LIBRARY KEN 54 THE ROYAL BOROUGH OF KENSINGTON. ANNUAL (INTERIM) REPORT on the HEALTH OF THE BOROUGH for the Year by JAMES FENTON, G.B.E., M.D., M.R.C.P., D.P.H. Medical Officer of Health. 1st July, l946. Town Hall, Kensington, W. 8. ROYAL BOROUGH OF KENSINGTON. Public Health Department, Town Hall, KENSINGTON, W. 8. 1st July, 1946. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lords, Ladies and Gentlemen, I have the honour to submit my annual report on the state of the Public Health in Kensington in 1945. GENERAL OBSERVATIONS. When the war ended during the period under review, the Council found various deficiencies in their health services. This was expected because as many as possible of the staff had been released for war service and those remaining gave all necessary time and attention to civil defence duties; furthermore, buildings and equipment used for the Council's normal functions were transferred to civil defence wherever necessary. Indeed, with universal accord, everything directed towards securing the successful termination of the war received priority. In the last months of 194 5 the Council reviewed the position. The housing shortage claimed first attention; but consideration was given to the needs of the health services, particularly the maternity and child welfare branch, with the result that long-term and shortterm policies of the Council's needs were formulated and finally adopted in 1946. At the present time, the Council are awaiting the approval of the Minister of Health to their proposals. Death rate. The steady decline over a long period in the number of deaths per thousand of population was checked during the war; but for 1945 the figure was 13.5, which compares with that of 16.1 for the previous year, and more nearly approximates to the pre-war average of about 12. The rate for London in 1945 was 13.8. Infant death rate. The number of deaths of children under one year of age for every thousand births has been falling since the beginning of the century from the high figure of about 150. Each of the years 1943 and 1944 showed a rate of 52 which was lower than any previous figure, and the rate for 194 5 has fallen to 49. The figure for London in 1945 was 53. - 2 - Diphtheria. In the report for 1944, attention was specially drawn to the spectacular decline in the incidence of diphtheria and in the number of deaths following the introduction of immunisation by the Council in 1934. In preimmunisation days there was an average of several hundred cases of diphtheria and about twenty deaths each year. In 1944 there were only 29 cases and no deaths. In 1945 the number was still further reduced to 19 cases. Unfortunately, there were two deaths - one was the death of a baby of 12 months and the other a lady of 64 years; neither had been immunised. Since 1934 there has not been in Kensington one death amongst the thousands that have been immunised. Infectious diseases generally. There was no occurrence of any disease in serious epidemic form during the year. Many men and women came to this country from typhus and smallpox infected areas, but the close surveillance of these people day by day for two or three weeks after arrival prevented any outbreak of these diseases. Scabies continues to cause much trouble and the Council's scheme for treatment and control was carefully operated throughout the year. Staff. During the war period, the Council relied very largely on temporary staff with a nucleus of permanent officers and it seems appropriate at this time to place on record the loyal service given by these officers under difficult conditions. The staff in the Public Health Department wish to acknowledge the encouragement and support they received from the Mayor, the Chairmen and ViceChairmen of the various committees, and all members of the Council. VITAL STATISTICS. Many members of the Council were away on national service during the war period and many new members were elected in November, 1945. In these circumstances, it is desirable that as early as possible a full health report should be presented. However, printing difficulties and paper shortage make this impracticable at this stage; but it will be helpful to members of the Council to have readily at hand in one document the following summary of vital statistics relating to the borough for 1945 and the six previous years covered by the war. -3- - 4 - SUMMARY OF VITAL STATISTICS FOR KENSINGTON. Description. 1945 1944 1943 1942 1941 1940 1939  POPULATION. Population (Estimated) 117,170 107,610 106,830 99,310 97,180 123,860 172,100 Density of population per acre 51 47 46.6 43 43 54 75 Total births 1,890 1,780 1,698 1,487 1,239 1,674 2,064 Legitimate births. 