NL4348 library KEN 58 THE ROYAL BOROUGH OP KENSINGTON ANNUAL REPORT on the HEALTH OF THE BOROUGH for the year 1949 by J. H. WEIR, M.D., B.S., B.Hy., D.P.H. Medical Officer of Health. 31st July, 1950. Public Health Department, Hornton Street, Kensington, W.8. THE ROYAL BOROUGH OF KENSINGTON Public Health Department, Hornton Street, KENSINGTON, W. 8. 31st July, 1950. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lord, Ladies and Gentlemen, I have much pleasure in presenting the Annual Report on the state of the public health in Kensington in 1949. The Minister of Health has requested that the report should be submitted in the same abbreviated form as has been the case each year since the outbreak of the last war. The report deals with the year before my appointment as Medical Officer of Health for Kensington. Dr. James Fenton, C.B.E., was the Medical Officer of Health until the end of September, 1949, when he retired after nearly 30 years service with the Council. Prom the 1st October, Dr. C. D. L. Lycett, the Deputy Medical Officer of Health, was in charge of the Public Health Department until I commenced duty on the 27th February, 1950. It will be appreciated that I cannot write from my own direct knowledge of events which occurred in the year 1949, and I have decided to retain the form of abridged report which Dr. Fenton has adopted since 1939 to comply with the directions of the Minister of Health. The Council, at their meeting following Dr. Fenton's retirement, placed on record their sincere appreciation of his long and distinguished service and extended to him their best wishes for good health and happiness in the future. I shall endeavour to continue and further the Public Health Services of the Royal Borough in accordance with the high traditions which my predecessor so expertly and painstakingly created during the past 29 years. GENERAL OBSERVATIONS POPULATION. There was a further increase in the estimated population of Kensington for 1949 (174,220) compared with that for the previous year (168,800). The latest figure is more than the prewar (1938) estimated population of 174,100. It appears from the Registrar General's most recent estimate of the "home" population of 178,870 that the influx of people since the end of the war is continuing. This increase in population, with its consequent increasing demand for housing accommodation, makes the task of maintaining reasonable standards of fitness in existing housing accommodation more important. - 2 - The number of repair notices (3,309) served under the Public Health (London) Act, 1936, by the Council's sanitary inspectors in 1949 exceeded the number served in the previous year by 223. Their enforcement necessitated the service of 291 summonses compared with 240 in 1948. It would appear that, in certain parts of the borough, it is becoming increasingly difficult to induce some owners to undertake repairs to their property owing to the high cost of such repairs and the shortage of labour and materials. The following table shows the numbers of sanitary notices and summonses served in each ward of the borough in 1949:- Ward No. of sanitary notices served in 1949. No. of summonses taken out under Public Health (London) Act in 1949. Golborne 864. 74 St. Charles 794 118 Norland 422 21 Pembridge 429 44 Holland 170 3 Earls Court 186 3 Queens Gate 72 2 Redcliff e 275 24 Brompton 97 2 3309 291 BIRTH RATS. The number of Kensington live births in 1949 was 2,681 compared with 2,908 in the previous year. The birth rate per thousand population was 15.4 and it is noted that this rate has been gradually declining since 1946, when it was 18.2. GENERAL DEATH RATE. The total number of deaths recorded in 1949 was 1,819 compared with 1,685 deaths in 1948. Owing to the increase in the population referred to above, the general death rate for last year, 10.4, shows only a slight increase over the lowest ever recorded figure of 10 for 1948. The increase in the total number of deaths was reflected mainly under the following headings:- 1948 1949 Increase Heart disease 432 506 74 Influenza, bronchitis, pneumonia and other respiratory diseases 183 222 39 Suicide and other violent causes 77 113 36 INFANT DEATH RATS. The number of deaths of children under twelve months for every thousand live births reached the borough's lowest record of 24 in 1949 There has been a continued fall in the infant death rate since 1942, when the figure was 65 deaths per thousand live births. MATERNAL MORTALITY RATS. For the first year on record, there was no death as a result of pregnancy or childbirth during 1949. - 3 - TUBERCULOSIS DEATH RATE. The death rate of 34 from all forms of tuberculosis per hundred-thousand population for 1949 was the lowest ever recorded. INFECTIOUS DISEASES. Apart from the comparatively large number of cases of acute poliomyelitis notified (47), the incidence of infectious diseases during 1949 showed no untoward variations from that in the previous year. It is noteworthy that there was almost an entire absence of diphtheria in the borough. Only two cases occurred, both in adult persons who had never been immunised. One of the two cases was a "carrier" of C.diphtheriae mitis, and was not considered to be dangerous from the infective point of view. It can he accepted that this excellent result is to a large extent due to the preventive public health measure of immunisation against diphtheria undertaken so vigorously by the Council from 1934 to 1948, since when it has been continued by the London County Council. From the foregoing observations, it will be seen that the public health of the borough remained satisfactory during 1949. VITAL STATISTICS The table set out on the next two pages gives the important vital statistics for 1949, together with comparative figures for the previous seven years. -5- SUMMARY OP VITAL STATISTICS FOR KENSINGTON Description 1949 1948 1947 1946 1945 1944 1943 1942 POPULATION. Population (estimated) 174,220 168,800 166,170 147,870 117,170 107,610 106,830 99,310 Density of population per acre 76 74 72 64 51 47 46.6 43 LIVE BIRTHS. Total births 2,681 2,908 3,012 2,695 1,890 1,780 1,698 1 ,487 Legitimate births 2,417 2,608 2,696 2,378 1,579 1,527 1,479 1,280 Illegitimate births 264 300 316 317 311 253 219 207 Birth rate per 1,000 population 15.4 17.2 18.1 18.2 16.1 16.5 15.9 15.0 STILL BIRTHS. Total still births 39 56 65 68 49 47 46 27 Legitimate still births 39 47 58 60 40 44 39 23 Illegitimate still births Nil 9 7 8 9 3 7 4 Still birth rate per 1,000 total births 14.3 18.9 21.1 24.6 25.3 25.7 27.1 18.1 DEATHS. Total deaths 1 ,819 1 ,685 1 ,866 1 ,821 1,586 1 ,735 1 ,769 1 ,595 Death rate per 1,000 population 10.4 10 11.2 12.3 13.5 16.1 16.5 16.0 i DEATHS OF INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 64 111 124 132 92 93 88 97 Legitimate deaths 52 103 105 117 73 76 76 87 Illegitimate deaths 12 8 19 15 19 17 12 10 Infant death rate per 1,000 births 24 38 41 49 49 52 52 65 Death rate of legitimate infants per 1,000 legitimate births 22 39 39 49 46 50 51 68 Death rate of illegitimate infants per 1 ,000 illegitimate births 45 27 60 47 61 67 55 48 MATERNAL DEATHS. Deaths of mothers as a result of pregnancy or childbirth Nil 5 4 3 4 1 3 6 Death rate of mothers per 1 ,000 live and still births Nil 1.68 1.3 1.08 2.06 0.55 1.70 3.90 TUBERCULOSIS DEATHS. Death rate from all forms per 100,000 population 34 51 47.5 55 84 76 92 68 Death rate from respiratory tuberculosis per 100,000 population 32 45 43 47 70 68 80 54 Death rate from nonrespiratory tuberculosis per 100,000 population 2 6 4.5 8 14 8 12 14 ZYMOTIC DISEASES. Death rate 0.04 0.11 0.19 0.16 0.14 0.21 0.17 0.37 - 6 - CAUSES OP DEATH AT DIFFERENT PERIODS OF LIFE IN 1949 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 2 1 – 1 – Whooping cough 1 – 1 – – Diphtheria – – – – – Phthi si s 56 – 1 19 36 Other forms of tuberculosis 3 – 2 1 Syphilis 11 – – – 11 Influenza 19 – – 1 18 Measles – – – – – Acute poliomyelitis etc. 4 _ – 4 – Acute infectious encephalitis 1 – – – 1 Cancer (all forms) 315 – 1 21 293 Diabetes 8 – – 1 7 Intra-cranial vascular lesions 168 – – 4 164 Heart disease 506 – – 15 491 Other diseases of circulatory system 94 – – 4 90 Bronchitis 81 1 – 1 79 Pneumonia 99 10 3 3 83 Other respiratory diseases 29 – – 2 27 Ulcers of the stomach 21 – – 3 18 Diarrhoea (under two years) 6 4 2 – – Appendicitis 6 – – 4 2 Other digestive diseases 45 2 1 42 Nephritis 47 – – 4 43 Puerperal sepsis — – – — — Other maternal causes – – – – – Premature birth 13 13 – – – Infantile diseases etc 32 30 – 1 1 Suicide 44 — – 13 31 Road traffic accidents 10 – 1 4 5 Other violent causes 69 3 2 23 41 All other causes 129 – 1 14 114 TOTALS 1819 64 12 145 1598 - 7 - GENERAL PROVISION OF HEALTH SERVICES IN THE AREA Bacteriological and Analytical Work From 1st January, 1949, pathological and bacteriological work has been carried oat at the Central Public Health Laboratory, Colindale Avenue, Hendon, free of charge to the Council who, however, bear the cost of transporting the specimens and samples. The new arrangements have proved satisfactory and the following is a summary of the work performed during the year. Nature of specimen or sample. Number examined. Nose and throat swabs 647 Sputum 127 Rectal swabs and other specimens 434 Faeces 279 Pertussis 89 Milk (bacteriological) 113 Water (drinking) 13 Water (swimming baths) 15 Ice Cream 105 Medicinal Baths (Personal Cleansing Station) The record of work done is as follows:- Description Scabies Vermin Impetigo Other conditions Persons Clean -sings Persons Clean -sings Persons Clean -sings Persons Clean -sings Adults Kensington Other 106 174 121 131 — — 6 8 boroughs 69 122 52 61 — — — — Schoolchildren Kensington Other 83 363 1807 1807 6 24 6 15 boroughs 26 63 391 391 — — – — Children under 5 Kensington Other 28 51 56 56 4 10 2 3 boroughs 23 41 6 6 — — — — Compulsory Cleansings — — 222 222 — — — — TOTALS 335 814 2655 2674 10 34 14 26 - 8- In addition to the cleansing of persons referred to above, articles of personal clothing disinfested at the Medicinal Baths during the year numbered 4,177. Disinfection and Disinfestation. A summary of the routine work of the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 450 (619 rooms) Houses disinfested after vermin 1401 (3718 rooms) Loads of furniture treated with hydrogen cyanide 63 Total weight of furniture, bedding, etc., dealt with 110 tons, 16 cwt. 3 quarters, 5 lbs Destruction of Rats and Mice. The Council's work under the Rats and Mice (Destruction) Act, 1919, and the Infestation Order, 1943, during the year continued to attract the grant of 50% of the approved net expenditure from the Ministry of Agriculture and Fisheries, 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 Ministry; (ii) that special attention is paid to efficient rodent control in sewers, refuse dumps, refuse destructors and other local authority properties, in accordance with guidance given by the Ministry; and (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 is 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. The Council agreed during 1949 to waive all charges for mice destruction treatment of private property (other than commercial buildings). On two occasions all the sewers in the borough were dealt with by poison bait, and it was estimated that in the first treatment 6,311 rats were destroyed; and in the second 5,500 rats were killed. - 9 - These figures show an increase over the corresponding figures for the previous year (4,915 and 3,880 respectively) due to the fact that the baiting of the sewers was not restricted to the side entrances, but included the circle access shafts to sewers in the northern half of the borough. The Council have decided that, in 1950, the biannual sewer baiting will be extended to include all circle access shafts in the borough. Block treatment procedure, involving simultaneous baiting of an entire area, was undertaken during the year at the Council's Wood Lane Depot on two occasions, and it was estimated that 205 rats were destroyed. Block treatment was also undertaken at the Kensal Gas Works, after certain structural alterations to the drains had been carried out, and it was estimated that 892 rats were destroyed. The following is a summary of other action taken Complaints investigated 1 ,240 Premises inspected following complaint 1,467 Premises where rats were found 399 Premises where mice were found 640 Premises where other vermin were found 141 Premises where no infestation existed 287 Number of visits made 10,808 Number of notices served 150 Premises successfully treated 1,142 Cases in which advice only was given 79 Borough Council properties dealt with 310 Public Mortuary- The number of bodies taken to the mortuary during the year was 475. Inquests were held in 104 cases. Care of the Aged. There are many old people in Kensington who, although not sufficiently infirm to require institutional treatment, are with increasing age and limitation of their physical activities, leading lonely and restricted lives. Some are found to be living in insanitary conditions. During the year consideration was given to measures which might be taken to alleviate the unsatisfactory conditions in which such old people are living. There are voluntary bodies working in the borough whose activities deal with certain aspects of the problem of the care of the aged, and consultations with these bodies took place. The Council considered that increased attention should be paid to the following requirements:- # (a) More frequent home visiting and supervision; (b) Rehabilitation of old people and cleansing of their homes; (c) Further provision of meals, recreational facilities and companionship; (d) Provision of holidays; (e) Additional housing accommodation for the aged. -10- A woman health officer appointed to deal, inter alia, with the care of the aged commenced duty on the 9th May, 1949. During the year 142 cases of old people needing attention were referred to this officer and, in many of the cases, her visits did in themselves have a beneficial effect. Owing to her other duties, she was not able to make visits with adequate frequency and regularity, and the Council agreed that an assistant woman officer should he appointed to help in this work. In regard to those old people found to be living in insanitary conditions, it was decided, as an experiment, to take steps to secure rehabilitation and cleansing in selected cases. The procedure adopted was broadly:- (i) to arrange for the old person to be temporarily accommodated in a hospital, home or hostel; (ii) to disinfest the room and contents; (iii) to arrange with owners to carry out necessary repairs and decorations. The Council hope to extend this work as necessary and the Housing & Town Planning Committee have agreed to provide where possible temporary accommodation for old people whose rooms are being disinfested and cleansed under this scheme. A summary of the work undertaken by the Council's woman health officer in connection with the care of old people is as follows Number of old people reported during the year Number of these cases assisted - 142 (a) through the National Assistance Board 62 (b) through voluntary societies 59 (c) by the provision of home helps 82 (d) by pensions from local charities 4 Cases provided with meals 69 Cases provided with holidays by co-operation with voluntary societies 7 Cases referred to recreational clubs 58 Cases assisted in the provision of medical and nursing care 56 Cases removed to homes 5 Cases removed to hospital 15 Cases compulsorily removed to institutions 1 Cases where disinfestation was carried out 16 Cases temporarily rehoused whilst home was 4 Total number of home visits paid to old people Number of other visits paid in connection with 504 old people 98 Cases remaining under observation at the end of the year 118 Removal of old and infirm persons to institutions etc., Under Section 47 of the National Assistance Act, 1948, the Council may apply to a Court for an order to remove to a suitable institution any person who - (a) is suffering from grave chronic disease or, being aged, infirm or physically incapacitated, is living in insanitary conditions, and (b) is unable to devote to himself, or is not receiving from other persons, proper care and attention. -11- Although many cases were investigated during the year, only one resulted in formal action being taken under the section. This was the case of an old woman of 84 years living alone in one room, which was in an extremely dirty and verminous condition. The furniture in the room was also dirty and verminous and the woman herself was dirty and apparently unaware of the insanitary conditions in which she was living. Attempts to persuade her to enter an institution failed and, on the 19th November, 1949, on the application of the Council, the Court made an order for her compulsory removal to a London County Council institution in Chelsea, for a period not exceeding three months. The order was carried out and subsequently the woman consented to the contents of her room being destroyed. At the time of writing this report, the woman was still in the institution as a voluntary patient. 