C 43 48 The Royal Borough of Kensington ANUUAL REPORT ON THE Health of the Borough FOR THE YEAR 1957 With the Compliments of the Medical Officer of Health of the Royal Borough of Kensington. The Red House, Homton Street, Kensington, W.8. THE ROYAL BOROUGH OF KENSINGTON Public Health Department, Hornton Street, Kensington, W.8. 1st June, 1958. To the Mayor, Aldermen and Councillors of the Royal Borough of Kensington. My Lords, Ladies and Gentlemen9 I have much pleasure in presenting the Annual Report on the state of the public health in Kensington for 1957° The Minister of Health has again requested (Circular l/58) that the Report should be in the same 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 population of the borough as ascertained at the Census in 1951 was l68,l60: but for the purpose of this report, the population for 1957 has been estimated by the Registrar-General to be 167,900. The estimated population figure for the previous year was 168,800. Birth Rate. The number of births per 1,000 population of the borough was 16.5 in 1957, which was the same figure as recorded for the previous year. Death Rate. The number of deaths per 1,000 population was 10.4, 0.1 lower than the death rate for the previous year (10.5). Area Comparability Factors for Birth and Death Rates. Comparisons of crude birth and death rates between local areas are not strictly valid since these rates take no account of the varying composition of the populations of the different areas by sex and age. In order to compare Kensington birth and death rates with England and Wales as a whole, the Registrar-General has, in the case of death rates since 1934 and in the case of birth rates since 1949, supplied area comparability factors (A.C.Fs). This is considered to be necessary as the proportion of old people to young, and of males to females, varies considerably in different districts. The local crude death rates are affected as the mortality at the extremes of life is much greater than in the middle period, and at practically all ages the mortality in females is rather less than in males of corresponding ages. Similarly, as far as the local birth rates are concerned, the child bearing component of the population varies in different districts. In a borough such as Kensington, which has a higher proportion of females amongst its inhabitants compared with most other districts, the crude birth and death rates cannot be compared satisfactorily with those of say an industrial district where the proportion of males is much higher. The factors are calculated from the final 1951 Census populations and the Registrar-General has supplied, for use in Kensington, 2 the figures of 0.72 for births and 1.03 for deaths. The crude birth and death rates for the borough should be multiplied by the appropriate factor, and when so adjusted the results are comparable with the crude rates for England and Wales or with the corresponding adjusted rates for any other area. The following table gives the adjusted Kensington birth and death rates compared with the rates for London and for England and Wales for the year 1957:- Kensington adjusted London England and Wales No. of births per 1,000 population 11.9 16.2 16.1 No. of deaths per 1,000 population 10.7 11.4 11.5 Infant Death Rate. This rate for 1957 was 28.2, an increase from the rate for the previous year of 7.1. The rate for the County of London was 22.0 and for England and Wales was 23.0. The following table shows the rates for the last five years:- Year Kensington London England & Wales 1957 28.2 22.0 23.0 1956 21.1 21.0 23.8 1955 31.4 23.3 24.9 1954 22.5 21.0 25.5 1953 19.7 23.9 26.8 It will be seen that the infant death rate for Kensington made a "jump increase" compared with last year's rate. A similar increase occurred in 1955. In each case this was mainly due to a rise in perinata] mortality, i.e. deaths in the first week of life, prematurity (see table below) and the statistical difficulties arising from the small numbers involved. Just over two deaths suffice to increase the rate by one. Number of deaths of babies under one week of age Year Age in days at death Total Total deaths due to prematurity 1 or under 2 3 4 5 6 1955 41 5 5 1 2 1 51 32 1956 24 4 4 2 4 - 58 21 1957 57 5 7 2 1 - 52 35 Maternal Death Rate. One death of a mother due to childbirth was recorded in 1957. giving a maternal death rate per 1,000 live and still births of 0.36. (The maternal mortality rate for the County of London was 0.52 and for England and Wales the figure was 0.39.) Infectious Diseases. There was no serious outbreak of infectious disease in the borough during 1957- The total number of notifications received was 1,781 in comparison with 1,331 in the previous year. The increase was almost entirely due to the larger number of cases of measles notified - 982 in 1957 compared with 358 in 1956. No case of diphtheria was notified in 1957. which compares with one case in the previous year. Only 22 cases of diphtheria have been notified in Kensington in the last ten years, in three of which there was a "nil" return. In the previous ten years (1938-47), 638 cases of diphtherit were notified, the highest number in one year being 156. Tuberculosis. The death rate from all forms of tuberculosis per 100,000 population was 10.1 which is lower than last year's figure of 11.8. The 1957 Kensington death rate is slightly better than the rate (10.7) for England and Wales. - 3 - Lung Disease. Kensington's death rate from pulmonary tuberculosis per 100,000 population decreased in 1957 compared with the previous year but the death rate for cancer of the lung showed an appreciable increase. Comparative figures for England and Wales showed a decrease of the rate in respect of pulmonary tuberculosis but a continuing increase in the death rate for lung cancer. The comparative figures for England and Wales and Kensington in the following tables show the trend in these diseases since the end of the war„ Year England and Wales Kensington Pulmonary Tuberculosis Cancer of the Lung Pulmonary Tuberculosis Cancer of the Lung Deaths Rate Deaths Rate Deaths Rate Deaths Rate 1947 19.753 47.3 9,204 22.0 71 43.0 58 34.9 1948 18,798 44.0 10,162 23.8 76 45.0 45 26.6 1949 17,471 40.5 10,975 25.5 56 32.0 50 28.7 1950 14,079 32.1 12,241 28.0 52 29.0 70 39.4 1951 12,031 27.5 13,247 30.2 36 17.5 70 40.9 1952 9,335 21.2 14,218 32.3 29 16.8 71 41.1 1953 7,913 17.9 15,132 34.3 26 15.1 65 37.9 1954 7,069 16.0 16,331 36.9 20 11.7 72 42.2 1955 5,838 13.1 17,271 38.9 12 7.1 73 43.1 1956 4,851 10.9 18,185 40.7 19 11.2 73 43.2 1957 4,250 9.5 19,118 42.6 13 7.7 90 53.6 (Death rates quoted above are per 100,000 population) It is of interest to note that whilst the death rate from lung cancer for the country as a whole has been increasing in recent years, the rate for Kensington has been farily steady for a number of years, with the exception of last year when a marked increase was recorded. Housing. The emphasis in regard to housing during the year was concentrated on the execution of the slum clearance programme, which the Council, jointly with the London County Council, had prepared in 1955/56. This programme scheduled the clearance of 63O premises and the Minister of Housing and Local Government had fixed ten years as the period for securing the demolition of the houses. Of the total of 630 premises, the County Council assumed responsibility for the clearance of 66 of these in the Fenelon Place/Warwick Road area. They have already acquired the premises and discussions are now taking place with this Council in regard to the future redevelopment of the area. Action in regard to the other 564 houses is being taken by the Borough Council. The majority are situated in the Kensel New Town area, which consists of 516 premises. A redevelopment plan was made in respect of this area, dividing it into three phases for the purposes of demolition and rebuilding. In the early part of 1957, the Council took steps to deal with Phase 1. It was decided that the first redevelopment of this phase should consist of the erection of two 14-storey blocks (each comprising 78 flats) and two 4-storey blocks (each comprising 10 maisonettes). The land and premises required for the erection of these flats were made the subject of three Compulsory Purchase Orders, which were submitted to the Minister for approval. Two of the Orders were confirmed as submitted, and the third was 4 confirmed with one or two minor modifications made after a Public Local Inquiry had been held. Steps are now being taken to acquire the land and premises specified by these Orders and Sir William Holford, F.R.I.B.A., M.T.P.I., has been appointed as architect to design the new blocks of flats. It will be remembered that the initial success of the redevelopment of Kensal New Town depends on synchronising the displacements from the condemned houses with the erection by the Council of 134 new flats in the Treverton Street area. It is expected that these flats will be completed in the late summer of 1958. Having achieved this first success in dealing with the redevelopment of Kensal New Town, the Council lost no time in advancing their plans, and two further areas (comprising 77 premises) in phase 1 were declared to be Clearance Areas; Compulsory Purchase Orders have been submitted to the Minister for confirmation. In addition to the steps taken in regard to Kensal New Town, a small area of unfit houses in Portland Road has also been declared by the Council to be a Clearance Area, and Compulsory Purchase Orders have been made and submitted to the Minister for confirmation. Although the work of dealing with slum clearance is given priority, the task of repairing and maintaining other houses in the borough in a fit state of habitation is of vital importance. It was expected that the introduction of the Housing Repairs and Rents Act, 1954» would enable the Council to resume the extremely valuable work of repairing houses under Section 9 of the Housing Act, which economic circumstances had brought to a standstill. Section 9 enabled the Council to require the repair of a house which was in any respect unfit for human habitation and which could be made fit at reasonable cost. The 1954 Act deleted the words "in any respect" and since then a number of Court judgements have made it clear that Section 9 standard of repair is a low one. For example, in one appeal by an owner against a Section 9 notice, the Court deleted 22 items from the 44 specified; of the remaining 22 items, all except 7 could have been dealt with under the Public Health (London) Act, 1936. Careful consideration was given to this position and, on the 15th October, 1957, the Council