1,579 1,527 1,479 1,280 1,099 1,514 1,828 Illegitimate births 311 253 219 207 140 160 236 Birth rate per 1,000 population 16.1 16.5 15.9 15 12.7 13.5 12 STILL BIRTHS. Total still births 49 47 46 27 54 53 65 Legitimate still births 40 44 39 23 45 47 59 Illegitimate still births 9 3 7 4 9 6 6 Still birth rate per 1,000 total births 25.3 25.7 27.1 18.1 41.8 31.6 32 DEATHS. Total deaths 1,586 1,735 1,769 1,595 1,664 2,269 2,072 Death rate per 1,000 population 13.5 16.1 16.5 16 17.1 17.4 12.2 deaths of INFANTS UNDER 12 MONTHS OF AGE. Total infant deaths 92 93 88 97 67 90 129 Legitimate infant deaths 73 76 76 87 62 75 110 Illegitimate infant deaths 19 17 12 10 5 15 19 Infant death rate per 1,000 births 49 52 52 65 62 58 64 Death rate of legitimate infants per 1,000 legitimate births 46 50 51 68 66 54 60 Death rate of illegitimate infants per 1,000 illegitimate births 61 67 55 48 36 95 81 MATERNAL DEATHS. Deaths of mothers as a result of pregnancy or child birth 4 1 3 6 2 7 6 Death rate of mothers per 1,000 live and still births 2.06 0.55 1.7 3.9 1.8 4.3 3.0 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000 population 84 76 92 68 106 81 55 Death rate from respiratory tuberculosis per 100,000 population 70 68 80 54 86 74 51 Death rate from non-respiratory tuberculosis per 100,000 population 14 8 12 14 20 7 4 ZYMOTIC DISEASES. Death rate 0.14 0.21 0.17 0.37 0.15 0.21 0.24 - 5 - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1945. Cause of death All ages. Under 1 Year. 1 year and under 5 5 years and under 45. 45 years and over.  Enteric Fever. 1 – – – 1 Cerebro-spinal fever. 5 3 – 1 1 Whooping Cough. – – – – – Diphtheria. 2 – 1 – 1 Phthisis. 82 – – 38 44 Other forms of tuberculosis. 16 – 2 11 3 Syphilis. 18 – – – 18 Influenza. 10 1 – 1 8 Measles. 1 – 1 – – Acute infectious encephalitis. 1 – – – 1 Cancer (all forms) 270 1 – 12 257 Diabetes. 9 – – 1 8 Intra-cranial vascular lesions. 123 – – 2 121 Heart disease. 415 – – 12 403 Other diseases of circulatory system. 68 – – – 68 Bronchitis. 82 – – 2 80 Pneumonia. 88 15 1 7 65 Other respiratory diseases. 17 – – 3 14 Ulcers of the stomach. 20 – – 5 15 Diarrhoea (under two years). 12 11 1 – – Appendicitis. 6 – – – 6 Other digestive diseases. 41 1 1 4 35 Nephritis. 45 – – 6 39 Puerperal sepsis. 3 – – 3 – Other maternal causes. 1 – – 1 – Premature birth. 28 28 – – – Infantile diseases. 31 26 – 2 3 Suicide. 16 – – 8 8 Road traffic accidents. 13 – – – 13 Other violent causes. 54 5 – 9 40 All other causes. 108 1 – 15 92 TOTALS 1586 92 7 143 1344 - 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 2,590 Sputum. 669 Faeces and urine. 1,301 Milk (bacteriological). 116 Water (drinking). 12 Water (swimming baths). 16 Miscellaneous. 324 Care of Aged and Infirm Persons. During the year, one of the Council's medical officers made 60 visits to 25 persons reported as old or infirm and living in insanitary conditions. The 25 cases were dealt with as follows:- Removed to suitable institutions compulsorily 4 Removed to suitable institutions voluntarily 10 Referred for action under Lunacy Acts 1 No action considered necessary 6 Still under observation at the end of the year 4 Medicinal Baths (Personal Cleansing Station). The record of work done is as follows:- Description. Scabies. Vermin. Impetigo. Other conditions. Persons Cleansings Persons Cleansings Persons Cleansings Persons Cleansings  Adults. Fensington Other 1147 2004 338 346 3 10 2 6 boroughs 1190 2233 141 142 – – – – School Children. Kensington Other 499 2252 2134 2134 9 18 7 40 boroughs 302 661 288 291 – – 1 2 Children under 5. Kensington Other 302 658 75 79 9 49 1 3 boroughs 279 504 18 18 – – – – Compulsory Cleansings. – – 283 283 – – – – TOTALS. 3719 8312 3277 3293 21 77 11 51 - 7 - Disinfection and Disinfestation. The Disinfesting station received a direct bomb hit during the war, but the Borough Engineer at once carried out temporary repairs and within a few days it was possible to restart work. In due course, reconstruction will be necessary. A summary of the work of the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 496 Rooms disinfected in such houses 528 Houses disinfested after vermin 294 Rooms disinfested in such houses 545 Loads of furniture treated with hydrogen cyanide 69 height of bedding dealt with - 216 tons 18 cwt. 2 qtr. Towards the end of the year, the Council adopted a scheme involving the use of Dichloro-diphenyl-tri-chlorethane (D.D.T.) for the eradication of bugs in dwelling houses. This substance had hitherto been reserved exclusively for use by the Armed Forces. The scheme is in the nature of an experiment which is being observed closely by officials of the Ministry of Health. It was put into operation early in 1946. Destruction of Rats ana Mice. Owing to bomb damage, egress of rats from drains and sewers became a problem of great importance during the war. Thu work of complying with the "directions" served on the Council by the Minister of Pood under the Infestation Order, 1943, continued during the year and the following table gives a summary:- Complaints received 745 Premises inspected following complaint 1070 Premises where rats were found 487 Premises where mice were found 116 Premises where other vermin were found 46 Premises where no infestation existed 421 Total number of visits to all premises 6084 Total number of notices served (formal & informal) 124 Premises successfully treated 682 Cases in which advice was given 106 Borough Council properties dealt with 65 In two areas, block treatment procedure was adopted which involved the simultaneous baiting of all the houses in the area by the pre-baiting method. On one occasion during the year, all the sewers in the borough were dealt with by poison baiting, when it was estimated that 1,200 rats were destroyed. Public Mortuary. The number of bodies taken to the mortuary during the year was 413. Inquests were held in 79 cases. Professional Nursing in the Homes. The total number of cases nursed by the Kensington District Nursing Association during the year was 1,712, and the number of visits paid was 41,015. On behalf of the Council the Association visited 