LIBRARY AC 4348 KEN 57 THE ROYAL BOROUGH OF KENSINGTON ANNUAL REPORT on the HEALTH OP THE BOROUGH for the Year 1948 by JAMES FENTON, C.B.E., M.D., M.R.C.P., D.P.H. Medical Officer of Health. 29th June, 1949. Town Hall, Kensington, W. 8. THE ROYAL BOROUGH OF KENSINGTON Public Health Department, Town Hall, KENSINGTON, W.8. 29th June, 1949. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lords, Ladies and Gentlemen, I have much pleasure in presenting the Annual Report on the state of the public health in Kensington in 1948. The Minister of Health has requested that the report should be submitted in an abbreviated form, as has been the case each year since the outbreak of the last war. The year under review saw the commencement of the operation of the National Health Service Act, the National Insurance Act and the National Assistance Act. These measures brought about great changes in the social welfare services of the country. As might be expected the year proved a very heavy one for public health departments generally; indeed, I remember no period when the responsibilities of health officers were greater. The Kensington maternity and child welfare and tuberculosis dispensary services were transferred mainly to the London County Council but partly to the Regional Hospital Board on 5th July, 19U8. The Borough Council had devoted thirty years to the building up of these services and, whilst they regretted losing them, they determined that, Parliament having so decided, they would do everything possible to smooth the task of the authorities taking over. The Council recognised that large public authorities assuming new responsibilities over a wide area would take some little time to "get into their stride", and they gave instructions that as far as Kensington was concerned such steps should be taken as would enable the services to operate efficiently from the day of transfer. The changes involved the departure from the Council's service of a number of valuable officers. These included Dr. Charles P. Hay, the Deputy Medical Officer of Health, who went to a Regional Hospital Board in April, 1948; Dr. Violet I. Russell, who was transferred on the 5th July,19U8, to the London County Council and is now Assistant Divisional Medical Officer for the L.C.C. area which includes Kensington; and Miss K.M. Roe, who is now Divisional Nursing Officer in a London County Council Divisional area. These officers and many others of those transferred had bbtained nraph experience in Kensington. Their work had been highly regarded by the Borough Council and it is satisfactory to record that the majority of them are still working in Kensington although for another authority. During the autumn, when I was absent from duty, Dr. Russell - by arrangement with the County Council - carried out my duties with efficiency. 2 Members of the staff of the Public Health Department, both those who were transferred to other authorities and those who remained in the service of the Council throughout the year, worked loyally during a very strenuous period; and they showed great enthusiasm in their endeavour to give effect to the wishes of the Council in this transition period. With the transfer of all the medical staff except myself, the Borough Council resolved to appoint a Deputy Medical Officer of Health. The successful candidate was Dr. C.D.L. Lycett, who took up his duties on 1st November. Although the Borough Council have now ceased to be responsible for the transferred services, arrangements have been made under which the Borough Medical Officer of Health carries out the day to day supervision of them, and in respect of these duties for the County Council, the Borough Council will, in due course, receive a grant. As I have continued to supervise the services it is possible to report from intimate knowledge that the transfer was effected smoothly and the services are still continuing to give the same benefits to Kensington residents as were enjoyed when the Borough Council had control. The pioneer work which the Borough Council had carried out for many years has laid a good foundation for such development as may from time to time be required. GENERAL OBSERVATIONS The estimated population of Kensington (168,600) showed a further slight increase in 1948 over that for the previous year (166,170), and the borough has nearly recovered the loss of population which resulted from evacuation in the early days of the war. The general public health of the borough remained satisfactory during the year. The maintenance of reasonable standards of fitness in existing housing accommodation continued to present difficulties; and it is noteworthy to record that in the process of enforcing the 3,086 Public Health Act repair notices served by the Council's sanitary inspectors, it was necessary to apply to the Court for 240 summonses. This is a high percentage and compares with an average annual number of twelve summonses in the ten years before the war. The shortage of labour and materials has been partly the cause of the increased difficulty in inducing owners to undertake repairs to their property, but the Council have been concerned with the health and the comfort of the residents, and they have not allowed temporary difficulties to enable owners to escape their responsibilities. The Council's programme of repair of war damaged houses up to the permitted standard was completed during the year. This proved a heavy task for all Departments of the Council, and it was as a result of good co-operation that such satisfactory results were achieved,, A commencement was made in building operations on the Council's new housing schemes at Becher Street, Portobello Street and Rackham Street; and completion of the proposed 575 flats and houses can be anticipated in the next year or two. 3 During the year the Government relaxed the conditions under which building licences could be granted to owners of private property, and this enabled many to undertake repairs which have brought about a cleaner and tidier appearance in the borough generally., The Council are still presented with frequent complaints about the unsightly appearance of open bombed sites., Representations have been made to the Metropolitan Boroughs Standing Joint Committee, and after lengthy negotiations, the Council have been able to make a by-law to control to some extent the condition of these sites. This by-law will come into force in 1949. BIRTH RATE. The number of Kensington live births in 1948 was 2,908 compared with 3,012 in the previous year. There was a gradual increase of the birth rate during the war up to the peak of 18„2 births per 1,000 population in 1946. There has, since then, been a gradual fall, and in 1948 the figure was 17.2 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 38 in 1948. The previous lowest record was 41 in 1947. In this connection it is worth noting that the Council's work in relation to the care of infants, which commenced officially under the Maternity and Child Welfare Act, 1918, has been accompanied by a great reduction of the infant death rate from 102 in 1919 to the present figure of 38. This enormous decline represents a saving of over 60 infant lives out of every thousand born. This in itself must give much gratification to members of the Borough Council who have been taking part in the administration of the maternity and child welfare services during the last thirty years; but, for the life of each child saved from any particular disease„ there must be other children attacked by that disease who, whilst not dying, were injured or handicapped throughout life in some way or other. It is this reduction in invalidity and handicapping which is perhaps even more gratifying than the reduction in the death rate itself. It means that many more children are able to lead healthier and happier lives, less handicapped by defects arising in infancy. GENERAL DEATH RATE. The general death rate in 1948 was 10, which is the lowest ever recorded in the borough. O0O VITAL STATISTICS The table set out on the next two pages gives the important vital statistics for 1948, together with comparative figures for the previous seven years. 