AC 4348 PUBLIC HEALTH DEPT. REPORTS COLLECTION COPY ack 22752 KEN 60 THE ROYAL BOROUGH OF KENSINGTON ANNUAL REPORT on the HEALTH OP THE BOROUGH for the year 1951 by J. H. WEIR, M.D., B.S., B.Hy., D.P.H. Medical Officer of Health 16th June, 1952. Public Health Department, The Red House, Hornton Street, Kensington, W.8. THE ROYAL BOROUGH OF KENSINGTON Public Health Department, Hornton Street, KENSINGTON, W.8. 16th June, 1952. 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 for 1951. The Minister of Health has again requested (Circular 42/51) that the report should be in the same abbreviated form as has been the case for some years past. The public health in Kensington during the year under review was maintained at a satisfactory standard. Population. The Registrar-General's estimate (171,300) of the population of the Borough for 1951 showed a decrease over the figure for the previous year (177,400). The actual population figure for Kensington obtained as a result of the 1951 Census was 168,051+. Birth rate. The number of births per 1,000 population of the borough was 15.5 in 1951, equivalent to the figure recorded for the previous year. The Kensington birth rate was lower than that for the County of London (17.8), and the same as that for the whole of England and Wales(15.5). Death rate. The number of deaths per 1,000 population was 11.2, an increase compared with last year (10.4), but lower than the death rate for the County of London (13.1) and that for England and Wales (12.5). Infant death rate. The number of deaths of infants under one year per 1,000 live births declined from 28 in 1950 to 24 in 1951. This figure equalled the lowest rate ever recorded in Kensington (24 in 1949), and was lower than the infant death rate for the County of London (26.4) and that for England and Wales (29.6). Maternal death rate. There were unfortunately three deaths of mothers due to childbirth recorded in 1951, compared with five for the previous year. The maternal mortality rate was 1.10 compared with a rate of 0.79 for England and Wales. (The figure for London is not yet available.) Infectious diseases. There was no serious outbreak of infectious disease in the borough during 1951; the total number of notifications received was 2,479 compared with 1,716 in 1950. These figures represent an increase of over 44% The main reason for this increase was the biennial epidemic of measles which resulted in 1,314 notifications in 1951, compared with only 696 the previous year. In fact, excluding the figures for measles and - 1- 2 whooping cough, which mainly are children's illnesses, the incidence of infectious disease was lower in 1951, compared with that for the previous year. The notifications of diphtheria (1 case), scarlet fever (68), scabies (34), erysipelas (13) and ophthalmia neonatorum (2), were in each case the lowest annual figures ever recorded in Kensington. Tuberculosis. New cases of tuberculosis notified for the first time numbered 238 in 1951 compared with 278 in 1950 and 266 in 1949. Whilst the number of cases of tuberculosis recorded in the notification register for Kensington increased during 1951 from 1,246 at the 1st January to 1,342 at the 31st December, the death rate (21) from all forms of tuberculosis for the year was the lowest ever recorded in the borough. The rate in 1950 was 33 deaths per 100,000 population. During the year under review, the department's activities in connection with the environmental aspects of tuberculosis were intensified. Each newly notified or incoming patient was visited and detailed enquiries made regarding housing and sanitary conditions, the source of infection and measures being taken to prevent its spread. In this regard, advice was given and any necessary action taken to improve living conditions. It will be seen from the foregoing remarks that statistically the position is encouraging and that in the main the health of the inhabitants of the Royal Borough continues to be maintained at a satisfactory level. Nevertheless there are many residents whose environmental conditions cannot be regarded with equanimity. Repair of houses. As reported in last year's Report, the problem of maintaining existing dwelling houses in a reasonable state of habitation is still the most urgent confronting the Council at the present time. A great deal of national and local consideration has been given to the question of relating rents, which are still controlled, to the rising cost of repairs. There is no doubt that owners of rent-controlled properties are finding it very difficult to carry out necessary repairs to old houses owing to comparatively low rents. The important work of maintaining existing dwelling houses in a reasonable state of habitation is becoming more and more difficult to carry out. Work under Section 9 of the Housing Act, 1936, which empowers the Council to require the repair of unfit houses, providing the cost of the works is reasonable, is gradually coming to a standstill. In the five years before the war, the average number of houses repaired under Housing Acts was 180. The numbers so repaired in the last five years are as follows Houses Repaired Notices Served 1951 62 21 1950 116 65 1949 98 94 1948 87 121 1947 43 93 If Housing Act procedure becomes impracticable owing to economic factors, the Council's statutory powers to repair houses will be limited to the nuisance sections of the Public Health (London) Act, 1936. For various reasons an adequate repair standard cannot be achieved under the Public Health (London) Act, 1936, but, of course, action - 3 - under this Statute is always taken in regard to any house found to be in such a state as to be a nuisance or injurious or dangerous to health. In this respect, the introduction of the London County Council (General Powers) Act, 1951, which strengthens the powers under the 1936 Act, is welcomed, as it enables the Council to recover as a charge on the property, expenses incurred in repairing houses under the Public Health (London) Act, where "owners" have failed to comply with Justices' Orders to abate nuisances. Slum clearance. In spite of the fact that reasons of national importance prevent slum clearance on a large scale, the Council have been able to make some progress as far as Kensington is concerned. The legal formalities in regard to the four areas represented for clearance in 1950 have been completed, and notwithstanding objections from interested parties, the action taken has been confirmed by the Minister of Housing and Local Government. Steps are now being taken to rehouse the occupiers and demolish the unfit buildings. During 1951, five additional areas have been represented for slum clearance. Hostels. An interesting development by the Council during the year was the making of special byelaws under the Public Health (London) Act, 1936, to control the management of hostels in the borough. Speaking generally, hostels are well maintained when under the control of recognised bodies, but standards in some of the privatelyowned hostels were not much better than in those common lodging houses which existed years ago for accommodating the vagrant or casual user. Action is being taken at the present time to secure proper standards and amenities in all hostels. Old People. The welfare work in relation to old people has been substantially extended and carried on vigorously during the year. A special feature, which proved most successful, was the introduction of a scheme to provide holidays for old people who had not had a change of air or scenery for many years. The gratitude and appreciation of the old people, who benefitted under the scheme, were very rewarding, and the Council have decided to make increased provision for 1952. VITAL STATISTICS The table set out on the next two pages gives the important vital statistics for 1951, together with comparative figures for the previous seven years. - 4 - - 5 - SUMMARY OP VITAL STATISTICS FOR KENSINGTON Description 1951 1950 1949 1948 1947 1946 1945 1944 POPULATION Population (estimated) 171,300 177,400 174,220 168,800 166,170 147,870 117,170 107,610 Density of population per acre 74 77 76 74 72 64 51 47 LIVE BIRTHS Total births 2,656 2,745 2,681 2,908 3,012 2,695 1,890 1,780 Legitimate births 2,390 2,470 2,417 2,608 2,696 2,378 1,579 1,527 Illegitimate births 266 275 264 300 316 317 311 253 Birth rate per 1,000 population 15.5 15.5 15.4 17.2 18.1 18.2 16.1 16.5 STILL BIRTHS Total still births 60 54 39 56 65 68 49 47 Legitimate still births 55 51 39 47 58 60 40 44 Illegitimate still birth 5 3 Nil 9 7 8 9 3 Still birth rate per 1,000 total births 22.1 19.3 14.3 18.9 21. 1 24. 6 25.3 25.7 DEATHS Total deaths 1,920 1,848 1,819 1,685 1,866 1,821 1,586 1,735 Death rate per 1,000 population 11.2 10.4 10.4 10 11.2 12.3 13.5 16.1 DEATHS OP INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 65 78 64 111 124 132 92 93 Legitimate deaths 55 69 52 103 105 117 73 76 Illegitimate deaths 10 9 12 8 19 15 19 17 Infant death rate per 1,000 births 24 28 24 38 41 49 49 52 Death rate of legitimate infants per 1,000 legitimate births 23 28 22 39 39 49 46 50 Death rate of illegitimate infants per 1,000 illegitimate births 38 33 45 27 60 47 61 67 MATERNAL DEATHS Deaths of mothers as a result of pregnancy or childbirth 3 5 Nil 5 4 3 4 1 Death rate of mothers per 1,000 live and still births 1.1 1.79 Nil 1.68 1.3 1.08 2.06 0.55 TUBERCULOSIS DEATHS Death rate from all forms per 100,000 population 21 33 34 51 47.5 55 84 76 Death rate from respiratory tuberculosis per 100,000 population 17.5 29 32 45 43 47 70 68 Death rate from nonrespiratory tuberculosis per 100,000 population 3.5 4 2 6 4.5 8 14 8 - 6 - CAUSES OP DEATH AT DIFFERENT PERIODS OF LIFE IN 1951 Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 45 years and over Respiratory tuberculosis 30 _ _ 14 16 Other forms of tuberculosis 6 _ _ 2 4 Syphilis 10 - - - 10 Diphtheria - - - - - Whooping cough 1 - 1 - - Meningococcal infections 3 _ 2 1 _ Acute poliomyelitis - - — - - Measles 1 1 — — — Other infective diseases, etc. 5 _ _ 1 4 Cancer (all forms) 347 — - 26 321 Leukaemia, aleukaemia 4 _ 1 1 2 Diabetes 13 _ — 1 12 Vascular lesions of nervous system 179 _ 4 175 Coronary disease, angina 244 _ _ 4 240 Hypertension with heart disease 50 _ _ _ 50 Other heart disease 290 — — 11 279 Other diseases of circulatory system 72 4 68 Influenza 41 - - v 41 Pneumonia 94 5 3 1 85 Bronchitis 129 2 — 2 125 Other respiratory diseases 16 _ _ _ 16 Ulcers of the stomach 31 — — 2 29 Gastritis, enteritis and diarrhoea 8 1 _ _ 7 Nephritis and nephrosis 22 _ _ 2 20 Hyperplasia of prostate 14 _ _ 14 Pregnancy, childbirth and abortion 3 _ _ 3 _ Congenital malformations 16 8 2 6 All other diseases 198 48 2 14 134 Motor vehicle accidents 12 _ _ 6 6 All other accidents 57 — 1 12 44 