673 cases, paying 10,596 visits. - 8 - Vaccination In 1944 the Kensington registrars reported 945 births to the Vaccination Officer. By 31st January, 1946, 53 per cent. of these had been vaccinated or were found to be insusceptible to vaccination. The other 47 per cent. were accounted for as follows:- Statutory declaration of objection 11% Died before vaccination 5% Referred to other districts 14% Removed, leaving no trace 16% Postponed or unaccounted for 1% In addition, 315 certificates of successful vaccination or insusceptibility were received in respect of children living in Kensington who were born outside the borough during 1944 . Provision of Insulin. In pursuance of their powers under Section 227 of the Public Health (London) Act, 1936, the Council decided in 1943 that 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 £33 13s. 4d. MATERNITY ANL CHILD WELFARE SERVICES. Immediately prior to the outbreak of war there were eight Infant velfare centres (including necessary ante-natal and dental clinics), the Baby Treatment Clinic and four day nurseries. Like elementary schools,they were closed down on the wholesale evacuation of London which occurred at the outbreak of hostilities; but within a short time it was found that these maternity and child welfare services were becoming more and more needed on the return of the population to London. At that early period of the war, the civil defence services were not being called into action and the Council adopted the wise policy of combining first-aid posts and infant welfare centres wherever possible. This proved an economy in the use of premises and staff. As the war progressed four war-time nurseries were established. All the pre-war infant welfare centres received bomb damage which varied from slight to total destruction. On the termination of hostilities there were in operation the following five infant welfare centres:- (1) Raymede, at its pre-war premises, 240, Ladbroke Grove. (2) Lancaster Road, at its pre-war premises, 63, Lancaster Road. (3) Bramley, temporarily accommodated at the Public Baths. (4) The Campden Hill, in temporary premises in Holland Street. (5) South Kensington, at its pre-war premises, 10, Redcliffe Street. - 9 - As a short-term policy the Council have decided to establish three or possibly, four new infant welfare centres in North Kensington, and one or possibly two in South Kensington. They propose to establish a day nursery in South Kensington. They have also approved plans for a foot clinic and a solarium. They have been reviewing a long-term policy for the Borough, and have concluded there should be in North Kensington three large health centres of a permanent character which will accommodate the maternity and child welfare services as well as other health services, and one or possibly two similar health centres in South Kensington. Health Visiting Staff. The work performed by the health visiting staff during 1945 in regard to maternity and child welfare is summarised in the following table:- First visits to infants (0-1 year) 1422 Re-visits to infants (0-1 year) 7186 Visits to children between 1 and 5 years 8816 Stillbirth enquiries 25 Visits to ophthalmia neonatorum cases 16 Visits to measles cases 1811 Visits to whooping cough cases 103 Visits to puerperal fever cases 3 Visits to puerperal pyrexia cases 13 Visits to enteritis cases 220 Infantile death enquiries 59 Pre-natal visits 2738 Half-days at welfare centres 2207 Visits to foster mothers 674 Visits to registered daily guardians 150 Other visits 3780 Infant Welfare Centres and Ante-natal Clinics. The work at these institutions during 1945 is shown in the following tables:- Sessions at which doctors attended for prenatal consultations 502 Individual mothers who attended pre-natal consultations 1995 Attendances of pre-natal mothers 8644 Sessions at which doctors attended for post- natal consultations 47 Individual mothers who attended post-natal consultations 122 Sessions at which doctors attended for infant consultations 506 Individual children who attended for the first time:- 0-1 year 1318 1-5 years 190 Attendances of children at doctors' consultations:- 0-1 year 4515 1-5 years 2765 Attendances at centres of children for all purposes:- 0-1 year 15266 1-5 years 6042 - 10 - The Baby Clinic, 92, Tavistock Road. Pre-school children minor ailment treatments. Doctors' sessions held 98 Individual children attending doctors' sessions 495 Total attendances at doctors' sessions 2293 Average attendance at doctors' sessions 23 Attendances for circumcision operations 103 Sessions held for dressings only 295 Attendances at dressing sessions 2968 Sessions held for sunlight and massage treatment 97 Sunlight treatments given 1195 Massage treatments given 623 Total individual children attending clinic 927 Total attendances 7561 Dental Treatment. The following table shows the dental treatment performed at 92, Tavistock Road during the year:- Sessions held 60 Patients (new cases) 187 Total attendances (all cases) 959 Extractions 764 Fillings 118 Dentures 44 Other treatments 519 Borough Council's Maternity Home. There are five beds at Queen Charlotte's Hospital reserved for Borough Council patients. Details for 1945. Applications for admission 127 Applications accepted 127 Applications subsequently withdrawn 15 Women confined in the home 114 The gross cost of the scheme to the Council during 1945 was £967 4s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £717 0s. 0d. Payments made by patients totalled £764 0s. Od. 