4 SUMMARY OP VITAL STATISTICS FOR KENSINGTON Description 1948 1947 1946 1945 1944 1943 1942 1941 POPULATION. Population (estimated) 168,800 166,170 147,870 117,170 107,610 106,830 99,310 97,180 Density of population per acre 74 72 64 51 47 46.6 43 43 LIVE BIRTHS. Total births 2,908 3,012 2,695 1,890 1,780 1,698 1,487 1,239 Legitimate births 2,608 2,696 2,378 1,579 1,527 1,479 1,280 1,099 Illegitimate births 300 316 317 311 253 219 207 140 Birth rate per 1,000 population 17.2 18.1 18.2 16.1 16.5 15.9 15.0 12.7 STILL BIRTHS. Total still births 56 65 68 49 47 46 27 54 Legitimate still births 47 58 60 40 44 39 23 45 Illegitimate still births 9 7 8 9 3 7 4 9 Still birth rate per 1,000 total births 18.9 21.1 24.6 25.3 25.7 27.1 18.1 41.8 DEATHS. Total deaths 1,685 1,866 1,821 1,586 1,735 1,769 1,595 1,664 Death rate per 1,000 population 10 11.2 12.3 13.5 16.1 16.5 16.0 17.1 DEATHS OF INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 111 124 132 92 93 88 97 67 Legitimate deaths 103 105 117 73 76 76 87 62 Illegitimate deaths 8 19 15 19 17 12 10 5 Infant death rate per 1,000 births 38 41 49 49 52 52 65 62 Death rate of legitimate infants per 1,000 legitimate births 39 39 49 46 50 51 68 66 Death rate of illegitimate infants per 1,000 illegitimate births 27 60 47 61 67 55 48 36 MATERNAL DEATHS. Deaths of mothers as a result of pregnancy or childbirth 5 4 3 4 1 3 6 2 Death rate of mothers per 1,000 live and still births 1.68 1.3 1.08 2.06 0.55 1.70 3.90 1.80 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000population 51 47.5 55 84 76 92 68 106 Death rate from respiratory tuberculosis per 100,000 population 45 43 47 70 68 80 54 86 Death rate from nonrespiratory tuberculosis per 100,000 population 6 4.5 8 14 8 12 14 20 ZYMOTIC DISEASES. Death rate 0.11 0.19 0.16 0.14 0.21 0.17 0.37 0.15 5 6 CAUSES OP DEATH AT DIFFERENT PERIODS OF LIFE IN 1948. Cause of death All ages. Under 1 year 1 year and under 5 5 years and under U5 45 years and over Enteric Fever - - - - - Cerebro-spinal Fever 1 - - 1 - Whooping Cough 5 3 2 - - Diphtheria 1 - - - 1 Phthisis 76 1 1 42 32 Other forms of Tuberculosis 10 - 4 4 2 Syphilis 9 - - - 9 Influenza 2 - - - 2 Measles 2 1 1 - - Acute Poliomyelitis etc. - - - - - Acute Infectious Encephalitis - - - - - Cancer (all forms) 321 - - 22 299 Diabetes 9 - - 1 8 Intra-cranial Vascular Lesions 149 - - 5 144 Heart Disease 432 - 1 12 419 Other diseases of circulatory system 81 - - 3 78 Bronchitis 78 3 - 6 69 Pneumonia 83 12 2 1 68 Other respiratory diseases 20 - 1 1 18 Ulcers of the stomach 25 - - 1 24 Diarrhoea (under two years) 10 10 - - - Appendicitis 4 - - 1 3 Other digestive 39 1 - 2 36 diseases Nephritis 50 - - 6 44 Puerperal Sepsis 1 - - 1 - Other maternal causes 4 _ - 4 - Premature Birth 29 29 - - - Infantile diseases etc. 52 45 2 2 3 Suicide 28 - - 10 18 Road Traffic Accidents 10 - 2 4 4 Other violent causes 49 1 1 15 32 All other causes 105 5 - 19 81 TOTALS 1685 111 17 163 1394 7 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, ear and throat swabs 940 Sputum 926 Rectal and other swabs 756 Faeces and urine 907 Milk (bacteriological) 134 Water (drinking) 9 Water (swimming baths) 12 Ice Cream 52 Miscellaneous 18 The Council's bacteriological work has been carried out by the Wright Fleming Institute at St. Mary's Hospital, Paddington, since 191+6, at a cost to the Council of £1+30. per annum. During the year it became possible to make arrangements for the Central Public Health Laboratory Service at Hendon to undertake the work free of charge, provided the Council undertook to arrange for the transport of the specimens. The change will effect a financial saving to the Council and accordingly the contract with the Wright Fleming Institute was cancelled. The Central Laboratory commenced carrying out the bacteriological work on 1st January, 19U9. Medicinal Baths (Personal Cleansing Station) The record of work done is as follows:- Description Scabies Vermin Impetigo Other conditions Persona Clean -sings Persons Clean -sings Persons Clean -sings Persons Clean -sings Adults Kensington 270 511 172 191 - - 6 31 Other boroughs 164 301 71 81 - - - - Schoolchildren Kensington 126 602 2080 2080 5 50 11 54 Other boroughs 59 145 466 466 2 15 1 1 Children under 5 Kensington 77 142 50 50 2 9 1 2 Other boroughs 26 53 18 18 - - - - Compulsory Cleansinfis - - 320 320 - - - - TOTALS 722 175U 3177 3206 9 74 19 88 8 In addition to the cleansing of persona referred to above, articlea of personal clothing disinfested at the Medicinal Baths during the year numbered 5,716. Diainfection and Diainfeatation A aummary of the routine work of the diainfecting ataff ia 8hown in the following table Houaes diainfected after infectioua diaeaae 490 Houaea disinfested after vermin 1,747 Loads of furniture treated with hydrogen cyanide 54 Total weight of furniture, bedding, etc. dealt with:- 147 tons, 5 cwt. , - quarter, 4 lb. Destruction of Rats and Mice Work under the Rats and Mice (Destruction) Act, 1919, and the Infestation Order, 1943, continued during the year and the following is a summary of the action taken:- Complaints investigated 1,253 Premises inspected following complaint 1,463 Premises where rata were found 506 Premiaea where mice were found 595 Premiaea where other vermin were found 107 Premiaea where no infeatation exi8ted 355 Number of visita made 10,324 Number of notices served 115 Premises successfully treated 905 Cases in which advice only was given 79 Borough Council properties dealt with 437 Block treatment procedure, involving simultaneous baiting of an entire area, was undertaken during the year at the Council's Wood Lane Depot, and it was estimated that 140 rats were destroyed. On two occasions all the sewers in the borough were dealt with by poison bait, and it was estimated that in the first treatment 4,915 rats were destroyed! and in the second 3,880 rats were killed. The responsibility for rodent control paseed from the Mini8try of Pood to the Miniatry of Agriculture and Pi8heriea and, aa from 1st April, 1948, all government granta were 8uperaeded by a conaolidated grant of 50% of the approved net expenditure, subject to compliance with the following conditions:- (i) that the Council maintain an organisation adequate for effective rodent control according to the condition of infestation in the area, and adopt the methods recommended by the Miniatry; (ii) that apecial attention ia paid to efficient rodent control in aewera, refuae dumpa, refuae deatructora and other local authority propertiea, in accordance with guidance given by the Miniatry; and 9 (iii) that effective action is taken to control rats and mice in all surface properties to which directions given under the Infestation Order, 1943, apply. The expenditure ranking for grant is that incurred on:- (i) administration and execution of the conditions set out in paragraph (i) above; (ii) treatment of sewers, refuse destructors and dumps and other local authority properties; (iii) treatment of private dwellings, after deduction of receipts, if any, from occupiers for work done by the Council; and (iv) such other expenditure as the Ministry may approve. No grant aid will be given in respect of expenditure on the treatment of infestations at commercial or industrial premises, the intention of the Ministry being that such expenditure shall be fully recovered from the occupiers and should not fall on public funds. Public Mortuary The number of bodies taken to the mortuary during the year was 430. Inquests were held in 100 cases. Chapel of Rest, Avondale Park This chapel was used during the year for the temporary reception of deceased persons pending burial on two occasions only. Owing to the