KEN 56 AC 4348 THE ROYAL BOROUGH OF KENSINGTON ANNUAL (INTERIM) REPORT on the HEALTH OF THE BOROUGH for the Year 1947 JAMES FENTON, C.B.E., M.D., M.R.C.P., D.P.H. Medical Officer of Health. 1st September, 1948. Town Hall, Kensington, W.8. ROYAL BOROUGH OF KENSINGTON. Public Health Department, Town Hall, KENSINGTON, W. 8. 1st September, 1948. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lords, Ladies and Gentlemen, On behalf of Dr. James Fenton, who is unfortunately indisposed, I have the unexpected privilege and honour to present the annual report on the state of the public health in Kensington in 1947. The Minister of Health has directed that this report should be compiled in the same abbreviated form which has been adopted, at his request, since 1939. GENERAL OBSERVATIONS. The population of Kensington in 1947, estimated by the Registrar General to be 166,170, showed an increase of over 18,000 compared with the previous year. The borough's lowest population figure of 97,180 was recorded in 1941, since when there has been a steady increase up to the present level. The general public health of the borough was maintained satisfactorily during the year, although the provision and maintenance of reasonable housing conditions for all has presented difficulties owing to the general shortage of accommodation and to heavy wear and tear on existing dwellings due to multi-family occupation. The cumulative effects of war damage, lack of maintenance work during the war, difficulties of obtaining labour and materials, and high building costs have resulted in a considerable amount of deterioration and dilapidation in certain dwelling houses in the borough. In this connection it is pleasing to report that the Council have re-introduced the procedure of repairing occupied houses under Section 9 of the Housing Act, 1936. It will be recalled that the operation of "Section 9 procedure" before the war was an important factor in the local authority's work of maintaining satisfactory standards in privately-owned dwelling houses. During the year, nearly one hundred houses were dealt with under this Section. BIRTH RATE. The number of Kensington live births in 1947 was 3,012. It is twenty-four years since the annual number of births exceeded 3,000. The birth rate for 1947 was 18.1. The average birth rate for the five years before the war (1934-38) was only 12.5. 2 INFANT DEATH RATE. The number of deaths of children under twelve months for every 1,000 live births reached the borough's lowest record of 41 in 1947. The previous lowest record was 49 in each of the years 1945 and 1946. MATERNAL DEATH RATS. Four mothers died in 1947 as a result of pregnancy or childbirth out of a total of 3,077 confinements (including still births). These figures give a maternal death rate of 1.3 per 1,000 confinements, a lower figure than this having been recorded on only two previous occasions. GENERAL DEATH RATE. The death rate in 1947 was 11.2 which is the lowest ever recorded in the borough. INFECTIOUS DISEASES. During 1947, acute poliomyelitis (or infantile paralysis) caused some concern throughout the country generally. In Kensington, 27 cases occurred during the year compared with one in 1946 and three in 1945. Two cases proved fatal. Special measures were taken to prevent the spread of this disease. Health propaganda and publicity were intensified, special film shows demonstrating diagnosis and treatment were organised for local doctors, and care was taken to avoid congestion at swimming baths. The disease did not reach epidemic proportions in Kensington. The number of cases of diphtheria (23) in 1947 was the second lowest ever recorded, and there were no deaths from this disease during the year. There was a marked reduction in the incidence of scabies during 1947. The number of cases notified was practically half the number in the previous year, and was the lowest recorded since this disease became notifiable in 1943. Measles attained epidemic proportions during the year, and special precautions were taken to ensure home visiting and nursing for all oases notified. There were 852 notified cases in 1947 compared with 264 in 1946, and five deaths occurred compared with two in the previous year. TUBERCULOSIS. The number of cases of tuberculosis notified during 1947 was 259 compared with 210 in the previous year. The 1947 total was the highest recorded in Kensington since 1932. The tuberculous death rate per 100,000 population was 47.5 which is the lowest ever recorded; the death rate in 1946 was 55, end in 1945 was 84. VITAL STATISTICS. The table set out on the next two pages gives the important vital statistics for 1947, together with comparative figures for the previous seven years. 3 4 SUMMARY OF VITAL STATISTICS FOR KENSINGTON. Description. 