library AC 4348 KEN 55 THE ROYAL BOROUGH OP KENSINGTON ANNUAL (INTERIM) REPORT on the HEALTH OP THE BOROUGH for the Year 1946 by JAMES PENTON, C.B.E., M.D., M.R.C.P., D.P.H. Medical Officer of Health. 28th June, 1947• Town Hall, Kensington, W. 8. ROYAL BOROUGH OF KENSINGTON. Public Health Department, Town Hall, KENSINGTON, W. 8. 28th June, 1947. 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 1946. In view of the continuing pressure in the public health department, and the need for strict economy in the use of paper, this report is in the abbreviated form which has been adopted since the outbreak of the war at the request of the Minister of Health; but full statistical records are maintained in the public health department for future reference. GENERAL OBSERVATIONS. The post-war expansion and renovation of the health services, especially the need to provide up-to-date premises in which these services function, have been overshadowed by the acute problems arising from the housing shortage. The position has been accentuated by the recent increase in the population of the borough, which dropped because of war conditions from 172,100 in 1939 to 97,180 in 1941, but which has now risen to approximately 150,000. This return of population has created demands for health services which have been at times difficult to meet; but, whilst more could be done in the way of environmental and preventive health work, the Council's services have coped with the demand to the extent that no crisis occurred. as an example, it might be mentioned that the increasing population and pressure on all available accommodation have resulted in many demands for the repair of dilapidated dwellings. This has created a heavy amount of work for the sanitary inspectors, who have been handicapped by the general shortage of building labour and materials in providing a reasonable standard of habitation for all families. It is hoped that an easing of the shortages will allow the Council's staff to increase their efforts to ameliorate some of the bad housing conditions under which residents are living. The arrears of work are so great that the staff will be engaged to the utmost capacity for some years at least. In this connection, the Council have introduced a scheme, in co-operation with the Ministry of Labour and National Service, for training sanitary inspectors, and it is anticipated that by this means the additional staff required in the next two or three years will be forthcoming. - 2 - BIRTH RATE. Although the population of the borough in 1946 was about 25,000 short of the population in 1939, the number of births in 1946 was 33% higher than the number in 1939. This increase is creating a marked addition to the work of the maternity and child welfare staff, which was augmented to meet the position. Extra infant welfare and ante-natal sessions have been arranged. INFANT DEATH RATE. In spite of difficult housing conditions and the heavy increase in the number of births in 1946, the infant death rate for the year was maintained at the low record of 49 per 1,000 births reached in the previous year. This infant death rate compares favourably with the figures which were recorded in the years before the war. In 1939, the rate was 64, and in 1938 it was 79. MATERNAL DEATH RATE. Three mothers died as a result of pregnancy or childbirth out of a total of 2,763 confinements (including stillbirths). These figures give a maternal death rate of 1.08 per 1,000 confinements which has been lower on only one previous occasion. GENERAL DEATH RATE. The death rate of 1946 was 12.3 which practically co-incides with the rate recorded before the war. The average figure for the war years was 16.1, and in the early part of the war it reached the high figure of 17.4. INFECTIOUS DISEASES. Apart from scabies, which continued to cause trouble, there was no occurrence of any infectious or contagious disease in serious form during the year. Although the number of cases of diphtheria was higher in 1946 than the lowest recorded (in 1945), it is noteworthy that, of the 37 cases notified, 16 were persons over the age of 15 years. The only death recorded as due to diphtheria was that of a man of 70 years, who died in hospital from heart failure complicated with diphtheria. He had not been immunised. The number of cases of tuberculosis notified was 210, compared with 188 in the previous year, but the death rate from this disease fell from 84 per 100,000 population in 194 5 to 55 in 1946. VITAL STATISTICS The table set out on the next two pages gives the important vital statistics for 1946, together with comparative figures for previous seven years. - 3 - - 4 - summary of vital statistics for kensington. Description. 1946 1945 1944 1943 1942 1941 1940 1939 POPULATION Population (estimated) 147 , 870 117,17 0 107,610 106,830 99,310 97,180 123,860 172,100 Density of population per acre 64 51 47 46.6 43 43 54 75 live births. Total births 2,695 1,890 1,780 1,698 1,487 1,239 1,674 2,064 Legitimate births 2,378 1,579 1,527 1,479 1,280 1,099 1,514 1,828 Illegitimate births 317 311 253 219 207 140 160 236 Birth rate per 1,000 population 18.2 16.1 16.5 15.9 15.0 12.7 13.5 12.0 STILL BIRTHS. Total still births 68 49 47 46 27 54 53 65 Legitimate still births 60 40 44 39 23 45 47 59 Illegitimate still births 8 9 3 7 4 9 6 6 Still birth rate per 1,000 total births 24.6 25.3 25.7 27.1 18.1 41.8 31.6 32.0 DEATHS. Total deaths 1,821 1,586 1,735 1,769 1,595 1,664 2,269 2,072 Death rate per 1,000 population 12.3 13.5 16.1 16.5 16.0 17.1 17.4 12.2 DEATHS OF INFANTS UNDER 12 MONTHS OF AGE. Total infant deaths 132 92 93 88 97 67 90 129 Legitimate infant deaths 117 73 76 76 87 62 75 110 Illegitimate infant deaths 15 19 17 12 10 5 15 19 Infant death rate per 1,000 births 49 49 52 52 65 62 58 64 Death rate of legitimate infants per 1,000 legitimate births 49 46 50 51 68 66 54 60 Death rate of illegitimate infants per 1,000 illegitimate births 47 61 67 55 48 36 95 - MATERNAL DEATHS. Deaths of mothers as a result of pregnancy or child birth 3 4 1 3 6 2 7 6 Death rate of mothers per 1,000 live and still births 1.08 2.06 0.55 1.70 3.90 1.80 4.30 3.00 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000 population 55 84 76 92 68 106 81 55 Death rate from respiratory tuberculosis per 100,000 population 47 70 68 80 54 86 74 51 Death rate from nonrespiratory tuberculosis per 100,000 population 8 14 8 12 14 20 7 4 zymotic diseases. Death rate 0.16 0.14 0.21 0.17 0.37 0.15 0.21 0.24 - 5 - causes of death at different periods of life in 1946. Cause of death All ages. Under 1 year 1 year and under 5 5 years and under 45 45 year and over Enteric Fever - - - - - Cerebro-spinal Fever. 