growth of other facilities for the temporary reception of deceased persons in recent years, there has been a rapidly diminishing demand for the service provided by the Council at the Chapel of Rest. The Council have therefore decided to close this chapel, and at the present time consideration is being given to plans for the conversion of the building into a branch public library. Burial of the Dead Section 50 of the National Assistance Act, 1948, imposes on the Council the duty to arrange for the burial or cremation of any person who dies or is found dead within the borough, where no suitable private arrangements are made for the disposal of the remains. This section came into force on 5th July, 1948, and the Council authorised the Medical Officer of Health to make arrangements for the burial of any person to whom it applies. This work was previously carried out by the London County Council through their public assistance officers. Arrangements were made to use the same contractors as were used by the County Council. The cost of the funeral varies according to the circumstances of death and the age of the deceased person, but the maximum charge is £10. Is. Od., including the fee for interment in a common grave at the Council'8 Cemetery at Gunnersbury. The expenses may be recovered from the estate of the deceased person or from any person liable for his maintenance at the time of death, except in so far as the expenses can be recouped from death grants payable under the National Insurance Act, 1946. (Death grants are not payable in any circumstances until after the 5th July, 1949.) 10 Prom 5th July to the end of the year, 32 persons, who died within the borough, were buried under the National Assistance Act, 1948. In 14 cases the full expenses have been recovered; in 12 other cases part of the expenses have been received; and in the remaining 6 cases the full cost has had to be borne by the Council The total cost to the Council amounted to £260. 18s. 0d., of which £158. 17s. lOd. has been recovered. Removal of aged and infirm persons to institutions, etc. Since 1936, the Council have had the power, under Section 224 of the Public Health (London) Act, 1936, to apply to the Court for an order to remove to suitable institutions any aged, infirm or physically incapacitated person living under insanitary condition Prom 5th July, 1948, this power was revoked and Section 47 of the National Assistance Act, 1948 re-enacted it with slight modifications. During the year under review it was not found necessary to take action, either under the Public Health (London) Act or under the National Assistance Act, to remove compulsorily any aged, infirm or physically incapacitated person living under insanitary conditions. SANITARY INSPECTION The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year:- 6,750 Public Health (London) Act, 1936 Houses inspected on complaint 6,750 Houses inspected after infectious disease 1,552 Special visits to "contacts" of infectious disease 1,351 Re- inspections 14,626 Smoke observations 28 Inspections of mews 333 Other inspections 2,654 Housing Act, 1936 Initial inspections (including preparation or revision of house-to-house cards) 279 Re-inspections 1,827 Inspections in regard to overcrowding 2,571 Underground Living Rooms Primary inspection 1,367 Re-inspection 3,400 Scabies Inspections 434 Drainage Applications 184 Plans submitted 140 House drains tested and inpected 3,650 Building licences Inspections 2,688 Shops Acts Inspections 945 11 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 3,086 Statutory notices 1,939 Final notices 959 Various Rent Restrictions Act certificates 15 Report of waste water to the Metropolitan Water Board 89 Report of dangerous structures to the London County Council 113 Other notices 53 The following is a summary of works completed under the supervision of the sanitary inspectors during the year (excluding war damage repairs) House drains, reconstructed 67 House drains, additions to 56 Defective Drains,repaired 259 House drains, cleansed 283 Water closets, reconstructed 78 Water closets, repaired 279 Water closets, new provided 236 Water closets, supplied with water 160 Soil pipes ventilated, repaired etc. 91 Soil pipes new provided 120 Ventilating pipes, new provided 122 Baths, new Provided 161 Sinks, new provided 144 Lavatory basins, new provided 416 Waste pipes, new provided 471 Cisterns, Cleansed 19 Cisterns, covered 18 Taps fixed on rising main 6 Yards and areas paved, drained, etc. 36 Dustbins provided 306 Accumulations of filth, etc., removed 135 Animal removed 10 Roofs repaired 1,432 Houses provided with water above basement level 101 Dampness in dwellings remedied 1,536 Infectious disease cases removed 366 Houses disinfected after infectious disease (including bedding, etc.) 490 Rooms in such houses, disinfected after infectious disease 700 Houses cleansed under Houses Let in Lodgings Bylaws 83 Cleansing of houses not on register 577 Verminous houses cleansed (including bedding, clothing, etc.) 1,747 Verminous rooms in such houses, cleansed 4,767 Dirty bedding, cleansed 80 Dirty bedding, destroted 6 Other sanitary works executed 4,076 12 HOUSING Inspection of dwelling houses during the year (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 11,519 (b) Inspections made for the purpose 34,026 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 279 (b-) Inspections made for the purpose 2,106 (iii) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (iv) Dwelling houses (excluding those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,207 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 1,147 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 121 (ii) Dwelling houses which were rendered fit after service of formal notices 87 (b) Proceedings under Public Health Acts:- (i) Dwelling houses in respect of which notices were served requiring defects to be remedied . 3,086 (ii) Dwelling houses in which defects were remedied after service of formal notices: - (a) by owners 1,939 (b) by local authority in default of Owndrs - (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (i) Dwelling houses in respect of which demolition orders were made 3 (ii) Dwelling houses demolished in pursuance 15 (d) Proceedings under Section 12 of the Housing Act,1936:- (i) Separate tenements or underground rooms in respect of which closing orders were made 189 (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 33 (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 169 13 Overcrowding A special Sub-Committee of the Public Health Committee consider all cases of overcrowding with a view to deciding what action should be taken. 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 1948 164 (a) Cases in which the Sub-Committee recommended that alternative accommodation should be offered by the Council 79 (b) Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 10 (o) Cases where action was postponed 57 (d) Cases withdrawn or where no action was taken 18 2. Cases in which overcrowding was abated during the year 85 FACTORIES The provision of 8ection 128 of the Factories Act, 1937, requiring the. Medical Officer of Health to make an annual report in regard to the Council's functions under the Act, was suspended during the war, but has now been reinstated. The following tables contain a summary of the inspections made and the defects found and remedied within the borough during 1948:- Inspections Premises Number on Register Number of Inspections Number of Written Notices. Factories with mechanical power 380 163 9 Factories without mechanical power 419 298 20 Other premises under the Act. (Including works of building and engineering construction but not including out-workers' premises. ) - - - TOTALS 799 461 29 - 11+ - Defects found Particulars. No. of defects found. No. of defects remedied. Number of defects referred to H.M. Inspectors. by H.M. Inspectors. Want of cleanliness. 