THE ROYAL BOROUGH OF KENSINGTON. ANNUAL (INTERIM) REPORT on the HEALTH OF THE BOROUGH for the Year 1944 by JAMES FENTON, G.B.E., M.D., M.R.C.P., D.P.H. Medical Officer of Health. 1st August, 1945. Town Hall, Kensington,W.8. -1- Town Hall, Kensington, W.8. 1st August, 1945. 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 1944. There are several features which will be gratifying to the Council. Diphtheria Immunisation. The Council introduced their scheme for diphtheria immunisation in the year 1934, and in the five years preceding the average annual number of cases of diphtheria was 317, and the average annual number of deaths was 16. The Council have, year by year, done much to encourage parents to have their children protected against diphtheria; most attention has been devoted to children at about one year of age, but immunisation has been advocated for all children up to the age of twelve years. The percentage of the children protected is gradually increasing; and the following table shows the position year by year since the scheme was introduced. Year No. of diphtheria cases notified. No. of deaths from diphtheria 1935 367 19 1936 142 11 1937 193 4 1938 177 8 1939 102 3 1940 54 4 1941 86 2 1942 78 1 1943 54 1 1944 29 - This table is more eloquent than words. Furthermore, not one child immunised by the Council since 1934 has died from diphtheria. Infant Death Rate. No figure in my annual reports over the last twentyfive years has aroused the Council's interest and attention more than this. At the commencement of the century, the infant death rate varied around 150; that is to say, of every thousand children born, 150 died before reaching the age of twelve months. In 1919 (the year after the last war) the figure was 102; in 1938 (the year before this war) it was 78; in 1943 it was 52 and in 1944 it was 52. The last two years constitute a record for the borough and they are better than the figures for London as a whole. The diseases which killed so many in days gone by, attacked many others and, whilst not killing them, interfered with their development into healthy and strong citizens. Looking closely into the bald death rate figures, the Council will be pleased to see that they reflect a great reduction in -2- serious ill-health and handicapping. Maternal Death Rate. In the earlier years of this century, the maternal death rate was about four to five, that is to say, for every thousand births, four or five women lost their lives in performing this primary function - a duty to the Nation which is normal and natural and which should be free from danger. Last year only one maternal death occurred amongst Kensington mothers and this gives a maternal death rate of 0.5. This record for Kensington is an outstanding one, but even one death is too many. The reduction of the maternal death rate represents not only a saving of the lives of a number of young women at the height of their value to the State, the home and the family, but it reflects a great reduction in the amount of permanent invalidity associated with child bearing in a number of other women. General Observations. The war in Europe has come to an end and we have so far escaped those devastating epidemics of disease (particularly typhoid and typhus fevers) so much feared several years ago when we thought over the problems of the Nation's food supply, the long hours of work performed by the people under difficult conditions in factories, etc., the crowded night life in shelters, the dangers to health arising from the bombing of houses, sewers and water, m???ins. The Council have laboured with great determination to surmount the problems with which they have been faced during the war and. although the results of successful preventive work may be described as negative in that there is no positive evidence that worse would have happened if the preventive work had not been done, we can at least be grateful that we have escaped so many perils. We must not, however, become complacent and think there are no problems ahead. it would be wrong on my part to call attention, as I have, to pleasing features without mentioning others which are not so happy to contemplate. Housing. This report contains no survey of the housing position. Indeed, any survey made with the short staff available and with the constantly changing conditions due to enemy action, would be incomplete and possibly misleading. All available members of the staff have been busy in the war years in making good the ravages of bombing, rather than in preparing statistics. It must, however, be obvious that the problem facing the Council today is greater than that which presented itself after the last