AC4348 KEN 59 THE ROYAL BOROUGH OP KENSINGTON ANNUAL REPORT on the HEALTH OP THE BOROUGH for the year 1950 by J. H. WEIR, M.D. , B.S., B.Hy., D.P.H. Medical Officer of Health 30th June, 1951. Public Health Department The Red House, Hornton Street, Kensington, W.8. THE ROYAL BOROUGH OF KENSINGTON Public Health Department, Hornton Street, KENSINGTON, W. 8. 30th June, 1951. 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 1950. In accordance with the request of the Minister of Health, the report is in the same abbreviated form as has been the case for the past eleven years. Since commencing duty as Medical Officer of Health for the Royal Borough of Kensington on 27th February, 1950, I have reviewed the local health services, especially those for which the Council are responsible. It would appear that the residents of Kensington are enjoying as full a health service as the legal and economic factors permit the Council to provide at the present time. It must not be assumed that this means that there is no room for extension or improvement. There is a great deal which could be done to improve environmental health conditions in the borough, and efforts are constantly being made in this direction. For example, the housing situation is deteriorating month by month, not only in Kensington, but possibly in all areas and districts containing property built in the nineteenth century and let to tenants at "controlled" rents. It is accepted on all sides that in many cases, owners are not able economically to carry out adequate repairs to such houses to maintain proper standards of fitness, owing to the high building costs compared with relatively low rents. The problem of maintaining existing dwelling houses in a reasonable state of habitation is probably the most urgent confronting the Council at the present time. Representatives of the Public Health and the Housing and Town Planning Committees have recently conferred together, and it has been decided to obtain the advice of the Ministry of Local Government and Planning in this matter. It would appear that some amendment in the housing legislation is needed, to afford the Council wider powers than they can at present operate. Notwithstanding the difficulties, the Council have continued to operate, in every possible case, their existing powers to secure repairs to houses under the Housing Acts, 1936/1949, and the Public Health (London) Act, 1936. In this connection, the Council have, on several occasions, had under review their procedure for securing rehabilitation of house property under Section 9 of the Housing Act, 1936. 2 Changing costs, falling house values and progressive dilapidation have necessitated considerable amendment of the criteria formerly adopted for determining the "reasonable cost" of property repairs. Government policy does not, at the present time, permit extensive slum clearance programmes, but pending a relaxation of restrictions, the Council have resolved to undertake clearance procedure in certain selected small areas and the necessary steps are in train. There is no doubt that the demand for housing accommodation in the borough, both permanent and temporary, is increasing year by year. As one consequence, it has been noted that the number of buildings converted into, or used as, hostels, is increasing. Investigation has shown that some of these establishments need stringent supervision and the Council are at the present time in the process of making byelaws which will simplify the task of ensuring that conditions in all hostels are maintained at a satisfactory standard. As later indicated the Council have furthered their campaign in relation to clean food by the holding of a Food Hygiene Exhibition and by the constitution of a Food Hygiene Advisory Committee, who have formulated basic and specific codes of practice covering the main food-handling occupations. Efforts to ameliorate the lot of the aged have continued and several new projects in this direction are described. The work in connection with the visiting of old people was increased during the year and an assistant Woman Health Officer was appointed. It was decided that a register of old people should be maintained and, by the end of the year, 2,538 names of old people were listed. The total number of visits made was 2,155 compared with 504 the previous year. There has been an attempt to improve the environmental conditions of persons suffering from tuberculosis and, with this end in view, the investigation of home circumstances of all newly notified cases has been intensified. Schemes for the provision of coster mongers' stabling and food stores were rendered possible by the passage of the London County Council (General Powers) Act, 1950, which contains a section conferring powers on the Borough Council. It is hoped that it will be possible in the near future to replace some of the unsatisfactory mews, stables and food stores by new premises of modern hygienic design. GENERAL OBSERVATIONS POPULATION. The Registrar General's estimate (177,400) of the population of the borough for 1950 again showed an increase over the figure for the previous year (174,220). The actual population figure for Kensington obtained as a result of the recent Census is not yet available. BIRTH RATE. The decline in the annual birth rate since 1946 was not maintained in 1950, when the rate (15.5) showed a slight increase compared with the previous year (15.4). The birth rate for London was 17.8 and that for England and Wales was 15.8. 3 GENERAL DEATH RATE. The death rate for 1950 was 10.4 which was the same as the previous year. The rate for London was 11.8 and that for England and Wales was 11.6. INFANT DEATH RATE. The number of deaths of children under twelve months for every thousand live births was 28 for 1950, which was the second lowest rate recorded in the borough. The lowest record of 24 infant deaths for every thousand live births was registered in 1949. The infant death rate for 1950 for London was 26.3 and for England and Wales was 29.8, MATERNAL MORTALITY RATE. There were unfortunately five maternal deaths recorded in 1950, compared with none for the previous year. The maternal mortality rate was 1.79 which compares with a rate of 0.86 for England and Wales. (The figure for London is not yet available.) TUBERCULOSIS DEATH RATE. Whilst the number of cases of tuberculosis recorded in the notification register as residing in Kensington increased during 1950 from 1,147 at the 1st January to 1,246 at the 31st December, the death rate (33) from all forms of tuberculosis for the year was the lowest recorded in the borough. New cases notified for the first time numbered 278 in 1950 compared with 266 in 1949 and 258 in 1948. In this connection, it is of interest that arrangements were made, on three occasions, to operate a Mass X-ray unit in the borough. Over 6,500 persons were examined, of whom just over were referred for further examination. INFECTIOUS DISEASES. There was no major outbreak of infectious disease in the borough during 1950; the total number of notifications received was 1,716 compared with 1,923 in 1949. These figures represent a reduction of over 10%. The 1949 outbreak of poliomyelitis (47) cases was not repeated in 1950, only thirteen cases were notified. The incidence of diphtheria was again limited to two cases in 1950, which was the same number occurring the previous year, the lowest record in the borough. Both the cases were of persons who had never been immunised against the disease. From the foregoing observations it will be seen that the public health of the borough remained satisfactory during 1950. — OOO' VITAL STATISTICS 41 The table set out on the next two pages gives the important vital statistics for 1950, together with comparative figures for the previous seven years. - 4 - - 5 - SUMMARY OF VITAL STATISTICS FOR KENSINGTON Description 1950 1949 1948 1947 1946 1945 1944 1943 POPULATION Population (estimated) 177,400 174,220 168,800 166,170 147,870 117,170 107,610 106,830 Density of population per acre 77 76 74 72 64 51 47 46. 6 LIVE BIRTHS Total births 2,745 2,681 2,908 3,012 2,695 1,890 1,780 1,698 Legitimate births 2,470 2,417 2,608 2,696 2,378 1,579 1,527 1,479 Illegitimate births 275 264 300 316 317 311 253 219 Birth rate per 1,000 population 15.5 15.4 17.2 18.1 18.2 16.1 16.5 15.9 STILL BIRTHS Total still births 54 39 56 65 68 49 47 46 Legitimate still births 51 39 47 58 60 40 44 39 Illegitimate still births 3 Nil 9 7 8 9 3 7 Still birth rate per 1,000 total births 19.3 14.3 18.9 21.1 24.6 25.3 25.7 27.1 DEATHS Total deaths Death rate per 1,000 population 1,848 1,819 1,685 1,866 1,821 1,586 1,735 1,769 10.4 10.4 10 11.2 12.3 13.5 16.1 16.5 DEATHS OF INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 78 64 111 124 132 92 93 88 Legitimate deaths 69 52 103 105 117 73 76 76 Illegitimate deaths 9 12 8 19 15 19 17 12 Infant death rate per 1,000 births 28 24 38 41 49 49 52 52 Death rate of legitimate infants per 1,000 legitimate births 28 22 39 39 49 46 50 51 Death rate of illegitimate infants per 1,000 illegitimate births 33 45 27 60 47 61 67 55 MATERNAL DEATHS Deaths of mothers as a result of pregnancy or childbirth 5 Nil 5 4 3 4 1 3 Death rate of mothers per 1,000 live and still births 1.79 Nil 1.68 1.3 1.08 2.06 0.55 1. 