KEN 50 THE ROYAL BOROUGH OF KENSINGTON. ANNUAL (INTERIM) REPORT. on the HEALTH OF THE BOROUGH for the Year 1941 JAMES PENTON, C.B.E., M.D. , M.R.C.P., D.P.H. Medical Officer of Health. 11th July, 1942. Town Hall, Kensington, W.8. Town Hall, Kensington, W.8. 11th July, 1942. To the Mayor, Alderman 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 1941. The report is considerably abbreviated, but detailed records are available for inspection. From the public health point of view the year was a satisfactory one. The incidence of infectious disease was low compared with pre-war years. The death rate from the principal infectious diseases is the lowest recorded for Kensington and the general death rate shows a slight decrease compared with the previous year's figure. Infant welfare sessions were held at two welfare centres and at four first aid posts. The personnel at the posts assisted in this work, and also helped in giving 8,832 free baths to school children in the attached gas cleansing stations. The issue of clothing coupons to expectant mothers and fruit juices and cod liver oil to children was a new feature of the maternity and child welfare service during the year. During the year the Council decided to provide war-time day nurseries to enable women to have their children cared for whilst they undertook full time work of rational importance. One nursery was opened in January of the present year, and another in the following month. Each provides accommodation for 45 children. They are open form 7 a.m. - 7 p.m. (2 p.m. Saturdays). First aid post nurses have volunteered to help and are being trained to become nursery nurses.. Transport is provided to convey the children from a convenient picking-up point to the Ladbroke nursery in the morning and back again in the evening. In June, 1941, the arrangements for dealing with the repair of war damaged houses were revised with the result that the public health department became responsible for initial and final inspections of damaged houses and the specification of repairs, while the Borough Engineer continued to supervise the work carried out by the builders, This change imposed new administrative duties on the public health department, but the new work is closely allied to ordinary peace-time duties of the department and was smoothly absorbed. During the year, the administrative work in connection with the Council's Civil Defence Casualty Services continued to impose heavy responsibilities on the public health department. The personnel of the first aid posts, gas cleansing stations, mobile aid units, stretcher party depots, medical aid. posts and ancillary units, carried on their duties satisfactorily. Medical supervision of persons using the public air raid shelters was continued and no outbreak of infectious disease occurred. Particular attention was given to the possible detrimental effect on children from sleeping night after night in public shelters, and one of the Council's medical officers visited these shelters to examine children therein at regular intervals. In addition, those children attending infant welfare centres were examined with a view to ensuring that they were not being adversely affected by having to sleep in shelters. Nearly three thousand children were examined, and it was found necessary to recommend for evacuation from London on health grounds only . thirty-three cases. There was only one case in which legal proceedings had to be taken to secure evacuation. -2- Owing to war conditions the incidence of scabies and verminous conditions began to increase, and special measures have been taken to control the outbreak. After forty years' service with the Council, Mr. J.H. Wilson, the Chief Clerk, retired on grounds of ill-health in 1941, and his place has been filled by Mr. J.S. Wheeler, one of the Council's sanitary inspectors. The public health staff, both permanent and temporary, have worked extremely well to maintain the public health and the efficiency of the Civil Defence Casualty Services, and they are grateful for the encouragement and support given by the Mayor, the Public Health Committee and members of the Council. STATISTICS FOR THE YEAR 1941. Area of Borough 2,291 acres No. of deaths 1,664 Rateable Value £3,033,729 Deaths rate 17.1 Product of 1d. rate £8,531 No. of infant deaths 67 Population (estimated) 97,180 (a)legitimate 62 Density of population per acre 43 (b)illegitimate 5 No. of inhabited houses 26,820 Infant Mortality rate:- (a) All infants per 1,000 births 62 Total live births 1,239 (b) Legitimate infante per 1,000 legitimate births 66 (a) legitimate 1,099 (c) Illegitimate infants per 1,000 illegitimate births 36 (b) illegitimate 140 Birth rate 12.7 No. of maternal deaths 2 Total still births 54 Maternal mortality rate per 1,000 total live and still births 1.8 (a) legitimate 45 (b) illegitimate 9 Still birth-rate per 1,000 live births 41.8 Zymotic disease death rate (lowest on record) 0.15 -3- Causes of death at different periods of life in 1941. Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 45 years and over. Cerebro-spinal fever 6 1 2 1 2 Diphtheria. 2 1 1 — — Phthisis 84 2 - 52 30 Other forms of culosis 19 - 4 10 5 Syphilis 24 — - 1 23 Influenza 22 — - 1 21 Measles 2 1 1 — - Whooping Cough 7 5 2 - - Poliomyelitis and polioencephalitis 1 - - 1 - Cancer (all forms) 227 — — 24 203 Diabetes 17 - - 5 12 Intereranial vascular 135 - - 1 134 Heart disease 398 - - 13 385 Other diseases of circulatory system 60 - - 3 57 Bronchitis 96 2 1 5 88 Pneumonia 120 13 6 6 95 Other respiratory diseases 16 - - 2 14 Ulcers of stomach 19 — - 1 18 Diarrhoea (under 2 years ) 4 3 1 - — Appendicitis 7 - — 2 5 Other digestive diseases 51 1 1 6 43 Nephritis 48 — — 10 38 Puerperal sepsis 1 — - 1 — Other maternal causes 1 - - 1 — Premature birth 16 16 - - - Infantile diseases 21 16 2 - 3 Suicide 14 — - 3 11 Road traffic accidents 12 - 1 3 8 Other traffic accidents 113 3 2 39 69 All other causes 121 3 2 15 101 TOTALS 1664 67 26 206 1365 PROVISION OF HEALTH SERVICES IN THE AREA. Bacteriological work. The work performed during the year was as follows:- Disease suspected Examinations Positive Diphtheria 790 40 Tuberculosis 654 43 Paratyphoid fever (faeces) 23 3 Dysentery (Sonne) (faeces) 29 4 The following examinations were also carried out:- Milk, general test 84 Milk for tubercle bacilli 18 (1 positive) WAter from wells, etc. 26 Miscellaneous 1 - 4 - Professional nursing in the home. On "behalf of the borough council, the Kensington district nursing association visited 372 cases, paying 4,540 visits. The total number of cases nursed during the year was 1,005, and the total number of visits paid was 33,932. Vaccination. There were 1,963 births reported in 1940 to the vaccination officer by the Kensington registrars. By the 31st December, 1941, 44.2 per cent. of these had been vaccinated or were insusceptible to vaccination. The other 55.8 per cent. were accounted for as follows:- Statutory declarations of objection 13.7% Died before vaccination 4.3% Referred to other districts 23.4% Removed, leaving no trace 11.1% Postponed, or unaccounted for 3.3% (In addition, by the 31st December, 1541, 121 certificates of successful vaccination had been received in respect of children living in Kensington who were born outside the Borough during 1940) MATERNITY AND CHILD WELFARE SERVICES Health visiting staff The work performed by the health visiting staff during 1941 in regard to maternity and chili welfare is summarised in the following table:- First visits to infants (0-1 year) 789 Re-visits to infants (0-1 year) 5,090 Visits to children between 1 and 5 years 8,550 Stillbirths enquiries 24 Visits to ophthalmia neonatorum cases 4 Visits to measles case 879 Visits to whooping-cough cases 526 Visits to puerperal fever cases 3 Visits to puerperal pyrexia cases 11 Visits to enteritis cases 83 Infantile death enquiries 48 Pre-natal visits 2,969 Half-days at welfare centres 1,475 Special visits 3,112 Infant welfare centres The work at these institutions during 1941 is shown in the following table:- Births occurring in the area suitable for welfare attention 821 Sessions at which doctor attended for prenatal consultations 392 Individual mothers who attended pre-natal sessions 826 Attendances of pre-natal mothers 4,041 Sessions at which doctor attended for infant consultations 402 Individual children who attended:- 0-1 year 1,384 1-5 years 1,295 Attendances of children at doctors' consultations:- 0-1 year 5,062 1-5 year 4,356 Attendances at centres of children for all purposes:- 0-1 year 9,918 1-5 year 6,602 weighings 16,520 -5- The Baby Clinic, 92, Tayistook Road. Five hundred and forty-eight children attended this institution, making 4,221 attendances. The average number seen at doctors' consultations was 17. Dental Treatment. The following table shows the dental treatment performed at the infant welfare centres during the year:- Patients 413 Attendances 948 Extractions 1,138 Fillings 70 Dentures 61 Other treatments 648 Maternity home. Applications for admission 49 Applications accepted 49 Applications subsequently 12 Women confined in the home 34 The gross cost of the scheme to the Council during 1941 was £175. 