, 1936. Sect. 9 (Repairs) — — — — — — — 177 177 Sect. 157 (Entry) — — — — — — — 500 500 Removal of manure — 3 1 1 — 3 — — 8 Smoke nuisance orders — — — — — — — — — Rent Restrictions Act certificates 1 3 — — — — 1 — 5 Other notices 1 59 47 15 8 38 6 35 209 Report of waste of water to M.W.B. 11 39 18 11 — 13 1 71 164 ,, dangerous structures to L.C.C. 12 26 8 2 1 2 2 50 103 29 Summary of works completed under the supervision of the district and housing inspectors during the year :— DESCRIPTION OF INSPECTIONS, Etc. WARD. Housing Inspectors. Total. St. Charles. Golborne. Norland. Pembridge. Holland. Earls Ct. & Queens Gt. Brompton & Rodcliffe 1 2 3 4 5 6 7 House drains reconstructed 6 14 32 19 8 I 15 41 136 ,, additions to 21 9 186 44 17 20 27 165 489 Defective drains repaired 11 23 40 37 3 19 18 109 260 House drains cleansed 29 45 41 24 9 24 6 83 261 Water-closets reconstructed 7 58 42 4 21 12 40 45 229 „ repaired 23 47 22 46 18 42 7 178 383 „ new provided 21 19 72 96 56 53 108 65 490 „ supplied with water 3 16 49 7 48 58 148 18 347 Soil pipes ventilated, repaired, etc. 6 10 24 31 17 46 34 24 192 „ new provided 26 27 36 38 18 13 31 102 291 Ventilating pipes, new provided 25 15 40 16 8 3 19 95 221 Baths, new provided 25 9 48 92 57 98 199 12 560 Sinks, „ „ 42 86 78 117 23 67 63 535 1,011 Bidets, pp ,, — — 1 3 8 11 1 - 24 Lavatory basins, new provided 27 27 102 163 136 242 238 — 935 Waste pipes „ „ 68 84 170 100 60 88 90 439 1,099 Cisterns cleansed 24 16 24 22 16 44 43 104 293 „ covered 7 10 3 9 4 3 ! 34 28 98 „ abolished — 2 4 4 4 1 1 31 47 Taps fixed on rising main 146 72 133 7 4 6 33 439 840 Yards, areas paved, drained, repaired 56 27 49 20 13 | 11 21 314 511 Dustbins provided 50 49 66 72 79 90 32 153 591 Ashpits abolished 1 — 1 — 1 1 — 13 17 Accumulations of filth, etc., removed 39 58 49 21 2 28 17 285 499 Animals removed — 1 3 — — — — 1 5 Overcrowding abated 10 23 4 5 — 1 1 5 49 Underground rooms, illegal occupation discontinued 7 12 - - 1 2 22 Roofs repaired 82 80 81 56 22 27 35 492 875 Houses provided with water above basement floor - 7 4 2 1 14 - 38 66 Dampness in dwellings remedied 85 67 88 44 8 41 15 384 732 Ventilated food cupboards provided — 17 4 — — 8 | 5 375 409 Artificial lighting of staircases provided - - 4 - - - - 36 40 Closing Orders made under Housing Acts— (a) Houses - - - - - - - - - (b) Underground rooms - - - - - - - 540 540 Closing Orders determined - - - - - - - 44 44 Repairs of houses completed under the Housing Acts - - - - - - - 180 190 Infectious disease cases removed 119 86 87 65 25 51 56 5 494 Houses disinfected after infectious diseases (including bedding, clothing, etc.) 380 196 96 182 49 247 131 6 1,287 Rooms in such houses disinfected after infectious disease 389 232 118 201 60 280 162 6 1,448 Houses cleansed under houses let in lodgings by-laws 105 134 91 101 88 40 77 132 768 Cleansing of houses not on register 32 3 24 11 — 20 11 5 10«: *Verminous houses cleansed (including bedding, clothing, etc.) 122 112 75 86 15 74 48 143 675 *Verminous rooms cleansed in such houses 227 158 285 129 16 92 55 324 1,286 Dirty bedding cleansed 4 19 - 5 13 — 60 10 111 „ ,, destroyed 2 — 2 1 1 3 — 1 10 Other sanitary works executed 118 150 13 119 30 69 25 1,500 2,024 *These cleansings do not include those which appear on page 34 under the heading of Disinfestation—treatment of verminous dwellings and treatment of slight infestations. 30 Summary of Legal Proceedings taken in 1938. Offence. No. of summonses Magistrate's decision. Allowing dog to deposit its excrement on the public footway. 70 Fines totalling £30 14s. Od. and 5s. costs were imposed in 65 cases; summons dismissed in 5 cases, three being under Probation of Offenders Act, 1907. Breach of by-laws of London county council with respect to the removal of offensive matter. 3 Fines totalling £\ were imposed in 2 cases; summons dismissed in one case under Probation of Offenders Act, 1907. Failure to deposit plans in respect of drainage work. 2 Summons dismissed in each case on payment of costs. Failure to abate nuisance 14 Fined 10s. and order made to carry out work in two cases; order made to carry out work in 8 cases; summons withdrawn— nuisance abated—in 3 cases; summons adjourned sine die in 1 case, work being in hand. Breach of Housing Act relating to overcrowding. 4 Summons withdrawn in each case, overcrowding having been abated. Obstruction under Housing Act, 1936 6 Summons dismissed in each case. Permitting underground rooms to be used in contravention of closing orders. 9 Fines totalling £60 10s. with £4 4s. Od. costs. Smoke Abatement. During the year twenty-nine 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 a few cases owners and stokers were advised to adopt better methods of stoking, and burn a more suitable grade of fuel. 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 swimming bath with a capacity of 40,000 gallons, (c) a men's second-class bath, and (d) a women's second-class bath, each of the latter having a capacity of 45.000 gallons. During the summer season (April to September) the four baths were in continuous use. Towards the end of September the two first-class baths were emptied and cleaned. At the end of October the two second-class baths were treated likewise, 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 when the free chlorine content of the water is kept at about 0-4 parts per million, and the temperature of the water at about 73 degrees F. Any attempt to lower the chlorine content has been found to be unsatisfactory from the bacteriological point of view. Complaints by swimmers of the ill-effects of chlorine were rare even during the cold weather, when the water temperature was raised to 80 degrees and a slightly higher chlorine content was found to be necessary to keep the bacteriological counts at a satisfactory level. Numbers of persons using the swimming baths.—The number of persons using the baths during 1938 was 106,959. This represents a decrease of 24,569 on the figure for 1937, accounted for by the comparatively cold weather during the summer season. A similar drop in numbers was recorded in other districts in London. Men 28,589 Women 23,844 L.C.C. Schools— Boys 29,303 Girls 25,223 106,959 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, making a total of 40 samples. A further 18 samples were taken from the two secondclass baths during the winter season. 31 The samples were collected in sterile screw-capped bottles which were filled by a swimmer at varying positions in the bath—near the inlet, outlet and centre, and at different depths. The bottles were then taken immediately for culture of the contents to the council's laboratory at the Princess Louise hospital. Results.—Of the 58 samples taken during the year, 13 were sterile, and 27 shewed a total cellcount of under 10 organisms per c.c. of water. In 11 samples the total cell count was between 10 and 100, and in five between 100 and 200. The remaining two samples shewing counts of 320 and 480 organisms per c.c. were taken during a spell of cold weather when the water temperature had been raised, proving the necessity for raising the chlorine content above the usual level under those conditions. B. coli were absent from all samples. Streptococci were present on only two occasions (in July and August), and were associated with a low total count of under 30 organisms per c.c. Summary.—During 1938 a total of 106,959 swimmers used the baths. On 11 occasions the water was subjected to bacteriological examination, a total of 58 samples being taken. These examinations shewed the water to be satisfactory, although on one occasion when the water temperature had been raised the cell-count was higher than normal. Baths and Washhouses. There are 13 men's and seven women's first-class slipper baths, 34 men's and 20 women's secondclass slipper baths, and six special warm baths. During 1938 the total number of persons using the slipper baths was 74,298. The total number of bathers using the swimming baths and slipper baths in the last five years is shewn in the following table :— Year. Bathers. 1934 248,606 1935 218,449 1936 207,863 1937 210,535 1938 181,257 In the washhouses or laundry department there were 88 washtubs in use in 1938. The number of women using the washtubs in the last five years is as follows :— Year. Washers. 1934 79,686 1935 73,843 1936 65,537 1937 59,094 1938 56,877 There are eight washing machines, and the number of women who used these during the year was 15,241. Mortuary and Chapel of Rest. During the year 143 bodies were deposited in the public mortuary in the following circumtances:- At the request of relations or friends of the deceased 9 At the request of undertakers 21 At the request of coroner 107 By the police 6 Total 143 In 107 cases post-mortem examinations were made under the coroner's warrant. Twenty-seven bodies were deposited in the chapel of rest, Avondale Park. In recent years this building has been redecorated and the furnishings greatly improved with a view to encouraging its use by the poorer persons in Notting Dale who have no satisfactory accommodation for the bodies of dead relations pending the funeral. The number of bodies deposited during 1938 was greater than during the previous year, but there is still a reluctance on the part of the residents of North Kensington to make use of the facilities provided. Increase of Rent and Mortgage Interest (Restrictions) Acts, 1920-38. Five applications were made to the council in 1938 for a certificate of fitness of habitation under these Acts, and all were granted. Inspection of Shops. During the year under review 3,516 inspections of shops were made and 256 notices were served. The works required to be executed were mainly of a minor character. 32 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 1938, three inspections were made and 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 or 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 past year, no fewer than 18 complaints in respect of old and infirm persons were - reported to the public health department. Each of these was visited by one of the council's medical officers, necessitating a total of 25 visits. In 10 instances the person concerned eventually yielded to persuasion and entered hospital voluntarily for proper care and treatment. In 2 cases, while application to the Court for removal was pending, the patients died, having refused all offers of hospital treatment. In 3 cases no action was taken, one woman being considered fit to look after herself, and in the other two satisfactory arrangements were made for their care by relatives. The remaining 3 cases were all old women who were found to be verminous and suffering from some chronic disease. 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 234 Total number of visits paid 2,285 Number of poison baits laid during the year 27,335 „ „ disappeared 24,410 „ „ removed by the rat officer 2,925 Number of premises where concreting of basement floors has been carried out under the direction of sanitary inspectors to prevent the ingress of rats... 8 Number of premises where other repairs have been carried out under the direction of sanitary inspectors to prevent the ingress of rats 43 Number of sewer defects allowing egress of rats made good 8 Number of premises cleared of rats 118 The number of complaints received was about the same as in the previous year and, for the most part, investigation did not reveal serious infestation. Fewer poison baits were laid during the year, for it was decided to give a trial to the use of cardboard on which is spread an exceedingly sticky substance which acts as a trap. The results obtained were successful. As in previous years, National Rat Week was held in November, and various methods of rat destruction were carried out throughout the borough. There was intensive baiting of the borough council's sewers and arrangements were made with railway companies whose lines run through the borough for special measures to be taken by them. 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 vear was 121. 1 he activities of the council have undoubtedly secured a reduction of the number in the borough. By the end of 1937, all church towers in the borough found to be used by pigeons as roosting places had been wired up. During the past year, additional traps were bought and installed in various places. 33 Much of the good work carried out by the council, however, is nullified by the persistence of a small proportion of the residents in feeding the birds. Persons known habitually to throw food to pigeons are visited by one of the council's officers and an endeavour is made to persuade them to cease this practice. In most cases, unfortunately, the officer is met with a blank refusal, and, until the council can obtain legislation enabling them to control this indiscriminate feeding of wild pigeons, it is doubtful if further progress can be made. Since the council first started to deal with this problem in 1929, 2,203 pigeons and a large number of eggs have been destroyed. Fouling of Footpaths by Dogs. It was as far back as 1921 that the council, after prolonged negotiation, succeeded in obtaining a by-law enabling them to deal with the fouling of footpaths by dogs. At that time, they were much criticised for this innovation, but the same by-law has since been adopted by a large number of local authorities throughout the country. As a result of repeated representations, some modifications of the original by-law have been made, and the borough council now have the most stringent measure the Home Office will approve. Eighteen years' experience has shown, however, that the by-law does not provide an adequate remedy. Seventy summonses were issued and 65 convictions were secured during the year in respect of nuisances by dogs, but the footways in the borough, more particularly in South Kensington, still leave room for considerable improvement. 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, but the time has now come when some more intensive propaganda work must be undertaken with a view to convincing the people in the borough that the council must very largely rely on them to secure footpaths free from nuisance by dogs. 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. ings. Adults. Kensington 180 448 48 49 — — 7 15 Other boroughs ... 239 702 26 28 — — 3 7 School Children. Kensington 235 235 3,461 3,461 309 848 1 1 Other boroughs ... 90 188 486 486 79 211 Children under 5. Kensington 48 130 24 24 — — Other boroughs ... 29 84 2 2 — — - Lodging-house cases... — — 133 133 — — 329 329 Totals 821 1,787 4,180 4,183 388 1,059 340 352 The total number of persons cleansed during the year was 5,729 ; the total cleansings numbered 7,381. This shows a considerable increase over the figures for the previous year, which were 5,287 and 6,927 respectively. The clothing worn by persons on their visit to the medicinal baths is disinfected, together ivith such other articles of clothing as the patients may bring. Altogether 20,716 articles were so dealt with and, in addition, 754 blankets and sheets, and 607 articles of night clothing. Of the 4,661 school-children cleansed at the medicinal baths, 642 were compulsory cases ; the remainder attended voluntarily. 34 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. Probably the most rapid, effective, and economical method of eradicating the bed bug in verminous houses is by means of hydrogen cyanide (HCN) fumigation. This chemical, however, is highly poisonous both to human beings and domestic animals, and its use in areas like Kensington where most of the houses are of the terrace type is fraught with considerable risk. Indeed, because of this risk other methods, perhaps not so effective but safer in operation, have to be employed. One method of treatment which has been evolved is that in which a substance known as washed heavy naphtha is used. The number of premises treated with naphtha during 1938 was 61, the total number of room! being 183, Forty borough council houses were treated with naphtha. 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. 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 858 premises were treated with sulphur or with a light spray, 1,115 rooms in these premises being affected ; and 1,532 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 earned unsuspectingly from condemned houses to houses hitherto free. To avoid this possibility all infested houses are disinfested 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, as a precautionary measure, 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. 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. lhe 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 th'-n 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 419 Number of loads treated with hydrogen cyanide 491 The weight of furniture removed and treated with hydrogen cyanide was 532 tons. 35 The bedding in connection with the above removals weighed 35 tons 11 cwt. 0 qr. 22 lb., and this was treated by steam at the council's disinfecting station. The articles treated by steam were as follows :— Mattresses and flock beds 1,526 Bolsters and pillows 2,636 Quilts 375 Blankets and sheets 1,328 Sundries 857 6,722 The following table gives the bodies for whom removals were undertaken during the year:— Kensington Borough Council 203 Kensington Housing Trust 27 Peabody Donation Fund 106 Sutton Trust 20 Improved Tenements Association 33 Aubrey Trust 5 Capitol Housing Trust 1 Church Army 2 Wilsham Trust 1 During the past few years the council have entered into contracts with Paddington and other 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 1938 thirteen Holborn families and eight families from Paddington were moved. The weight of the furniture removed for these boroughs was 20 tons 5 cwt. ; and 246 articles, weighing 1 ton 1 cwt. 2 qr. 22 lb. were treated by steam at the council's disinfecting station. Inspections and re-inspections of premises. During the latter half of the year, 249 properties owned by the council in North Kensington were inspected for vermin. Seventy, or a percentage of 28 per cent., of these were found to be verminous. In most cases the infestation was slight ; in these the tenants were provided with hand sprayers and a quantity of insecticide, and asked to majce special efforts to rid the premises of bugs ; occupiers displayed a willingness to co-operate in this way. In the few premises where the infestation was extensive it was dealt with by the council's disinfestation staff. FACTORIES. The Factories Act, 1937, which came into operation in July, 1938, repealed the Factory and Workshop Act, 1901, and a number of other enactments relating to factories and workshops. The main object of the new Act is the consolidation, with modifications, of provisions formerly contained in the repealed enactments ; but it also introduces a number of new requirements, the general effect of which is to bring the law relating to factories into line with modern standards and conditions. The distinction between factories and workshops is abolished and the elaborate definitions contained in the 1901 Act are now condensed into one section which defines the term " factory." Workshops are no longer defined, but broadly speaking they are covered by the expression " factories in which no mechanical power is used." The former arrangement whereby factory inspectors and district councils shared the responsibility of enforcing sanitary conditions in factories and workshops is continued by the Act but in a modified form. The borough council are required to enforce in their area the provisions of the Act relating to cleanliness, overcrowding, temperature, ventilation,and drainage of floors in those factories where no mechanical power is used, and the provisions regarding sanitary conveniences in all factories, whether mechanical power is used or not. During the year under review, 151 defects relating to these matters were found, and sanitary notices requiring their remedy were served. The borough council are also entrusted with the control of bakehouses in their area, and an important alteration concerns the use of basement bakehouses. These cannot now be used unless they were in use as such on the 30th July, 1937, and a certificate of suitability had been granted under the Factory and Workshop Act, 1901. A basement bakehouse not used as a bakehouse for over twelve months cannot be so used again. The council must make an examination of every basement bakehouse in the year beginning 1st July, 1938, and in every fifth succeeding year, and if they are not satisfied as to suitability tb^v must give notice that the certificate will cease to have effect after the period, not less than one month, specified in the notice. A survey of all the basement bakehouses in Kensington for the purpose of this provision is now in progress. 