70 TUBERCULOSIS DEATHS Death rate from all forms per 100,000 population 33 34 51 47.5 55 84 76 92 Death rate from respiratory tuberculosis per 100,000 population 29 32 45 43 47 70 68 80 Death rate from nonrespiratory tuberculosis per 100,000 population 4 2 6 4.5 8 14 8 12 6 CAUSES OP DEATH AT DIFFERENT PERIODS OF LIFE IN 1950 Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 45 years and over Respiratory tuberculosis 52 1 1 17 33 Other forms of tuberculosis 7 1 — 3 3 Syphilis 9 — — — 9 Diphtheria — — — — — Whooping cough — — — — — Meningococcal infections 1 — _ — 1 Acute poliomyelitis 3 — — 3 — Measles 1 — 1 — — Other infective diseases, etc. 2 1 1 — Cancer (all forms) 352 1 — 22 329 Leukaemia, aleukaemia 9 — — 4 5 Diabetes 6 — — 1 5 Vascular lesions of nervous system 211 — — 3 208 Coronary disease, angina 225 — — 6 219 Hypertension with heart disease 43 — — 1 42 Other heart disease 245 — — a 237 Other diseases of circulatory system 88 — — 3 85 Influenza 20 — — — 20 Pneumonia 82 3 — 2 77 Bronchitis 104 3 — 5 96 Other respiratory diseases 10 — _ 1 9 Ulcers of the stomach 26 — — 2 24 Gastritis, enteritis and diarrhoea 10 2 1 — 7 Nephritis and nephrosis 19 _ — 4 15 Hyperplasia of prostate 29 — — — 29 Pregnancy, childbirth and abortion 5 — — 5 — Congenital malformations 23 16 2 3 2 All other diseases 169 47 1 10 111 Motor vehicle accidents • 7 — — 2 5 All other accidents 60 3 2 11 44 Suicides 27 — — 11 16 Homicide and operations of war 3 — 1 2 — TOTALS 1,848 78 9 130 1,631 7 GENERAL PROVISION OP HEALTH SERVICES IN THE AREA Bacteriological and Analytical Work Prom 1st January, 1949, athological and bacteriological work has been carried out 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 arrangements have continued to prove satisfactory and the following is a summary of the work performed during the years:- Nature of specimen or sample Number examined Nose and throat swabs 406 Sputum 54 Faeces, rectal swabs and other specimens 437 Milk (bacteriological) 134 Water (drinking) 11 Water (swimming baths) 16 Ice cream 77 Miscellaneous 177 Medicinal Baths (Personal Cleansing Station) The record of work done during 1950 is as follows Description Scabies Vermln Impetigo Other conditions Persons clean -sings Persons Clean -sings Persons Clean-sings Persons Clean -sings Adults Kensington 74 134 80 86 1 2 8 17 Other boroughs 25 51 66 72 - - 2 2 Schoolchildren Kensington 32 137 1409 1409 - - 9 18 Other boroughs 21 67 356 356 - - 3 5 Children under 5 Kensington 26 45 24 24 - - - - Other boroughs 13 23 15 15 - - - - Compulsory Cleansings - _ 177 177 - - - - TOTALS 191 457 2127 2139 1 2 22 42 8 In addition to the cleansing of persons referred to above, articles of personal clothing disinfested at the Medicinal Baths during the year numbered 1,511. Disinfection and Disinfestation A summary of the routine work of the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 418 (625 rooms) Houses disinfested after vermin 954 (2199 rooms) Loads of furniture treated with hydrogen cyanide 233 Total weight of furniture, bedding, etc. dealt with:- 300 tons, 13 cwt. 3 quarters, 9 lbs. During the year 186 new Council flats became ready for occupation, and the furniture of the ingoing tenants was treated with H.C.N. This accounts for the large increase in the number of loads (233) of furniture treated by this poison gas compared with last year (63). Prevention of Damage by Pests The Prevention of Damage by Pests Act, 1949, received the Royal Assent in July, 1949, and came into operation on 31st March, 1950. This Act, which repealed the Rats and Mice Destruction Act, 1919, and revoked the Infestation Order, 1943, improves the Council's powers in the control of rats and mice. In a circular PDP 1950/1, dated 30th March, the Ministry of Agriculture and Fisheries emphasised the important differences between the 1919 Act and the new provisions. Attention was called to the primary obligation now placed on the Council to ensure that as far as practicable the borough is kept free from rats and mice, an obligation which formerly rested on occupiers of individual premises. Section 4 of the Act enables the Council to serve notices requiring rat destruction treatment and precautionary works and the Council empowered the Medical Officer of Health, the Deputy Medical Officer of Health, all sanitary inspectors and the rodent officers to take necessary action. A duty is imposed on occupiers of premises to notify the Council of rodent infestation. It will be remembered that this duty was originally placed on occupiers by the Infestation Order, 1943. With the introduction of the 1949 Act, the Council decided that new publicity should be undertaken in the borough, reminding the public of their duty imposed by the Act to notify cases of rat infestation, and intimating that the Council will deal with rat and mice infestation in dwelling houses without cost to occupiers. The Council's work under the Prevention of Damage by Pests Act, 1949. (and 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. 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. - 9 - On two occasions all the sewers in the borough were dealt with by poison bait, and it was estimated that in the first treatment 4,070 rats were destroyed; and in the second 4,014 rats were killed. The following is a summary of other action taken Complaints investigated 1,426 Premises inspected following complaints 1,666 Premises where rats were found 484 Premises where mice were found 720 Premises where other vermin were found 156 Premises where no infestation existed. 306 Number of visits made 10,063 Number of notices served 125 Premises successfully treated 1,294 Cases in which advice only was given 72 Borough Council properties dealt with. 86 The Ministry recommended that information obtained by inspection and complaints, and all case work, should be suitably collated to present a clear picture of the conditions and to furnish a guide for subsequent action. The Minister is empowered from time to time to require reports and, in particular, an Annual Report must be submitted to the Minister on (i) the extent of infestation, (ii) special circumstances to which any undue presence of rats and mice might be attributed and (iii) the nature and extent of co-operative working with contiguous local authorities. The following is the Report submitted to the Ministry of Agriculture and Fisheries for the nine months from 31st March to 31st December, 1950:- Prevalence of Rats and Mice Type of Property Total Number of properties in Local Authority's area in which infestation was Number of properties infested by:- Notified by Occupier Otherwise discovered Recorded Total Rats + Mice only Major infestations. Minor infestations. Local Authority's Property 31 1 2 3 1 1 1 Dwelling houses 34,689 626 39 665 11 209 445 Business Premises 7,636 109 2 111 3 36 72 Agricultural Property - - - - - - - Total: 42,356 736 43 779 15 246 518 10 Measures of Control by Local Authority Type of Property No. of properties inspected. No, of inspections made No. of notices served under Section 4 No.of treatments carried out:- Block treatments of properties in diff. erent occupancies under Section 6(i) or by informal arrangement By arrangement with Occupier Under Section 5(i) Treat ments Works Rats + Mice only Rats + Mice only No. of blocks Surface properties Associated sewers No. of separate ooc upanclflB No. of manholes treate Local Authority' s Property 7 27 - - 3 1 - - - - - Dwelling houses 923 5,733 - 2 350 445 - - - - - Business premises 134 798 - 1 45 72 - - - - - Agricultural property - - - - - - - - - - - Total: 1,064 6,558 - 3 398 518 - - - - - + Include under this heading properties infested with both rats and mice. ø Excluding treatments included under block treatments. (i) During the period under review, 122 notices were served under the Public Health (London) Act, 1936, in respect of defective drainage causing rat infestation. It has not been necessary to institute proceedings under the Prevention of Damage by Pests Act, as works required were either completed or in progress. (ii) There were no special circumstances to which any undue presence of rats and mice in the district could be attributed. (iii) Sewer baiting was carried out in co-operation with contiguous Local Authorities. Public Mortuary The number of bodies taken to the mortuary during the year was 482. Inquests were held in 88 cases. 11 Welfare of Old People The Council have decided to take responsibility, within their powers, for co-ordinating, and assisting in the extension of, activities for aged persons and to alleviate unsatisfactory conditions under which many old people are living. Consultations took place with representatives of the various local voluntary organisations associated with the wellbeing of aged persons, and a list of their functions was compiled for general use. Pour members of the Public Health Committee were nominated to represent the Council on the Kensington Old People's Welfare Voluntary Committee. This Voluntary Committee acts as an intermediary between the Council and the Local Voluntary Organisations. It acts as a co-ordinating non-executive Committee through which voluntary bodies claim assistance from the Council and through which the Council pass requests for executive action. Any financial aid which the Council grant is given direct to the voluntary organisation concerned. In this connection the Council decided to exercise the powers of Section 31 of the National Assistance Act, 1948, to make contributions to voluntary bodies in respect of the provision of recreation for old people. The following is a review of the assistance which is, or will be, available for old people's welfare :- Cleansing. Arrangements have been made whereby old people, their living accommodation and household articles are cleansed and, if