Suicides 23 — — 10 13 Homicide and operations of war 1 - - 1 - TOTALS 1,920 65 10 124 1,721 KENSINGTON BIRTHS PER 1000 POPULATION KENSINGTON DEATHS PER 1000 POPULATION KENSINGTON INFANTILE DEATH RATES (Deaths of children under 1 year per 1000 births) - 7 - GENERAL PROVISION OP HEALTH SERVICES IN THE AREA Bacteriological and Analytical Work Pathological and bacteriological work is 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 year Nature of specimen or sample Number examined Nose and throat swabs 308 Sputum 79 Faeces, rectal swabsdtand other, specimens 367 Milk (bacteriological) 108 Water (drinking) 10 Water (swimming baths) 16 Ice cream 61 Miscellaneous 225 Medicinal Baths (Personal Cleansing Station) The record of work done during 1951 is as follows:- Description Scabies Vermin Impetigo Other conditions Persons Clean -sings Persons Clean -eings Persons Clean -sings Persons Clean -sings Adults Kensington Other 61 119 74 87 - - 7 8 boroughs 34 55 60 62 - - 1 1 Schoolchildren Kensington Other 27 109 1184 1184 - _ 7 14 boroughs 16 42 301 301 - - - - Children under 5 Kensington Other 11 29 26 26 - - 2 2 boroughs 12 18 6 6 - - - - Compulsory Cleansings - - 172 172 - - - - TOTALS 161 372 1823 1838 - - 17 25 - 8 - In addition to the cleansing of persons referred to above, articles of personal clothing disinfested at the Medicinal Baths during the year numbered 1,565. Disinfection and Disinfestation A summary of the routine work of the disinfecting staff is shown in the following table Houses disinfected after infectious disease 466 (639 rooms) Houses disinfested after vermin 677 (1396 rooms) Loads of furniture treated with hydrogen cyanide 174 Total weight of furniture, bedding, etc. dealt with 231 tons 0 cwt. 1 quarter 14 lb. During the year 124 new Council flats became ready for occupation, and the furniture of the ingoing tenants was treated with H.C.N. 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. Although the duty is imposed on occupiers of premises to notify the Council of rodent infestation, the Council must ensure that as far as practicable the borough is kept free from rats and mice. Section 2+ of the Act enables the Council to serve notices requiring rat destruction treatment and precautionary works and the Medical Officer of Health, the Deputy Medical Officer of Health, all sanitary inspectors and the rodent officers have been authorised to take necessary action. The Council have decided that they 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, 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 publuc funds. The Minister is empowered from time to time to require reports and, in particular, an Annual Report must be submitted to him 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 year ended 31st December, 1951 - 9 - Prevalence of Rats and Mice Type of Property Local Authority Dwelling Houses All other (including Business & Industrial) Total I. Total number of properties in Local Authority's District 31 34,889 7,636 42,556 II. Number of properties inspected by the Local Authority during 1951 as a result (a) of notification or (b) otherwise (a) 20 1,049 141 1,210 (b) 8 1+5 14 67 III. Number of properties (under II) found to be infested by rats Major 1 - 2 3 Minor 18 313 50 381 IV. Number of properties (under II) found to be seriously infested by mice 3 580 52 635 V. Number of infested properties (under III and IV) treated by the Local Authority 22 893 104 1,019 VI.- Number of notices served under Section 4:— (1) Treatment - - - - (2) Structural Works (i.e. Proofing) - 11 - 11 Total - 11 - 11 VII. Number of cases in which default action was taken by Local Authority following issue of notice under Section 4 - - - - VIII.Legal Proceedings - - - - IX. Number of "block" control schemes carried out 3 The three area "block" control schemes dealt with included two of the Council's Depots and a building site. It was estimated that a total of 103 rats were destroyed by these treatments. - 10 - On two occasions all the sewers in the borough were dealt with by poison bait, and it was estimated that in the first treatment 7,572 rats were destroyed; and in the second 4.,637 rats were killed. Sewer baiting was carried out in co-operation with contiguous Local Authorities. The rodent staff deal with infestations from pests other than rats and mice, and the following is a summary of all action taken during the year:- Complaints investigated 1,181 Premises inspected following complaints 1,387 Premises where rats were found 384 Premises where mice were found 635 Premises where other vermin were found 133 Premises where no infestation existed 235 Number of visits made 8,024 Number of notices served 59 Premises successfully treated 1,082 Cases in which advice only was given 78 Borough Council properties dealt with 92 Public Mortuary The number of bodies taken to the mortuary during the year was 505. Inquests were held in 86 cases. Destruction of Pigeons A considerable amount of nuisance and damage is occasioned by the activities of wild pigeons. The Council have authorised a pigeon-catcher to catch pigeons on the high-way and provide him with the pigeon food used as bait. Twenty-five complaints of nuisance caused by pigeons were passed to him and, as a result of his action, 500 birds were caught and destroyed during the year. Better results would have been obtained but for the opposition of some members of the public. For example, one old lady not only disturbed the pigeons so that they could not be caught, but actually assaulted the pigeon catcher. If the wild pigeon population of the borough is to be reduced, it is essential that the work of the pigeon catcher should not be made more difficult by the action of private persons. 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. Co-operation with voluntary bodies interested in the welfare of old people is effected wherever possible. In order that action taken shall be uniform, the Kensington Old People's Welfare Voluntary Committee act as an intermediary between the Council and the voluntary bodies. Four members of the Public Health Committee are nominated to serve on the Kensington Old People's Welfare Voluntary Committee which 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. - 11 - 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. During the year grants were made as follows (a) St. Luke's Darby and Joan Club, Ifield Road, were granted £20 to purchase oil stoves, etc. for heating their premises. (b) The Seventh Feathers Club were granted £5 towards the cost of gramophone records. (c) The North Kensington Old Age Pensioners' Club were granted £10 for canteen equipment. Holidays. The Council approved a scheme for providing holidays for old people, in co-operation with the Family Welfare Association. Applications are made direct to the Medical Officer of Health, who arranges for the investigation of the applicant's circumstances. An assessment is made, in accordance with an approved scale, of the contribution towards the holiday expenses, which the old person is asked to make. Each case recommended is submitted to the Chairman of the Public Health Committee for approval. It is then referred to the Family Welfare Association who arrange for the holiday, as far as possible meeting the applicant's wishes and needs. The Council make themselves responsible for the expenses, subject to collection of the old person's contribution by the Family Welfare Association. During the year, sixty-six old persons were sent away for holidays of one or two weeks. The total cost to the Council amounted to £256.0s.Od. Altogether eighty-one cases were accepted under the scheme, but in thirteen of the cases the old people concerned cancelled the arrangements after the booking had been made, due it was thought to the fear of travelling alone. To overcome this, arrangements were made with the Women's Voluntary Services for all necessitous cases to be escorted to and from the station at each end of the journey. 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, where necessary, while old people's belongings are being dealt with at the disinfecting station. Thirty-six old people were dealt with in 1951. Two 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. 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 responsible official organisations. 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. During the year it was possible to arrange for sixty-two old people to be admitted to hospital for institutional treatment and, in addition, thirty-five cases were admitted to homes for the aged. -12- 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 affected or endangered thereby. The cleansing of grossly fouled bedding in cases of incontinence may be dealt with under this section. 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. In 66 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 works smoothly and appears to fill a much felt want. Prom stocks of bedding held, the Council are able to supply linen and bedding on loan to old people while their own is being laundered, and where possible voluntary organisations are asked to undertake replacements of much worn articles. During the year, 304 separate collections of laundry were made under this scheme, and the number of articles cleansed totalled 2,233. 