KEN 52 THE ROYAL BOROUGH OF KENSINGTON. ANNUAL (INTERIM) REPORT on the HEALTH OF THE BOROUGH for the Year 1943 by JAMES FENTON, C.B.E. , M.D. , M.R.C.P. , D.P.H. Medical Officer of Health. 10th July, 1944. Town Hall, Kensington, W.8. 1 Town Hall, Kensington, W.8. 10th July, 1944. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. I have the honour to submit my annual (interim) report for 1943 on the state of the public health in Kensington, which has remained satisfactory notwithstanding the present emergency. There was no serious outbreak of infectious disease during the year. The incidence of scarlet fever and measles was greater than in the previous year, but the zymotic death rate was less than half that for 1942. Scabies was made notifiable in 1943 and the Council's scheme to prevent the spread of infection appears to have met with success, as the number of Kensington cases attending the cleansing station was fewer than in the previous peak year, Diphtheria is still on the decline and there is no doubt that the immunisation work in past years is now having its effect on the incidence of this disease. Both the birth rate and the death rate for the year showed a slight increase when compared with last year's figures. A pleasing feature of the year's work was the substantial drop in the infant mortality rate from 65 in 1942 to 52 in 1943. The maternal mortality rate also dropped from 3.9 to 1.7. The infant and maternal mortality rates were the lowest recorded for the borough. Staff shortages have made increased demands on the individual officers of the public health department, who appreciate the encouragement and support they have received from the Mayor, the Chairman and Vice-Chairman of to the Public Health Committee and all members of the Council. STATISTICS FOR THE YEAR l943. Area of Borough 2,291 acres No. of deaths 1,769 Rateable Value £2,995,268 No. of infant deaths 88 Product of Id. rate £8,840 (a) legitimate 76 Total live births 1,698 (b) illegitimate 12 (a) legitimate 1,479 Infant Mortality rate:(a) All infants per 1,000 births 52 (b) illegitimate 219 (b) Legitimate infants per 1,000 legitimate' births 51 Total still births 46 (a) legitimate 39 (c) Illegitimate infants per 1,000 illegitimate births 55 (b) illegitimate 7 Still birth-rate per 1,000 live births 27.1 No. of maternal Maternal mortality rate per 1,000 total live and still births 1.7 2 (Certain figures in regard to population, etc. are purposely omitted). Causes of death at different periods of life in 1943. Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 10 years and over. Ce.rebro-spinal fever 2 1 1 ' ' ; 1 Whooping cough 3 2 1 - - Diphtheria 1 - 1 - Phthisis 86 - 42 44 Other forms of tuberculosis 13 1 3 6 3 Syphilis .22 •. — -■ 2 20 Influenza 39 1 1 1 36 Measles i - 1 - - Acabe infectious encephalitis 1 — -- _ 1 Cancer (all -forms i 30'+ - 18 286 Diabe teu 19 - - 2 17 Intra-cranial vascular lesions 145 _ - — 145 Heart di sease 400 - 12 388 Other diseases cf culatory syatem 86 - — 5 81 Bronchitis 87 4 2 1 80 Pneumonia 150 19 3 5 123 Other respiratory diseases 20 - - 3 17 Ulcers of stomach 19 -- -" 3 16 1 Diarrhoea (under 2 years) 16 16 - - Appendicitis 2 - - — 2 Other digestive diseases 58 1 1 1 55 Nephritis 47 - - 6 41 Puerperal sepsis 2 — - 2 - Other maternal causes 11 4 - 1 Premature birth 16 16 - - - Infantile diseases,etc 21 16 -- 1 4 Suicide 14 - -• 6 8 Road traffic accidents 7 - - — 7 Other violent causes 71 6 3 10 52 All other causes 116 5 3 18 90 • TOTALS 1769 88 18 147 1516 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. Bacteriological and analytical work. The Work performed during the year was as follows:Nature of specimen or sample Number examined The work performed during the year was as follows:- Nature of specimen or sample Number examined Nose and throat swabs 2,862 Sputum 607 Faeces and urine 274 Milk (bacteriological) 48 Milk (phosphatase) 48 Water 38 Miscellaneous 41 3 Care of aged and infirm persons. During the year, one of the Council's medical officers made 48 visits to 27 persons reported to the department as old or infirm, and living in insanitary conditions. Eleven cases voluntarily entered hospital and arrangements were made for six cases to enter suitable hostels or homes. In one case, a court order was obtained and the person was removed compulsorily to an institution. One case was dealt with under the Mental Deficiency Acts and in the remaining eight cases no action was deemed necessary by the medical officer, although three of them are being kept under observation. Medicinal Raths (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 Kensington Other boroughs 1162 990 2581 2605 202 132 223 142 – – – –- 13 – 20 – School Children. • Kensington Other boroughs 717 284 5143 1339 2479 368 2479 368 16 1 115 2 2 – 3 – Children under 5. Kensington Other boroughs 337 235 978 609 54 18 63 19 4 – 47 – -– – – – Refugees 12 82 118 118 – –- –- –.. Compulsory Cleansings –- –- –- 442 –- - – – – Totals 3737 13337 3371 3854 21 164 15 23 Special attention was paid