necessary, disinfested. The Regional Hospital Boards, the London County Council and the Kensington Council of Social Service co-operate by providing temporary accommodation while old people's belongings are being dealt with at the disinfecting station. Seventeen old people were dealt with in 1950. Five of these cases were rehoused whilst their rooms were disinfested and redecorated. In the other cases rehousing was not necessary, as the old people had more than one room and were able to manage whilst their rooms were dealt with separately. Clubs and Recreational Facilities. During 1950, only one direct request for assistance to provide recreational facilities was received from an old people's club in the borough. A grant of £20 was made to the North Kensington Old Age Pensioners Federation for the purchase of a piano. Housing. The Housing and Town Planning Committee give sympathetic consideration to the claims of old age pensioners for housing accommodation and, where possible, attempts are made to meet their particular needs and desires. The position at the end of 1950 was summarised as follows:- "Of the people registered with the Council for housing accommodation, fifty-one were old people living alone in the borough, about half of whom were seventy years of age and over. There were also nineteen old people on the register who have a residential qualification in Kensington, but who were living outside the borough. The Council have fifty-one units of accommodation suitable for individual old people and thirty-four units are being provided. In addition a number of two-room flats built by the Council some years ago are suitable for old people living together and a 12 number of lettings in requisitioned properties are suitable for individual old people or old couples. In one hundred and fifteen cases old people occupied Council or requisitioned properties. Whenever a suitable letting becomes available particular priority is given to an individual old person. The approximate number of lettings falling vacant each year and let to old people is twelve in Council owned property and fourteen in requisitioned property. It will be appreciated that generally it is only death or removal to hospital that creates a vacancy in these lettings. The demand from individual old people for housing accommodation appears to be slightly on the increase. In Kensington there are many domestic workers who want a room to live in when they retire. These are nearly all women and frequently they have to remain in residential work after they have become unfit because they have nowhere else to go. Men, generally, retire to common lodging houses. The question of the rehousing of old people is continually under review." Institutional Care, etc. Facilities for institutional care, hospital treatment, medical care, nursing care, ophthalmic, dental and pharmaceutical services, sick room equipment, convalescent holidays, financial aid and pensions are dealt with by the various official organisations responsible. These and the various services provided by the Council are in many instances made available to old persons through the intervention of the Women Health Officers who act as liaison officers in this respect. Where applicable, charity pensions are granted by various local charity bodies, on four of which the Council are represented. So far it has been impracticable to establish a service for home chiropody, nor has it been possible to extend the facilities for clinic chiropody which the London County Council provide at the Raymede Centre, Ladbroke Grove. The Council have no direct power to provide such a service but steps have been taken to make the services of a chiropodist available to old people in their own homes through a voluntary society. Holidays. Where a voluntary organisation arranges for a suitable hostel for the reception of old people in need of rest or recuperation, a grant towards the expenses can be made by the Council under the powers of Section 31 of the National Assistance Act. The Council agreed in principle to make grants to a voluntary organisation in respect of holidays for old people, and a suitable scheme is being made. In the meantime, the Chairman of the Public Health Committee was authorised to approve cases where it appears that old people would benefit by a holiday under this scheme. Laundry. At present no direct authority exists for the Council to provide a laundry service, as such, for old people. Section 122 of the Public Health (London) Act, 1936, enables the Council to cause any article in a house in the borough to be cleansed, disinfected or destroyed if it is in such a filthy, dangerous or unwholesome condition that health is 13 affected or endangered thereby. The cleansing of grossly fouled bedding in cases of incontinence may be dealt with under this Section. In seventeen cases action was taken on an experimental basis. The bedding was marked, laundered at the Council's disinfecting station and returned to the old people. The scheme worked smoothly and appears to fill a much felt want. From stocks of bedding held, the Council are able to supply on loan linen and bedding to old people while their own is being laundered, and where possible voluntary organisations are asked to undertake replacements of much worn articles. To comply with the legal requirements, the Council have given a general authority to the Medical Officer of Health to take whatever action appears to be requisite under the terms of Section 122 of the Public Health (London) Act, 1936. Library facilities. The Libraries Committee co-operate in providing books for old people confined to their homes. The circulation of the books is effected by the Woman's Voluntary Services mobile library. Meals. The arrangements for meals either delivered to old people in their homes or in canteens are being continued with great success by the Women's Voluntary Services in conjunction with Kensington Communal Kitchens. Visiting. The Council's Women Health Officers visit old people brought to their notice. At present the compilation of a comprehensive record system is in progress, which includes personal particulars, environmental conditions and needs of old people in the borough. The local voluntary organisations are supplying records of old people whom they are helping and every endeavour is being made to keep this information up to date. The following is a summary of the work carried out by the Counoil's Women Health Officers in connection with the care of old people during the year 1950 Cases on register at the beginning of year 118 New cases added to register 2,528 Cases removed to hospitals 28 Cases removed to homes (voluntarily) 16 Cases removed to homes (compulsorily) - Cases removed from district 6 Number of deaths 58 Total number of cases remaining on register .. 2,538 Number of old people provided with Council's laundry service 17 Number of old people provided with Meals on Wheels" 115 Cases referred to National Assistance Board 190 Cases referred for assistance from Home Help Departmenrt 150 Cases referred for assistance from Voluntary Organisations 60 Cases referred to Recreational Clubs 96 Cases assisted with provision of medical and nursing care 78 Cases where disinfestation was carried out 28 Number of initial home visits made 1,162 Number of re-visits 993 Number of other visits made in connection with old people, including visits to clubs 136 14 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. Although many cases were investigated during the year, only one resulted in formal action being taken under the section. This was the case of a man, aged eighty-one. He and the room occupied were found to be in an extremely dirty and verminous condition. The man was confined to bed and was quite incapable of any exertion. Repeated visits were made by the Council's Woman Health Officer in the earlier part of December, but the man refused all offers of help or to be removed from his room even temporarily, so that he and his room could be cleansed. The conditions were so bad that on 20th December the Chairman of the Public Health Committee authorised me to take action under Section 1+7 of the National Assistance Act, 1948, for the compulsory removal of the man to hospital. All necessary steps were taken and the case was due to be heard on 9th January, 1951. On 1st January, however, it was learned that the man had been found dead the previous day and the proceedings were withdrawn. 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 the twelve months ended 31st December, 1950, the Council became responsible for the burial of 1+2 persons dying in the borough. The following is a summary of the action taken (a) Cases where the Council's funeral expenses have been fully recovered 16 (b) Cases where part only of the expenses has been recovered 17 (i) Number of these where balance of expenses will be recovered 6 (amounting to £9.13s.5d. ) (ii) Number of these where there is no estate or "liable" relative 7 (iii) Number of these where "liable" relatives are unable to contribute 4 15 (c) Cases where full cost has been borne by the Council 9 (i) Number of these where expenses will be recovered 2 (amounting to £15.15s.Od.) (ii) Number of these where there is no estate or "liable" relative 4 (iii) Number of these where "liable" relatives are unable to contribute 3 Total cost to the Council £354. 0s. Od. Amount recovered to date £185. 11s. 1d. Additional amount expected to be recovered £ 25. 