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 Women's Voluntary Services mobile library. Chiropody. On the 22nd May, 1951, the Council decided to make a grant of £24 to the Kensington Council of Social Service for the purpose of a chiropody service for house-bound old people and, in the first instance, the treatment of old people was limited to ten per month at a cost of 4s. per treatment. All patients are referred by the Medical Officer of Health to the Council of Social Service which administers the financial aspect of the scheme. The British Red Cross Society arrange the treatments, including providing the chiropodist and making the appointments. After the scheme had been in operation for a few months, it was found that the majority of cases required multiple treatment and practically all required follow-up, with the result that there was likely to be progressive delay before new cases could receive attention. The Council therefore decided to extend the chiropody scheme to allow for a further ten treatments each month. The total number of home chiropody treatments given during the year was 74. Meals service. The arrangements for meals either delivered to old people in their homes or in canteens were continued with great success by the Women's Voluntary Services in conjunction with Kensington Communal Kitchens. The Women's Voluntary Services undertake the work of verifying the bona fides of applicants, arrange delivery of meals at the homes of old people and collect the money. The Kensington Communal Services Committee supply the meals and allow the use of three vehicles for delivery. - 13 - The original price was 10d. a meal (including sweet). Subsequently the London County Council decided to make a grantin-aid of the service throughout London, and accordingly the price of the meal to old people was reduced to 8d. in order to qualify for a grant of 4d. a meal from the County Council. The following statement shows the progress of the service and the financial effect since it was taken over by the Kensington Communal Services Committee:- Period Number of meals Gross Cost Receipts from old people Grant from LCC. Net Cost October 1948 - £ £ £ £ 31st March,1949 3,535 352 149 - 203 Year 1949/50 10,461 1,016 432 27 557 Year 1950/51 13,758 1,250 577 115 558 Year 1951/52 18,370 Not yet available It will be observed that the number of meals served is growing and that the net cost is substantial. The deficiencies have been met by the Kensington Communal Services Committee. Under Section 31 of the National Assistance Act, 1948, the Council have power to make grants to voluntary bodies undertaking the supply of meals to old people, but up to the present they have not been requested to do so. Visiting. The Council's Women Health Officers visit old people brougnt to their notice. A comprehensive record system is kept of old people in the borough including personal particulars, environmental conditions and special needs. The local voluntary organisations supply records of old people whom they help and every endeavour is made to keep this information up to date. The following is a summary of the work carried out by the Council's Women Health Officers in connection with the care of old people during the year 1951:- Cases on register at the beginning of year 2,538 New cases added to register 1,128 Cases removed to hospitals 62 Cases removed to homes (voluntarily) 35 Cases removed to homes (compulsorily) 1 Cases removed from district 20 Number of deaths 160 Total number of cases remaining on register 3,388 Number of old people sent away for holiday 66 Number of old people provided with Council's laundry service 66 Number of old people provided with "Meals on Wheels" 246 Cases referred to National Assistance Board 76 Cases referred for assistance from Home Help Department 113 Cases referred for assistance from Voluntary Organisations 108 Cases referred to Recreational Clubs 140 Cases assisted with provision of medical and nursing care 62 Cases where disinfestation was carried out 36 Number of initial home visits made 1,742 Number of re-visits 1,356 Number of other visits made in connection with old people, including visits to clubs 431 -14- Removal of old and infirm persons to institutions etc. Under Section 2+7 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. The National Assistance (Amendment) Act, 1951, which came into operation on 1st September, 1951, amended Section 2+7 of the National Assistance Act, 1948. Previously, it was necessary for the Medical Officer of Health to certify in writing that a person should be removed, and the Council had to apply to the Court for a Removal Order. Seven clear days' notice had to be given to the person concerned and to the Superintendent of the hospital or institution to which it was proposed to remove such person. Under the new Act, application for removal of urgent cases may be made by the local authority or by the Medical Officer of Health, if authorised by the Council to do so, without giving the seven days' notice. Such applications may be made either to a Court of Summary Jurisdiction or to a single Justice, on a certificate by the Medical Officer of Health and another registered medical practitioner. Further, where the hospital or institution agree to receive the case, it is no longer necessary to give seven days' notice to the manager thereof. Under this emergency arrangement, detention Orders made in respect of these urgent cases are limited to three weeks, and if it is necessary to extend this time, compliance must be made with the original requirements of Section 47. The new Act will simplify and expedite the task of securing the removal to hospital of urgent cases of old and infirm persons, but it is probable that difficulties may occur in cases where it is desired to extend the detention order beyond three weeks. The Medical Officer of Health was authorised by the Council to make applications where necessary for the urgent removal of persons to hospitals, etc., as provided by the National Assistance (Amendment) Act, 1951. Although many cases were investigated during the year, only one resulted in formal action being taken to secure compulsory removal,, An old lady of 86 years, suffering from advanced cardiac insufficiency, lived in a single room in Ifield Road. She was without friends or relatives and both she and the room she occupied were in a most insanitary state. Every endeavour was made to persuade her to enter a home voluntarily - on two separate occasions a vacancy was obtained for her in a suitable home, but at the last minute she refused to leave. The conditions worsened to such an extent that it was decided to take action for her compulsory removal to hospital. The London County Council agreed to admit her to one of their homes and the necessary certificates were supplied by the Medical Officer of Health and his Deputy. These were placed before a Justice of the Peace, wno, after a visit, authorised - 15 - removal to the institution and detention therein for a period not exceeding three weeks. She died three days after removal to the institution. 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. The Council have authorised the Medical Officer of Health to make arrangements for the burial of any person to whom it applies. This increasing work frequently entails difficult and often unpleasant tasks in the detailed listing and disposal of effects. These, and the sometimes prolonged and involved correspondence with relatives, claimants and Government Departments, have substantially added to the work of the administrative staff. In the twelve months ended 31st December, 1951, the Council became responsible for the burial of 53 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 28 (b) Cases where part only of the expenses has been recovered 17 (i) Number of these where balance of expenses will be recovered 1 (amounting to £3.10s. 0d. ) (ii) Number of these where there is no estate or "liable" relative 11 (iii) Number of these where "liable" relatives are unable to contribute 5 (c) Cases where full cost has been borne by the Council 8 (i) Number of these where part expenses will be recovered 1 (amounting to £5.Os.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 Amount recovered by end of year £237. 13. 5d. • Additional amount expected to be recovered 8. 10. Od £246. 3. 5d. Irrecoverable §08. 11. 7d. Total cost £454. 15. 0d. It is of interest to note that of the 53 cases dealt with, only 17 were eligible for a Death Grant from the Ministry of National Insurance. The total amount recovered - 16 - from this source amounted to £86.16s. 0d. (included in the above figures.) Borough Cremation Service The General Cemetery Company, who own the Kensal Green Crematorium situated at the north-west corner of the borough, agreed with the Council to make a reduced standard charge of four guineas for cremation of Kensington residents, subject to certain financial conditions. The agreement came into force on the 1st January, 1951. In order to publicise the new facilities, the Council arranged a Public Meeting, which was held at the Town Hall on the 10th April, 1951. The principal speaker was the Rt. Hon. Lord Horder, G.C.V.0., M.D. , F.R.C.P. In addition, leaflets describing the Kensington Scheme and the advantages of cremation generally, were distributed widely throughout the borough. In 1951, there were 174 Kensington cremations, the net cost of which to the Council amounted to £115° 10s. Od. The total of 174 compares with a figure of 60 Kensington cremations in 1948, which year was taken as the basis on which the financial provisions of the Agreement were framed. Medical Examinations of Staff The Medical Officer of Health undertakes all medical examinations of staff for the purposes of the Borough Council's Superannuation Scheme. During the year 197 examinations were made. SANITARY INSPECTION The following table shows a summary of the inspections, etc., carried out by the sanitary inspectors during the year :- Public Health (London) Act, 1936 Houses inspected on complaint 4,812 Houses inspected after infectious disease 3,455 Re-inspections.. 15,655 Smoke observations 18 Inspections of mews 106 Other inspections 3,926 Housing Act. 1936 Initial inspections (including preparation or revision of house-to-house cards) 388 Re-inspections 2,722 Inspections in regard to overcrowding 1,170 Underground Living Rooms Primary inspections 170 Re-inspections 1,045 Drainage Applications 271 Plans submitted 139 House drains tested and inspected 2,769 - 17 - The following table shows the number of notices issued in respect of nuisances, defects, etc., found during the year Public Health (London) Act, 1936 Intimation notices 2,364 Statutory notices 1,066 Pinal notices 464 Various Notice of intention to enter premises for inspection 624 Rent Restrictions Act certificates 16 Report of waste water to the Metropolitan Water Board 71 Report of dangerous structures to the London County Council 162 Other notices 42 The following is a summary of works completed under the supervision of the sanitary inspectors during the year House drains, reconstructed 19 House drains, additions to 75 Defective drains repaired 143 House drains cleansed 220 Water closets, reconstructed 24 Water closets, repaired 108 Water closets, new provided 211 Water closets, supplied with water 69 Soil pipes ventilated, repaired etc. 24 Soil pipes, new provided 94 Ventilating pipes, new provided 135 Baths, new provided 147 Sinks, new provided 111 Lavatory basins, new provided 515 Waste pipes, new provided 295 Cisterns, cleansed 19 Cisterns, covered 3 Taps fixed on rising main 10 Yards and areas paved, drained etc 10 Dustbins provided 101 Accumulations of filth, etc. removed 109 Animals removed 5 Roofs repaired 919 Houses provided with water above basement level 11 Dampness in dwellings remedied 937 Infectious disease cases removed 224 Houses disinfected after infectious disease (including bedding, etc.) 466 Rooms in such houses, disinfected after infectious disease 639 Houses cleansed under Houses let in Lodgings Byelaws 137 Cleansing of houses not on register 218 Verminous houses cleansed (including bedding, clothing, etc. ) 677 Verminous rooms in such houses, cleansed 1,396 Dirty