5 2 2 1 - Whooping Cough. 3 1 2 — — Diphtheria. 1 — — — 1 Phthisis. 70 — 1 36 33 Other forms of Tuberculosis. 12 - 3 3 6 Syphilis. 22 1 - 4 17 Influenza. 23 — — 4 19 Measles. 2 - 2 — — Acute Infectious Encephalitis. 1 - - - 1 Cancer (all forms). 290 — - 13 277 Diabetes. 11 - - 2 9 Intra-cranial Vascular Lesions. 159 - - 3 156 Heart Disease. 501 — — 14 487 Other diseases of circulatory system. 78 - - 4 74 Bronchitis. 101 2 - 4 95 Pneumonia. 104 14 2 3 85 Other respiratory diseases. 16 - 1 1 14 Ulcers of the stomach. 19 - - 1 18 Diarrhoea (under two years). 18 18 - - - Appendicitis. 10 - — 4 6 Other digestive diseases. 44 4 - 8 32 Nephritis. 32 - - 3 29 Puerperal Sepsis. — — — — — Other maternal causes. 3 - — 3 — Premature Birth. 24 24 - - - Infantile Diseases. 57 50 1 1 5 Suicide. 24 - - 14 10 Road Traffic Accidents. 13 - - 1 12 Other violent causes. 58 8 4 12 34 All other causes. 120 8 3 15 94 TOTALS 1821 132 21 154 1514 - 6 - GENERAL PROVISION OP HEALTH SERVICES IN THE AREA Bacteriological and Analytical Pork. The work performed during the year was as follows:- Nature of specimen or sample. Number examined. Nose and throat swabs. 2,222 Sputum. 444 Faeces and urine. 569 Milk (bacteriological). 116 Water (drinking). 8 Water (swimming baths). 26 Ice Cream. 21 Miscellaneous. 163 Care of Aged and Infirm Persons. During the year, one of the Council's medical officers made 67 visits to 31 persons reported as old or infirm and living in insanitary conditions. The 31 cases were dealt with as follows:- Removed to suitable institutions voluntarily 15 No action considered necessary 8 Died of natural causes 4 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 Cleanpings Persons Cleansings Persons Cleansings Adults. Kensington. 1087 1974 193 219 4 10 4 10 Other boroughs. 991 1815 103 109 - - - - School Children. Kensington. 506 2057 2319 2330 4 7 6 11 Other boroughs. 228 580 405 407 - - 2 6 Children under 5. Kensington. 230 461 74 78 9 35 3 5 Other boroughs. 223 420 14 15 - - - - Compulsory Cleansings. - - 352 352 - - - - TOTALS. 3265 7307 3460 3510 17 52 15 32 - 7 - In addition to the cleansing of persons referred to above the number of articles of personal clothing disinfested at the Medicinal Baths during the year was 34,436. Disinfection and Disinfestation. A summary of the routine work of the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 533 Houses disinfested after vermin 259 Loads of furniture treated with hydrogen cyanide 159 Total weight of furniture, bedding, etc., dealt with:261 tons, 2 cwt., 1 quarter. Verminous Houses - Treatment by D.D.T. On 1st April, 1946, an experimental scheme for the eradication of bugs in dwelling houses, involving the use of dichloro-diphenyl-trichlorethane (D.D.T.) was put into operation. This substance had hitherto been reserved exclusively for use by the Armed Forces. The work is being observed by officials of the Ministry of Health. In addition to D.D.T. in 2and 5$ solutions, a similar compound known as Gammexane has been used as a disinfestant. Further, a number of rooms have been treated with D.D.T. and Gammexane "smokes". In order to estimate the lethal effects of these preparations, lethane has been used as a "control disinfestant" in a number of cases. Actual spraying in connection with the experiment was suspended on 9th December, 1946, after a total of 4,953 rooms had been treated in the following manner:- 1,334 rooms treated with 5% D.D.T. 1,164 ,, ,, ,, 2½ D.D.T. 1,196 ,, ,, ,, 0.35% Gammexane. 53 ,, ,, ,, "smokes". 1,206 ,, ,, ,, Lethane. The work of collating the results, involving re-inspect ions of the rooms, is now proceeding and until this is finished it is impossible to arrive at a final conclusion. The preliminary results indicate, however, that D.D.T. used in a 5% solution appears to give better results than any other disinfestant used by the Council in the past. It is hoped to have the final conclusions by the end of the summer of 1947 . Destruction of Rats and Mice. The work of complying with the "directions" served on the Council by the Ministry of Food under the Infestation Order, 1943, continued during the year and the following table gives a summary:- Complaints received 1,025 Premises inspected following complaint 1,445 Premises where rats were found 601 Premises where mice were found 243 Premises where other vermin were found 82 Premises where no infestation existed 519 Total number of visite to all premises 7,558 Total number of notices served 123 Premises successfully treated 730 Case in which advice was given 51 Borough Council properties dealt with 45 - 8 - In two areas, one comprising the Ashley Cottages and Fenelon Place, and the other in Lonsdale Road, block treatment procedure was adopted which involved simultaneous baiting of all the houses in the area by the pre-baiting method. In April, 1946, all the sewers in the borough were dealt with by poison bait, when it was estimated that 4,251 rats were destroyed. Public Mortuary. The number of bodies taken to the mortuary during the year was 464. Inquests were held in 101 cases. Chapel of Rest. Avondale Park. This chapel was used during the year for the temporary reception of deceased persons pending burial on 14 occasions. Professional Nursing in the Homes. The total number of cases nursed by the Kensington District Nursing Association during the year was 2,022 and the number of visits paid was 52,501. On behalf of the Council, the Association visited 819 cases, paying 12,457 visits. Vacc ination. In 1945, the Kensington registrars reported 660 births to the Vaccination Officer. By 31st January, 1947, 66.7$ of these had been vaccinated or were found to be insusceptible to vaccination The other 33.3% were accounted for as follows:- Statutory declaration of objection 14.8% Died before vaccination 3.8% Referred to other districts 3.5% Removed, leaving no trace 10.7% Postponed or unaccounted for 0.5% In addition, 471 certificates of successful vaccination or insusceptibility were received in respect of children living in Kensington who were born outside the borough during 1945. Provision of Insulin. In pursuance of their