war. -3- There was a housing section in the Public Health Department in pre-war years, which secured the repair, up to a full habitable standard, of large numbers of deteriorating houses. That section should be re-established in the near future to tackle that deterioration which has been accruing in the war years, quite apart from the actual war damage itself. War damage repairs, repair of deteriorating houses and the provision of new houses are urgent problems. Maternity and Child Welfare Institutions. Owing to a variety of reasons, the infant welfare centres have become inadequate for the needs of the borough. This question was receiving the Council's attention in the years before the war; and, indeed, the war itself brought to a stop the provision of the new Raymede Health Centre and the new Bramley Road Infant Welfare Centre which were both in hand at the outbreak of hostilities. The Public Health Committee have this matter under careful review at the moment. Scabies. This contagious skin disease, commonly called "itch", has been prevalent throughout the war in all parts of the country. Although it is not a fatal malady, it causes much suffering and interferes with working capacity. To enable local authorities to treat the disease more thoroughly it was made "notifiable" in the London area in 1943. The Council have not only given necessary treatment to residents in Kensington, but have been able to offer facilities to several neighbouring boroughs at the "Medicinal Baths. Experience gained has enabled more efficient methods of treatment to be introduced; and, at the present time, there is some evidence that the incidence of the disease is decreasing. Vermin Infestation. This, in its different forms, has been more troublesome than in pre-war years; but now that more normal conditions of life are returning, it is hoped to be able to deal with the problem energetically. Illegitimacy. There has been an increase in the number of births of illegitimate children. Speaking generally, these children have not had, in the past, the same chance of growing up into healthy citizens as those born to married couples, and their welfare calls for the special attention of the Council's Maternity and Child Welfare staff. Staff Shortages. The reduced number of officers left in the Public Health Department have responded splendidly to the call for devoted service. They wish to acknowledge the encouragement and support they have received from the Mayor, the Chairmen and Vice-Chairmen of the various Committees and all members of the Council. With the end of the war in Europe, and the prospects of the return of a number of the staff, the problems ahead will be approached with renewed vigour. -4- SUMMARY OF STATISTICS FOR 1944. Certain figures for 1943 were omitted from the annual report for that year for security reasons; they are now included for record purposes. Figures for 1938 (the last complete year before the war) are given for purposes of comparison. POPULATION etc. 1944 1943 1938 Population 107,610 106,830 174,100 Density of population per acre 47 46.6 76 No. of inhabited houses 32,872 32,875 37,519 Rateable value £2,899,238 £2,995,268 £3,427,044 Product of Id. rate £9,300 £8,840 £14,279 LIVE BIRTHS. Total births 1,780 1,698 2,236 Legitimate births 1,527 1,479 2,009 Illegitimate births 253 219 227 Birth rate per 1,000 population 16.5 15.9 12.8 (15.0) (15.8) (13.4) (Figures for County of London in brackets) STILL BIRTHS. Total still births 47 46 62 Legitimate still births 44 39 52 Illegitimate still births 3 7 10 Stillbirth rate per 1,000total births 25.7 27.1 27 DEATHS. Total deaths 1,735 1,769 2,049 Death rate per 1,000 population 16.1 16.5 10.9 (15.7) (15.0) (11.4) (Figures for County of London in brackets) INFANT DEATHS. No. of infant deaths 93 88 175 Legitimate infant deaths 76 76 147 Illegitimate infant deaths 17 12 28 Infant death rate per 1,000 births 52 52 78 (61) (58) (57) (Figures for County of London in brackets) Death rate of legitimate infants per 1,000 legitimate births 50 51 73 Death rate of illegitimate infants per 1,000 illegitimate births 67 55 123 -5- MATERNAL DEATHS. 1944 1943 1938 Deaths of mothers as a result of pregnancy or childbirth 1 3 5 Death rate of mothers per 1,000 live and still births 0.55 1.7 2.2 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000 population 76 92 60 Death rate from respiratory tuberculosis per 100,000 population 68 80 53 Death rate from non- respiratory tuberculosis per 100,000 population 8 12 7 ZYMOTIC DISEASES - death rate 0.21 0.17 0.45 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1944. 