bedding, cleansed 112 Dirty bedding, destroyed 17 Other sanitary works executed 2,356 18 HOUSING Inspection of dwelling houses during the year (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Acts) 9,995 (b) Inspections made for the purpose 33,343 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 388 (b) Inspections made for the purpose 3,110 (iii) Dwelling houses found not to be in all respects reasonably fit for human habitation 2,385 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 21 (ii) Dwelling houses which were rendered fit by owners under Section 9 55 (iii) Dwelling houses rendered fit by the Council in default of owners under Section 10 7 (b) Action 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 1 (iii) Dwelling houses rendered fit for habitation by owners in accordance with undertakings to do so 3 (c) Action under Section 12 of the Housing Act, 1936:- (i) Separate tenements or underground rooms in respect of which closing orders were (20 premises made (45 rooms (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms (25 premises having been rendered fit (45 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 (18 premises for purposes other than sleeping (29 rooms (iv) Separate tenements or underground rooms in respect of which the Council accepted undertakings from owners to render fit ( U premises within specified time ( 6 rooms (v) Number of undertakings by owners to render separate tenements or underground rooms fit, which were cancelled, the ( 5 premises necessary works having been completed ( 9 rooms 19 (d) Action under Section 25 of the Housing Act, 1936:- (i) Number of areas represented to Council for clearance 5 (ii) Number of dwellings in such areas 61 (iii) Approximate number of persons to be displaced 118 (e) Action under the Public Health (London) Act, 1936:- (i) Number of Intimation Notices served requiring defects to be remedied 2,364 (ii) Number of Statutory Notices served 1,066 (iii) Number of Summonses issued 232 Rent and Mortgage Interest (Restrictions) Acts Seventeen applications by occupiers were made to the Council during the year for certificates of unfitness for habitation under these Acts and sixteen were granted. In the remaining case, the applicant moved away before the certificate could be issued. The provision of new housing accommodation The post-war new housing schemes completed or being erected by the Council are summarised as follows Henry Dickens Court 300 flats Rackham Street 116 flats 4 houses Portobello Court 158 flats Kelfield Court 18 flats St. Columbs House, Blagrove Road 16 flats St. Marks Place 12 flats Corbett House, Cathcart Road 15 flats Elgin Crescent/Ladbroke Grove 16 flats Walmer Road/Clarendon Road 72 flats Lansdowne Road 8 flats Old Brompton Road 15 flats Other schemes for building are in various stages of preparation. Slum Clearance The question of slum clearance in London as a whole has been under consideration by the appropriate Government Departments, the London County Council and the Metropolitan Boroughs Standing Joint Committee. 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 houses (i) That the conditions of the houses are 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. 20 (iii) That the work of demolition and clearance can be undertaken without serious diversion of building labour from new building. Representations regarding the following four areas were made and duly approved during 1950 by the Council as being ready for clearance, and the action taken so far is as follows:- Elgin Mews (28 premises) A Compulsory Purchase Order in respect of this clearance area was made by the Council on the 3rd October, 1950, and the site and building of a storage shed adjoining the area was included in the Order. The Minister of Housing and Local Government held a Public Inquiry on the 6th February, 1951, and subsequently confirmed the Order, without modification, on the 28th March, 1951. Lionel Mews (13 premises) A Compulsory Purchase Order in respect of this clearance area was made by the Council on the 27th February, 1951, and included in the Order was the vacant site of No. 8, Lionel Mews. A Public Inquiry was held on the 3rd July, 1951, and the Order was confirmed by the Minister of Housing and Local Government, without modification, on the 13th September, 1951. Lonsdale Mews (19 premises) A Compulsory Purchase Order in respect of this clearance area was made by the Council on the 1st May, 1951. No objections were received and the Order was confirmed by the Minister of Housing and Local Government on the 14th September, 1951. Munro Mews (24 premises) A Compulsory Purchase Order in respect of this clearance area was made by the Council on the 1st May, 1951. A Public Inquiry was held on the 30th October, 1951, and the Order was confirmed by the Minister of Housing and Local Government on the 18th January, 1952, subject to a slight modification which arose on a legal point. At the present time steps are being taken to acquire the above four areas, to demolish the buildings and erect new stabling and storage accommodation for costermongers. During 1951, the following five areas were represented to the Council as Clearance Areas, and the specified statutory procedure is being followed in each case:– South End Row and South End Gardens 10 premises East Mews Road 14 premises Powis Mews 13 premises St. Lukes Mews 20 premises Portobello Road 4 premises In addition, a clearance area representation was made in respect of eleven premises in Wornington Road, but before statutory steps were taken, the owners voluntarily demolished the premises, which at the time were unoccupied. No further action was necessary. 21 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 unit mewsways. Since 28th July, 1950, special legislation has enabled the Kensington 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, 1936/49, 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 were taken to extend these special powers throughout the Administrative County, under the London County Council (General Powers) Act, 1951. Plans for erecting costermongers' stabling and storage accommodation in Gadsden Mews have been prepared by the Borough Engineer, and the acquisition of the mewsway (which is cleared of buildings) is now proceeding. Overcrowding When the war ended in 1945, it was considered that, owing to the large number of houses destroyed or severely damaged during air raids, overcrowding might present a formidable problem. It was felt that the rigid enforcement of the overcrowding standards in the Housing Act, 1936, would be impracticable and, therefore, the Public Health Committee approved a scheme for dealing with the worst cases in the first place. In September, 1945, the Committee adopted a Modified Standard which involved increasing the "permitted number" for a dwelling house by a specific amount according to the number of rooms. This Standard has been applied throughout, although minor amendments have been made as a result of experience gained. All cases of overcrowding coming to notice have been classified under four headings as follows Category 1. Overcrowding under the legal standard where alternative accommodation has been offered and refused. Category 2. Overcrowding in excess of the Modified Standard. Category 3. Overcrowding above the legal standard but within the Modified Standard, where there are special medical reasons involved. 22 Category 4. As in Category 3, but without special medical circumstances. Cases within Categories 1, 2 and 3 have been considered by a special Sub-Committee of the Public Health Committee which was established for that purpose. Cases within Category 4 have not been reported but records have been made and the families are kept under observation by the sanitary inspectors who try and secure abatement by persuasion. By the end of 1951, 842 cases of overcrowding, under Categories 1, 2 and 3 had been considered, and no fewer than 627 of these had been abated. Of the remaining 215 cases, 53 have been reduced to within the Modified Standard and re-classified in Category 4, seven stand adjourned sine die, and in 24 action has been postponed for varying periods. One hundred and thirty-one are registered for alternative accommodation and are awaiting suitable offers from housing authorities. Details of 88 new cases coming to notice and dealt with in 1951 by the special Sub-Committee, are as follows:- (a) Recommended for alternative accommodation by the Council 50 (b) Proceedings ordered to be taken without prior offer of alternative accommodation 14 (c) Action postponed 24 The total number of cases of overcrowding abated during the year was 128. Hostels On the 3rd May, 1949, the Council were informed that a number of hostels existed in the borough occupied mainly by students or by persons without homes of their own or whose places of employment are far removed from their homes. Most of the hostels are under the control of religious or semireligious bodies, business houses or the Government or sponsored by the Government. Whilst the accommodation provided differed widely, these hostels were generally satisfactory. In a few privatelyowned establishments, however, conditions left much to be. desired, particularly in regard to overcrowding and sanitary arrangements. Overcrowding is normally dealt with under Part IV of the Housing Act, 1936, and it was possible that Sections 58 and 59 of that Act applied to these hostels provided they were occupied or suitable for occupation by persons of the working classes. Particular attention was drawn to three unsatisfactory hostels. Details of twenty-one other hostels were obtained and although these were generally well-conducted, clean and quite desirable premises, in every case the number of persons in occupation exceeded that laid down by Housing Act standards, and it was common to find four, five or even six or seven persons sleeping in one room. If the Housing Act standard of two persons per room were rigidly applied, it was doubtful whether the hostels would be able to continue in existence, and many persons would be deprived of accommodation which they regarded as being quite satisfactory. 