powers under Section 227 of the Public Health (London) Act, 1936, the Council provide insulin 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, 8 persons were supplied with insulin, and the cost to the Council amounted to £25 17s. 5d. MATERNITY AND CHILD WELFARE SERVICES. During 1946, there were in operation the following five infant welfare centres:- (1) Raymede, at its pre-war premises, 240, Ladbroke Grove, W. 10. (2) Lancaster Road, at its pre-war premises, 63, Lancaster Road, W. 11. (3) Bramley, temporarily accommodated at the Public Baths, Lancaster Road, W. 11. (4) Campden Hill, in temporary premises at 9, Holland St.,W.8. (5) South Kensington, at its pre-war premises, 10, Redcliffe Street, S. W. 10. - 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 have also approved plans for a foot clinic and a solarium. The birth rate, which is increasing not only in Kensington but throughout the country generally, resulted in increased demands for the maternity and child welfare services. Comparison with 1938, the last full year before war broke out, reveals the large increase in the number of births despite the fact that the population of the borough last year was 26,000 less than the population in 1938. 1946. 1938. Population. 147,870 174,100 Total live births. 2,695 2,236 Birth rate. 18.2 12.8 Health Visiting Staff. The work performed by the health visiting staff during 1946 in regard to maternity and child welfare is summarised in the following tablet:- First visits to infants (0-1 year) 2,131 Revisits to infants (0-1 year) 6,672 Visits to children between 1 and 5 years 7,633 Stillbirth enquiries 41 Visits to ophthalmia neonatorum cases 49 Visits to measles cases 317 Visits to whooping cough cases 324 Visits to puerperal fever cases 12 Visits to puerperal pyrexia cases 14 Visits to enteritis cases 119 Infantile death enquiries 119 Ante-natal visits 2,436 Half-day at welfare centres 2,604 Visits to foster mothers 539 Visits to registered daily guardians 72 Other visits 3,246 Ante-natal Clinics and Infant Welfare Centres. The work at these institutions during 1946 is shown in the following table:- Sessions at which doctors attended for natal consultations 749 Individual mothers who attended ante-natal consultations 2,870 Attendances of ante-natal mothers 13,472 Sessions at which doctors attended for postnatal consultations 50 Individual mothers who attended post-natal consultations 169 Sessions at which doctors attended for infant consultations 655 Individual children who attended for the first time:- 0-1 year 1,733 1-5 years 240 Attendances of children at doctors' consultations:- 0-1 year 7,721 1-5 years 3,902 Attendances at centres of children for all purposes:- 0-1 year 20,288 1-5 years 6,521 - 10 - The Baby Clinic, 92, Tavistock Road. W. 11. Pre — school children minor ailment treatments. Doctors' sessions held 137 Individual children attending doctors' sessions 645 Total attendances at doctors' sessions 3,565 Average attendance at doctors' sessions 26 Individual circumcision operations 138 Sessions held for dressings only 306 Attendances at dressing sessions 3,066 Sessions held for sunlight and massage treatment 112 Sunlight treatments given 1,666 Massage treatments given 847 Total individual children attending clinic 1,096 Total attendances 8,507 Dental Treatment. The following table shows the dental treatment performed at 92, Tavistock Road during the year:- Sessions held 118 Patients (new cases) 386 Total attendances (all cases) 1,610 Extractions 1,582 Fillings 325 Dentures 88 Other Treatment 773 Borough Counci1's Maternity Home . There are five beds at Queen Charlotte's Hospital reserved for Borough Council patients. Details for 1946. Applications for admission 128 Application accepted 128 Application subsequently withdrawn 7 Women confined in the home 120 The gross cost of the scheme to the Council during 1946 was £1,062 15s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £659 7s. 8d. Payments made by patients totalled £822 5s. 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 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, 93 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 181 cases at a cost of £1,031 2s. 6d. Domestic Helps. During 1945, 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 68 E. 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 20th February, 194 5, but great difficulty was experienced in obtaining the necessary domestic helpers. With a view to overcoming the difficulties experienced, it was decided to appoint a whole-time Almoner, who commenced duty in 1946. The following is a summary of the action taken during 1946:- Applications received 206 Applications refused on the grounds of unsuitability 27 Applications withdrawn 68 Applications granted 1ll Total cost to Council - £424 15s. 7d. Contributions by applicants - £155 2s. 2d. Wartime Day Nurseries. The four day nurseries, which were established during the war, were maintained by the Council in full operation during 1946. The following table shows the total number of attendances of children at each nursery during the year:- Nursery. Total attendances during the year. Ladbroke, 1, Ladbroke Square, W. 11. (45 places). 9,907 Kensa1 House, Ladbroke Grove, W. 10. (65 places). 15,946 St. Charles, St. Charles Square, W. 10. (65 places). 14,560 St. Quint in, 90, Highlever Road, W. 10. (50 places) . 10,780 - 12 - The Council's proposal to open a fifth nursery in the South Kensington area proceeded with difficulty, but it can now. be reported that the consents of the Ministry of Health and the London County Council have been obtained, and premises have been acquired which will be suitably converted. However, owing to difficulties of building labour and materials, it is not likely that the fifth nursery will be opened during 1947. Registered Daily Guardians. The scheme for the registration of daily guardians to care for children for whom no place can be found in day nurseries was continued during 1946. Under this scheme the Council make a payment to the guardian, in addition to the mother's contribution, of 6s.0d. per week for each child taken for four days or more per week, and 3s.0d. for each child taken for less than four days per week. During the year, 15 guardians were placed on the register and 32 children were cared for. The cost amounted to £116 9s. 0d. At the end of the year, there were on the register 