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. In 1949, the Council became responsible for the burial of 66 persons dying in the borough. In only one case was the body cremated. The following is a summary of the action taken:- (a) Cases where the Council's funeral expenses have been fully recovered 39 (b) Cases where part only of the expenses have been recovered 13 (i) Number of these where balance of expenses will be recovered 5 (amounting to £17.13s.6d.) (ii) Number of these where there is no estate or "liable" relative 8 (c) Cases where full cost has been borne by the Council 14 (i) Number of these where expenses will be recovered 2 (amounting to £12.0s.6d.) (ii) Number of these where there is no estate or "liable" relative 10 (iii) Number of these where "liable" relatives are unable to contribute 2 Total cost to the Council £554. 8s. 0d. Amount recovered to date £380. 10s. 0d. Additional amount expected to be recovered £29. 14s. 0d. -12- Dog Nuisances. Since 1921 the Council have operated in Kensington a byelaw to prevent the fouling of public footpaths by dogs. The present form of the byelaw is as follows:- (1) No person being in charge of a dog shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this byelaw, if he satisfies the Court that the fouling of the footway by the dog was not due to culpable neglect or default on his part. (2) For the purposes of this byelaw the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person. (3) Any person offending against this byelaw shall be liable on summary conviction to a fine not exceeding five pounds. Since the byelaw first came into operation, the Council have obtained more than 300 convictions, but despite this the number of complaints of nuisances by dogs was considerable. In 1949 the Council decided to intensify their efforts to secure reasonable cleanliness of pavements and included in the measures taken were :- (1) The display of a special poster, designed by Councillor Ian Harvey, M.P., on dustbins, sandbins and other suitable places; (2) The distribution of special handbills, also designed by Councillor Ian Harvey, M.P., and "fly-posting" slips; (3) Practical public demonstrations by the Canine Defence League of the training of dogs; (4) Local shop window displays and press announcements, combined with a simple dog-competition for members of the public. The prizes for the competition were given free of charge to the Council by commercial firms; and (5) Fixing of permanent dog nuisance warning notices on lamp posts. Vacant, Derelict and Bombed Sites. The problem of dealing with vacant, derelict and bombed sites continued to present difficulties during the year, mainly owing to the fact that these sites are used as dumping grounds for rubbish. In an attempt to deal with this nuisance, the Council on the 4th October, 1949, made the following byelaw, which has now been confirmed by the Home Secretary and came into operation on 1st January, 1950:- - 13 - "No person shall (except by permission in writing of the owner or occupier, or of the person or authority having control thereof, or unless authorised by law to do so) place or deposit and leave on or in - (a) any highway or roadside waste, or any unfenced ground abutting on any highway; (b) any of the lands devastated by enemy action described in the Schedule to this byelaw if a notice stating the effect of this byelaw is conspicuously exhibited on such land; (c) any common, park, recreation ground or other open space to which the public have access for the time being; or (d) any water, watercourse, or ditch in or abutting on any such highway roadside waste or other place aforementioned, any rubbish or waste or discarded matter whatsoever so as to create or tend to create a litter. Provided that where an offence is committed against this byelaw and against any byelaw with respect to any pleasure ground, public walk, recreation ground, park, roadside waste, common, or open space, or any limitation or condition imposed by the Minister of Agriculture and Fisheries under Section 193 of Law of Property Act, 1925, a person shall not be liable to more than one penalty in respect of the same offence. Any person offending against this byelaw shall be liable on summary conviction to a fine not exceeding five pounds. Paragraph (b) of this byelaw shall cease to have effect after the 4th day of October, 1952, unless a byelaw continuing it in force has been duly made and comes into force before that date." From and after the date upon which this byelaw shall come into operation the byelaw relating to littering of streets made by the Council of the Royal Borough of Kensington on 25th March, 1930, shall be and is hereby repealed. Before the byelaw can apply to any particular bombed site, a notice stating this fact must be exhibited thereon. Instructions were given by the Council to exhibit notices on twenty-two of the sites in the borough. It is too early to say whether the byelaw will effectively prevent the use of these sites as dumping grounds for rubbish. -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 6,589 Public Health (London) Act, 1936 Houses inspected on complaint 6,589 Houses inspected after infectious disease 1 ,682 Re-inspections 17,419 Smoke observations 12 Inspections of mews 334 Other inspections 1,860 Housing Act, 1936 Initial inspections (including preparation or revision of house-to-house cards) 741 Re-inspections 2,149 Inspections in regard to overcrowding 2,266 Underground Living Rooms Primary inspections 862 Re-inspections 2,158 Drainage Applications 223 Plans submitted 117 House drains tested and inspected 3,651 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 3,309 Statutory notices 1,872 Final notices 876 Various Rent Restrictions Act certificates 46 Report of waste water to the Metropolitan Water Board 88 Report of dangerous structures to the London County Council 119 Other notices 50 - 15 - The following is a summary of works completed under the supervision of the sanitary inspectors during the year :- House drains, reconstructed 35 House drains, additions to 61 Defective drains, repaired 203 House drains, cleansed 248 Water closets, reconstructed 35 Water closets, repaired 204 Water closets, new provided 206 Water closets, supplied with water 137 Soil pipes ventilated, repaired etc. 57 Soil pipes, new provided 90 Ventilating pipes, new provided 135 Baths, new provided 124 Sinks, new provided 98 Lavatory basins, new provided 329 Waste pipes, new provided 476 Cisterns, cleansed 18 Cisterns, covered 21 Taps fixed on rising main 1 Yards and areas paved, drained, etc. 21 Dustbins provided 221 Accumulations of filth, etc., removed 133 Animals removed 9 Roofs repaired 1,117 Houses provided with water above basement level 22 Dampness in dwellings remedied 1,127 Infectious disease cases removed 475 Houses disinfected after infectious disease (including bedding, etc) 450 Rooms in such houses, disinfected after infectious disease 619 Houses cleansed under Houses let in Lodgings Byelaws 1,083 Cleansing of houses not on register 366 Verminous houses cleansed (including bedding, clothing, etc.) 1,401 Verminous rooms in such houses, cleansed 3,718 Dirty beddings cleansed 108 Dirty bedding, destroyed 15 Other sanitary works executed 5,106 HOUSING Inspection of dwelling houses during the year (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 13,140 (b) Inspections made for the purpose 37,520 (ii) (a) Dwelling houses (including those under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 741 (b) Inspections made for the purpose 2,890 (iii) Dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 60 (iv) Dwelling houses (excluding those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 3,403 - 16 - Remedy of defects during the year without service of formal notices Defective dwelling houses rendered fit in consequence of informal action by the local authority or their officers 1,537 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 94 (ii) Dwelling houses which were rendered fit after service of formal notices 98 (b) Proceedings under Public Health Acts:- (i) Dwelling houses in respect of which notices were served requiring defects to be remedied 3,309 (ii) Dwelling houses in which defects were remedied after service of formal notices:- (a) by owners 1,872 (b) by local authority in default of owners - (c) Proceedings under Sections 11 and 13 of the Housing Act, 1936:- (i) Dwelling houses in respect of which demolition orders were made 6 (ii) Dwelling houses demolished in pursuance of demolition orders (d) Proceedings under Section 12 of the Housing Act, 1936:- (i) Separate tenements or underground rooms in respect of which closing orders were made 101 (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit 39 (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 98 The provision of new housing accommodation. The post-war new housing schemes being dealt with by the Council are summarised as follows :- Becher Street (Henry Dickens Court) 300 flats Rackham Street 112 flats 4 houses Portobello Street 157 flats Keifield Gardens 18 flats Blagrove Road 16 flats Holland Street (library) site 30 flats St. Marks Place 12 flats Cathcart Road 15 flats Slum Clearance. Consideration was given to the question of a future - 17 - programme for the clearance of unhealthy areas and, in this connection, the London County Council asked to be furnished with an approximate estimate of the provisional slum clearance programme. A survey of various areas in the borough was made and those areas which might prove suitable for treatment under the Housing Act, 1936, were divided into two classes, viz.:- Class I - Areas adequately planned but where structurally the buildings are worn out and where demolition is necessary on health grounds, and which would then provide sites suitable for the erection of housing accommodation. Class II - Areas consisting chiefly of mews dwellings which, owing to sanitary defects inherent in the original buildings and sanitary or structural defects due to disrepair, are prejudicial to the health of the occupants; or where the area is so badly planned as to cause congestion of the buildings in the area. At the end of the year consideration was being given to five areas in Class I and ten areas in Class II. Any schemes for demolition and clearance of these areas will be governed by the availability of accommodation for rehousing the persons to be displaced. As a commencement to a slum clearance programme, the following two areas were officially represented as clearance areas under the Housing Act, 1936:- Elgin Mews - Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27 and 28. Lionel Mews - Nos. 1, 2, 3, 4, 6, 10, 12, 14, 16, 17, 18, 19 and 20. Overcrowding. All cases of overcrowding are considered by the special Sub-Committee of the Public Health Committee with a view to deciding what action should be taken. The following are details of the cases dealt with in 1949:- 1. New cases reported to the Sub-Committee during 1949 176 (a) Cases in which the Sub-Committee reconmended that alternative accommodation should be offered by the Council 98 (b) Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 21 (c) Cases where action was postponed 48 (d) Cases withdrawn or where no action was taken 9 2. Cases of overcrowding abated during the year 147 - 18 - FACTORIES Section 128 of the Factories Act, 1937, requires the Medical Officer of Health to make an annual report in regard to the Council's functions under the Act. The following tables contain a summary of the inspections made and the defects found and remedied within the borough during 1949 Inspections Premises Number on Register Number of Inspections Number of Written Notices. Factories with mechanical power 289 83 2 Factories without mechanical power 504 196 4 Other premises under the Act. (Including works of building and engineering construction but not including out-workers' premises.) _ _ TOTALS 793 279 6 Defects found Particulars No. of defects found. No. of defects remedied. No. of defects referred To H. M. Inspectors By H. M. Inspectors Want of cleanliness 1 1 _ 1 Overcrowding _ _ _ _ Unreasonable temperature _ _ _ _ Inadequate ventilation _ _ _ _ Ineffective drainage of floors _ _ _ _ Sanitary conveniences:- (a) insufficient 1 1 _ 1 (b) unsuitable or defective 4 1 _ _ (c) not separate for sexes _ _ _ _ Other offences (not including offences _ _ _ _ relating to Homework) _ _ _ _ TOTALS 6 3 _ 2 During 1949, no prosecutions were instituted under the Factories Act, 1937. - 19 - Outworkers. The following table shows the nature of the work carried out by the 246 home workers on the register of outworkers during 1949 :- Nature of work Number Wearing apparel - (a) Making, etc. 116 (b) Cleaning and washing 6 Household linen 5 Lace, curtains, etc. 1 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 46 Basket making 1 Cosaques, crackers, stockings, etc. 10 Textile weaving 1 No instance of infectious disease occurring in premises where home work is carried on was reported during the year. 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 food inspectors engaged on this work for 1949 :- Food factories 36 Bakehouses - underground 37 others 53 Ice-cream premises 226 Preserved food premises 60 Butchers 304 Grocers 507 Dairies 396 Public houses 202 Greengrocers 169 Fishmongers 182 Restaurants and cafes 453 Hotels 271 Sweetshops 132 General stores 80 Street traders' premises 91 Other inspections: stalls, etc. 413 Re-inspections (all premises) 1347 Clean Food Campaign In 1948 the Council gave special consideration to the question of protection of the public food supply. They decided to carry out a comprehensive survey of food premises in the borough with the object of ascertaining the improvements 20 required in the light of modern standards and whether it was desirable to urge the Minister of Health to make regulations under Section 8 of the Food and Drugs Act, 1938. The actual survey was completed "by 30th April, 1949; two special visits were paid to each food establishment in the "borough, and information was collected on the condition of the premises and equipment and on the methods employed and the standard of hygiene maintained in the handling of food. One thousand one hundred and ninety-two establishments were surveyed, that is, almost all the food establishments in the borough, besides visits to street stalls. At the first visit a general survey of the establishment was carried out and a suitable record form was completed. At the second, which took place in most cases after an interval of several months, further information was obtained with particular reference to the standard of hygiene in handling food rather than to structural conditions. The data obtained were collated and, as far as possible, put in standardised form. The aim was to secure as much information as possible at each visit and to leave time, after the inspection, for discussion with the person in charge of the establishment; this was important and exacting work, for which unhurried visits were essential. By this means the inspectors were able to impart a considerable amount of information and advice on the measures necessary to ensure clean food. In addition, many visits were necessary to follow up 663 notices which were served for contraventions of Section 13 of the Food and Drugs Act, 1938, Section 10 of the Shops Act, 1934, or Section 82 of the public Health (London) Act, 1936. Appreciation must be expressed of the spirit of