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 Committee, arranged with voluntary hospitals to provide an additional 200 beds in the London Area. The London County Council accepted financial responsibility 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 1st June, 1944, four additional maternity beds at Queen Charlotte's Hospital have been reserved for the use of Kensington patients,and during the year, 95 expectant mothers were admitted to these beds for their confinements. - 11 - Home Helps. The Council's scheme for the provision of home helps for mothers during confinement, which has been in operation since 1920, was extended during 1944 to enable home helps to be granted to mothers who, for reasons of ill-health at any time, are temporarily unable to look after their young children. Home helps were supplied in 58 cases at a cost of £174 10s. 0d. Domestic Helps. During the year attention was drawn to the position of sick or infirm persons (whether through old age or otherwise) who were unable to obtain domestic help, and the Ministry of Health requested the Council to organise a service to provide such help in the more serious cases of hardship. The necessary powers were conferred on the Council by Defence Regulation 68E. The principal functions of the Council are- (a) To appoint, and maintain a register of domestic helpers available for work at any time, and to arrange for their payment; (b) To determine who are the most, urgent of the applicants for help; and (c) To assess what part of the cost of the help provided should be recovered from each household and to secure its payment. The Council approved a suitable scheme on the 20th February, 1945, but great difficulty has been experienced in obtaining the necessary domestic helpers. The following is a summary of the action taken during the year;- Applications received 40 Applications refused on the grounds of unsuitability 11 Applications withdrawn 10 Applications granted 19 Of the 19 applications granted, 12 were supplied with domestic helpers, but in the remaining 7 cases no assistance could be given as the necessary domestic help was not available. With a view to overcoming the difficulties experienced, it was decided to appoint a whole-time Almoner who commenced duty in 1946. - 12 - War-time Day Nurseries. The following table shows the average daily attendances each month during 1945 at each of the four day nurseries now in operation in the borough:- 1945 Ladbroke. Kensal House. St. Charles. St. Quintin.  January 29.3 59.6 54.0 29.2 February 36.6 64.8 42.5 43.0 March 20.7 45.2 37.9 49.5 April 34.8 46.6 52.9 43.0 May 31.8 55.2 50.7 45.2 June 40.6 58.0 55.8 37.8 July 41.8 64.2 53.4 33.6 August 44.0 54.1 47.1 46.7 September 45.2 50.8 49.6 43.1 October 41.6 50.5 49.6 45.5 November 52.5 48.4 51.6 35.5 December 38.8 48.5 49.6 38.6 Plans were made to open a fifth day nursery in North Kensington and arrangements were practically completed when the war in Europe ended. The Ministry of Health reconsidered the proposal and decided at that time that the opening of the nursery would not he justified. Steps are now being taken with a view to opening a day nursery in the South Kensington area. Registered Daily Guardians. In co-operation with the Ministry of Labour, a scheme has been introduced for the registration of daily guardians to care for children for whom no place can be found in day nurseries. Under thi3 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 - 13 - or more per week, and 2s.0d. for each child taken for less than four days per week. During the year, 23 women were placed on the register and 28 children were cared for. The cost, which is reimbursed by the Ministry of labour, amounted to £154 14s. 0d. At the end of the year there were on the register 7 daily guardians who were caring for 9 children. Child Life Protection. Foster mothers on register on 1st January, 1945 23 Foster mothers remaining on register at the end of the year 31 Foster children on register on 1st January, 1945 39 Foster children remaining on register at the end of the year 45 Total visits paid to foster mothers 674 Care of Illegitimate Children. 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 came into operation on the 1st January, 1945, and provided for the payment to approved foster mothers of 17s.6d. per week for a child under one year of age and 15s.0d. per week for a child over one year and under five years. A scale was approved by the Council under which the weekly contribution by the mother from her own resources would be assessed. In no case during 1945 was the Council asked to make a payment. Five London moral welfare organisations submitted a scheme for improving their services involving an additional expenditure, for the first year, of £5,615. It was agreed by London boroughs that the apportionment of this amount should be on the basis of rateable value and Kensington's contribution amounted to £305 per annum. Care of Premature Infants. The Council have adopted proposals for the care of premature infants, including the loan of special equipment, the supply of breast milk, the service of a paediatrician, etc. During the year under review, the births in the borough of 27 premature infants were notified. Of these, 26 were born at home and one in hospital. Of