10 daily guardians who were caring for 12 children. Child Life Protection. Poster mothers on register on 1st January, 194 6 31 Poster mothers remaining on register at the end of the year 26 Foster children on register on 1st January, 1946 45 Foster children remaining on register at the end of the year 37 Total visits paid to foster mothers 539 The Curtis Report on the Care of Children was reviewed by the Maternity and Child Welfare Committee and the Council in accordance with the request of the Ministry of Health. The principal criticisms in the Report dealt with children's residential institutions, and these are not the direct concern of the Borough Council. It was in the section dealing with child life protection (foster children under the care of private individuals), that the Borough Council are directly concerned. The Curtis Committee recommended that the age of foster children should be raised from nine to sixteen years, and that all foster homes should be under supervision whether reward was taken for the child or not. As the welfare authority, the Council are at present responsible under the Public Health (London) Act, 1936, for supervision of all foster children in the borough. The Act makes provision for the protection of foster children under nine years of age who are "nursed and maintained by any person for reward apart from their parents, or having no parents". Any person undertaking such nursing and maintenance for reward must notify the Council before the child is received, not less than seven days beforehand for the first child so received, and not less than 48 hours beforehand for any subsequent child. "Reward" includes money or money's worth and is irrespective of profit. A person maintaining a foster child must give at least seven days' notice of any change of residence. Notice must be given within 24 hours of the death of a foster child or his removal. - 13 - The Council fix the maximum number of children under nine years who may be kept in any premises. If a foster child is about to be received or is being kept in overcrowded, insanitary, or dangerous premises, or by persons unfit to have the care of the child, or in any environment detrimental to the child, the Court may order the child's removal to a place of safety. The supervision of foster children is one of the important duties of the Council's maternity and child welfare officers. Pour medical officers and all the health visitors have been appointed child life protection visitors, and are authorised to carry out duties under the Act. Any one of these officers can take action in urgent cases. Inspections of foster homes and children are made not less often than once a month, or more frequently if there is any doubt about the care the child is receiving. It seems that there is an increasing demand for accommodation of the "short stay" type for foster children. Table showing the length of stay in the borough of foster children who left Kensington in 1946 compared with the similar figures for 1936. Length of stay with foster mother. 1946 1936 Children Children No. % No. % Under 7 days. 30 13.8 6 4.5 Between 7 and 14 days. 28 12.9 11 8.3 Between 14 and 21 days. 24 11.0 3 2.2 Between 21 days and 1 month. 22 10.1 7 5.3 Between 1 and 2 months. 51 23.5 18 13.5 Between 2 and 3 months. 12 5.6 12 9.0 Between 3 and 4 months. 17 7.8 15 11.3 Between 4 and 5 months. 6 2.8 5 3.8 Between 5 and 6 months. 8 3.7 6 4.5 Between 6 and 12 months. 13 6.0 15 11.3 Over 12 months. 6 2.8 35 26.3 TOTALS. 217 100 133 100 Whereas before the war a high proportion of foster children (26% in 1936) stayed with their foster parents for more than twelve months, only 3% of the foster children leaving Kensington in 1946 had been with their foster parents for more than one year. Of the foster children who left last year, 70% had stayed with their foster parents for less than 2 months, compared with 33% in 1936. These figures indicate that the "fostering" of children no longer has the character of providing "homes" for children, but rather it is being used as a temporary expedient, pending other arrangements being made, such as adoption. - 14 - Thus, the importance of supervising foster children in these "temporary homes" has increased, to prevent cases of neglect. One cannot expect foster mothers to develop a strong affection for children who they know will be taken from them in a few weeks. Supervision to be efficient under these conditions needs "local touch and knowledge". Care of Illegitimate Children. In co-operation with the Ministry of Health, the London County Council and all other London boroughs, the Council have decided (a) to institute a scheme of guaranteed payments to foster mothers, and (b) to provide greater financial assistance to voluntary bodies. The scheme for guaranteed payments to foster mothers came into operation on 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. The payment per foster child was increased during the year to 21s.0d. 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 1946 were the Council asked to make a payment. In 1945, 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. During 1946, the second year of operation, Kensington's contribution remained the same. 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 borowh of 53 premature infant? were notified. Of these, 51 were born at home and two in nursing homes. Of those born at home, 48 survived at the end of one month, one infant died within 24 hours, and two others died before reaching the age of one month. The two children born in nursing homes survived at the end of one month. (Note. These figures do not include Kensington premature infants born outside the borough, as the Ministry of Health have requested that these births should be reported on by the local authorities in whose area the confinement actually occurred.) Arrangements have been made for notifications of birth to give the weight of the child when born. - 15 - SANITARY INSPECTION. The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the years:- Total complaints received 7,611 Public Health (London) Act. 1936. Houses inspected on complaint 7,465 ,, ,, after infectious disease 878 Re-inspections 10,476 Smoke observations 10 Inspections of mews 89 Other inspections 2,525 Housing Act. 1936. Initial inspections (including preparation or revision of house-to-house cards) 408 Re-inspections 464 Underground