decided that owing to the lowering of the standard set by the Housing Acts, the position had been reached in which repairs required under the Public Health (London) Act, 1936, are not substantially different from those which can be required under Section 9 of the Housing Act, 1957» especially as the limited repairs now possible under Section 9 frequently would be insufficient to justify a rent increase under the Rent Act, 1957, with the result that in such cases the premises would remain "not repairable at reasonable cost." In these circumstances, the Council proposed that in the areas previously designated for repairs under Section 9 of the Housing Act, systematic inspection of dwelling houses should be undertaken and, where necessary, the remedying of defects should be accomplished by action under the Public Health (London) Act, 1936. This simplified procedure will eliminate the necessity for the preparation of detailed specifications and, moreover, urgent repairs can be required under the London County Council (General Powers) Act, 1955, which enables the Council to deal more expeditiously with certain types of nuisances where an early remedy is essential. Routine inspection of houses in areas throughout the borough commenced in October, 1957. By the end of the year, 510 houses were inspected and in 274 cases notices requiring repairs had been served. The work of the routine inspection of houses requiring repair is being pursued energetically, because it is felt that, with the higher rents that will, in many cases, be recoverable under the Rent Act, 1957, owners will be in a better position to carry out repairs than they have been able to do since 1939, when the majority of houses were placed under the control of the Rent and Mortgage Increase Restrictions Acts. 5 Food Hygiene. The work of enforcing the requirements of the Food Hygiene Regulations was continued throughout the year. There is no doubt that both the food traders and the general public are becoming more and more conscious of the need of maintaining a high hygienic standard in connection with the storage, preparation and sale of food. The general willingness of most people to co-operate in the task of ensuring clean food becomes more evident as time goes on. One of the requirements of the Regulations which the Council's officers stringently enforce is the prohibition of smoking by persons while handling open food. This restriction applies only to employees in food premises. Comments are constantly being made that the restriction should apply to the customers. At the end of the year, the Public Health Committee felt the time had arrived when an attempt should be made to persuade the general public not to smoke whilst in food shops. An appropriate printed notice (size 10"x 8") was prepared and copies have been given to those traders willing to exhibit them in their premises. The following is a facsimile of the wording of the notice s- Royal Borough of Kensington NO SMOKING The staff of this shop are prohibited, by law, from smoking while handling food In the interests of food hygiene, customers also are requested to refrain from smoking. J. H. Weir Medical Officer of Health. This notice is issued by the Public Health Committee of the Royal Borough of Kensington General. The increasing momentum of the work of dealing with slum clearance, the repair of houses, food hygiene in shops. Clean Air Act and smoke abatement, etc., is placing a heavy burden on the staff of the Department, especially the public health inspectors. For the past few years it has not been possible to recruit the required number of public health inspectors and this position is common throughout the Metropolitan area. This persistent shortage of inspectors could have an adverse effect on the work of health departments. The Council have adopted a scheme for training students as public health inspectors. Two men have commenced work in the department and they are giving increasingly valuable assistance to the inspectorial staff, whilst undergoing training. The Minister of Health has stated that the best training is obtained by those students who are engaged by local authorities specifically as pupils or student public health inspectors and he has no doubt that local authorities will bear this in mind and consider the advantages of adopting a system of paid pupillage or, where appropriate, of extending existing arrangements. VITAL STATISTICS The table set out on the next two pages gives the important vital statistics for 1957, together with comparative figures for the previous seven years . 6 7 SUMMARY OF VITAL STATISTICS FOR KENSINGTON Description 1957 1956 1955 1954 1953 1952 1951 1950 POPULATION Population (estimated) 167,900 168,800 169,400 170,600 171,500 172,800 171,300 177,400 Density of population per acre 73 74 74 74 74 75 74 77 LIVE BIRTHS Total births 2,765 2,792 2,674 2,707 2,642 2,810 2,656 2,745 Legitimate births 2,404 2,422 2,361 2,399 2,321 2,508 2,390 2,470 Illegitimate births 361 370 313 308 321 302 266 275 Birth rate per 1,000 population 16.5 16.5 15.8 15.9 15.4 16.3 15.5 15.5 STILL BIRTHS Total still births 50 51 40 48 53 48 60 54 Legitimate still births 42 43 31 40 47 37 55 51 Illegitimate still births 8 8 9 8 6 11 5 3 Still birth rate per 1,000 total births 17.8 17.9 14.7 17.4 19.7 16.8 22.1 19.3 DEATHS Total deaths 1,750 1,772 1,744 1,643 1,708 1,936 1,920 1,848 Death rate per 1,OOO population 10.4 10.5 10.3 9.63 9.96 11.2 11.2 10.4 DEATHS OF INFANTS UNDER 12 MONTHS OF AGE Total infant deaths 78 59 84 61 50 75 65 78 Legitimate deaths 58 50 66 54 42 67 55 69 Illegitimate deaths 20 9 18 7 8 8 10 9 Infant death rate per 1,000 births 28.2 21.1 31.4 22.5 19.7 27 2d 28 Death rate of legitimate infants per 1,000 legitimate births 24.1 20.6 27.9 22.5 18 27 23 28 Death rate of illegitimate infants per 1,000 illegitimate births 55.4 24.3 57.5 22.7 25 26 38 33 MATERNAL DEATHS Deaths of mothers as a result of pregnancy or childbirth 1 5 1 2 Nil 5 3 5 Death rate of mothers per 1,000 live and still births 0.36 1.76 0.37 0.72 Nil 1.75 1.1 1.79 TUBERCULOSIS Death rate from all forms per 100,000 population 10.1 11.8 10.0 14.0 19.2 18.5 21 33 Death rate from respiratory tuberculosis per 100,000 population 7.7 11.2 7.1 11.7 15.1 16.8 17.5 29 Death rate from non-respiratory tuberculosis per 100,000 population 2.4 0.6 2.9 2.3 4.1 1.7 3.5 4 9 CAUSES Of DEATH AT DIFFERENT PERIODS OF LIFE IN 1957 Cause of death All ages Under 1 year 1 year and under 5 5 years and under 45 45 years and over Respiratory tuberculosis 13 - - 4 9 Other forms of tuberculosis 4 - - 2 2 Syphilis 4 - - - 4 Diphtheria - - - - - Whooping Cough - - - - - Meningococcal infections - - - - - Acute poliomyelitis 1 - - - 1 Measles 1 - - - 1 Other infective diseases, etc., 2 1 - - 1 Cancer (all forms) 356 - - 19 337 Leukaemia, aleukaemia 8 - 1 3 4 Diabetes 9 - - 1 8 Vascular lesions of nervous system 215 - - 3 212 Coronary disease, angina 259 - - 5 254 Hypertension with heart disease 38 - - - 38 Other heart disease 167 - 1 4 162 Other diseases of circulatory system 107 - - 3 104 Influenza 14 - 1 2 11 Pneumonia 94 8 - 1 85 Bronchitis 108 3 1 - 104 Other respiratory diseases 17 - - - 17 Ulcers of the stomach 22 - - 1 21 Gastritis, enteritis and diarrhoea 12 3 - - 9 Nephritis and nephrosis 10 - - 1 9 Hyperplasia of prostate 10 - - - 10 Pregnancy, childbirth and abortion 1 - - 1 - Congenital malformations 12 10 - 1 1 All other diseases 169 53 1 8 107 Motor vehicle accidents 17 - - 7 10 All other accidents 37 - 3 11 23 Suicide 39 - - 17 22 Homicide and operations of war 4 - - 2 2 TOTALS 1,750 78 8 96 1,568 10 RETROSPECT AND PROSPECT Health Problems in Kensington, 1856 - 1956 It is interesting to compare health problems in Kensington nowadays with those of a hundred years ago. This was at a time when there was no Welfare State; no National Health Service; School Health Service; Maternal and Child Health Service; no London County Council main drainage and no Metropolitan Water Board. Long before the Public Health Act of 1875; before Infectious Disease was notifiable, and when diseases such as typhus, cholera, smallpox, plague and enteric were still rampant. I have recently re-read the first report of the first Medical Officer of Health of the Parish of St. Mary Abbots, Kensington, in the County of Middlesex for the year 1856. This Dr. Francis Godrich submitted his report to the Vestry on 22nd April, 1857, at a time when Kensington had a total population of 44,000 people occupying 6,136 houses in an area of 1,942 acres. In that year there were 1,199 deaths, giving a death rate of 27•2 per thousand, or 1806 after deducting hospital deaths. The causes of death in order of frequency were respiratory tuberculosis, bronchitis, diarrhoea, (which included enteric fever),' old age, pneumonia and heart disease. Respiratory tuberculosis caused 296 deaths; the next most frequent, bronchitis, caused 94. It is interesting to note that there were 15 deaths from typhus, 2 from cholera, 13 from smallpox, 20 from scarlet fever, 30 from measles and 19 from whooping coughs. From the report it is evident that the health problems of the day were many and varied. The Medical Officer of Health complained of people in slum areas being unable to bury the deado In some cases, corpses were retained for many days or even weeks in overcrowded living rooms, because of inability to pay for the funeral. He complained of the effluvia nuisance from tallow melting at the candle factory in the High Street opposite the Vestry, describing it as "poisonous to the air of the neighbourhood". He noted the dreadful conditions under which milch cows were kept on domestic premises; the non-removal of domestic refuse; the 46 licenced slaughter houses; the offensive smells from brick and clay burning in North Kensington the necessity for condemning "putrid sausages, beef, mutton and fish"; the use of alum for bread whitening. He also reported on the water supplies of the borough, advising that all the superficial wells were generally unfit for potable purposes and that many water storage cisterns were neglected, dirty and fouled, while lead cisterns contaminated the water with lead salts. Incidentally, he reported that he had examined the gas for illuminating power and chemical purity: Above all, he complained of the dreadful housing and living conditions in certain parts of the borough. He complained, for example, of the bad housing in Jennings Buildings. These were situated in a cul de sac approached from an entrance in the High Street nearly opposite Kensington Palace Gardens and standing on the present site of Kensington Court. In all, approximately 800 people lived there and it is recorded