23 The problem appeared to be common to many London boroughs and it was felt that the matter should be referred to the Metropolitan Boroughs' Standing Joint Committee to determine the amount of space per lodger, and the provision of proper amenities so that uniform standards could be applied to hostels throughout the Metropolis. Other unsatisfactory conditions in hostels came to notice, such as insufficient W.C. accommodation (in one hostel there were 38 lodgers with only one W.C.); the absence of, or insufficient, bathing and washing facilities (in the same hostel there was neither a serviceable bath nor sanitary lavatory basin); unsatisfactory food preparation and storage facilities; and lack of cleanliness (filthy ceilings and walls, uncovered and dirty floors, accumulations of dirt, dust and debris, stained and dirty bed-clothing). The question of hostels was referred to the Joint Committee of the Ministry of Health, the London County Council and the Metropolitan Boroughs' Standing Joint Committee. The view was expressed at this Joint Committee that byelaws made under Section 155 of the Public Health (London) Act, 1936, would be the appropriate statutory authority for dealing with hostels, and an undertaking was given that the authorities would be prepared to consider byelaws submitted to them. The Council approved draft byelaws, which were submitted to the Minister of Local Government and Planning, under Part VIII of the London Government Act, 1939, for confirmation. The Byelaws were confirmed by the Minister and came into operation on the 1st November, 1951. The following matters are dealt with in the byelaws Interpretation of terms Registration Inspection Sleeping rooms Tickets as to the number of lodgers to be exhibited Byelaws to be exhibited and kept undefaced Two children under the age of ten years to be counted as one person Use of underground rooms as sleeping rooms Separation of sexes Cleansing of hostels Condition and use of dust receptacles Yards, etc., to be kept in good order and clean Ventilation Furniture Bed and bedclothes to be aired Precautions as to infectious disease Water closets Bathing and washing accommodation Penalties At the end of the year routine inspections of hostels were being carried out to enforce the requirements of the Byelaws. 24 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 1951:- Inspections Premises Number on Register Numbe r of Inspect ions Number of Written Notices Factories with mechanical power 275 296 8 Factories without mechanical power U2k 662 19 Other premises under the Act. (Including works of building and engineering construction but not including out-workers' premises.) - - - TOTALS 699 958 27 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 — — — — Overcrowding — — — — Unreasonable temperature — — — — Inadequate ventilation — — — — Ineffective drainage of floors — — — — Sanitary conveniences:- (a) insufficient 3 3 — — (b) unsuitable or defective 22 16 — 4 (c) not separate for sexes 1 1 — — Other offences (not including offences relating to Homework 2 2 1 — TOTALS 28 22 1 4 During 1951, no prosecutions were instituted under the Factories Act, 1937. 25 Outworkers The following table shows the nature of the work carried out by the 278 home workers on the register of outworkers during 1951 Nature of work Number Wearing apparel - making, etc. 199 Fur pulling 1 Curtains, etc. 2 Paper bags, etc. 26 Umbrellas 1 Feather sorting 5 Carding etc. of buttons, etc. 15 Stuffed toys 23 Cosaques, crackers, stockings, etc. 1 Furniture and upholstery 1 Lampshades 2 Box making 1 Textile weaving 1 278 During the year, 295 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. Rag Flock and other Filling Materials Act. 1951 This Act came into operation on 1st November, 1951, and regulates the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Subject to certain exceptions, the Act makes it unlawful in the course of a business to use filling materials to which the Act applies except on premises registered by a local authority. The exceptions are the remaking or reconditioning of any article and upholstering in connection with the making of railway carriages, road vehicles, ships or aircraft. The local authority are required, on the application of the occupier of premises, to register the premises on payment of a registration fee of one pound. If on registered premises there are unclean filling materials the occupier shall be guilty of an offence, but there are safeguarding provisions for secondhand articles brought on the premises for remaking. The Act provides that no rag flock shall be delivered to registered premises except from premises licensed for manufacturing rag flock or premises licensed under the Act as a rag flock store. A local authority on receiving from the occupier of premises an application for the grant or renewal of a licence authorising him to manufacture rag flock on those premises, or for the licensing of the premises as a rag flock store, may grant or renew a licence on payment of a fee of one pound. Licences are to be renewed annually. No new licence is to be granted until the premises have been inspected and reported upon. A person aggrieved by a refusal of a licence has a right of appeal to the Minister of Local Government and Planning. The Act makes it an offence to sell or offer for sale any article to which the Act applies which is upholstered with unclean filling materials; secondhand articles are excepted. 26 An authorised officer of a local authority shall, on producing some duly authenticated document, have a right at all reasonable times to enter and inspect premises for the purposes of the Act. The Medical Officer of Health and sanitary inspectors are, by virtue of their appointments, deemed to be authorised officers. A person guilty of an offence under the Act is liable for a first offence to a fine not exceeding fifty pounds and, for a second or subsequent offence, to a fine not exceeding one hundred pounds or six months' imprisonment or to both. It is the duty of every local authority to enforce the Act in its area. A local authority in London is defined as the sanitary authority for the purposes of the Public Health (London) Act, 1936, that is, a metropolitan borough council. Public advertisements were issued by the Council calling attention to the provisions of the Act and Regulations made thereunder. By the end of the year 17 premises had been registered under the Act. INSPECTION AND SUPERVISION OP 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 frequentlv inspected. The following is a record of the inspections made by the food inspectors engaged on this work for 1951:- Pood factories 23 Bakehouses - underground 14 - others 29 Ice-cream premises 131 Preserved food premises 53 Butchers 201 Grocers 382 Dairies and milk shops 574 Public houses 80 Greengrocers 65 Fishmongers 75 Restaurants and cafes 224 Hotels 111 Sweetshops 13 General stores 176 Street traders' premises 72 Other inspections: stalls, etc., 271 Re-inspections (all premises) 267 Clean Food Campaign The Council decided that a Clean Pood Advisory Committee should 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. 27 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 Pood 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 and have met on a number of occasions. Basic principles for codes of hygiene were formulated by the Food Advisory Committee for the use of employers and employees of food trades in the borough. The basic codes approved were set out in full in last year's Report. Copies were distributed to all food premises and additional copies were supplied to employers on request. Nearly 4,000 copies of the codes were distributed during 1951. As a means of promoting food hygiene, as far as the general public were concerned, the Council decided to issue a leaflet entitled "A Guide to Food Cleanliness in the Home" to all housewives in the borough. This leaflet was prepared by the Public Health Department, and 40,000 copies were printed by the Borough Treasurer's Multilith Staff. Distribution of this leaflet and a Ministry of Agriculture and Fisheries pamphlet on rat and mice eradication was effected by courtesy of the Local Food Officer, who arranged for a copy of each to be handed to every person applying for a new ration book in 1951. In co-operation with the Pood Advisory Committee the Council decided that notices, signed by the Medical Officer of Health, requesting customers not to take their dogs into food premises should be supplied for exhibition to all food shops in the borough. Other matters under consideration by the Food Advisory Committee at the end of the year included the arranging of film shows and lectures to food handlers, and the appointment and training of "food hygiene liaison officers" in the larger food establishments in the borough. Food Byelaws. Model byelaws under Section 15 of the Food and Drugs Act, 1938, were issued in 1950 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. 28 The London County Council are the byelaw making authority for metropolitan boroughs, and they published draft byelaws in 1950 which were 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. Milk (Special Designations) (Raw Milk) Regulations, 1949 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; 84 17 Eighteen samples of Tuberculin Tested milk were submitted for examination during the year,, Two failed to pass the prescribed test and warning letters were sent to the vendors of these unsatisfactory samples. In addition, six samples of Tuberculin Tested milk were submitted for examination for the presence of tubercle bacilli. The results of the tests were satisfactory in all cases. Milk (Special Designations) (Pasteurized and Sterilized Milk) Regulations, 1949 Details of licences granted during 1951 are as follows s- Principal Supplementary Dealers licences to sell Pasteurized Milk; 98 18 Dealers licences to sell Sterilized Milk; 106 20 The following table shows the number of samples of processed milk taken during the year, together with results of examinations:- Grade No. of samples Methylene blue test Phosphatase test Turbidity test Passed Failed Passed Failed Passed Failed Tuberculin tested (Pasteurized) 55 + 45 Nil 55 Nil — — Pasteurized 28 ++ 26 Nil 28 Nil — — Sterilized 1 — — — — 1 Nil + Ten samples not examined by Methylene Blue test - Atmospheric shade temperature exceeded 65° F. as laid down in the Regulations. ++ Two samples not examined by Methylene Blue Test - Atmospheric shade temperature exceeded 65° F. as laid down in the Regulations. 29 Milk During the year 384 samples of milk were submitted to the Public Analyst and, with the exception of one, were found to be of genuine composition. A warning was sent to the producer of the adulterated sample. 