2 2 2 1 Overcrowding. - - - - Unreasonable temperature. 1 1 — — Inadequate ventilation. - - - — Ineffective drainage of floors. - - - - Sanitary conveniences:- (a) insufficient. 3 3 — — (b) unsuitable or defective. 19 19 - - (c) not separate for sexes. 8 8 - 3 Other offences (not including offences relating to Homework) 6 6 - - TOTALS 39 39 2 4 During 1948, no prosecutions were instituted under the Factories Act, 1937. Outworkers The following table shows the nature of the work carried out by the 286 home workers on the register of outworkers during 1948:- Nature of Work Number Wearincc apparel- (a) Making, etc. 136 (b) Cleaning and washing 5 Household linen 4 Furniture and upholstery - Fur pulling 3 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., 54 Stuffed toys 48 Basket making 1 Cosaques, crackers, stockings, etc. 10 Textile weaving 2 Miscellaneous 20 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. 15 Basement Bakehouses. Section 54 of the Factories Act, 1937, requires the Council to inspect in every fifth year all basement bakehouses in the borough in regard to which certificates of suitability have been issued. If the Council are satisfied that a basement bakehouse is suitable, the certificate will continue to operate. Since the last survey in 1943, one basement bakehouse had been demolished and another had ceased to be used as such. There are now 28 basement bakehouses in the borough. All these were inspected during the year, and in respect of 27 of them, the certificates of suitability have been continued. In the remaining case, the premises are not at the present time being used for baking purposes, as the owner is proposing to carry out works of alteration. If these works are carried out within twelve months and are satisfactory, a certificate will be issued. INSPECTION AND SUPERVISION OF FOOD General There are no abattoirs or slaughter-houses in the borough, and no killing of animals for human consumption is carried out. All premises where food is prepared, stored or exposed for sale for human consumption are frequently inspected and the following is a record of the inspections made by the Pood Inspectors engaged on this work for 19U8:- Pood factories 20 Bakehouses - underground 82 others 41 Ice-cream premises 272 Preserved food premises 30 Butchers 282 Grocers 419 Dairies 442 Public houses 237 Greengrocers 145 PishmongerSo 158 Restaurants and cafes 389 Hotels 109 Sweetshops 99 General stores 91 Street traders1 premises 135 other inspections: stalls 911 In the early part of the year the Council gave much consideration to the question of protection of the public food supply and it was thought that the Food & Drugs Act, 1938, should be extended to include the registration of all food premises with power to cancel or refuse the registration of unsuitable premises. The Council decided to carry out a comprehensive survey of all food premises in the borough with the object of ascertaining the improvements required in the light of modern standards and whether it is desirable to urge the Minister of Health to make regulations under Section 8 of the Food & Drugs Act, 1938o The survey has now been completed and the task of collating the results is proceeding. It was found, during the survey, that certain premises needed repair or cleansing, and in all cases the owners or occupiers have been required to carry out the necessary works. It is intended to submit a report on the survey to the Public Health Committee at the earliest opportunity. 16 Milk Pour hundred and twenty-eight 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 3.35 8.70 July 41 3.43 8.72 February 26 3.27 8.63 August 39 3.61 8.71 March 57 3.24 8.63 September 24 3.82 8.84 April 27 3.21 8.67 October 65 3.84 8.86 May 15 3.28 8.76 November 45 3.96 8.93 June 34 3.43 8.84 December 49 3.64 8.75 Legal Minimum Standards: - Milk fats - 3°00%.Non-fatty solids - 8.50% Average standard for the year:- Milk fats - 3.55%.Non-fatty solids - 8.76% Milk (Special Designations) Regulations, 1936/1946 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 licences granted were as follows:- Principal. Supplementary. Dealers licensed to bottle and sell tuberculin tested milk 1 - Dealers licensed to sell tuberculin tested milk 37 4 Dealers licensed to sell pasteurised milk 74 4 Thirty-three samples of tuberculin tested milk were submitted for examination, and of these 10 failed to pass the prescribed tests. Twenty-seven samples of tuberculin tested (pasteurised) milk and 59 samples of pasteurised milk were submitted for examination. Two of the tuberculin tested (pasteurised) samples failed to pass the prescribed tests. 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. 17 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 fb) 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 shows the number of samples of processed milk taken during the year, together with the results of the examinations. Grade No. of samples. Methylene blue test. Phosphatase test. Passed. Failed. Passed. Failed. Tuberculin tested (pasteurised). 27 27 Nil 25 2 Pasteurised 59 59 Nil 59 Nil Heat treated 10 10 Nil 10 Nil Sterilised 5 4 1 3 Nil TOTALS 101 100 1 99 2 Warning letters were sent to the vendors of the unsatisfactory samples. Adulteration of Food Pour hundred and sixty-five formal samples of food and drugs were taken, of which 6 (1.29%) were adulterated. Five hundred and thirty-five informal samples were taken, of which 5 (0.93%) were adulterated. 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 or disposed of for purposes other than human consumption. There were 2 instances during the year of food being seized and condemned. In both cases the Public Health Committee decided to take proceedings against the vendors. One was fined £10. and ordered to pay £1. 18s. 0d„ costs and the second was convicted (in March, 1949) and fined £25. and ordered to pay £5° 5s. 0d. costs. 18 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 6,715 tins of various foods, and nearly 7 tons of other foods, the principal items of which were:- Tons. Cwt. qrs. Lbs. Pruit 10 - 24 Pish: Wet 3 3 - Dried 19 2 - Shell 1 23 Meat and bacon . . 1 5 1 12 Butter, cheese, etc. 2 1 10 Sugar 1 - 16 Poultry and rabbits 3 - 16 Flour 4 1 16 Whalemeat 3 26 Cereals 2 16 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 maintainec by the Council was 142. Of this number 10 were new registrations during the year. Water Supply In Kensington, the water supply is almost entirely provided by the Metropolitan Water Board, There are, however, 3 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. Ice Cream Owing to the continued national shortage in milk and milk products,, the prohibition on the use of these ingredients in the manufacture of ice cream still continued to operate, and the Government have not so far found it practicable to fix either nutritional or bacteriological legal standards. With the shortage of supplies, it is not surprising that the nutritional standard of ice cream was low. During the year, 43 samples were taken for chemical analysis and the results showec the fat content to vary from 0.3% to 8.2%, and the non-fatty soli( content from 17.6% to 31.3%. The average fat content was 3.53% and the average non-fatty solids content was 21.55%. The Council have expressed the opinion that the fat content of ice cream should not be less than 8%. In May, 1947, regulations were made by the Minister of Health requiring, subject to certain qualifications, the heat treatment of ice cream ingredients after mixing. These regulations also require that the apparatus used for manufacturing purposes should be installed, maintained and operated to the satisfaction of the Council. 