36 Water Supply. A duty imposed upon the council by the Act relates to the water supply to factories where it is not obtained from a public main. In such cases the supply must be approved by the council. In Kensington there are four sets of premises coming within the scope of the Act, all of which obtain water from artesian wells. In one case the water is drawn from four wells, in another from three wells, and in the remaining two from one well each, making a total of nine wells in all. The council decided that samples of water from these wells should be examined at quarterly intervals. In three of the premises it was found that the samples obtained were satisfactory and approval has been given ; in the fourth case (indicated in the following tables as " D ") the water is not uniformly satisfactory and the granting of a certificate is still under consideration. The results of the examinations made are set out in the following table. (A) Chemical Analysis. (i) Samples collected at premises of A. 10th January, 1938.' 9th March, • 1938. 9th June, 1938. 5th October, 1938. 30th January, 1939." Free ammonia 0-032 0-04 0-04 0-03 0-06 Albuminoid ammonia Nil Nil Trace Trace Trace Nitrogen as nitrites Nil Nil Nil Nil Nil ,, ,, nitrates Nil Nil Trace Nil Trace Chlorine as chlorides 160 16-0 15-8 15-6 15-2 Total solids 74 0 77-0 77-0 76-0 77-0 Oxygen absorbed in 3 minutes 0-005 0-009 0-006 0-006 0-003 ,, 4 hours 0-02 0-022 0-024 0-02 0-018 Poisonous metals Nil Nil Nil Nil Nil (ii) Samples collected at premises of B. 10 th January, 1938." 9th March, 1938. 9th June, 1938. 5th October, 1938. 30th January, 1939." Free ammonia 0-018 0-06 0-02 0-003 0-032 Albuminoid ammonia 0-008 0-008 Trace 0-008 Nil Nitrogen as nitrites Nil Nil Nil Nil Nil ,, ,, nitrates Nil Trace Trace Nil Trace Chlorine as chlorides 21-0 20-0 20-8 21-1 20-5 Total solids 90-0 86-0 90-0 67-0 87-0 Oxygen absorbed in 3 minutes 0-01 0-012 0-012 0-01 0-006 ,, ,, ,, 4 hours 0-025 0-032 0-024 0-023 0-021 Poisonous metals... Nil Nil Nil Nil Nil (iii) Samples collected at premises of C. 9th June, 1938. 5th October, 1938. 30th January, 1939. Free ammonia 0-07 0-03 * 0-016 Albuminoid ammonia Nil Nil 0-012 Nitrogen as nitrites Trace Trace 0.024 ,, „ nitrates Trace Trace 0-25 Chlorine as chlorides 18-5 18-5 6-3 Total solids 90-0 89-0 42-0 Oxygen absorbed in 3 minutes 0-003 0-003 0-022 4 hours 0-012 0-006 0-122 Poisonous metals Nil Nil Nil * 1 his sample consisted of mixed Metropolitan Water Board and well water. The above results indicate that the samples are free from contamination and are fit for drinking and all domestic purposes. 37 (iv) Samples collected from premises of D. 10 th January, 1938. 9th March, 1938. 9th June, 1938. 5th October, 1938. No. 1. 5th October, 1938. No. 2. 30th January, 1939. Free ammonia * 0-056 * 0-08 t 0-08 * 0-06 * 0-06 X 0-112 Albuminoid ammonia Nil Nil Trace Nil Nil Trace Nitrogen as nitrites Nil Nil Nil Nil Nil Nil ,, „ nitrates Nil Trace Trace Trace Trace Trace Chlorine as chlorides 16-0 16-0 15-9 16-5 16-0 15-7 Total solids 86-0 82-0 85-0 86-0 85-0 85-0 Oxygen absorbed in 3 mins. 0-01 0-009 0-009 0-003 0-003 0-003 >> ,, ,, 4 hours 0-025 0-016 0-11 0-006 0-01 0-018 Poisonous metals ... Nil Nil Nil Nil Nil Nil * These samples are free from contamination and fit for drinking and all domestic purposes, t This sample was distinctly opalescent and only of medium purity. J This sample contained an excess of free ammonia, but in the absenoe of other evidence the sample cannot be regarded as a polluted one. (B) Bacteriological Examination. Date. Organisms per ml. incubated on agar after 2 days at 37°C. Organisms per ml. incubated in gelatine after 3 days at 20°C. Samples collected at the premises of A ... 9-1-38 Nil Nil 9-1-38 1 • 1 9-1-38 1 1 9-1-38 Nil. Nil. 9-1-38 Nil. Nil. 9-1-38 Nil. Nil. 9-1-38 Nil. Nil. 9-1-38 Nil. Nil. 9-3-38 32 20 9-3-38 299 60 9-6-38 33 34 5-10-38 1 1 30-1-39 2,560 Nil. Samples collected at the premises of B ... 9-1-38 Nil. Nil. 9-1-38 1 Nil. 9-1-38 4 Nil. 9-3-38 29 2 9-6-38 6 77 o—10—38 20 3 30-1-39 25 Nil. Samples collected at the premises of C ... 9-6-38 5 1 5-10-38 Nil. Nil. 30-1-39 14 Nil. Samples collected at the premises of D ... 18-1-38 66 448 9-3-38 510 100 9_3_38 8,448 5 9-6-38 8 8 5-10-38 17 4 5-10-38 28 7 30-1-39 6 Nil. No B. coli, streptococcus faecalis, or B. Welchii was found in any of the above samples. In addition to the above samples, others have been taken by the owners of the wells aud, with the exception of two which indicated slight contamination, submitted by the owner of the weh at premises D, all the results were satisfactory. Register. The council are required to keep a register of all factories, and the following table shows various trades and occupations carried on at the premises registeied in Kensington. Trade or Business. Factories in which power is used. Factories in which power is not used. Total. Aerated water manufacturers 2 — 2 Arts and crafts 3 — Baby carriage makers — 1 o 1 A Basket makers z Bedding makers 2 2 i Biscuit manufacturers I 1 Blacksmiths, farriers 2 6 » Blind makers — 3 3 Boot makers and repairers 50 28 78 Bottle dealers — 1 1 Builders 12 58 70 Button makers — 1 1 Cabinet makers 12 12 24 Cardboard box makers 1 — 1 Carpet repairers — 6 6 Chromium-platers 1 — 1 Coach builders 8 2 10 Coffee grinders 3 — 3 Corset makers 1 6 i Cosmetic manufacturers — 1 1 Cycle repairers — 3 3 Dentists — 1 1 Departmental stores 6 2 8 Dressmakers 21 106 127 Dry cleaners 10 1 11 Dyers and cleaners 7 3 10 Electrical apparatus 7 8 15 Electrical generating station 5 — 5 Embroidery — 4 4 Engineering works and motor garages 64 34 98 Fine needlework 1 1 2 Firewood choppers 2 1 3 Florists — 11 11 Fried fish shop 1 — 1 Furniture remover 1 — 1 Furriers 13 8 21 Gasworks 1 — 1 Glovemakers 1 — 1 Hair dressers — — — . Ice cream manufacturers 1 — 1 Instrument makers 1 — 1 Invisible menders 3 1 4 Ironmongers — 2 2 Jewellers 5 3 8 Lampshade makers — 3 3 Laundries 42 17 59 Lacquerers 1 — 1 Leatherwork — 2 2 Marine stores — 5 5 Metal workers 4 3 7 Millinery — 26 26 Mineral water manufacturers 1 — 1 Oil and grease manufacturers 1 1 2 Organ builders 1 — 1 Optician — 1 1 Paint manufacturers 1 1 2 Dhotographers — 2 2 'iano repairers — 2 2 'icture framemakers 1 6 7 Pipe makers 2 — 2 Printers 23 — 23 39 Trade or Business. Factories in which power is used. Factories in which power is not used. Total. Radio repairers 3 5 8 Sadlers 1 1 Sausage makers 24 24 Scrap metal dealers 2 2 Sign writers 1 4 5 Soft furnishers o 2 Starch manufacturers 1 1 Steam pressers 3 — 3 Stonemasons 2 6 8 Sundries 11 11 22 Tailors 17 97 114 Toilet requisites 1 3 4 Toy makers 1 — 1 Trunk makers 6 6 Umbrella manufacturers 2 2 Undertakers 3 4 7 Upholstery 2 19 21 Wax figures 1 1 2 Watch makers 2 4 6 Wheelwrights 1 — 1 Wig makers — 4 4 Window blind makers — 1 1 Window screen manufacturers 2 2 Totals 402 555 957 Outworkers. The requirements of the new Act with regard to outworkers are substantially the same as those contained in the 1901 Act. An occupier of a factory is required to keep a list in a prescribed form of all outworkers employed and to send copies of the list twice annually to the district council. Where a list includes outworkers employed outside the borough the council must send the names of such outworkers to the authority concerned. Of the 225 outworkers employed in the borough, 66 are employed in factories within the meaning of the Factories Act, 1937, whilst the remaining 159 are genuine outworkers engaged in their homes on the work given out to them by various firms and contractors in Kensington and other districts. The nature of the work given out to the 159 home workers on the register is as follows :— Hand knitting 54 Tailoring . 45 Dressmaking 26 Bootmaking 11 Linen working 9 Sundries 8 Fancy goods 4 Chair caning 2 159 r During the year there have been seven cases of infectious disease (two of diphtheria and five of scarlet fever) in outworkers' premises. In each case the employers of the respective outworkers were informed, and work was suspended until the patient had been isok ;ed in hospital, and the material on hand and the premises had been satisfactorily disinfected. 40 Home Office Tables- The following tables contain a summary of the inspections made and the defects found and remedied in factories within the borough :— 1.—Inspections. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories with mechanical power 565 29 __ Factories without mechanical power 866 34 — . f Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 717 16 — Total 2,148 79 — f Electrical stations are reckoned as factories. 2.—Delects Found. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Particulars. Found. Remedied. Referred to H.M. Inspector. (n (2) (3) (4) (5) Want of cleanliness (S. 1) 65 61 Overcrowding (S. 2) 1 1 — — Unreasonable temperature (S. 3) — — — — Inadequate ventilation (S. 4) 2 2 — — Ineffective drainage of floors (S. 6) 1 1 — — Sanitary conveniences (S. 7) :— Insufficient 3 3 — — Unsuitable or defective 31 31 — — Not separate for sexes 8 8 — — Other offences ... (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) 67 67 33 Totals 151 147 33 — 3.—Outwork in Unwholesome Premises. Nature of Work. Instances. Notices served. Prosecutions (1) (2) (3) (4) Wearing apparel:— Making, etc. 19 19 Cleaning and washing 1 1 Curtains c*.id furniture h ngings . 1 1 Fur pulling ... 1 1 Lampshades. 1 1 — Total 23 23 Nil 41 HOUSING. Clearance Areas. Since 1930 the council have dealt with thirteen clearance areas in which there were 219 premises occupied by 1,117 people; in every instance the premises have been demolished. The following table gives particulars of the five further clearance areas which have been recently represented but in which the premises have not been demolished :— Name of area. Ward. Date of representation. No. of houses in area. No. of persons in occupation. Royal Crescent Mews Norland ... 31st Dec., 1937 16 70 Yeomans Row (No. 2) Brompton 11th Oct., 1938 4 42 Portobello Street ... Pembridge 22nd Nov., 1938 8 81 Elgin Mews do. 20th Dec., 1938 28 113 Silchester Terrace, Mersey Street St. Charles do. 4 28 Compulsory Purchase Orders. The council, in pursuance of their powers to provide housing accommodation for the working classes within the borough, had before 1938 made compulsory purchase orders in respect of six 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. The council have demolished the existing buildings and are erecting 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. The council have demolished the existing buildings (together with two houses already in their ownership) and are erecting 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. At the end of the year 60 flats and two shops were under construction and will provide accommodation for 354 persons. (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. By the end of the year the premises had been demolished and the Aubrey Trust were preparing to erect 45 flats on the site to provide accommodation for 262 persons. (f) 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 council have acquired the property and are preparing a scheme for the erection, in 1939, of working class flats on the site. Improvement Areas. The council's five years housing programme, adopted in 1933, proposed that seven areas in the borough, containing 910 houses with a population of 12,010 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, ajid 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 42 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 3,124 inspections were made of the houses in the area, and 461 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 1,101 inspections of basement rooms in the area were carried out, and in 107 cases notices under the by-laws were served requiring cleansing works, the removal of rubbish, etc. (2) Crescent Street Improvement Area.—This area, consisting of 129 premises with a population of 1,782 persons, was declared an improvement area in April, 1934. The by-laws for the abatement of over-crowding 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 oi the area, including other houses and land adjoining. On the 5th April, 1938, the Council approved, in principle, the redevelopment of this area by the provision of blocks of working class flats and arrangements were made for plans and estimates to be obtained. At the end of the year the council had acquired a large proportion of the land and were negotiating for the acquisition of the remainder. (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 taken were the closure of unfit basement dwellings, the rehousing of persons so displaced, and the elimination of overcrowding. Closing orders were made in respect of 219 underground rooms and undertakings from owners to make the rooms fit for habitation were accepted in 52 cases. The number of families occupying closed underground rooms and needing other accommodation was 114, consisting of 420 persons. These families have been rehoused and the underground rooms are now empty. The number of overcrowded families (living in rooms above basement level) was 113, comprising 605 persons, and these have all been rehoused. 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 the results obtained up to the 31st December, 1938 :— Notices served up to the 31st December, 1938 189 Notices satisfactorily co/nplied with by owners 153 Notices in respect of which the council carried out the work following default by the owners 5 Notices in respect of which progress was being made by owners on the 31st December, 1938 7 Notices in respect of which nothing had been done on 31st December, 1938. (The time allowed had not expired in these cases) W It is satisfactory to know that although these Housing Act notices were necessarily of an extensive nature require the provision of extra sanitary accommodation, such as water closet apartments, sinks, etc., "there has been no appeal to the county court in any case. During 1938, 15 houses were reconditioned voluntarily by the owners and the number of houses found to be satisfactory on inspection was 10. The only houses remaining to be inspected and dealt with on the 31st December, 1938, were 24 in number. When these 24 houses have been dealt with the reconditioning of the Treverton Street area will be complete. 43 Individual Unfit Houses not Repairable at Reasonable Cost. Section 11—Housing Act, 1936. During 193 < two houses in Becher Street had been represented as unfit for habitation and not repairable at reasonable cost. The question of making demolition orders was under consideration in 1938 when the owners offered to sell the ground to the council. This offer was accepted and the premises which are situated in the Becher Street area will be demolished in connection with the council's scheme for redeveloping the area. Individual Unfit Parts of Houses not Repairable at Reasonable Cost. Section 12—Housing Act, 1936. The following table shows the action taken during 1938 in respect of unfit parts of houses (underground rooms) :— Closing orders made 256 (508 rooms). Closing orders determined 44 (87 rooms). Undertakings by owners not to use for human habitation accepted nil. Undertakings by owners to make premises fit accepted 60 (119 rooms). Undertakings cancelled—Premises having been made fit for habitation 47 (89 rooms). Cases of default in undertakings to make premises fit for habitation (closing orders made) 17 (32 rooms). On the 17th May, 1938, appeals by the owner against closing orders in respect of three underground rooms in Dartmoor Street were heard at the West London county court, when the judge made an order quashing the closing orders on the terms that the appellant carried out to the satisfaction of the council within two months the work which would render the underground rooms fit for habitation. Although the closing orders were quashed, costs amounting to £15 15s. Od. were awarded to the council. Subsequently the appellant decided not to carry out the undertaking and her solicitor applied to the court for the closing orders to be restored, which was done on the 11th July, 1938. On the 5th December, 1938, appeals against closing orders in respect of two underground rooms in Cornwall Road (now West bourne Park Road) were heard in the Marylebone county court. The judge confirmed the closing orders and the appeals were dismissed. Costs amounting to £19 6s. 8d. were awarded to the council. All the 256 closing orders made during the year were in respect of basement rooms. At the time the orders were made, 105 of the basements were empty and in 86 cases the basement tenants were able to move upstairs to adequate accommodation in the same house, or found their own accommodation elsewhere. Sixty-five families (293 persons) were rehoused by the council, or through their agency, by the London county council and housing associations. Generally speaking, the closing orders made by the council are not contravened and in the previous two years it was unnecessary to resort to legal proceedings to enforce closing orders. In 1938, however, the council found it necessary to take proceedings in respect of the illegal occupation of seven closed underground rooms ; fines amounting to £60 10s. Od. were imposed on the owners and the council were awarded a total of £4 4s. Od. costs. Permitted Use of Closed Rooms. During the year, applications were received for permission to use 104 closed rooms or parts houses, and the following table gives a summary of the purposes approved by the council :— Kitchens 33 Storage 24 Dining rooms 17 Sitting rooms 11 Washhouses 8 Bathrooms 4 Offices 2 Total 99 Five applications were refused. Three were for permission to use closed rooms as kitchens, one as a workshop and one as a maid's room. 44 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. 1938 :— Outside improvement areas. Inside improvement areas. Total. Notices served in 1937 which were outstanding on 1st January, 1938 35 52 87 Notices served from 1st January to 31st December, 1938 92 85 177 Notices satisfactorily complied with by the owners 66 103 169 Notices in respect of which the council carried out the work following default by the owners... 8 3 11 Notices in respect of which progress was being made by the owners on 31st December, 1938... 21 7 28 Notices in respect of which the council's contractors were engaged in executing repairs on 31st December, 1938 7 7 Notices in respect of which nothing had been donfe on 31st December, 1938 (the time allowed had not expired in these cases) ... 