that there was a separate family in each room; no water supply; no drainage and no water closet accommodation. Overcrowding was rife. For instance, in one back room 1,008 cubic feet in capacity, lived 9 persons, including the father ill with pleuritis. The mortality among the children under five was 61.3% of the total deaths, and more than half resulted from infectious disease. Mercifully, Jennings Buildings were demolished in 1873. An even greater public health problem was described as "the gigantic evil of pig keeping in the Potteries". This area was described in the following terms s- "One of the most deplorable spots, not only in Kensington, but in the whole metropolis, is the Potteries at Notting Dale, a locality which is from its position, difficult to drain. It occupies eight or nine acres of ground and contains about a thousand inhabitants, the majority of whom obtain a living by rearing and fattening pigs upon the house refuse obtained 11 from club houses and hotels and upon offal, entrails, liver and blood from slaughter houses. This offensive food, often in a high state of decomposition when brought to the place, is boiled down in coppers and the fat separated for sale. The number of pigs varies from one to two thousand (as many as three thousand have been kept) in filthy and badly paved styes close to the houses. The drainage, in nearly all cases very defective, permits the liquid manure to run over the yards, saturating the ground to a great depth, contaminating all the wells with putrid matter and polluting the atmosphere for a considerable distance around There were, until lately, several immense accumulations of stagnant water into which this pig matter found its way. One enormous piece called "The Ocean" formerly occupied nearly an acre of ground. It was covered with filthy slime and bubbling with poisonous gases caused with the drainage of pig styes and privies flowing into it. The general death rate varies from 40 to 60 per annum, of these deaths the very large proportion of 87•5% are under five years of age, and nearly all the deaths occur from zymotic disease. The most appalling fact, however, connected with this subject and the one most likely to make a deep sensation in the public mind is that for a period of three years the average age at death is under 12 years." From the report it also appears that the drainage in Kensington generally left much to be desired. The Medical Officer of Health complained of offensive cesspools and open privies, and strongly recommended that "all places at present imperfectly or not at all provided therewith, should be immediately furnished with that great requisite of health - drainage." It will be seen that the Medical Officer of Health was concerned with the major problems of a high death rate, enormous child mortality rate, high death rates from infectious disease, impure water supply, inefficient scavenging and drainage, public health nuisances, infected food, food adulteration, bad housing and occupational hazards. Some of these problems have been solved by voluntary action; some by official action under national or local legislation; some by progress in medical science. Some of the problems have been removed; some are under routine control; others are still with us and new ones have been added. The remainder of the nineteenth century saw the establishment of a great London drainage system, first proposed in 1856 and completed in 1875» an elaborate system of street cleansing, refuse collection and disposal, paving and maintenance of streets and roads, street lighting, nuisance abatement, epidemic control and the establishment of public baths and washhouaes, but nevertheless, at the end of the century many problems remained and Kensal New Town was added. Kensal New Town, originally under the control of Chelsea Council, was built about 90 years ago and described by the Hon. Charles Booth as "endowed with most of the features which in London would combine towards leading to poverty and low life - a canal and railway, gas works, isolation and the washing industry. Because of the latter, it was known as "Soap Suds Island". It was colonized by the riff raff from the slums of Tyburnia on the construction of the Great Western Railway and those from Lisson Grove on the construction of the Great Central Railway. It became one of the most notorious slums in London. About this time, the so-called Notting Dale Special Area was receiving particular attention. It was an accumulation of 280 slum houses, including 23 common lodging houses and 216 houses let in lodgings, in the area now occupied by Henry Dickens Court. Two hundred and ten of the houses had major sanitary or structural defects. It was populated by 4,000 persons, the number per house varying from 10 to 21.6. These people had been displaced from Jennings Buildings, the Clanricarde Gardens area, or the St. Giles Circus district when redevelopment had taken place. A contemporary report refers to "the vicious proclivities and evil habits in the neighbourhood." It mentions overcrowding, drunkenness, prostitution 12 and inherited diseases; the people themselves being described as made up of "loafers, cab runners, beggars, thieves and prostitutes." The whole district was described in 1893 as a West End Avernus. The death rate in the area was 55 to 60 per thousand, and the infantile mortality rate was appalling, reaching 508 per thousand in 1899, at the time when the London average was 150. At the beginning of the century, Kensington with a population of 173i000, had a death rate of 19•4 as opposed to the present death rate of 10•55; an infantile mortality rate of 179 as opposed to 21.1 nowadays. Deaths from infectious disease numbered 403 per annum as compared with 14 in this age and 306 people died of tuberculosis as compared with 20 at the present time. It is significant that the deaths under the age of 5 were approximately one-third of the total deaths, the present proportion being approximately one-twentyseventh. An enormous number of children died from gastro-enteritis and dysentery, starvation, want of breast milk and prematurity. In fact, in 1900, 113 children under one year died of diarrhoeal diseases and 26 died of non-pulmonary tuberculosis. The value of the subsequent cleaning up of milk supplies is reflected in the 1956 figures - in place of these 139 deaths there was only one. In 1904, the Metropolitan Water Board took over the responsibility for London water from the many separate undertakings then existing. The London School Board, who had previously appointed two halftime medical assistants to examine defective children, in 1902 appointed a full-time medical officer with assistants to investigate health conditions in the schools. At this time conditions were appalling. The vision of 60,000 children was so bad that they could not see the blackboard; there were 20,000 cases of ring worm and one-third of the girls had verminous heads. The London County Council took over responsibility from the London School Board in 1904, and commenced the school health service as we now know it. In 1905, the Kensington Council appointed a lady to act as a Health Visitor, and in the same year the Kensington Health Society was established to care for the welfare of mothers and children. The first Infant Welfare Centre was opened in Kensington in 1907 and, by 1909, the Society was holding weekly infant consultations in the Norland and Golbome Wards, providing nursing and expectant mothers with dinners at the cost of Id. and had established St. James Nursery. In 1908 the Home Science Department of Kings' College for Women (now Queen Elizabeth College) was founded largely for the purpose of helping to combat the terrible rate of infantile mortality. This Department was first housed in Kensington Square, the Campden Hill site being acquired in 1912 and the Department transferring there in 1915. The first "School for Mothers" was established in Lancaster Road towards the end of 1910, and during 1911 three further schools were in being, having developed from the previous consultation centres. At these there were provided consultations, baby weighing, sewing classes, lectures on infant care, medical consultations, cooking classes and penny dinners for nursing and expectant mothers. A Health Visitor was in attendance. By 1919 there were seven of these voluntary "Schools for Mothers" and two baby clinics in addition. By 1920, the "Schools for Mothers" had been redesignated Infant Welfare Centres and to the existing facilities had been added ante-natal sessions, treatment sessions, thrift clubs, baths for mothers and dental treatment. In all this work and in most important work which was to follow, a pioneering and vital part was played by Dr. H. Ronald Carter who, I am pleased to say, is still living in the borough. It was he who, under Dr. Fenton's administration in 1924, was mainly responsible for operating the Council's scheme for the treatment of cases of infantile enteritis. At this time the disease caused up to 100 or more deaths among infants each year, representing anything between 10 and 28 per cent. of the total deaths under one year of age. The disease was made locally notifiable in 1924 and the Council's scheme of treatment included provision of home nursing, home visiting, advice, the services of a doctor where none was attending, hospital 13 admission where necessary9 health education and lectures to nurses. It secured a significant reduction in mortality. Another facet of child welfare in the borough was the establishment of the Mothercraft Training Society in Trebovir Road about 1920. This accepted patients from all over the country, treated children, advised mothers and taught hospital nurses, maternity nurses and welfare nurses the principles of child welfare. A unique provision was the Fathers' Council instituted in 1922. This was the first of its kind in the country and was intended to foster paternal responsibility, to advance the interests of the Centre and to raise funds for various Centre activities. It was attached to the Lancaster Road Infant Welfare Centre, and was recognized by the award of the Norah March Trophy to the Council in 1954. To quote from the 1925 annual report of the Medical Officer of Health "a hospital for the treatment of children's diseases is probably the most urgent requirement in the health services of Kensington." A children's hospital of eleven beds established in Church Street in 1840 was worn out. Funds were raised by local endeavour under the gracious patronage of H.R.H. Princess Louise, and the children's hospital bearing her name was commenced in 1926. The needs are just as great today