those born at home, all were nursed entirely at home, and 25 survived at the end of one month. The one child born in hospital died within the first twenty-four hours. Arrangements have been made for notifications of birth to give the weight of the child when born. - 14 - sanitary inspection. The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year:- Total Complaints received 6180 Public Health (London) Act, 1936. Houses inspected on complaint 5915 ,, ,, after infectious disease 905 Re-inspections 7005 Smoke observations 98 Inspections of mews 67 Other inspections 1675 By-laws re Houses Let in lodgings. Houses inspected on complaint 4 Re-inspections 6 Housing Act. 1936. Initial inspections (including preparation or or revision of house-to-house cards) 98 Re-inspections 38 Underground Living Rooms. Primary inspections 136 Re-inspections 205 Scabies Order. Inspections 959 Drainage. Applications 69 Plans submitted 12 House drains tested and inspected 239 Shoos Act. Inspections 857 (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.) 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 1605 Statutory notices 475 Pinal notices 123 Various. Rent Restriction Act Certificates 2 Report of waste of water to the Metropolitan Water Board 172 Report of dangerous structures to the London County Council 75 Other notices 117 - 15 - 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 14 ,, additions to 11 Defective drains repaired 128 House drains cleansed 261 Water closets reconstructed 58 ,, ,, repaired 100 ,, ,, new provided 71 ,, ,, supplied with water 103 Soil pipes, ventilated, repaired, etc. 32 ,, ,, new provided 9 Ventilating pipes new provided 25 Baths, new provided 31 Sinks, new provided 40 Lavatory basins, new provided 73 Waste-pipes, new provided 76 Cisterns cleansed 16 ,, covered 6 Taps fixed on rising main. 10 Yards and areas paved, drained, etc 16 Dustbins provided 201 Accumulations of filth, etc., removed. 184 Animals removed 37 Roofs repaired 352 Houses provided with water above basement level 32 Dampness in dwellings remedied 432 Infectious disease cases removed 329 Houses disinfected after infectious disease (including bedding, etc.) 926 Rooms in such houses disinfected after infectious disease 1106 Houses cleansed under Houses Let in Lodgings By-laws 71 Cleansing of houses not on register 81 Verminous houses cleansed (including bedding, clothing, etc.) 118 Verminous rooms in such houses cleansed 194 Dirty bedding cleansed 61 ,, ,, destroyed 11 Other sanitary works executed 412 HOUSING. (Excluding war damage). Inspection of dwelling houses during the year. (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 7125 (b) Inspections made for the purpose 16054 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925) 98 (b) Inspections made for the purpose 136 (iii) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 41 (iv) Dwelling houses (excluding those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation. 1605 - 16 - Remedy of defects during the year without service of formal notices. Defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers 1130 Action under statutory cowers during the year. (a) Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936:- (i) Dwelling houses in respect of which notices were served requiring repairs Nil (ii) Dwelling houses which were rendered fit after service of formal notices Nil (b) Proceedings under Public Health Acts:- (i) Dwelling houses in respect of which notices were served requiring defects to be remedied 475 (ii) Dwelling houses in which defects were remedied after service of formal notices - (a) by owners 475 (b) by local authority in default of owners Nil (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (i) Dwelling houses in respect of which demolition orders were made Nil (ii) Dwelling houses demolished in pursuance of demolition orders Nil (d) Proceedings under Section 12 of the Housing Act, 1936:- (i) Separate tenements or underground rooms in respect of which closing orders were made 43 (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 2 Underground Rooms. The rigid policy adopted by the Council to prevent the occupation of unfit underground rooms before the war, was relaxed in the war period because many of these rooms were necessarily occupied as shelters. When the need for shelter accomodation disappeared early in 1945, it was decided to revert to the pre-war practice of closing underground rooms where the degree of unfitness constituted a serious danger to the health of the occupants. The number of rooms closed during the year was forty-three. * - 17 - Overcrowding. Following the 1914-1918 war, overcrowding rapidly became a major problem. Kensington attracted a large number of families, probably becaused it was near the places of work of a large number of people engaged in Central London, and industry was moving south from the north of England. After a few years, the families became, as it were, Kensington residents and the Council were left with a considerable legacy of overcrowding. The Council found difficulty in dealing with the matter, because there was inadequate alternative accommodation available. The question received earnest attention for many years and it was only shortly before the recent war commenced that the Council appeared to be getting the problem well in hand. Routine inspections to detect overcrowding were abandoned