25 24 49 From the time the council commenced enforcing the repair of houses by the service of Housing Act notices up to the 31st December, 1938, they have expended £6,762 Is. 8d. in carrying out work following default by owners. Of this sum £5,591 13s. lid. has been recovered, and the outstanding amount of £1,170 7s. 9d., with interest, is being collected by instalments. The total expenditure by the council during 1938 in executing repairs was £1,274 3s. 6d. In the past sixteen years 1,790 houses have been repaired under Housing Act procedure. Certificates of Fitness of Houses. Section 51 of the Housing Act, 1936, states 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, one house was considered under this section of the Act and the council decided to grant a certificate specifying a period of five years. Overcrowding. Under the Housing Act, 1936, a dwelling-house is deemed to be overcrowded when the number of persons sleeping in the house either :— [а) 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 (б) 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 (6) :— 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 (herein of the floor area specified in the first column of Table II in the annex hereto, the number specified in the second column of that table in relation to that area, whichever is the less— provided that in computing for the purposes of the said Table I the number of rooms in a house, no regard shall be had to any room having a floor area of less than 50 square feet. 45 Table I. Where a house consists of :— one room 2 units two rooms 3 three rooms 5 fourrooms H five rooms 10—with an additional two in respect of each room in excess of five. Table II. Where the floor area of a room is :— 110 sq. ft. or more 2 units 90 sq. ft. or more, but less than 110 sq. ft H „ 70 Sq. ft. or more, but less than 90 sq. ft 1 50 sq. ft. or more, but less than 70 sq. ft * .. 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. Particulars of the number of overcrowded families rehoused since the survey are as follows :— 1936. 1937. 1938. Families. Persons. Families. Persons. Families. Persons. No. of families overcrowded at beginning of year 2,529 11,686 2,428 11,251 2,034 9,234 No. of new overcrowded families discovered during the year 14 71* 56 239£ 68 335£ No. of families rehoused during the year 115 606i- 450 2,256£ 175 846£ No. of overcrowded families remaining at end of the year 2,428 11,251 2,034 9,234 1,927 8,623 In this table children between the ages of one and ten years are counted as half-persons. Infants tinder one year of aee are not counted. 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 it necessary to institute legal proceedings in respect of four overcrowded families but in each case the summons was withdrawn as the overcrowding was abated before the Court hearing. 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 1,92/ (8,623 units). The number of new cases of overcrowding reported 68 (335J units). The number of cases of overcrowding relieved 175 (846£ 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 conneccion 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." 46 (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.# jfr (4) The Act contains special provisions relating to overcrowding already existing on the above-Vnentioned date or which is due to a child attaining the age of either one or ten years after that date, or which is due to exceptional circumstances. Full information about these special provisions and all provisions as to overcrowding can be obtained free on application to the borough council, whose address is Town Hall, Kensington, W.8. The Act provides that the council shall, upon application of either the landlord or occupier, give in writing the permitted number of persons in respect of the dwelling-house owned or occupied by the applicant. In order to deal with the maximum number of -applications from owners for permitted numbers, the council during the summer 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 1938, however, it was found necessary to employ only one assistant. The following table shows particulars of the work carried out during 1938 :— Number of applications received ... ... ... ... ... 223 Number of houses involved in these applications ... ... 3,273 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 3,097, and the number of inspections of these houses during the year was 8,627. The number of houses cleansed as a result of notices served under the by-laws was 768. New £v-laws were made by the London county council which are substantially the same as the old bj^d with the addition of the power to prevent nuisances in closed rooms. They came into openypnn on the 1st January, 1939. Public Health (London) Act, 1936. The number of written intimation notices served in respect of defects or nuisances in dwellings was 2,377. 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 462 statutory notices and 97 final notices; and fourteen summonses were eventually served. The following list shows the major improvements secured :— Houses cleansed 1,549 House drains reconstructed 136 „ „ additions to 489 Defective drains repaired 260 House drains cleansed. 261 Water closets reconstructed or repaired 512 (new) provided. 490 „ „ supplied with water 347 Soilpipes ventilated, repaired, etc 192 (new) provided 291 Ventilating pipes (new) provided 221 Baths (new) provided 560 Sinks (new) provided 1,011 Lavatory basins (new) provided 935 Waste pipes (new) provided 1,099 Cisterns cleansed, covered, etc. 391 Taps fixed on rising main 340 Yards and areas, paved, drained, repaired 511 Dustbins provided . 591 Ashpits a-Dolished 17 Accumulations of filth, etc., removed 499 Roofs repaired 375 Houses provided with water above basement floor 66 Dampness in dwellings remedied 732 Ventilated food cupboards provided. 409 Artificial lighting of staircases provided 40 47 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. During the year, these houses were reconditioned by the council and have been let to large overcrowded families who could not be satisfactorily accommodated in the usual type of council house or flat. 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. In 1937 there were two lodging houses for women and one for men. In 1938 the lodging house for men at Nos. 28 & 30, Crescent Street was acquired by the council for the purpose of demolition in connection with the proposal to redevelop Becher Street Area, and, therefore, the licence was not renewed. The following table shows the licensed common lodging houses and the accommodation available on the 31st December, 1938 :— Ward. Premises. No. of lodgers. Norland No. 40, Becher Place ... ... ... (Formerly Crescent Street.) 21 women." *. Golborne No. 194, Kensal Road 49 women. Although these two lodging houses can accommodate 70 persons, a recent census, taken at night, revealed only 40 persons 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 Talbot Grove and Mews 44 "Vos. 84-90, Princes Road and ,*9S. 32 and 34, St. Charles Square 9 Octavia House In addition to the above property there are 16 occupied houses under the management of the borough council which were acquired during 1938 in connection with the scheme of redeveloping the Becher Street area. 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. 48 Accommodation provided in the Borough by Housing Associations. The following is a table of properties in the borough owned and managed by housing associations. Association. Houses. Flats. Kensington Housing Trust, Ltd. 53 230 Wilsham Housing Trust 129 60 Improved Tenements Association 330 32 Aubrey Trust and Horace Street Trust 39 14 Sutton Trust — 641 Peabody Donation Trust — 363 Capitol Housing Association — 68 Church Army Housing Association 24 Totals 551 1,438 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 2,000 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 1938 and set out in circular 1728 :— 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) ... 7,677 (b) Number of inspections made for the purpose 28,891 (ii) (a) Number of dwelling-houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 ... 2,115 (b) Number of inspections made for the purpose 7,224 (iii) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 44 (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 2,554 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 1,815 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 169 (b) By local authority in default of owners 11 (b) Proceedings under Public Health Acts— t^i) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 2,377 (ii) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) By owners 2,377 (b) By local authority in default of owners Nil 49 (c) 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 (ii) Proceedings under section 12 of the Housing Act, 1936— (i) Number of separate tenements or underground rooms in respect of which closing orders were made 273 (540 rooms) (ii) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 44 (87 rooms) 4. Housing Act, 1936, Part IV—Overcrowding :— (a) (i) Number of dwellings overcrowded at the end of the year 1,927 (ii) Number of families dwelling therein 1,927 (iii) Number of " equivalent " persons dwelling therein 8,623 (b) (i) Number of new cases of overcrowding reported during the year 68 (ii) Number of " equivalent " persons concerned in such cases 335£ (c) (i) Number of cases of overcrowding relieved during the year 175 (ii) Number of " equivalent " persons concerned in such cases 846* (d) Number of cases in which dwelling-houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding ... Nil Note.—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. INSPECTION AND SUPERVISION OF FOOD. 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 1938 eleven samples were so examined, and in every case a negative result was obtained. Composition of Milk Samples.—Of the 461 samples of milk taken under the Food and Drugs (Adulteration) Act, 1928, in 1938, seven 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 milk samples taken. Month. Number of 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 42 3-65 8-82 3-65 8-82 February 42 3-64 8-85 3-64 8-85 March 27 3-44 8-77 3-44 8-77 13 3-37 8-86 3-37 8-86 May 44 3-17 8-86 3-33 8-82 June ... 32 3-38 8-78 3-38 8-78 3 0 8-5 July 38 3-52 8-78 3-52 8-78 August 56 3-46 8-73 3-46 8-73 September 8 3-52 8*81 3 *52 8 *81 Avbragb composition of normal cow's milk. October November 72 52 3-68 3- 70 8*70 8-80 3-73 3-70 8 *80 8-81 Percentage of milk fat. Percentage of solids not fat. December 35 3-74 8-85 3*74 8*85 J 461 3-52 8-80 3*54 8-8-1 3.7 8.9 The table shows that the average fat and non-fatty solid content for each month of the is well above the legal standard, and makes it clear that suspicion should fall on every sample which at any time of the year shows a fat content as low as three per cent. 50 The following table has been prepared to show the number of samples (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. 1938. First quarter 10 90 10 110 Second quarter ... 1 43 41 85 Third quarter 5 85 12 102 Fourth quarter ... 24 133 — 157 Totals ... 40 351 63 454 Percentages 8-8 77-3 13-9 100 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." 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, and 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 1938, 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 5 2 2 Vacated and removed from register 1 1 Dairymen with premises outside the borough added to the register _ 3 On register 1st January, 1938 165 173 137 On register 31st December, 1938 170 177 138 (+) Increase. (—) Decrease +5 +4 + 1 During the year the council took action under Section 2 of the Milk and Dairies (Amendment) Act, 1922, to secure the removal of a firm of dairymen from the register. In July last the firm were suspected of adding a fluid reconstituted from skimmed milk powder to their supplies of fresh milk. This firm occupied a large dairy overlooking which were a number of flats. One of these was not occupied for residential purposes, and it was here that the milk was believed to be " manufactured." A magistrate's warrant was obtained to enable a search of the premises to be carried out, and a forced entry to the flat was made. In the flat were found drums of skimmed milk powder, milk-testing apparatus, stirring rods, etc. A hose pipe was found in the dairy, and the markings on it pointed to its having been used as a connecting pipe between the bathroom and the milk storage tank in the dairy. Further investigations revealed that no less than twelve tons of skimmed milk powder had been purchased by the firm over a period of eighteen months. In addition, quantities of cream, far in exccss of the assumed normal requirements, had been purchased during the corresponding period. An attempt was made to examine the books of the firm, but complete records were not made available to the council's officers ; but from the limited records examined it was brought to light that on some days over 200 gallons of milk per day were distributed in excess of the amount shown in the books to have been received bv the firm. A notice was served upon the company under section 2 of the Milk and Dairies (Amendment) Act, 1922, requiring them to show cause why their name should not be removed from the council's register of milk purveyors, and after interviewing the firm's representatives, the council, in July, decided to remove the company's name from the register absolutely. An appeal was entered, but on 14th January, 1939, after several hearings at the police court, it was dismissed. The company at once gave notice of a further appeal to a higher court, but on 7th February they notified the council of its abandonment. At the time of preparing this report it seems probable that the company will shortly cease to exist. 51 Although the council decided to cancel the registration of this firm in July, 1938, it was not until February, 1939, that they were legally barred from carrying on a milk trade, and had the final appeal not been abandoned they could have continued until such time as it had been determined in the courts. It would seem unfortunate that the existing law for dealing with this type of offence provides the defendant with an opportunity of securing such a long drawn out procedure. Sterilisation of Milk Utensils. During the latter half of 1937, the public health committee resolved to regard as unsuitable for retention on the register of dairies any milk shop in which milk was sold in bottles, filled and closed on the premises, unless scalding equipment had been provided. All milk shops in Kensington where milk is sold in bottles filled on the premises have now been supplied with this equipment, and the council's inspectors pay surprise visits from time to time to satisfy themselves that the bottles are being properly scalded. Attention is also given to this matter during routine inspections, 482 of which were made during the year. Milk (Special Designations) Orders, 1936 and 1938.—The 1936 order revoked an earlier one, and reduced the number of designated milks to three, namely, Tuberculin Tested, Accredited, and Pasteurised. In 1937, the (iuty of inspecting dairy cattle was transferred from the local authorities to the new veterinary service organised by the Minister of Agriculture, and a new order, dated 1938, gave effect to this change. One or two other minor alterations were also made. The following is a brief summary of the requirements for each grade of milk:— 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 1938 were as follows:— Principal Supplementary licences. licences. Dealers' licence to bottle and to sell Tuberculin Tested milk 2 – Dealers' licence to sell Tuberculin Tested milk 15 4 Dealers' licence to pasteurise milk 1 – Dealers' licence to sell Pasteurised milk 45 8 (Note.—Supplementary licences enable the holders to sell graded milks in Kensington from premises situated outside the borough.) The council, under the Milk (Special Designations) Orders, may, subject to the licence holder's right of appeal to the Ministry of Health, suspend or revoke a licence where there has been a breach of any of the conditions under which it has been granted. The council took action under this power against the company referred to under the heading " Milk and Dairies (Amendment) Act, 1922, on page 50 of this report. The company had held a licence to pasteurise milk for three years, during which time a number of complaints had been made with regard to the milk sold by them in Kensington and elsewhere. Other complaints dealing with the conduct of the business had also been made. When the company applied for a renewal of the licence in December, 1937, the public health committee adjourned consideration of the application until the directors of the company had appeared before them. In due course two of the directors attended on the committee, and were told of the various matters which had been the subject of complaint. They were informed that before the licence could be renewed the committee desired to be assured that there would not be further breaches of the conditions of the licence. They gave this assurance and the licence was renewed, but a warning was given to the company that any further breach of the conditions of the licence might lead to its revocation. Further unsatisfactory samples were taken in April, 1938, and a notice was served upon the company requiring them to show cause why their pasteuriser's licence should not be revoked. After considering the representations made by the company, the committee decided to revoke the licence. The company appealed to the Ministry of Health within the prescribed time, but a decision was withheld in view of the other proceedings which were then in progress against the company. At the beginning of 1939 this appeal was withdrawn. 52 During the year 21 samples of Tuberculin Tested milk and 108 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:— Grade. Maximum no. of bacteria permitted per ml. Standard for bacillus coli. Tuberculin Tested No bacterial standard, but must conform to a prescribed methylene blue reduction test. Must not be found in l/100th ml. 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. 23rd February Satisfactory Absent. „ „ „ „ 30th March „ „ „ „ „ „ „ „ „ „ * „ „ „ Present in 1·100 ml. * 6th April „ „ „ 1·100 „ 27th April „ Absent. 20th July „ „ * „ „ „ Present in 1·100 „ „ „ „ Absent. * 6th September „ Present in 1·100 „ * „ „ „ „ „ 1·100 „ * „ „ „ „ „ 1·100 „ „ „ „ Absent. „ „ „ „ 22nd December „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ „ * In each of these cases a warning letter was sent to the vendor. Pasteurised Milk. Samples collected on Bacteria per ml. Samples collected on Bacteria per ml. 25th January 5,800 8th March 1,250 „ „ 6,400 „ „ 58,000 „ „ 2,500 „ „ 338,000 „ „ 7,800 30th March 9,300 „ „ 250 „ „ 9,100 1st February 28,500 „ „ 9,400 „ „ 75,000 „ „ 34,800 „ „ 56,000 „ „ 30,100 „ „ 25,500 „ „ 55,200 „ „ 12,400 „ „ 17,200 8th February 2,800 6th April 204,000 „ „ 37,000 „ „ 18,500 „ „ 250 „ „ 21,000 „ „ 2,300 „ „ 96,000 „ „ 2,100 16th February 1,500 „ „ 43,000 „ „ 38,000 27th April 33,000 „ „ 12,100 „ „ 13,800 „ „ 79,000 „ „ 88,000 „ „ 66,000 „ „ 113,000 „ „ 83,000 „ „ 104,000 23rd February 49,000 „ „ 146,000 „ „ 26,500 2nd June 25,600 „ „ 289,000 „ „ 9,200 „ „ 98,000 „ „ 8,600 „ „ 94,000 „ „ 6,200 „ „ 185,000 „ „ 11,700 „ „ 4,800 „ „ 152,000 53 Samples collected on Bacteria per ml. Samples collected on Bacteria per ml. 13th July 2,500 5th October 2,900 „ „ 12,600 „ „ 1,440 „ „ 6,500 „ „ 12,100 „ „ 14,200 „ „ 7,400 „ „ 9,600 „ „ 15,600 „ „ 14,000 31st October 9,400 20th July 630 „ „ 7,200 „ „ 6,300 „ „ 29,000 „ „ 6,100 „ „ 21,500 2nd August 4,500 „ „ 20,400 5th August 6,700 8th November 18,400 10th August 5,200 „ „ 15,100 „ „ 2,900 „ „ 4,700 „ „ 4,100 18th August 3,100 „ „ 46,000 25th August 5,400 „ „ 1,340 30th August 3,100 19th December 6,400 „ „ 28,000 „ „ 5,600 „ „ 12,400 „ „ 12,500 1st September 1,200 „ „ 2,600 „ „ 540 „ „ 11,000 „ „ 6,100 „ „ 9,400 The majority of the above results show a low bacterial count. There were however eight samples which failed to conform to the standard laid down. Three of these were purchased from the same vendor. The milk from which these samples were taken was pasteurised outside the borough, and in addition to warning letters being sent to the vendor, the medical officer of health in whose area the milk was pasteurised was also notified. In two cases the milk was pasteurised by the Kensington firm whose licence was subsequently revoked. Each of the remaining samples was purchased from a separate vendor, and a warning letter was sent in each case. 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 1938. 