19 There are 14 manufacturers with premises in the borough and, with one exception, the premises have been maintained in accordance with the Council's requirements. The one exception was dealt with under the Pood and Drugs Act, 1938, which resulted in the occupier carrying out various works to restore the premises to a satisfactory condition. The Minister of Health has stated that he is not satisfied that there is any reliable test to justify the imposition of a bacteriological standard. He has, however, drawn the attention of local authorities to a form of methylene blue test for ice cream. This test divides ice cream into four grades, defined in relation to the time taken to decolourise the methylene blue, and it was suggested that if ice cream consistently failed to reach grades 1 and 2, it would be reasonable to regard this as indicating defects of manufacture or handling which called for further investigation. Owing to the numerous factors governing the hygienic quality of ice cream, and to the experimental error of the laboratory test itself, it is unwise to pay too much attention to the bacteriological results on any given sample: judgment should be based on a series of samples. During 191+8, 52 samples were taken and submitted to the methylene blue test, and the results were as follows:- Grade No. of samples 1 16 2 12 3 8 4 16 These samples were also submitted to a plate count test which indicates the general bacteriological content, and to a coliform test. The results on the whole cannot be regarded as altogether satisfactory, and endeavours are still being made to secure improvements. The traders are co-operative and appear to be willing to give effect to the suggestions made by the Council's officers; but have put forward the plea of inability to obtain supplies of equipment. There was no outbreak of disease during the year attributable to ice cream sold in the borough. POOD POISONING Under Section 17 of the Food and Drugs Act, 1938, any medical practitioner, on becoming aware that a person is suffering, or is suspected to be suffering, from food poisoning must notify the Medical Officer of Health. The following table shows particulars of notifications received in 1948. - 20 - Food poisoning notifications (corrected) No. received in first quarter Nil " " " second quarter 1 " " " third quarter 6 " " " fourth quarter 4 TOTAL 11 Outbreaks due to identified agents Nil Outbreaks of undiscovered cause Nil Single cases: agent identified 8 unknown cause 3 TOTAL 11 The following are brief particulars of the eleven individual cases of food poisoning notified:- Case No. 1 Female Aged 1¾ years Suspected food: Agent identified: Duck eggs. Salmonella aertrycke. This patient fell ill on 24th April with diarrhoea and was admitted to hospital the following day. Investigations revealed that on 23rd April, the family (man, wife and 2 children) had eaten pancakes made with duck eggs. The mother suffered from slight diarrhoea at the same time as the patient, but father and the other child suffered no ill effects. The mother's faeces revealed the presence of Sonne bacillus (dysentery). Case No. 2 Male Aged 6l years Suspected food: Agent identified: Sausages. Salmonella aertrycke. The patient fell ill with diarrhoea and vomiting on 3rd July. He was admitted to hospital on 6th July. Owing to the lapse of time between date of onset and date of notification (27th July), it was not possible for investigations to be made until 29th July, It was found that the patient and his son had lunch in a Westminster cafeteria on 2nd July. The patient's lunch consisted of sausages whilst his son had fish, The son suffered no ill effects. The M.O.H. of Westminster was informed of the suspected meal and he reported that no other complaints had been received. Case No. 3 Male Aged 40 years Suspected food: Agent identified: Ham. Toxic strain of B. Proteus. The patient consumed a meal of ham in a canteen in Hackney at 2.30 a,m. on 31st July, Two hours later he became ill and was removed to hospital. Other persons who had the same meal became ill. The M.O.H. of Hackney submitted the remains of the ham for bacteriological examination and the results suggested the presence of a toxin or a toxic strain of proteus. - 21 - Case NO. 4 Female Aged 50 years Suspected food: Agent identified: Not known, Salmonella aertrycke. This person fell ill on 6th August and was removed to hospital on 8th August. Salmonella aertrycke was found and on 17th August the patient was removed to Isolation Hospital. The case was first notified on 18th August. The patient was a newly appointed housekeeper at a hotel, where she had eaten all her meals. Owing to the delay in notification it was impossible to obtain any evidence of suspicious food eaten prior to the onset of the disease. No other member of the staff at the hotel had been ill. The arrangements for the preparation and cooking of food at the hotel were satisfactory. Case No. 5 Female Aged 80 years Suspected food: Agent not identified. Mutton. The patient purchased a small mutton joint on 1st September which was cooked and eaten the following day. The patient, a widow, was the only person to eat any of the meat, although some of the gravy was given to two of her grandchildren. The patient suffered from severe diarrhoea and the two grandchildren were slightly upset. Notification was received on 6th September and investigation made on that day revealed that the remainder of the meat had been destroyed and the patient had recovered. Case No. 6 Male Aged 45 years Suspected food: Agent not identified. Mussels. The patient stated that for lunch on 16th September he consumed some mussels in a public house in the West India Docks, and suffered from diarrhoea and vomiting during that afternoon. He had recovered by 20th September, but could not recall the name of the public house. The Port Health Authority stated there were no public houses in the docks and the M.O.H. of Poplar reported that there had been no similar cases of food poisoning in this area at that time. Case No. 7 Male Aged 3½ years Suspected food: Agent identified: Ice cream. Salmonella aertrycke. The patient fell ill with diarrhoea and vomiting on 31st August and was removed to hospital on 5th September. Salmonella aertrycke was isolated in hospital on 8th September. The notification was not received until 27th September, the day on which the patient was discharged, and it was difficult to trace the source of infection. It was found that the family (man, wife and two children) had been in Bournemouth just prior to the onset, and the only suspicious food eaten that could be remembered was ice cream. The patient's sister had been slightly ill at the same time. Case No. 8 Female Aged 27 years Suspected food: Agent identified: Not known. Salmonella aertrycke. This patient fell ill with diarrhoea on 27th October and was removed to hospital on 29th October, where salmonella aertrycke was isolated. It was found that the patient had had all her meals at home and on the evening before the onset she had eaten bacon and potato fritters. The fritters were obtained ready made from Kensington premises found to be in a good condition. No other complaints had been received regarding the fritters, which were made with dehydrated potatoes. - 22 - Case No. 9 Female Aged 1¾ years Suspected food: Cream doughnut. Agent identified: Salmonella aertrycke. This patient suffered from diarrhoea and vomiting late on 28th November and was removed to hospital the following day. The only suspicious item of food eaten by the child was a cream doughnut consumed early in the evening of 28th November. The doughnut was purchased from a Kensington retailer whose premises were in good condition. The doughnuts were obtained from a Paddington manufacturer and a report from the M.O.H. for that area showed that the conditions of manufacture were good. No other complaints in connection with cream doughnuts were reported either in Paddington or Kensington. Case No. 10 Female Aged 24 years Suspected food: Agent not identified. Sausage, sauerkraut and ice cream. The patient fell ill with diarrhoea and vomiting on 3rd