during the war for the following reasons:- (a) Many basement rooms were, on occasions, grossly overcrowded because families used them as air raid shelters at night time, and no Court would convict against the defence that the people were avoiding the danger of bombs. (b) The evacuation of London reduced the population enormously and there was ample accommodation for all who remained. (c) The repair of war damaged houses was a much greater question and the depleted staff devoted its time to this, rather than to overcrowding problems. In April, 1945, when tie war in Europe seemed near its termination, it appeared that there would shortly be a great influx of people to Kensington; and, with the large number of houses damaged and uninhabitable, the" overcrowding might present the Council with a greater problem than they faced after the 1914-1918 war. A special sub-oommittee of the Public Health Committee was established for the purpose of considering the action to be taken in all cases of overcrowding reported. Owing to the shortage of suitable alternative accommodation, it was difficult to make much progress in the remaining months of the year. Cases reported to the sub-committee during 1945 31 Cases in which the sub-committee recommended that alternative accommodation should be offered by the Council 19 Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 5 Cases where action was postponed 7 Cases in which overcrowding was abated during the year 4 (Note. In some of the above cases, remedies were effected in the early part of 1946 and will be reported subsequently.) - 18 - Portobello Street Clearance Area. In September, 1944 , the Council, following an official representation by the Medical Officer of Health, resolved that the area containing the following houses should be deemed a clearance area. 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. In 1945, the Council resolved to acquire the area under Part V of the Housing Act, 1936, for the purpose of providing housing accommodation. Appropriate steps are now being taken to buy the land and build flats thereon. INSPECTION AND SUPERVISION OP FOOD. Milk. Three hundred and thirty-nine samples of milk were submitted to the Public Analyst during the year and only one sample was found to be adulterated. The following table shows the average percentages of milk fats and non-fatty solids of the samples taken each month. Month. No. of samples taken Average Percentage Milk fats Non-fatty solids  January. 12 3.65 8.74 February. 24 3.83 8.75 March. 33 3.40 8.67 April. 16 3.29 8.71 May. 23 3.25 8.87 June. 18 3.31 8.87 July. 36 3.55 8.92 August. 13 3.43 8.96 September. 30 3.59 8.99 October. 52 3.55 8.99 November. 57 3.61 8.90 December. 25 3.50 8.98 Legal Minimum Standards. 3.00 8.50 Milk (Special Designations) Regulations. 1936/1943. During the year, nineteen samples of Tuberculin Tested milk and ninety-one samples of Pasteurised milk were submitted for bacteriological examination. One sample of Tuberculin Tested milk was found to be unsatisfactory and one sample of Pasteurised milk contained an excess of bacteria. All other samples were satisfactory. - 19 - Heat Treated Milk (Prescribed Teats) Order. 1944. Under Defence Regulation 55G (restriction on the sale of raw milk), the Minister of Pood may specify areas in which it will he illegal to sell milk unless it is tuberculin tested milk, accredited milk, or processed milk (heat-treated milk, pasteurised milk and sterilised milk). When an area has been so specified, all processed milk sold therein must conform to the prescribed phosphatase and methylene blue tests. No aræ , in London has yet been prescribed by the Minister and the new requirements are not at present in operation in this borough. The Minister of Pood has, however, requested the Council to apply the phosphatase test and the methylene blue test to all samples of pasteurised and tuberculin-tested pasteurised Milks and report the results to him. During the year, 55 samples of pasteurised milk, 13 samples of tuberculin-tested pasteurised milk, 5 samples of sterilised milk and one sample of heat-treated milk were subjected to these tests. Seven samples failed to satisfy the methylene blue test and one sample failed to pass the phosphatase test. Letters were sent to the vendors and the Minister of Pood was notified. Adulteration of Food. Three hundred and ninety-six formal samples of food are taken, of which twenty, or 5.05%, were adulterated. Six hundred and four informal samples were taken of which seven, or 1.1%, were adulterated. The following is a summary of the results of analyses of the twenty-seven adulterated formal and informal samples, together with a record of the action taken by the Council. Article. Nature and amount of adulteration. Action taken.  1. Lung and Throat Mixture. 69% deficient in Acetic Acid. Informal sample. 2. do. do. Proceedings instituted but withdrawn. 3. Lemon flavoured beverage powder. Contained citric acid 65.8%, Epsom Salt 23%, Common Salt 10.2%. Informa1 sample. 4. do. do. Letter to Ministry of Food as powder was produced under licence. 5. Self raising flour. Devoid of raising ingredients. Informal sample. 6. Malt vinegar. Consisted of distilled malt vinegar. do. 7. Salad vinegar. Consisted of an acetous fluid other than malt vinegar. do. 3. Horse radish sauce. Consisted of pickled shredded beetroot. do. 9. do. do. Proceedings. £20 penalty and £3 3s. costs. - 20 - Adulteration of Food(continued). Article. Nature and amount of adulteration. Action taken.  