Ac 4348 KEN 49 THE ROYAL BOROUGH OF KENSINGTON. ANNUAL (INTERIM) REPORT. on the HEALTH OF THE BOROUGH for the Year 1940 by JAMES FENTON, C.B.E., M.D,, M.R.C.P., D.P.H. Medical Officer of Health. Town Hall, Kensington, 7th August, 1941. W. 8. 1 Town Hal1? Kensington, w. 8. 7th August , 1941. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. I have the honour to submit my annual report on the state of. the public health in Kensington in 1940. As in the previous year the report has been considerably curtailed, but detailed records of the year's work are available for inspection. When air raids on London commenced at the beginning of September, the Council's A.R.P. casualty services,, consisting of eight first aid posts and gas cleansing stations, five mobile units, two large stretcher party depotB and ancillary units, were found to be ready, and, in spite of the lack of previous experience, tho personnel met all demands made upon them with skill and promptitude. They withstood all pressure and much credit is due to the large number of A.R.P. workers who accepted long hours of work ??? When night bombing commenced, the public air raid shelters in tho borough began to be used extensively as dormitories from dusk till dawn every night. These shelters had not been constructed for sleeping purposes, and there thus appeared to arise a potential danger to the health of the public from overcrowding and the spread of epidemic disease. To meet this contingency, a whole-time medical officer, a health visitor, and a sanitary inspector were immediately allocated to deal with health problems arising in shelters. The Emergency Committee appointed a number of general medical practitioners and nurses to work in these shelters,. Shelter medical aid posts were established where necessary. Happily there was no outbreak of infectious disease. Although it is going toe far to say that the steps taken by the Emergency Committee were mainly responsible, there is little doubt that the measures adopted did contribute in securing a complete absence of epidemic disease conditions in tho shelters throughout the entire winter. The administrative work in connection with Civil Defence duties imposed on the public health department very heavy responsibilities. In the first eight months of the year training and preparation for dealing with casualties were carried out on an intensive scale, and in the last four months there was much work thrown on officers in the department in connection with the raitls which occurred. These duties over-shadowed the normal public health work, but nevertheless this was carried out by 'he staff quietly and thoroughly throughout tho twelve months. The Emergency Committee and every member of the staff appreciated that bad health and epidemics, by hampering production and wasting useful lives, can have an adverse effect on the. war effort, and thus postpone ultimate victory, It was this knowledge that kept public health problems fully in front of their minds, notwithstanding the additional responsibilities of Civil Defence duties. From a public health point of view the year was a satisfactory one, and no doubt this yas due in large measure to the evacuation of children to reception areas. Indeed, no disease appeared in epidemic form. 2 It is interesting to relate that during the year there were only 82 cases of scarlet fever, compared with 117 in 1939 and 238 in 1938. There were only 54 cases of diphtheria, compared with 102 in 1939 and 156 in 1938. The death rate from the principal infectious diseases, based on the estimated population, is the lowest in the history of the borough. The infant mortality rate of 58 is the lowest on record for the borough. The scheme of holding infant welfare sessions at the first aid posts was continued throughout the year. Her Majesty the Queen paid a special visit to inspect this feature of the Counoil's work, and graciously conveyed to Hie Worship the Mayor her approval. The deputy Medical Officer of Health, twelve clerical assistants, four sanitary inspectors, one woman health officer and four other officers in the department had joined His Majesty's forces before the end of 1940. The remaining members of the permanent staff and the temporary officers have worked hard in an effort to maintain the public health and the efficiency of the A.R.P. casualty services throughout the year, and in this work they are all grateful for the support and encouragement they received from the Mayor, the Emergency Commitee and the Public Health Committee. SUMMARY OF STATISTICS FOR THE YEAR 1940. Comparable figures for the last full year of peace - 1938 appear in brackets. The Registrar-General's estimate of population in mid 1940 is 