as evidenced by figures and by the opinions held by the Council, the people of the borough and the local medical profession. It is to be hoped that the four years wrangle on the future of this institution will not end in this essential, efficient and beautiful children's hospital being sacrificed on the grounds of academic expediency put forward by a hospital authority not even situated in the Royal Borough. In 1938, the Council approved the acquisition of properties which occupied part of the original Notting Dale Special Area. Over the years these had deteriorated even further and, despite efforts at rehabilitation, constituted a major slum and social problem. Foremost in the area was Bangor Street, wherein the notorious Rag Fair was held on Sunday mornings. This was known as "The Poor Man's Petticoat Lane" and many highly doubtful sales and transactions were there conducted. The war prevented the progress of the Council's plans for the area, which appropriately enough became a centre for street fighting training, but in 1945 the redevelopment, resulting in the present blocks of Henry Dickens Court, was commenced. In 1946, what has been described as the "bed bug blitz" took place. Three thousand, two hundred and fifty houses were treated experimentally with D.D.T. and it was shown that one treatment was successful in eradicating the infestation in 97.2% of cases. As a result, bed bug infestation is now almost negligible in Kensington. During the century another public health problem has been gradually reduced - that relating to bakehouses. In 1901, there were 114 underground bakehouses in the borough, the great majority providing most insanitary conditions for work and food production. Over the years these have been gradually reduced, until now there are only 6 remaining. What then are the problems of today? I have already mentioned the reduction in death rates in the age distribution of deaths, and in the types of diseases causing death. Nowadays the commonest causes among 1,772 deaths in 1956 are heart and blood vessel disease (605), followed by cancer (362), then by strokes, bronchitis and pneumonia in descending order of frequency0 We have our comprehensive Health and Social Services among which such items as sanitary engineering, water supply, refuse collection and disposal, drainage, street cleansxng and lighting; nuisance abatement, disinfection, disinfestation, the control of infectious disease and tuberculosis, dirty dogs, pigeons, rats and mice, still occupy a considerable part of the working time of my department and that of the Borough Engineer. These are essential and fundamental problems, but in each case they have either been solved or are under control, and the continued control is a question of well tried routine. There remain, however, many major and as yet unsolved public health problems. These are housing, atmospheric pollution, care of old people, food hygiene, home and road safety, mental health, nuclear radiation hazards and health education. 14 HOUSING is still a major problem. In my view it is the greatest unsolved public health problem. Its solution would solve a host of allied problems of physical, mental and moral health. We still have the problems of a waiting list of approximately 3,500 a lot of defective property, overcrowding, and underground rooms. The harmful effects of bad housing on physical health are well known, and accepted. Perhaps less well known are the effects on the individual. The INFANT mewling and puking in his mother's arms, deprived of adequate air, sunlight, exercise, space and quietude, exposed to increased risk of infection, its mother lacking facilities for washing the babe or its nappies, for preparing feeds or storing the pram. The whining SCHOOLBOY, creeping like a Snail unwillingly to school. Unwillingly because he hasn't had enough rest and hasn't been able to do his homework. He has no place to play, to work, to relax, to pursue a hobby. Suffering from the results of this and noisy and inadequate sleeping accommodation, he is driven to seek his joys and his sorrows in the streets. Next the LOVER sighing with a woeful ballad. Woeful modern ballad maybe, to which the adolescent, fleeing home discomforts, gives tongue at the street corner or in the frequently undesirable haunts of youth. ..... And so on, the YOUNG MARRIED COUPLE, facing frustrations, friction and their fractious in-laws the FATHER, driven from home to seek doubtful pleasures elsewhere poor MOTHER, overwhelmed with the impossible tasks of home and family management, her physical and mental health below par, depressed, run down and worn out and finally, the AGED AND INFIRM; lonely, weary and apathetic, on a barely adequate pension, incapable of striving against discomforts, inconveniences and lack of facilities, abandons attempts at household care, neglects nutrition and personal cleanliness, becomes ill, becomes still less able to cope and ends in second childishness and mere oblivion sans everything. To combat these sequences, the Council have provided 1,255 dwellings since the war; they are proceeding apace with the major slum clearance and redevelopment schemes in the Treverton Street and the Kensal New Town Areas. The repair of defective houses is being secured. Defective underground rooms are being closed or rehabilitated, and overcrowding is being abated under the provisions of the Housing and Public Health Acts. ATMOSPHERIC POLLUTION, apart from material damage estimated nationally at £M100-150 per annum, causes smog deaths and contributes to lung cancer and bronchitis. Lung cancer deaths in England and Wales have risen from 11,000 to 18,186 in the past seven years. Bronchitis averages 30,000 deaths per annum - six times as many as caused by road accidents - and is also the greatest single cause of incapacity in this country - 26 million working days lost annually. Under the Clean Air Act, the Council hope to commence the establishment of a smoke control area (smokeless zone) in the Holland Ward, in which there are some 6,349 ' premises in an area of about 485 acres, with a population of 18,877 persons. This would result in a smokeless zone of approximately 2½ sq. miles, extending on the north from Shepherds Bush Green to Marble Arch, and on the south from Olympia to Hyde Park Corner. The first phase of the scheme, consisting of the area bounded by Holland Park Avenue, Campden Hill Road, Kensington High Street, Melbury Road and Abbotsbury Road, is awaiting the approval of the Minister of Housing and Local Government. OLD PEOPLE. There are approximately 24,000 people of pensionable age living in Kensington- Of these about 6,000 are on our Old People's Register. Through the Council's visitors, we trv to contact all those who may be in need. These needs mainly arise from enfeeblement, loneliness, poverty, insufficient provision of institutional care and ignorance of facilities which are available for them. Where required, we try to satisfy their wants through National services - the National Health Service, the National Assistance Board, the Ministry of National Insurance, London County Council 15 or Borough services, or with the help of voluntary organisations. It is all very much "on a shoe string" because in law, all the Borough Council is permitted to do is to make a donation to a voluntary organisation which, as part of its activities, provides meals or recreation for old people, and to remove to a suitable institution compulsorily, old people who can no longer care for themselves. Incidentally, this latter procedure is fraught with difficulties and obstructions . We do manage somehow to provide a service (sometimes by stretching our powers), often with the aid of voluntary organisations which provide, for example, such facilities as meals on wheels, holidays, chiropody, outings, visiting and clubs. In many of these activities the Kensington Council of Social Service plays a prominent part. It is essential to recognize that the aged form about 15% of our population, and this percentage is rapidly approaching the point where they will equal the numbers of young people under 15 years. Care must be provided for those approaching the end of life, just as provision is made for maternal and child welfare at the beginning of life. What is needed is legislation providing a comprehensive scheme for their welfare - what my colleague in Pinsbury described as a "Charter for the Aged" some time ago. FOOD HYGIENE. It is a long cry from sand in the sugar and water in the milk to modern food and drugs control, and Kensington has always taken a lead in food sampling and hygiene. One may mention the efforts made in 1923 to secure the accurate labelling and the control of colouring matters and preservatives in food which resulted in appropriate legislation; the improvements secured in butchers' shops after the introduction of the 1924 Meat Regulations, the recommendations in 1930/32 regarding hygiene of public houses and their cellars, subsequently nationally adopted; the 1948 food premises survey; the 1950 Clean Food Campaign, including Food Hygiene Exhibitions and our more recent action under the Food Hygiene Regulations, under which some 5,302 inspections have been made and a substantial improvement obtained in food handling practices. Efforts have even been made to keep dogs and smokers out of food shops. In all this work, we have had the willing co-operation and assistance of the great majority of the food traders. HOME SAFETY. It is not generally appreciated that home accidents cause more deaths than those on the road - 6,908 as opposed to 4,939 in England and Wales during 1956. This is in addition to non-fatal accidents requiring hospital care, involving probably one and three-quarter million people annually, and costing between four and five million pounds. Kensington have been very concerned with this problem for a long time and have been instrumental in securing legal powers to spend money on home safety propaganda. In the same connection they have initiated action to promote safety in tenement houses by legislation to secure the compulsory artificial lighting of staircases. The Public Health Committee are proposing to take action in the near future when certain outstanding details have been settled with the Ministry of Health. MENTAL HEALTH. Out of a total of roughly 424,000 occupied hospital beds, approximately 151,000 are occupied in mental hospitals, approximately 54»000 in mental deficiency institutions and among the greatest causes of incapacity for work are mental psychoneurotic, nervous or psychosomatic illnesses. It has been estimated that as many as 75% of patients visiting general practitioners, are