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 5 - - 2 3 Whooping cough 6 4 2 - - Diphtheria - - - - - Phthisis 73 1 - 33 39 Other forms of tuberculosis 9 - 1 4 4 Syphilis 14 - - - 14 Influenza 10 1 - 1 8 Measles - - - - - Acute infectious encephalitis 3 - - 3 - Cancer (all forms) 263 - 2 13 248 Diabetes 19 — - - 19 Intra-cranial vascular lesions 137 - - - 137 Heart disease 390 - - 14 376 Other diseases of circulatory system 83 - - 1 82 Bronchitis 92 2 - 2 88 Pneumonia 94 11 3 3 77 Other respiratory diseases 23 - 2 4 17 Ulcers of stomach 14 - - - 14 Diarrhoea (under 2 years) 17 17 - - - Appendicitis 4 - - - 4 Other digestive diseases 30 2 1 1 26 Nephritic 45 - - 3 42 Puerperal sepsis - - - - - Other maternal causes 1 — - 1 - Premature birth 26 26 - - - Infantile diseases,etc 23 18 2 1 2 Suicide 16 - - 8 8 Road traffic accidents 12 - — 5 7 Other violent causes 190 5 6 63 116 All other causes 136 6 3 19 108 TOTALS 1735 93 22 181 1439 -6- 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. Nose and throat swabs 2,322 Sputum 750 Faeces and urine 504 Milk (bacteriological) 59 Milk (phosphatase) 67 Water 12 Miscellaneous 98 Care of Aged and Infirm Persons. During the year, one of the Council's medical officers made 52 visits to 29 persons reported to the department as old or infirm, and living in insanitary conditions. Twelve cases voluntarily entered hospital and arrangements, were made for five cases to enter suitable hostels or homes. In two cases, Court orders were obtained and the persons were removed compulsorily to an institution. One case died before a Court order could be obtained. In the remaining nine cases no action was deemed necessary by the medical officer, although five of them are being kept under observation. Medicinal Baths (Personal Cleansing Station). The record of work done is as follows:- Adults Scabies | Vermin Impetigo Other conditions . Persons Cleansings Persons Cleansings Persons Cleansings Persons Cleansings. Kensington 1054 2001 345 350 5 27 2 2 Other boroughs 1037 2268 208 223 - - - - School Children. Kensington 495 3003 2257 2257 14 100 11 24 Other boroughs 222 666 339 339 1 2 - - Children under 5. Kensington 312 784 105 107 7 51 1 2 Other boroughs 229 500 37 38 - - - - Refugees 3 10 22 22 - - - - Compulsory Cleansings - - 198 198 - - - - Totals 3352 9232 3511 3534 27 180 14 28 -7- 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 4,114. Disinfection and Disinfestation. A summary of the work of the disinfecting staff is shown in the following table Number of houses disinfected after infectious disease 355 Number of rooms disinfected in such houses 411 Number of shelters disinfected 112 Number of houses disinfested after vermin 193 Number of rooms disinfested in such houses 330 Number of loads of furniture treated with hydrogen cyanide 32 Weight of bedding dealt with - 231 tons. 13 cwt. 1 qr. 6 lb. Destruction of Rats and Mice. In accordance with a direction served on the Council by the Minister of Food under the Infestation Order, 1943, a survey of the borough was made and 2,221 premises were found to be infested with rats or mice. Following this survey, further directions were served on the Council by the Minister of Food to proceed with all necessary steps for remedying these infestations. In the beginning of 1944, the Council adopted a special scheme involving the appointment of extra staff in order to comply with the Minister of Food's directions. The work was placed under the control of the chief sanitary inspector. In January, an extensive baiting of the sewers in the borough was undertaken, and it was estimated that approximately 1,400 rats were destroyed. In July, a second treatment of the sewers was commenced but, owing to enemy action by flying bombs, this was not completed. During the year, 498 complaints of rat infestation were received in the Public Health Department. The number of visits paid by the rat officers was 3,125. In 304 cases, notices were served on owners under the Public Health (London) Act, 1936, to remedy drainage defects which were considered to be the source of the infestation. Forty-nine informal notices under the Rats and Mice (Destruction) Act, 1919, were served. In 13 cases, the Ministry of Food were asked to serve notices Upon owners to carry out preventive and remedial works to rid the premises of rats. This latter action was necessary because the Rats and Mice (Destruction) Act, 1919, permits the Council to deal only with occupiers of premises but, under the Infestation Order, 1943, the Ministry of Food have power to serve "directions" upon owners of premises. The Infestation Order, 1943, has imposed additional duties upon the Council, whose financial responsibility has been fixed as that which is laid upon them under the Rats and