December. It was established that the patient had eaten a meal in a Westminster restaurant consisting of Strasbourg sausages, sauerkraut and ice cream a few hours before the onset. The M.0.H. of Westminster carried out investigations at the restaurant and reported that there was no evidence to support the suggestion that the food poisoning arose from the suspected meal. The patient was treated at home. Case No. 11 Female Aged 3¾ years Suspected food: Agent identified: Not known. Salmonella aertrycke. This child fell ill with bronchitis on 10th November and was removed to hospital on 16th November. Within half an hour of admission she developed severe diarrhoea which continued throughout the night and she was removed the following morning to an isolation hospital. No suspicious food had been consumed. INFECTIOUS DISEASES Smallpox No case of smallpox was notified in the borough during the year 1948. Many persons came to Kensington from places abroad who were reported to have been in contact with smallpox. These "contacts" were kept under observation until the possibility of developing the disease had disappeared. Scarlet Fever The number of cases notified in 1948 was 105,but 11 were subsequently found not to be suffering from scarlet fever. Of the total number of cases notified 54 were removed to Hospital. There were no fatal cases. - 23 - Diphtheria Thirty-five cases of diphtheria were notified and removed to hospital, but 23 of these were subsequently found not to be suffering from the disease and were discharged to their homes. There was only one instance where more than one case occurred in the same house. The net figure of 12 cases is the lowest annual figure ever recorded in Kensington. There was no death from diphtheria among the cases notified during the year, but there was a case where a Kensington woman died outside London and the cause of death was attributed after post-mortem examination to "diphtheritic meningitis". It was understood that this woman, aged 48 years, had never been immunised against diphtheria. The work of diphtheria immunisation, which had been carried out by the Council since 1934, was transferred under the National Health Service Act to the London County Council on 5th July, For record purposes, the following table gives a summary of the work carried out from the b®ginning of the year to 4th July, 1948:- Pre-school children immunised 922 School children immunised 159 Children attending for pre- immunisation Schick tests 170 Number who gave positive re-action 100 Children attending for Schick tests after being immunised 1,745 Number proving negative 1,522 Number proving positive 97 Number who failed to attend for readings 126 Number of "re-inforcing" doses given to immunised children 343 Enteric Fever There was one case of typhoid fever and three cases of paratyphoid B. fever notified during the year. All the cases were treated in hospital, and there was no death. The patient suffering from typhoid fever had recently returned from a holiday on the continent. One of the paratyphoid B. patients was a doctor in a London hospital who was believed to have contracted the disease in the course of his duty. The second case was connected with osteomyelitis of the left arm and the source of infection was not traced. The third case was a nurse in a Kensington hospital who had nursed a Paddington child suffering from paratyphoid B. fever. The source of the child's infection was traced to an area in Cornwall. - 24 - Puerperal Pyrexia Twenty-five cases of this disease were notified and 11 were treated in hospital, No deaths occurred in any of the notified cases. Pneumonia There are various forms of pneumonia, but the only kinds notifiable are acute primary pneumonia and acute influenzal pneumonia. One hundred and forty-two notifications were received during the year, 130 patients being certified as suffering from acute primary and 12 from acute influenzal pneumonia. Of these 142 cases, 87 were treated in hospital. During the year, the number of deaths from pneumonia (all forms) was 83 and 2 deaths were certified to be due to influenza. Dysentery There were 145 cases of dysentery notified during the year. All were bacillary in origin and the majority of cases were due to the Sonne bacillus. Many of the cases notified followed bacteriological examinations of the faeces in very slight cases of diarrhoea in children at day nurseries. Other cases who gave no history of intestinal upset, were discovered as a result of examination of faeces from "contacts". The cases generally were of a mild type and no deaths occurred. Erysipelas Of the 24 cases notified, 12 were admitted to hospital. There were no deaths. Cerebro-spinal Meningitis Four cases of this disease were notified during the year. One, a male child aged 8 months, died in hospital; but the other 3 cases recovered. Malaria During 1948 there were two cases of malaria notified, both of whom were young men recently returned from military service in tropical zones with a history of the disease. Poliomyelitis There were 9 cases notified during the year, none of which proved fatal. Measles Of the 868 cases notified during 1948, 1+9 were admitted to hospital for treatment. A special measles nurse was appointed temporarily to carry out home visiting of cases. Two deaths were reported during the year. - 25 - Ophthalmia Neonatorum Seven cases of this disease were notified. Two of these cases were treated in hospital and the others at home. All recovered without injury to sight. Enteritis This disease is notifiable in children up to the age of five years and during the year 64 cases were reported; of these 57 were treated in hospital. During the year, there were 10 deaths of children under 2 years of age suffering from diarrhoea. With the approval of the Council an anti-fly propaganda campaign was carried out during the summer. The major feature of the campaign was the staging of an exhibition during the week 17th to 24th July, 1948, at the National Savings premises in Kensington High Street. Various exhibits and posters supplied by the Army School of Hygiene and by the Ministry of Agriculture and Fisheries were on display; and suitable literature, including the Council's Handbook of Health and Other Services, was distributed. A member of the staff of the Public Health Department attended each day to explain the exhibits and to answer questions. Approximately two thousand people attended the exhibition during the week. Acute Rheumatism The Kensington (Acute Rheumatism) Regulations expired on 30th November, 1948. These Regulations were introduced in 1927 and provided for the notification of the disease in children up to the age of 14 years. A supervisory scheme included home visiting, a special clinic for treatment at Princess Louise Hospital for Children, and the reservation of beds at this hospital for in-patient treatment. / The Minister of Health decided not to extend the Acute Rheumatism Regulations beyond 30th November, 1948, in view of the treatment facilities available under the National Health Service Act, 1946. However, arrangements were made to continue the special facilities at Princess Louise Hospital. During the period 1st January, 1948, to 30th November, 1948, there were 7 cases of acute rheumatism notified and three of these were admitted to Princess Louise Hospital for treatment. Scabies The special scheme of control of scabies introduced during the war in 1941 was withdrawn by the Minister of Health on 31st December, 1947. The normal vigilance exercised by the Council continues and in 1948 the number of notifications was only 141, compared with 239 in the previous year and 463 in the peak year 1946. Whooping Cough Two hundred and sixty-four cases were notified during the year, 33 of which were treated in hospital. Five deaths occurred from this disease. - 26 - Notifications The following tables show (1) the number of oases of infectious disease notified during the year 1948, with comparative figures for the previous seven years; (2)the number of notifications divided into age groups; and (3) the number of cases notified in each ward of the borough. TABLE 1 Notifiable disease. Number of cases notified. 