Living Rooms. Primary inspections 2,691 Re-inspections 1,738 Scabies Order. Inspections 778 Drainage. Applications 202 Plans submitted 69 House drains tested and inspected 1,044 Shoos Act. Inspections 1,572 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 2,660 Statutory notices 731 Final notices 200 Various. Rent Restriction Act Certificates 8 Report of waste of water to the Metropolitan Water Board 78 Report of dangerous structures to the London County Council 60 Other notices 153 - 16 - The following is a summary of works completed under the supervision of the sanitary inspectors during the year:- House drains reconstructed 30 „ „ additions to 21 Defective drains repaired 235 House drains cleansed 238 Water closets reconstructed 66 „ „ repaired 154 „ „ new provided 67 ,, ,, supplied with water 87 Soil pipes, ventilated, repaired, etc 37 „ „ new provided 35 Ventilating pipes new provided 39 Baths, new provided 73 Sinks, new provided 94 Lavatory basins, new provided 160 Waste-pipes, new provided 165 Cisterns cleansed 15 „ covered 8 Taps fixed on rising main 28 Yards and areas paved, drained, etc 14 Dustbins provided 304 Accumulations of filth, etc., removed 234 Animals removed 41 Roofs repaired 609 Houses provided with water above basement level 11 Dampness in dwellings remedied 824 Infectious disease cases removed 275 Houses disinfected after infectious disease (including bedding, etc.) 533 Rooms in such houses disinfected after infectious disease 611 Houses cleansed under Houses Let in Lodgings By-laws 77 Cleansing of houses not on register 240 Verminous houses cleansed (including bedding, clothing,etc.) 359 Verminous rooms in such houses cleansed 977 Dirty bedding cleansed 70 „ „ destroyed 2 Other sanitary works executed 651 HOUSING. Inspection of dwelling houses during the year. (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts). 11,593 (b) Inspections made for the purpose 26,796 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing ated Regulations, 1925) 408 (b) Inspections made for the purpose 872 (iii) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 3 (iv) Dwelling houses (excluding those referred to under the preceding sub-head) found not be in all respects reasonably fit for human habitation 2,660 - 17 - 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 1,829 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 74 (ii) Dwelling houses which were rendered fit after service of formal notices 16 (b) Proceedings under Public Health Acts:- (i) Dwelling houses in respect of which notices were served requiring defects to be remedied 731 (ii) Dwelling houses in which defects were remedied after service of formal notices:- (a) by owners 731 (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 order 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 253 (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 25 Underground Rooms. On 11th December, 1945, the Council decided to resume work under Part II of the Housing Act, 1936. With regard to closure of underground rooms under Section 12 of that Act, the Council decided not to insist on the rigid enforcement of the underground room regulations in all cases, especially where technical infringements only existed and the rooms were reasonably fit for human habitation, having regard to present day standards. The Council made this decision in view of the housing shortage, their main concern being to secure additional accommodation. Rules of procedure were approved by the Council with the object of holding a balance between the need to close seriously unfit underground rooms and the need to preserve as much housing accommodation as possible. - 18 - Broadly speaking, underground rooms in Kensington fall into four categories, namely:- (a) Rooms which cannot be made to comply with the Council's regulations. These rooms, in the main, comprise cases where the necessary light cannot be obtained and the rooms are virtually cellars. Closing orders are made in respect of t he s e ro oms. (b) Rooms where, ov.ing to the nature of the subsoil or for any other reasons, there is extensive rising dampness and it is considered that the full requirements of the Council's regulations should be enforced in order to render the rooms fit for habitation. These rooms are closed unless the owners offer to make them comply with the regulations. (c) Rooms in well-constructed houses, on dry soil, which are healthy although they do not comply with all the technical requirements of the Council's regulations, but in which it is not considered necessary at the present time to demand full compliance in order to make the rooms fit for habitation. The owners' undertakings to carry out the minimum repairs are accepted in these cases. (d) Rooms where there is no evidence of rising dampness and which are adequately lighted and ventilated. These rooms have not been closed for habitation, but the persons having control have been informed that the decision is without prejudice to any future action which might be taken by the Council. The number of underground rooms closed during the year was 250, but a number of them have been, or are being, made fit, which results in the withdrawal of the closing order. Overcrowding. A Special Sub-Committee of the Public Health Committee has been established to which all cases of overcrowding coming to the notice of the Department are reported. Despite the shortage of accommodation, a considerable measure of success has been achieved as will be seen from the following table:- Cases reported to the Sub-Committee during 1946 135 Cases in which the Sub-Committee recommended that alternative accommodation should be offered by the Council 73 Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 20 Cases where action was postponed 38 Cases withdrawn or where no action was taken 4 Cases in which overcrowding was abated during the year 72 - 19 - FACTORIES. Factories Act. 1957. The provision of Section 128 of the Factories Act, 1937, requiring Medical Officers of Health to make an annual report in regard to the Council's functions under the Act, was suspended by the Home Secretary and the Minister of Health during the war. With the shortage of inspectorial staff, little work was done in regard to routine inspections of factories, but all urgent matters arising from complaint or otherwise have been dealt with. The following tables contain a summary of the inspections made and the defects found and remedied within the borough during 1946:- Inspections. Premises. Number of Inspections. Number of Written Notices. Factories with mechanical power. 