123,860 (174,100) Area of borough in acres 2,291. Density of population per acre 54 (76). Rateable value £3,203,927 (£3,427,044). Product of a 1d. rate £7,948 (£14,279). No. of inhabited houses 28,310 (37,519). Total M. F. Live births (legitimate) 1,514 (2,009) 754 (1052) 760 (957) illegitimate 160 227) 81 (111 79 116) Birth rate 13.5 (12.8) Total M. F. Stillbirths 53 (62) 32 (31) 21 (31) Stillbirths rate per 1,000 total births 31.6 (27) Total M. F. Deaths 2,269 (2,049) 993 (952) 1,276 (1,097) Death rate (after adjustment) 17.4 (10.9) Deaths from puerperal cause:- Deaths Rate per 1,000 total (live and till)births Puerperal sepsis 5 (2) 3.1 (0.9) Other puerperal causes 2(3) 1.2 (1.3) Total 7 (5) 4.3 (2.2) 3 Death rate of infants under one year of age:- All infants per 1,000 births 58 (78) Legitimate infants per 1,000 legitimate live births 54 (73) Illegitimate infants per 1,000 illegitimate live births 95 (123) Deaths from measles 3 (13) Deaths from cancer 268 (314) Deaths from whooping cough Nil (5) Deaths from diarrhoea (under 2 years of age) 17 (55) Deaths from phthisis 92 (93) Phthisis death rate 0.74 (0.53) Deaths from all forms of tuberculosis 101 (106) Tuberculosis death rate 0.81 (0.60) Deaths from the zymotic diseases 26 (85) Zymotic death rate (Lowest on record) 0.21 (0.43) Causes of death at different periods of life in 1940. Cause of death. All ages. (1938 figures in brackets) Under 1 year 1 year and under 5 5 years and under 45 45 years and over. Typhoid 1 (1) - - - 1 Cerebro-spinal fever 7 (1) 2 2 2 1 Scarlet fever 1 (-) - - 1 - Diphtheria 4 (8) - 2 2 - Phthisis 92 (93) - - 54 38 Other forms of tuberculosis 9 (13) 1 2 4 2 Syphilis 25 (13) 1 - 2 22 Influenza 37 (13) 1 - 3 33 Measles 3 (12) - 3 - - Whooping Cough - (5) - - - - Poliomyelitis and polioencephalitis 2 (-) - - 2 - Ac. Inf. encephalitis 4 (-) - - 3 1 Cancer (all forms) 268 (314) - - 22 246 Diabetes 24 (24) - - 3 21 Intercranial vascular lesions 178 (106) - - 3 175 Heart disease 513 (573) - - 19 494 Other diseases of circulatory system 80 (125) 1 - 2 77 Bronchitis 140 (55) 2 1 - 137 Pneumonia 120 (143) 19 4 8 89 Other respiratory diseases 42 (15) - 1 3 38 Ulcers of stomach 25 (15) - - 3 22 Diarrhoea (under 2 years) 17 (55) 16 1 - - Appendititis 10 (8) - - 3 7 Other digestive diseases 56 (58) 1 1 7 47 Nephritis 60 (34) 1 - 5 54 Puerperal sepsis 5 (2) - - 5 - Other maternal causes 2 (3) - - 2 - Premature birth 16 (66) 16 - — - Infantile diseases 24 21 2 1 - Suicide 27 (24) - - 10 17 Poad traffic accidents 19 (70) - 1 7 11 Other violent causes 298 3 3 129 163 All other causes 160 (200) 5 3 23 129 TOTALS 2269 (2049) 90 26 328 1825 4 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Bacteriological Work The work performed during the year was as follows:- Disease suspected Examinations. Positive. Diphtheria 741 12 Tuberculosis 761 53 Typhoid fever (blood) 5 1 (faeces) 34 1 Paratyphoid fever (blood) 2 1 (faeces) 5 1 Dysentery (Sonne) (faeces) 22 4 Gonorrhoea 1 — The following examinations were also carried out:- Milk, general test 140 Milk, for tubercle bacilli 6 Virulence tests 5 Water from public swimming baths 2 Water from wells, etc. 27 Miscellaneous 14 Professional Nursing in the Home On "behalf of the borough council, the Kensington district nursing association visited 334 cases, paying 3933 visits. The total number of cases nursed during the year was 1,039, and the total number of visits paid was 34,019. Vaccination There were 2,074 births reported in 1939 to the vaccination officer by the Kensington registrars. By the 31st December, 1940, 52.84 per cent of th se had been vaccinated or were insusceptible to vaccination. The other 47.16 per cent are accounted for as follows:- Statutory declarations of objection 13.79% Died before vaccination 4.87% Referred to other districts 16.64% Removed, leaving no trace 10.17% Postponed, or unaccounted for 1.69% (In addition by the 31st December, 1940, 228 certificates of successful vaccination had been received in respect of children living in Kensingtoh who were born outside the borough during 1939) MATERNITY AND CHILD WELFARE SERVICES Health visiting staff. The work performed by the health visiting staff during 1940 in regard to maternity and child welfare is summarised in the following table:- First visits to infants (0-1 year) 1,224 Re-visits to infants (0-1 year) 6,751 Visits to children between 1 and 5 years 9,119 Stillbirth enquiries 56 Visits to ophthalmia neonatorum cases 25 Visits to measleg cases 186 Visits to whooping-cough cases 30 Visits to puerperal fever cases 7 Visits to puerperal pyrexia cases 19 Visits to enteritis cases 21 5 Infantile death enquiries 48 Investigations re milk applications 107 Pre-natal visits 3,085 