Mice (Destruction) Act, 1919. The expenditure incurred by the Council under that Act in the financial year ended -8- 31st March, 1938, has been adopted as the basis (subject to adjustment for increased costs), and the Ministry of Food have agreed to reimburse any excess expenditure above this figure incurred by reason of increased duties. Public Mortuary. The number of bodies taken to the mortuary during the year was 565. Inquests were held in 90 cases. Of the total cases 182 were due to enemy action. Professional Nurging in the Home. The total number of cases nursed by the Kensington District Nursing Association during the year was 1,281 and the number of visits paid was 32,413. On behalf of the Borough Council the Association visited 498 cases, paying 7 ,766 visits. There were 1,509 births reported in 1943 to the vaccination officer by the Kensington registrars. By the 31st December, 1944, 59.18 per cent. of these had been vaccinated or were found to be insusceptible to vaccination. The other 40.82 per cent. were accounted for as follows:- Statutory declarationsof objection 12.32% Died before vaccination 5.7% Referred to other districts 14.11% Removed, leaving no trace 7.36% Postponed, or unaccounted for 1.33% In addition, 281 certificates of successful vaccination or insusceptibility were received in respect of children living in Kensington who were born outside the borough during 1943. Provision of Insulin. In pursuance of their powers under Section 227 of the Public Health (London) Act, 1936, the Council decided that from 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, nine persons were supplied with insulin, and the cost to the Council amounted to £28. 1s. 6d. -9- MATERNITY AND CHILD WELFARE SERVICES. Health Visiting Staff. The work performed by the health visiting staff during 1944 in regard to maternity and child welfare is summrised in the following table:- First visits to infants (0-1year) 1,301 Re-visits to infants (0-1 year) 6,834 Visits to children between 1 and 5 years 9,579 Stillbirth enquiries 21 Visits to ophthalmia neonatorum cases 10 Visits to measles cases 176 Visits to whooping-cough cases 414 Visits to puerperal fever cases 13 Visits to puerperal pyrexia cases 24 Visits to enteritis cases 141 Infantile death enquiries 63 Pre-natal visits 2,944 Half-days at welfare centres 1,952 Visits to foster mothers 653 Visits to registered daily guardians 203 Other visits 4,361 Infant Welfare Centres and Ante-natal Clinics. The work at these institutions during 1944 is shown in the following table:- Sessions at which doctor attended for prenatal consultations 458 Individual mothers who attended pre-natal consultations 1,709 Attendances of pre-natal mothers 7,551 Sessions at which doctor attended for postnatal consultations 12 Individual mothers who attended post-natal consultations 21 Sessions at which doctor attended for infant consultations 476 Individual children who attended:- 0 – 1 Year 1,808 1 – 5 Years 819 Attendances of children at doctors' consultations:- 0 – 1 Year 4 ,249 1 – 5 Years 2,513 Attendances at centres of children for all purposes 0 – 1 Year 12,517 1 – 5 Years 5,216 -10- The Baby Clinic. 92. Tavistock Road. Pre-school children minor ailment treatments. Doctors' sessions held 109 Individual children attending doctors' sessions 511 Total attendances at doctors' sessions 2,280 Average attendance at doctors' sessions 21 Sessions held for dressings only 298 Attendances at dressing sessions 3,396 Sessions held for sunlight and massage treatment 79 Sunlight treatments given 582 Message treatments given 506 Total individual children attending clinic 826 Total attendances 6,764 Dental Treatment. The following table shows the dental treatment performed at 92, Tavistock Road during the year:- No. of sessions 65 Patients (new cases) 160 Total attendances (all cases) 813 Extractions 800 Fillings 76 Dentures 50 Other treatments 471 Borough Council's Maternity Home (at Queen Charlotte's Hospital). Applications for admission 107 Applications accepted 107 Applications subsequently withdrawn 22 Women confined in the Home 90 The gross cost of the scheme to the Council during 1944 was £733. 17s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £571. 10s. 0d. Payments trade by patients totalled £674. 