helpfulness and co-operation shown by the proprietors of all the different kinds of establishments and their staffs. It is gratifying to record that of the 663 notices served, 575 had been complied with by the end of the year. The results of the inspections were carefully analysed and collated, and a study of the information indicated the desirability of additional legislation requiring the registration with local authorities, of all premises where food is prepared, sold, or stored for the purposes of sale and of the proprietors or persons in charge of the premises. If such power were granted, each local authority could take into account local conditions in deciding desirable and practicable requirements and would be in a stronger position than at present to secure the observance of satisfactory food handling procedure. Another desideratum indicated was the formulation of detailed hygiene requirements for food shops suited to local conditions. Such requirements can be embodied partly in byelaws made under Section 15 of the Food and Drugs Act, 1938, and partly in locally agreed "Codes of Practice". The increased interest and more active public opinion, which are now apparent, make this the right time to press forward with health education in matters relating to food, directed both to those in the food trade and to the public generally. A voluntary organisation of food traders, in collaboration with the Council, would be of great value in advising upon the most effective means of promoting clean food handling. It would also foster mutual understanding between the Council and those working in food establishments. 21 A full report on the survey was submitted to the Council at the end of 1949, and copies were sent to appropriate Government Departments and other local authorities. After full consideration of all the facts revealed by the survey, the Council decided- (a) that representations be made to the Minister of Health and the Minister of Pood that legislation should be introduced requiring the registration with the local authority under the Food and Drugs Act, 1938, of:- (i) any premises where food is prepared, sold or stored for the purpose of sale; (ii) the proprietor or person in charge of any such premises; the local authority being empowered after hearing the interested parties to refuse or cancel registration if it appears to them that the public health is, or is likely to be, endangered by the condition of the premises or by any act or default of the proprietor or person in charge, subject to a right of appeal to a court of summary jurisdiction; and that such legislation should provide for the automatic registration in the first instance of all premises in existence when such legislation is introduced and of the persons who shall then be the proprietors or persons in charge of any such premises; (b) that the Metropolitan Boroughs' Standing Joint Committee be asked to make representations to the London County Council on the need for byelaws to be made under Section 15 of the Food and Drugs Act, 1938, and as to provisions which should be included in the bye laws; (c) that a Clean Pood Advisory Committee be formed in Kensington of representatives of the various sections of food traders to advise upon the methods of promoting hygienic practices among food handlers, and to further co-operation between the Council and the food traders in improving the hygiene of the preparation, sale and storage of food; and (d) that measures be taken for the promotion of knowledge among the public in matters of food hygiene. Food Legislation. During the year new or revised legislation relating to food came into operation, and, from the Council's viewpoint, the most important were as follows Food & Drugs (Whalemeat) Regulations, 1949 Date of operation 20th March, 1949 Provisions are included for protecting whalemeat against contamination in shops, on stalls, daring transport, and handling in wholesale markets, and are similar to those in the case of meat under the Public Health (Meat) Regulations, 1924. The Mineral Oil in Food Order, 1949 Date of operation 9th Aprils 1949. This Order prohibits the use of mineral oil in the composition or preparation of any food intended for sale or sold for human consumption. It also prohibits with certain provisos, the sale or possession for sale for human consumption of any article of food containing mineral oil. 22 Food & Drags (Milk and Dairies) Act, Date of operation 1st October, 1949 This Act amends the provisions of the Food and Drugs Act, 1938, relating to Milk and Dairies Regulations, but does not materially alter the Council's functions. Milk (Special Designation) Act, 1949 Date of operation 1st October, 1949 Under this Act it is obligatory to use special designations in regard to milk sold by retail for human consumption in any area declared by the Minister of Pood to be a specified area. No area had been specified by the end of the year. Milk (Special Designation) (Raw Milk) Regulations, 1949 Date of operation 1st October, 1949. These regulations amend and re-enact the Milk (Special Designation) Regulations, 1936/1948, so far as they relate to raw milk. Under these new regulations the special designations, when applicable, continue to be "Tuberculin Tested" and "Accredited". Producers' licences are granted by the Minister of Agriculture and Fisheries, and dealers' licences are granted by the Council. Pees for licences are abolished. There is a new provision in regard to sampling requiring any sample taken to be transferred immediately to a sealed container, not artificially cooled, for transport to the laboratory, unless the time taken in transport is more than two hours. During the year particulars of licences granted were as follows Principal Supplementary Dealers licences to bottle and sell Tuberculin Tested milk; 1 - Dealers Licences to sell Tuberculin Tested milk; 75 12 Twenty-five samples of Tuberculin Tested milk were submitted for examination during the year, and of these 6 failed to pass the prescribed test. Warning letters were sent to the vendors of the unsatisfactory samples. Milk (Special Designation) (Pasteurized & Sterilized Milk) Regulations, 1949. Date of operation 1st October, 1949 These regulations supersede the Milk (Special Designation) Regulations, 1936/1948, so far as they relate to Pasteurized Milk. Under the new regulations a licence is now required to produce or sell Sterilized milk, in the same way as that required in the case of Pasteurized Milk. The granting of licences to both producers and dealers of these milks is the function of the Council. The regulations provide for the pasteurization of milk either by (a) retaining at a temperature of not less than 23 145°F, and not more than 150°F for at least 30 minutes and immediately cooling to a temperature of not more than 50°F or, (b) retaining at a temperature of not less than 161°F for at least 15 seconds, followed by immediate cooling to a temperature of not more than 50°F or, (c) retaining at such temperature and for such period as may be specified by the licensing authority with the approval of the Ministry. The conditions applying to Sterilized Milk are that it should be filtered or clarified, homogenized and heated to a temperature of not less than 212°F. Bottles must be sealed with an airtight seal and legibly and conspicuously marked "Sterilized Milk". Details of licences granted during 1949 are as follows:- • Principal Supplementary Dealers licenses to sell Pasteurized milk 89 12 Dealers licenses to sell Sterilized milk 99 14 With regard to sampling, the regulations state that samples shall be transferred to an insulated container for transport to the laboratory. The following table shows the number of samples of processed milk taken during the year, together with results of examination:- Grade No. of samples Methylene blue test Phosphatase test Passed. Failed. Passed. Failed Tuberculin tested (Pasteurized) 42 31 11 42 Nil Pasteurized 37 30 7 37 Nil Sterilized 6 5 1 6 Nil Heat treated + 13 9 4 11 2 + Note: The term Heat Treated will cease to be used as and from 1st October, 1950. Warning letters were sent to the vendors of the unsatisfactory samples. Milk & Dairies Regulations, 1949 Date of operation 1st October. 