suffering from a neurosis of one kind or another. In addition, there is the enormous increase in crime (a social disease arising from psychopathic tendencies), whose extent was revealed in the House of Lords recently, where it was stated that prisoners had increased from 20,739 (July,1956), to 24,300 (beginning April, 1958), an increase of about one-sixth in twenty-one months. These figures include an increase in Borstal inmates from 2,600 to 4,000 over the same period. The Minister without Portfolio stated "that a serious problem of adolescent crime exists is now all too painfully clear." Apart from drastic changes which will be required in the public's outlook upon crime and discipline 16 at all ages and. in all places, the problem of the prevention of mental illness urgently requires attention. One aspect of this, housing, I have already touched upon. There remain the questions of educating people to lead a healthy, mental life, to have a healthy mental outlook and the fostering of the services fleetingly mentioned in the Report of the Royal Commission on the Law relating to Mental Illness and Mental Deficiency, as having a value in helping to prevent difficulties which might lead to mental disturbance or might provide useful social support whether the need arose from mental or other causes. Such things as the local health and welfare services, including the mental health services, national insurance and assistance, employment services, child guidance, family welfare, problem family, marriage guidance councils, social clubs, youth organisations, community centres, old people's welfare services and clubs. NUCLEAR RADIATION HAZARDS. To our problemshave now been added the risks from radioactive substances, which are being increasingly produced and used in arms production, in power production, in industry, in processing and sterilizing foods, in pest control, and in diagnosis and treatment in hospital. It would, however, be wrong to overrate the risks or to get them out of perspective. Although the presence of these substances cannot be detected by any of the unaided senses, their natures and the safeguards against them have been most carefully studied by the scientists who have most carefully laid down precautions for all concerned as the science has developed. Apart from the most greatly publicised accident at Windscale and excluding Russia, there have been six reactor accidents in all. Nobody has been killed in any of them, and nobody seriously damaged. In fact, the Windscale incident lends additional point in that, although major irreparable and enormously expensive engineering damage was done to the atomic reactor, no one inside or outside the establishment suffered any health damage and this, despite the fact that the Kodak laboratories in London showed radioactivity one hundred times the normal after the accident. The various Ministries have the question of radiation hazard very much in mind; the scientific staff of the London County Council are constantly investigating the position and the public health departments are very mindful of their responsibilities in this matter. HEALTH EDUCATION. The Chief Medical Officer of the Ministry of Health wrote in 1951 "We have in fact arrived at a time when the citizen himself must actively participate in the campaign for better health if substantial progress is to be made. We are leaving the era of sanitary engineering and are entering into that of personal hygiene, in which each person must definitely contribute to the common weal." Although it does not pay immediately recognisable dividends, Health Education as a long term project is essential to enable the individual to play his part in the national effort. Education as distinct from information is required. Education in the true sense, in which the individual must play his part. But it must be done in a big way. To be effective, Health Education must be fostered at National level by radio, television and national press, and locally by personal contact by health visitors, women health officers, public health inspectors, teachers, doctors and by the local press. The whispered and pathetic "wolf wolf" against smoking and lung cancer employing such posters as the "yellow peril" have no chance against the televised advertisements of fifteen different brands of cigarettes, all employing clever and different emotional approaches and reaching seven million people several times each night. On reflection, I think it will be agreed that we have conquered or brought under control such natural hazards as infectious disease, maternal and child mortality, impure water, infected milk, refuse accumulation, defective drainage, animal and insect pests, and so on. Unfortunately, "he who adds to knowledge adds to sorrow" and, in solving some problems, we have created others. We are now having to cope with such man made problems as radiation hazards, atmospheric pollution, housing, home accidents, - 17 - road accidents, food poisoning, lung cancer, psychoneurosis, psychosomatic diseases, "degenerative" diseases, which have some relation to the stress and diet of modern civilisation, and the care of old people, whose lives have been prolonged by the successful conquest of many diseases. Preventive medicine wages a constant battle to prevent a recrudescence of old problems, to keep continuing problems under control and to cope with new problems as they arise. I feel that in all this, the people of Kensington would be even better served if the Council's recent recommendations on the re-organisation of London Government were adoptedo GENERAL PROVISION OP HEALTH SERVICES IN THE AREA Bacteriological and Analytical Work The following is a summary of the work performed during 1957:- Nature of specimen or sample Number examined Nose and throat swabs 240 Faeces and rectal swabs 836 Milk (bacteriological) 166 Water (drinking) 6 Water (swimming baths) 31 Ice Cream 35 Miscellaneous 22 Water Supply The water supply in Kensington is almost entirely provided by the Metropolitan tfater Board, but there are two 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., Medicinal Baths (Personal Cleansing Station) The record of work done during 1957 is as follows:- 18  Scabies Vermin Impetigo Other conditions Desciption Persons Cleans -ings Persons Cleans -ings Persons Cleans -ings Persons Cleans -ings Adults Kensington 82 148 80 89 - - - - Other boroughs 9 18 35 36 - - - - Schoolchildren Kensington 48 260 764 764 4 11 3 5 Other boroughs 1 2 259 259 - - - - Children under 5 Kensington 17 42 25 25 - - - - Other boroughs 5 12 5 5 - - - - Compulsory cleansings - - 106 106 - - - - TOTALS 162 482 1,274 1,284 4 11 3 5 In addition to the cleansing of persons referred to above, articles of personal clothing disinfested at the Medicinal Baths during the year numbered 1,586. Disinfection and Disinfestation A summary of the routine work of the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 237 (361 rooms) Houses disinfested after vermin 355 (701 rooms) Loads of furniture treated with hydrogen Total weight of furniture, bedding, etc. dealt with :33 tons 18 cwt. 1 qtr. 21 lb. It is the practice of certain foreign countries to prohibit the import of parcels of clothing, unless accompanied with a certificate that the articles have been disinfected. The Council afford facilities to persons desirous of sending clothing abroad, but make a charge of 2/6d. for each certificate provided. During the year, 450 parcels of clothing were disinfected and the income amounted to £56. 5s • Od. The following table indicates the destination of these parcels 8:- No. of parcels Russia 167 Czechoslovakia 123 Italy 26 Rumania 8 Spain 7 Nigeria 5 Hungary 2 Poland 1 Germany 1 +Unknown 110 +All these parcels were dealt with by one Kensington firm of exporters. 19 Some countries allow the import of clothing if accompanied, by a certificate stating that no case of infectious disease has occurred at the sender's address within twenty-one days prior to mailings During the year, one such certificate was issued- H.C.N, Disinfestation For many years, the Council adopted the policy of disinfesting with H.C.N.the furniture and household effects of all tenants moving to new Council property, as a method of preventing bed bugs being taken from old houses into the new dwellings. There has been considerable reduction in the number of bug infested houses in the borough, no doubt due to the introduction of new and effective insecticides such as D.D.T, and, from the beginning of 1954» the Council decided to discontinue the policy of treating the furniture of all incoming tenants, irrespective of whether there was evidence of infestation or not, and substitute the following scheme :- (a) A public health inspector examines the furniture and home of each prospective tenant; (b) If bug infestation is present, the furniture is dealt with by H.C.N. at the disinfecting station. (c) If no infestation is apparent, no action is taken in regard to the furniture, but the walls and ducts of new flats are treated with D.D.T. or Gammexane smoke preparations. (d) The inspector re-visits the flat after a period of six months, and takes appropriate action if the flat is found to have become infested. During 1957, thirty-four new flats, which became ready for occupation, were treated with Gammexane smoke generators before being occupiedo The furniture, etc. of the families selected to move into these flats were inspected. With two exceptions every case was found to be free from vermin and the tenants were allowed to move directly into their new homes. In the two infested cases, the furniture was taken to the Council's disinfecting station and treated with H.C.N. before being moved into the new accommodation. In addition to the above cases, the furniture of fourteen other families, selected to move into vacated Council flats (or conversions) was found to be infested and was treated with H.C..N. at the disinfecting station. Prevention of Damage by Pests The Prevention of Damage by Pests Act, 1949, imposes a duty on occupiers of premises to notify the Council of rodent infestation, and the Council are required to ensure that the borough is, as far as practicable, kept free from rats and mice. The Ministry of Agriculture, Fisheries and Food pay a grant of 50% of the approved net expenditure incurredo The Council deal with rat and mice infestation in dwelling houses without cost to the occupiers, but expenditure incurred in treating infestations on commercial and industrial premises is recovered from the owners. The Council are required to submit reports 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 Minister has requested a report