KEN 51 Not for publication THE ROYAL BOROUGH OF KENSINGTON ANNUAL (INTERIM) REPORT on the HEALTH OF THE BOROUGH for the Year 1942 by JAMES FENTON, C.B.E., M.D., M.R.C.P., D.P.H., Medical Officer of Health. 25th June, 1943. Town Hall, Kensington, W. 8. -2- Town Hall, Kensington, W.8. 25th June, 1943. 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 1942. The statistics for the present year indicate that public health work in the borough has, to a large extent, returned to its peace-time volume, and health standards are being maintained at a satisfactory level notwithstanding various difficulties. There was no large outbreak of infectious disease during the year and the number of cases of endemic notifiable illnesses was less than in the previous year. The number of oases of tuberculosis notified was smaller and the death rate from this disease showed a substantial decline. The general death rate decreased from 17.1 to 16.0 but the death rate from zymotic infectious diseases increased from 0.15 to 0.37, owing to the increased number of deaths from enteritis. The number of births (1,487) and the birth rate (15.0) showed increases in comparison with the figures for 1941, (1,239 and 12.7). The maternity and child welfare services were in full operation throughout the year; but there was a slight increase in the infant mortality rate. Two war-time day nurseries (Ladbroke arid Kensal House) were opened during the year, one accommodating 45 children and the other 65 children. In addition, two more nurseries for 115 children were being erected. The Ladbroke Nursery was opened by H.R.H. the Princess Royal, and the Right Honourable Ernest Brown, the Minister of Health, was present at the ceremony; the Kensal House Nursery was opened by Lady Louis Mountbatten. Special measures have been taken to control and prevent scabies and verminous conditions which, since the outbreak of war, have increased; additional baths have been made available for the treatment of scabies, and extra staff have been employed. The Scabies Order, 1941, has been fully operated; as far as practicable all contacts have been medically examined and, if necessary, treated by the Council's staff or by private doctors. In addition to 2,305 Kensington cases, 1,524 cases from adjoining boroughs were treated at the Medicinal Baths (Personal Cleansing Station), The total number of treatments given during the year was 12,695. Efforts to secure the immunisation against diphtheria of every child in the borough have been intensified, and the number of children immunised during the year was 2,363. The work of repairing war damaged houses continued to be carried out jointly by the Borough Engineer's Department and -3- the Public Health Department. Mr. Hunt, one of the Council's sanitary inspectors, was lent to the former department to supervise certain duties, and progress was satisfactorily maintained. The Council's civil defence medical services, which are controlled by the Public Health Department, carried out their duties satisfactorily. Light rescue party men and first aid post personnel have given valuable help in the work of disinfection, rat destruction, day nurseries, etc. The public health staff, both permanent and temporary, have worked extremely well during the year under difficult conditions, and they are grateful for the support given by the Mayor, the Chairman and Vice-Chairman of the Public Health Committee and all the members of the Council. STATISTICS FOR THE YEAR 1942 Area of Borough 2,291 acres No. of deaths 1,595 Rateable Value £2,983,521 Death rate 16.0 Product of ld. rate £8,950 No. of infant deaths 97 Population (estimated) 99,310 (a) legitimate 87 Density of population (b) illegitimate 10 per acre 43 Infant Mortality rate:- ftoo of inhabited houses 30,506 (a) All infants per Total live births.*. 1,487 1,000 births ... 65. (a) legitimate 1,280 (b) Legitimate infants per 1,000 legiti- (b) illegitimate... 207 mate births 68 (c) Illegitimate infants Birth rate 15*0 per 1,000 illegitimate births 48 Total still births.. 27 . Nn. of maternal deaths' 6 (a) legitimate 23 Maternal mortality rate (b) illegitimate... 4 per 1,000 total live and still births ... 3*9 Still birth-rate per Zymotic disease 1,000 live births.. 