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 1938, one hundred and seven samples were so examined, but four of these were not sold as pasteurised milk, although they had undergone some form of heat treatment. Of the 103 samples of pasteurised milk, 98 passed the test satisfactorily; in three cases the result indicated slight error in pasteurisation technique; but in the other two cases the milk was reported to be either grossly under-heated or raw. The milk in the latter cases was stated to be pasteurised in another borough. A letter directing attention to the result of the test in each case 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 43 slaughter-house inspections were made, 169 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. The licence in respect of the only slaughter-house in Kensington has been renewed for the twelve months ending the 30th June, 1939. 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 1937 were renewed for a further twelve months in 1938. Bakehouses.—There are 80 bakehouses in the borough, and of this number 59 are underground. As a result of 105 inspections which were made during the year, 13 notices were served for the cleansing of walls and ceilings. 54 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 1938:— On register Dec. 31, 1937. Added to register during 1938. On register Dec. 31, 1938. Manufacturers of ice-cream 101 1 102 Storage and sale of ice-cream 199 22 221 Butchers' shops, including premises used for manufacture of sausages and the preservation of meat 111 6 117 Cooked meat shops 84 7 91 Fishmongers' shops—premises used for the purpose of cooking or curing fish (excluding fried fish shops) 20 1 21 Fried fish shops 46 1 47 Totals 561 38 599 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. Public Houses.—A complete survey of all the licensed premises in the borough, other than clubs and restaurants, was carried out during the year. Apart from clubs, there are four classes of licensed premises. In three of these intoxicating liquor may be consumed on the premises, and in the remaining one intoxicants may be purchased only for consumption off the premises. The classification of these licensed premises, and the number of each class in the borough is as follows:— (1) licensed for beer, wines, and spirits 122 (2) licensed for beer and wines only 10 (3) licensed to sell beer only 16 (4) licensed for the sale of intoxicating liquor for consumption off the premises 32 During the survey particular attention was directed to the following matters:— (1) Cellars, including utensils, beer pipes, filters, waste beer, etc. (2) Bar counters (cleanliness, presence of hot and cold water). (3) Beer pumps or engines. (4) Storage and preparation of food. (5) Staff living and sleeping rooms. (6) W.C. accommodation— (i) public. (ii) private. The general cleanliness of the cellars was on the whole much higher than in 1930 when the last survey was made. Licensees appear to have become conscious of the need to observe cleanliness in the cellars, and in only six cases was it found necessary to direct attention to the dirty condition of the cellars due to accumulations of rubbish. In 63 other cases notices requiring the cleansing and lime-whiting of the walls and ceilings were served. Considerable improvement was to be observed in the pipes which carry the beer from the cellars to the bar counters. In 1930 the majority of the pipe systems consisted of lead horizontal ceiling pipes, and either rubber hose or small lengths of tin alloy pipes jointed with rubber to form a connection between the lead pipes and the barrels. Such systems could be cleansed only by soaking in a detergent solution followed by rinsing with clean water. It was impossible to assist the cleansing with the aid of brushes. At the present time no fewer than 69 pipe systems are glass installations throughout, and 78 consist of either glass or porcelain down pipes, and a new type of metal known as mono-metal or non-rust able steel for the horizontal ceiling pipes. Little fault can be found with either type of installation. They are so constructed that every part of the system can be cleansed and brushed. In only two cases were the pipe systems so unsatisfactory as to justify the service of notices requiring new installations. The use of filters in beer cellars is still common, but in a large number of premises the use of conical-shaped felt bags is being superseded by the more hygienic filter papers fitted into funnels, new paper being used for each separate filtering operation. 55 In a number of premises utilisers are still used. A utiliser enables waste beer to pass through a filter and to be then re-incorporated at a pre-determined rate with new beer for re-sale to customers. I here can be little objection to the use of these appliances provided they are kept clean and "glass dregs" are not incorporated, but licensees generally deny using "glass dregs." During the inspections special investigations were not made to test the truth of the licensees' contention. As on the former inspections, the bar counters were, for the main part, in a cleanly condition. There are, however, one or two features which are deserving of attention. In 43 premises no hot water supply is available at the counter, and in such cases the licensee has to carry hot water from some other part of the bar to the bar counter, with the result that in many cases during rush periods the glasses are merely rinsed in cold water. The council have at present no power to insist on hot water being installed, but such power is in the new Food and Drugs Act, which comes into operation next October. An interesting feature regarding bar counters is the new departure by one brewery company of fitting close to their counter sinks a separate receptacle into which "glass dregs" can be tipped before the glass is immersed in water for washing. Kensington was the first place in which these receptacles were supplied, and licensees of houses where they have been fitted consider the idea a good one, for in periods of pressure it is found that the water in the sink does not get dirty so quickly as in those places where no such appliance is installed. Beer pumps, or engines as they are sometimes called, are located under the bar counter, and access is obtained by removing the front of the counter. A certain amount of difficulty in removing these counter fronts was observed in many cases, and in a number a screw driver had to be employed before the front could be removed. It is not surprising that in such cases the pumps were found to be in a defective condition. Of the premises inspected the pumps were found to be defective in 23, and notices were served requiring the defects to be remedied. It was noticeable that in the more modern houses, or in houses which had been rebuilt, a hinged door fitted with a key was provided to the counter front, so as to enable access to these pumps to be more readily obtained. The tendency to increase the food trade in licensed premises which was observed in 1930 was still in evidence during the present examinations. It is only the smaller houses in the poorer parts of the borough where no provision whatsoever is made for the supply of food to customers. Kitchens in which food is prepared are usually the domestic kitchens used by the licensees, and with just a few exceptions, where it was found necessary to serve notices requiring the cleansing of walls and ceilings, the conditions found were satisfactory. Unlike the position in a number of restaurants, the kitchens found in public houses are usually located on one or other of the upper floors where ventilation to the external air is easily obtainable. In nearly all public houses where food is provided, electric refrigerators were found, and in only seven cases was it found necessary to direct attention by means of a notice to unsatisfactory food storage conditions. There has been some extension of the "snacks at the bar" trade, and in several premises special counters have been erected where cold collations are served. In those places where these counters have been constructed little fault can be found. There are, however, a number of premises where these snacks are displayed on the ordinary bar counter, and customers stand within a few inches of the food. In such cases there is danger of contamination of the food. In all the larger public houses it was usual to find that one or more employees lived on the premises. In such cases an inspection was made of the living and sleeping rooms used by these persons. In five cases it was found that sleeping rooms were overcrowded, and licensees were asked to make alternative arrangements. The general cleanliness of these rooms was on the whole satisfactory, but in 36 it was necessary to serve notices requiring cleansing of the walls and ceilings. The question of w.c. accommodation in public houses is one which presents difficulty, and it might be well to draw attention to one or two points. In London there is no obligation on the owner or occupier of licensed premises to provide sanitary accommodation for his customers, although in the provinces such accommodation is enforceable under the Public Health Act, 1936. With regard to the staff, however, licensed premises come within the scope of the Shops Act, and under that Act the owner or occupier is required to provide suitable and sufficient sanitary conveniences for the use of the employees, including provision for the separation of the sexes. In the larger houses provision is adequate for both the staff and the customers, but it is otherwise in the smaller type of house. It is found in practice that where provision for w.c. accommodation has not been made for customers, such persons are frequently allowed to use the w.c. s normally intended for the use of persons residing on the premises. There would seem to be some justification for urging that metropolitan boroughs be given power similar to that at present operating in the provinces for enforcing sanitary accommodation for customers. Section 89 (1) of the provincial Public Health Act, 1936, reads as follows:— A local authority may by notice require the owner or occupier of any inn, public-house, beer-house, refreshment house or place of public entertainment, to provide and maintain in a suitable position such number of sanitary conveniences for the use of persons frequenting the premises as may be reasonable. The survey revealed that sanitary conditions in public houses in the borough have greatly improved since 1930, and this affords justification for the action taken by the council in that year 56 in calling attention to the unsatisfactory conditions then found. With the increasing food trade now carried on in this type of premises, it becomes more and more important that greater attention should be given to them than in the past. 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, 5,767 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. Traders generally observe the requirements of the various orders, although as in former years there were instances where imported tomatoes were exposed for sale when not properly marked, and cautions were given. one trader was prosecuted for exposing for sale imported tomatoes bearing a show ticket with the words "English Seed," the word English being more than twice the size of the word Seed; a fine of £1 was imposed. Agricultural Produce (Grading and Marking) Act, 1928.—This act empowers the Minister of Agriculture and Fisheries to take orders for the grading and marking of agricultural produce of England and Wales. A series regulations has been made by the Minister under the act, and these provide grade designations indicate specific standard qualities of the various foodstuffs mentioned, but it is not compulsory such foodstuffs to be so marked. When, however, the goods are marked, they must Unform 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 1938 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 1938. 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:— Fish, canned (tins) 74 Meat, canned (tins) 41 Fish (lb.) 77 Meat (lb.)191 Fruit, canned (tins) 667 Milk, canned (tins) 22 Fruit (lb.) 92 Turkeys 4 Jam (jars and tins) 6 Vegetables (tinned) 161 Winkles (lb.) 50 The Food and Drugs (Adulteration) Act, 1928.—The council's food inspector is the sampling officer under the act, and he is instructed to take samples in any place within the borough. The samples procured are of two kinds, namely, formal and informal. (a) Formal Sample.—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 722, of which 14 or 1.9 per cent. were adulterated. (b) Informal Samples.—These are taken without compliance with the strict formalities of the Pood 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. 57 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 - - 5 - Brawn 3 — 6 — Butter 25 — 14 — Camphorated oil — — 6 — Candied peel — — 7 — Cheese 27 —— 12 — Chocolate — — 6 — Chocolate confectionery 5 1 5 3 Cocoa 3 — 3 — Coffee 9 — 3 — Coffee and chicory essence — — 6 — Cream 6 — 2 — Cream, tinned — — 3 — Curry powder — — 5 1 Dripping — — 6 — Egg noodles — — 1 — Fish paste 6 — 6 — Flour — — 1 — Flour, self-raising 1 — 8 — Hair lotion — — 1 — Honey — — 7 — Honey, prepared — — 2 — Ice cream 6 — — — Jam 4 3 22 5 Lard 24 — 8 — Lardex — — 1 - Lemon curd — — 3 — Margarine 29 — 13 — Mayonnaise — — 3 — Meat paste — — 6 — Meat pie — — 3 — Milk 456 7 5 — Milk, condensed — — 12 — Milk, dried — — 1 — Mincemeat — — 9 — Mustard 3 — 3 — Nerve tonic — — 1 1 Peas, tinned — — 5 — Pepper 6 — 3 — Pickles — — 3 — Rice 11 — 7 — Sardines — — 12 — Sausages 26 — 11 2 Sausages, preserved 2 — 1 — Saveloys — — 3 — Semolina 3 — — — Sponge cakes 15 — 3 — Steak pie — — 3 — Sugar 4 2 6 3 Sweets 6 — — — Tea 12 — — — Tomatoes, tinned — — 2 — Tomato puree — — 1 — Vinegar 18 1 9 — Vinegar, non-brewed 5 — 3 — Vinegar, spirit 1 —— — — Vita cream — — 2 — Whisky 6 — '— — Totals 722 14 279 15 58 The following is a summary of the results of analyses of the 29 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. Chocolate cake Contained no cocoa Informal sample. „ „ „ „ „ „ Chocolate cream sandwich Chocolate covering contained only 1 per cent. of fat-free dry cocoa. „ „ Chocolate Swiss roll Contained only 2 per cent. of fatfree dry cocoa. „ „ Curry powder Contained 50 parts of lead per million. „ „ Jam, apricot Contained 33 per cent. of apricots in place of 40 per cent. required. „ „ „ „ Contained 35 per cent. of apricots „ „ „ blackcurrant Contained only 3 per cent. of the named fruit. „ „ „ „ „ „ „ Proceedings instituted but withdrawn. „ raspberry „ „ „ Informal sample. „ „ „ „ „ Proceedings instituted but withdrawn. „ strawberry „ „ „ Informal sample. „ „ „ „ „ Proceedings instituted but withdrawn. Milk 27·3 per cent, deficient in fat Vendor cautioned. „ 24 per cent. „ „ Proceedings. Summons dismissed. „ 21·3 per cent. „ „ Proceedings. Summons dismissed on payment of 10/6 costs. „ 20 per cent. „ „ Proceedings. Summons dismissed. „ 12·3 per cent. „ „ Proceedings. Summons dismissed on payment of 10/6 costs. „ 11 per cent. „ „ Vendor cautioned. „ 1 per cent. „ „ „ „ Nerve tonic Consisted of cane sugar with a small proportion of cocoa, barley flour and milk powder. Informal sample. Sausages 250 parts of sulphur dioxide per million. „ „ „ 150 „ „ „ „ Sugar, demerara 71 parts of tin per million „ „ „ „ „ „ „ Vendor cautioned. „ „ 0·5 grain of tin per lb. Informal sample. „ „ „ „ „ „ „ pudding 257 parts of tin per million Proceedings. Summons withdrawn. Vinegar 19 per cent. deficient in acetic acid. Proceedings. Summons dismissed on payment £1 costs. The number of prosecutions under the Food and Drugs Act was nine. The fines and costs amounted to £2 1s. 0d. Food and Drugs Act, 1938.—The above act received the Royal Assent on the 29th July, 1938, but it will not come into operation until the 1st October, 1939. It is the second of the great new acts consolidating the law relating to public health. Although a consolidating measure, the opportunity has been taken to include important drafting alterations, some simplification of procedure, and some alterations deemed necessary in the light of modern practice. It is worthy of mention that the new act tightens up the law dealing with three matters in which the council have seen particularly interested in recent years. The first of these deals with the inadequacy of the existing law to deal with certain adulterations of milk in which skimmed milk is used. By section 24 of the act all possible forms of reconstitution or sophistication of milk will be prohibited. The second matter arose in 1936, when I drew attention to the desirability of extending the time for taking proceedings where a warranty defence is pleaded. At the present moment the time limit is six months, but under section 80 of the act this time limit is extended to twelve months. In my last two annual reports I have commented adversely on the use of misleading and deceptive labels for food. It is gratifying to observe that under sections 5 and 6 of the Act, the 59 law regarding the false labelling of food is tightened up, and will make it an offence to give a label which falsely describes a food or drug, or is otherwise calculated to mislead. These sections will also make it an offence to take part in the publication of an advertisement which contains a false description or is otherwise calculated to mislead. Another matter which calls for some comment is the wider power given to the Minister of Health by section 8, to make food regulations regulating generally the composition of food. Recognition is given in the act to the increasing use of automatic machines for selling food, and a procedure is provided for the taking of samples from these machines. During the year under review, two dismissed summonses in respect of milk obtained from slot machines affixed to shop doors might have succeeded had the new act been in force. The Public Health (Condensed Milk) Regulations, 1923-27, and the Public Health (Dried Milk) Regulations, 1923-27.—During the year, twelve samples of condensed milk and one of dried milk were taken, and each was found to comply with the regulations in every respect. 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 poisns board of a poisons list divided into two parts, 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, 1938, was 205; 196 of these were in respect of persons who had applied for renewal of their registration for the twelve months ending 30th April, 1939, and the remainder were new registrations. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Notifiable Infectious Diseases. The following diseases are compulsorily notifiable in Kensington:— Anthrax. Polio-encephalitis (acute). Cerebro-spinal fever. Poliomyelitis (acute). Cholera. Pneumonia (acute influenzal). Continued fever. Pneumonia (acute primary). Diphtheria. Puerperal fever. Dysentery. Puerperal pyrexia. Encephalitis lethargica (acute). Relapsing fever. Enteric fever. ‡ Rheumatism (acute) in children under Erysipelas. sixteen years of age. Food poisoning. Scarlatina or scarlet fever. Glanders. Smallpox. Hydrophobia. Typhoid fever. Malaria. Typhus fever. † Measles. Tuberculosis. Membranous croup. †Whooping cough. Ophthalmia neonatorum. *Zymotic enteritis in children under five Plague. years of age. † Measles and whooping cough became notifiable on 1st October, 1933, but no notification is required if a previous case in the household has been notified within the past two months. ‡ 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 m 1924. The other London boroughs in which this disease is notifiable are Fulham, Finsbury, Poplar, Southwark, Deptford, Greenwich. Woolwich and Paddington. Table showing Notifications of certain Infectious Diseases received in 1934-38. 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. spinal meningitis. Dysentery. Enteritis. Totals. 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 1938 – 238 156 14 49 11 6 36 98 – – 6 49 6 85 50 804 Cases of mistaken diagnosis are excluded from the above table. 