8s. 5d. It is of interest to note that of the 42 cases dealt with, only 12 were eligible for a Death Grant from the Ministry of National Insurance. The total amount recovered from this source amounted to £52. 7s. Od. (included in the above figures). SANITARY INSPECTION The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year:- Total complaints received 5,955 Public Health (London) Act. 1936 Houses inspected on complaint 5,955 Houses inspected after infectious disease 2,944 Re-inspections 16,740 Smoke observations 15 Inspections of mews 351 Other inspections 1,622 Housing Act. 1936 Initial inspections (including preparation or revision of house-to-house cards) 881 Re—inspections 2,375 Inspections in regard to overcrowding 1,423 Underground Living Rooms Primary inspections 493 Re-inspections 1,518 Drainage Applications 342 Plans submitted 176 House drains tested and inspected 3,707 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 3,220 Statutory notices 1,768 Pinal notices 792 16 Various Notice of intention to enter premises for inspection 582 Rent Restrictions Act certificates 24 Report of waste water to the Metropolitan Water Board 100 Report of dangerous structures to the London County Council 101 Other notices 45 The following is a summary of works completed under the supervision of the sanitary inspectors during the year House drains, reconstructed 17 .House drains, additions to 180 Defective drains, repaired 188 House drains, cleansed 261 Water closets, reconstructed 38 Water closets, repaired 214 Water closets, new provided 249 Water closets, supplied with water 89 Soil pipes ventilated, repaired etc 66 Soil pipes, new provided 68 Ventilating pipes, new provided 125 Baths, new provided 125 Sinks, new provided 171 Lavatory basins, new provided 552 Waste pipes, new provided 489 Cisterns, cleansed 20 Cisterns, covered 13 Taps fixed on rising main 11 Yards and areas paved, drained, etc 17 Dustbins provided 152 Accumulations of filth, etc., removed 139 Animals removed 15 Roofs repaired 1,023 Houses provided with water above basement level 34 Dampness in dwellings remedied 1,249 Infectious disease cases removed 304 Houses disinfected after infectious disease (including bedding, etc.) 418 Rooms in such houses, disinfected after infectious disease 625 Houses cleansed under Houses let in Lodgings Byelaws 794 Cleansing of houses not on register 236 Verminous houses cleansed (including bedding, clothing, etc.) 1,039 Verminous rooms in such houses, cleansed 2,424 Dirty bedding, cleansed 99 Dirty bedding, destroyed 18 Other sanitary works executed 4,577 17 HOUSING Inspection of dwelling houses during the year (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 11,696 (b) Inspections made for the purpose 33,951 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 881 (b) Inspections made for the purpose 2,375 (iii) Dwelling houses found not to be in all respects reasonably fit for human habitation 3,285 Action under statutory powers during the year (a) Action under Sections 9 and 10 of the Housing Act, 1936:- (i) Dwelling houses in respect of which notices under Section 9 were served requiring repairs 65 (ii) Dwelling houses which were rendered fit by owners under Section 9 98 (iii) Dwelling houses rendered fit by the Council in default of owners under Section 10 18 (b) Action under Sections 11 and 13 of the Housing Act, 1936:- (i) Dwelling houses in respect of which demolition orders were made 2 (ii) Dwelling houses demolished in pursuance of demolition orders 7 (c) Action under Section 12 of the Housing Act, 1936:- (i) Separate tenements or underground rooms in respect of which closing orders were 43 premise made 104 rooms (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms 22 premises having been rendered fit 33 rooms (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 38 premises for purposes other than sleeping 71 rooms (iv) Separate tenements or underground rooms in respect of which the Council accepted undertakings from owners to render fit 2 premises within specified time 3 rooms (v) Number of undertakings by owners to render separate tenements or underground rooms fit, which were cancelled, the 8 premises necessary works having been completed 20 rooms 18 (d) Action under Section 25 of the Housing Act, 1936:- (i) Number of areas represented to Council for clearance 4 (ii) Number of dwellings in such areas 84 (iii) Approximate number of persons to be displaced 193 (a) Action under the Public Health (London) Act, 1936:- (i) Number of Intimation Notices served requiring defects to be remedied 3,220 (ii) Number of Statutory Notices served 1,768 (iii) Number of Summonses issued 294 The -provision of new housing accommodation The post-war new housing schemes completed or being dealt with by the Council are summarised as follows Henry Dickens Court 300 flats Rackham Street 116 flats 4 houses Portobello Street 157 flats Keifield Gardens 18 flats Blagrove Road 16 flats Holland Street (library) site 32 flats St. Marks Place 12 flats Cat heart Road 15 flats Elgin Crescent/Ladbroke Grove 16 flats Walmer Road/Clarendon Road 72 flats Landsdowne Road 8 flats Old Brompton Road 15 flats Slum Clearance The question of slum clearance in London as a whole is under consideration by the appropriate Government Departments, the London County Council and the Metropolitan Boroughs Standing Joint Committee, but a limited programme has been possible subject to the Council being fully satisfied on the following points before proceeding with action for the demolition of the houses:- (i) That the conditions of the houses is such that they constitute a danger to life and limb and to the health of the occupants and that even in the present shortage of housing accommodation they should no longer be occupied. (ii) That the necessary rehousing accommodation can be provided as part of the Council's housing programme and that any necessary priority in the selection of tenants for their dwellings can be given to the displaced persons. (iii) That the work of demolition and clearance can be undertaken without serious diversion of building labour from new building. The following four areas represented by me, were approved during 1950 by the Council as being ready for clearance and appropriate action is being taken 1. Elgin Mews 28 dwellings 2. Lionel Mews 13 dwellings 3. Lonsdale Mews 19 dwellings 4. Munro Mews 24 dwellings 19 Accommodation for Costermongers The general condition of mews dwellings in the borough has received much attention from the public health viewpoint for many years. In certain of the mewsways occupied by persons of the street trading class, the stable accommodation is used for storage etc., and difficulties constantly arise owing to the nature of the businesses carried on. In connection with the policy of clearing unsatisfactory mews dwellings, the Council appreciated that street traders must have storage accommodation for their horses, vehicles, barrows and goods. Accordingly, the London County Council were requested to promote legislation to enable the Borough Council to provide accommodation for costermongers, who might be displaced from unfit mewsways. On 28th July, 1950, the London County Council (General Powers) Act, 1950, Section 35, came into operation enabling the Borough Council to provide and maintain storage and stabling accommodation for use by street traders and other like persons displaced by reason of the exercise by the Council of their powers under the Housing Acts 1936/1949 or by the acquisition of lands under any other enactment. It is satisfactory to know that Kensington were pioneers in this matter and that steps are being taken to extend these special powers throughout the Administrative County. 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 oases dealt with in 1950:- 1. New cases reported to the Sub-Committee during 1950 168 (a) Cases in which the Sub-Committee recommended that alternative accommodation should be offered by the Council 92 (b) Cases in which proceedings were ordered to be taken without prior offer of alternative accommodation 25 (c) Cases where action was postponed 47 (d) Cases withdrawn or where no action was taken 4 2. Cases of overcrowding abated during the year 128 20 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 1950 Inspections Premises Number on Register Number of Inspections Number of Written Notices Factories with mechanical power 285 256 10 Factories without mechanical power 446 455 37 Other premises under the Act. (Including works of building and engineering construction but not including out-workers' premises.) — — — TOTALS 731 711 47 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 2 2 — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors 1 1 — — Sanitary conveniences:- (a) insufficient 3 3 — — (b) unsuitable or defective 35 27 2 (c) not separate for sexes 7 6 — — Other offences (not including offences relating to Homework) 2 2 — — TOTALS 50 41 — 2 / During 1950, no prosecutions were instituted under the Factories Act, 1937. 21 Outworkers The following table shows the nature of the work carried out by the 169 home workers on the register of outworkers during 1950:- Nature of work Number Wearing apparel - 126 (a) Making, etc (b) Cleaning and washing 1 Household linen 1 Lace, curtains, etc. 1 Paper bags, etc 16 Umbrellas 1 Feather sorting 2 Carding etc. of buttons, etc 12 Stuffed toys 6 Cosaques, crackers, stockings, etc. 1 Furniture and upholstery 1 Lampshades 1 169 During the year, 277 inspections of outworkers' premises were made, but in no case was action necessary to prevent work being carried on in unwholesome premises. 