18»1 death rate 0*37 t STATISTICS FOR THE YEAR 1942 Area of Borough 2,291 acres No. of deaths 1,595 Rateable Value £2,983,521 Death rate 16.0 Product of ld. rate £8,950 No. of infant deaths 97 • Population (estimated) 99,310 (a) legitimate 87 Density of population per acre 43 (b) illegitimate 10 Infant Mortality rate:- No. of inhabited houses 30,506 (a) All infants per 1,000 births 65 Total live births 1,487 (a) legitimate 1,280 (b) Legitimate infants per 1,000 legitimate births 68 (b) illegitimate 207 Birth rate 15.0 (c) Illegitimate infants per 1,000 illegitimate births 48 Total still births 27 No. of maternal deaths 6 (a) legitimate 23 Maternal mortality rate per 1,000 total live and still births 3.9 (b) illegitimate 4 Still birth-rate per 1,000 live births 18.1 Zymotic disease death rate 0.37 A -4- Causes of death at different periods of life in 1942. 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 1 — 1 — — Whooping cough 5 2 3 — — Diphtheria 2 — 1 1 — Phthisis 54 — — 29 25 Other forms of culosis 14 — 2 6 6 Syphilis 30 1 — 4 25 Influenza 9 3 — 1 5 Measles 1 1 — — — Acute infectious encephalitis 1 — — 1 — Cancer (all forms) 258 — 1 18 239 Diabetes 14 — — — 14 Intra-cranial vascular lesions 126 — — 3 123 Heart disease 378 — — 14 364 Other diseases of circulatory system 55 — — 2 53 Bronchitis 96 2 — 5 91 Pneumonia 111 16 3 6 86 Other respiratory diseases 20 __ — 2 18 Ulcers of stomach 21 — — 2 19 Diarrhoea (under 2 years) 29 28 1 — — Appendicitis 12 — — 1 11 Other digestive diseases 51 — — 8 43 Nephritis 40 — — 5 35 Puerperal sepsis 2 — 2 — Other maternal causes 4 — — 4 — Premature birth 22 22 — — — Infantile diseases 23 19 — 1 3 Suicide 20 — — 8 12 Road traffic accidents 9 — 1 2 6 Other violent causes 54 1 3 7 45 All other causes 133 2 1 13 117 TOTALS 1595 97 17 143 1338 r GENERAL PROVISION Off HEALTH SERVICES IN THE AREA Bacteriological work The work performed during the year was as follows:- Disease suspected Examinations Positive Diphtheria 1425 30 Tuberculosis 524 51 Paratyphoid fever (faeces) 47 — Dysentery (Sonne) (faeces) 138 11 Cerebro-spinal fever 4 1 The following examinations were also carried out:- Milk (bacteriological) 66 Milk (phosphatase) 66 Water (bacteriological) 24 Water (chemical) 24 Miscellaneous 12 -5- Care of aged and infirm persons During the year, one of the Council's medical officers made 63 visits to 40 persons reported to the department as old, infirm or otherwise unsatisfactory and living in insanitary conditions. Twenty-one cases voluntarily entered hospital and arrangements were made for two cases to enter suitable hostels. One man died after refusing to leave his home in the ambulance which came to take him to hospital and before a court order for his removal could be obtained. In two cases, court orders were obtained and the persons were removed compulsorily to an institution. In the remaining fourteen cases no action was deemed necessary by the medical officer. Medicinal Baths (Personal Cleansing Station). The record of work done is as follows:- Scabies Vermin » Impetigo Other conditions Persons Cleansings Persons Cleansings Persons | Cleansings Persons Cleansings Adults i Kensington Other boroughs l077 2983 169 179 — — 17 29 986 2715 113 116 — — 6 6 School Children. \ 1 Kensington Other boroughs 778 3916 2005 2019 181 796 19 49 328 1088 291 291 26 74 5 15 Children under 5. Kensington Other boroughs 369 1095 77 82 — — 1 1 210 598 11 12 — — — — Refugees 81 301 228 228 — — — — Compulsory Cleansings — — — 474 — — — — Totals 3829 12696 2894 3401 207 870 48 100 Bathing of school children The personnel of three of the first aid posts,under the supervision of the health visitors continued to give free baths to school children in the gas cleansing stations attached to the posts. The number of baths given was 11,432. Twenty-two children found to be suffering from scabies and 92 children with verminous heads were referred to the Council's cleansing station for treatment. -6- Public -Mortuary The number of bodies taken to the mortuary during the year was 364. Inquoats were held in 105 cases Rats and Mice (Destruction) Act 1919 The following table is a record of the rat officers' work for the year:- No. of complaints received 362 No. of individual premises visited 906 No. of visits paid 2,993 Drainage defects remedied (including defective outlet drains, sewers, missing stoppers to interceptors, etc.) 269 The number of rat complaints received, during the year showed a marked increase compared with the previous year. Experiments were undertaken in regard to pre-baiting, a comparatively recent method evolved for killing rats, and after exhaustive tests it was used in the borough during the last two months of the year. The number of rats killed during the year is estimated to be 2,000. Professional nursing in the heme On behalf of the borough council, the Kensington District Nursing Association visited 483 cases, paying 6,019 visits. The