1947 1946 1945 1944 1943 1942 1941 1940 POPULATION. Population (estimated) 166,170 147,870 117,170 107,610 106,830 99,310 97,180 123,860 Density of population per acre 72 64 51 47 46.6 43 43 54 LIVE BIRTHS. Total births 3,012 2,695 1,890 1,780 1,698 1,487 1,239 1,674 Legitimate births 2,696 2,378 1,579 1,527 1,479 1,280 1,099 1,514 Illegitimate births 316 317 311 253 219 207 140 160 Birth rate per 1,000 population 18.1 18.2 16.1 16.5 15.9 15.0 12.7 13.5 STILL BIRTHS. Total still births 65 68 49 47 46 27 54 53 Legitimate still births 58 60 40 44 39 23 45 47 Illegitimate still births 7 8 9 3 7 4 9 6 Still birth rate per 1,000 total births 21.1 24.6 25.3 25.7 27.1 18.1 41.8 31.6 DEATHS Total deaths 1,866 1,821 1,586 1,735 1,769 1,595 1,664 2.269 Death rate per 1,000 population 11.2 12.3 13.5 16.1 16.5 16.0 17.1 I 17.4 DEATHS OF INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 124 132 92 93 88 97 67 90 Legitimate infant deaths 105 117 73 76 76 87 62 75 Illegitimate infant deaths 19 15 19 17 12 10 5 15 Infant death rate per 1,000 births 41 49 49 52 52 65 62 58 Death rate of legitimate infants per 1,000 legitimate births 39 49 46 50 51 68 66 54 Death rate of illegitimate infants per 1,000 illegitimate births 60 47 61 67 55 48 36 95 MATERNAL DEATHS. Deaths of mothers as a result of pregnancy or child birth 4 3 4 1 3 6 2 7 Death rate of mothers per 1,000 live and still births 1.3 1.08 2.06 0.55 1.70 3.90 1.80 4.30 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000 population 47.5 55 84 76 92 68 106 81 Death rate from respiratory tuberculosis per 100,000 population 43 47 70 68 80 54 86 74 Death rate from nonrespiratory tuberculosis per 100,000 population 4.5 8 14 8 12 14 20 7 ZYMOTIC DISEASES. Death rate 0.19 0.16 0.14 0.21 0.17 0.37 0.15 0.21 5 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1947. Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 45 years and over Enteric Fever - - - - - Cerebro-Spinal Fever 1 1 - - - Whooping Cough 4 2 1 - 1 Diphtheria - - - - - Phthisis 71 - 33 38 Other forms of Tuberculosis 8 1 - 3 4 Syphilis 18 1 - - 17 Influenza 18 1 - 4 13 Measles 5 3 - - 2 Acute Poliomyelitis,etc 2 1 - 1 - Acute Infectious Encephalitis 1 - - - 1 Cancer (all forms) 294 - - 22 272 Diabetes 11 - - 4 7 Intra-cranial Vascular Lesions 183 - - 2 181 Heart Disease 488 - - 15 473 Other diseases of circulatory system 90 - - 90 Bronchitis 106 3 - 4 99 Pnoumonia 107 9 3 8 87 Other respiratory diseases 15 - - 2 13 Ulcers of the stomach 24 - - - 24 Diarrhœa (under two years) 24 22 2 - - Appendicitis 10 - - 3 7 Other digestive diseases 41 1 - 3 37 Nehritis 43 - 1 4 38 Puerperal Sepsis 2 - - 2 - Other maternal causes 2 - - 2 - Premature Birth 24 24 - - - Infantile Diseases,etc. 53 44 1 3 5 Suicide 25 - - 13 12 Road Traffic accidents 17 - 2 5 10 Other violent causes 60 6 1 12 41 All other causes 119 5 2 21 91 TOTALS 1,866 124 13 166 1,563 6 GENERAL PROVISION OP 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 1,177 Sputum 578 Faeces and urine 213 Milk (bacteriological). 126 Water (drinking) 22 Water (swimming baths) 34 Ice Cream 43 Miscellaneous 52 Care of Aged and Infirm Persons. During the year, one of the Council's medical officers made 78 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 institution under Court Order 2 Removed to suitable institution voluntarily 14 No action considered necessary 10 Died of natural causes 2 Under observation at the end of the year 3 Medicinal Baths (Personal Cleansing Station). The record of work done is as follows:– Description Scabies Vermin Impetigo Other conditions Persons Cleansings Persons Cleansings Persons Cleanisings Persons Cleansings Adults Kensington 589 1117 157 181 2 7 6 15 Other boroughs 416 764 62 71 - - 1 2 School Children. Kensington 244 868 2150 2150 17 89 7 13 Other boroughs 91 240 469 469 7 2 - - Children under 5 Kensington 117 254 56 56 15 110 - - Other boroughs 95 181 11 14 - - - - Compulsory Cleansings - - 398 398 - - - - TOTALS 1552 3424 3303 3339 36 208 14 30 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 16,471. Disinfection and Disinfestation. A summary of the routine work of the disinfecting staff is shown in the following table:– Houses disinfected after infectious disease 507 Houses disinfected after vermin 882 Loads of furniture treated with hydrogen cyanide 87 Total weight of furniture, bedding, etc., dealt with:188 tons, 11 cwt. , 1 quarter. Verminous Houses - Treatment by D.D.T. In 1946 an experimental scheme for the eradication of bugs in dwelling houses, involving the use of dichlorodiphenyl-trichlorethane (D.D.T.) was put into operation. In addition to D.D.T. in 2½% and solutions, a similar compound known as Gammexane was used as a disinfestant, and a number of rooms were treated with D.D.T. and Gammexane "smokes", Lethane was used as a "control disinfestant" in a number of cases. For the systematic operation of this scheme, four areas of the borough were selected containing approximately 3,250 houses, a large number of which were known to be bug infested. The actual spraying of these rooms took place in 1946, but the work of collating the results, involving reinspections of the rooms in 1947, was not completed until the end of the year under review, A comprehensive report, together with a detailed summary and analysis of the results obtained was submitted to the Council in December,1947, and copies were sent to the Ministry of Health, the London County Council and other authorities. The experiment showed that the most effective disinfestant used was the 5% solution of D.D.T. in kerosene, as, after very severe teste, it was successful in eradicating bugs,in 97,2% of the rooms treated. As a result of this operation, the Council decided that, in addition to routine disinfestation, a syatematlc programme for the eradication of bed-bugB should be carried out using 5% D.D.T. as the primary disinfestant. 