1948 1947 1946 1945 1944 1943 1942 1941 Scarlet Fever. 94 98 195 136 74 216 108 91 Diphtheria (including Membranous Croup). 12 23 37 19 29 54 78 86 Enteric Fever. 4 4 6 3 3 3 1 16 Puerperal Fever. ø - 3 4 7 18 10 7 1 Puerperal Pyrexia. 25 9 8 12 23 25 7 11 Acute primary pheumonia and acute influenzal pneumonia. 142 103 111 81 91 133 21 65 Dysentery. 145 21 49 142 43 73 68 25 Erysipelas. 24 34 37 33 16 37 30 43 Cerebrospinal meningitis. 4 7 10 3 6 11 17 22 Malaria. 2 4 8 11 8 1 1 - Poliomyelitis and polioencephalitis. 9 27 1 3 1 1 2 2 Encephalitis lethargica. - 2 - 1 - - - - Tuberculosis (all forms) 258 259 210 188 211 202 203 234 Measles. 868 852 264 868 102 624 365 366 Ophthalmia Neonatorum. 7 4 4 8 4 11 4 3 Enteritis. + 64 102 69 100 71 69 96 48 Food Poisoning. 11 7 7 6 7 4 8 2 Acute Rheumatism x (up to 30th November) 7 11 15 32 11 9 6 2 Scabies / 141 239 463 460 363 252 - - Whooping Cough 264 274 209 62 189 102 146 176 ø Only Puerperal Pyrexia notifiable in London now. Section 50, London County Council (General Powers) Act, 1948. + Notifiable only in children under the age of 5 years. x Notifiable only in children under the age of 16 years. Kensington (Acute Rheumatism) Regulations now rescinded. / Notifiable as from 1st August, 1943. Note: Cases of mistaken diagnosis are excluded from the above table. - 27 - TABLE 2 Notifiable Disease. Number of Cases Notified in 1948 Age Groups in Years. Under 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 15 15 to 35 35 to 65 65 and over. Scarlet Fever. — 6 3 8 9 50 13 5 — Diphtheria (including Membranous Croup). — 1 — 2 — 3 5 1 — Enteric Fever — — — — — — 4 — — Puerperal Pyrexia — — — — — — 22 3 — Acute primary pneumonia and acute influenzal pneumonia. 12 5 8 4 7 18 27 49 12 Dysentery. 12 29 20 7 8 12 28 22 7 Erysipelas. 1 — — — — — 4 18 1 Cerebro-spinal meningitis. 3 — — — — 1 — — — Malaria. — — — — — — 2 — — Poliomyelitis and polioencephalitis. — 2 — — — — 6 1 — Encephalitis lethargica. — — — — — — — — — Tuberculosis (all forms). 4 4 2 3 4 12 156 66 7 Measles. 41 132 136 104 110 301 36 8 — Ophthalmia neonatorum. 7 — — — — — — — — Enteritis. 42 12 5 3 2 — — — — Food poisoning. — 2 — 2 — — 2 4 1 Acute rheumatism. — — — — — 7 — — — Scabies. 3 3 4 — 2 39 62 25 3 Whooping cough. 30 41 38 29 29 89 6 2 — TOTALS 155 237 216 162 171 532 373 204 31 TABLE 3 Notifiable Disease. Total Cases Notified in each Ward. St. Charles Golborne Norland Pembr1dge Holland Earls Court Queens Gate Redcl1ffe Brompton Scarlet Fever. 18 9 23 16 5 10 4 8 1 Diphtheria (including Membranous Croup) 1 — 4 3 — 1 — 3 — Enteric Fever. 1 — — — — 2 — l — Puerperal Pyrexia. 10 1 1 2 8 1 1 1 — Acute primary pneumonia and acute influenzal pneumonia. 34 32 33 19 3 9 2 9 1 Dysentery. 61 14 17 32 8 6 3 2 2 Erysipelas, 6 4 4 — 1 1 8 — — Cerebro-spinal meningitis. 1 2 1 — — — — — — Malaria. — — 1 — — — 1 — — Poliomyelitis and polioencephalitis. — 1 1 3 1 2 — 1 — Encephalitis lethargica. — — — — — — — — — Tuberculosis (all forms). 49 27 25 20 37 18 37 22 Measles. 238 84 139 118 34 83 42 110 20 Ophthalmia neonatorum. 4 — 2 — — 1 — — — Enteritis. 15 26 7 8 4 3 — 1 — Food poisoning. 3 2 1 3 — 2 — — — Acute rheumatism. 4 — 3 — — — — — — Scabies. 25 29 4 32 17 12 2 17 3 Whooping Cough. 74 31 38 29 15 21 7 46 3 - 28 - LEGAL PROCEEDINGS Public Health (London) Act, 1936 Nuisances. During the year 240 summonses were issued for various nuisances under the Public Health (London) Act, 1936. In 57 cases abatement or prohibition orders were secured; fines amounting to £14. were imposed and £3. 5s. 0d. costs were awarded to the Council,, In 154 cases the summonses were withdrawn, the nuisances having been abated by the owners prior to the Court hearings. In the remaining 29 cases the summonses were adjourned as the work required was in progress when the cases came forward for hearing. Nine prosecutions were undertaken for failure to comply with Justices Orders to abate statutory nuisances. In 6 cases further penalties amounting to £35. were imposed; in one case a daily penalty of 5/- was imposed for 71 days; in another case a daily penalty of 3/- was imposed for 110 days; and in another a daily penalty of 1/- was imposed for 126 days; In addition costs amounting to £3. 12s. 6d. were granted to the.Council. Food and Drugs Act, 1938 Seven prosecutions under this Act were instituted during the year and convictions were obtained as follows:- (a) Sale of adulterated rum: fined £2, plus £2, 2s, costs; (b) Sale of adulterated vinegars fined £1. plus £2. costs; (c) Exposure of unsound food for sale: fined £10. plus £1. Is. costs; (d) Use of unregistered premises for the storage of ice cream (three summonses); total fines of £6. plus £1. ls. costs; (e) Illegal sale of horseflesh; fined £5. A further prosecution was undertaken in 1948 in respect of a sample of non-brewed vinegar certified to be 19% deficient in acetic acid. This case was heard at the Petty Sessional Court, and the summons was dismissed, costs of £2. 2s„ being granted to each of three defendants. The magistrates were invited "to state a case" and the Council appealed to the Divisional Court against their decision. The Appeal was heard in the King's Bench Division on 24th November, 1948, when the Court decided to allow the Appeal and referred the case back to the Kensington magistrates with an intimation that the offence had been proved. The Council's costs were allowed. The second hearing took place in 1949, when the Kensington magistrates fined the defendants £10. and ordered them to pay £10. 10s. costs. This case is of particular interest because it sets a standard of not less than 4% acetic acid for non-brewed vinegar. Milk and Dairies Order Two prosecutions under this Order were instituted in respect of the dirty condition of milk bottles and fines amounting to £55. plus £9. 4s, Od. costs were imposed. Council's By-laws Dog Nuisances. Seven cases were successfully prosecuted and fines amounting to £5. 0s. 6d. were imposed. Housing Act. 1936 Overcrowding. In 7 cases summonses were issued in respect of overcrowding offences. In 2 cases convictions were obtained and fines amounting to £4. were imposed. In 3 cases the summonses were adjourned sine die and in the remaining 2 cases the summonses were withdrawn as the overcrowding had been abated. Contravention of Closing Orders. Pour summonses were issued in respect of the illegal occupation of underground rooms. Convictions were obtained in all cases and fines amounting to £14. plus £2. costs were imposed. - 29 - PART III OF NATIONAL HEALTH SERVICE ACT, 1946 MATERNITY AND CHILD WELFARE SERVICES, ETC. Under this Act, certain services were transferred on 5th July, 1948, from the Jurisdiction of the Council to the control of the London County Council and the Metropolitan Regional Hospital Boards. For record purposes, the following main details of the work carried out between 1st January and 4th July, 1948, are set out:- Health Visiting Staff The work performed by the health visiting staff during the period from 1st January, 1948, to 4th July, 1948, in regard to maternity and child welfare is summarised in the following table:- First visits to infants (0-1 year) 1,286 Revisits to infants (0-1 year) 3,719 Visits to children between 1 and 5 years 6,118 Stillbirth enquiries 26 Visits to ophthalmia neonatorum cases 25 Visits to measles cases 564 Visits to whooping cough cases 156 Visits to puerperal pyrexia cases 14 Visits to enteritis cases 31 Infantile death enquiries 54 Ante-natal visits 1,215 Half-days at welfare centres 1,697 Visits to foster mothers 411 Visits to registered daily guardians 84 Other visits 2,078 Ante-Natal Clinics and Infant Welfare Centres The work at these institutions during the period from 1st January, 1948, to 4th July, 1948, is shown in the following table:- Sessions at which doctors attended for ante-natal consultations 461 Individual mothers who attended antenatal consultations 1,687 Attendances of ante-natal mothers 6,026 Sessions at which doctors attended for post-natal consultations 49 Individual mothers who attended postnatal consultations 135 Sessions at which doctors attended for infant consultations 451 Individual children who attended for the first time:- 0-1 year 1,099 1-5 years 137 Attendances of children at doctors' consultations:- 0-1 year 4,778 1-5 years 2,732 Attendances at centres of children for all purposes:- 0-1 year 18,991 1-5 years - 30 - The Baby Clinic. 