total number of cases nursed during the year was 1,244, and the total number of visits paid was 38,925. Vaccination There were 707 births reported in 1941 to the vaccination officer by the Kensington registrars. By the 31st January, 1943, 57.14 per cent. of these had been vaccinated or were found to be insusceptible to vaccination. The other 42.86 per cent. were accounted for as follows:- Statutory declarations of objection 14.43% Died before vaccination 6.22% Referred to other districts 12.59% Removed, leaving no trace 8.35% Postponed, or unaccounted for 1.27% (In addition, by the 31st January, 1943, 205 certificates of successful vaccination had been received in respect of children living in Kensington who were born outside the Borough during 1941.) MATERNITY AND CHILD WELFARE SERVICES Health Visiting Staff The work performed by the health visiting staff during 1942 in regard to maternity and child welfare is summarised in the following table:- First visits to infants (0-1 year) 1,158 Re-visits to infants (0-1 year) 6,207 Visits to children between 1 and 5 years 8,562 Stillbirth enquiries 16 Visits to ophthalmia neonatorum cases 7 Visits to measles cases 875 Visits to whooping-cough cases 484 Visits to puerperal fever cases 10 Visits to puerperal pyrexia cases 12 Visits to enteritis cases 157 Infantile death enquiries 80 Pre-natal visits 4,167 Half-days at welfare centres 1,768 Special visits 5,100 -7- Infant welfare centres The work at these institutions during 1942 is shown in the following table:- Sessions at which doctor attended for prenatal consultations 417 Individual mothers who attended pre-natal sessions 901 Attendances of pre-natal mothers 5,196 Sessions at which doctor attended for infant consultations 405 Individual children who attended:- 0 — 1 year 1,695 1—5 years 1,352 Attendances of children at doctors' consultations:- 0 — l year 5,199 1—5 years 3,192 Attendances at centres of children for all purposes:- 0—1 year 13,588 1—5 years 7,295 The Baby Clinic, 92. Tavistock Road. Eight hundred and forty-seven children under 5 years attended this institution, making 5,855 attendances. The average number seen by the doctor was 19 per session. Dental Treatment The following table shows the dental treatment performed at the infant welfare centres during the year:- No. of sessions 52 Patients (new cases) 235 Total attendances (all cases) 994 Extractions 1,196 Fillings 72 Dentures 68 Other treatments 685 Maternity Home Applications for admission 138 Applications accepted 138 Applications subsequently withdrawn 6 Women confined in the home 99 The gross cost of the scheme to the Council during 1942 was £504. 18s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £544. 0s. 0d. Payments made by patients totalled £482. 16s. 0d. -8- The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year:- Total complaints received 1,957 Public Health (London) Act, 1936. Houses inspected on complaint 1,956 „ „ after infectious disease 535 Re-inspections 6,824 Inspections of mews 114 Other inspections 6,331 By-laws re Houses Let in Lodgings. Houses inspected on complaint 1 Re-inspections 10 Housing Act, 1936. Initial inspections (including preparation or revision of house-to-house cards) 16 Re-inspections 52 Underground Living Rooms. Primary inspections 30 Re-inspections 11 Drainage. Applications made 77 Plans submitted 8 House drains tested and inspected 181 (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. Intimation notices 1,203 Statutory notices 348 Final notices 89 Summonses issued 28 Various Rent Restriction Act certificates 4 Report of waste of water to M.W.B. 163 Report of dangerous structures to L.C.C. 84 Other notices 80 Home helps Home helps were supplied under the Council's scheme in 44 cases at a cost of £75. 8s. 4d. Issue of clothing coupons to expectant mothers In connection with clothes rationing the Public Health Department is responsible for the issue of special clothing coupons to expectant mothers residing in the borough, and during the year 1,959 applications were granted. SANITARY INSPECTION -9- 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 20 „ „ additions to 23 Defective drains repaired 95 House drains cleansed. 