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 1950:- Food factories 77 Bakehouses - underground 31 others 53 Ice-cream premises 256 Preserved food premises 41 Butchers 352 Grocers 391 Dairies and milk shops 617 Public houses 113 Greengrocers 110 Fishmongers 140 Restaurants and cafes 505 Hotels 127 Sweetshops 84 General stores 170 Street traders' premises 165 Other inspections: stalls, etc 744 Re-inspections (all premises) 1326 22 Clean Food Campaign (a) Food Advisory Committee Following the comprehensive survey of food premises in the borough which was carried out in 1948 and 1949, it was decided that a Clean Food 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. The various food trades were divided into the following twelve categories covering both indoor and outdoor sales:- Bakehouses Retail cake and bread shops Butchers (including horse-meat shops) Dairies and milk shops Food factories Fishmongers and poulterers Fried fish shops Grocers and general food stores Greengrocers and fruiterers Hotels, restaurants, catering establishments and other licensed premises Ice-cream manufacturers and retailers Sweet shops and shops where soft drinks are sold Representatives of these groups., together with the local Chamber of Commerce, combined with the Council to form a Food Advisory Committee which met on a number of occasions during the year. The Food Advisory Committee approved the Council's clean food policy and adopted the following fundamental points and axioms as a basis for furthering the clean food campaign (i) Infected food causes illness. (ii) Food may be infected by germs from the nose, throat, skin or bowel, or through the intermediary of flies, bluebottles, animals or dust. (iii) Danger may be averted by taking care to avoid this infection of food at any stage from production to consumption. These precautions should be extended to all utensils, containers and wrappings coming in direct contact with food. (iv) The greater the number of persons at risk, the greater the precautions which must be taken. (v) The greater the manhandling of food, the greater the likelihood of infection. (vi) Infection can be prevented by scrupulous attention to cleanliness of materials, equipment, clothing and person at all stages of manufacture and handling of food and drink. The Food Advisory Committee then proceeded to formulate basic principles for codes of hygiene for distribution to employers and employees of food trades in the borough. The basic codes approved are as follows:- 23 Basic codes of practice General requirements for all food handlers Hygiene Standards for Persons 1. Cleanliness of employees, their clothing and all utensils and equipment is absolutely essential. 2. Do not smoke while engaged in the preparation or handling of foodstuffs. 3. When handling food at any stage of preparation take great care to avoid transmitting infection from dirty hands, septic sores, and avoid touching the nose or mouth particularly when suffering from a cold in the head or a sore throat. In the latter circumstances, or if you have diarrhoea, or a septic spot or sore on the hand or on any other part of the skin, inform your Manager at once. 4. Never directly handle food if it can be avoided. Preferably use spoons, forks, scoops, tongs, ladles, slices or other appropriate implements whenever possible. If impracticable, be certain that the hands are clean, keep the nails short and well scrubbed with a nail brush. Always wash your hands if you have been handling any unclean material. 5. Always wash the hands after visiting the toilet. Hygiene Standards for Food 6. Ensure that all food ingredients are clean and uncontaminated. If in any doubt as to whether any are wholesome, don't risk using them. The Council's Pood Inspector is always willing to advise in cases of difficulty. 7. Take extreme care regarding food storage. Use a refrigerator, ice-box or cold store, and protect food from dust, flies, vermin and domestic animals. 8. Wherever possible keep food covered and protected from contamination. Open displays of food on shop forecourts should be so arranged as to avoid any risk of contamination. 9. Foods liable to contamination should be eaten as soon as possible after preparation. If "madeup" foods are not to be eaten at once, see that they are stored in a cool room or refrigerator. Hygiene Standards for Premises and Equipment 10. Ensure that all food preparing premises are well arranged and kept in a good state of repair and decoration, clean, adequately lighted and ventilated and provided with adequate hot and cold water supply, sanitation, lavatory and washing facilities and suitable arrangements for the disposal of refuse. 11. Exterminate rats, mice, flies, blue-bottles and other pests. 12. See that all food containers are properly cleaned by washing first in a hot detergent solution and rinsing in very hot water. 24 13. Keep dustbins and refuse accumulations covered and protected from flies and vermin. 14. Keep all containers, cooking utensils, crockery, glassware and cutlery clean and in sound condition. 15. Polishing cloths used for cutlery and glassware should be kept clean and frequently boiled. 16. Discourage customers, so far as possible, from bringing dogs into premises where food is on sale. If the customer will not co-operate, insist on the dog being kept on its lead. Hygiene Standards for Methods 17. Do not handle or expose to contamination those surfaces of glassware, crockery and cutlery which come into direct contact with food, drink or the mouth. 18. Scald or otherwise sterilise all receptacles for milk, and plates or dishes upon which food is stored. 19. Use washing-up water as hot as possible and change it frequently. The addition of washing-up powder or liquid is of great assistance in securing cleanliness and safety. After washing, crockery and cutlery should be rinsed in very hot water. 20. Use dish mops in preference to dish cloths and boil them frequently. 21. Where practicable, don't dry up crockery - allow it to drain and dry in a draining rack. 22. Remember constant vigilance is the price of safety. In addition to the above basic principles, specific points relating to each particular trade are added when the codes are distributed to particular food traders. The Council decided to print approximately 10,000 copies of the Codes of Practice for distribution. (b) Food Hygiene Exhibition As part of the Clean Pood Campaign a Pood Hygiene Exhibition was held in the Town Hall from 24th to the 29th July, 1950, and it is estimated that over five thousand persons attended. The opening ceremony was performed by His Worship the Mayor, and was attended by officials of the Ministry of Health and the Ministry of Pood, Medical Officers of Health of several of the Metropolitan and other boroughs, local doctors, and representatives of various business interests. The Exhibition was also visited by the Parliamentary Secretary and the Assistant Secretary of the Ministry of Food. The main stands were provided by the Ministry of Agriculture and Fisheries and a number of smaller stands by the Central Council for Health Education, all without cost to the Council. They related to sources and conveyance of germs, hygiene in food handling, and prevention and investigation of food infection. 25 Films dealing with rodent infestation control were shown at intervals during each day. The total cost of the Exhibition amounted to approximately £350, of which £163 was borne by the Council. Some of the Borough Council's exhibits were subsequently borrowed by the Central Council for Health Education for exhibition at the Pood Pair at Olympia. (c) Food Byelaws Model byelaws under Section 15 of the Food and Drugs Act, 1938, were issued by the Ministry of Food. The byelaws are divided into three main parts as follows:- Part I is the interpretation section. Part II includes those byelaws which apply to persons handling, wrapping, or delivering food intended for sale for human consumption. Part III includes those byelaws which apply to persons selling or exposing for sale in the open air food intended for human consumption. The London County Council are the byelaw making authority for metropolitan boroughs, and they published draft byelaws which are identical with the model byelaws except for the addition of certain administrative clauses. So far the London County Council's byelaws have not come into force. Food Legislation During the year, new or revised legislation relating to food was introduced; the most important being as follows:- Food & Drugs (Milk, Dairies and Artificial Cream) Act, 1950 Date of operation 1st January, 1951 This Act makes no important change in the existing law; it consolidates certain enactments relating to milk, dairies and artificial cream, and is considered part of the Food and Drugs Act, 1938. It replaces the whole of Part II of the Food and Drugs Act, 1938, and the Milk (Special Designations) Act, 1949. Labelling of Food Order, 1950 Date of operation 1st November, 1950 This Order substantially re-enacts the Labelling of Food Order, 1946, and subsequent amending Orders, and deals with the requirements regarding the labelling, in specific form, of food for sale in pre-packed form. Milk (Special Designations) (Raw Milk) Regulations. During the year licences under these Regulations were granted as follows:- Principal Supplementary Dealers licences to bottle and sell Tuberculin Tested Milk; 1 — Dealers licences to sell Tuberculin Tested Milk; 86 15 26 Sixteen samples of Tuberculin Tested Milk were submitted for examination during the year