60 Table showing Cases of Infectious Diseases occurring during the year, arranged in Four-Weekly Periods (2nd January, 1938, to 31st December, 1938). Four Weeks ending Smallpox. Scarlet fever. Diphtheria. Enteric fever. sipelas. Ophthalmia neonatorum. Puerperal fever. Puerperal pyrexia. Pneumonia. Polio myelitis. Acute rheumatism. Cerebro spinal meningitis. Dysentery. Enteritis. Totals. January 29 – 19 11 3 3 - – 3 14 - 2 1 17 3 76 February 26 – 15 18 1 6 l – 1 6 – 9 3 22 7 89 March 26 – 23 13 – 2 2 1 2 21 – 4 – 10 8 86 April 23 – 22 12 – 3 1 1 3 8 – 3 – 12 5 70 May 21 – 16 11 1 7 5 – 7 4 – 8 – 4 5 68 June 18 – 18 17 1 2 - 1 3 8 - 9 – 5 3 67 July 16 – 25 13 – 4 - 2 4 2 – 1 – 3 7 61 August 13 – 14 13 1 4 – – – 4 – – – – 2 38 September 10 – 12 4 – 1 – – 2 3 3 4 – 3 1 33 October 8 – 20 4 1 5 – – 3 6 1 – – – 2 42 November 5 – 29 12 5 2 2 – 1 6 1 4 2 3 4 71 December 3 – 18 13 – 5 – 1 2 12 – 3 – 2 2 58 December 31 – 7 15 1 5 - – 5 4 1 2 – 4 1 45 Totals – 238 156 14 49 11 6 36 98 6 49 6 85 50 804 Cases of mistaken diagnosis are excluded from the above table. 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 1938. Notifiable Disease. Number of cases notified Total cases notified in each ward. Cases admitted to hospital. Total deaths. At all ages At ages.—Years. St. Charles. Golborne. Norland. Pembridge. Holland. Earl's Court. Queen's Gate. Redcliffe. Brompton. Under 1. 1 to 2. 2 to 3. 3 to 4. 4 to 5. 5 to 10. 10 to 15. 15 to 20. 20 to 35. 35 to 45. 45 to 65. 65 and over. Smallpox – – – – – – – – – – – – – – – – – – – – – – – – Scarlet fever 238 – 6 10 19 20 95 37 13 25 8 5 – 83 40 30 34 17 15 5 11 3 223 — Diphtheria (including membranous croup) 156 5 12 15 12 17 53 10 9 16 5 1 1 56 34 25 17 7 5 5 5 2 152 8 Enteric fever 14 – 2 – – – – – 1 7 1 1 2 – – 3 1 1 3 1 3 2 12 1 Puerperal fever 6 – – – – – – – – 5 1 – – 2 1 1 1 – – – – 1 5 2 Puerperal pyrexia 36 – — – – – – – 3 27 6 – – 10 5 8 3 1 2 1 5 1 33 3 Primary pneumonia 86 3 4 10 9 3 10 2 4 19 3 9 10 22 31 11 3 5 4 – 6 4 56 43 Influenzal pneumonia 12 2 – 1 – – 1 – – 3 1 3 1 1 6 2 1 – – 2 – – 7 7 Dysentery 85 8 12 10 9 3 24 2 3 10 1 3 – 30 22 8 7 8 1 3 3 3 60 1 Erysipelas 49 – 1 – – — 1 2 3 11 8 12 11 6 12 11 3 3 4 – 6 4 35 2 Encephalitis lethargica – – – – – – – – – – – – – – – – – – – – – – – 1 Cerebro-spinal meningitis 6 – 1 – – – – – – 3 2 – – 2 1 – – – – 3 – – 6 1 Polio-myelitis and polio-encephalitis 6 – – – – – 3 – 1 2 – – – – – – – 1 – – 4 1 6 2 Pulmonary tuberculosis 150 – – – – 2 2 4 14 69 25 27 7 34 20 17 18 14 13 12 16 6 138 93 Other forms of tuberculosis 37 2 – 2 2 2 2 6 5 9 5 1 1 11 7 5 5 1 2 1 3 2 37 13 Ophthalmia neonatorum 11 11 – – – – – – – – – – – 1 6 1 – – – 1 1 1 7 – Malaria – – – – – – – – – – – – – – – – – – – – – – – – *Enteritis (diarrhoea) 50 30 13 2 5 – – – – – – – – 12 10 16 4 1 1 3 3 – 38 59 †Acute rheumatism 49 – – – 1 – 20 26 2 – – – – 20 15 6 3 3 – – 2 – 24 – Totals 991 61 51 50 57 47 211 89 58 206 66 62 33 290 210 144 100 62 50 37 68 30 839 236 * Notifiable only in children under the age of 5 years † „ „ „ „ „ 16 „ Cases of mistaken diagnosis are excluded from the above table. 61 Smallpox.—No case of smallpox was notified in the borough during the year 1938. Many Kensington residents had been in contact with cases in other districts, and several came to live in the borough who had been in contact with cases on board ship. These contacts were kept under daily observation until all possibility of developing the disease had disappeared. The object of repeatedly visiting these contacts is to secure immediate isolation should any suspicious symptoms arise. Scarlet Fever.—The number of cases notified was 248, but after observation in hospital 10 were found not to be suffering from scarlet fever. It will be seen from the first table on page 59 that the number of notifications received during 1938 is only 43 per cent. of those received during 1934. The character of the disease was generally mild, and no case proved fatal. Of the total number of cases notified, 233 were removed to hospital. Five 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 five 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.—One hundred and seventy-seven cases of diphtheria were notified. One hundred and seventy-three patients were removed to hospital, but 21 of these were subsequently found not to be suffering from diphtheria and were returned home after the acute illness had subsided. There were 10 instances where more than one case occurred in the same house. The number of deaths from diphtheria was 8, which represents a case mortality of 7.5. In the three preceding years the deaths were 19, 11 and 4, the respective case mortality rates being 6, 8 and 2. During the year 2,006 throat swabs were examined at the council's laboratory at Princess Louise hospital, and 26 of these showed the presence of the diphtheria bacillus. Six cases of diphtheria were reported from St. Mary Abbots hospital, 35 from St. Charles hospital, and 15 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.ll, Mr. W. Reeves, chemist, at No. 221, Westbourne Park Road, W.11, or from the public health department at the town hall. The anti-toxin is obtainable at all hours of the day and night from Mr. Evans'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. Doctors 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 1938 the council supplied 270,000 units of anti-toxin for 31 patients at a cost of £16 0s. 7½d. 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 1938. From the 1st October, 1938, the council have supplied immunisation material free to doctors for use in the case of any Kensington child. In addition the council pay the doctor at the rate of 2s. 6d. for each injection given. In November last an innovation was introduced into the scheme in the form of a diphtheria immunisation clinic. In the past it has been found that there is a considerable number of children whose parents have no family doctor; whilst quite willing to take their children to a clinic, for various reasons they do not wish to attend the surgeries of the doctors on the immunisation panel. The new clinic is for the purpose of serving this comparatively large group. The clinic is staffed by a panel of Kensington general practitioners attending in rotation. A borough council nurse is in constant attendance, and all material used is supplied by the council. The doctors are paid at the rate of 2s. 6d. for each injection. The clinic is held at No. 304, Westbourne Grove (formerly No. 28b, Archer Street), every Friday at 3 p.m. The total attendance for the two months during which this clinic has been in existence was 197, which is most encouraging. The general practitioners have shown the greatest willingness to co-operate with the borough council in their endeavours to increase the number of children who are immunised against diphtheria in this borough. From the introduction of the scheme in 1934 to the end of 1938 the number of children immunised has been 4,328. Dr. Guy Bousfield continued throughout the year to hold a schick-testing clinic at No. 304, Westbourne Grove. The total number of children attending for pre-immunisation Schick tests 62 was 164, of which number 73 gave a positive reaction. The number of children who were presented for schick testing after having received immunising inoculations totalled 564, of this number 493 proved negative, 46 remained positive, and 25 failed to reattend for the reading. Considerable efforts have been made to bring the value of diphtheria immunisation to the notice of the public. The propaganda officer frequently spoke on this subject at welfare centres, clubs and so on; the council's diphtheria immunisation film was shown 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, ten being in South Kensington and four in North Kensington. Twelve of the patients were removed to hospital. The fourteen cases were all of a sporadic nature. A thorough investigation regarding the origin of the disease took place in every case Disinfection of the patient's home and personal effects was undertaken. There was one death from this diease during the year. Erysipelas.—Forty-nine cases were notified, 35 of these being removed to hospital. There were two deaths from this disease, as compared with 3, 5 and 3 in the three preceding years. Ophthalmia Neonatorum.—Eleven cases of this disease were notified. Seven of the patients were removed to hospital, and the other four were nursed at home. In every case the patient recovered without any injury to sight. Puerperal Fever.—Six cases of this disease were notified and five were removed to hospital. The sixth case was nursed at home. In all notified cases the patient recovered. There were two deaths. Puerperal Pyrexia.—-Thirty-six cases of this disease were notified, 32 of the patients being confined in hospital and four in their own homes. One of the four confined at home was subsequently removed to hospital for treatment. Two 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 acute influenzal pneumonia. Ninety-eight notifications were received during the year, 86 patients being certified as suffering from acute primary pneumonia and 12 from influenzal pneumonia. The number of deaths from pneumonia was 143, and 13 deaths were certified to be due to influenza. Acute Rheumatism.—Forty-nine cases were notified. The tenth annual report on the working of the rheumatism scheme during the period 1st October, 1937, to 30th September, 1938, 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.—Six cases of this disease were notified, four of the patients being females aged 40, 39, 23 and 1 year, and the other two males aged 24 and 21 years. In each case the patient recovered completely. Dysentery.—Eighty-five 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. It was noted in the 1937 report that there had been an increase in the incidence of dysentery which had affected the country as a whole. This epidemic was still present in the first four months of 1938, and was responsible for the relatively large number of cases notified. 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 generally were of a mild type but there was one death. Enteritis (Zymotic) or Summer Diarrhœa.—Fifty 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 63 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 is 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 59 deaths certified as due to diarrhoea, etc., and of these there were 50 children under one year of age. Eight 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 five years it has operated from the 1st January to the 31st December. All cases of notified enteritis are visited by the health visitors and of the 50 notified during the year 21 were classed as severe and 29 as mild. Thirty cases occurred in infants under one year of age, and 20 in infants aged one year and over. In four 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 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 1938, I attended 60 cases in their own homes and paid 430 visits. One case was removed to hospital and died. This was the only death that occurred among the cases attended by me. Doctors in the borough consulted me in regard to difficult cases. A health visitor requested me to see an infant five weeks old who vomited breast milk for a week and had lost half a pound in weight. It had a hard tumour at one end of the stomach, which is a sign of congenital pyloric stenosis, so I took the case to the Infants' Hospital, Vincent Square, where they operated next day; the child is now feeding well on the breast only. In this case the mother had been advised from an outside source to stop breast feeding. A few cases of zymotic enteritis with high temperatures all did well at home on routine treatment. The return to normal feeding had to be very gradual in some cases. Too rapid weaning when the mother had to go to work caused several cases of diarrhoea and vomiting. Overfeeding on dried milk was another cause. Ordinary liquid cows' milk was the food most frequently associated with diarrhœa. The majority of the cases of diarrhœa and vomiting were due to catarrhal and dietetic causes. Cases of " habit vomiting " were cured by giving belladonna before each feed. 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 diarrhœa. During the year the nurses attended 127 cases, the total number of visits paid being 1,094. Twenty of the cases did not respond to home nursing, and these were admitted to hospital, where three died. Poliomyelitis and Polio-encephalitis.—Six cases of this disease were notified during the year, three of the patients being females aged 21, 17 and 5¼ years and three males aged 25, 8 and 5¾ years. In two cases the patient died; two cases are still receiving treatment, and two recovered after treatment. Measles.—This disease was made notifiable on the 1st October, 1938, but the following provision is laid down in the Regulations—only the first case occurring in a family within two months shall be notified. Between 1st October and 31st December, five measles cases were notified. During the year the women health officers paid 762 visits to measles patients. The number of cases admitted to the London county council hospitals was 407. There were 12 deaths. Whooping cough.—Whooping cough became notifiable for the first time on 1st October, 1938. Only the first case occurring in a family within a period of two months is notifiable. Up to the end of the year 118 cases were notified, and there were 5 deaths. Seventy-two cases were admitted to London county council hospitals. In the last quarter of the year a slight epidemic occurred in the borough, which tended to increase towards December. Whooping Cough Clinic. In order to assist Kensington practitioners in the early diagnosis of whooping cough, and to protect those children who have been exposed to infection, the council, in March, 1938, agreed to the establishment of a whooping cough clinic with facilities for bacteriological diagnosis and prophylactic inoculation of contacts. The clinic was established at the Princess Louise hospital, and since 25th April, 1938, sessions have been held on Mondays at 12 noon and on Thursdays at 2 p.m. Dr. R. H. Dobbs, honorary assistant physician to Princess Louise hospital, is in charge. Mrs. Gerald Jacobson undertook the preliminary organisation of the social work, and Miss Hazel Kahn was appointed honorary social worker. During 1938, 188 patients were seen by the physician in charge. These came from the following sources:— Public health department 151 Private practitioners 11 Family contacts 12 Other sources 14 Total 188 64 Thanks are due to the staff of Princess Louise hospital for their assistance, and to the voluntary workers for so ably carrying out the social work. Clinical Report by Dr. R. H. Dobbs. Since the opening, bi-weekly sessions have been held continuously except for the month of August when whooping cough was almost non-existent in the borough. The clinic was established to provide facilities for the diagnosis of whooping cough. The children referred thereto are treated as suspicious until a definite clinical diagnosis is made. A cough plate is taken from each suspect, or failing that, a pharyngeal swab. In addition, blood counts are made in a number of cases. The results are sent to the referring practitioners at the next session—three or four days later. In addition, the immunisation by the injection of vaccine is undertaken in the case of children who have recently been in contact with cases of whooping cough. No case, however remote the contact, is refused immunisation, and indeed, a few cases have been immunised in whom no contact had occurred. These contact cases are given three injections during the course of one week. Two vaccines are used, Parke Davis whooping cough vaccine "A," and Glaxo dissolved vaccine. During 1938, about equal numbers were given each type of vaccine, but no attempt has been made to take comparable series. The dosage varied somewhat, but approximately 1 c.c., 2 c.cs. and 4 c.cs. at successive sessions, or 7 c.cs. in all, was usually given. This is equivalent to 28,000 million organisms for Parke Davis and 70,000 million for Glaxo preparation. Results. Diagnostic Section. Seventy-four children were referred to the clinic for diagnosis during the year. A history was taken from the parent, and the child was examined if necessary. As a result of the history and examination, the cases were classed as "A," "B" or "C." "A" cases are those in whom the examining doctor considers that, either from the history or from having heard the child cough, the case is in all probability whooping cough. "C" cases are those in whom the examining doctor considers from hearing the history that the probability is much against the diagnosis of whooping cough. "B" cases comprise all cases not classed as "A" or "C." It will be seen that group "B" consisted of cases in whom the probability of diagnosis varied tremendously from case to case. Cases were classed as "A" or "C" only when the observer felt certain that they were or were not cases of whooping cough. Cough plates or throat swabs, and as an additional aid to diagnosis, blood counts, were taken in all cases in these three categories except some in group " A," who were actually heard to whoop whilst attending the clinic. The following table summarises the results:— Group. No. Positive Results. Negative Results. Spoilt or not taken. Swab & Plate. Swab or Plate. Swab & Plate. Swab or Plate. A 19 - 10 - 2 7 B 32 1 16 2 13 — C 23 1 2 - 19 1 It will be seen that in group "A" in two cases only was the diagnosis not supported by the culture of the organisms from either a plate or swab or both. In group "C," culture was attempted in all cases. The cough plate was positive in one case, and the plate and the swab in a second case. In group "B," the largest group, the organism was not cultured in 15 cases; of these three only went on later to develop symptoms of whooping cough. In these three cases a blood count was at the time suspicious. It seems, therefore, that a carefully taken cough plate, or failing that a throat swab, is a moderately satisfactory method of diagnosing the disease. Blood Counts. It was not found practicable to take cough plates or swabs from cases at times other than at sessions. These cases were, therefore, referred to the pathological laboratory, and blood counts were taken for a white cell estimation and a differential count, and the patients told to attend at the next clinic session. Twenty-two blood counts were taken. Very little can be deduced from so few figures, but the results indicate that the blood count may give valuable confirmatory evidence of the absence of whooping cough, and since a result can be obtained in less than an hour, this aid to diagnosis should be retained. In three cases where both swabs and plates were negative, the blood counts were suggestive, i.e., with totals over 12,000 and a differential count with more than 70 per cent. lymphocytes. 