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 recevied 1070 Premises inspected following complaint 1252 Premises where rats were found 480 Premises where mice were found 290 Premises where other vermin were found 118 Premises where no infestation existed 364 Total number of visits to all premises 9539 Total number of notices served 119 Premises successfully treated 680 Cases in which advice was given 53 Borough Council properties dealt with 72 8 Block treatment procedure, involving simultaneous baiting of all the area, was undertaken on three separate occasions at the Council's Wood Lane Depot, and it was estimated that 483 rats were destroyed. Similar treatments were undertaken on two occasions at the Council's Lots Road Depot, Chelsea, when it was estimated that a total of 44 rats were destroyed. On two occasions during the year, all the sewers in the borough were dealt with by poison bait, and it was estimated that in the first treatment 5,048 rats were destroyed, and in the second 2,795 rats were destroyed. Public Mortuary. The number of bodies taken to the mortuary during the year was 492, Inquests were held in 107 cases. Chapel of Rest, Avondale Park, This chapel was used during the year for the temporary reception of deceased persons pending burial on 18 occasions. Professional Nursing in the Homes. The total number of cases nursed by the Kensington District Nursing Association during the year was 2,166, and the number of visits paid was 54,048. On behalf of the Council, the Association visited 819 cases, paying 10,099 visits. Vaccination. In 1946, the Kensington registrars reported 1,110 births to the Vaccination Officer. By 31st January, 1948, 71.8% of these had been vaccinated or were found to be insusceptible to vaccination. The other 28.2% were accounted for as follows:- Statutory declaration of objection 9.1% Died before vaccination 3.1% Referred to other districts 4.6% Removed, leaving no trace 11.2% Postponed or unaccounted for 2% In addition, 578 certificates of successful vaccination or insusceptibility were received in respect of children living in Kensington who were born outside the borough during 1946. 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 £46. 12s, 4d. MATERNITY AND CHILD WELFARE SERVICES. On the 11th July,1947, the new Infant Welfare Centre incorporated in the Bramley House Flats, Bramley Road, was officially opened by H.R.H. The Princess Royal who was welcomed by His Worship the Mayor, the Chairman, Vice-Chairman, and other members of the Maternity and Child Welfare Committee. To this new Centre was transferred the work which had been carried out since the beginning of the war at temporary premises located in the Public Swimming Baths, Lancaster Road, W.11. At the end of the year there were in operation the following five infant welfare centres:- 9 (1) Raymede Centre, 240, Ladbroke Grove, W. 10. (2) Lancaster Road Centre, 63, Lanoaster Road, W.11. (3) Bramley Centre, Bramley House Plats, W.10. (4) Campden Hill Centre, 9, Holland Street, W.8. (5) South Kensington Centre, 10, Redcliffe Street, S.W.10. The Council's proposal to open a new Maternity and Child Welfare Centre (including an Infant Welfare Centre and Day Nursery) in South Kensington proceeded with difficulty. Eventually premises were acquired and plans were in the course of preparation by the end of the year. Owing to the changes under the National Health Service Act, 1946, it wa6 impossible for the Council to complete the scheme, and the project has now been transferred to the London County Council for completion. Health Visiting Staff. The work performed by the health visiting staff during 1947 in regard to maternity and child welfare is summarised in the following table:– First visits to infants (0-1 year) 2,546 Revisits to children (0-1 year) 6,855 Visits to children between 1 and 5 year 8,826 Stillbirth enquiries 46 visits to ophthalmia neonatorum 22 Visits to measles cases 1,751 Visits to Whooping cough cases 449 Visits to puerperal fever cases 3 Visits to enteritis cases 9 Visits to enteritis cases 169 Infantal death enquries 134 Ante—natal visits 2,626 Half-days at welfare centres 2,972 Visits to foster mothers 569 Visits to registered daily guardians 80 Others visits 3,263 Ante-natal Clinics and Infant Welfare Centres. The work at these institutions during 1947 is shown in the following table:- Sessions at which doctors attended for antenatal consultations 893 Individual mothers who attended ante-natal consultations 2,886 Attendances of ante-natal mothers 13,049 Sessions at which doctors attended for post- natal consultations 51 Individual mothers attended post-natal consultations 297 Sessions at which doctors attended for infant consultations 747 Individual children who attended for the first time:- 0-1 year 2,192 1-5 years 305 Attendances of children at doctors' consultations:- 0-1 year 8,901 1-5 years 3,915 Attendances at centres of children for all purposes:- 0-1 year 26,818 1-5 years 6,614 10 The Baby Clinic, 92, Tavistock Road. W.11. Pre-school children minor ailment treatments. Doctors' sessions held 157 Individual children attending doctors' sessions 702 Total attendances at doctors' sessions 3,391 Average attendance at doctors' sessions 22 Individual circumcision operations 188 Sessions held for dressings only 303 Attendances at dressing sessions 3,285 Sessions held for sunlight and massage treatment 209 sunlight treatments given 2,913 Massage treatments given 1,318 Total individual children attending clinic 1,316 Total attendances 11,248 Dental Treatment. The following table shows the dental treatment performed at 92, Tavistock Road during the year for expectant and nursing mothers, and children under five years:– Sessions held 159 Patients (new cases) 643 Total attendances ( all cases) 1,945 Extractions 1,753 Fillings 516 Dentures 71 Other Treatments 1,226 Borough Council's Maternity Home. Five beds at Queen Charlotte's Hospital were reserved for Borough Council patients. Details for 1947. Applications form admission 112 Application accepted 112 Applications subsequently withdrawn 9 Women confined in the home 110 The gross cost of the scheme to the Council during 1947 was £895.14s. Od. The assessments made in respect of patients whose applications were accepted and not withdrawn during the year amounted to £745.5s.0d. Payments made by patients totalled £752. 