0s. 0d. Additional Maternity Accommodation. Owing to the shortage of institutional maternity accommodation in London, the London Maternity Services Joint Committee in consultation with the Metropolitan Boroughs' Standing Joint Comittee, arranged with voluntary hospitals to provide an additional 200 beds in the London area. The London County Council accepted financial respossibility for the scheme, although bookings are made by the borough councils. No charges fall directly on borough councils and the collection of contributions from patients is undertaken by the voluntary hospitals. From the 1st June, 1944, four maternity beds at Queen Charlotte's Hospital were reserved for the use of Kensington patients and by the end of the year, 51 expectant women were admitted for their confinements. -11- War-time Day Nurseries. The following table shows the average daily attendances each month during 1944 at each of the four day nurseries now in operation in the borough:- 1944 LADBROKE KENSAL HOUSE ST. CHARLES ST. QUINTIN January 31.7 45.9 47.7 26.7 February 38.8 58.3 50.2 26.0 March 36.9 54.9 52.9 41.5 April 34.4 64.6 53.8 45.3 May 27.8 67.3 62.3 40.1 June 26.2 58.8 51.7 39.7 July 24.7 44.2 49.1 35.3 August 33.5 36.5 45.6 34.2 September 39.7 51.7 50.1 38.4 October 39.5 50.4 58.3 32.4 November 41.6 62.8 60.4 32.3 December 40.8 64.9 58.7 27.5 Child Life Protection. Number of foster mothers on register on 1st January, 1944 25 Number of foster mothers remaining on register at the end of the year 23 Number of foster children on register on 1st January,1944 99 Number of foster children remaining on register at the end of the year 39 Total number of visits paid to foster mothers 653 (The decrease in the number of children cared for by foster mothers is largely due to the fact that in 1943 there were two babies' homes in the borough, which evacuated to the country during 1944, owing to flying bomb raids.) -12- Home Helps. The Council's scheme for the provision of home helps, which has been in operation since 1920, was revised during the year. The effects of the revision were to increase the weekly family income limit within which home helps may be provided, and to increase to £2. 0s. 0d. per week the wages paid to casual home helps. The scheme was extended also to provide for hone helps being granted to mothers who, for reasons of health, other than childbirth, are temporarily unable to look after their young children. Hone helps were supplied under the Council's schene in 76 cases at a cost of £138. 8s. 0d. 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 pothers 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 4s. 0d. per week for each child taken for four days or pore per week, and 2s. 0d. for each child taken for less than four days per week. During the year 41 women were placed on the register and 71 children were cared for under the scheme. The cost to the Council, which is reimbursed by the Ministry of Labour, amounted to £212. 6s. 0d. At the end of the year there were on the register 14 daily guardians who were caring for 17children. Care of Illegitimate Children. During the year, particular attention was given to the care of illegitimate children and, in co-operation with the Ministry of Health, the London County Council and all other London boroughs, it was decided:- (a) to institute a scheme of guaranteed payments to foster mothers, and (b) to provide greater financial assistance to voluntary bodies. A detailed scheme was prepared by a special Advisory Committee of the Metropolitan Boroughs' Standing Joint Committee, and this was adopted by the Council. That part dealing with guaranteed payments to foster mothers cane into operation on the 1st January, 1945, and the part dealing with increased financial assistance to voluntary bodies was scheduled to take effect as fron the 1st April,1945 Care of Premature Infants. On the 22nd March, 1944, the Minister of Health issued circular 20/44, approving recommendations of his Advisory Committee on the Welfare of Mothers and Young Children dealing with the care of premature infants. The Council adopted the recommendations which included such provisions as the loan of special equipnent, the supply of breast milk, the services of a paediatrician, etc., and authorised the granting of these services to any -13- necessitous Kensington mother giving birth to a premature infant. During the year under review, the births of 94 premature infants were notified. Of these, 26 were born at home and 68 in hospitals outside Kensington. Of those born at home:- 25 were nursed entirely at home. 11 died during the first twenty-four hours. 12 survived at the end of one month. Of those born in hospital:- 12 died during the first twenty-four hours. 