10s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £132. 16s. 0d. Payments made by patients totalled £123. 10s. 6d. Supply of extra nourishment for expectant and nursing mothers and for infants. 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, and continued throughout 1941. 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 free No. of persons receiving free milk Permits issued for milk at 2d.a pint Persons receiving milk at. 2d. a pint. 3,354 4,548 6,624 7,929 Dried milk Permits issued free Permits issued for milk equivalent to 2d. a pint to children under one year. 294 245 In connection with the Government's scheme, the borough council decided to grant supplementary supplies of dried milk in special 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 195 and the cost to the council was £11. lls. 0d. -6 - Home helps. Home helps were supplied under the council's scheme in 28 cases at a cost of £30. 10s. 10d Issue of clothing coupons to expectant mothers. In connection with clothes rationing the Public Health Department is responsible for the issue of social clothing coupons to expectant mothers residing m the borough, and during the year 661 applications ware granted, SANITARY INSPECTION The following table shows a Summary of the inspections, etc., carried out by the sanitary inspectors during the year:- Total complaints received 1,476 Public Health (London) Act 1936. Houses inspected on complaint. 1,386 ,, ,, after infectious disease 432 Re-inspections 4,680 Inspections of mews 18 Other inspections 6,731 By-laws re Houses Let in Lodgings Houses inspected on complaint 90 First annual inspections 5 Re-inspection 15 Housing Acts. Initial inspections (inc1uding preparation or revision of house-to-house cards) 5 Re-inspections 40 Underground Living Rooms. Primary inspections 7 Re-inspections 11 Drainage. Applications made 35 Plans submitted 11 House drains testes and inspection 143 (In addition to carrying out the Above inspections, the sanitary inspectors have been engaged on the inspection and repair of houses damaged by enemy action. The following table shows the number of notices issued in respect of nuisances, defects, etc., found during the year:- Public Health (London) Act, 1936. Inspection notices 645 Statutory notices. 200 Final notices 49 Summonses issued 7 Various Rent Restriction Act certificates 2 Report of waste of water to M.W.B 109 Report of dangerous structures to L.C.C. 33 Other notices 7 ■ -7- The following is a summary of works completed under the supervision of the sanitary inspectors during the year (excluding war damage repairs):- House drains reconstructed 8 „ „ additions to 6 Defective drains repaired 33 House drains cleansed 101 Water-closets reconstructed 12 „ repaired 47 „ new provided 3 „ supplied with water 12 Soil pipes ventilated, repaired, etc., 4 „ new provided 5 Ventilating pipes, new provided 3 Baths, new provided 3 Sinks, new provided 6 Lavatory basins, new provided 4 Waste pipes „ „ 20 Cisterns cleansed 1 „ covered 1 Taps fixed on rising main 5 Yards, area paved, drained, repaired 9 Dustbins provided 34 Accumulations of filth, etc, removed 106 Overcrowding abated 7 Animals removed 3 Roof repaired 138 Houses provided with water above basement level 18 Dampness in dwellings remedied 173 Ventilated food cupboards provided 2 Infectious disease cases removed 189 Houses disinfected after infectious disease (including bedding, clothing, etc.) 595 Rooms in such houses disinfected after infectious disease 667 Houses cleansed under houses let in lodgings by-laws 53 Cleansing of houses not on register 24 Verminous houses cleansed (including bedding, clothing, etc.) 578 Verminous room in such houses 806 Dirty bedding cleansed 55 „ „ destroyed 23 Other sanitary work executed 172 Legal Proceedings under the Public Health Act, etc. Nuisances. During the year 7 summonses were taken out for various nuisances under the Public Health (London) Act, 193o. In 3 cases abatement orders were made; the remaning 4 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. Dog nuisances. Proceedings were taken in 2 cases during the year and fines amounting to £1. 0. 