210 2 Factories without mechanical power. 125 13 Other premises under the Act. (Including works of building and engineering construction but not including outworkers' premises.) - - TOTALS 335 15 Defects Found. Particulars. Number of defects found. Number of defects remedied. Number of defects referred to H. M. Inspector. Want of cleanliness. 9 9 - Overcrowding. - - - Unreasonable temperature. 1 1 - Inadequate ventilation. 1 1 - Ineffective drainage of floors. - - - Sanitary conveniences:- - - - (a) insufficient. - - - (b) unsuitable or defective. 6 6 - (c) Not separate for sexes. 1 1 - Other offences (not including offences relating to Homework) 7 6 1 - 20 - During 1946, no prosecutions were instituted under the Factories Act, 1937. The Minister of Labour has indicated that he will expect to be furnished with the usual detailed annual report for 1947, and a re-arrangement of the inspectorial staff has taken place so that the arrears of work in connection with factories can be overcome and routine inspections recommenced. Outworkers. The following table shows the nature of the work carried out by the 260 home workers on the register of outworkers during 1946:- Nature of Work. Number. Wearing apparel - (a) Making, etc. 98 (b) Cleaning and washing 4 Household linen 6 Lace. lace curtains and nets 1 Furniture and upholstery 2 Fur pulling 2 Umbrellas, etc 1 The making of boxes or other receptacles or parts thereof made wholly or partially of paper 2 Carding, etc., of buttons, etc 73 Stuffed toys 55 Basket making 1 Watchmaking 1 Boot and shoe repairing 11 Handbag repairing 3 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. INSPECTION AND SUPERVISION OF FOOD. Milk. Three hundred and forty-eight samples of milk were submitted to the Public Analyst during the year and only one sample was found to be. adulterated. The following table show3 the average percentages of milk fats and non-fatty solids of the genuine samples taken each month. Month. No. of samples taken. Average Percentage. Month. No. of samples taken. Average Percentage. Milk fats. Non fatty solids. Milk fats. Non fatty solids. January. 24 3.45 9.27 July. 12 3.37 8.96 February. 36 3.39 8.84 August. 12 3.55 9.58 March. 28 3.37 8.88 September. 35 3.70 9.12 April. 30 3.21 8.79 October. 41 3.79 9.04 May. 37 3.29 8.97 November. 37 3.65 9.00 June. 22 3.28 9.03 December. 33 3.73 8.98 Legal Minimum Standards:- Milk fats - 3.00. Non-fntty solids - 8.50. - 21 - Milk (Special Designations) Regulations. 1956/1946. The above regulations provide for licensed dairymen to use the designation tuberculin tested, accredited, or pasteurised, in connection with the sale of milk. During the year, particulars of licenses granted were as follows:- Principal. Supplementary. Dealers licensed to bottle and sell tuberculin tested milk .. 1 Dealers licensed to sell tuberculin tested milk 22 4 Dealers licensed to sell pasteurised milk '. 71 4 Twenty samples of tuberculin tested milk were submitted for examination, and of these four failed to pass the prescribed tests. Eight samples of tuberculin tested (pasteurised) milk and sixty-eight samples of pasteurised milk were submitted for examination. One of the tuberculin tested (pasteurised) samples failed to pass the prescribed tests, but all the pasteurised milks were found to be satisfactory. In March, th<- Milk (Special Designations) Regulations, 1946, cam<~ into operation. Prior to this date, it was a requirement that tuberculin tested milk (pasteurised) and pasteurised milk must not contain more than thirty thousand and one hundred thousand bacteria per ml. respectively, but with the coming into force of the 194 6 Regulations these standards were abolished, and the phosphatase and methylene blue tests were substituted for these grades of milk. Heat Treat Milk (Prescribed Tests) Order. 1944. Under Defence Regulation 55G, (restrictions on the sale of raw milk), the Minister of Pood may specify areas in which it will be illegal to sell milk unless it is either - (a) Tuberculin tested milk. (b) Accredited milk. (c) Processed milk (heat-treated, pasteurised, or sterilised.) When an area has been specified all processed milk sold in that area must conform to the methylene blue and phosphatase tests as prescribed in the Heat Treated Milk (Prescribed Tests) Order, 1944, made by the Minister of Health. No area in London has yet been specified, but the Minister of Pood has, however, requested the Council to apply the two tests to all processed milks, and to report the results to him monthly. The following ,table chows the number of samples of processed milk taken during the year, together with the results of the examinations. 22 Grade. Number of samples. Methylene blue test. Phosphatase test. Passed. Failed. Passed. Failed. Tuberculin tested (pasteurised). 8 7 1 8 — Pasteurised. 68 68 — 68 — Heat treated. 10 7 3 10 — Sterilised. 4 4 — 4 — TOTALS. 90 86 4 90 — Warning letters were sent to the vendors of the unsatisfactory samples. Ice Cream. During the war, the manufacture and sale of ice cream were prohibited by the Minister of Pood, but in November, 1945, the ban was lifted. Owing to the continued shortage of supplies, the use of milk products in the manufacture of ice cream was prohibited, and although a small amount of margarine was allocated to manufacturers in lieu thereof, the nutritional standard of ice cream generally is low. The bacterial content in many cases has been found to be high. Adulteration of Food. Three hundred and eighty-one formal samples of food and drugs were taken, of which twelve (3.14%) were adulterated. Six hundred and nineteen informal samples were taken of which twelve (1.94%) were adulterated. Public Health (Meat) Regulations. 1924. The Government's meat distribution depot serving Kensington and neighbouring boroughs, established during the war in the borough, was closed on 4th April, 1946. The supply of meat to Kensington butchers has since been distributed from Smithfield Market. In the first three months of the year, 2,902 tons of meat were examined at the Kensington depot, and approximately 2¾ tons were condemned and voluntarily surrendered. Unsound Food. Seizure. Under Section 10 of the Food and Drugs Act, 1938, food sold, exposed for sale, or in preparation for sale, and found in an unfit condition, can be seized and taken before a justice who can condemn it and order it to be destroyed. There was only one instance during the year of food being seized and condemned; proceedings were instituted against the offender, who was fined £15 at the court hearing, which took place in 1947. 