55 survived at the end of one month. Arrangements have been made for birth notifications to give the weight of the child when born. SANITARY INSPECTION. The following table shows a summary of the inspections, etc. carried out by the sanitary inspectors during the year:- Total Complaints recived 2,301 Public Health (London) Act, 1936. Houses inspected on complaint 2,264 ,, ,, after infectious disease 911 Re-inspections 6,440 Inspections of news 16 Smoke observations Nil Other inspections 2,859 By-laws re Houses Let in Dodgings. Houses inspected on complaint 37 Re-inspections 170 Housing Act, 1936. Initial inspections (including preparation or revision of house-to-house cards) 33 Re-inspections 468 Underground Living Rooms. Primary inspections 18 Re-inspections 42 Scabies Order. Inspections 1,046 Drainage. Application made 42 Plans submitted 9 House drains tested and inspected 89 Shops Act, 1934. Inspections made 866 (The above record does not include the heavy amount of work performed by the sanitary inspectors on the inspection of houses damaged by enemy action.) -14- 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 934 Statutory notices 316 Final notices 75 Various Rent Restriction Act certificates 3 Report of waste of water to M.W.B. 76 Report of dangerous structures to L.C.C 20 Other notices 384 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 25 ,, ,, additions to 10 Defective drains repaired 46 House drains cleansed 151 Water-closets reconstructed 33 ,, ,, repaired 59 ,, ,, new provided 22 ,, ,, supplied with water 21 Soil pipes, ventilated, repaired, etc 17 ,, ,, new provided 10 Ventalating pipes new provided 22 Baths new provided 16 Sinks new provided 16 Lavatory basins new provided 47 Waste pipes new provided 36 Cisterns cleansed 17 ,, covered 3 Taps fixed on rising main 4 Yards,areas paved, drained repaired 18 Dustbins provided 97 Accumulations of fifth, etc.removed 147 Overcrowding abated 3 Animals removed 8 Roofs repaired 165 Houses provided with water above basement level 11 Dampness in dwellings remedied 235 Infectious disease cases removed 184 Houses disinfected after infectious disease (including bedding, clothing, etc.) 355 Rooms in such houses disinfected after infectious disease 411 Houses cleansed under houses let in lodgings by-laws 70 Cleansing of houses not on register 14 Verminous houses cleansed (including bedding, clothing, etc.) 193 Verminous rooms in such houses cleansed 330 Dirty bedding cleansed 5 ,, ,, destroyed 4 Other sanitary works excuted 160 -15- HOUSING. (Excluding war damage) Inspection of dwelling houses during the year:- (i) (a) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 3,279 (b) Number of inspections made for the purpose 14,304 (ii) (a) Number of dwelling houses (included under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations,1925 33 (b) Number of inspections made for the purpose 501 (iii) Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 127 (iv) Number of dwelling houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 934 Remedy of defects during the year without service of formal notices: Number of defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers 618 Action under statutory powers during the year:- (a) Proceedings under Sections 9,10 and 16 of the Housing Act,1936 - (i) Number of dwelling houses in respect of which notices were served requiring repairs Nil (ii) Number of dwelling houses which were rendered fit after service of formal notices (a) by owners Nil (b) by local authority in default of owners Nil (b) Proceedings under Public Health Acts - (i) Number of dwelling houses in respect of which notices were served requiring defects to be remedied 316 (ii) Number of dwelling houses in which defects were remedied after service of formal notices - (a) by owners 316 (b) by local authority in default of owners Nil (c) Proceedings under sections 11 and 13 of the Housing Act,1936 - (i) Numbor of dwelling housos in respect of which demolition orders were made Nil (ii) Number of dwelling houses demolished in pursuance of demolition orders Nil (d) Proceedings under Section 12 of the Housing Act,1936 - (i) Number of separate tenements or underground rooms in respect of which closing orders were made 15 (ii) Number of separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 2 -16- Portobello Street Clearance Area. On the 26th September, the Council, following an official representation by the Medical Officer of Health, resolved that the dwelling houses in an area containing the following houses were, by reason of disrepair or sanitary defects, unfit for human habitation, or by reason of their bad arrangement or the narrowness or bad arrangement of the streets, dangerous or injurious to the health of the inhabitants, and that other buildings in the area were for a like reason dangerous or injurious to the health of the said inhabitants:- Lonsdale Road - 16 houses Portobello Road - 16 houses Portobello Place - 21 mews dwellings (and 17 sheds) Portobello Street - 23 houses Westbourne Grove - 