65 Immunisation Section. Immunisation was commenced in 109 cases. Of these, 16 cases did not receive the full three doses, either because they developed whooping cough, or because they did not return for the second and third dose. These cases are omitted from the results. Cases were visited at home by the borough council's health visitors during inoculation, and for four weeks after the last injection. If whooping cough had not occurred before the fourth week, the cases were considered to have been protected from the infection. All cases immunised were revisited after an interval of six months, in order to gain information if possible regarding the period of protection. At the time of preparing this report a few of the earlier cases have been visited, and only two cases (twins) have been known to have contracted the disease. Both were mild cases from a fresh infection seven months after immunisation. Of the 93 cases fully immunised, 66 had not developed whooping cough four weeks after immunisation, 10 developed the disease, and 17 children were either not visited or could not be traced. All cases who developed whooping cough, except one, were classed as "mild" or "very mild." One case was moderate. In May, 1938, twenty-one children at the Golborne day nursery were inoculated following contact with a child who had been coughing for two weeks, and who eventually developed whooping cough. Of these 21 children, two developed whooping cough several weeks later. The attack was mild. In December, 1938, nine children at the Lancaster Road day nursery were immunised. A child had developed whooping cough the previous day. Two of these children developed a mild attack. These figures are in themselves satisfactory, although a definite conclusion cannot be drawn from a small number in one epidemic only. It seems that only nine of 93 contacts (varying from close contact with a whooping brother or sister, to only indefinite contact with children in the same building) developed an attack attributable to the contact for which they were referred. Two groups of children, all contacts of the same whooping cough case, were inoculated, and form a good indication of the value of the method of protection. General. There are one or two points regarding the administration of the clinic that need to be stressed. The clinic could with ease deal with a larger number of cases, especially contact cases needing immunisation. It is probable that since the introduction of compulsory notification of the first case in each house, contact cases can with much greater ease be visited and encouraged to attend the clinic. In addition, the clinic facilities are always available to the medical officers of welfare centres and day nurseries, and indeed, children in such centres would probably be most benefited by wholesale immunisation upon the occurrence of a case of whooping cough. With regard to visiting immunised contact cases, it is probably desirable for these cases to be visited up to six weeks after the last injection, instead of four weeks as heretofore. A weekly visit is probably unnecessary, and it is suggested that visits be made only once during immunisation to ensure continued attendance, and two, four and six weeks after the last injection. For record purposes an extension of the health visitors' duties is suggested. It would be of great value if cases which have been referred for diagnosis, i.e., "suspects," and in which clinical or laboratory evidence of whooping cough is negative, were visited once after attending the clinic in order to establish whether the conclusions reached were correct. It is preferable that such cases should be visited instead of being asked to attend again, because mothers whose children have not developed whooping cough cannot be relied upon to attend a second time. Two weeks is the suggested interval for this single visit to be made in such cases, and health visitors could be informed in the same way as they are for immunised cases. Other notifiable diseases.—With the exception of tuberculosis, which is dealt with in a separate section, no other notifiable infectious disease was notified. Disinfection after Infectious Diseases, etc. SUMMARY OF WORK CARRIED OUT BY THE DISINFECTING STAFF DURING 1938. Nature of infection. Premises disinfected. Rooms disinfected. Disinfections at Wood Lane. No. of articles disinfected. Scarlet fever 242 257 238 4,224 Diphtheria 156 178 175 1,657 Typhoid fever 42 66 64 2,951 Para-typhoid fever 14 32 25 2,333 Measles 517 566 60 1,206 Consumption 150 230 132 1,266 Cancer 49 55 81 680 Other diseases 619 704 589 6,687 Totals 1,789 2,088 1,364 21,004 This table does not include the work carried out at Wood Lane on behalf of the Paddington borough council. 66 The total weight of the bedding, clothing, etc., of Kensington residents disinfected was 40 tons 9 cwt. 0 qr. 11 lb. The number of articles disinfected only was 21,193 and the number disinfected and washed, 1,343. The laundry work for the medicinal baths is performed at the disinfecting station and this work involved the washing of 11,050 towels, 347 sheets and 119 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 20 tons 12 cwt. 0 qr. 6 lb. The number of articles disinfected only was 7,238 and the number disinfected and washed was 2,037. 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 64. The number of private subscribing library books destroyed was 85, and the number disinfected by formalin and returned to the householders was 8. TUBERCULOSIS. In accordance with the Public Health (Tuberculosis) Regulations, 1930, which rescinded the regulations previously issued and consolidated their provisions with minor amendments, all forms of tuberculosis 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., at the request of general practitioners. When the bacteriologist finds tubercle bacilli in a specimen submitted by a practitioner, and a notification is not received in the course of a few days, a letter is sent to the doctor asking him to notify the case and in addition he is informed of the facilities for treatment offered by the council. The following table shows the number of cases of tuberculosis in the various parts of the borough on the 31st December, 1938, and the number of cases notified for the first time during the year:— Cases in the borough on 31st December, 1938. New cases notified during 1938. The Borough 623 187 North Kensington 428 117 South Kensington 195 70 Wards. St. Charles 155 45 Golborne 114 27 Norland 85 22 Pembridge 74 23 Holland 35 15 Earls Court 44 15 Queens Gate 25 13 Redcliffe 74 19 Brompton 17 8 Since the notification of tuberculosis became compulsory in 1912, there has been a general decline in the number of new cases in spite of an occasional rise in individual years. In 1936 and again in 1937 the number of new cases increased over that of the previous year, but it is pleasing to 67 report that the number of new cases notified in 1938 has fallen considerably and is now at the same level as in 1935. The following graph shows the general downward trend since 1932:— 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 – – 1 – 1-5 1 1 3 3 – 1 1 3 5-15 4 2 6 2 1 – 1 – 15-25 14 21 5 4 8 10 3 - 25-35 18 30 1 4 8 10 – 1 35—45 15 10 2 3 10 4 1 1 45-55 10 2 – – 12 4 – – 55-65 11 4 1 – 9 6 – – 65 and over 4 3 1 – 8 2 1 – Totals 77 73 20 17 56 37 8 5 When the above table is compared with last year's figures it shows that there has been definite decrease in respiratory tuberculosis in all ages with the exception of the male age group 35-45 years and the female age group 25-35 years, where there has been a slight increase. 68 The number of deaths recorded for the year is lower for both males and females but this is especially noticeable amongst the latter, where the reduction has been considerable. The following table shows the source of the new notifications during the year:— Cases. Brompton Hospital 12 St. Charles Hospital 18 St. Mary Abbots Hospital 20 Hospitals and sanatoria other than above 52 Total cases notified by hospitals 102 General practitioners 72 Tuberculosis officer 13 It will be noted that 54 per cent. of the cases are notified from hospitals or allied institutions. 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, 1938 265 257 85 83 690 Cases notified for the first time during the year 77 73 20 17 187 Cases brought to notice otherwise than by notification 35 39 5 8 87 Cases removed from the register during the year on account of having:— (a) recovered from the disease 11 9 19 13 52 (b) removed from district, lost sight of, etc. 62 83 10 18 173 (c) died 60 40 9 7 116 Cases remaining on the register on 31st December, 1938 244 237 72 70 623 The following table shows the number of deaths and the death rate from respiratory and nonrespiratory tuberculosis in each of the past ten years:— 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. 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 1938 93 53 13 7 106 60 69 It is pleasing to report that the slight rise in the number of deaths from tuberculosis which occurred in 1936 and 1937 has ceased and there has been a considerable reduction in the total deaths from respiratory tuberculosis. Deaths from Tuberculosis in 1938 Allocated to District of Usual Residence of Patients. Respiratory tuberculosis. Non-respiratory tuberculosis. The Borough 93 13 North Kensington 60 12 South Kensington 32 1 No fixed abode 1 - Wards. St. Charles 29 6 Golborne 12 2 Norland 7 3 Pembridge 12 1 Holland 5 — Earl's Court 8 — Queen's Gate 4 — Redcliffe 11 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 25 1 St. Mary Abbots Hospital 3 — St. Charles Hospital 31 5 Brompton Hospital 3 — Other institutions 31 7 Seventy-five 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 need 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 87 per cent. of all cases notified. 70 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 1938 1938 Previous to 1938 1938 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Bones and joints Abdominal Other organs Peripheral glands Total Bones and joints Abdominal Other organs Peripheral glands Total Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on dispensary register on 31st December Disease arrested Adults M. 6 9 10 — 19 - - - - - 5 — 1 2 8 – - - - - F. 10 4 10 1 15 - - - - - 2 1 3 3 9 - - - - - Children 4 - - - - - - - - - 11 5 2 9 27 — — — - — Disease not arrested Adults M. 16 10 74 9 93 22 7 12 2 21 2 – — 2 4 3 — 3 — 6 F. 34 14 64 9 87 20 12 13 1 26 7 4 2 1 14 2 — 3 2 7 Children 3 2 1 — 3 7 1 — — 1 13 5 3 10 31 4 1 — 4 9 Condition not ascertained during the year 13 8 8 — 16 - - - - - 1 2 2 5 10 - - - - - Total on dispensary register at 31st December, 1938 86 47 167 19 233 49 20 25 3 48 41 17 14 31 103 9 1 6 6 22 (b) Not now on dispensary register and reasons for removal therefrom Discharged as recovered Adults M. 172 26 6 1 33 - - - - - 13 2 1 13 29 - - - - - F. 304 21 13 – 34 - - - - - 18 10 3 19 50 - - - - - Children 409 3 — - 3 — — — — — 48 18 10 228 304 - - - - - Lost sight of, or otherwise removed from dispensary register 1,766 338 294 70 702 20 4 3 1 8 151 69 35 244 499 3 1 2 4 10 Dead Adults M. 162 92 242 371 705 — 1 2 9 12 8 2 5 1 16 — — 3 — 3 F. 235 127 191 235 553 3 — 3 1 4 4 4 4 1 13 — — — — — Children 76 14 5 8 27 - - - - - 7 4 5 15 31 1 — 1 1 3 Total written off dispensary register 3,124 621 752 684 2,057 23 5 8 11 24 249 110 63 524 946 4 1 6 5 16 Grand totals 3,210 668 919 703 2,290 72 25 33 14 72 290 127 76 552 1,045 13 2 12 11 38 71 Of the cases entered on the dispensary register previous to 1938, 34 were removed as recovered and 55 owing to the death of the patient during the year. Of the cases arising during 1938, 25 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 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 223 336 100 124 783 New cases with respiratory tuberculosis 62 73 5 4 144 New cases with non-respiratory tuberculosis 10 10 10 8 38 New cases still under observation 2 2 – 1 5 New cases diagnosed as nontuberculous 149 251 85 111 596 In the diagnosis and supervision of the disease there are in addition to clinical investigations certain laboratory facilities for the examination of specimens. These are carried out at the council's laboratory, and during the year 783 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 radiology. X-ray facilities are provided, by arrangement with the London county council, at St. Mary Abbots hospital and St. Charles hospital, and during the year 648 radiological 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; this is an arrangement which is generally recognized 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 examination. 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 62 cases were added to the dispensary register because of their removal into the borough, as compared with 75 in 1937, and 154 cases were removed from the register because of their transfer out of the district. This tendency to migration creates 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 advantage 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 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 332 contacts of the new cases arising in 1938, and of these 186 were examined at the dispensary, 41 by their own doctors, 4 by school medical officers, 5 by medical officers at infant welfare centres and 8 at various hospitals; 88 or 27 per cent. failed to undergo an appropriate examination. During the year 3,536 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 each health visitor of the council having a district in which she was responsible for the whole of the health visiting. The new arrangement allows the two health visitors 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 clinical tuberculosis officer, who accompanies them on many of their visits 72 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 1938. The following table shows the work carried out during the year:— Number of patients treated 15 Number of extractions 14 Patients' attendances 71 Number of dentures 9 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 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 treatment. During the year 40 patients were undergoing this treatment and received 966 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 treatment 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. Beds and Bedding. The council provide a service of decided value which temporarily alleviates border-line housing conditions by the lending 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 a great benefit while the patient is awaiting residential treatment, or in cases where the family are awaiting the provision of better housing accommodation. In 1938, 26 patients had assistance under this heading for varying periods. The following is a list of the articles lent:— Bedsteads 19 Mattresses and covers 20 Pillow-slips 48 Pillows 44 Blankets 50 Sheets 68 Quilts 22 On 31st December, 1938, the following articles of bedding were on loan to 20 patients:— Bedsteads 14 Mattreses and covers 14 Pillow-slips 38 Pillows 34 Blankets 40 Sheets 53 Quilts 17 Extra Nourishment. It is well known that the nutrition of the tuberculous patient must be adequately maintained after undergoing residential treatment, so that he can derive full benefit from the convalescence. Patients awaiting admission to a sanatorium, or who have some intercurrent disease lowering their resistance, also require extra nourishment. During the year 109 patients received grants for varying periods. These grants take the form of milk, eggs and butter or medicated dried milk, according to the needs of individual cases. 73 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 large 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. 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. 1934 32 1,319 1935 24 1,001 1936 23 920 1937 13 1,595 1938 24 1,644 The nurses carry out their work splendidly and are very much appreciated. Care Committee. "Care work" may be said to refer to all that part of the anti-tuberculosis scheme which does not deal directly with the diagnosis and treatment of the disease. In London, as in the country generally, the dividing line between care work under an official scheme and care work done by voluntary committees varies considerably, but of recent years there has been an increase in that part of the work which has come under the official scheme. For instance, the London county council pay patients fares to and from sanatorium, provide clothing for patients in sanatorium (where this cannot be obtained from voluntary sources), training and settlement in tuberculosis colonies, and a scheme for boarding out of child contacts in order to allow mothers to accept residential treatment or where the home conditions are unsatisfactory and there is a patient who is a potential source of infection. The Kensington borough council provide extra nourishment, dental treatment, beds and bedding, sputum flasks and paper handkerchiefs, etc. In addition co-operation takes place between the clinical tuberculosis officer and the local officers of the public assistance department and the unemployment assistance board, whereby patients can be recommended for extra grants. There has been a gradual growth up to the present scheme and during the year under review the tuberculosis care committee which was established in 1922, taking into consideration the changes that had taken place since its inception, was of the opinion that it had ceased to fulfil the purpose for which it was originally intended and voted itself out of office. It was considered important to maintain close co-operation with the principal charitable organisations in the area, and the borough council requested the secretary of the Charity Organisation Society and the secretary of the Invalid Children's Aid Association to act as official almoners for tuberculosis care work. The two societies concerned not only consented to their secretaries performing this work, but they gave the greatest possible assistance and co-operation in the tuberculosis care work of the borough. The care committee as at present constituted consists of the clinical tuberculosis officer, the two secretaries of the above societies, the borough council's two tuberculosis health visitors, and the committee secretary, who is a full-time officer at the council's tuberculosis dispensary; the committee meets at fortnightly intervals. The arrangement has worked with the utmost smoothness and greatly facilitates the care of tuberculous patients and their families. General. Eighty-seven per cent. of the cases of tuberculosis in Kensington are dealt with under the council's scheme; 73 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 140 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 from 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. 74 APPENDIX I. ELEVENTH ANNUAL REPORT on THE KENSINGTON ACUTE RHEUMATISM SCHEME (1st October, 1937—30th September, 1938) BY JAMES FENTON, C.B.E., 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, C.B.E., M.D., M.R.C.P., D.P.H. The 11th year of work at the rheumatism centre of the Royal Borough of Kensington was completed on the 30th September, 1938. 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 the disease. In 1927, the Minister of Health made regulations under which acute rheumatism became a notifiable disease in Kensington for a period of three years ; similar regulations were made in 1930, 1933 and 1936. The regulations define acute rheumatism as denoting the following conditions, occurring separately or together, in a child under the age of sixteen years:— (а) Rheumatic pains or arthritis, if accompanied by a rise in temperature. (b) Rheumatic chorea. (c) Rheumatic carditis. Response to Notification. Detailed particulars in regard to notification 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 1937-38 18 16 6 9 49 22 Totals 160 345 81 159 745 427 It will be noted from the above figures that there has been, during the past year, an increase in the number of notifications from medical officers at the supervisory centre. This is, no doubt, due to the fact that more cases are being referred to the centre for diagnosis in the early stages of the disease, before any severe manifestations have occurred. These cases may be referred by general practitioners or school medical officers, or from other clinics in the borough; but, as will be seen from another part of this report, children are also being taken direct to the centre by their parents, who are now beginning to realise the significance of early symptons of rheumatic disease. For instance, "growing pains" are no longer lightly dismissed as necessary accompaniments of childhood, as was so often the case in the past. Epidemiology. The relationship between poverty and the incidence of the disease has again been confirmed, as during the period under review by far the greater proportion of cases has occurred in the northern part of the borough— that is, in the poorer and more overcrowded districts. It is interesting to note that in several instances more than one member of the same family has attended the supervisory centre, thus confirming the familial character of the disease. 