by the health visitors during the year to head-lice in children under five years. Serious cases were referred to the Council's cleansing station for treatment, but in milder cases the mothers were taught how to deal with the condition. A supply of Sacker's hygienic combs was purchased and kept for re-sale at cost price to mothers who found difficulty in obtaining them. In addition hygienic combs were lent to mothers who were unable to afford to purchase them. 4 Bathing of School Children. The personnel 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 10,273. Nine children found to be suffering from scabies, five suffering from impetigo and three children with verminous heads were referred to the Council's cleansing station for treatment. Destruction of Rats and Mice. Under the Infestation Order, 1943, directions were served on the Council by the Minister of Pood requiring (a) a report on the extent of infestation by rats and mice within the borough and (b) a special report in regard to major infestations. In order to ascertain the necessary information the staff of the Public Health department was augmented by men of the Light Rescue Farties who were given rapid training to enable them to assist in the necessary survey. The investigation revealed 2,221 infestations of rats and mice and further directions under the Infestation Order were served on the Council by the Minister of Pood to take the necessary steps to remedy these. In addition to this work, which is now in progress, an experimental scheme for exterminating rats in sewers was carried out early in the year and as a result it was calculated that as many as 6,000 rats were killed. This experiment was approved by the Ministry of Pood who reimbursed the Council seventy per cent, of the cost. This baiting of sewers in Kensington gave experience to enable the Ministry of Pood to servo formal notices on other local authorities to carry out similar work. Subsequently, a second baiting of sewers was carried out -in Kensington, and it was estimated that in this second treatment about 3,000 rats were destroyed. Public Mortuary. The number of bodies taken to the mortuary during the year was 424. Inquests were held in 97 cases. Professional Nursing in the Home. On behalf of the borough council, the Kensington District Nursing Association visited 819 cases, paying 8,480 visits. The number of cases nursed during the year was 1,620, and the number of visits paid was 33,898. Vaccination. There were 1,484 births reported in 1942 to the vaccination officer by the Kensington registrars. By the 31st December, 1943, 62.06 per cent. of these had been vaccinated or were found to be insusceptible to vaccination. The other 37.94 per cent. were accounted for as follows:- Statutory declarations of objection 11.12% Died before vaccination 5.39% Referred to other districts 13.21% Removed, leaving no trace 7.62% Postponed, or unaccounted for 0.60% (In addition, 259 certificates of successful Vaccination were received in respect of children living in Kensington who were born outside the borough during 1942.) 5 Provision of Insulin. In pursuance of their powers under Section 227 of the Public Health (London) Act, 1936, the Council decided that from the 1st April, 1943, insulin should be provided free of cost to necessitous Kensington diabetics (not. otherwise eligible for such provision under the National Health Insurance Acts or the Education Acts.) During the year, six persons were supplied with insulin, and the cost to the Council amounted to £8. 16s. 9d. MATERNITY AND CHILD WELFARE SERVICES Health Visiting Staff. The work performed by the health visiting staff during 1943 in regard to maternity and child welfare is summarised in the following table:- First visits to infants (0 - 1 year) 1,368 Re-visits to infants (0-1 year) 7,533 Visits to children between 1 and 5 years 10,407 Stillbirth enquiries 29 Visits to ophthalmia neonatorum cases 39 "Visits to measles cases 1,805 Visits to whooping-cough cases 264 Visits to puerperal fever cases 15 Visits to puerperal pyrexia cases 22 Visits to enteritis cases 179 Infantile death enquiries 49 Pre —natal visits 3,489 Half-dayu at welfare centres 2,176 0ther visits 5,622 The work at these institutions during 1943 is shown in the following table:- Sessions at which doctor attended for prenatal consultations 458 Individual mothers who attended pre-natal sessions 1,358 Attendances of pre-natal mothers 7,586 Sessions at which doctor attended for infant consultations 463 Individual children who attended:- 0-1 year 1,942 1— 5 years 1,177 Attendances of children at doctors consultations:- 0—1 year 5,775 1 — 5 years 3,364 Attendances at centres of children for all purposes:- 0—1 year 16,217 1 — 5 years 7,567 Infant welfare centres and ante-natal clinics. The Baby Clinic. 92. Tavistock Road. Pre-school children minor ailment treatments. Nine hundred and sixty children under five years attended this institution, making 7,554 attendances. The average number seen by the doctor was 23 per session. In addition the nurse paid 1,024 home visits. 