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 percentages Milk fats Non-fat solids January 42 3ok5 8.77 February 57 3*k3 8.76 March 55 3.40 8.80 April 23 3.46 8.76 May 19 3.39 8.82 June 6 3.76 8.85 July 23 3.4 8.79 August 15 3.66 8.72 September 26 3.5 8.75 October 35 3.7 8.81 November 58 3.83 8.76 December 24 3o72 8.70 Average for whole year: 3.55% 8.77% Legal minimum standards: 3.00% 8.50% Milk and Dairies Regulations, 1949 A summary of the alterations made in the register of dairymen and dairies during 1951, 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 4 4 5 Additions to register - - 12 Removals from register 18 19 1 Dairymen with premises outside borough added to register — - — On register 31st December, 1951 97 82 86 Under Article 20 of the Milk and Dairies Regulations, 1949, the Medical Officer of Health is empowered to prevent the sale of milk in his area from any registered premises where he is satisfied that any person is suffering from disease caused by consumption of the milk, or that the milk is infected with disease communicable to man. 30 There was no occasion during the year where the exercise of these powers was necessary. Adulteration of Food During the year 543 formal samples of food and drugs were taken of which 6 (1.10%) were adulterated. Four hundred and fifty-seven informal samples were taken of which 2 (0.44%) were adulterated. Details of the adulterated samples are as follows:- Sample Nature of Adulteration Remarks Ice Cream Deficient in non-fat milk solids to the extent of 10% of the minimum limit (7.5%) prescribed by the Food Standards Ice Cream Order, 1951. Warning to vendor Double Cream 10.4% deficient in fat Warning to vendor Double Cream 7.3% deficient in fat Warning to vendor Ice Cream 34% deficient in fat Warning to vendor Ice Cream 23% deficient in fat Warning to vendor Milk 3.3% deficient in fat Warning to producer Sponge Pudding Mixture (packet) Insect infested and unfit for food Informal sample (No packets of same stock remained) Cream Cheese Decomposed and unfit for food Informal sample (Remainder of stock held by retailer surrendered and destroyed) 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. No food was seized and condemned under these Sections during the year. Surrender Any person having in his possession, 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. 31 During the year the following amounts of food were surrendered and condemned as unfit for human consumption:- Food Tons Cwts. Qrs. Lb. Meat (Raw) - 19 1 1 Meat (Tinned) - 12 1 11 Bacon - 2 2 25 Ham 4 7 - 20 Sausages - 3 3 22 Luncheon Meat — 2 3 7 Poultry - 2 1 19 Fish (Wet and Dry) l 2 2 - Fish (Shell) - 1 2 27 Prunes - - 1 14 Chocolate Coconut Ice - - - 9 Cheese - - - 7½ Rice - 1 - - Pat - - - 6¼ Sweetmeats - - - 10 TOTAL: 7 16 2 l0¾ Tins,, jars, packets or cartons of fruit, vegetables and miscellaneous foodstuffs 9,146 Shell eggs 1 case & 4¼ dozen Shrimps 21 nets Rabbits 66 Pork Pies 27 Imported Tinned Ham During 1951 there was a considerable increase in the number of requests for condemnation of imported tinned ham. Requests came from departmental stores, hotels, restaurants, cafes and many of the smaller food shops. The total amount condemned was 4 tons 7 cwts. 20 lb. This food had been imported mostly from European countries and from various packers and suppliers. The tins ranged in weight from a few ounces to over 20 lb. Some of the tins were "blown", whilst others had a normal external appearance although the contents were found to be discoloured and gave off an offensive smell. Some showed liquefaction only, while others showed liquefaction and gas. Many were found damaged due to careless packing or transportation, and a number of the tins showed strained seams with consequent leakage, indicating imperfect canning. It appeared that large tins of ham were not being sterilised because of the alteration to taste caused by the process. They were only pasteurised and this treatment was inadequate to destroy spores with the resultant possibility of spoiling during storage, unless kept at a sufficiently low temperature. Whilst the labels on some tins indicated that the contents were perishable and should be stored under refrigeration, a large number bore no indication that this precaution was essential; and, of course, traders had no control over non-refrigerated storage in wharves, wholesale ware houses or in transit. 32 Whilst most traders have refrigerators of sufficient capacity for their normal perishable goods, they have no refrigerated accommodation to store large tins of ham in bulk. Apparently, it was not fully understood by dealers that these hams had been subjected to mild heat treatment only and were, therefore, unlike the canned meats of smaller packs which they normally handle and keep for long periods under almost any conditions. Apart from the economic loss in preparing, canning and shipping this food, and, in addition, the food wastage involved, there was the added risk that public confidence in tinned foodstuffs might be seriously undermined if the position were allowed to continue. In view of the fact that an outbreak of food poisoning, attributable to infected ham and affecting some forty-nine sufferers, had been recorded in the Ministry of Health Bulletin for August, 1951, concern was felt as to the possible presence of pathogens and potential risk of infection in those tins which, upon opening, did not present evidence of decomposition. The Council, on receiving a report on this matter, decided to make representations to the Metropolitan Boroughs' Standing Joint Committee to request the Ministry of Food- (i) to prohibit the importation of inadequately sterilised or imperfectly tinned hams, and (ii) to take suitable steps to deal with stocks existing in the country. 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 137. Of this number 2 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. The Pood Standards (Ice Cream) Order, 1951, made under the Pood Standards (General Provisions) Order, 1944, came into operation on 1st March, 1951, and provided that ice cream shall contain not less than 5 per cent fat, 10 per cent sugar and per cent milk solids other than fat. The Order also provided that in ice cream containing fruit, the content of non-fatty milk solids may be reduced but the total content of fat, sugar and milk solids not fat must be at least 25 per cent with minimum contents of 7½ per cent fat, 10 per cent sugar and 2 per cent milk solids not fat. This allows manufacturers to increase the content of one or more of the ingredients at their discretion 33 to reach the 25 per cent minimum total content. The standard of fat content laid down in this Order is still below that of 8 per cent which was the minimum advocated by the Council in representations to the Ministry of Food in 1946. In the case of "Parev" (Kosher), however, ices sold under that name shall contain not less than 10 per cent fat and not less than 14 per cent sugar. The following table shows the number of samples taken during the year for chemical analysis, compared with 1950:- 1951 1950 No. of samples 55 77 Variation of fat content % 2.0 to 14.7 1.24 to 19.90 Variation of non-fat solids content % 14.6 to 33.0 17.20 to 32.79 Average fat content % 7.94 6.57 Average non-fat solids content % 24.47 25.11 Of those samples of ice cream taken subsequently to the introduction of the Food Standards (Ice Cream) Order, 1951, three were found to be deficient in fat. Warnings were sent to the vendors concerned. There is still no legal bacteriological standard for ice cream. As in previous years, samples were taken and submitted for examination under the provisional Methylene Blue Reduction test which is aimed to give a simple and practical means for the routine examination of ice cream. The test is not of sufficient precision to justify its use as a statutory test. The grading is determined by the length of time ice cream takes to decolourise the Methylene Blue and it is suggested that if samples consistently fail to reach grades 1 and 2 it would be reasonable to regard this as an indication of defects in manufacture or handling which warrant further investigation. During 1951, sixty-one samples of ice cream were taken and submitted to the Methylene Blue test and the results were as follows:- Grade No. of samples 1 24 2 11 3 11 4 15 Premises in the borough where ice cream is manufactured stored or sold were frequently inspected during the year and found to be in a satisfactory condition. A further measure to control the manufacture of ice cream was contained in the Ice Cream (Heat Treatment, etc.) (Amendment) Regulations, 1951, which enabled local authorities to require the use of thermometers to indicate 34 and record the temperatures to which ice cream mixtures are subjected in manufacture???. This requirement of thermometers was contained in the original Regulations of 1947 hut the enforcement of this was held in abeyance by the Minister until the 1st March, 1951. All ice-cream manufacturers in the borough have installed thermometers to their plants as required by these Regulations. Milk (Special Designations) (Specified Areas) Order, 1951 The Pood and Drugs (Milk, Dairies & Artificial Cream) Act, 1950, which came into operation on the 1st January, 1951, consolidated certain enactments relating to milk, dairies and artificial cream. It provides, under Section 19 (1), that the use of special designations is compulsory in respect of all retail sales of milk for human consumption (except catering sales) where the place of sale is in an area, declared a specified area by order of the Minister of Food under the provisions of Section 23 of the Act. Greater London was declared a specified area on the 1st October, 1951. The effect of this Order makes it illegal for any person to sell, by retail, milk for human consumption other than milk sold as specially designated milk, in accordance with the provisions of the Milk (Special Designations) (Raw Milk) Regulations, 1949, or the Milk (Special Designations) (Pasteurized and Sterilized) Regulations, 1949. Prom the 1st October, 1951, all milk sold by retail in Kensington must be either (a) Tuberculin Tested, (b) Accredited milk from a single herd, (c) Pasteurized milk, or (d) Sterilized milk. For many years past Kensington retail dairymen have obtained their supplies from the large wholesale milk firms who have, as a routine practice, subjected the milk to the Pasteurization process. In addition, the majority of the local dairymen have adopted the practice whereby the wholesaler supplies milk in sealed bottles, ready for retail sale, and bearing the appropriate designations. The operation of the Order did not materially affect the supply position in the borough and merely resulted in placing the sale of designated milks on a compulsory basis instead of a voluntary one. The Order amended the statutory procedure relating to the refusal, suspension and revocation of licences regarding the sale of designated milk. Briefly, this means that the licences held by retailers authorising the use of a special designation in relation to milk sold in the area, may not be revoked or its renewal refused unless (a) a breach of one of the specified conditions has been committed, and only then if such breach is the second of two breaches occurring within twelve months, or (b) if the retailer