15s.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 were made by the borough councils. No charges fell directly on borough councils and the collection of contributions from patients was undertaken by the voluntary hospitals. Four additional maternity beds at Queen Charlotte's Hospital were 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 395 cases at a cost of £1,935.7s.3d. Contributions by applicants towards the cost of help provided amounted to £628.0s.9d. Domestic Helps. The Council's scheme, under Defence Regulation 68 E, for the provision of domestic help to sick or infirm persons continued in operation during the year, and, as the service became more widely known, the demand for assistance steadily increased. 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 following is a summary of the action taken during 1947:- Applications. New applications received 340 Refused as being unsuitable for help 4 Withdrawn by applications 37 Number in which help was given 299 Reasons for giving help. Chronic illness in aged persons 54 Other chronic invalids 47 Acute illnesses, accidents, etc 91 Before admission to or after discharge from hospital 50 Debilitated housewives 57 Period for which help given. One week or less 48 One to two weeks 64 Two to four weeks 109 Over four weeks 73 Costs. Full cost paid by applications 95 Part „ „ „ „ 89 Full cost paid by Council 115 Cost to Council - £3,352.12s.1d. Contributions by applicants- £503. 2s.1d. Day Nurseries. The four day nurseries, which wore established during the war, were maintained by the Council in full operation during 1947. The following table shows the total number of attendances of children at each nursery during the year:- 12 Nursery. Total attendances during the year. Ladbroke, 1, Ladbroke Square, W. 11. (45 places) 10,045 Kensal House, Ladbroke Grove, W. 10. (65 places). 14,808 St. Charles, St.Charles Square, 10. (65 places). 14,591 St. Quintin, 90,Highlever Road, W. 10. (50 places). 14,733 In addition to the attendances referred to above, two Kensington children were accommodated in nurseries under the control of the Paddington Borough Council from the 1st January to the 31st March, 1947, and the Council contributed £19.l6s.8d. towards the cost. Following enquiries into the hours worked by mothers of children attending the day nurseries, it was found that some mothers were not in full-time employment and others had failed to notify changes in their work as required by the Council's conditions of admission to nurseries. Revised rules of admission were adopted by the Council in October, 1947, with the object of ensuring that children of mothers in full-time employment were given prior consideration in the filling of vacancies in the nurseries as they occurred from time to time. On 1st July, 1947, the Ministry of Health issued Circular 119/47, which provided inter alia that, in order to bring day nurseries into line with nursery schools, liquid milk (for drinking purposes only) would be available free of charge from 1st July to all day nurseries. The amount available i6 twothirds of a pint daily for each child, and the Government reimburse the cost up to the price which is or should be paid for ordinary non-designated milk, and which does not exceed the maximum retail price. During the last six months of the year in which this arrangement was in force, the gross saving to the Council was about £350. 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 1947. 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, 72 children were cared for, and the cost to the Council amounted to £246.l8s.0d. At the end of the year, there are on the register 29 daily guardians who were caring for 29 children. Child Life Protection. Foster mothers with children at 1st January,1947 30 " " added during 1947 62 " " removed during 1947 65 " " with children at end of the year 27 13 Poster children on register at 1st January,1947 37 " " added to register during year 212 " " removed from register during year 199 " " remaining on register at end of year 50 Total visits paid to foster mothers 569 Care of Illegitimate Children. In co-operation with the Ministry of Health, the London County Council and all other London boroughs, the Council:- (a) operated a scheme of guaranteed payments to foster mothers, and (b) provided greater financial assistance to voluntary bodies. The scheme for guaranteed payments to foster mothers first came into operation in 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 1946 to 21s,0d. A scale was approved by the Council under which the weekly contribution by the mother from her own resources is assessed. In one case during 1947 the Council were required to make the guaranteed payment to a foster mother. 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 1947, Kensington's contribution remained the same, with the proviso that it covered the period up to the 4th July, 1948, when the London County Council assumed responsibility. 