23 Surrender. Any person, having for the purpose of sale, food which is diseased, unsound or unfit for human consumption can, under Section 180(8) of the Public Health (London) Act, 1936, surrender it to the Council for destruction as trade refuse. During the year, surrender was made of 3,260 tins of various foods, and 4 tons, 19 cwts. of other food, the principal items of which were:- Tons. Cwts. Crs. Lbs. Fish 2 14 — 24 Flour 1 4 — 7 Sugar — 3 3 26 Dried Vegetables — 6 2 23 Fruit — 2 2 18 Bacon, butter and cheese — — 7 4 Sale of Food and Drinks in public places. The Pood and Drugs Act, 1938, requires every dealer in ice cream to have his name and address conspicuously displayed on any vehicle or container in which he sells or exposes for sale ice cream in the street or public place. This requirement can be extended by a local authority to apply to vendors of any kind of food or drink, excepting milk, in streets of public places. In view of the difficulties which were being experienced in ascertaining the names and addresses of itinerant street traders dealing in food, in certain cases under unsatisfactory conditions, the Council resolved that as from 9th December, 1946, street vendors of all kinds of food and drink, except milk, should display conspicuously their names and addressee on their vehicles or stalls. 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 140. Of this number 16 were initial registrations during the year. 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 the water was suitable for drinking and domestic purposes. LEGAL PROCEEDINGS. Public Health (London) Act. 1936. Nuisances. During the year, 12 summonses were taken out for various nuisances under the Public Health (London) Act, 1936. In 8 cases abatement or prohibition orders were secured and fines amounting to £22 0s. 0d. were imposed. In the remaining 4 cases, the summonses were withdrawn, the nuisances having been abated. 24 Drainage Bye-laws. Seven summonses were issued in respect of contraventions of the Drainage Bye-laws. In all cases, convictions were secured and fines amounting to £4 0s. 0d. were imposed. Food and Drugs Act. 1958. Seven prosecutions under this Act were instituted during the year. Convictions were secured in 4 cases and fines amounting to £32 0s. 0d., and costs amounting to £3 6s. 6d. were imposed. The three remaining cases were dismissed on payment of costs to the Council amounting to £1 8s. 0d. Council's Bye-laws. Dog Nuisances. Six cases were successfully prosecuted and fines amounting to £2 15s. d. were imposed, and costs of 10s. 0d. were awarded in one of the cases. Milk and Dairies Regulations. Four summonses were issued under these Regulations; in three cases convictions were obtained. Pines amounting to £20 0s. 0d., and costs amounting to £5 5s. 0d. were imposed. The fourth case was dismissed under the Probation of Offenders Act, but costs of £1 1s. 0d. were awarded to the Council. Housing Act, 1956. Overcrowding. In three cases summonses were issued in respect of overcrowding offences. In one, a fine of £2 0s. 0d. was imposed; in the second case a nominal fine of 1s. 0d. was imposed, and the third case was adjourned sine die. INFECTIOUS DISEASE. The following table shows the number of cases of infectious disease notified during the year 1946, with comparative figures for the previous seven years:- The following table shows the number of cases of infectious disease notified during the year 1946, with comparative figures for the previous seven years:- 25 Notifiable disease. Number of cases notified. 1946 1945 1944 1943 1942 1941 1940 1939 Scarlet Fever. 195 136 74 216 108 91 82 117 Diphtheria (including Membranous Group.) 37 19 29 54 78 86 54 102 Enteric Fever. 6 3 3 3 1 16 11 9 Puerperal Fever. 4 7 18 10 7 1 6 5 Puerperal Pyrexia. 8 12 23 25 7 11 18 34 Acute primary pneumonia and acute influenzal pneumonia. 111 81 91 133 91 65 59 109 Dysentery. 49 142 43 73 68 25 15 114 Erysipelas. 37 33 16 37 30 43 47 45 Cerebro-spinal meningitis. 10 3 6 11 17 22 45 4 Malaria. 8 11 8 1 1 — — — Poliomyelitis and polioencephalitis . 1 3 1 1 2 2 1 4 Encephalitis lethargica. — 1 — — — — 1 2 Tuberculosis (all forms). 210 188 211 202 203 234 200 190 Measles. 264 868 102 624 365 366 242 31 Ophthalmia neonatorum. 4 8 4 11 4 3 9 8 Enteritis. + 69 100 71 69 96 48 12 31 Food poisoning. 7 6 7 4 8 2 6 2 Acute rheumatism. x 15 32 11 9 6 2 6 18 Scabies. * 463 460 363 252 — — — — Whooping cough. 209 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. Gases of mistaken diagnosis are excluded from the above table. Diphtheria Immunisation. The following table shows the diphtheria immunisation work carried out during the year:- Pre-school children immunised 1,284 School children immunised 482 Children attending for pre-immunisation schick tests 489 No. who gave positive re-action 292 Children attending for schick tests after being immunised 2,855 Number proving negative 2,276 Number proving positive 414 Number who failed to attend for readings 165 On 14th November, 1945, the Minister of Health issued Circulars 193/45 and 194/4 5, placing the responsibility for immunising children under school age upon Welfare Authorities, and recommending that (a) each health visitor should be responsible for securing the immunisation of children under school age in her district, (b) the adoption of a standardised record card for each child immunised, and (c) the form of annual return to be made at the end of each year of immunisation work carried out in relation to the child population. 26 Following these circulars, each health visitor was instructed to keep a record book showing every notified birth in her district, and a day by day record as to whether such children had been immunised or not. This book is examined periodically (not less frequently than once a quarter) when every child who has attained the age of 1 year is checked to see whether it has been immunised and, if not, the reason for the failure. The record card recommended by the Minister was practically the same as that which had been used in Kensington for a long time previously, and it was decided that no change was necessary. The figures for 1946 in regard to immunisation of the child population already supplied to the Minister are as follows:- Age of children at 31st Dec., 1946. Total number immunised. Under 1 year. 273 Between 1 and 2 years. 