for the year ended 31st March, 1958, and the following table gives the details for this period s:- - 20 - Prevalence of Rats and Mice Type of Property Total Local Authority Dwelling Houses All other (including Business & Industrial) I. Total number of properties in Local Authority's district 36 39,393 11,296 50,725 II. Number of properties inspected by the Local Authority during twelve months ended 31/3/58 as a result (a) 10 743 89 842 (a) of notification (b) survey (b) 3 66 14 83 or (c) otherwise (c) - 116 - 116 III. Total inspections carried out, including re-inspections 66 6,030 502 6,598 IV. Number of properties (under II) found to be infested Major by rats - - 1 1 Minor 10 236 37 283 V. Number of properties (under II) found to be infested Major by mice - - - - Minor 2 473 46 521 VI. Number of infested properties (under IV and V) treated by the Local Authority 12 709 84 805 VII. Total treatments carried out 16 936 98 1,050 VIII. Number of notices served under Section 4:(l) Treatment - - - - (2) Structural Works (i.e.Proofing) - 12 - 12 IX. Number of cases in which default action was taken by Local Authority following issue of notice under Section 4:- - - - - X. Legal Proceedings - - - - XI. Number of "block" control schemes carried out - - - - - 21 - For a number of years, all the sewers in the borough have been treated with poison bait, to destroy rats, twice yearly. This work has hitherto been carried out in January and June each year, coinciding with similar treatments carried out in neighbouring boroughs. The Ministry of Agriculture, Fisheries and Food have had this sewer-baiting under review generally, and from experiments carried out by them, it was recommended that a new system of treatment should be introduced. The new system, which was adopted by the Council, involved changing the times of baiting to April and September each year, allowing a longer period of time during which baits were left in the sewers, and mixing a mould inhibitor (paranitrophenol) with the baiting material to act as a preservativeo The January treatment under the old method had already been carried out, but the following table shows the results obtained during the year, compared with the results obtained in the previous five years:- Year Estimated number of rats killed First treatment Second treatment 1952 5,982 4,133 1955 5,458 4,312 1954 4,142 4,667 1955 4,515 5,430 1956 4,764 4,138 1957 4,476 (January) 7,751 ( April ) 7,044 (September) 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 years- Complaints investigated 1,195 Premises inspected following complaints 1,254 Premises where rats were found 304 Premises where mice were found 589 Premises where other vermin were found 148 Premises where no infestation existed 213 Number of visits made 6,322 Number of notices served 15 Premises successfully treated 1,100 Cases in which advice only was given 64 Borough Council properties dealt with 24 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 one hundred and twenty-two. Of this number, seven were new registrations during the year. Rag Flock and Other Filling Materials Act, 1951 This Act 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 to use prescribed filling materials except on premises registered by a local authority. The exceptions are in the remaking and reconditioning of any article or 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. At the end of the year, there were nineteen registered premises in the borough. The Act further provides that no rag flock shall be delivered to - 22 - registered premises except from premises licensed for manufacturing rag flock or used as a store for rag flock. A local authority on receiving from the occupier of premises an application for the grant or renewal of an annual licence authorising him to manufacture rag flock or to use his premises as a rag flock store, may grant or renew the licence on payment of a fee of one pound. No licences have been issued in Kensington. If on registered premises there are unclean filling materials, the occupier shall be guilty Of an offence; and it is also an offence to sell or offer for sale any article which is upholstered with unclean filling materials (second-hand articles are excepted). Inspections of the registered premises were made during the year and nine samples of rag flock and other fillings were taken for analysis. The results were satisfactory. Description No. of samples taken Hair 1 Coir fibre 2 Woollen Felt 1 Cotton Pelt 3 Rag flock 1 Algerian Fibre 1 Pet Animals Act, 1951 This Act requires that no person shall keep a pet shop except under the authority of a licence issued by the Council and in compliance with any conditions specified in the licence. During the year, eight premises were licensed under the Act. The general conditions for pet shops approved by the Council are those recommended for their constituent councils by the Metropolitan Boroughs' Standing Joint Committee. Health Education Health education is being increasingly recognised as a vital part of the public health service. In recent years, the public health department has organised a Health Exhibition, a Pood Hygiene Exhibition, and several smaller campaigns, mainly in connection with atmospheric pollution, flies, nuisances from dogs and home safety. Whilst these periodic campaigns are an extremely valuable form of health propaganda, they are soon forgotten, and there is need for a more continuous form of health education. This has been accomplished by the distribution each month of copies of "Better Health" (the monthly journal of the Central Council for Health Education) to clubs, hospitals and various other organisations in the borough; by the display of suitable posters on the ex-Empire Marketing Board poster-frames and other sites in Kensington; and by the distribution of booklets, bookmarks, leaflets, posters, etc., dealing with such matters as food hygiene, food poisoning, infectious diseases, home safety, etc. The Council make an annual grant of fifteen guineas to the Central Council for Health Education, a body recognised by the Ministry of Health as the medium through which health education material is distributed throughout England and Wales. Good use is made of the services available and posters, leaflets and other materials are frequently obtained from the Central Council for use in Kensington. - 25 - Mass Radiography Mass radiography is undertaken by the Regional Hospital Boards. Kensington is included in the area covered by the Mass X-ray Unit No. 5A operated by the North-West Metropolitan Regional Hospital Board. The purpose of mass radiography is twofold :- (i) to find abnormalities of the chest, and in particular tuberculosis and cancer of the lungs, and (ii) to give those whose x-ray is within "normal limit" a certain degree of security. During 1956, the Mass X-ray Unit No. 5A undertook a large scale mass x-ray operation in Kensington covering a period of approximately two months. A total of 12,086 persons (5.920 men and 6,166 women) was examined. Consequently, during 1957, the Mass X-ray Unit 5A was engaged mainly in other districts; nevertheless, 418 persons were mass x-rayed at the Royal College of Arts in South Kensington. No active case of tuberculosis was found and the only abnormality discovered was a case of sarcoidosis. Atmospheric Pollution Clean Air Act, 1956. Only certain provisions of the Clean Air Act, 1956, which received Royal Assent on 5th July, 1956, came into force on 31st December, 1956. (The remaining provisions come into operation on 1st June, 1958.) During the year under review, the principal sections of the Act in force affecting this Council were Sections 3 and 11 to 15. Section 3 requires that new furnaces, not used mainly for domestic purposes and exceeding a specified capacity, shall be so far as is practicable smokeless. Any person installing such a furnace must give prior notice to the Council and may submit detailed plans and specifications for approval before the work of installation takes place. Two applications for approval were received during the year; one in respect of the renewal of the central heating plant in a large block of flats, and the other in respect of the installation of a new boiler at a hospital. After due consideration, both applications were formally approved. Sections 11 to 15 relate to the declaration by the Council of smoke control areas, in which the emission of smoke from the chimney of any building would be an offence. In order to obtain the information needed to assess the full implications of these sections, a preliminary survey was made of the Holland Ward of the borough. The survey, which was carried out by one of the Council's public health inspectors, assisted by two student inspectors, was commenced in July, 1957> and completed in February, 1958. After consideration of the information obtained, the Council decided to submit preliminary proposals to the Minister of Housing and Local Government in respect of a specified area of the Holland Ward, asking for his approval to proceed with making an official declaration. The Minister has given his preliminary approval (May, 1958), and the next steps, as laid down in the Clean Air Act, are being taken at the present time. Routine measurement of atmospheric pollution The Council maintain two atmospheric pollution measuring stations as follows:- (1) North Kensington (St. Joseph's Convent, Portobello Road) (2) South Kensington (Messrs. John Barker's Furniture Depository, Pembroke Road) The apparatus at each station consists of a standard deposit - 24 - gauge for collecting soluble and insoluble deposits and a lead peroxide apparatus for measuring the sulphur content of the air. Readings are taken at each station at the end of each month. In addition to the above mentioned stations, the Council have established three smoke measuring stations as follows :- (1) Public Health Department, Hornton Street, W.8. (2) Public Library, Ladbroke Grove, W.10. (3) L.C.C. Welfare Centre, Redcliffe Street, S.W.10. The equipment at the public health department consists of a smoke filter and a hydrogen peroxide bubbling apparatus. The smoke filter measures the daily concentration of smoke suspended in the atmosphere, and the hydrogen peroxide bubbler extracts the sulpur dioxide content of the atmosphere. Readings are taken each day, and results are averaged to produce figures for each calender month. The equipment at the public library and the Welfare Centre consists of smoke filters only. Measurements are taken three times a week, and daily and monthly averages are calculated from the results. All information obtained is forwarded each month to the Director of