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 58 premature infants were notified. Of these, 50 were born at home and eight in nursing homes. Of those born at home, 44 survived at the end of one month, three infants died within 24 hours, and three others died before reaching the age of one month. Of the eight children born in nursing homes, six survived at the end of one month; the remaining two died in the first twenty-four hours. (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 areas the confinements actually occurred.) 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 7,479 Public Health (London) Act, 1936. Houses inspected on complaint 7,497 " " after infectious disease 843 Special visits to "contacts" of infectious disease 2,163 Re-inspections 12,504 Inspections in regard to overcrowding 4 Inspections of mews 287 Other inspections 2,807 Housing Act,1936. Initial inspections (including preparation or revision of house-to-house cards) 422 Re-inspections 727 Inspections in regard to overcrowding 532 Underground Living Rooms. Primary inspections 2,511 Re-inspections 3,007 Scabies Order. Inspections 554 Drainage. Applications 213 Plains sumitted 93 House drains tested and inspected 2,220 Building Licences. Inspections 5,167 Shops Act. Inspections 912 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 3,376 Statuory notices 1,266 Final notices 402 Various. Rent Restriction Act certificates 18 Report of waste of water to the Metropolitan Water Board 105 Report of dangerous structures to the London Country Council 124 Other notices 118 15 The following is a summary of works completed under the supervision of the sanitary inspectors during the year:- House drains reconstructed 53 " " additions to 94 Defective drains repaired 275 House drains cleansed 316 Water closets reconstructed 115 " " repaired 306 " " new provided 156 " " supplied with water 227 Soil pipes, ventilated, repaired, etc 88 " " new provided 110 Ventilating pipes new provided 85 Baths, new provided 136 Sinks, new provided 162 Lavatory basins, new provided 274 Waste-pipes, new provided 266 Cisterns cleansed 41 " covered 25 Taps fixed on rising main 22 Yards and areas paved, drained, etc 28 Dustbins provided 339 Accumulations of filth, etc., removed 235 Animals removed 14 Roofs repaired 1,445 Houses provided with water above basement level 87 Dampness in dwellings remedied 1,779 Infectious disease cases removed 179 Houses disinfected after infectious disease (including bedding, etc. ) 507 Rooms in such houses disinfected after infectious disease 643 Houses cleansed under Houses Let in Lodgings By-laws 184 Cleansing of house not on register 174 Verminous houses cleansed (including bedding, clothing, etc.) 882 Verminous roons in such houses cleansed 2,271 Dirty bedding cleansed 108 " " destroyed 12 Other sanitary works executed 3,308 Training of Sanitary Inspectors. Owing to the fact that all training of sanitary inspectors was suspended throughout the period of the war there was a scarcity of qualified men for public health work. In cooperation with the Ministry of Labour, the Council adopted a scheme of training for sanitary inspector students involving a two years' course of study. Students are required to work full-time in the public health department where they receive practical training in the duties of a sanitary inspector, and attend, at their own expense, an approved course of study at a recognised technical institute during the evenings. In the first year the Ministry of Labour grant eligible students subsistence allowances, and, in the second year, the Council employ these men as assistants to the sanitary inspectors, subject to the usual conditions of service. During the year, six ex-service men were accepted by the Council as students under this scheme, and the results, so far, have been satisfactory. 16 HOUSING. Inspection of dwelling houses during the year. (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 11,273 (b) Inspections made for the purpose 30,313 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 422 (b) Inspections made for the purpose 1,149 (ill) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 20 (iv) Dwelling houses (excluding those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,376 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 2,110 Action under statutory powers 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 93 (ii) Dwelling houses which were rendered fit after service of formal notices 43 (b) Proceedings under Public Health Acts:- (i) Dwelling houses in respect of which notices were served requiring defects to be remedied 1,266 (ii) Dwelling houses in which defects were remedied after service of formal notices:(a) by owners 1,265 (b) by local authority in default demolition orders were made 1 (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (i) Dwelling houses in respect of which demolition orders were made 20 (ii) Dwelling houses demolished in pursuance of demolition orders 8 (d) Proceedings under Section 12 of the Housing Act, 1936:- (i) Separate tenements or underground rooms in respect of which closing orders were made (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit (iii) Separate tenements or underground rooms in respect of which closing orders operate, but where the Council consented during the year to the use of the rooms for purposes other than sleeping 17 Despite the shortage of housing accommodation, a considerable measure of success has been achieved as will be seen from the following table:- 1. New cases reported to the Sub-Committee during 1947 80 (a) Cases in which the Sub-Committee recommended that alternative accommodation should be offered by the Council 26 (b) Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 27 (c) Cases where action was postponed 22 (d) Cases withdrawn or where no action was taken 5 2. Cases in which overcrowding was abated during the year 81 FACTORIES. 