147 Water-closets reconstructed 22 „ repaired 71 „ new provided 23 „ supplied with water 25 Soil pipes ventilated, repaired, etc. 18 „ new provided 7 Ventilating pipes, new provided 22 Baths, new provided 23 Sinks, new provided 21 Lavatory basins , new provided 115 Waste pipes, new provided 39 Cisterns cleansed 10 „ covered 15 Taps fixed on rising main 28 Yards, areas paved, drained, repaired 17 Dustbins provided 62 Accumulations of filth, etc.. removed 197 Overcrowding abated 6 Animals removed 17 Roofs repaired 206 Houses provided with water above basement level 5 Dampness in dwellings remedied 309 Infectious disease cases removed 178 Houses disinfected after infectious disease (including bedding,clothing,etc.) 629 Rooms in such houses disinfected after infectious disease 644 Houses cleansed under houses let in lodgings by-laws 52 Cleansing of houses not on register 40 Verminous houses cleansed (including bedding, clothing, etc.) 1,281 Verminous rooms in such houses cleansed 1,363 Dirty bedding cleansed 68 „ „ destroyed 5 Other sanitary works executed 285 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) 2,003 (b) No. of inspections made for purpose 15,238 (ii)(a) No. of dwelling houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 16 (b) No, of inspections made for purpose 52 (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 human habitation 1,203 (War damage excluded). -10- LEGAL PROCEEDINGS Public Health (London) Act. 1956. Nuisances. During the year, 22 summonses were taken out for various nuisances under the Public Health (London) Act, 1936. In 13 cases, abatement orders were secured: in 1 case, a fine of £5. 0s. 0d. and £2. 2s. 0d. costs were imposed, and in the remaining 8 cases, the summonses were withdrawn, the nuisances having been abated. Removal of aged and infirm persons. Applications were made to the Court in two cases, and orders were obtained for the compulsory removal of the persons to suitable institutions. Housing Act. 1936. Contravention of Closing Orders. Six summonses under Section 14 of the Housing Act, 1936, were taken out in respect of the illegal occupation of closed underground rooms. In each of four cases, a fine of £1. 0s. 0d. was imposed, and the other two were dismissed under the Probation of Offenders Act. Food and Drugs Act. 1938. Sixteen prosecutions under this Act were instituted during the year. Convictions were secured in eight cases and fines amounting to £222 and costs amounting to £33. 12s. 0d. were imposed. Four defendants pleaded "warranty defences" and the summonses were dismissed. Three cases were dismissed, but costs amounting to £4. 14s. 6d. were awarded to the Council. The remaining case was dismissed and no costs were given. Council's Bv-laws. Dog Nuisances. Twelve cases were prosecuted. In each of nine cases a fine of 10/- was imposed, and 5/- each in the other three cases. INSPECTION AND SUPERVISION OF FOOD Milk Two hundred and thirty-two samples of milk were submitted to the public analyst, and two were found to be adulterated . At the end of the year there were o:a the register, 181 purveyors registered for the sale of milk in sealed containers, 158 dairymen and 118 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. More than 10,506 tons of meat were examined during the year, of which approximately 3 tons were condemned as unfit for human consumption. Adultration of food Two hundred and sixty-one formal samples of food were taken of which 19, or 7.2% were adulterated. Seven hundred and thirty-two informal samples were taken of which 42, or 5.7% were adulterated. 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 1942:- Notifiable disease Number of Gases Total Gases admitted to hospital. North Kensington. . South sington. Scarlet fever 80 28 108 103 Diphtheria (including membranous croup) 50 28 78 78 Enteric fever — 1 1 1 Puerperal fever 6 1 7 7 Puerperal pyrexia 3 4 | 7 7 Acute primary pneumonia and acute influenzal pneumonia 60 22 91 69 Dysentery 56 12 68 61 Erysipelas 16 14 30 19 Cerebro-spinal meningitis 7 10 17 15 Malaria — 1 1 1 Poliomyelitis and polioencephalitis 1 1 2 2 All forms of tuberculosis 118 85 203 152 Measles 294 71 365 78 Ophthalmia neonatorum 2 2 4 4 Whooping cough 111 35 146 48 +Enteritis (diarrhoea) 84 12 96 87 Food Poisoning 5 3 8 4 øAcute rheumatism 5 1 6 5 + Notifiable only in children under the age of 5 years. ø„ „ „ „ „ „ „ „ 16 years. Cases of mistaken diagnosis are excluded from the above table. -11- -12- Diphtheria immunisation The following table shows the diphtheria immunisation work carried out during the year:- No. of pre-school children immunised 1,189 No. of school children immunised 1,174 Total no. of children attending for pre-immunisation schick tests 976 No. which gave positive re-action 569 No. of children presented for schick testing after having received immunising innoculations 2,067 No. proving negative 1,770 No. proving positive 231 No. who failed to attend for readings 66 The total number