has been convicted for an offence under the Milk and Dairies Regulations, 1949. Any suspension of the licence on such grounds by the licensing authority can only be for a period not exceeding three months at any one time. 35 Suspension of revocation of licences is also affected by the conditions laid down in the Milk (Special Designations) Regulations. Cream The Food Standards (Cream) Order, 1951, came into operation on 30th April, 1951, and laid down the standards for cream as follows Cream sold as "Single Cream", "Fruit Cream", or "Coffee Cream" to have a minimum of 18 per cent milk fat. "Double" or "Thick" cream and clotted cream, a minimum of 48 per cent milk fat. Sterilized cream, i.e., tinned sterilized cream, bottled sterilized cream, a minimum of 23 per cent milk fat. The Order applied to all cream whether home produced or imported, and included cream sold by catering establishments. The Cream Order, 1950, prohibited the manufacture and supply of cream except under licence and also restricted the serving of clotted cream by catering establishments to specified areas; and imposed maximum prices for clotted, cream except when supplied as part of a meal by a catering establishment in any of the specified areas. These restrictions ware abolished by the Cream (Revocation) Order, 1951, which came into operation on 11th May, 1951, but the sale of cream was permitted for a very short period only and ceased on 3rd July, 1951. During this period, nine samples of cream were taken. Of this number, two were found to be below standard and warnings were sent to the vendors. FOOD POISONING Under Section 17 of the Pood and Drugs Act, 1938, any medical practitioner, on becoming aware that a person is sufferings, or is suspected to be suffering, from food poisoning, must notify the Medical Officer of Healtho The following table shows particulars of notifications received in 1951 Food poisoning notifications (corrected) Received in first quarter - " " second quarter 4 " " third quarter 11 " " fourth quarter 3 TOTAL: 18 Outbreaks due to identified agents - NIL Outbreaks off undiscovered cause - Total outbreaks 2 Total cases 5 Single cases Unknown cause 6 Agent identified 7 Total cases 13 36 Outbreaks due to unidentified agents (a) Three persons belonging to the same family were notified as cases of food poisoning after suffering with severe symptoms of pain, diarrhoea and vomiting over a period of 24 hours. Faeces specimens from the patients were examined. The remains of a bottle of pasteurized "sour cream" consumed by the family on the day before the onset was also examined. No organism of pathogenic significance was found in any of these specimens. (b) A mother and daughter living in South Kensington were notified as cases of food poisoning. Before investigations could be made, the family left Kensington for an unknown address. The only information obtained was that the two patients had suffered from a stomach upset, but had recovered in a few days. Single eases. In addition to the outbreaks mentioned above, there were 13 single cases of food poisoning notified. In 6 of these, no agent was identified. The remaining 7 cases were due to salmonella typhi-murium. INFECTIOUS DISEASE Smallpox No case of smallpox was notified in the borough during the year 1951. Many persons came to Kensington from places 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. In the Ministry of Health's Memorandum on Vaccination against smallpox, it is recommended that public health officers, likely to have to deal with cases of smallpox at short notice, should be regularly re-vaccinated at not more than yearly intervals. During the year 28 members of the staff of the Public Health Department were vaccinated or re-vaccinated by the Medical Officer of Health. Scarlet fever The number of cases notified in 1951 was 68 and, of this total, 23 were treated in hospital. There was no fatal case during the year. Diphtheria Only one case of diphtheria occurred in Kensington during 1951. This was an adult female who was an American staying temporarily in this country. She had not been immunised against the disease. This figure of one case is the lowest ever recorded in Kensington; the previous lowest figure was two cases which was recorded for each of the years 1949 and 1950. No death from diphtheria occurred during the year. Diphtheria immunisation work, commenced by the Council in 1934, was continued by the London County Council during the year. A summary of the work carried out in Kensington YEARS 1929-1951 -37- is as follows:- Number of pre-school children immunised 830 " " school « " 449 " " re-inforcing injections given 905 " " children attending for pre-Schick tests 393 " which gave a positive reaction 338 " of children attending for post- Schick tests 1,051 " proving negative 913 " proving positive 20 " who failed to attend for reading 118 Enteric fever Two cases of typhoid fever, four cases of paratyphoid B fever and one case of paratyphoid A fever were notified during the year. All the cases were treated in hospital and there was no death. The investigations of the two cases of typhoid, which occurred in the same family, revealed that the infection had been contracted abroad. In two of the five cases of paratyphoid fever, the source of infection was unestablished, but the remaining three patients almost certainly contracted the disease abroad. Puerperal Pyrexia On 1st August, 1951, the Puerperal Pyrexia Regulations, 1951, came into operation and replaced regulations which had been in force in London and the remainder of the country respectively. Under the new regulations, the provision which allowed London authorities to remit, if necessary, notifications received from hospitals within their areas to the authorities responsible for the patients' home addresses, has been withdrawn. Kensington now has to accept notifications for persons normally resident outside the borough who contract the disease in Kensington hospitals. During the year, 22 cases of this disease were notified and 15 were treated in hospital. Of this total, 3 were patients normally resident outside the borough. Information was received in the Public Health Department concerning 3 patients normally resident in Kensington who were notified in other London areas. 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 forty-nine notifications were received during the year, seventy patients being certified as suffering from acute primary pneumonia and seventy-nine from acute influenzal pneumonia. Of these one hundred and forty-nine cases, twentyfour were treated in hospital. During the year, the number of deaths from pneumonia (all forms) was ninety-four and forty-one deaths were certified as due to influenza. Dysentery Eighty-one cases of dysentery were notified during the - 38- year. Seventy-nine cases were bacillary in origin and the majority of these were due to Sonne bacillus; all of these cases were of a mild type. The remaining two cases were of amoebic dysentery. One patient was an air hostess who contracted the disease in Hong Kong. The second patient suffered a "recurrent" attack, having first contracted the disease in the Middle East during the war. There were no deaths. Erysipelas Of the thirteen cases notified, two were admitted to hospital. There were no deaths. Meningococcal Infection Eight cases of this disease were notified during the year. All these patients were removed to hospital for treatment but two died shortly after admission. Malaria Two cases of malaria were notified during the year. Both patients had histories of contracting the disease during war service. Neither case proved fatal. Poliomyelitis There were twelve confirmed cases of acute poliomyelitis notified during 1951, compared with thirteen in the previous year, and forty-seven in 1949. Ten patients were treated in hospital and eight suffered with paralysis. There were no deaths. Acute encephalitis One case of acute encephalitis was notified during 1951• It was of the post-infectious type following an attack of mumps. The patient recovered after hospital treatment. Measles Of the one thousand, three hundred and fourteen cases notified during 1951, sixty-seven were admitted to hospital for treatment. There was only one death. Ophthalmia Neonatorum Two cases of this disease were notified, one of whom was treated in hospital. Both 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 twenty-five cases were reported; of these, seven were treated in hospital. During the year there was only one death of a child under the age of 2 years suffering from diarrhoea. Scabies The number of notifications was only thirty-four compared with seventy-two in the previous year and four hundred - 39- and sixty-three in the peak year of 1946. Tuberculosis During the year two hundred and thirty-eight new cases of tuberculosis were notified, of which two hundred and four were respiratory and thirty-four 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 M P On register of notifications on 1st January, 1951 571 537 58 80 1,246 Notified for the first time during the year 118 86 18 16 238 Brought to notice other than by notification 69 62 3 5 139 Removed from register on account of having - (a) recovered from disease 7 4 1 — 12 (b) removed from district lost sight of, etc., 113 97 8 12 230 (c) died 25 12 1 1 39 Remaining on register on 31st December, 1951 613 572 69 88 1,342 In April, 1951, a new system of investigation into the environmental condition of tuberculous patients was introduced. The enquiries have been designed to enable closer supervision to be paid to notified cases of tuberculosis whilst at the same time permitting discharge of the duties laid down by the Public Health (Tuberculosis) Regulations, 1930, of investigating the source of infection, preventing the spread of infection and removing conditions favourable to infection. Cases of tuberculosis notified for the first time, old cases transferring to Kensington from other areas and cases changing residence within the borough have been visited by the sanitary inspectors. Strict attention has been given to the environmental conditions in addition to the dissemination of advice to prevent the transmission of infection. Since April, 1951, visits have been made to the homes of two hundred and thirty-four tuberculous patients. In one hundred and fifty of these, the environmental conditions were such as to require no further action on the part of the Public Health Department. At the end of the year, there were twelve cases where the sanitary inspectors had been unable to gain access to the homes owing to the patients' absence in hospital. The action taken in the remaining seventy-two cases is summarised as follows:- -40- Action taken Cases Further investigation of supervision