Half-days at welfare centres 1,365 Special visits 4,609 Infant Welfare Centres The work at these institutions during 1940 is shown in the following table:- Births occurring in the area suitable for welfare attention 1,16 Sessions at which doctor attended for prenatal c onsultations 41 Individual mothers who attended pre-natal sessions during the year 1,19 Attendances of pre-natal mothers 4,37 Sessions at which doctor attended for infant consultat ions 58 Individual children who attended during year 1,89 0-1 year 1-5 years 1,62 Attendances of children at doctors' consultations during the year. 0-1 year 6,11 1-5 years 4,12 Attendances at centres of children for all purposes 0-1 year 14,10 1-5 years 8,24 Weighings 22,35 Dental Treatment The following table shows the dental treatment per formed at the infant welfare centres during the years- Patients 501 Attendances 1,348 Extractions 1,582 Fillings 78 Dentures 75 Other treatments 793 Maternity Home The following is a statement of the work done during the years:- Applications for admission 112 Applications accepted 112 Applications withdrawn after acceptance 46 Women confined during the year 66 The gross cost of the scheme to the council during was £535. 10s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £237. 12s. 0d. Payments made by patients totalled £319. 8s. 6d. 6 The Baby Clinic, 92, Tavistock Road. Pour hundred and ninety-four children attended this institution, making 3,199 attendances. The average number seen at doctors' consultations was 18. Supply of Extra Nourishment for Expectant and Nursing Mothers and for Infants. Under the borough council's scheme for the supply of dried milk, 1,120 applications were granted, of which 176 were new cases. The number of packets of dried milk issued free of charge was 14,982 and the cost to the council was £990. 0s. 11d. In addition, 8,660 packets of milk were sold at infant welfares centres to mothers at cost price, the total value being £559. 16s. 2d. The Government's war time scheme for the supply of Milk at reduced prices or free to children under five years and expectant or nursing mothers came into force in July,1940. The following figures show the number of permits issued for the supply of liquid or dried milk at reduced prices or free of charge and the number of persons involved. Liquid milk. Permits issued No. of persons Permits issued persons free receiving free for milk at ceiving milk milk 2d. a pint at 2d.a pint 2,260 3,260 3,476 4,404 Dried milk. Permits issued free permits issued for milk at price equivalent to 2d. a pint to children under one year. 205 208 In connection with the Government's scheme, the borough council decided to grant supplementary supplies of dried milk inspecial cases in which the medical officers certified,that the amount of milk granted under the Government's scheme was inadequate. The number of supplementary packets of dried milk supplied was 143 at a cost to the council of £8. 6s. 10d. In a few cases special packets of modified dried milks were applied through local chemists. As a result of the introduction of the Government's milk scheme, the arrangements for the supply of free milk at the expense of the council had almost completely ceased to oparate by the end of the year. The council's scheme for the supply of free dinners to necessitous expectant and nursing mothers was continued during the year and 1,192 dinners were supplied at a cost to the council of £41. 17s. 0d. Home Helps. Eighty-nine home helps were supplied under the council's scheme at a cost of £133. 10s. 0d. 7 SANITARY INSPECTION The following table shows a summary of the inspect etc., carried out by the district and housing inspectors during the year:- Total complaints received 2,09 Public Health (London) Act, 1936. Complaints received 1,78 Houses inspected on complaint 1,79 ,, ,, after infectious disease 44 Re-inspections 6,05 Inspections of mews 21 Smoke observations Other inspections 6,62 By-laws re Houses let in Lodgings. Complaints received 31 Houses inspected on complaint 31 First annual inspections 5 Re-inspections 54 Housing Acts. Initial inspections (including preparation or revision of house-to-house cards) 171 Re-inspections 75 Underground Living Rooms. Primary inspections 175 Re-inspections 595 Drainage. Applications made 95 Plans submitted 24 House drains tested and inspected 234 The following table shows the number of notices which have been issued in respect of nuisances, defects, etc. form during the years- Public Health (London) Act, 1936. Intimation notices 1,08 Statutory notices 36 Pinal notices ? Summonses issued ??? Housing Act, 1936. Section 9 (repairs) ??? Section 157 (entry) Various. Rent Restriction Act certificates ??? Report