75 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 who conduct the social work of the centre consist of a paid part-time worker—Miss H. Caton— who is in charge, one honorary secretary, three voluntary visitors—Miss Dudley Baxter, Miss Greer and Miss Reitlinger—and a voluntary helper, Miss Kahn, who renders clerical assistance. These ladies conduct their work with considerable tact and enthusiasm, and it is in no small measure due to their efforts that the number of children attending has increased. The centre has now been in existence for eleven years, and it has been decided to re-visit old cases who have not been visited since attaining the age of 16 years. It is hoped that from information thus obtained, it will be possible to form a better opinion of the value of the work of a centre such as this. Patients attaining the ages of 20 to 25 years have to assume greater responsibilities, and often perform harder work, and the medical officers feel that it would be interesting to know the condition of the patient in these circumstances. It is also proposed to establish an evening session at which patients over 16 years of age, who have been discharged for more than three years, can be invited to attend. The patients attending will be subjected to a general overhaul, a screening of the heart and an electrocardiagraph. Over 300 old patients have been selected by the doctors for visiting; some of these reside in neighbouring boroughs. Those residing in Kensington will be visited by the council's health officers, and those outside the borough by the voluntary workers. If old patients are in attendance at a hospital, or are being seen by a private doctor, the consent of the medical practitioner in each case will be obtained before the patient will be permitted to attend the evening session. It is hoped that at least 100 patients will be persuaded to attend and that by this means valuable information may be gathered. PART II. The Work of the Centre by JANET K. AITKEN, M.D., M.R.C.P., and D. JANE HEALEY, M.D., M.R.C.P. In the eleven years, 1927-38, during which the centre has been in existence, 2,580 cases of rheumatism or cases sent for observation 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 six years. 1932-33 1933-34 1934-35 1935-36 1936-37 1937-38 Kensington 290 311 296 285 288 289 Hammersmith 51 45 39 37 36 39 Acton - - - - - 28 Other boroughs 20 35 40 45 50 20 361 391 375 367 374 376 During the year 1937-38, 49 sessions have been held at the Princess Louise Hospital. Average attendance per session of Kensington patients 21·70 ,, ,, ,, other patients 6·02 27·72 The total number of attendances of patients was:— Kensington Notified cases (a) New 17 (b) Old 379 Unnotified cases (a) New 82 (b) Old 590 Hammersmith (a) New 12 (b) Old 112 Paddington (a) New 2 (b) Old 33 Acton (a) New 14 (b) Old 80 Other boroughs (a) New 5 (b) Old 37 1,364 76 The number of notifications during the period was 49 (2 subsequently not verified):— 18 notified at centre. 16 „ by p-ivate doctors. 9 „ by hospitals. 6 „ by school medical officers. 49 Total number notified during the year who attended the Centre 22 The new Kensington cases were recommended to attend the clinic from the following sources:— Invalid Children's Aid Association 5 School Medical Officers 24 Princess Louise hospital 13 Private practitioners 13 Tuberculosis dispensary 7 Infant welfare centres 9 Parents 18 Visitors 10 99 The disposal of cases which attended the centre and which needed special treatment may be summarised as follows:— Admission as in-patients to Princess Louise hospital (eleven for tonsillectomy only) 50 Sent to convalescent homes 20 Referred to special schools 4 „ for remedial exercises 4 „ to St. Charles hospital 2 Clinical Report. One more session was held during the past year than in 1937, and the average attendance increased from 26-1 to 27-72. There are no statistics in the country to prove whether the incidence of rheumatism in children is diminishing or not; rheumatism is not universally notifiable, and the notifications in the Royal Borough of Kensington do not suggest that the number of children suffering from this disease is diminishing. It is true there were larger figures in the first three years. These, however, are due to notification of children with permanent cardiac abnormalities who developed the disease before the period of notification. The question naturally arises, therefore, whether the services provided by public authorities during the last decade have been of benefit to the community. We are quite sure that they have because, although an equal number of cases may occur, there is not a shadow of doubt that the cardiac complications of this disease are far less extensive and severe. Apart from the damage to the heart's endocardium, myocardium and pericardium, juvenile rheumatism does not as a rule leave any permanent disability, the acute arthritis which often occurs clearing up completely. Before this last decade one saw numbers of children suffering from a pancarditis of great severity. This resulted in such extensive damage to the whole heart that they did not recover or reach adult life; in others, the damage was less severe, but sufficient to limit permanently the activities of these patients. Thus they were not able to undertake anything but light work and in females childbirth was a danger to life. In chorea also, the condition was often so severe that the children could not possibly feed themselves, for weeks they had to be screened from other children, and their nursing was a difficult problem. Now we rarely see a severe case either of carditis or chorea. The progress of the acute cases is closely watched as one of the doctors at the centre is on the honorary staff of the Princess Louise Kensington Hospital for Children, to which a large proportion of the acute cases are admitted. Further, the social workers report progress in cases which are nursed at home or admitted to other hospitals. The cases of chorea, although their symptoms may have persisted for some time when they were in their own homes, usually disappear within the first week or two after admission to hospital. The accompanying table will show that during the period under review eight cases of chorea were admitted to Princess Louise Kensington hospital, where their progress was closely observed. None of them was severe. At the moment of writing there is a fairly acute case in the wards, admitted from the clinic. For a day or two she could hardly feed herself, but after three weeks of in-patient treatment her symptoms have almost subsided. A rather drastic hyperpyrexial treatment has been suggested for persistently severe cases, but during the last three years every case admitted has so quickly responded to the usual routine treatment of rest and sedatives that one has not been justified in submitting the child to hyperpyrexial treatment. During the year thirteen cases of active juvenile rheumatism were admitted, and were all very mild except two. One child had a fairly extensive cardiac lesion; her attack this year was an exacerbation of old-standing heart disease, she has responded well and her future activities should not be severely limited. The other was admitted as an acute rheumatic carditis; she developed infective endocarditis and died quite shortly after admission. When first seen early in 1938, she had a well developed mitral stenosis; although she had no history of an acute attack of juvenile rheumatism, she had suffered from pains in her calves and legs on and off for two years. Another three cases are known to have died during this year. One of these was in a cardiac home; she had been admitted to Princess Louise hospital during the previous year. The second had had an acute attack of rheumatism in 1932, preceded by rheumatic pains. She gradually developed mitral stenosis, but remained well until 1937 when she developed nephritis, and it is thought that this was the cause of her death. The third had his first attack in 1932, a second one in 1933, and a third in 1937; he died at home. There was no postmortem, but from the history of the case it is possible that this also was a case of infective endocarditis in addition to rheumatic infection. Before admission some of these children had been resting at home under observation with no improvement. 77 Apart from these admissions, forty-two patients were sent home to bed, and the district nurse was sent in. •Of these, thirty-five had pains or tachycardia or slight fever which was suggestive of juvenile rheumatism, and seven had a definite cardiac murmur originating from a previous attack of rheumatic fever. All these cases responded to a short rest at home, their symptoms having subsided when next seen. During the year no cases with nodules, which are in our opinion a sign of a severe rheumatic infection, have been seen. In fact, during the last four or five years nodules have become a rarity. Cases admitted to hospital from Clinic, October, 1937—October, 1938. I. Chorea—Eight cases. Case Initials. Reason for Admission. Remarks. R. C. Early chorea Very mild. General health poor. C. H. Chorea Very mild. E. D. Chorea - W. J. Chorea - P. W. Chorea Very mild. Growing pains severe. J. A. Chorea and carditis - A. B. Chorea and carditis - J. G. Chorea and carditis' - II. Active Juvenile Rheumatism—Thirteen cases. Case Initials. Reason for Admission. Remarks. R. C. Arthritis, tachycardia, extra systoles - P. H. Rheumatic pains, canter rhythm - E. P. Pains, pyrexia, tachycardia Old case of mitral regurgitation. J. P. Tachycardia, rheumatic pains, restless Old case of mitral regurgitation. J. G. Active carditis Old case mitral stenosis. Abnormal electrocardiogram. R. G. Infective endocarditis Old case rheumatic mitral stenosis. M. H. Rheumatic pains and carditis - M. L. Tachycardia Old case mitral regurgitation, severe scabies. W. W. Pyrexia, joint pains - M. W. Persistent pains Old case mitral stenosis. A. Y. Severe debility. No definite evidence active carditis. Old case mitral regurgitation. R. B. Arthritis Old case mitral stenosis. R. W. Pains and carditis Old case mitral stenosis. III. Doubtful Juvenile Rheumatism—Three cases. Case Initials. Reason for Admission. Remarks. B.C. Persistent tachycardia Later tonsillectomy. P. B. Pyrexia Later tonsillectomy followed by persistent tachycardia. G. W. Rheumatic pains—tonsils infected - IV. General—Six cases. E. G. Otitis media Old case mitral regurgitation. E. T. Erythema nodosum - W. S. Pneumonia - S. M. Pneumonia Old case rheumatic mitral regurgitation. G. B. Investigation subclavicular mass - W. T. Tubercular peritonitis - V. Admitted into Medical Ward with a view to Tonsillectomy—Nine cases. Six were cases of quiescent rheumatic carditis. Two had congenital heart disease. One general health very poor. Owing to the educative value of a supervisory clinic such as this, private and school doctors, school teachers, and parents themselves now send children to the clinic for observation if they suspect juvenile rheumatism in any form. This has led to an increased knowledge of early diagnosis and of preventive treatment. It is, however, impossible to prove that this has caused the present milder manifestations already discussed. Certain diseases, notably scarlet fever and smallpox, are known to have natural cycles of severity, and as juvenile rheumatism is a disease the incidence of which increases directly with poverty, the decrease in its severity may in part be due to the improvement in general hygiene initiated by the public health authorities. However, the fact remains that the comparative rarity of gross cardiac disabilities is co-incident with the increased interest aroused in this subject, and we feel sure that some of this striking difference must be attributed to the increased care and supervision now given. During the year under review a statistical research has been begun into the significance of what are commonly called growing pains. These pains vary and are certainly not all due to rheumatism. Is it possible to make a clear differential diagnosis? How seriously must one view their incidence? The material at the clinic is extensive and nearly a thousand cases are being considered. Various avenues of investigation have been opened up, but the statistics required are not yet complete, so that no conclusion can be published in the report of this year. 78 APPENDIX II. FIRST ANNUAL REPORT ON THE KENSINGTON CHRONIC RHEUMATISM CLINIC BY JAMES FENTON, C.B.E., M.D., M.R.C.P., D.P.H., WILLIAM S. C. COPEMAN, M.A., M.D., F.R.C.P., and HUGH A. BURT, B.A., M.B., B.Ch. (Cantab). Chronic Rheumatism. On the 10th May, 1938, the borough council approved a scheme for the treatment at the West London Hospital of Kensington patients suffering from chronic rheumatism, and made a grant of £2,00 to the Empire Rheumatism Council in respect of this service. Dr. Hugh A. Burt has been appointed Kensington Clinical Assistant, and conducts the sessions at which patients from the Royal Borough receive treatment. The council already have a rheumatism centre for the early diagnosis and supervision of rheumatic fever in children under the age of 16 years, in respect of which they pay grant to the Princess Louise Kensington Hospital for Children. Thus the provision now made at the West London hospital makes a complete rheumatism scheme embracing all ages. The following report, prefaced by a short note by Dr. W. S. C. Copeman, the physician in charge, shows the work carried out at the department of the hospital up to the end of the year. Dr. Burt's report is of special interest in that it refers to the first clinic set up in this country by the Empire Rheumatism Council in collaboration with a local authority. Foreword by W. S. C. COPEMAN, M.A., M.D., F.R.C.P., Physician m charge of the Department of Chronic Rheumatic Diseases at the west London Hospital. In the report of the Chief Medical Officer of the Ministry of Health for 1928, it was recommended that the war against rheumatism could best be furthered by the establishment of arthritis units or departments which, if possible, should be attached to teaching or general hospitals. Sir Arthur MacNalty, the present Chief Medical Officer, who has shown himself most sympathetic and interested in this matter, recently confirmed this recommendation after enquiring further into the whole subject. The Empire Rheumatism Council was founded in 1936, under the presidency of H.R.H. The Duke of Gloucester, and one of its first important moves was to approach the West London hospital and the council of the Royal Borough of Kensington. The outcome of the discussions between these two progressive authorities was the establishment of the department of chronic rheumatic diseases at the West London hospital, of which I have the honour to be physician-in-charge. This is the first complete special department for this purpose to be attached to a teaching hospital in the British Isles. The interest aroused during the past year by the opening and working of this department is shown by the fact that the chairman of the Empire Rheumatism Council, Lord Horder, has visited it on two occasions, as have other officials including Sir William Willcox and Sir Frank Fox, and also medical men from most of the countries in Europe. The chairman of the public health committee of the Royal Borough of Kensington, other members of the council, and the medical officer of health have visited the clinic on several occasions. To the devoted and skilled work performed by Dr. Hugh Burt, the Kensington clinical assistant, the following report on the first year's working will bear witness. In view of the fact that the department has been in existence for so short a time, it has been decided in this first annual report to include all those treated in the clinic rather than to confine it entirely to those patients from Kensington. The Work of the Department by HUGH A. BURT, B.A., M.B., B.Ch. (Cantab). The department of chronic rheumatism was opened at the West London hospital in the spring of 1938. A report based on less than a year's work cannot provide information of much statistical value. Nevertheless there is growing evidence that the department fulfils a real need, and it appears probable that the formation of further clinics along these lines will prove an invaluable weapon in the fight against rheumatism. For these reasons this report takes the form of an account of the workings of the department. Although it is primarily an out-patient department, two or three beds are allotted to it in the main hospital and as, in addition, pathological and X-ray investigations are carried out by the hospital staff a complete unit is in existence, the first in this country. 79 The clinic is held in the out-patient department of the hospital. The advantage of this arrangement has already become apparent, for the advice and help of the surgeons, gynaecologists, pathologists, neurologists, dentists, etc., are more easily obtainable than would be the case in an isolated clinic. There is, however, a possible disadvantage that the clinic had to be organised in a pre-existing building and only two rooms were available. Patients are first seen in a large consulting room in which cubicles have been curtained off for examination and special treatments. Massage and electrical treatments are given in a small room, which though under the supervision and control of the staff, is not directly attached to the department. Wax baths are arranged for in a special room adjacent to the clinic. The department is open on Wednesday mornings for women and Friday afternoons for men. It is under the charge of one of the honorary physicians on the staff of the hospital, supported by a chief assistant. The interest that this clinic has aroused is shown by the fact that in spite of the short time that it has been in existence six other medical men from London and the provinces, interested in, and with a knowledge of, the investigation and treatment of chronic rheumatism are already giving their services. Thus, on Fridays, there are three or four, and, on Wednesdays, as many as five doctors working in the department. If more accommodation had been available the ofler of several further workers could have been accepted. The advantage of this arrangement is self-evident. In the first place more time can be devoted to each individual patient. Secondly, in difficult and obscure cases, opportunity is given for a combined discussion as to the best treatment to be adopted. Thirdly, it enables treatments such as the manufacture of moulded plaster splints which normally consume too much time to be carried out at out-patient sessions to be provided at the time of attendance, thereby saving the necessity for an additional journey to the hospital. The sisters in charge of the massage and of the out-patient departments have been extremely helpful both in the arrangement and running of the clinic. In the consulting room two nurses have been found necessary to assist the medical staff in special treatments, and in the massage department five trained masseuses are in attendance. Apart from Kensington, the majority of patients are drawn from the nearby boroughs of Hammersmith, Fulham and Chiswick, but doctors have sent cases for consultation from as far afield as Sittingbourne and Marlborough. The following figure shows the steady rise in attendance since May of last year. Patients are seen in the first instance only at the request of their private doctors or if referred from another department of the West London hospital. Every effort is made to keep the doctor informed of the treatment and progress of his patient. The Nature ol the Cases. The following table shows the different types of rheumatic disease treated in the department up to the end of December, 1938. The largest proportion of cases, as would be expected, were those of fibrositis; this term includes many different conditions of which lumbago, sciatica and brachial