and of these four failed to pass the prescribed test. Warning letters were sent to the vendors of these unsatisfactory samples. In addition, five samples of Tuberculin Tested Milk were submitted for examination for the presence of tubercle bacilli. In one of these samples the result was positive,, The Ministry, of Agriculture and Fisheries, the Ministry of Food and the Medical Officer of Health of the district in which the milk was produced were notified, with the object of preventing further sale of infected milk. Subsequently, the Ministry of Agriculture and Fisheries stated that, after appropriate action, the milk from the herd in question had been certified as nontuberculous. Milk (Special Designations) (Pasteurized and Sterilized Milk) Regulations, 1949 Details of licences granted during 1950 are as follows:- Principal Supplementary Dealers licences to sell Pasteurized milk; 106 16 Dealers licences to sell Sterilized milk; 120 18 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 Turbidity test Passed Failed Passed Failed Passed Failed Tuberculin tested (Pasteurized) 43 40 3 43 — — — Pasteurized 68 67 1 68 — — — Sterilized 4 — — — — 4 — Warning letters were sent to the vendors of the unsatisfactory samples. Milk Daring the year 460 samples of milk were submitted to the Public Analyst and all were found to be of genuine composition. The following table shows percentages of milk fats and non-fat solids of the samples taken during each month:- 27 Month No, of samples taken Average percentage Milk fats Non-fat solids January 50 3.49 8.74 February 46 3.52 8.76 March 38 3.42 8.68 April 41 3.39 8.69 May 45 3.36 8.73 June 12 3.57 8.71 July 24 3.46 8.70 August 18 3.69 8.71 September 51 3.56 8.81 October 48 3.68 8.78 November 47 3.61 8.76 December 40 3.65 8.78 Average for whole year 3.53 8.69 Legal minimum standards:- Milk fats Non-fat solids 3.00% 8.50% Milk and Dairies Regulations, 1949 A summary of the alterations made in the register of dairymen and dairies during 1950, and the number of persons and dairies registered at the end of the year is shown in the following table:- Dairymen Dairies Purveyors of milk in sealed containers Transfers 6 6 2 Additions to register — — 7 Removals from register — — — Dairymen with premises outside borough added to register 8 — — On register 31st December, 1950 115 101 75 Adulteration of Food During the year 525 formal samples of food and drugs were taken of which 2 (0.38%) were adulterated; 475 informal samples were taken of which 2 (0.42%) were adulterated. 28 Details of the adulterated samples are as follows:- Sample Nature of Adulteration Remarks Vinegar Decomposed and unfit for food Informal sample. Vinegar Decomposed and unfit for food Proceedings instituted. Summons dismissed. Vinegar 4% deficient in acetic acid Warning to vendors and report to Ministry of Food. Cake and Pudding Mixture Unfit for human consumption owing to rancidity. Informal sample. Remainder of stock surrendered. Unsound food Seizure Under Sections 9 and 10 of the Food and Drugs Act, 1938, it is an offence to sell, offer, or expose for sale, food intended for human consumption, which is in an unfit condition. Such food 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 six instances during the year when the provisions of these sections were enforced. In four cases the Public Health Committee decided to give warnings to the manufacturers or vendors. In the other two cases it was decided to take proceedings. These resulted in a fine of £5. 0. 0. plus 2-guineas costs in one case, but in the second case the proceedings were subsequently cancelled, owing to the death of a material witness. 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 consumption:- Food Tons Cwts. Qrs. lb. Meat (Raw and Bacon) 2 9 3 22½ Meat (Tinned) — 4 — 12 Sausages — 10 2 20 Poultry and Rabbits — 4 — 21 Pish (Wet and Dry) 2 12 2 10½ Pish (Shell) — 1 — 20 Butter, Margarine and Cheese — 1 3 9½ Tea — — 3 16 Sugar — 1 3 — Fruit — 3 1 27½ Nuts — 15 — — Flour and Flour Mixture — 7 2 24 Cereals — 3 — 4 Miseellaneous — 3 2 24 Tins or jars of assorted foods 12,531 Shell eggs 2,000 - 29 - 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 140. Of this number 10 were new registrations during the year. Water Supply Although the water supply in Kensington is almost entirely provided by the Metropolitan Water Board, there are 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 that the waters were suitable for drinking and other domestic purposes. Ice Cream The use of milk and milk products in the manufacture of ice cream continued to be prohibited during the year. In continuation of arrangements made in 1949, increased allocations of sugar and fat to ice cream manufacturers were made by the Ministry of Food. The average fat content of ice cream samples during 1950, whilst showing a slight improvement compared with the previous year, still continued to be lower than the minimum of 8% which was advocated by the Council in representations to the Ministry of Pood in 1946. The following table shows the number of samples taken during the year for chemical analysis, compared with 1949. No. of samples Variation of fat content. Variation of non-fat solids content Average fat content Ave rage non-fat solids content 77 From 1.24% to 19.90% From 17. 20% to 32.79% 6.5% 25.11% 1949 72 Prom 2.3% to 11.7% From 16.1% to 31.9% 5.1% 23.4% There is still no legal bacteriological standard for ice cream. In order to assess the bacteriological cleanliness of ice cream, samples have been taken and subjected to the methylene blue reduction test. This test affords a simple and practical means for the routine grading of ice cream, but it is not of such precision as would justify its use as a statutory test, non-compliance with which would constitute an offence. By means of the methylene blue test, ice cream can be divided into four grades according to the time taken in decolourizing the methylene blue. 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 in manufacture or handling which warrant further investigation. - 30 - During 1950, eighty-three samples were taken and submitted to the test with the following results:- Grade No. of samples 1 24 2 23 3 15 4 21 Ice cream premises in the borough were frequently inspected and on only one occasion was it necessary to secure the remedy of minor defects. Manufacturers and traders throughout the borough co-operate willingly with the Council's officers and there was no outbreak of disease during the year attributable to ice cream sold in Kensington. FOOD 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 1950:- Food poisoning notifications (corrected) Received in first quarter — " " second quarter 14 " " third quarter 4 " 11 fourth quarter 5 TOTAL 23 Outbreaks due to identified agents - Total outbreaks 2 Total cases 24 Outbreaks due to:- (a) Chemical poison — (b) Salmonella organisms 1 (c) Staphylococci (including toxin) — (d) Cl.botulinum — (e) Other bacteria 1 Outbreaks of undiscovered cause - Total outbreaks 2 Total cases 4 Single cases - Unknown cause 7. Agent identified 10 Total 17 Outbreaks due to identified agents (a) Salmonella typhi-murium. The two patients involved were members of one family. Both were removed to hospital 31 following symptoms of pain, diarrhoea and vomiting. Investigations made at the home revealed nothing conclusive as to the source of infection. The remaining nine members of the family were not affected and faeces specimens submitted by them all proved negative. (b) Clostridium Welchii. This outbreak occurred at a school, where 22 members of the staff of 35 were affected. All sufferers reported pain and diarrhoea which lasted for approximately 12 hours. No children were affected. Faeces specimens submitted by certain members of the staff showed the presence of heat resistant Clostridium welchii, an organism often associated with the practice of cooking, cooling and reheating meat. Investigations showed that a joint of beef had been steamed for five hours on one day and left to cool overnight. The following day the joint was sliced, warmed at hotplate temperature only and served to the staff. On this day, the children had a minced beef dish, which had been cooked at a high temperature. The attention of the school authorities was drawn to certain aspects of this outbreak and action was taken to secure improvements at this school kitchen. None of the cases in this outbreak was formally notified. Outbreaks due to unidentified agents. (a) Two persons from different addresses in Kensington were admitted to hospital following severe symptoms of pain, diarrhoea, vomiting and fever, and were notified as suffering from food poisoning. These symptoms lasted for 48 hours. Specimens from these patients were examined in hospital but no organisms of pathogenic significance were found. Specimens submitted by family contacts were also examined with negative results. Investigations revealed that both these patients had attended the same wedding reception in Mitcham earlier on the day of the onset of symptoms. At this reception a meal was served consisting of cold tongue, ham or beef followed by custard and trifle. The circumstances were reported to the Medical Officer of Health for Mitcham, and it is understood that of the 26 guests at the reception, 11. had had symptoms similar to those experienced by the two Kensington cases. (b) A husband and wife living in South Kensington were notified as suffering from food poisoning following symptoms of pain and diarrhoea. However, the bacteriological examination of faeces specimens from these two patients showed negative results, and investigations made at the home did not reveal any definite source of infection. Single cases. In addition to the outbreaks mentioned above, there were 17 single cases of food poisoning notified. In 7 of these, no agent was identified. Of the remaining 10 cases, 9 were due to salmonella typhi-murium and one to salmonella heidelburg. INFECTIOUS DISEASE Smallpox No case of smallpox was notified in the borough during the year 1950. Many persons came to Kensington from places 32 abroad who were reported to have been in contact with smallpox. All contacts were kept under surveillance until the possibility of developing the disease had disappeared. Scarlet fever The number of cases notified in 1950 was 104, but 4 were subsequently found not to be suffering from scarlet fever. Of the total number of cases notified, 39 were treated in hospital. There was no fatal case during the year. 