of waste of water to M.W.B. 20 Report of dangerous structures to L.C.C. 8 Other notices 2 8 The following is a summary of works completed under the supervision of the district and housing inspectors during the year:- House drains reconstructed 30 ,, ,, , additions to 19 Defective drains repaired 56 House drains cleansed 169 Water-closets reconstructed 34 ,, repaired 149 ,, new provided 50 ,, supplied with water 40 Soil pipes ventilated,repaired, etc. 21 ,, new provided 22 Ventilating pipes, new provided 30 Baths, new provided 30 Sinks, ,, 64 Lavatory basins, new provided 41 Waste pipes, ,, ,, 105 Cisterns cleansed 32 ,, covered 17 ,, abolished 3 Taps fixed on rising main 44 Yards, areas paved, drained, repaired 57 Dustbins provided 78 Accumulations of filth, etc. removed 216 Overcrowding abated 6 Animals removed 6 Underground rooms, illegal occupation, discontinued 9 Roofs repaired 363 Houses provided with water above basement level 47 Dampness in dwellings remedied 461 Ventilated food cupboards provided 84 Artificial lighting of staircases provided 5 Closing orders made under Housing Act 36 Closing orders determined 6 Repairs of houses completed under Housing Act, 39 Infectious disease cases removed 144 Houses disinfected after infectious disease (including bedding, clothing, etc.) 559 Rooms in such houses disinfected after infec- 953 Houses cleansed under houses let in lodgings by-laws 151 Cleansing of houses not on register 113 Verminous houses cleansed (including bedding, clothing, etc. ) 444 Verminous rooms in such houses 771 Dirty bedding cleansed 39 ,, ,, destroyed 5 Other sanitary works executed 391 Legal Proceedings under the Public Health Act. etc. Nuisances. During the year 18 summonses were taken out for various nuisances under the Public Health (London) Act, 1936. In 11 cases abatement orders were made; in 2 cases fines were imposed amounting to 15s.; three cases were dismissed under the Probation of Offenders Act; and the remaining 2 cases were withdrawn, the nuisances having been abated. Removal of aged and infirm persons. Application was made to the court in one case, and an order was obtained for the compulsory removal of the person to a suitable institution. 9 Dog nuisances. Proceedings were taken in lb cases during the year and fines amounting to £8. 2s. 6d. were imposed. OTHER SERVICES. The following activities have also been conducted throughout the year and records of the work done may be seen in the public health departments- Work at the public baths and washhouses. Work at the mortuaries and chapel of rest. Rats and mice destruction. Destruction of pigeons. Cleansing of verminous persons. Disinfection after infectious diseases. Disinfestation. Factories, workshops and outworkers, inspections. Pharmacy and Poisons Act - inspections. HOUSING. Basement Rooms. Thirty-six closing orders were made during the year in respect of unfit basement rooms. Seven prosecutions were instituted in respect of the illegal occupation of olosed rooms and fines amounting to £17. 15s. Od. were imposed. Overcrowding. At the beginning of the year, records based on the national overcrowding survey showed that there were 1,777 overcrowded families living in the borough. Owing to the movement of population due to evacuation and calling up of men and women for service with the Armed Forces, it is impossible to give an estimate of the number of over- crowded families remaining at the end of the year, but there can be no doubt that it has been considerably reduced. By rehousing the Council abated overcrowding in 111 cases. General 1. Inspection of dwelling houses during the year:- (i) (a) Total no. of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 2,514 (b) No. of inspections made for purpose 17,128 (ii) (a) No. of dwelling houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 171 (b) No. of inspections made for purpose 931 (iii) No. of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation Nil (iv) No. of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects 1,08 2. Remedy of defeots during the year without the service of formal notices:- No. of defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers Nil 10 3. Action under statutory powers during the year:- (a) Proceedings under sections 9, 10 and 16 of the Housing Act, 1936 (i) No. of dwelling houses in respect of which notices were served requiring repairs 42 (ii) No. of dwelling houses which were rendered fit after service of formal notices in 1940 or the previous year- (a) By owners 18 (b) By local authority in default of owners 21 (iii) Notices withdrawn 22 (b) Proceedings under Public Health Acts- (i) No. of dwelling houses in respect of which notices were served requiring