Observations at the Fuel Research Station of the Department of Scientific and Industrial Research, for correlation with the results obtained from other sites throughout the country. The following tables set out details of the results obtained in Kensington during 1957:- A. Deposit Gauge Month 1957 Days exposed Rain fall (ins.) Total deposits for period in tons per square mile Deposits per day in tons per square mile (average) Soluble Insoluble Total Soluble Insoluble Total North Kensington (Portobello Road) January 30 0.92 6.88 7.95 14.83 .229 .265 .494 February 28 3.13 8.09 7.92 16.01 .289 .283 .572 March 32 1.01 8.09 12.89 20.98 .253 .403 .656 April 30 0.16 4.50 9.93 14.43 .150 .331 .481 May 29 0.97 5.47 10.44 15.91 .189 .360 .549 June 32 0.24 4.90 9.70 14.60 .153 .303 .456 July 28 3.23 7.68 9.87 17.55 .274 .353 .627 August 35 1.58 6.64 10.03 16.67 .190 .286 .476 September 29 2.15 8.02 8.93 16.95 .276 .308 .584 October 30 1.62 5.94 9.46 15.40 .198 .315 .513 November 32 2.44 8.59 10.40 18.99 .268 .325 .590 December 30 1.81 9.03 8.76 17.79 .301 .258 .593 TOTALS 365 19.26 83.83 116.28 200.11 - 25 - A. Deposit Gauge Month 1957 Days exposed Rain fall (ins.) Total deposits for period in tons per square mile Deposits per day in tons per square mile (average) Soluble Insoluble Total Soluble Insoluble Total South Kensington (Pembroke Road) January- 30 0.91 5.54 6.04 ll.58 .185 .201 .386 February 28 2.94 7.92 7.65 15.57 .283 .273 .556 March 32 0.99 6.68 11.61 18.29 .209 .363 .572 April 30 0.20 3.66 6.21 9.87 .122 .207 .329 May 29 l.ll 4.90 8.22 13.12 .169 .283 .452 June 32 0.90 4.90 7.99 12.89 .153 .250 .403 July 28 3.11 6.51 7.22 13.73 .232 .258 .490 August 35 1.57 6.14 7.99 14.13 .175 .228 .403 September 29 2.18 7.22 7.18 14.40 .249 .248 .497 October 30 1.37 5.27 8.19 13.46 .175 .273 .448 November 32 2.09 8.83 9.50 18.33 .275 .296 .571 December 30 1.96 7.72 9.90 17.62 .257 .330 .587 TOTALS 365 19.33 75.29 97.70 172.99 B. Estimation of atmospheric sulphur Milligrams of sulphur trioxide per day Month 1957 Days exposed North Kensington South Kensington January 30 2.66 2.83 February 28 3.01 3.19 March 32 3.42 3.45 April 30 2.07 2.33 May 29 1.40 1.54 June 32 1.06 1.49 July 28 1.20 1.58 August 35 1.15 1.54 September 29 1.41 1.65 October 30 2.83 2.79 November 32 3.16 3.48 December 30 3.69 4.01 Average for years 2.25 2.42 C= Comparison of results The following table compares the results obtained in Kensington with the results from a country district in the Home Counties and a large industrial area in the North of Englands- Area Total weight of deposit for year in tons per sq. mile Daily average of sulphur over the year in milligrams of sulphur trioxide North Kensington 200.11 2.25 South Kensington 172.99 2.42 Country District 65.30 0.88 Industrial area 215.30 3.26 - 26 - Readings from the two monthly stations in Kensington have now extended over four years, and it is possible to compare the results. Year No. of days exposed Total weight of deposited matter in tons per square mile Daily average of sulphur in milligrams of sulphur trioxide North Kensington South Kensington North Kensington South Kensington 1954 364 205.11 181.47 2.15 2.57 1955 367 227.73 191.70 2.32 2.77 1956 365 207.82 191.75 2.56 2.81 1957 365 200.11 172.99 2.25 2.42 Measurement of smoke and sulphur by the volumetric method 1957 Volumetric smoke Concentration of smoke in milligrams per cubic metre Average daily values at:- Volumetric sulphur Concentration of sulphur in parts per million volumes of air Average daily values at:- Public Health Department Public Library South Kensington Welfare Centre Public Health Department January .149 .282 .169 9.3 February .242 .204 .200 11.2 March .218 .289 .371 13.5 April .172 .235 .262 9.0 May .094 .l79 .180 5.4 June .126 .145 .160 5.2 July .102 .171 .193 4.2 August .098 .166 .189 4.7 September .125 .205 .164 5.2 October .156 .337 .246 10.9 November .167 .341 .268 10.9 December .288 .352 .253 16.4 General observations The results obtained in 1957 indicate a lessening in the measured atmospheric pollution as compared with previous years. Pollution has continued higher during winter months, falling to a minimum in the summer. Deposited matter again has been heavier in North Kensington than in South Kensington, but, as in previous years, the sulphur content of the air has been higher in South Kensington than in North Kensington. On the 4th December, 1957, a warning of persistent fog was issued. Special readings for smoke and sulphur were made at two-hourly intervals, throughout the days of the 4th and 5th December at the Public Health Department Station, and the results obtained were immediately supplied to the Fuel Research Station for correlation with other results obtained elsewhere in the London area. Action taken in regard to Smoke Nuisances During the year there were eighteen complaints of smoke nuisance - 27 - as a result of which eighty-seven observations were made. Remedial measures by informal action were secured in all cases. 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 the Section applies. In the twelve months ended 31st December, 1957, the Council became responsible for the burial of twenty-nine persons dying in the borough. The following is a summary of the action taken (a) Cases where the funeral expenses have been fully recovered 10 (b) Cases where part only of the expenses has been recovered 9 (i) Number of these where balance of expenses will be recovered ... 2 (amounting to £23.4s.9d.) (ii) Number of these where there was no further estate or "liable" relative 4 (iii) Number of these where "liable" relatives were unable to contribute ... 3 (c) Cases where full coot has been borne by the Council 10 (i) Number of these where balance of expenses will be recovered ... 4 (amounting to £40.Os.Od.) (ii) Number of these where there was no estate or "liable" relative ... 3 (iii) Number of these where "liable" relatives were unable to contribute 3 Amount recovered by the end of the year ... £185. 1s. 1d. Additional amount expected to be recovered 63. 4s. 9d. £248. 5s. l0d. Irrecoverable 102. 6s. 5d. Total cost £350.12s. 3d. Of the twenty-nine cases dealt with, ten were eligible for Death Grant from the Ministry of Pensions and National Insurance. The total amount recovered from this source amounted to £87. 6s. Od. (included in the above figures.) Since the National Assistance Act came into force on the 5th July, 1948, the Council have arranged for the burial of three hundred and seventy-three persons under Section 50. Public Mortuary The number of bodies taken to the Public Mortuary, maintained - 28 - by the Council at No. lA, Hornton Place, W.8., during the year was three hundred and eighty-one. Post-mortem examinations were made in three hundred and ten cases, and in sixty-seven instances the Coroner held inquests. 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 1957, there were two hundred and eighty-three Kensington cremations, in comparison with two hundred and fifty-five in 1956 and two hundred and fifty-six in 1955 and sixty in 1948; the latter year was taken as the basis on which the financial provisions of the agreement were framed. (Note: The standard charge was increased to £5. 5s. Od. as from the 1st January, 1958.) 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 one hundred and fifty-nine examinations were made. Dog Nuisances Apart from being an objectionable social offence, fouling of footways by dogs is a public health nuisance for which an adequate remedy is hard to find. While it has been shown that dogs can carry and excrete germs capable of producing illness in man, it is seldom that cases of human disease can positively be related to infections originating from this source. Nevertheless, such instances do occur and the potential risk cannot be ignored. Certainly dog filth is an attraction to flies and blowflies, with consequent possibilities of conveyance of infection. The main objection, however, to the fouling of pavements and grass verges by dog excreta is the nauseating revulsion, embarrassment and distress caused by chance pollution of shoes, clothing, mats and carpets, necessitating disgusting and time-consuming cleansing operations. The Council's byelaw dealing with this nuisance provides that:- "No person being in charge of a dog shall allow the animal to foul the footway of any street or public place by depositing its excrement thereon. For the purpose of this byelaw the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that at the time when the dog fouled the footway it had been placed in or taken into the charge of some other person." During the year one summons was issued under this byelaw. A conviction was obtained and a fine of 10s. Od. was imposed. WELFARE OF OLD PEOPLE The Council have accepted the responsibility, within their powers, - 29 - 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 serve on the 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. Advice Leaflets During the year the Council arranged for the distribution of five thousand copies of a revised pamphlet giving information of the services available to old people individually or through a club. S.O.S. Cards Window display cards are provided by the Council, bearing the letters "S.O.S" in red on one side and, on the reverse side, directions how to use the card, with space for particulars of next-of-kin or nearest relative. These cards are distributed to appropriate old people. Any person seeing one of the cards in a window is able to summon help from one of the sources given on the back of the card. The local press have generously assisted in making this service known.. Grants to Clubs, etc. Under Section 31 of the National Assistance Act( 1948, the Council can make contributions to voluntary bodies in respect of the provision of recreation or meals for old people. During the year grants were made as follows:- (a) The Kensington Communal Kitchens Service were granted £500 as a contribution towards the cost of operating a Meals-on-Wheels service in co-operation with the Kensington Women's Voluntary Services. (b) Latymer Road Mission Old People's Luncheon Club were granted £25 towards their general expenses in providing meals, including replacement of equipment. (c) The Kensington Men's Old Age Pensioners' Social and Angling Club were granted £10 towards their recreational equipment. (d) The British Red Cross Society Old People's Club were granted £8 to purchase a tea urn. (e) The North Kensington Old Age Pensioners' Club were granted £6 for the purchase of cutlery. (f) The Kensington Council of Social Service were granted £96 for chiropody. (g) The Seventh Feathers' Club were granted £15 for recreational equipment. (h) The Home from Home Club, Royal Palace Hotel, were granted £40 towards their general running expenses. - 30 - Holidays The Council have a scheme under which the Family Welfare Association co-operate in arranging holidays for old people. An application for a holiday is made to the Medical Officer of Health, who investigates the applicant's circumstances, and an assessment is made in accordance with an approved scale of the contribution towards the expenses which the old person is required to make. When the application is approved it is referred to the Family Welfare Association, who make all the arrangements for a holiday. The Association apply to the Council for reimbursement of expenses after deducting the contribution from the old person. Bookings were made at two holiday resorts, Southsea and Ramsgate. Private coaches were hired to take the old people to and from these towns, and convenient assembly points in the borough arranged. The Family Welfare Association undertook the work, including the bookings at the holiday homes and the hire of the coaches, and the Council paid towards their administrative expenses the sum of five shillings for each person (or man and wife) for whom a holiday was arranged. The following is a summary of work carried out in 1957 :- Total applications received 115 Unsuitable on medical grounds 9 Consideration deferred 22 Referred to other organisations _6 37 Number approved 78 Cancellations after approval 18 Number sent on holiday 60 Number sent to Lennox House, Southsea 40 Number sent to Ramsgate 20 Contributions by applicants £54. . 