892 ,, 2 and 3 ,, 831 ,, 3 and 4 ,, 817 ,, 4 and 5 ,, 859 ,, 5 and 9 ,, 5,354 ,, 9 and 15 ,, 5,652 Total. 14,678 Estimated child population for the borough in mid-1946- Up to 5 years 8,810 Between 5 and 15 12,740 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 eighty Kensington children attended making a total of four hundred and twelve attendances. Of these, eleven were referred to the Princess Louise Hospital for in-patient treatment. These children were in-patients for periods varying from six days to one hundred and sixty-seven days. The average stay in hospital was forty-one days. One of the Council's health visitors attends each session to act as liaison officer, and she made ninety-eight visits to the homes of the patients. 27 Chronic Rheumatism. (a) The clinic established at the West London Hospital for the treatment of patients suffering from chronic rheumatism in Kensington has continued its work satisfactorily, and the Council have made their customary grant of £200 towards the running costs. The physician-in-charge has reported on the work carried out and the following points may be of interest. (1) The pathological and radiological services of the West London Hospital are available to the department and full use is made of them. Where necessary, cases are referred to other special departments, such as orthopaedic, neurological, dental, gynaecological and psychiatric. The following are the percentages of the chief disease groups seen during the period under review:- Fibrositis 45% Osteo-arthritis 25% Rheumatoid and infective arthritis15% Gout5% Ankylosing spondylitis10% (2) Various forms of electrical treatment, massage and the teaching and supervision of remedial exercises are carried out in the physiotherapy department. This is equipped with radiant heat, long and short wave diathermy, ultra-violet light, wax baths, and apparatus for galvanism, faradism and sinusoidal baths. (3) Gold salt injections are given where necessary in the treatment of rheumatoid arthritis. Local injections of various substances are used in the treatment of fibrositis. Vaccines have been prepared and administered in certain cases, and the new technique of intra-articular injection has been tried. (4) Investigation has proceeded on the use of various solutions for local injection in fibrositis. Different preparations of gold salts have been compared on selected groups of cases of rheumatoid arthritis. It was decided that valuable information might be obtained by the radioscopal screening of joints in certain rheumatic diseases. This line of research is being carried out with interesting results which will be published later. (b) The British Red Cross Society's Rheumatism Clinic at 15, Holland Park Gardens, functioned satisfactorily throughout the year, and the Council made their annual grant of £70 to this institution. The clinic is fully equipped for massage, diathermy, galvanism, ultra-violet ray and heat treatment, x-ray work, etc., and these highly specialised treatments are given to those who cannot afford to secure them privately. In addition to being a rheumatism clinic, cases are taken when physiotherapy is likely to be beneficial. 28 There has been a steady increase in the numbers of Kensington patients attending each year, as is shown below:- Year. No. of patients. 1941 160 1942. 260 1943 334 1944 354 1945 408 1946 431 The clinic is open on five days each week. TUBERCULOSIS Notifications. During the year, 210 new cases of tuberculosis were notified, of which 187 were respiratory and 23 non-respiratory cases. Death Rate, Seventy persons died from respiratory tuberculosis and twelve from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 47 and that for non-respiratory 8. The rate for all forms of tuberculosis was 55. Dispensary Service. Nine hundred and fifty four new patients were examined. Of these, two hundred and fifty-seven were suffering from respiratory tuberculosis, 19 from non-respiratory tuberculosis, 4 2 new cases were still under observation at the end of the year, and 636 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:- Description. Respiratory. NonRespiratory . Total. M. P. M. F. On register of notifications on 1st January, 1946. 345 352 50 49 796 Notified for the first time during the year. 103 84 10 13 210 Brought to notice other than by notification. 60 58 5 5 128 Cases removed from register on account of having- (a) recovered from disease. 6 10 2 3 21 (b) removed from district, lost sight of, etc. 45 66 7 7 125 (c) died. 53 26 4 6 89 Remaining on register on 31st December, 1946. 404 392 52 51 899 29 Specimens of sputum examined were 444, of which 67 were found to contain tubercle bacilli; 1,434 radiological examinations were made; and 2,753 visits were paid to the homes of patients by the health visitors. Fourteen patients made seventy-five attendances at the dental clinic. One hundred and eight patients received 1,817 artificial pneumothorax treatments. Grants of extra nourishment were made in 50 cases; beds and bedding were loaned to 21 patients; and the district nurses attended 32 patients in their homes and paid a total of 2,212 visits. Allowances for Tuberculous Persons Undergoing Treatment. The Government's scheme to give maintenance allowances to tuberculous persons undergoing treatment was continued throughout 1946. 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 aft r 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 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 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 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 55 Discretionary Allowances 45 The amount disbursed during the year was £4,133 2s. 11d. 30 CONCLUSION. On behalf of the staff of the public health department, I wish to acknowledge the encouragement and support received from the Mayor, the Chairmen and Vice-Chairmen of the various Committees, all members of the Council, and our colleagues in other departments. I am, Mr. Mayor, Aldermen and Councillors, Your Obedient Servant, * JAMES PENTON Medical Officer of Health.