6 Dental Treatment. The following table shows the dental treatment performed at 92, Tavistock Road, during the year:- No. of sessions 51 Patients (new cases) 255 Total attendances (all cases) 1,094 Extractions 1,254 Fillings 58 Dentures 48 Other treatments 662 Maternity Home. Applications for admission. 138 Applications accepted 138 Applications subsequently withdrawn 14 Women confined in the home 121 The gross cost of the scheme to the Council during 1943 was £861. 12s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £701. 6s. 0d. Payments made by patients totalled £615. 13s. 6d. War-time Day Nurseries. During the year two additional war-time nurseries, accommodating 115 children, were opened, and the following table shows the average daily attendance's each month at each cf the four day nurseries now, in operation in the borough:- 1943 Ladbroke acommodating 45 children. Kensal House accommodating 65 children. St. Charles accommodating 65 children.' ' (Opened 16th April,1943) St. Quintin accommodating 50 children. (Opened 20th September, 1943) January 32. 2 48.5 – – February 24.5 55.3 – – March 39.7 43.8 – – April 45.0 42.2 16.0 – May 39.0 51.0 47.8 – June 42.4 56. 6 48.7 – July 41.0 52.5 43.3 – August 44.0 54.2 54.8 – September 46.5 56.9 61.4 32.6 October 44.4 57.8 46.4 35.9 November 34.3 58.7 48.9 33.4 December 31.7 48.6 44.7 34.3 A fifth nursery to accommodate 60 children was being planned at the end of the year. 7 Registered Daily Guardians. In co-operation with the Ministry of Labour, the Council have introduced a scheme for the registration of daily guardians to care for children under five years of age whose mothers are engaged on work of national importance. Under this scheme the Council make a payment to the guardian, in addition to the mother's contribution, of four shillings per week for each child taken for four days or more per week, and two shillings for each child taken for less than four days per week. During the year 43 women were placed on the register and 85 children were cared for by these women. The cost to the Council, which is reimbursed by the Ministry of Labour, amounted to £263. 10s. 0d. At the end of the year there were 6n the register, 31 daily guardians who were caring for 27 children. Home Helps. Home helps were supplied under the Council's scheme in 38 case s at a cost of £89. 4s. 0d. SANITARY INSPECTION The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year:- Total complaints received 2160 Public Health (London) Act, 1936. House inspected on complaint 2,270 ,, ,, after infectious disease..... 645 Re-inspections 8,486 Inspections of mews 135 Smoke observations 16 Other inspections 2,085 By-laws re Houses Let in Lodgings. Houses inspected on complaint 1 Re-inspections 6 Housing Act, 1956. Initial inspections (including preparation or revision of house-to-house cards) 41 Re-inspections 77 Underground Living Rooms Primary inspections 20 Re-inspections 82 Scabies Order. Inspections 2,840 Drainage. Applications made 129 Plans submitted 33 House drains tested and inspected 137 Shops Act, 1934. Inspections made 426 (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.) 8 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 34 " " additions to 22 Defective drains repaired 96 House drains cleansed 218 Water-closets reconstructed 44 " " repaired 68 " " ,new provided 30 " " supplied with water 22 Soil pipes, ventilated, repaired, etc 31 " " new provided 14 Ventilating pipes, new provided 26 Baths, new provided 16 Sinks, new provided 50 Lavatory basins, new provided 48 Waste pipes, new provided 82 Cisterns cleansed 9 " covered 5 Taps fixed on rising main 45 Yards, areas paved, drained, repaired 64 Dustbins provided 114 Accumulations of filth, etc., removed 227 Overcrowding abated 8 Animals removed 8 Roofs repaired 339 Houses provided with water above basement 5 Dampness in dwellings remedied 440 Infectious disease cases removed 285 Houses disinfected after infectious disease (including bedding,clothing, etc.) 518 Rooms in such houses disinfected after 558 Houses cleansed under houses let in lodgings by-laws 217 Cleansing of houses not on register 51 Verminous houses cleansed (including bedding, clothings, etc.) 806 Verminous rooms in such houses cleansed 991 Dirty bedding cleansed 45 " " destroyed 2 Other sanitary works executed 357 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 1,288 Statutory notices 417 Final notices 160 Various Rent Restriction Act certificates 2 Report of waste of water to M.W.B. 119 Report of dangerous structures to L.C.C. 68 Other notices 101 9 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) 2,332 (b) No. of inspections made for purpose 13,068 (ii) V (a) No. of dwelling houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 41 (b) No. of inspections made for purpose 77118 (iii)- No. of dwelling houses found to be in a a state so dangerous or injurious to health as to be unfit for human habitation 1 (iv) No. of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects fit for 1,288 (War Damage excluded) LEGAL PROCEEDINGS Public Health (London) Act. 1936. Nuisances. During the year, 19 summonses were taken, out for various nuisances under the Public Health (London) Act, 1936. In 11 cases, abatement orders were secured; in 2 cases fines of £6. 