neuritis are the most important. The number of cases of rheumatoid arthritis was rather unexpectedly high. Fibrositis (including lumbago, sciatica, etc.) 95 Rheumatoid and infective arthritis 32 Osteo-arthritis 31 Subacute rheumatic infection 22 Gout 14 Spondylitis 2 196 80 The Types of Treatment. The various forms of electrical treatment and massage are carried out in the department of physical medicine, which, as mentioned before, is not directly attached to the department though under the control of the physicianin-charge. The essentials for a clinic such as this comprise radiant heat and infra-red lamps, diathermy, ultraviolet light (general and local) and electrical apparatus for faradism, galvanism and sinusoidal baths. Most of these were already in the department of physical medicine before the rheumatism clinic opened. Since then the General Inductance Company have, through the Empire Rheumatism Council, kindly presented a new and effective infra-red lamp. The department, however, still lacks an ultra-short-wave diathermy, a modern innovation which is daily proving more valuable in the relief of pain. Special Forms of Treatment. In addition to massage and electricity, certain specialised forms of treatment are employed in the clinic itself ; these can only be carried out by members of the medical staff. The extent to which they were used is shown by the following table:— Injections of gold 192 Injections of novocaine 62 Injections of histamine 32 Vaccines 67 Manipulations 24 Plaster of Paris splints and casts 28 405 A number of photographs are included in this report which illustrate some of the various forms of treatment enumerated above. It might also be of interest to discuss the indications for some of them. Injection of Gold and the Application of Plaster Splints. These may be considered together, for it is in the treatment of rheumatoid arthritis that they are both almost exclusively used. The features of this distressing malady are familiar to most; the thin pale patient, usually a female, often attacked in the prime of life, with painful swollen joints, particularly those of the hands and fingers, which sooner or later if untreated will become bent and deformed. Until recently little could be done for such patients ; no known way existed of arresting the disease. During the last few years, however, treatment by the injection of gold salts has been introduced, and in a great number of those patients on whom this drug has been tried the disease process has been damped down and even stopped. The application of plasters hitherto used by surgeons only for fractures and other injuries has proved of considerable value when used in a modified way in the treatment of rheumatoid arthritis. If used judiciously they relieve inflammation, lessen the swelling and correct the deformity, provided that the case comes up for treatment in the early stages of the disease. Above all, by use of plasters a great proportion of the appalling deformities so commonly seen in the past can be prevented. These points serve to emphasise the importance of treatment in the early months of the arthritis. It might also be added here that gold is more likely to be effective at this early period. It is perhaps in the treatment of rheumatoid arthritis that some of the most satisfactory results have been obtained in the last few months in the department of chronic rheumatism. One case illustrates this particularly well. A woman of 47 came up in August with an arthritis of such severity that she had to be brought by relatives with great difficulty in a taxi. Her knee was put in plaster and she was given a course of gold ; no other treatment was tried. She is now able to come up to hospital unaccompanied and by underground railway. In all, twenty-one patients have been treated with gold and of these fourteen required plasters of this type. Injection of Novocaine. During the last two years a considerable amount of work has been done on the subject of muscle pain. It has been found that a small area of inflammatory tissue in a muscle may give rise to pain of great severity, not necessarily at the site of the trouble, but often some distance away. Thus, for example, an inflammatory nodule situated in the shoulder may give rise to severe pain down the arm and even in the fingers. It is obvious therefore that careful search has to be made for such a place so that treatment can be directed there rather than in the place to which the pain has been referred. It has been found furthermore that if this place is located with extreme accuracy permanent relief may follow injection of a local anaesthetic (such as novocaine in saline) into it. Injection of Histamine. A painful condition of the knees commonly occurs in women in the late forties. This, if allowed to go untreated, is apt to lead to a chronic arthritis ; but in the earlier stages the trouble is for the most part outside the actual joint, and if an attack is made on the extra-articular structures much good can be done. It is in cases of this nature that injections of histamine have proved of value. The method of giving these is illustrated. In view of the high cost of running a department of this type efficiently we have appreciated the publicspirited action of several important firms in presenting the Empire Rheumatism Council with considerable supplies of their products for the use of our patients. These include Messrs. Pharmex for Diuromil Granules and Ralgex solid liniment, Messrs. Bengu6 for supplies of their balsam, and Messrs. Smith and Nephew for Elastoplast and Cellona bandages. Reference has already been made to the gift of an infra-red lamp by the General Inductance Company. Various preparations of gold have been tried, and Messrs. Schering kindly supplied us with Neosolganal. Recently research work has been undertaken into the therapeutic value of a new preparation of gold which it is hoped will prove an advance upon the ones at present in use. For this purpose Messrs. Bayer's medical department have placed an unlimited supply at our disposal for the period of a year. This investigation is under the control of the Kensington clinical assistant and will be reported upon in due course. THE CONSULTING ROOM THE DEPARTMENT OF PHYSICAL MEDICINE Left:- THE TREATMENT OF MENOPAUSAL ARTHRITIS BY INJECTION OF HISTAMINE Right :— THE TREATMENT OF LUMBAGO BY MANIPULATION OF THE SPINE Left:— THE TREATMENT OF LUMBAGO BY INJECTION OF NOVOCAINE Right:— THE TREATMENT OF DEFORMED ARTHRITIC HANDS A PLASTER OF PARIS SPLINT IS BEING APPLIED TO CORRECT THE DEFORMITIES 83 APPENDIX III. TABLE I. Vital statistics of whole district for 1938 and previous years. Year. Population estimated to middle of each year. Births. Total deaths registered in the district. Transferable deaths Net deaths belonoino to the district Uncorrected number. Net. of nonresidents registered in the district. of residents not registered in the district. Under 1 year of age. At all ages. Number. Rate.* Number. Rate.* Number. Rate per 1,000 net births. Number. Rate.* 1 2 3 4 5 6 7 8 9 10 11 12 13 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 1938 174,100 2,253 2,236 12.8 2,443 14.0 1,064 670 175 78 2,049 11.7 *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 84 TABLE II. Causes of Death at Different Periods of Life in 1938. Causes of Death. Sex. All ages. Under 1 year. 1 and under 2 years. 2 and under 5 years. 5 and under 15 years. 16 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 year. 75 and upwards. ALL CAUSES M. 952 106 20 8 12 29 25 42 88 163 246 213 F. 1,097 69 13 11 9 23 37 38 80 156 270 391 Typhoid and paratyphoid fevers M. 1 .. .. .. .. .. .. .. .. 1 .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Measles M. 7 1 2 2 2 .. .. .. .. .. .. .. F. 5 2 1 1 .. .. .. .. .. .. .. .. Scarlet fever M. .. .. .. .. .. .. .. .. .. .. .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Whooping cough M. 4 2 2 .. .. .. .. .. .. .. .. .. F. 1 .. 1 .. .. .. .. .. .. .. .. .. Diphtheria M. 3 .. 1 2 .. .. .. .. .. .. .. .. F. 5 .. .. 4 1 .. .. .. .. .. .. .. Influenza M. 5 .. .. .. .. .. .. .. 1 1 1 1 F. 8 .. .. .. .. .. .. .. 2 2 3 1 Encephalitis lethargica M. .. .. .. .. .. .. .. .. .. .. .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Cerebro-spinal fever M. 1 .. .. .. .. 1 .. .. .. .. .. .. F. .. .. .. .. .. .. .. .. .. .. .. .. Tuberculosis of respiratory system M. 56 .. .. .. .. 8 8 10 12 9 6 2 F. 37 .. .. 1 .. 10 1 0 4 4 6 2 .. Other tuberculous diseases M. 8 1 .. 1 1 3 .. 1 .. .. 1 .. F. 5 .. 1 2 .. .. 1 1 .. .. .. .. Syphilis M. 10 1 .. .. .. .. .. .. 3 4 2 .. F. 3 .. .. .. .. .. 1 1 1 .. .. .. General paralysis of the insane, tabes dorsalis M. 6 .. .. .. .. .. .. .. .. 3 2 1 F. 1 .. .. .. .. .. * * 1 • • .. .. .. Cancer, malignant disease M. 138 .. .. .. .. .. * * 3 14 44 56 20 F. 176 .. .. .. .. .. 2 9 20 13 53 48 Diabetes M. 9 .. .. .. .. .. .. .. .. 2 2 5 F. 15 .. .. .. .. .. .. .. 1 3 6 4 Cerebral haemorrhage, etc. M. 37 .. .. .. .. .. .. 1 3 7 20 6 F. 62 .. .. .. .. .. .. 1 4 16 19 22 Heart disease M. 248 .. .. .. 2 2 4 3 23 47 78 89 F. 315 .. .. .. 1 2 4 4 12 32 86 174 Aneurysm M. 6 .. .. .. .. .. .. .. .. 2 3 1 F. 4 .. .. .. .. .. 1 1 .. 1 1 .. Other circulatory diseases M. 52 .. .. .. .. .. .. .. .. 6 15 31 F. 73 .. .. .. .. .. .. 1 1 6 22 43 Bronchitis M. 30 6 2 .. .. 1 .. .. 2 3 7 9 F. 25 3 .. .. .. 1 .. .. 4 1 4 12 Pneumonia (all forms) M. 83 21 7 1 .. 6 1 8 * 9 10 13 7 F. 60 14 4 2 2 1 2 1 5 2 9 18 Other respiratory diseases M. 7 .. .. .. .. .. .. 1 .. 2 1 3 F. 8 .. .. .. .. .. .. .. 3 1 2 2 Peptic ulcer M. 9 .. .. .. .. .. .. .. 2 4 3 2 F. 6 .. .. .. .. .. .. 1 .. .. 3 .. Diarrhoea, etc. M. 41 36 3 .. .. .. .. .. .. 1 .. 1 F. 18 14 2 .. .. .. 1 .. .. 1 .. .. Appendicitis M. 3 .. .. 1 1 .. .. 1 .. .. .. .. F. 5 .. .. .. .. .. .. .. .. 2 1 2 Cirrhosis of liver M. 3 .. .. .. .. .. .. .. 2 .. .. .. F. 3 .. .. .. .. .. .. .. .. 1 2 .. Other diseases of liver, etc. M. 3 .. .. .. .. .. .. .. 1 .. 1 1 F. 3 .. .. .. .. .. .. .. .. 2 1 .. Other digestive diseases M. 13 1 .. .. .. .. .. 2 2 2 4 2 F. 29 .. .. .. .. .. 1 2 3 7 11 5 Acute and chronic nephritis M. 16 .. .. .. 2 .. .. .. 2 4 5 3 F. 18 .. .. .. .. .. .. 1 3 5 4 5 Puerperal sepsis F. 2 .. .. .. .. .. 2 .. .. .. .. .. Other puerperal causes F. 3 .. .. .. .. .. 3 .. .. .. .. .. Congenital debility, premature birth, malformation, etc. M. 33 32 .. 1 .. .. .. .. .. .. .. .. F. 33 32 .. .. .. .. .. .. .. .. 1 .. Senility M. 4 .. .. .. .. .. .. .. .. .. 1 3 F. 18 .. .. .. .. .. .. .. .. .. 3 15 Suicide M. 11 .. .. .. .. 1 3 2 2 1 1 1 F. 13 .. .. .. .. 3 1 1 2 2 3 1 Other violence M. 25 .. 1 .. .. 4 3 4 4 .. 1 8 F. 45 1 .. .. 2 2 3 .. 4 8 7 18 Other defined diseases M. 80 5 1 .. 3 3 5 5 6 10 23 19 F. 94 3 3 1 3 3 5 9 11 14 27 15 Causes ill-defined, or unknown M. .. .. .. .. .. .. .. .. .. .. .. .. F. 4 •• •• .. .. .. •• .. •• 1 .. 3 85 TABLE III. Infant Mortality during the Year 1938. Net Deaths from, stated Causes, at Various Ages under One Year of Age. Cause of Death. Under 1 week. 1-2 weeks. 2-3 weeks. 3-4 weeks. Total under 4 weeks. 1-3 months. 3-6 months. 6-9 months. 9-12 months. Total deaths under one year. All causes. Certified 43 8 2 2 55 29 49 15 15 163 Uncertified 4 .. .. 1 5 4 2 .. 1 12 Measles .. .. .. .. .. .. .. .. 3 3 Whooping cough .. .. .. .. .. . . 1 .. 1 2 Meningitis .. .. .. .. .. .. .. .. .. . . Acute tuberculosis .. 1 .. .. 1 .. .. .. .. 1 Other tuberculous diseases .. .. .. .. .. .. .. .. .. .. Bronchitis .. .. .. .. .. .. .. .. 1 1 Pneumonia 1 .. .. 1 2 12 13 5 3 35 Other respiratory diseases .. .. .. .. .. .. .. .. .. .. Diarrhoea, etc. .. .. .. .. .. 11 24 8 7 50 Complications of birth 13 1 1 .. 15 .. .. .. .. 15 Malformation 6 1 . . .. 7 2 1 .. .. 10 Premature birth 23 4 1 2 30 .. .. .. .. 30 Deaths from violence 1 .. .. .. 1 .. .. .. .. 1 Atrophy, debility and marasmus 2 1 .. .. 3 3 3 .. .. 9 Other diseases 1 .. .. .. 1 3 3 1 1 9 Totals 47 8 2 3 60 33 51 15 16 175 Net births in the legitimate, 2,009. Net deaths in the legitimate, 147. year of year of illegitimate, 227. illegitimate, 28. 86 TABLE IV. Vaccination Officer's Return respecting the Vaccination of Children whose Births were Registered in 1937. 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 DATE. 1937. Registration sub-districts comprised in vaccination officer's district. Number of births returned in birth-list sheets. 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, 1938. Column I. Successfully vaccinated Insusceptible of vaccination Certificate of conscientious objection. 1st January to 31st Dec. North 680 439 4 92 35 1 13 91 5 2,087 South 1,622 891 5 205 109 1 318 92 1 Total 2,302 1,330 9 297 144 2 331 183 6 87 INDEX. page Advisory committee 27 After-care of tuberculous patients 73 Aged, infirm and physically incapacitated persons, removal of 32 Agricultural Produce (Grading and Marking) Act 56 Analysis of tuberculosis register 68 Ante-natal services 10 & 21 Anti-toxin (diphtheria) 61 Artificial Cream Act 56 ,, light therapy 72 ,, pneumothorax treatment 72 „ sunlight 24 Baby clinic 22 ,, hospital 23 Bacteriological examinations (infectious disease and milk) 13 & 52 Bacteriological examinations (tuberculosis) 13 & 71 Bakehouses 53 Basement rooms 43 Baths and washhouses 30 & 31 Bedding for tuberculous patients 72 Birth control 26 Births 3 ,, in wards and rates 4 ,, notified 4 Boarding out of children 26 By-laws for houses let in lodgings 46 Canal Boats 32 Cancer 6 Care of tuberculous patients 73 Cerebro-spinal meningitis 62 Certificates of fitness of houses 44 Chapel of rest 31 Child life protection 26 Children, boarding out of 26 Chronic rheumatism clinic 78 Cleansing station 33 Clearance areas 41 Closing orders 43 Common lodging houses 47 Compulsory purchase orders 41 Convalescent homes 24 Crescent Street improvement area 42 Day nurseries 25 Day nursery scheme 25 Deaths 5 ,, , causes of 6 ,, from certain diseases 7 ,, from cancer 6 ,, from tuberculosis 67 ,, in wards and rates 5 Defects (housing) remedied 29 Dental treatment at infant welfare centres 21 ,, ,, for tuberculous patients 72 Diarrhœa (summer) 62 Diphtheria 61 ,, immunisation 61 Disinfection (infectious disease) 65 Disinfestation 34 Dispensary diagnosis and treatment of tuberculosis 69 Dog nuisances 33 Domiciliary midwifery 22 Drainage and sewerage 27 Dwelling-house inspection 28 Dysentery 62 page Electrical treatment 24 Employment of tuberculous patients 73 Enteric fever 62 Enteritis, Zymotic 62 Erysipelas 62 Extra nourishment for expectant and nursing mothers and their infants 25 Extra nourishment for tuberculous patients 72 Factories and workshops 35 Food, inspection and supervision 49 Food and Drugs Act, 1938 58 Food and Drugs (Adulteration) Act 56 „ „ (proceedings) 58 Food premises, inspection 56 „ „ registration 54 ,, unsound 56 Foster-children 26 Fouling of footpaths by dogs 33 Gold therapy 72 Grants to maternity and child welfare institutions 17 Gynæcological clinic 26 Health lecturer 16 & 26 „ propaganda 16 „ services (general) 11 ,, visiting staff 19 Home contacts of tuberculosis 73 ,, helps 26 ,, nursing (general) 13 ,, nursing of tuberculous patients 73 ,, Office tables (factories and workshops) 40 ,, visiting of tuberculous patients 71 ,, workers 39 Houses let in lodgings 46 Housing 41 Housing Act 45 ,, accommodation provided by council 47 „ accommodation provided by associations 48 ,, action under statutory powers 48 „ , five years programme 41 „ statistics 48 Hydrocyanic acid gas disinfestation 34 Ice cream 54 Improved Tenements Association 48 Improvement areas 41 Increase of Rent and Mortgage Interest (Restrictions) Acts 31 Indecent occupation 44 Infant and toddlers' treatment clinic 23 Infant consultations at infant welfare centres 20 ,, mortality 7 ,, „ , death rates 8 „ ,, , causes of deaths 8 ,, „ , deaths each month 8 ,, „ , deaths in wards 7 „ „ , deaths in quarters 9 Infant welfare centres 19 Infectious diseases 59 Inspection and supervision of food 49 Invermead 21 88 INDEX—continued. page Kensington District Nursing Association 13 ,, Housing Trust 48 „ Maternity home 21 Lectures, health 16 & 26 Legal proceedings, food and drugs 58 ,, ,, sanitary administration 30 Light treatment at baby clinic and hospital 24 Marriages 3 Massage 24 Maternity mortality 10 Maternity and child welfare services18 „ home 21 Measles 63 Medicinal baths 33 Merchandise Marks Acts 56 Midwifery arrangements 21 Midwifery, domiciliary 22 Milk (bacteriological examination) 13 & 52 Milk and Dairies (Amendment) Act 50 ,, „ (Consolidation) Act 49 ,, „ Order 50 Milk (Special Designation) Orders 51 Milk supplied in Kensington 49 Milk utensils, sterilisation of 51 Mortuary 31 Notifiable infectious diseases 59 Notifications, age periods, deaths and admissions to hospital table 60 ,, of infectious diseases since 1934 59 , „ births 4 ,, ,, tuberculosis (age and sex distribution) 67 tuberculosis (deaths and death rates) 68 ,, „ tuberculosis (in wards) 66 Nourishment, provision of extra 25 Nursing (professional) in the home 13 Obstetric work 10 Ophthalmia neonatorum 62 Orthopaedic treatment 23 Outworkers 39 Overcrowding 44 Peabody Donation Fund 48 Permitted use of closed rooms 43 Pharmacy and Poisons Act 59 Phosphatase test (milk) 53 Pigeons, nuisances from 32 Pneumonia and influenzal pneumonia 62 Pneumothorax treatment of tuberculous patients 72 Poliomyelitis and polioencephalitis 63 Population 3 Post-natal examination 22 Pre-natal services 21 Prevalence of infectious disease 59 Princess Beatrice Hospital 14 Princess Louise Hospital 14 Proceedings under Food and Drugs (Adulteration) Act 58 PAGE Proceedings under Housing Act 30& 48 „ ,, Public Health Acts (housing) 30 & 48 ,, ,, Public Health (London) Act (General) 30 ,, „ Public Health (London) Act (unsound food) 58 Propaganda (health) 16 Public Health (Condensed Milk) Regulations 59 ,, „ (Dried Milk) Regulations 59 ,, „ (London) Act notices served 28 & 48 „ ,, (Meat) Regulations 53 ,, ,, (Prevention of Tuberculosis) Regulations 73 Public houses 54 Puerperal fever and pyrexia 62 Queen Charlotte's Hospital ante-natal clinic 22 Rats and Mice (Destruction) Act 32 Reconditioning and repair work 44 Refuse collection and removal 27 Registration of food premises 54 ,, houses let in lodgings 46 Rehousing accommodation 47 Rent Restrictions Acts 31 Residential treatment of tuberculosis 73 Rheumatism in children, acute 14, 62 & 74 ,, chronic 78 ,, supervisory centre 14 & 74 Samples, adulterated 58 ,, formal 57 „ informal 57 Sanitary circumstances of the area 27 ,, inspection 28 ,, notices 28 ,, works completed 29 Scarlet fever 61 Schick test 61 School medical service 15 ,, treatment centres 15 Sewerage and drainage 27 Shops Act, 1934 31 Slaughterhouses 53 Slaughter of Animals Act 53 Smallpox 61 Smoke abatement 30 Southam Street improvement area 41 Staff 11 & 12 Statistics, summary of 2 ,, vital 3 & 83 Sterilisation of milk utensils 51 Subscriptions to hospitals, voluntary health organisations, etc. 17 Sunlight treatment (artificial) 24 Sutton Dwellings Trust 48 Swimming baths 30 „ bath water, purification of 30 ,, ,, bacteriological examination of 30 Travelling expenses of women breast-feeding infants 26 Treverton Street improvement area 42 Tuberculosis 66 ,, prevention and treatment 69 Tuberculosis register, analysis of 68 Typhoid and paratyphoid fever 62 Underground rooms 43 Unsound food 56 89 INDEX—continued. page Vaccination 16 „ officer's return 86 Verminous furniture disinfested by HCN 34 ,, persons cleansed 33 ,, premises cleansed 34 Vital statistics 3 & 83 Washhouses 30 & 31 Water supply 36 Whooping cough 63 Whooping cough clinic 63 Wilsham Housing Trust 48 Women health officers 19 X-ray diagnosis of tuberculosis 71 Zymotic enteritis 62 „ death rate 2 page APPENDIX I. Eleventh annual report of the Kensington rheumatism scheme 74 APPENDIX II. First annual report of the chronic rheumatism clinic 78 APPENDIX III. Causes of death at different periods of life in 1938 (Table II) 84 Infant mortality during 1938 (Table III) 85 Vaccination officer's return for 1937 (Table IV) 86 Vital statistics for 1938 and five preceding years (Table I) 83