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 two cases equals the lowest annual figure ever recorded in Kensington; the previous occasion being during 1949. The first case occurred in a woman aged 24 living in a South Kensington hostel. The case was confirmed as one of faucial diphtheria. Precautionary measures were taken and no secondary case occurred. The patient, who had not been immunised, remained in hospital three weeks. The second case, confirmed as one of faucial and laryngeal diphtheria, occurred in a boy of 5 years in North Kensington, who had not been immunised. Other children in this patient's family had not been immunised and steps were taken to remedy this. No secondary case occurred. The child remained in hospital nearly seventeen weeks. No death from diphtheria occurred during the year. Diphtheria immunisation work, commenced by the Council in 1934, was continued on the same lines by the London County Council during the year. A summary of the work carried out in Kensington is as follows:- Number of pre-school children immunised 1,444 " " school " " 231 " " re-inforcing injections given 721 " " children attending for pye-Schick tests 322 " which gave a positive reaction 308 " of children attending for post-Schick tests 1,745 " proving negative 1,623 " proving positive 35 " who failed to attend for reading 87 Enteric fever Eight cases of typhoid fever and four cases of paratyphoid B fever were notified during the year. All the cases were treated in hospital and there was no death. Ths histories of the eight cases of typhoid, revealed that the source of infection in three of them was abroad and three others were associated with the sufferers who had contracted the disease abroad. Of the remaining two cases, one was a carrier and the other was believed to have contracted the disease from the carrier. Of the four cases of paratyphoid B fever, the source of infection was unestablished in three, whilst the remaining patient was believed to have contracted the disease abroad. Puerperal Pyrexia Eighteen cases of this disease were notified and thirteen were treated in hospital. No death occurred amongst these cases. 33 Pneumonia There are various forms of pneumonia, but the only kinds notifiable are acute primary and acute influenzal. Sixtynine notifications were received during the year, forty-four patients being certified as suffering from acute primary pneumonia and twenty-five from acute influenzal pneumonia. Of these sixty-nine cases, twenty-eight were treated in hospital. During the year, the number of deaths from pneumonia (all forms) was eighty-two and twenty deaths were certified as due to influenza. Dysentery There were eighteen cases of dysentery notified during the year. Seventeen cases were bacillary in origin and the majority of these were due to sonne bacillus; all cases were of a mild type. There was one case of amoebic dysentery, believed to have been contracted from the patient's Anglo-Burmese wife, from whom he was separated. The patient was believed to have suffered from the disease for a year prior to admission to hospital. He died three weeks after admission to hospital. Erysipelas Of the seventeen cases notified, four were admitted to hospital. There were no deaths. Cerebro-spinal meningitis Five cases of this disease were notified during the year, but all recovered after hospital treatment. Malaria Two cases of malaria were notified during the year. One patient had a history of contracting the disease during war service. The second patient was admitted to hospital within a week of returning to this country from Egypt. Neither case proved fatal. Poliomyelitis There were thirteen confirmed cases of acute poliomyelitis notified during 1950, compared with forty-seven in the previous year. All thirteen patients were treated in hospital, seven of whom suffered with paralysis. Of these notified cases, only one patient died. Encephalitis lethargica No case of encephalitis lethargica was notified during 1950. Measles Of the six hundred and ninety-six cases notified during 1950, sixty-six were admitted to hospital for treatment. The only fatal case occurring during the year was a child aged 20 months who died three days after admission to hospital. From time to time attention has been drawn to the rise in the number of measles cases in alternate years. 34 The biennial swing in the incidence of measles observed in pre-war years was not peculiar to London but was observed in most towns in the northern hemisphere. Although measles did not become notifiable in London until 1938, such information as was available indicated that the two year fluctuation which occurred was very similar to that occurring in New York. Occasionally the epidemic rhythm "changed step". Since 1940 New York has maintained the pre-1940 rhythmic pattern, whereas in London the post-1940 pattern is somewhat different in that each year has contained a greater or lesser outbreak of epidemic nature, but never attaining the proportions of a prewar peak. Studies of the rise and fall of measles epidemics in the counties of England and in London and the larger towns during the period 1940 onwards, have disclosed a remarkably wide variation in the timing of peaks in different areas. The peaks were by no means all in the late winter and spring, the scatter being wide (although not completely random) throughout the year. One feature only was universal, i.e. low incidence in autumn. Whatever variations there may be in the duration of an epidemic, the rhythm of the various phases generally corresponds to a set pattern. It hat. been shown that if the graphs of epidemics are superimposed, it appears that each epidemic is comparable within the two yearly period, so that the resemblances in fact are not annual but bienniel, and that a repetitive form emerges which, whatever departures from rigid conformity, remains an unmistakable type. The rise in incidence begins in each case at the beginning of the first year, rises to its maximum in the first three months of the second year, falls to the lowest level again in August and September of the second year, and remains at this low level until the end of the year. The ascending limb of the wave is marked by a depression known as the "Autumnal notch" which, rightly or wrongly, has been attributed to the influence of school closure. Attempts have been made from time to time to explain the biennial periodicity of measles, and among others have been theories that it is dependent on the proportion of susceptibles to immunes, the topography and rate of spread in an urban unit, the dispersal or concentration of the population, the possibility of latent immunisation arising from sub-clinical attacks, or the periodic fluctuation in the infecting power of the virus. While no final agreement has been reached, it seems likely that war-time dispersal of the population and the wide variation in the timing of epidemic peaks in different areas may account for the irregularity of the epidemic curves which has occurred during and since the war. So far as Kensington is concerned, the position since the introduction of notification is shown in the following table of annual figures, and the attached graph showing the four weekly incidence during this period:- 35 Year Measles notifications. 1939 31 19140 242 1941 366 1942 365 1943 624 1944 102 1945 868 1946 264 1947 852 1948 868 1949 740 1950 696 1951 1,196 (up to 31st May) The total number of cases notified during the period 1st October, 1950, to the 31st May, 1951, was 1,442; there was only one death. This is in marked contrast with the former case mortality of between 1.4% and 4% which obtained in the earlier decades of the present century. Deaths in England and Wales from measles within the past century have fallen as follows Year England and Wales Total deaths from measles 1855 7,351 1870 7,543 1885 1,495 1900 12,710 1915 16,445 1930 1,188 1948 326 It is the more remarkable when one realises that in measles there is no known preventive and no specific cure. Even allowing for ecological variation between the causative virus and human susceptibility, it is reasonable to assume that much of the reduction in mortality is due to improvements in environment and personal health which have resulted from general public health measures and from measures especially directed to child welfare, such as the Maternity and Child Welfare Act, 1918. 