remedy of defects 1,086 (ii) No. of dwelling houses in which defects were remedied after service of formal notices (a) By owners 1,086 (b) By local authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act, 1936;- (i) No. of dwelling houses in respect of which demolition orders were made Nil (ii) No. of dwelling houses demolished in pursuance of demolition orders Nil (d) Proceedings under section 12 of the Housing Act, 1936:- (i) No. of separate tenements or underground rooms in respect of which closing orders were made 18 (36 rooms) (ii) No. of separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 3 (6 rooms) INSPECTION AND SUPERVISION OP POOD. Milk. Three hundred and twenty samples of milk were submitted to the public analyst, and four were found to be adulterated. At the end of the year there were on the register, 204 purveyors registered for the sale of milk in sealed containers, 174 dairymen, and 133 dairies and milkshops. Public Health (Meat) Regulations, 1924. Daily inspections were made at the Government's meat distribution centre established in the borough, which serves not only Kensington but other neighbouring boroughs. Unsound Pood. Unsound food in one case was seized and condemned and che trader prosecuted. A large amount of other unscund food was surrendered voluntarily during the year. Adulteration of Food. Pour hundred and twenty formal samples of food were taken, of which 18, or 4.3%. were adulterated. Five hundred and seventy-nine informal samples were taken of which 16, or 2.8%, were adulterated. Prosecutions were instituted in three cases and fines and costs amounting to £5. 13s. 6d. were imposed. Underground Bakehouses. Proceedings were taken in, respect of the illegal occupation of one underground bakehouse and a fine of £5. was imposed. 11 INFECTIOUS DISEASE. The following table shows the number of cases of infectious disease notified, the number of cases in North and South Kensington respectively, the number admitted to hospitals and the number of deaths in 1940:- Notifiable disease Number of cases Cases admitted to hospital. Total deaths. North Kensington. South Kensington. Total Smallpox - - - - - Scarlet fever 58 24 82 75 1 Diphtheria (including membraneous croup 25 29 54 54 4 Enteric fever 5 6 11 11 1 Puerperal fever 5 1 6 6 - Puerperal pyrexia 14 4 18 18 - Acute primary pneumonia & acute influenzal pneumonia 40 19 59 20 120 Dysentery 9 6 15 14 - Erysipelas 29 18 47 34 - Encephalitis lethargica - 1 1 1 4 Cerebro-spinal meningitis 27 18 45 45 7 Continued fever - - - - - Poliomyelitis and polioencephalitis - 1 1 1 2 Pulmonary tuberculosis 106 64 170 127 92 Other forms of tuberculosis 20 10 30 27 9 Measles 43 191 242 135 3 Ophthalmia neonatorum 8 1 9 6 - Whooping cough 12 4 16 8 - Malaria - - - - - +Enteritis(diarrhoea) 9 3 12 8 17 Food poisoning 3 3 6 3 - øAcute rheumatism 6 - 6 3 - Totals 419 411 830 596 260 + Notifiable only in children under the age of 5 years. ø ,, ,, ,, ,, ,, ,, ,, ,, 16 ,, Cases of mistaken diagnosis are excluded from the above table. 12 Diphtheria Immunisation The following table shows the diphtheria immunisation work carried out during the years- No. of pre-school children immunised 207 No. of school children Immunised 57 Total No. of children attending for preimmunisation schick tests 37 No. which gave positive re-action 20 No. of children presented for schick testing after having received immunising innoculations 335 No. proving negative 281 No. proving positive 23 TUBERCULOSIS Two hundred new cases of tuberculosis were notified, of which 170 were respiratory and 30 non-respiratory cases. Ninety-two persons died from respiratory tuberculosis and nine from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 74 and that of nonrespiratory 7. The rate for all forms of tuberculosis was 81. Dispensary Service Five hundred and forty-five new patients were examined. Of these, 144 were suffering from respiratory tuberculosis, 18 from. non-respiratory tuberculosis, 3 were new cases still under observation at the end of the year and 380 persons were diagnosed as non-tuberculous. Seven hundred and sixty-one specimens of sputum were examined. Six hundred and twenty-one radiological examinations were made; and 2,647 visits were paid to the homes of the patients by the women health officers. Nine patients made 36 attendances at the dental clinic. Sixty patients received 976 artificial pneumothorax treatments. Ninety-five patients received grants of extra nourishment. Twenty patients were assisted with beds and bedding. The district nurses attended fifteen cases in their homes and paid 639 visits. I am , Mr. Mayor, Aldermen and Councillors, Your obedient servant, JAMES FENTON. Medical Officer of Health.