14 houses Colville Road - 9 houses. In addition, the sites of 25 demolished houses in Portobello Street, Westbourne Grove and Lonsdale Road were included in the area and the Council resolved to make the whole area a clearance area under the Housing Act, 1936. On the 19th December, the Council resolved to make a compulsory purchase order in respect of the Portobello Street area. Individual Unfit Houses. Following representation by the Medical Officer of Health that seven houses in Portland Road and one in Yeomans Row were unfit for habitation and not repairable at reasonable cost, the Council accepted undertaking from the owners under Part II of the Housing Act, 1936, that the houses would not be used for human habitation. Individual Unfit Parts of Houses. Undertakings were accepted from the owners that one basement dwelling and four separate underground rooms would not be used for human habitation until rendered fit. Closing orders were made by the Council in respect of 15 unfit underground rooms, and two orders in respect of 2 other underground rooms were determined by the Council, on being satisfied that the rooms had been made fit for habitation by the owners. LEGAL PROCEEDINGS. Public Health (London) Act. 1936. Nuisances . During the year, 18 summonses were taken out for various nuisances under the Public Health (London) Act, 1936. In 14 cases, abatement or prohibition orders were secured, and fines of £21. 14s. Od. were imposed. Of the remaining 4 cases, two summonses were withdrawn, the nuisances having been abated, and two were adjourned sine die. -17- Removal of Aged and Infirm Persons. Two applications were cade to the Court and in each case an order was obtained for the compulsory removal of the person to a suitable institution. Removal of Infectious Disease Case to Hospital. In one case, it was necessary to apply to the Court for the compulsory removal to hospital of a person suffering from infectious disease. An order was obtained and the case removed. Food and Drugs Act. 1938. Twelve prosecutions under this Act were instituted during the year. Convictions were secured in nine cases and fines amounting to £80. 5s. 0d. and costs amounting to £59. 10s. Od. were imposed. In the remaining three cases, two of the offences were discontinued and the summonses withdrawn, and the third summons was dismissed under the Probation of Offenders Act, 1907. Council's By-laws. Dog Nuisances. Three cases were prosecuted. In two cases fines amounting to 15s. 0d. were imposed and the other case was dismissed under the Probation of Offenders Act, 1907• Scabies Order. Seventeen summonses were issued against persons failing to comply with the provisions of this Order. In eleven cases, fines amounting to £26. 5s. 0d. and costs of 10s. 6d. were imposed. In the other six cases, five persons complied with the Order before the hearing of the summonses, which were withdrawn, and the last case was. dismissed under the Probation of Offenders Act, 1907. INSPECTION AND SUPERVISION OF FOOD. Milk. Two hundred and sixty-one samples of milk were submitted to the public analyst, and three were found to be adulterated. At the end of the year there were on the register 173 purveyors registered for the sale of milk in sealed containers, 156 dairymen and 116 dairies. Adulteration of Food. Two hundred and seventy-six formal samples of food were taken of which 9. or 3.2% were adulterated. Seven hundred and twenty-four informal samples were taken of which 12, or l.6% were adulterated. Public Health (Meat) Regulations. 1924. The Government's meat distribution centre established in the borough serves not only Kensington but other neighbouring boroughs. More than 12,000 tons of meat were examined in 1944, of which approximately 3 tons were condemned. WATER SUPPLY. In Kensington the water supply is almost entirely provided by the Metropolitan Water Board. There are, however, four premises which obtain water from artesian wells. Samples of water from these wells are taken regularly,both by the Council and the owners,for bacteriological and chemical examination. The samples showed that the water was suitable for drinking and domestic purposes. (There is a fifth building in the borough which contains an artesian well but the water from this source was not used during the year.) -18- 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 1944:- Notifiable disease Number of Cases Total Cases admitted to hospital North Kensington. South Kensington. Scarlet fever 55 23 78 74 Diphtheria (including membranous croup) 23 6 29 29 Enteric fever 1 2 3 3 Puerperal fever 13 5 18 18 Puerperal pyrexia 15 8 23 17 Acute primary pnoumonia and acute influenzal pneumonia 67 24 91 54 Dysentery 29 14 43 30 Erysipelas 9 7 16 9 Cerebro-spinal meningitis 1 5 6 6 Malaria 4 4 8 4 Poliomyelitis and polioencephalitis 1 - 1 1 All forma of tuberoulosis 126 85 * 211 164 Measles 59 43 102 33 Ophthalmia neonatorum 2 2 4 4 Whooping cough 158 31 189 50 †Enteritis (diarrhoea) 61 10 71 61 Food poisoning 7 - 7 2 ¢Acute rheumatism 8 3 11 6 =Scabies 269 94 363 - + Notifiable only in children under the age of 5 years. ¤ 99 99 9 9 9 9 99 99 99 16 9 9 = Notifiable as from 1st August,1943. Cases of mistaken diagnosis are excluded from the above table. 