1949. These regulations made under the Pood & Drugs (Milk and Dairies) Act, 1944, revoke the Milk and Dairies Regulations, 1926/1943. The Minister of Agriculture and Fisheries now becomes responsible for the registration of dairy farms and of persons carrying on, or proposing to carry on, the trade of dairy farmer. The registration of all other premises and persons dealing with milk, remains with the local authority. 24 General provisions are made for the protection of milk against contamination, the cleansing and storage of vessels used in connection with milk, and the distribution of milk. Milk in bottles or cartons must not be left on a public highway, except upon final delivery of a retail sale. The name and address of the retailer must be displayed on any stall, cart or barrow from which milk is sold or offered for sale. Milk. During the year 379 samples of milk were submitted to the Public Analyst and, with one exception, were found to be of genuine composition. The following table shows percentages of milk fats and non-fat solids of the genuine samples taken during each month:- Month No.of samples taken Average percentage Milk fats Non-fat solids January 29 3.55 8.77 February 56 3.60 8.60 March 23 3.33 8.66 April 17 3.41 8.62 May 31 3.64 8.70 June 11 3.62 8.82 July 27 3.73 8.72 August 12 3.74 8 . 61 September 25 3.76 8.68 October 63 3.63 8.76 November 57 3.59 8.78 December 27 3.60 8.76 Average for whole year 3.60 8.70 Milk fats Non-fat solids Legal minimum standards:- 3.00% 8.50% Adulteration of Food. During the year 477 formal samples of food and drugs were taken of which 2 (0.41%) were adulterated; 523 informal samples were taken of which 2 (0.38%) were adulterated. Unsound Pood. 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 or disposed of for purposes other than human consumption. There were five instances during the year of food being condemned under these provisions. In three cases the Public Health Committee decided to give warnings to the vendors. Proceedings were taken in the other two cases and a fine of £10 and five guineas cost were imposed in each instance. In one of these cases an appeal was dismissed by the Quarter Sessions (February,1950), twenty guineas costs being allowed to the Council. 25 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 the following amounts of food were surrendered and condemned as unfit for human consumptions- Tons. Cwt. Qrs. Lbs. Meat (Raw) and Bacon 1 15 2 11 Meat (Tinned) 10 - 23 Pish (Wet and Dried) 3 19 1 - Pish (Shel1) 2 6 Poultry and Rabbits 9 1 11 Butter and Cheese 1 - 15 Pruit 2 - 17 Sausages 1 1 14 Cerea1s 1 1 6 Tea 2 19½ Sweets 23 Haggis 2 - Brawn 15 In addition to the foregoing, the following amounts of foods were also condemned:- 102 shell eggs; 1½ gallons ice cream; 2 bags swedes; 1 bag cauliflowers; ½ hag carrots; 5 bags greens; 7 bags potatoes; and 4,223 tins and jars of assorted food stuffs. Pharmacy and Poisons Act, 1933. At the end of the year the number of sellers of Part II Poisons (other than registered Pharmacists) on the list maintained by the Council was 139. Of this number 6 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, three premises which obtain water from artesian and deep wells. Samples of water were taken both by the Council and the owners for bacteriological and chemical examination. Results showed the water was suitable for drinking and domestic purposes. Ice Cream. General prohibition of the use of milk and milk products as ingredients in the manufacture of ice cream continued to operate during 1949. The Ministry of Food, however, arranged for increased allocations of sugar and fat to ice cream manufacturers, willing to give an undertaking that the fat content of their product would hot fall below 2½%. It was emphasised by the Ministry that this was not to be interpreted as the introduction of 2½% fat staridard, but was a step taken to ensure that the additional supplies available should go only to those manufacturers who were prepared to put them to good use. In order to safeguard this, results of the chemical analyses of samples of ice cream were forwarded to the Ministry of Food. 26 The Foods Standards Committee, appointed by the Minister of Pood to review the composition of foods and to recommend standards, have stated that they are of the opinion that a standard for ice cream is in principle desirable. The average fat standard of ice cream sampled daring 1949, whilst slightly "better than that of the previous year, was lower than the minimum of 8% advocated by the Council. The following table shows the number of samples taken during the year for chemical analysis compared with 1948 :- No. of samples Variation of fat content. Non-fat solids content Average fat content Average non-fat solids content 1949 72 From 2.3% to 11.7% From16.1% to 31.9% 5.1% 23.4% 1948 43 From 0.3% to 8.2% From 17.6% to 31.3% 3.53% 21.5% The ice cream premises in the borough were frequently inspected and there was no occasion on which formal action under the Pood and Drugs Act, 1938, was necessary. Further representations were made to the Ministry of Health to fix a bacteriological standard for ice cream, and it was stated in reply that whilst the Methylene Blue Reduction test afforded a simple and practical means for the routine grading, the test had not such precision as would justify its use as a statutory test, non-compliance with which would constitute an offence. By the Methylene Blue Test ice cream can be divided into four grades. It is suggested that if ice cream consistently fails to reach grades 1 and 2 it would be reasonable to regard this as indicating defects of manufacture or handling, calling for further investigation. During 1949, 98 samples of ice cream were taken and submitted to the Methylene Blue Test and the results were as follows:- No.of Samples 1 23 2 23 3 17 1 35 These results on the whole cannot be regarded as satisfactory. Special investigations were made in the cases of two manufacturers owing to the consistent low grade results obtained from their products. The results indicated that the manufacturers had failed to appreciate the paramount need for meticulous cleaning of the somewhat complicated machinery. Appropriate action taken produced improved results. 27 Traders are co-operative and are willing to give effect to the suggestions pat forward by the Council's officers. There was no outbreak of disease during the year attributable to ice cream sold in the borough. FOOD POISONING Under Section 17 of the Pood and Drugs Act, 1938, any medical practititioner, 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 1949:- Food poisoning notifications (corrected) Received in first quarter 4 " " second quarter 4 " " third quarter 10 " " fourth quarter 15 TOTAL 33 Outbreaks due to identified agents Nil Outbreaks of undiscovered cause 1 (5 cases) Single cases: agent identified 8 unknown cause 20 TOTAL 28 In the one outbreak involving five cases, the patients were all members of the same family. They suffered from similar symptoms of pain, vomiting, diarrhoea, thirst and fever. Diarrhoea persisted intermittently for about a week, but the other symptoms disappeared after 12 hours from onset. Investigations showed that all the five patients had partaken of an early evening meal at home consisting of soup, cold tongue, potatoes and runner beans. They had subsequently fallen ill, the times of onset varying from 1½ to 4½ hours after the meal. None of the food was left over which could have been submitted to examination and, unfortunately, the patients themselves refused to co-operate by providing specimens for laboratory examination. Prom such evidence as could be obtained, it was thought that the tongue, which had been cooked the previous day and kept in an unsuitable food larder, might have given rise to this outbreak. The tongue was one of a consignment of about 12, all of which had been sold from a Kensington shop. No other cases of illness were reported in this connection. The following table shows an analysis of the 28 notifications of individual cases, setting out the nature of the food suspected or proved to have "been at fault. 