36 Ophthalmia Neonatorum Twelve cases of this disease were notified, seven of whom were treated in hospital. All twelve cases recovered without injury to sight. Gastro-Enteritis This disease is notifiable in children up to the age of 5 years and during the year sixty-three cases were reported; of these fifty-five cases were treated in hospital. During the year there were three deaths of children under the age of 2 years suffering from diarrhoea. Scabies The number of notifications was only seventy-two compared with one hundred and six in the previous year and four hundred and sixty-three in the peak year of 1946. Tuberculosis During the year two hundred and seventy-eight new cases of tuberculosis were notified, of which two hundred and forty-eight were respiratory and thirty 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. P. Mo Fo On register of notifications on 1st January, 1950. 520 495 63 69 1,147 Notified for the first time during the year. 145 103 11 19 278 Brought to notice other than by notification 76 52 2 7 137 Removed from register on, account of having - (a) recovered from disease 4 2 5 1 12 (b) removed from district, lost sight of, etc. 124 98 12 10 244 (c) died. 42 13 1 4 60 Remaining on register on 31st December, 1950. 571 537 58 80 1,246 37 Mass Radiography Prior to the appointed day (5th July, 1948) under the National Health Service Act, mass radiography was undertaken by the London County Council. Under the new Health Act, this work was transferred to Regional Hospital Boards. In 1950, the North-West Metropolitan Regional Hospital Board requested the Council to co-operate in providing facilities to enable an X-ray unit to function in Kensington. It was agreed to make available accommodation in the Royal Palace Hotel for a major session of three to four weeks. In addition, two short period sessions were arranged, one at the Royal College of Arts and one at the North Kensington Community Centre. The following table gives a summary of the results obtained: - Royal Palace Hotel 30th Aug.to 21st Sept. Royal College of Arts 16th Nov. N.Kensington Comnunity Centre 20th Nov. to 23rd Nov. Number examined: 5,306 357 936 Males 2,569 235 352 Females 2,737 122 584 Number recalled 187 13 63 for large films (3.52%) (3.64%) (6.73%) Disposal of large film cases - No further action 120 7 49 To return for further X-ray 10 1 4 Further examination required 44 4 9 (0.83%) (1.12%) (0.96%) Known cases had or having treatment 1 1 — Failed to return for large films 12 — 1 Whooping cough Three hundred and sixteen cases were notified during the year, thirty five of which were treated in hospital. No death occurred from this disease. 38 Notifications The following tables show (1) the number of cases of infectious disease notified during the year 1950, 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 1950 1949 1948 1947 1946 1945 1944 1943 Scarlet fever 100 114 94 98 195 136 74 216 Diphtheria (including Membranous Croup) 2 2 12 23 37 19 29 54 Enteric fever 12 7 4 4 6 3 3 3 Puerperal fever Ø — — — 3 4 7 18 10 Pueperal Pyrexia 18 33 25 9 8 12 23 25 Acute primary pneumonia and acute influenzal pneumonia 69 121 142 103 111 81 91 133 Dysentery 18 33 145 21 49 142 43 73 Erysipelas 17 15 24 34 37 33 16 37 Meningococcal infection 5 8 4 7 10 3 6 11 Malaria 2 — 2 4 8 11 8 1 Acute poliomyelitis - Paralytic 7 47 9 21 1 3 1 1 Non-paralytic 6 Encephalitis lethargica — 1 — 2 — 1 — — Tuberculosis (all forms) 278 266 258 259 210 188 211 202 Measles 696 740 868 852 264 868 102 624 Ophthalmia Neonatorum 12 5 7 4 4 8 4 11 Enteritis † 63 88 64 102 69 100 71 69 Pood poisoning 23 33 11 7 7 6 7 4 Scabies / 72 106 141 239 463 460 363 252 Whooping cough 316 304 264 27 4 209 62 189 102 Ø Puerperal Pyrexia only notifiable in London since 1948. + Notifiable only in children under the age of 5. / Notifiable as from 1st August, 1943. NOTE: Cases of mistaken diagnosis are excluded from above table. 39 TABLE 2 Notifiable Disease Number of Cases Notified in 1950 Age Groups in Years Under 1 1 to 2 3 to 4 5 to 9 10 to 14 15 to 24 25 & over age unknown Scarlet fever 1 7 22 45 18 5 2 — Diphtheria (including Membranous Croup) — — — 1 — 1 — — Enteric fever 2 — — — 1 4 5 — Puerperal Pyrexia — — — — — 4 14 — Acute primary pneumonia and acute influenzal pneumonia 3 5 — 3 3 4 49 2 Dysentery — 4 2 5 2 — 5 — Erysipelas — — — 1 — — 15 1 Meningococcal infection 2 1 — — — — 2 — Malaria — — — — — 2 — Acute poliomyelitis Paralytic 1 1 — 2 — 1 2 — Non-paralytic 1 1 — 2 2 — — — Encephalitis lethargica — — — — — — — — Tuberculosis (all forms) 2 3 12 7 7 58 189 — Measles 26 179 186 260 11 10 23 1 Ophthalmia neonatorum 12 — — — — — — — Enteritis 40 11 12 _ — — — Pood poisoning 2 2 2 1 — 4 12 — Scabies — 8 6 8 9 13 27 1 Whooping cough 33 103 88 85 3 — 3 1 TOTALS 125 325 330 420 56 104 350 6 TABLE 3 Notifiable Disease Total Cases Notified in each Ward St.Charles Golborne Norland Pembridge Holland Earls Court Queens Gate Redcliffe Brompton Scarlet fever 24 9 19 13 11 9 2 11 2 Diphtheria (including Membranous Croup) — — 1 — — — 1 — Enteric fever 2 — — — 2 3 1 3 1 Puerperal Pyrexia 2 3 2 5 2 1 — 2 1 Acute primary pneumonia and acute influenzal pneumonia 17 18 6 14 2 4 1 7 — Dysentery 1 4 2 1 2 — 2 5 1 Erysipelas 1 2 3 2 1 2 — 3 3 Meningococcal infection 1 1 — 2 — — — — 1 Malaria — — 1 — — — — 1 — Acute poliomyelitis Paralytic 1 — 1 — — 2 1 1 1 Non-paralytic 2 — 2 — — 1 1 Encephalitis lethargica — — — — — — — — — Tuberculosis (all forms) 50 38 18 36 30 40 22 27 17 Measles 165 141 109 54 56 64 28 66 13 Ophthalmia neonatorum 1 3 4 2 — 1 — 1 — Enteritis 17 16 7 8 7 3 2 3 — Pood poisoning 7 3 3 2 3 — — 3 2 Scabies 16 9 13 8 7 6 1 6 6 Whooping cough 54 53 61 28 47 23 2 43 5 40 LEGAL PROCEEDINGS Public Health (London) Act. 1936 Nuisances During the year 266 summonses were issued for various nuisances under the Public Health (London) Act, 1936. In 63 cases abatement orders were secured; fines amounting to £61. 7s. Od. were imposed and £94. 10s. Od. costs were awarded to the Council. In 78 cases the summonses were withdrawn, the nuisance having been abated by the owners prior to the Court hearings. In 123 cases the summonses were adjourned as the necessary works were in progress of being carried out by the owners. In the remaining two cases the summonses were dismissed and costs against the Council amounting to £5. 5s. Od. were awarded. Twenty-eight prosecutions were undertaken for failure to comply with Justices Orders to abate statutory nuisances. In 20 caeas fines amounting to £321. 10s. 6d. were imposed and costs amounting to £12. 12s. Od. were awarded to the Council. In one case the Justices varied the abatement order by making a closing order prohibiting the premises to be used for human habitation. The remaining 7 cases were withdrawn as the necessary works had been carried out. Food and Drugs Act. 1938 Three prosecutions under this Act were instituted during the year. In one case the offence was under Section 13 of the Act, and related to the unsatisfactory condition of a fish shop. The defendant was fined £10 and costs of £3. 3s. Od. were awarded to the Council. In the second case the offence complained of was under Section 3 of the Act relating to an unsatisfactory sample of vinegar. The summons was dismissed and costs against the Council amounting to £70. 3s. 8d. were awarded to the defendant. The third case (under Section 9) was in respect of unfit bread, and the defendant was fined £5 and costs of £2. 2s. Od. were awarded to the Council, Milk and Dairies Regulations. 1949 One prosecution under these Regulations was instituted in respect of the alleged dirty condition of a milk bottle. The summons was dismissed on a technical point, and costs against the Council amounting to £2. 2s. Od. were awarded to the defendants. Pharmacy and Poisons Act. 1933 Two prosecutions under Section 18 were instituted in respect of the sale of preparations containing poison, not labelled in the prescribed manner. Convictions were obtained in both cases and fines amounting to £6. 6s. Od. were imposed and £8. 3s. 0d. costs were awarded to the Council. Council's Byelaws Dog Nuisances Pour summonses were issued under this byelaw, and in all cases convictions were obtained and fines totalling £2 were imposed. Housing Act. 1936 Tenement House Byelaws One summons was issued in respect of contravention of 41 these byelaws, but was withdrawn before Court hearing as the necessary works had been carried out. Contravention of Closing Orders Seven summonses were issued in respect of illegal occupation of closed underground rooms. A conviction was obtained in one case and a fine of £20 was imposed. In two cases the summonses were withdrawn as the illegal occupation had been abated. The remaining four cases were adjourned by the Magistrates. In two of these cases the summonses were withdrawn in 1951 as the illegal occupation had been discontinued, and in the other two cases fines were obtained in 1951 amounting to £12. Overcrowding In one case a summons was issued in respect of illegal overcrowding, and a fine of 10s. Od. was imposed. CONCLUSION The presentation of this Report affords me the opportunity of expressing my grateful appreciation of the kind co-operation, which I have received, in my first year of office as Medical Officer of Health of the Royal Borough of Kensington, from His Worship the Mayor, the Chairmen and Vice-Chairmen of the various Committees and all members of the Council. I would like also to record my sincere thanks to the staff of the Public Health Department for their loyal and efficient service during the year, and to the other Chief Officers and their staffs for their willingness to co-operate at all times. I have the honour to be Your obedient Servant, J. H. WEIR Medical Officer of Health.