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, but has now been re-instated. The following tables contain a summary of the inspections made and the defects found and remedied within the borough during 1947:- Inspections. Premises Number on Register. Number of Inspections. Number of Written Notices. Factories with mechanical power 347 634 19 Factories without mechanical power 406 458 42 Other premises under the Act.(Including works of building and engineering construction but not including out-workers' premises.) - -, _ TOTALS 753 1,092 61 Overcrowding. A special Sub-Committee of the Public Health Committee considers all cases of overcrowding with a view to deciding what action should be taken. 18 Defects Found. Particulars Number of defects found. Number of defects remedied. Number of defects referred by H.M.Inspector. Want of cleanliness 9 9 - Overcrowding 1 1 - Unreasonable temperature - - - Inadequate ventilation - - - Ineffective drainage of floors - - - Sanitary conveniences:- (a) insufficient 5 5 1 (b) unsuitable or defective 49 45 1 (c) Not separate for sexes. 2 2 - Other offences (not including offences relating to Homework) 2 2 - TOTALS 68 64 2 During 1947, no prosecutions were instituted under the Factories Act,1937. Outworkers. The following table shows the nature of the work carried out by the 288 home workers on the register of outworkers during 1947:- Nature of Work. Number Wearing apparel:- (a) Making, etc. 132 (b) Cleaning and washing 4 Household linen 3 Furniture and upholstery 1 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. 56 Stuffed toys 53 Basket making 1 Cosaques, crackers, stockings, etc. 9 Miscellaneous 24 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. 19 INSPECTION AND SUPERVISION OF FOOD Milk. Three hundred and forty-four samples of milk were submitted to the public Analyst during the year and all were found to be of genuine composition. 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. Month No. of samples taken Average Percentage. Milk fats Non fatty solids Milk fats Non fatty solids January 6 3.47 8.95 July 68 3.42 8.97 February 32 3.45 8.84 August 12 3.44 8.98 March 25 3.35 8.80 September 12 3.56 8.85 April 9 3.37 8.75 October 72 3.62 8.96 May 6 3.25 8.84 November 15 3.68 8.76 June 47 3.33 9.03 December 40 3.45 8.66 Legal Minimum Standards:- Milk fats - 3.00. Non-fatty solids - 8.50. Milk (Special Designations) Regulations. 1936/1946. The above regulations provide for licensed dairymen to use the designation tuberoulin 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 23 4 Dealers licensed to sell pasteurised milk 70 4 Twenty-six samples of tuberculin tested milk were submitted for examination, and of these 16 failed to pass the prescribed tests. Twenty-three samples of tuberculin tested (pasteurised) milk and 59 samples of pasteurised milk were submitted for examination. Four of the tuberculin tested (pasteurised) samples and two of the pasteurised milks failed to pass the prescribed tests. 20 In March, 1946, the Milk (Special Designations) Regulations, 1946, came 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 1946 Regulations these standards were abolished, and the phosphatase and methylene blue tests were substituted for these grades of milk. Heat Treated 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 Food 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 shows the number of samples of processed milk taken during the year, together with the results of the examinations. ! Grade. Number of samples. Methylene blue test. Phosphatase test. Passed. Failed. Passed. Failed. Tuberculin tested (pasteurised). 23 19 4 21 2 Pasteurised. 59 59 - 57 2 Heat treated. 14 12 2 13 1 Sterilised. 4 3 1 3 1 TOTALS 100 93 7 94 6 Warning letters were sent to the vendors of the unsatisfactory samples. Adulteration of Food. Three hundred and seventy-nine formal samples of food and drugs were taken, of which seven (1.84%) were adulterated Six hundred and twenty-one informal samples were taken, of which seven (1.12%) were adulterated. 21 Unsound Food. Seizure. Under Section 10 of the Pood 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 were two instances during the year of food being seized and condemned. In each case, the Public Health Committee decided to warn the vendor. 