28 Type of food suspected No. of cases No. of patients where causative agent was identified Toxin Salmon -ella Chemical Not proven MEAT AND MEAT PRODUCTS Cold beef 1 1 Bacon 1 1 Chops 2 1 1 Sausage meat 3 3 Tinned beef and pork roll 1 1 Meat pie 3 1 2 Rissole 1 1 FISH AND PISH PRODUCTS • Pried fish 2 2 Jellied eels 1 1 Tinned salmon 2 1 1 Tinned lobster 1 1 Crab paste 1 1 EGGS Duck egg 1 1 Omelette (hen's egg) 1 1 FOOD NOT KNOWN 7 4 3 In 7 of the 8 cases where agents were identified, the organism isolated was salmonella typhi-murium. In the remaining case, the organism isolated was salmonella newport. In no case did death occur. INFECTIOUS DISEASE Smallpox. No case of smallpox was notified in the borough during the year 1949. Many persons came to Kensington from places abroad who were reported to have been in contact with smallpox. Early in April, the s.s. "MOOLTAN" arrived in London carrying about 1,400 people. During the voyage a death had occurred on board from smallpox and on arrival several other suspected cases were removed to hospital. No fewer than 87 persons (passengers and crew) feame to Kensington, including one passenger who subsequently moved out of London and died suffering from the disease. All contacts were kept under surveillance until the possibility of developing the disease had disappeared. Scarlet fever. The number of cases notified in 1949 was 124, but 10 were subsequently found not to be suffering from scarlet fever. Of the total number of cases notified, 65 were treated in hospital. There was no fatal case daring the year. 29 Diphtheria. Fourteen cases of diphtheria were notified, but of these 12 were subsequently found not to be suffering from diphtheria. The two remaining cases were unconnected. The net figure of 2 cases is the lowest annual figure ever recorded in Kensington. The first case occurred in a woman aged 42 years who was shown to be a carrier of C. Diphtheriae Mitis. The organism was found to be avirulent on guinea pig inoculation and the patient was not considered to constitute a danger. She was treated at home for the eradication of the organism from her throat. The second case occurred in a woman aged 37 years who was admitted to hospital as suffering from tonsilitis but subsequently a diagnosis of faucial diphtheria was confirmed. Neither of these two persons had been immunised. No death from diphtheria occurred during the year. Diphtheria immunisation work, commenced "by the Council in 193U, was continued on the same lines "by the London County Council daring the year. A summary of the work carried out in Kensington is as follows Number of pre-school children immunised 1,646 " " school " " 332 " " reinforcing injections given 1 ,049 " " children attending for pre Schick Tests 238 " which gave a positive reaction 168 " of children attending for post Schick Tests 2,787 " proving negative 2,612 " proving positive 78 " who failed reading 97 Enteric fever. Pour cases of typhoid fever and three cases of paratyphoid B fever were notified during the year. All the cases were treated in hospital and there was no death. Three of the four patients suffering from typhoid fever had recently arrived in this country from the continent, and it is likely that the infection was contracted abroad. In the fourth case the source of infection was not traced. Prom the histories of two of the three cases of paratyphoid B fever, it was established that the sources of infection were outside London, one in Sussex and one in Cornwall. In the third case nothing could be established from the history. Puerperal Pyrexia. Thirty-three cases of this disease were notified and twenty-nine were treated in hospital. No death occurred amongst these cases. Pneumonia. There are various forms of pneumonia, but the only kinds notifiable are acute primary and acute influenzal. One hundred and twenty-one notifications were received during the year, 30 one hundred and one patients being certified as suffering from acute primary pneumonia and twenty from acute influenzal pneumonia. Of these one hundred and twenty-one cases, seventy-eight were treated in hospital. During the year, the number of deaths from pneumonia (all forms) was ninety-nine and nineteen deaths were certified as due to influenza. Dysentery. There were thirty-three cases of dysentery notified during the year. All were bacillary in origin and the majority of cases were due to sonne bacillus. Many of the notifications followed "bacteriological examination of 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 the routine examination of faeces from contacts. All cases were of a mild type, but in one case the patient (an old lady of 82 years) died in a Kensington nursing home and dysentery (Plexner) was shown as a contributory cause of death. Erysipelas. Of the fifteen cases notified, nine were admitted to hospital. There were no deaths. Cerebro-spinal meningitis. Eight cases of this disease were notified during the year. One, a female child aged 5 months, died in hospital, but the remainder recovered after hospital treatment. Malaria. No case of malaria was notified during the year. Poliomyelitis. During 1949, fifty-nine cases of poliomyelitis were notified in Kensington, in forty-seven of which the diagnosis was confirmed, (twenty-three males and twenty-four females). There were five deaths. In addition, eleven unnotified cases were admitted for observation in hospital, where the diagnosis was not confirmed. Porty-aix of the forty-seven confirmed cases were treated in hospital, the exception being a woman of 19 years who died at home in the early stages of the disease. The following table shows the age distribution of patients with and without paralysis - 31 - Age Groups (years) Paralytic NonParalytic Total Total persons M. F. M. F. M. F. Under 1 year - - - - - - - Between 1 and 3 7 4 - - 7 4 11 3 and 5 1 3 - 1 1 4 5 5 and 10 3 4 - - 3 4 7 10 and 15 6 4 1 - 7 4 11 15 and 25 1 5 - 2 1 1 8 25 and over 2 - 2 1 4 1 5 TOTALS 20 20 3 4 23 24 47 The five deaths occurred in males of 25 and 24 years and females of 19, 13 and 11 years. It will be noted that slightly more than half of the patients (24) were 10 years of age or over and that the five deaths were all in this older group. The forty paralytic cases included the five deaths. Of the remaining thirty-five, subsequent enquiry has shown that on 31st January,1950, eight were still undergoing orthopaedic treatment in hospital, thirteen were at home but continuing orthopaedic treatment as out-patients for residual paralysis, eight were reported to have fully recovered and six patients were found to have left Kensington. The first case was notified during the first week in April and the last during the third week in November. The following table shows the number of cases notified each month in Kensington from March to December, 1949, (confirmed cases in brackets) together with the number of cases notified in the Administrative County of London and in England and Wales Notifications of Poliomyelitis (including Polio-Encephalitis) Mch. Apl. May June July Aug. Sept. Oct. Nov. Dec. KENSINGTON - 1 1 - 5 14 13 16 6 3 (-) (1) (1) (-) (5) (12) (9) (15) (4) (-) County of London 4 9 5 15 46 130 163 286 150 64 England and Wales 65 60 58 122 543 1015 1251 1975 1065 530 During the late summer and autumn, poliomyelitis was prevalent in England and Wales, with a peak of 463 cases in the week ending 15th October; for the County of London the maximum incidence was also in the week ending 15th October (68 cases). In Kensington the peak was reached in the week ending lst October, with 6 notified cases. 