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 -19- approval of the Ministry of Health, have taken 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 Westminster. 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. Diphtheria Immunisation. The following table shows the diphtheria immunisation work carried out during the year:- Pre-school children immunised 692 School children immunised 346 Children attending for pre-immunisation schick tests 329 Number who gave positive recation 217 Children attending for Schick tests after being immunised 1,451 Number proving negative 1,176 Number proving positive 243 Number who failed to attend for readings 32 Acute Rheumatism in Children. In 1927, the Council resolved to ask the Minister of Health to make acute rheumatism in children a notifiable disease, and this request was granted. The Councils established a rheumatism, supervisory centre at the Princess Louise Hospital and this continued to operate up to the outbreak of war in 1939,when the hospital closed. In June, 1944, the rheumatism supervisory centre was re-established and Dr. Janet Aitken was appointed physician-in-charge. The hospital provide nursing assistance and other facilities, including the allocation of two beds for acute rheumatism patients recommended by the centre. The centre re-opened on the 23rd June, 1944, and has been held on each Friday from 11 a.m. to 1 p.m. The re-conmencement of the work coincided with the appearance of flying bombs, and this had an unfortunate effect on the number of attendances. Forty-eight individual cases attended during the year. Of these 12 were referred to the Princess Louise Hospital for in-patient treatment and were admitted to the two hospital beds reserved by the Council. - These children were in-patients for periods varying from one week to three months . One of the Council's health visitors attends each session to act as liaison officer, and she made 28 visits to the homes of patients. TUBERCULOSIS. During the year, 211 new cases of tuberculosis were notified, of which 199 were respiratory and 12 nonrespiratory cases. -20- Seventy-three persons died from respiratory tuberculosis and nine from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 68 and that for non-respiratory 8. The rate for all forms of tuberculosis was 76. * Dispensary Service. Nine hundred and sixty-two new patients were examined. Of these 254 were suffering from respiratory tuberculosis, 14 from non-respiratory tuberculosis, one new case was still under observation at the end of the year and 693 persons were diagnosed as non-tuberculous. The following table shows the number of oases 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.1944 294 296 54 50 694 Cases notified for first time during the year 103 96 5 7 211 Cases brought to notice other wise than by notification 42 39 4 5 90 Cases removed from the register on account of having - (a) Recovered from disease 9 9 2 6 26 (b) Removed from district, lost sight of, etc. 58 84 9 10 161 (c) Died 44 30 - 4 78 Cases remaining on register on 31st December,1944. 328 308 52 42 730 Specimens of sputum examined were 750, of which 69 were found to contain tubercle bacilli; 1,341 radiological examinations were made; and 2,054 visits were paid to the homes of patients by the women health officers. Three patients made 12 attendances at the dental clinic. Eighty-nine patients received 1,398 artificial pneumothorax treatments. Grants of extra nourishment were made in 27 cases; beds and bedding were loaned to 14 patients; and the district nurses attended 15 patients in their homes and paid a total of 887 visits. -21- 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, 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 oases 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 weekly in advance, During the year, patients received allowances classified as follows:- Maintenance allowances 103 Special allowances 48 Discretionary allowances 21 The amount disbursed during the year was £2,952. l1s. 3d. I am, Mr.Mayor, Aldermen and Councillors, Your obedient Servant, JAMES FENTON. Medical Officer of Health.