10. Horse Radish Sauce. Falsely labelled as containing 10 ozs. whereas jar contained only 4½ ozs . Informal sample. 11. do. do. do. 12. do. do. do. 13. Vinegar. Consisted of artificial vinegar. Vendor cautioned. 14. do. 11.5% deficient in Acetic Acid. Proceedings. £5 penalty and 14/costs. 15. do. Consisted of artificial vinegar 19% deficient in Acetic Acid. Proceedings. Summons dismissed on payment of costs. 16. do. Consisted of artificial vinegar. Vendor cautioned. 17. do. do. do. 18. do. do. do. 19. do. do. do. 20. do. do. do. 21. do. do. do. 22. do. do. do. 23. do. do. do. 24. Vinegar (nonbrewed) . 4% deficient in Acetic Acid. do. 25. do. 7% deficient in acetic Acid. Proceedings. Summons dismissed. 26. Concentrated Vinegar (nonbrewed). Contained 15.1% Acetic Acid instead of 16% as declared on label. Manufacturer cautioned. 27. Milk. 9% deficient in non-fatty solids. Proceedings. £15 penalty and 10s.6d. costs. Public Health (Meat) Regulations. 1924. The Government's meat distribution centre established in the borough serves not only Kensington but other neighbouring areas. Nearly 12,000 tons of meat were examined in 1945, of which approximately 4 tons were condemned. Pharmacy and Poisons Act. 1933. At the end of the year, the number of sellers of Part 2 poisons (other than registered pharmacists) on the list maintained by the Council was 121. 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 were 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. - 21 - LEGAl PROCEEDINGS. Public Health (London) Act, 1956. Nuisances. During the year, 7 summonses were taken out for various nuisances under the Public Health (London) Act, 1936. In 4 cases, abatement or prohibition orders were secured and fines amounting to £2 0s. 0d. were imposed. In the remaining 3 cases, the summonses were withdrawn, the nuisances having been abated. In one case, where an abatement order had been obtained in 1944, the defendant defaulted, and upon being summonsed, was fined 5s.0d. per day for a period of 53 days. Drainage By-laws . Seventeen summonses were issued in respect of contraventions of the Drainage By-laws. In fourteen cases, convictions were secured and fines amounting to £10 10s. 0d were imposed. The remaining three cases were dismissed and costs amounting to 53 3s. 0d. were awarded to the defendants. Removal of Aged and Infirm Persons. Four applications were made to the Court and in each case an order was obtained for the compulsory removal of the person to a suitable institution. Child life Protection. One foster mother was prosecuted for failing to give notice of the reception of a foster child. A conviction was secured and a fine amounting to £15 0s. 0d. was imposed. Food and Drugs Act, 1938. Six prosecutions under this Act were instituted during the year. Convictions were secured in three cases and fines amounting to £40 0s. 0d. and costs amounting to £4 7s. 6d. were imposed. The fourth case was dismissed on payment of costs to the Council. In the fifth case, the summons was withdrawn and the defendants were paid costs by the Council amounting to ???4 4s. 'Od. In the remaining case, proceedings were pending at the end of the year. Council's By-laws. Dog Nuisances. Six casts were successfully prosecuted and fines amounting to £7 15s. 0d. were imposed. Scabies Order. Two summonses were issued against persons failing to comply with the provisions of this Order. In one case, a fine amounting to £1 0s. 0d. was imposed. In the other case, the person complied with the Order before the hearing of the summons, which was withdrawn. Housing Act,1936, (Part II). Six summonses were issued in respect of the illegal occupation of closed underground rooms. In four cases, convictions were secured and fines amounting to £15 0s. 0d. were imposed. In the remaining two cases, the summonses were withdrawn as the closed rooms were vacated before the hearing. - 22 - INFECTIOUS DISEASE. The following table shows the number of cases of infectious disease notified during the year 1945, with comparative figures for the previous six years:- Notifiable disease. Number of cases notified. 1945 1944 1943 1942 1941 1940 1939  Scarlet Fever. 136 74 216 108 91 82 117 Diphtheria (including Membranous Croup.) 19 29 54 78 86 54 102 Enteric Fever. 3 3 3 1 16 11 9 Puerperal Fever. 7 18 10 7 1 6 5 Puerperal Pyrexia. 12 23 25 7 11 18 34 Acute primary pneumonia and acute influenzal pneumonia. 81 91 133 91 65 59 109 Dysentery. 142 43 73 68 25 15 114 Erysipelas. 33 16 37 30 43 47 45 Cerebro-spinal meningitis. 3 6 11 17 22 45 4 Malaria. 11 8 1 1 – – – Poliomyelitis and polioencephalitis . 3 1 1 2 2 1 4 Encephalitis lethargica. 1 – – – – 1 2 Tuberculosis (all forms). 188 211 202 203 234 200 190 Measles. 868 102 624 365 366 242 31 Ophthalmia neonatorum. 8 4 11 4 3 9 8 Enteritis. + 100 71 69 96 48 12 31 Food poisoning. 6 7 4 8 2 6 2 Acute rheumatism. X 32 11 9 6 2 6 18 Scabies. * 460 363 252 – – – – Whooping cough. 