32 The year under review showed the highest incidence of poliomyelitis recorded in Kensington, the previous highest being twenty-seven cases in 1947 and ten in 1924 In the thirty-eight years before 1949 during which poliomyelitis was notifiable (1911—1948) the total number of cases in Kensington was one hundred and eleven. Encephalitis lethargica. There was one case of this disease notified during the year. The patient, aged 4 months, died in hospital. Measles. Of the seven hundred and forty cases notified during 1949. seventy-two were admitted to hospital for treatment. No death was reported during the year. Ophthalmia Neonatorum. Five cases of this disease were notified. Three of these cases were treated in hospital. All five cases recovered without injury to sight. Gastro-Bnteritis. This disease is notifiable in children up to the age of 5 years and during the year eighty-eight cases were reported; of these eighty-six cases were treated in hospital. During the year, there were six deaths of children under the age of 2 years suffering from diarrhoea. Scabies. The special scheme of control introduced during the war in 1941 was withdrawn by the Minister of Health on 31st December, 1947. The normal vigilance exercised by the Council continued during 1949. The number of notifications was only one hundred and six compared with one hundred and forty-one in the previous year and four hundred and sixty-three in the peak year of 1946. Tuberculosis. During the year two hundred and sixty-six new cases of tuberculosis were notified, of which twohundred and thirty-four were respiratory and thirty-two non-respiratory cases. The following table shows the number of cases added to and the number removed from, the notification register during the year 33 Description Respiratory NonRespiratory Total M. F. M. F. On register of notifications on 1st January 1949. 533 476 58 78 1145 Notified for the first time during the year 127 107 15 17 266 Brought to notice other than by notification. 76 53 3 4 136 Removed from register on account of having- (a) recovered from disease 32 20 4 2 58 (b) removed from district, lost sight of, etc. 133 93 9 28 263 (c) died. 51 28 — — 79 Remaining on register on 31st December,1949. 520 495 63 69 1147 Whooping cough. Three hundred and four cases were notified during the year, forty-nine of which were treated in hospital. One death occurred from this disease. Notifications. The following tables show (1) the number of cases of infectious disease notified during the year 1949, with comparative figures for the previous seven yearsj (2) the number of-notifications divided into age groupsj and (3) the number of cases notified in each ward of the borough. TABLE 1 Notifiable disease Number of cases notified 1949 1948 1947 1946 1945 1944 1943 ###] Scarlet fever 114 94 98 195 136 74 216 108 Diphtheria (including Membranous Croup) 2 12 23 37 19 29 54 78 Enteric fever 7 4 4 6 3 3 3 1 Puerperal fever ø — — 5 4 7 18 10 7 Puerperal Pyrexia 33 25 9 8 12 23 25 7 Acute primary pneumonia and acute influenzal pneumonia 121 142 103 111 81 91 133 91 Dysentery 33 145 21 49 142 43 73 68 Erysipelas 15 24 34 37 33 16 37 30 Cerebro-spinal meningitis 8 4 7 10 3 6 11 17 Malaria — 2 4 8 11 8 1 1 Poliomyelitis and polioencephalitis 47 9 27 1 3 1 1 2 Encephalitis lethargica 1 — 2 — 11 — — — Tuberculosis (all forms) 266 258 259 210 188 211 202 203 Measles 740 868 852 264 868 102 624 365 Ophthalmia Neonatorum 5 7 4 4 8 4 11 4 Enteritis + 88 64 102 69 100 71 69 96 Pood poisoning 33 11 7 7 6 7 4 8 Scabies / 106 141 239 463 460 363 252 — Whooping cough 304 264 274 209 62 189 102 146 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. / Notifiable as from 1st August, 1943. NOTE; Cases of mistaken diagnosis are excluded from the above table. 34 TABLE 2 Notifiable Disease Number of Cases Notified in 1949 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 11 11 12 66 6 2 - Diphtheria (including Membranous Croup) - - - - - - - 2 - Enteric fever - 1 - - - 1 5 - - Puerperal Pyrexia - - - - - - 30 3 - Acute primary pneumonia and acute influenzal pneumonia 3 7 8 1 2 12 19 45 24 Dysentery 3 4 5 4 2 4 7 3 1 Erysileplas - - - - - - 3 10 2 Cerebro-spinal meningitis 3 1 1 1 - 1 - 1 - Malaria - - - - - - - - - Poliomylitis and polioencephalitis - 7 4 2 3 18 13 - - Encephalitis lethargica 1 - - - - - - - - Tuberculosis (all forms) - 4 2 1 2 21 137 89 10 Measles 32 111 100 90 97 261 35 14 - Ophthalmia neonatorum 5 - - - - - - - - Enteritis 61 15 7 2 3 - - - - Pood poisoning - - - - - 4 13 14 2 Scabies - 2 6 2 4 30 43 13 6 Whooping cough 42 47 62 35 36 81 1 - - TOTALS 150 205 206 149 161 499 312 196 45 TABLE 3 Notifiable Disease Total Cases Notified in each Ward StoCharles Golborne Norland Pembri dge Holland Earls Court Queens Gate Re deliffe Brompton Scarlet fever 38 8 14 15 8 11 3 14 3 Diphtheria (including Membranous Croup) - - - - 1 1 - - - Enteric fever - - - 1 1 1 2 2 - Puerperal Pyrexia 9 4 5 6 3 2 1 3 - Acute primary pneumonia and acute influenzal pneumonia 31 20 19 19 8 8 8 5 3 Dysentery 5 10 3 2 7 1 2 2 1 Erysipelas 1 - 1 1 6 2 2 2 - Cerebro-spinal meningitis - 2 2 1 - 1 - 2 - Malaria - - - - - - - - - Poliomyelitis and polioencephali tis 8 6 5 4 11 3 3 6 1 Encephalitis lethargica - - - - - - - 1 - Tuberculosis (all forms) 45 39 26 28 33 31 20 31 13 Measles 115 41 121 94 129 104 32 82 22 Ophthalmia neonatorum 1 - 2 1 - - - 1 - Enteritis 21 18 10 7 15 4 1 8 4 Pood poisoning 3 2 3 14 2 2 - 6 1 Scabies 23 22 9 20 11 7 3 9 2 Whooping cough 107 50 31 41 16 31 1 25 2 35 LEGAL PROCEEDINGS Public Health (London) Act, 1936 Nuisances. During the year 291 summonses were issued for various nuisances under the Public Health (London) Act, 1936. In 106 Cases abatement or prohibition orders were secured; fines amounting to £63 were imposed and £39.5s.0d. costs were awarded to the Councilo In 1814. cases the summonses were withdrawn, the nuisances having been abated by the owners prior to the Court hearings. In the remaining case the summons was dismissed under the Probation of Offenders Act. Twenty-eight prosecutions were undertaken for failure to comply with Justices Orders to abate statutory nuisances; fines amounting to £226.1ls.6d. were imposed and costs amounting to £5.4s.6d. were awarded to the Council. Drainage Byelaws. One prosecution was instituted for failure to deposit plans in regard to proposals to carry out drainage work. A conviction was secured and a fine of £2 was imposed. Food and Drugs Act, 1938 Two prosecutions under this Act were instituted during the year and convictions were obtained as follows (a) Exposing for sale unsound tinned food; fined £25 plus £5.5s.0d. costs. (A second summons in regard to this offence, namely for being in possession of unfit food, was not proceeded with on obtaining this conviction.) (b) Sale of strawberry flavoured powder with false labels fined £5. A further prosecution was undertaken in respect of a sale of milk deficient in non-fatty solids. The summons was dismissed under the Probation of Offenders Act, but costs of £2.2s.0d. were awarded to the Council. Milk and Dairies Order Two prosecutions under this Order were instituted in respect of the dirty condition of milk bottles, and fines amounting to £20 were imposed and the Council were awarded £10.10s.0d. costs. In one of these cases the defendants appealed to Quarter Sessions. The appeal, heard in 1950, was disallowed and the Council were granted £21 costs. Council's Byelaws Dog Nuisances. Thirteen summonses were issued under this byelaw, and in 12 cases convictions were obtained and fines of £6.5s.0d. were imposed plus costs of £1. The last case was dismissed under the Probation of Offenders Act, on payment of 10s.6d. costs. Housing Act, 1936 Contravention of Closing Orders. In one instance a summons was issued in respect of illegal occupation of underground rooms. A conviction was obtained and a fine of £1 was imposed. 36 National Assistance Act, 1948 In one case an application to the Court under Section 47 was made by the Council for the compulsory .removal of an old lady to an institution. The application was successful and an Order was made for her removal for a period not exceeding three months. CONCLUSION I would like to place on record an appreciation of the loyal and excellent work performed by all members of the public health department. On their behalf, I acknowledge the kind co-operation and assistance received from other departments of the Council, and the welcome encouragement and support given by the Mayor, the Chairmen and the Vice-Chainnen of the various Committees, and the Aldermen and Members of the Council. I have the honour to be Your obedient Servant, J. H. WEIR Medical Officer of Health.