0s. 0d. were imposed, and in the remaining 6 cases, the summonses were withdrawn, the nuisances having been abated. Removal of aged and infirm persons. An application was made to the Court in one case, and an order was obtained for the compulsory removal of the person to a suitable instititon. Drainage By-laws. Three summonses were taken out for offences against the London County Council's Drainage By-laws and a fine of five shillings was imposed in each case. Housing Act. 1956. Contravention of Closing Orders. Three summonses under Section 14 of the Housing Act, 1936, were taken out in respect of the illegal occupation of closed underground rooms. In each case a fine of £2, 0s. 0d. was imposed. Food and Drugs Act. 1958. Nine prosecutions under this Act were instituted during the year. Convictions were secured in six cases and fines amounting to £52 and costs amounting to £11. 11s. 0d. were imposed. The remaining three cases were not proceeded with as the offences were discontinued. Council's By-laws. Dog Nuisances. Nine cases were prosecuted. In eight cases fines amounting to £2. 10s. 0d. were imposed and the other case was dismissed under the Probation of Offenders Act, 1907. -10- Legal Proceedings (contnd.) Scabies Order. Three summonses were issued against persons failing to comply with the provisions of this Order. In one case a fine of £l. 0s. 0d. was imposed. In the other two cases, the persons complied with the Order before the hearing of the summonses, which were withdrawn. INSPECTION AMD SUPERVISION OF FOOD. Milk. Two hundred and seventy-seven 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, 181 purveyors registered for the sale of milk in sealed containers, 157 dairymen and 117 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 10,801 tons of meat were examined during the year, of which approximately 5 tons were condemned as unfit for human consumption. ... Adulteration of Food. Two hundred and fifty-eight formal samples of food were taken of which 13, or 5.0% were adulterated. Seven hundred and forty-two informal samples were taken of which l4, or 1.9% were adulterated. WATER SUPPLY. In Kensington the water supply is almost entirely provided by the Metropolitan Water Board. There are, however, five premises which obtain water from artesian wells. Samples of water from these wells are taken regularly, both by the Council and the owners. Early in 1943, the supply at one premises was found to be unsatisfactory, and certain alterations to the system had to be made. Samples taken after this work had been carried out showed that the water was suitable for drinking purposes. -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, and the number admitted to hospital in 1943:- Notifiable disease Number of Cases. Total Cases admitted to hospital. North Kensington. South Kensington. Scarlet fever 170 46 216 213 Diphtheria (including membranous croup) 43 11 54 54 Enteric fever 1 2 3 3 Puerperal fever 9 1 10 9 Puerperal pyrexia 20 5 25 24 Acute primary pneumonia and acute influenzal pneumonia 114 19 133 79 Dysentery 64 9 73 63 Erysipelas 18 19 37 22 Cerebro-spinal meningitis 6 5 11 11 Malaria — 1 1 1 Poliomyelitis and polioencephalitis 1 — 1 1 All forms of tuberculosis 121 81 202 132 Measles 510 — 624 173 Ophthalmia ne???natorum 8 3 11 10 Whooping cough 83 19 102 39 +Enteritis (diarrhoea) 61 8 69 66 Food Poisoning 2 2 4 3 øAcute rheumatism 8 1 9 6 ???Scabies 198 54 252 — + Notifiable only in children under the age of 5 years. ø ,, ,, ,, ,, ,, ,, ,, ,, 16 years. ???Notifiable as from 1st August, 1943. 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 year:- No. of pre-school children immunised 979 No. of school children immunised 595 Total no. of children attending for pre-immunisation schick tests 697 No. which gave positive reaction 420 No. of children presented for schick testing after having received immunising innoculations 2,662 No. proving negative 2,155 No. proving positive 363 No. who failed to attend for readings 144 During the ten years 1934 to 1943 inclusive, 13,348 children resident in the Borough have been immunised against diphtheria or found by Schick test to be naturally immune to the disease. In this same period 68 deaths due to diphtheria occurred, but in no case has death occurred in a child who had been immunised. In 1943 fifty-four cases of diphtheria were notified and,of these, four had been previously immunised. None of the immunised cases was severe and all yielded readily to treatment. Further analysis of these four cases showed that two of the children had not had a postschick test so that it cannot be certain that the immunisation was complete, and in the other two cases, the immunisation process had been completed seven years previously Rather