62 189 102 146 176 16 345 + Notifiable only in children under the age of 5 years. x Notifiable only in children under the age of 16 years. * Notifiable as from 1st August, 1943. Note. Cases of mistaken diagnosis are excluded from the above table. Whooping Cough. In order to assist in the early diagnosis of whooping cough and to protect contacts, the Council, with the approval of the Minister of Health, decided to reestablish their Whooping Cough Clinic at the Princess Louise Kensington Hospital for Children, with facilities for bacteriological diagnosis and prophylactic inoculation of contacts. The arrangements include the appointment of a medical officer- (on a sessional basis), the provision of vaccine and drugs, and facilities for x-ray examinations and blood counts. There was no outbreak of whooping cough during the year to justify setting the clinic into operation. - 23 - Diphtheria Immunisation. The following table shows the diphtheria immunisation work carried out during the years- Pre-school children immunised 977 School children immunised 260 Children attending for preimmunisation schick tests 405 No. who gave positive re-action 248 Children attending for schick tests after being immunised 1952 Number proving negative 1607 Number proving positive 277 Number who failed to attend for readings 68 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 Council 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 centre was re-established and Dr. Janet Aitken was re-appointed physician-in-charge. The hospital provides nursing assistance and other facilities, including the allocation of two beds for acute rheumatism patients recommended by the centre. Sessions were held on each Friday during the year and one hundred and twelve Kensington children attended. Of these, thirteen were referred to the Princess Louise Hospital for inpatient treatment. These children were in-patients for periods varying from two days to thirty-nine days. The average stay in hospital per child was twenty-four days. One of the Council's health visitors attends each session to act as liaison officer, and she made one hundred and nine visits to the homes of patients. Chronic Rheumatism. A clinic was established at the West London Hospital in pre-war days for the treatment of patients suffering from chronic rheumatism in Kensington. The clinic was closed down in the early days of the war and after its re-opening in 1940 various difficulties and changes in personnel were experienced. Whilst the treatment was satisfactory, the records were not kept adequately. During the course of 1945, the physician-in-charge returned from the Armed Forces and more normal work is now in progress. The British Red Cross Society's Rheumatism Clinic at 15, Holland Park Gardens, functioned throughout the war period satisfactorily. The Council make annual grants to both these institutions . - 24 - TUBERCULOSIS. The Tuberculosis Dispensary at 119,Ladbroke Grove received nothing but very minor damage during the war and functioned normally throughout, with the exception of one occasion when, for a few weeks, the work was transferred to the basement of 240, Ladbroke Grove, for reasons of safety. Notifications. During the year, 188 new cases of tuberculosis were notified, of which 169 were respiratory and 19 non-respiratory cases. Death Rate. Eighty-two persons died from respiratory tuberculosis and sixteen from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 70 and that for non-respiratory 14. The rate for all forms of tuberculosis was 84. Dispensary Service. Nine hundred and twenty-one new patients were examined. Of these two hundred and seventy-four were suffering from respiratory tuberculosis, 22 from non-respiratory tuberculosis, 15 new cases were still under observation at the end of the year and 610 persons were diagnosed as nontuberculous . The following table shows the number of cases added to, and the number removed from, the Dispensary Notification Register during the year:- Description. Respiratory. NonRespiratory. Total.  M. F. M. F. On register of notifications on 1st January, 1945. 328 308 52 42 730 Notified for the first time during the year. 87 82 9 10 188 Brought to notice other than by notification. 56 60 5 8 129 Cases removed from register on account of having - (a) recovered from disease. 9 16 4 5 34 (b) removed from district, lost sight of etc. 62 51 6 1 120 (c) died. 55 31 6 5 97 Remaining on register on 31st December, 1945. 345 352 50 49 796 Specimens of sputum examined were 669, of which 81 were found to contain tubercle bacilli; 1,327 radiological examinations were made; and 2,302 visits were paid to the homes of patients by the women health visitors. Five patients made thirty-seven attendances at the dental clinic. Eighty-five patients received 1,549 artificial pneumothorax treatments. - 25 - Grants of extra nourishment were made in 39 cases; beds and bedding were loaned to 18 patients; and the district nurses attended 25 patients in their homes and paid a total of 1,991 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, the; 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 incomes 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 ispaid 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 to make 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 London County Council 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 to receive them. The payments are made weekly in advance. During the year, patients received allowances classified as follows:- Maintenance Allowances. - 124. Special Allowances. - 28. Discretionary Allowances.- 36. The amount disbursed during the year was £3,780 12s.lOd. I am, Mr. Mayor, Aldermen and Councillors, Your Obedient Servant, JAMES FENTON Medical Officer of Health.