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 or other suitable method of disposal. During the year, surrender was made of 12,176 tins of various foods, and 39 tons, 8 cwt. 3 qrs. of other foods, the principal items of which were:– Tons. Cwt. Qrs. Lbs. Fruit 29 3 1 9 3 18 2 1U Fish 2 - - 8 Meat and Bacon 1 1 1 21 Butter, cheese, etc 18 - 23 Sugar 5 - 1 Poultry and rabbits . ... k 1 1 2 - 2 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 137. Of this number 12 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 seven 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. During the year the Minister of Health asked the Council to undertake a survey of disused artesian wells as it was thought that the bombing of London might have increased the danger of pollution, both from damaged buildings and from the abandonment of wells formerly in use. This survey was undertaken and a detailed report submitted to the Council and to the Minister of Health. There are eight disused wells in the borough but there does not appear to be any risk of pollution from them. 22 Ice-Cream. The prohibition of the use of milk products in the manufacture of ice-cream continued to operate throughout the year, and, although a small amount of margarine was allocated to manufacturers, the nutritional standard of ice-cream generally was low. Chemical analyses reveal that the fat content of ice-cream was seldom above 2.6%; the Council, in representations made to the Minister of Health considered that the fat content should not be less than 8%. The Ice-Cream (Heat Treatment, etc. ) Regulations, 1947, came into force on the 1st May and generally require that, subject to certain qualifications, the ingredients of icecream shall be heat treated after being mixed and then reduced to, and kept at, a temperature of 45°F. until freezing before sale; that the apparatus used for the purpose shall be installed, maintained and operated to the satisfaction of the Borough Council; that the ice-cream shall be protected from contamination, and that apparatus and utensils used shall be kept clean. The Minister of Health has stated that he is unable to impose a bacteriological standard for ice-cream, but drew attention to a form of methylene blue test which provides for the categorisation of ice-cream into one of four grades. It is suggested that if ice-cream consistently fails to reach Grades 1 or 2, it will be reasonable to assume the existence of defects in manufacture calling for investigation. During the year 43 samples were taken and submitted to the methylene blue test and the results were as follows:- Grade No. of samples. 1 8 2 11 3 15 4 9 LEGAL PROCEEDINGS. Public Health (London) Act. 1936. Nuisances. During the year 54 summonses were issued for various nuisances under the Public Health (London) Act,1936. In 33 cases abatement or prohibition orders were secured and fines amounting to £54 were imposed and costs were awarded to the Council amounting to £2.12s.0d. In the remaining 21 cases the summonses were withdrawn, the nuisances having been abated. Seven prosecutions were undertaken for failure to comply with Justices Orders, In four cases further penalties amounting to £28 were imposed; in two cases a daily penalty of £1 each was imposed, and in the seventh case a daily penalty of 2/- was imposed. Drainage Bye-laws. Pour summonses were issued in respect of contraventions of the Drainage Bye-laws. In three cases each hearing was adjourned as the defendant undertook to make the drainage work comply with the Bye-laws. The fourth case was dismissed under the Probation of Offenders Act. Food and Drugs Act. 1938. Three prosecutions under this Act were instituted during the year. In one case penalties amounting to £4.2s.0d. were imposed; the second case was dismissed under the Probation of Offenders Act, the Council being awarded 1/- costs; and in the third case the summons was dismissed. 23 Milk and Dairies Order. Two prosecutions under this Order were instituted in respect of the dirty condition of milk bottles. In each case a penalty of £5 and costs to the Council of £1.1s.0d. were imposed. Council's B.ye-laws. Dog Nuisances. Six cases wore successfully prosecuted and fines amounting to £2.15s.6d. were imposed. Housing Act. 1936. Overcrowding. In seven cases summonses were issued in respect of overcrowding offences. In three cases convictions were obtained and fines amounting to £10 were imposed. In the remaining four cases the summonses were withdrawn as the overcrowding had been abated. Contravention of Closing Orders. Five summonses were issued in respect of the illegal occupation of underground rooms. Convictions were obtained in four cases and fines amounting to £4.10s.6d. were imposed. In the fifth case the summons was withdrawn as the contravention had been abated. INFECTIOUS DISEASE. The following table shows the number of cases of infectious disease notified during the year 1947, with comparative figures for the previous seven years:- Notifiable disease. Number of cases notified. 1947 1946 1945 1944 1943 1942 1941 1940 Scarlet Fever. 98 195 136 74 216 108 91 82 Diphtheria (including Membranous Croup.) 23 37 19 29 54 78 86 54 Enteric Fever. 4 6 3 3 3 1 16 11 Puerperal Fever. 3 4 7 18 10 7 1 6 Puerperal Pyrexia. 9 8 12 23 25 7 11 18 Acute primary pneumonia and acute influenzal pneumonia. 103 111 81 91 133 91 65 59 Dysentery. 21 49 142 43 73 68 25 15 Erysipelas. 34 37 33 16 37 30 43 47 Cerebro-spinal meningitis 7 10 3 6 11 17 22 45 Malaria. 4 8 11 8 1 1 — — Poliomyelitis and encephalitis. 27 1 3 1 1 2 2 1 Encephalitis lethargica. 2 - 1 — — - — 1 Tuberculosis (all forms). 259 210 188 211 202 203 234 200 Measles. 852 264 868 102 624 365 366 242 Ophthalmia neonatorum. 4 4 8 4 11 4 3 9 Enteritis. + 102 69 100 71 69 96 48 12 Food poisoning. 7 7 6 7 4 8 2 6 Acute rheumatism.* 11 15 32 11 9 6 2 6 Scabies. /- 239 463 460 363 252 - - - Whooping Cough. 274 209 62 189 102 146 176 16 + Notifiable only in children under the age of 5 years. * 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. 