92 Tavistock Road. W.11 The work at this institution during the period from 1st January to 4th July, 1948, is shown in the following tables:- Pre-school children minor ailment treatments Doctors' sessions held 65 Individual children attending doctors' sessions 426 Total attendances at doctors' sessions 1,503 Average attendance at doctors' sessions 23 Circumcision operations 90 Sessions held for dressings only 155 Attendances at dressing sessions 1,270 Sessions held for sunlight and massage treatment 98 Sunlight treatments given 2,165 Massage treatments given 515 Total individual children attending clinic 764 Total attendances 5,679 Dental Treatment Sessions held 102 Details for Mothers Patients (new cases) 352 Total attendances (all cases) 1,070 Extractions 834 Fillings 297 Dentures 39 Other treatments 654 Details for Children Patients (new cases) 120 Total attendances (all cases) 181 Extractions 68 Fillings 59 Other treatments 101 Borough Council's Maternity Home Five beds at Queen Charlotte's Hospital were reserved for Borough Council patients from the beginning of the year until 4th July, 1948. The following table gives details for this period:- Applications received for admission 41 Applications accepted 41 Applications subsequently withdrawn 2 Total women confined in the home 54 The gross cost of the scheme to the Council during 1948 was £448. 10s. 0d. The assessments made in respect of patients whose applications were accepted and not withdrawn during the period amounted to £82. 10s. 0d. Payments made by patients totalled £82. 7s. 0d. - 31 - Home Helps The scheme for the provision of home helps for mothers during confinement, which has been in operation since 1920, was continued. Home helps were supplied in 197 cases at a gross cost of £1125. 4s. 2d. Contributions by applicants towards the cost of help provided amounted to £400. 10s. 4d. Domestic Helps The Council's scheme, under Defence Regulation 68E, for the provision of domestic help to sick or infirm persons continued in operation during the year up to 4th July. The principal functions of the Council were:- (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. This service has grown enormously since its inception in 1945 and the following is a summary of the action taken between 1st January and 4th July, 1948, compared with the figures for the previous twelve months:- 1948 (part only) 1947 Applications New applications received 247 340 Refused as unsuitable for help 2 4 Withdrawn by applicants 14 37 Number in which help was given 231 299 Reasons for giving help Chronic illness in aged persons 56 54 Other chronic invalids 29 47 Acute illness, accidents, etc 87 91 Before admission to, or after discharge from hospitals 32 50 Debilitated housewives 27 57 Period for which help given One week or less 26 48 One to two weeks 56 64 Two to four weeks 109 109 Over four weeks 40 78 Costs Full cost paid by applicants 69 95 Part cost paid by applicants 79 89 Pull cost paid by Council 83 115 Total contributions by applicants £386. 17s. 5d. £503. 2s. 1d. Gross cost to Council £3,559. 9s. 1d.£3,352.12s. 1d. (the net costs were reimbursable by the Government). - 32 - Day Nurseries The four day nurseries established by the Council continued to operate during the period under review. Name of Nursery No. of Places Ladbroke 45 Kensal 65 St. Charles 65 St.Quintin 50 225 Foot Clinic The Council's Foot Clinic at 240, Ladbroke Grove, commenced work on the 2nd February, 1948. The opening ceremony was performed by His Worship the Mayor. Members of the Public Health and Maternity and Child Welfare Committees were present to see the commencement of this new branch of the Council's work. Up to the time the Clinic was transferred to the London County Council, nearly 2,000 attendances had been made. TUBERCULOSIS Notifications During the year, 258 new cases of tuberculosis were notified, of which 227 were respiratory and 31 non-respiratory cases. The following table shows the number of cases added to, and the number removed from, the notification register during the year:- Description. Respiratory. NonRespiratory. Total. M F M F On register of notifications on 1st January, 1948. 457 448 51 60 1,016 Notified for the first time during the year. 133 94 10 21 258 Brought to notice other than by notification. 47 40 2 5 94 Removed from register on account of having- (a) recovered from disease 4 6 1 3 14 (b) removed from district, lost sight of, etc. 64 72 3 4 143 (c) died. 36 28 1 1 66 Remaining on register on 31st December,1948. 533 476 58 78 1,145 - 33 - Death Rate Seventy-six persons died from respiratory tuberculosis and ten from non-respiratory tuberculosis. The death rate for respiratory tuberculosis was 45 per 100,000 population, and that for non-respiratory tuberculosis was 5.9. The rate for all forms of tuberculosis was 50.9, which was a slight increase compared with the rate (47.5) for 1947. Mass Radiography Arrangements were made for a mass radiography unit to operate in Kensington from 28th May to 18th June, 1948. The apparatus was set up, with the consent of Messrs. John Barker and Company, in the Council's temporary offices in the Derry and Toms building. Invitations to attend for X-ray were extended to employees of business houses in the borough (and in Paddington) and also the Council's staff. A total of 2,915 persons were examined. One thousand, seven hundred and ninety-five men were seen and of these 41 were asked to submit to a large film being taken. Five disclosed no abnormality whatever, and in the case of a further 17 no action was considered necessary. Eighteen showed signs of probable tuberculosis. The remaining one case failed to attend. Of the 1,120 women seen, 27 were invited to have a large film taken. Six disclosed no abnormality and a further 12 were classified as requiring no further action. Eight were thought to be probably tubercular, and one failed to attend. Tuberculosis Dispensary The staff of the Tuberculosis Dispensary and the building itself were transferred to the North West Metropolitan Regional Hospital Board on the 5th July, 1948, and the clinical work in connection with the treatment of tuberculosis has ceased to be the responsibility of the Borough Council. The following table gives a summary of the work carried out at the Dispensary from the beginning of the year until the 4th July, 1948:- No. of new patients examined 522 No. found to be suffering from pulmonary tuberculosis 16 6 No. found to be suffering from non-pulmonary tuberculosis 9 No. found to be non-tubercular 318 No. kept under observation 29 Total number of attendances (all cases) 1,811 No. of visits paid to patients' homes by the tuberculosis officer 85 No. of visits made by health visitors 1,406 Specimens of sputum examined 353 X-ray examinations 1,202 No. of patients granted extra nourishment 79 Cost to the Council £286. 18s. 7d. No. of patients granted maintenance allowances 151 Cost to the Council (re-imbursable) £4, 453. 10s. 0d. - 34 - CONCLUSION On behalf of the staff of the public health department I wish to acknowledge with warm thanks 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 FENTON Medical Officer of Health.