of children of all ages immunised during the year was 832 more than in 1941. This was due both to the national publicity given to the work by the Ministry of Health and to the special efforts of the health visiting staff, who concentrated attention in securing the immunisation of children not habitually attending the infant welfare centres. The Council's immunisation scheme commenced in 1934, and in the early days all immunisations were undertaken by general practitioners, either in the patient's home or in the doctor's surgery; the Council pay a fee for each treatment. Subsequently, a clinic was opened at 304, Westbourne Grove, to deal with those cases which did not go to private doctors. During the year under review, additional immunisation sessions have been held at the clinic and new sessions have been held at the South Kensington infant welfare centre, Throughout the year medical practitioners, acting on behalf of the Borough Council, have, by arrangement with the London County Counoil, visited the elementary schools for the purpose of immunising children in attendance. The following table shows the steady decline in the number of cases of diphtheria and. the number of deaths, year by year, since the Council's scheme of immunisation was first introduced:- Year No. of diphtheria No. of deaths cages notified,, from diphtheria, 1933 326 22 1934 384 14 1935 367 19 1936 142 11 1937 193 4 1938 177 8 1939 102 3 1940 54 4 1941 86 2 1942 78 2 Typhus fever. Owing to typhus fever being prevalent in other countries and the consequent danger of the spread of infection to this country, the Borough Council, with the approval of the Ministry of Health, took preliminary steps to deal with any possible outbreak of the disease in the borough. The scheme includes arrangements for doing disinfection and delousing at the Kensington station for the adjoining boroughs of Hammersmith, Chelsea, Fulham and Wesminister. Certain equipment has been purchased. The cost, and any expenses incurred during an outbreak of typhus fever, will be borne by the five boroughs proportionately in the ratio of their respective populations. -13- TUBERCULOSIS During the year, 203 new cases of tuberculosis were notified, of which 166 were respiratory and 37 non-respiratory cases. Fifty-four persons died from respiratory tuberculosis and fourteen from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 54 and that for non-respiratory 14. The rate for all forms of tuberculosis was 68. Both the number of new cases notified and the number of deaths during the year are less than the corresponding figures for 1941. The following table shows that this is the first time since the war commenced that the death rate has decreased. Year No. ot deaths Death rate per 100,000 population 1939 88 55 1940 101 81 1941 103 106 1942 68 68 The reduction in deaths from tuberculosis during 1942 is noticeable in the age group between 15 and 45 years, but as there are no recent statistics of the age groups of the Borough's population available, no definite conclusions can be drawn. Dispensary Service Seven hundred and forty-two new patients were examined. Of these 173 were suffering from respiratory tuberculosis, 27 from non-respiratory tuberculosis, 4 were new cases still under observation at the end of the year and 538 persons were diagnosed as non-tuberculous. The following table shows the number of cases added to and the number removed from the Dispensary Notification Register during the year:- Respiratory Non-respiratory. Total M. F M. F Cases on register of notifications on 1st Jan.,1942 278 248 43 63 632 Cases notified for first time during the year 101 65 19 18 203 Cases brought to notice otherwise than by notification 32 23 4 2 61 Cases removed from the register on account of having- (a) Recovered from disease 9 8 9 9 35 (b) Removed from district, lost sight of, etc. 84 62 6 21 173 (c) Died 40 18 7 6 71 Cases remaining on register on 31st December, 1942. 278 248 44 47 617 -14- Specimens of sputum examined were 521, of which 51 were found to contain tubercle bacilli; 923 radiological examinations were made; and 2,427 visits were paid to the homes of patients by the women health officers. Eight patients made 35 attendances at the dental clinic. Fifty-nine patients received 987 artificial pneumothorax treatments. Grants of extra nourishment were made in 39 oases; beds an d bedding were loaned to 9 patients; and the district nurses attended 23 patients in their homes and paid a total of 690 visits. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FENTON, Medical Officer of Health.