undertaken in respect of:- (a) re-arrangement of existing accommodation 24 (b) patients' occupations 12 (c) tracing of contacts 15 (d) precautions to prevent spread of infection 16 Recommended for priority treatment in rehousing 27 (Note. Nine tuberculous patients were members of families found to be overcrowded.) Statutory action taken:- (a) Written Intimation Notices 14. (b) Underground rooms closed 1 Incidence of tuberculosis in Kensington amongst immigrants and semi-permanent residents from areas outside the United Kingdom where racial tuberculosis immunity is low During 1951, it appeared that the incidence of tuberculosis amongst such persons resident in, or moving to, Kensington was high, and attention was focussed on this disturbing trend. The information available for the year is not full enough to present accurate statistics, but there is evidence to suggest that this group may constitute almost as much as 20% of the total number of persons added during the year to the Tuberculosis Register, i.e. the total of new notifications and inward transfers. Arrangements have been made to pursue an investigation of this problem during 1952 by obtaining, where possible, accurate information of the origin and subsequent movements of patients whose names are added to the Register of notified cases in the borough. Although the records for 1951 cannot provide an unquestionable basis for assertion, there is enough evidence to warrant the sounding of a general note of warning to immigrants (not bona fide holiday makers) who might be well advised to consider the advisability of securing an acquired immunity to tuberculosis by B.C.G. vaccination. Mass Radiography Since the 5th July, 1948, mass radiography has been undertaken by Regional Hospital Boards. On four occasions in 1951 the North-West Metropolitan Regional Hospital Board provided facilities for mass radiography of the general public at premises in Kensington. The number of persons examined totalled 6,291. The following table gives a summary of the results obtained - 41-  Kensington High Street (John Barker & Co. Ltd.,) 20.11.5126.11.51 Imperial College 27.11.513.12.51 Charles House Warwick Road 4.12.5117.12.51 Earls Court Exhibition 17.12.518.1.52 Number examined: 1,312 1,268 2,521 1,190 Males 599 1,024 1,122 582 Females 713 244 1,399 608 Number recalled 48 35 100 39 for large films (3.66%) (2.76%) (3.97%) (3.28%) Disposal of large film cases- No further action 27 31 78 27 To return for further X-ray 3 — 2 — Further examination required 16 (1.22%) 3 (0.24%) 17 (0.67%) 9 (0.76%) Known cases had or having treatment 1 — 1 1 Failed to return for large films 1 1 2 2 Malignant disease of the lungs A very disturbing feature of recent years has been the marked increase of deaths from cancer or other malignant disease of the lungs. This is shown in the subjoined table, where the corresponding figures for pulmonary tuberculosis are given for comparison. The relation to the population and general mortality is also indicated. Deaths from Pulmonary Tuberculosis and Malignant Disease of the Lungs Kensington: 1930-1951 inclusive Year Population Total Deaths Malignant Disease of the Lungs Pulmonary Tuberculosis Male Female Total Male Female Total 1930 176,000 2,242 10 4 14 81 59 140 1931 174,800 2,455 6 6 12 73 54 127 +1932 183,500 2,490 13 17 30 66 41 107 1933 181,100 2,336 12 7 19 66 58 124 1934 179,080 2,377 18 11 29 52 51 103 1935 178,300 2,154 20 11 31 47 31 78 1936 176,100 2,201 24 22 46 67 38 105 1937 175,600 2,345 26 19 45 58 56 114 1938 174,100 2,049 17 10 27 56 37 93 1947 166,170 1,866 44 14 58 37 34 71 1948 168,800 1,685 35 10 45 46 30 76 1949 174,220 1,819 33 17 50 36 20 56 1950 177,400 1,848 54 16 70 38 14 52 1951 171,300 1,920 57 13 70 21 15 36 +Census in 1931-183,893 -42- This problem has been receiving close attention from statisticians and scientific investigators, and although no hopeful discovery in the fields of prevention or treatment has been made, the following information has so far emerged:- During the past quarter of a century, the annual number of deaths from cancer of the lung has increased roughly fifteenfold. Malignant disease of the lung affects males more than females, the mortality figures for the past three decades being- Males Females England & Wales 1920 309 191 1930 1,056 433 1940 3,749 1,066 1950 10,254 1,987 Above the age of 45, the risk of developing the disease increases in simple proportion with the amount smoked and may be approximately fifty times as great among those who smoke 25 or more cigarettes a day as among non-smokers. Cigarette smoking appears to be more closely related than pipe smoking to lung cancer, but surprisingly no association has been found with inhaling. The incidence appears to be greater among those living in densely populated areas-particularly those where atmospheric pollution is heavy-than among those living in country districts. Whooping Cough Four hundred and eighty-four cases were notified during the year, thirty-two 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 1951, 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. - 43 - TABLE 1 Notifiable disease Number of cases notified 1951 1950 1949 1948 1947 1946 1945 1944 Scarlet fever 68 100 114 94 98 195 136 74 Diphtheria (including Membranous Croup) 1 2 2 12 23 37 19 29 Enteric fever 7 12 7 4 4 6 3 3 Puerperal fever Ø — — — — 3 4 7 18 Puerperal Pyrexia 22 18 33 25 9 8 12 23 Acute primary pneumonia and acute influenzal pneumonia 149 69 121 142 103 111 81 91 Dysentery 81 18 33 145 21 49 142 43 Erysipelas 13 17 15 24 34 37 33 16 Meningococcal infection 8 5 8 4 7 10 3 6 Malaria 2 2 — 2 4 8 11 8 Acute poliomyelitis Paralytic 8 7 Non-paralytic 4 6 47 9 27 1 3 1 Acute encephalitis 1 — 1 — 2 — 1 — Tuberculosis (all forms) 238 278 266 258 259 210 188 211 Measles 1314 696 740 868 852 264 868 102 Ophthalmia Neonatorum 2 12 5 7 4 4 8 4 Enteritis + 25 63 88 64 102 69 100 71 Food poisoning 18 23 33 11 7 7 6 7 Scabies 34 72 106 141 239 463 460 363 Whooping Cough 484 316 304 264 274 209 62 189 TOTALS 2479 1716 1923 2074 2072 1692 2143 1259 Ø Puerperal Pyrexia only notifiable in London since 1948. + Notifiable only in children under the age of 5. NOTE: Cases of mistaken diagnosis are excluded from above table. -44- TABLE 2 Notifiable Disease Number of Cases Notified in 1951 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 —- 6 12 36 2 8 4 — Diphtheria (including Membranous Croup) — — — _ — — 1 — Enteric fever — 1 1 — — 2 3 — Puerperal Pyrexia — — — — — 9 13 — Acute primary pneumonia and acute influenzal pneumonia 5 8 7 8 1 13 107 — Dysentery 7 21 12 17 4 3 16 1 Erysipelas — — — — — — 13 — Meningococcal infection 2 3 1 — — — 2 — Malaria — — — — — — 2 — Acute poliomyelitis Paralytic — 1 — — 1 1 5 — Non-paralytic 1 — — 2 1 — — — Acute encephalitis — — — 1 — — — — Tuberculosis (all forms) 2 2 16 12 3 55 148 — Measles 43 278 390 451 44 45 48 15 Ophthalmia neonatorum 2 — — — — — — — Enteritis 8 11 6 — — — — — Pood poisoning 3 — 1 2 — 2 10 — Scabies — 1 2 2 7 9 13 — Whooping cough 55 134 148 126 4 2 9 6 TOTALS 128 466 596 657 67 149 394 22 TABLE 3 Notifiable Disease Total Cases Notified in each Ward St.Charles Golborne Norland Pembridge Holland Earls Court Queens Gate Redcliffe Brompton Scarlet fever Diphtheria (including 10 10 7 6 10 6 2 9 8 Membranous Croup) — — — 1 — — — — — Enteric fever 2 1 — — 1 — 1 2 — Puerperal Pyrexia 4 4 2 3 2 2 3 2 — Acute primary pneumonia and acute influenzal pneumonia 19 22 9 36 31 9 8 10 5 Dysentery 24 11 9 13 9 4 3 4 4 Erysipelas 2 2 1 3 1 1 — 2 1 Meningococcal infection 1 — 3 — 1 1 1 — 1 Malaria — 1 — 1 — — — — — Acute poliomyelitis Paralytic 1 — — 1 1 2 — 3 — Non-paralytic — — 1 — — — 1 2 — Acute encephalitis — — — 1 — — — — — Tuberculosis (all forms) 35 31 27 29 16 34 24 28 14 Measles 216 134 178 192 182 119 67 156 70 Ophthalmia neonatorum — 1 — — — — — 1 — Enteritis 4 13 1 — 7 — — — — Pood poisoning 4 3 3 1 6 — — 1 — Scabies 6 7 5 5 4 2 2 — 3 Whooping cough 138 79 60 71 37 39 12 38 10 -45LEGAL PROCEEDINGS Public Health (London) Act. 1936 Nuisances During the year 230 summonses were issued for various nuisances under the Public Health (London) Act, 1936. In 55 cases abatement orders were secured; fines amounting to £39. 0s. 0d. were imposed and £80. 17s. 0d. costs were awarded to the Council. In 69 cases the summonses were withdrawn, the nuisances having been abated by the owners prior to the Court hearings. In 106 cases the summonses were adjourned as the necessary works were in progress of being carried out by the owners. Twenty-three prosecutions were undertaken for failure to comply with Justices' Orders to abate statutory nuisances. In 13 cases fines amounting to £126. 1s. 9d. were imposed and costs amounting to £6. 6s. 0d. were awarded to the Council. In one case the Justices gave instructions that a warrant should be issued. The remaining 9 cases were withdrawn or adjourned as the necessary works had been, or were being, carried out. One defendant appealed against a conviction for failing to comply with a Justices' Order. The appeal was heard at the County of London Sessions and was dismissed, the Council being awarded £10. 10s. 0d. costs. Drainage Byelaws Two summonses were issued in respect of offences under these byelaws. In one case a fine of 10s. 0d. was imposed, and the second case was adjourned sine die. Provision of Dustbins (Section 105) An appeal by the owner of a house in North Kensington, against a notice requiring him to provide two dustbins at the premises was allowed by the Appeals Committee of the London County Council on 1st October, 1951. The Appeals Committee did not give any reasons for their decision, but it is believed that they were influenced to some extent by the landlord's allegation that the tenant was about £100 in arrears with the payment of his rent. Council's Byelaws Dog Nuisances Three summonses were issued under this byelaw. In two cases convictions were obtained and fines totalling £1. 10s. 0d. were imposed. In the third case the defendant was discharged absolutely on payment of 10s. 0d. costs. Housing Act, 1936 Tenement House Byelaws Twenty-three summonses were issued in respect of contraventions of these byelaws, but all were withdrawn, or adjourned, as the necessary works had been, or were being, carried out. —46— Contravention of Closing Orders Nine summonses were issued in respect of illegal occupation of closed underground rooms. Convictions were obtained in six cases and fines of £43. 6s. Od. were imposed. In three cases the summonses were withdrawn as the illegal occupation had been abated. CONCLUSION The presentation of this Report affords me the opportunity of expressing my grateful appreciation of the kind co-operation, which I have received, 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.