24 Diphtheria Immunisation. The following table shows the diphtheria immunisation work carried out during the year:- Pre-school children immunised 1,471 School children immunised 345 Children attending for pre-immunisation Schick tests 414 No, who gave positive re-action 174 Children attending for schick tests after being immunised 2,896 Number proving negative 2,554 Number proving positive 212 Number who failed to attend for readings 130 Number of "re-inforcing" doses given to immunised children 495 On 14th November, 1945, the Minister of Health issued Circulars 193/45 and 194/45, 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. 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 figures for 1947 in regard to immunisation of the child population already supplied to the Minister are as follows:- Age of children at 31st Dec., 1947. Total number immunised. Under 1 year 475 Between 1 and 2 years 1,043 II 2 " 3 " 15575 11 3 „ 4 11 911 11 4 " 5 " 898 11 5 " 9 " 5,770 " 9 " 15 " 5,785 Total. 15,578 Estimated child population for the borough in mid-year 1947: Up to 5 years 9,680 Between 5 and 15 13,570 Acute Rheumatism in Children. Acute rheumatism in children under 16 years of age has been a notifiable disease in Kensington since 1927. 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. 25 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 Kensington children made a total of 523 attendances. One of the Council's health visitors attended each session to act as liaison officer, and she made 273 visits to the homes of the patients. 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 again made their customary annual grant of £200 towards the running costs. During the year 805 new patients were examined. The following are the percentages of the chief disease groups seen:- Fibrositis Osteo-arthritis 45% 30% Rheumatoid and infective arthritis 15% Gout 5% Ankylosing spondylitis 5½ Various forms of electrical treatment, massage, injections, etc., were available for patients. (b) The British Red Cross Society's Rheumatism Clinic at 15, Holland Park Gardens, continued to function satisfactorily, and 438 patients attended. During 1947 a laboratory of clinical pathology was completed and fully equipped, providing facilities for the treatment, investigation and diagnosis of rheumatic conditions. In addition, all treatment rooms were reequipped with up-to-date apparatus. The Council made their customary annual grant of £70 towards the running costs. TUBERCULOSIS. Notifications. During the year, 259 new cases of tuberculosis were notified, of which 233 were respiratory and 26 non-respiratory cases. Death Rate. Seventy-one persons died from respiratory tuberculosis and eight from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 43 and that for nonrespiratory tuberculosis 4.5. The rate for all forms of tuberculosis was 47.5. 26 Dispensary Service. One thousand and fifty-five new patients were examined. Of these, 288 were found to be suffering from respiratory tuberculosis, 27 from non-respiratory tuberculosis, 74 were still under observation for diagnosis at the end of the year, and 666 were found to be 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 F M F On register of notifications on 1 st January, 1947. 404 392 52 51 899 Notified for the first time during the year. 127 106 12 14 259 Brought to notice other than by notification 63 57 4 10 134 Cases removed from register on account of having - . (a) recovered from disease. 9 4 4 17 (b) removed from district, lost sight of, etc. 83 70 14 8 175 (c) died. 45 33 3 3 84 Remaining on register on 31st December,1947. 457 448 51 60 1,016 Specimens of sputum examined were 578, of which 107 were found to contain tubercle bacilli; 1,665 radiological examinations were made; and 2,688 visits were paid to the homes of patients by the health visitors. Nine patients made thirty-seven attendances at the dental clinic. One hundred and twenty three patients received 2,377 artificial pneumothorax treatments. Grants of extra nourishment were made in 52 cases; beds and bedding were loaned to 14 patients; and the district nurses attended 20 patients in their homes and paid a total of 2,004 visits. Allowances for Tuberculous Persons Undergoing Treatment. The Government's scheme to give maintenance allowances to tuberculous persons undergoing treatment was continued throughout 1947. 27 The allowances were payable to patients for their own maintenance and that of their dependants whilst the patients were waiting to go away for treatment, whilst undergoing treatment, or after discharge if, in the opinion of the Tuberculosis Officer, they were not fit to return to work. The Tuberculosis Officer had the power to continue the allowance for two periods of six months after discharge from a sanatorium. In exceptional cases, the allowance was continued for a further period at the discretion of the Minister of Health. In addition, the incomes of persons able to do part-time work only were supplemented through the scheme. Some patients undergoing treatment in institutions, although having no dependants, had no income of any 6ort. In these cases, pocket money was allowed under the scheme and was paid to them by the steward of the institution. During the year, patients received allowances classified as follows:- Maintenance allowances 149 Special allowances 52 Discretionary allowances 58 The amount disbursed during the year was £5,563.8s.1d. CONCLUSION. On behalf of Dr. Penton and 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, VIOLET I.RUSSELL Acting Medical Officer of Health.