0. were imposed. -8- HOUSING Inspection of dwelling houses during the year:- (i) (a) Total no. of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 1,493 (b) No. of inspections made for purpose 12,970 (ii) (a) No. of dwelling houses (included under sub-head (i) above ) which were inspected and recorded under the Horsing Consolidated Regulation, 1925 5 (b) No. of inspections made for purpose 45 (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 fit for (War damage excluded) 645 Overcrowding. By re-housing the council abated overcrowding in 70 cases during the year. INSPECTION AND SUPERVISION OF FOOD Milk. Three hundred and forty-two samples of milk were submitted to the public analyst, and nine were found to be adulterated. At the end of the year there were on the register, 181 purveyors registered for the sale of milk in sealed containers, 158 dairymen and 118 dairies and milkshops. Two summonses were issued tor offences under the Milk and Dairies Order, 1926, and costs amounting to £4. 4s. 0d. were awarded, no convictions being recorded. Public Health (Meat) Regulafcioris,1924. Daily inspections were made at the Governments meat distribution centre established in the borough, which serves not only Kensington but other neighbouring boroughs. Adulteration of food. Four hundred ana ten formal samples of food were taken, of which 20, or 4.9%, werc adulterated. Five hundred and eightynine informal samples were taken, of Which 24, or 4%, were adulterated. Prosecutions were instituted in eight cases,and fines and cost3 amounting to £67. 2s. 0d. were imposed. -9- INFECTIOUS DISEASE The following table shows the number of cases of infectious disease notified, the number of cases in North and South Kensington respectively, and the number admitted to hospital in 1941:- Notifiable disease Number of Cases Total Cases admitted to hospital. North Kensington. South Kensington. Scarlet fever 74 17 91 84 Diphtheria (including membranous croup) 57 29 86 86 Enteric fever 5 11 16 14 puerperal fever 1 - 1 1 ,, pyrexia 7 4 11 11 Acute primary pneumonia and acute influenzal pneumonia 55 10 65 32 Dysentery 21 4 25 23 Erysipelas 22 21 43 23 Cerebro-spinal meningitis 10 12 22 22 Poliomyelitis and polioencephalitis 2 - 2 1 All forms of tuberculosis 126 108 234 155 Measles 33O 36 366 166 Ophthalmia neonatorum 2 1 3 3 Whooping cough 165 11 176 96 +Enteritis (diarrhoea) 38 30 48 43 Food poisoning 1 1 2 2 øAcute rheumatism 2 - 2 - + Notifiable only in children under the age of 5 years. ø ,, ,, ,, ,, ,, ,, ,, ,, 16 year. Cases of mistaken diagnosis are excluded from the above table. ' - 10 - Diphtheria immunisation. The following table shows the diphtheria immunisation work carried out during the year:- No. of pre-school children immunised 651 No. of school children immunised 880 Total no. of children attending for immunisation schick tests 1,005 No. which gave positive re-action 563 No. of children presented for schick testing after having received immunising innoculations 667 No. proving negative 600 No. proving positive 67 TUBERCULOSIS During the year, 234 new cases of tuberculosis were notified, of which 204 were respiratory and 30 non-respiratory oases. Eighty-four persons died from respiratory tuberculosis end nineteen from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 86 and that for nonrespiratory 20. The rate for all forms of tuberculosis was 106. The increase in the death rate from tuberculosis which has been occurring throughout the country since the commencement of the war is also evident in this borough. Dispensary service. Seven hundred and fifty-seven new patients were examined. Of these, 256 were suffering from respiratory tuberculosis, 38 from non-respiratory tuberculosis, 6 were new cases still under observation at the erd of the year and 457 persons were diagnosed as non-tuberculous. Specimens of sputum examined were 654, of which 43 were found to contain tubercle bacilli; 786 radiological examinations were made; and 2,5 83 visits were paid to the homes of patients by the women health officers. Nine patients made 29 attendances at the dental clinic. Fifty-four patients received 951 artificial pneumothorax treatments. Grants of extra nourishment were made in 72 cases; beds and bedding were loaned to 15 patients; and the district nurses attended 17 patients an their hornet and paid a total of 404 visits. I am, Mr. Mayor, Aldermen and Councillors, Your obedient servant, JAMSE PENTON, Medical Officer of Health.