more than 60% of children now resident in the borough have been immunised, so it will, therefore, be seen that fifty cases occurred amongst 40% non-immunised, and only four in the 60% who had been immunised. Thus it will be seen that the chances of a non-immunised child contracting the disease are many times greater than those of an immunised child. Moreover, the illness is almost invariably less severe in the immunised child, and there is no record in this borough of a death from diphtheria of an immunised child. A number of children who had been immunised some years previously have had further schick tests in 1943, and the results show that immunisation is not always permanent. Although the number of cases so far retested is relatively small, it is probably safe to say that after an interval of five years, between 10% and 15% have lost part of their immunity. During the past year, therefore, a Schick test has been advised in the case of all "school entrants" who had been previously immunised, and other school children who had been immunised some years before, and in all cases where a positive result was obtained, further immunisation was given. It is hoped that by this means even the small number of cases of diphtheria which may occur among immunised children will be prevented. -13- TUBERCULOSIS During the year, 202 new cases of tuberculosis were notified, of which 171 were respiratory and 31 non-respiratory cases. Eighty-six persons died from Respiratory tuberculosis and thirteen from non-respiratory tuberculosis. Dispensary Service. Nine hundred and sixteen new patients-were examined. Of these 233 were suffering from respiratory tuberculosis, 40 from non-respiratory tuberculosis, 17 were new cases still under observation at the end of the year and 626 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,1943. 278 248 44 47 617 Cases notified for first time during the year 86 85 17 14 202 Cases brought to notice otherwise than by notification 48 47 9 6 110 Cases removed from the register on account of having(a) Recovered from disease 9 10 4 5 28 (b) Removed from district, lost sight of, etc. 52 43 7 3 105 (c) Died, 57 29 2 4 102 Cases remaining on register on 31st December, 1943. 294 288 57 55 694 Specimens of sputum examined were 607, of which 51 were found to contain tubercle bacilli; 1,198 radiological examinations were made; and 2,226 visits were paid to the homes of patients by the woman health officer. Pour patients made 20 attendances at the dental clinic. Sixty-nine patients received 1,031 artificial pneumothorax treatments. Grants of extra nourishment were made in 34 cases, beds and bedding were loaned to 12 patients; and the district nurses attended 19 patients in their homes and paid a total of 588 visits. Allowances for Tuberculous Persons .undergoing Treatment. In June, 1943, the Government's scheme to give maintenance allowances to tuberculous persons undergoing treatment was introduced. The allowances are payable to patients for their own maintenance and that of their dependants whilst the patients are waiting to go away for treatment, whilst undergoing treatment and after discharge if, in the opinion of the Tuberculosis Officer,. -14- they are not fit to return to work. The Tuberculosis. Officer has the power to continue the allowance for two periods of six months after discharge from a sanatorium. In exceptional cases the allowance may be continued for a further period at the discretion of the Minister of Health, to whom the case must be referred by the Tuberculosis Officer. In addition, the income of persons able to do part-time work only may be supplemented through the scheme. Some patients undergoing treatment in institutions, although having no dependants, have no income of any sort. In these cases pocket money is allowed under the scheme, and is paid to them by the steward of the institution. In the London area the County Council are responsible for assessing the allowances. The machinery of the borough council's tuberculosis dispensary is, however, used for making enquiries in regard to allowances, and the actual payments are made at the dispensary. Application forms for allowances are issued from the dispensary, and the dispensary staff give any necessary help to the applicants. The L.C.C. Assessment Officer attends the dispensary once a week to assess all new cases, and to review the old ones when any change in financial circumstances has occurred. Details of payments to be made are sent in advance to the Borough Treasurer and a member of his staff attends the dispensary weekly to make the necessary payments to persons authorised by the patients to receive them. The payments are made one week in advance, and started on the 30th June, 1943. During the year, 92 patients received allowances classified as follows:- Maintenance allowances- 70 Special allowances 28 Discretionary allowances- 6 The amount disbursed during the year was £1,013. 15s. 9d. I am, Mr. Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FENTON, Medical Officer of Health.