7s. 0d. Net cost of holidays to the Council £506. 16s. 0d. Booking fees paid by Council to Family Welfare Association £13. Os. 0d. Domiciliary Cleansing Arrangements have been made whereby old people's 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 the old people's belongings are being dealt with at the disinfecting station. Twenty old people were dealt with in 1957. National Health Service - Institutional Care,, etc. Facilities for institutional care, home nursing, sick room equipment and home helps are provided by the London County Council. Hospital treatment, medical care, ophthalmic, dental and pharmaceutical services are provided under statute. The borough is situated in the area of two Metropolitan Regional Hospital Boards. One Hospital Management Committee in the borough utilizes the part-time service of a local medical practitioner as a clinical assessor to decide the priority need for admission of all patients submitted to that Hospital Group as being in need of hospital treatment and classed as "chronic sick". This ensures the early or immediate admission of patients where the need is urgent on - 31 - medico/social grounds. There is usually no difficulty in the admission to hospital for the treatment of acute conditions. During the year it was possible to arrange for one hundred and seventy-five old people to he admitted to hospitals for institutional treatment and, in addition, ninety-nine cases were admitted to homes for the aged. Domiciliary care of "chronic sick" All the cases on the chronic sick waiting lists of the hospitals in the borough are referred to the public health department. They are visited and assessed by the Women Health Officers. Where necessary, medical care, home nursing, home helps, convalescent holidays, financial aid and pensions are arranged with the appropriate statutory bodies. These, together with various services operated by the Council augmented by voluntary bodies are provided to such good effect that, in many cases, the need for hospital admission is postponed indefinitely. The number of "chronic sick" visits during the year totalled six hundred and seven. 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 the house 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 him to be necessary under the terms of Section 122 of the Public Health (London) Act, 1936. In fifty-nine cases action was taken under the Section. 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. From 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 seven hundred and sixteen separate collections of laundry were made under this scheme, and the number of articles cleansed totalled nine thousand, three hundred and fifty-two. 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 During the year, the Council made a grant of £96 to the Kensington Council of Social Service for the purpose of enabling the provision of a chiropody service for house-bound old people. 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 chiropodists and making the appointments. - 32 - The total number of persons treated under the home chiropody scheme was one hundred and sixty-eight and the number of treatments given was four hundred and eighty. 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 the Kensington Communal Services Committee. 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 (l0d. per meal). The Kensington Communal Services Committee supply the meals and the vehicles for delivery. The following statement shows the progress of the service and financial effect since the inception of the scheme. Period Number of meals Gross Cost Receipts from old people Subsidy from L.C.C. Grant from R.B.K. Net Cost October, 1948/ £ £ £ £ £ March, 1949 3,535 352 149 0 _ 203 1949/50 10,461 1,016 432 27 - 557 1950/51 13,758 1,250 477 115 - 558 1951/52 18,370 1,634 625 445 - 564 1952/53 28,426 2,103 954 948 — 201 1953/54 39,196 3,459 1,317 1,306 200 636 1954/55 45,116 3,853 1,611 1,512 300 430 1955/56 45,933 4,204 1,926 1,531 300 447 1956/57 45,995 4,211 1,933 1,758 500 20 1957/58 49,334 Not yet available - It will be observed that the number of meals served continues to increase and for the year 1957/58 has reached a record total of 49,334. The net deficiencies of the scheme (after crediting subsidies from the London County Council and grants from the Kensington Council) have been met to date by the Kensington Communal Services Committee. The reduction in the net deficiency for 1956/57, as compared with previous years, is accounted for by an increase of £200 in the grant by the Kensington Council and by an increase of 2d. per meal (8d. to l0d.) in the subsidy paid by the County Council as from September, 1956. 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 and a grant of £500 was made to the Kensington Communal Services Committee for 1957/58. Visiting The Council's Women Health Officers visit old people brought 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 1957:- - 33 - Cases on register at the beginning of year 5,176 New cases added to register 582 Cases removed to hospitals 175 Cases removed to homes (voluntarily) 99 Cases removed to homes (compulsorily) 4 Cases removed from district 174 Number of deaths 298 Total number of cases remaining on register at end of year 5,008 Number of old people sent away for holiday 60 Number of old people provided with Council's laundry service 59 Number of old people provided with "Meals on Wheels" 225 Cases referred to National Assistance Board 188 Cases referred for assistance from Home Help Department 206 Cases referred for assistance from Voluntary Organisations 68 Cases referred to Recreational Clubs 216 Number of visits to chronic sick cases 607 Cases assisted with provision of medical and nursing care 229 Cases referred to home chiropody service 168 Cases where disinfestation was carried out 20 Number of initial home visits made 503 Number of re-visits 4,043 Number of other visits made in connection with old people, including visits to clubs 122 Number of interviews, enquiries, etc. on behalf of old people 1,847 Removal of old and infirm persons to institutions, etc. Under Section 47 of the National Assistance Act, 1948, the Council may apply to a Court for an order to remove to a suitable institution any person who - (a) is suffering from grave chronic disease, or being aged, infirm or physically incapacitated, is living in insanitary conditions, and (b) is unable to devote to himself, or is not receiving from other persons, proper care and attention. The National Assistance (Amendment) Act, 1951, amended Section 47 of the National Assistance Act, 1948, and provided that 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 seven days' notice as previously required. 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 not necessary to give seven days' notice to the manager thereof. 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. Although many cases were investigated during the year, in only four cases was formal action taken to secure compulsory removal. Brief details of these four cases are as follows :- (a) An old lady, aged 89 years, without relations or - 34 - friends, living alone in South Kensington. She had been under the supervision of the public health department since 1953, and had been in receipt of all the domiciliary services such as home help, mealson-wheels, etc. Her condition deteriorated and eventually she was completely unable to give herself care and attention, and the domiciliary services were insufficient for her needs. A Justice's Order was obtained for her compulsory removal to hospital. Later she was transferred to an Old People's Home where she agreed to stay permanently. (b) An old lady, aged 87 years, without relations or friends, living alone in a top floor room in North Kensington. She was suffering from senility and a fractured femur and living in insanitary conditions. A Justice's Order for her compulsory removal to hospital was obtained, and she is still there as a patient in a chronic sick ward. (c) An old lady, aged 77 years, without relations or friends, living alone in South Kensington. She was blind and bedridden, and in need of medical and nursing care. She stubbornly refused all domiciliary services, and was unable to give herself proper care and attention. A Justice's Order was obtained and she was removed to hospital, where she died six weeks after admission. (d) An old lady, aged 83 years, without relations or friends, living alone in North Kensington. She was found to be living in extremely insanitary conditions, and was gravely ill and urgently in need of medical treatment and nursing. Although every effort was made to persuade the woman to enter hospital immediately, she refused, and steps had to be taken to obtain a Justice's Order. She was removed to hospital, but unfortunately died two days after admission. SANITARY INSPECTION The following table shows a summary of the inspections, etc. carried out by the public health inspectors during the year:- - 35 - Public Health (London) Act, 1936 Houses inspected on complaint 2,242 Houses inspected after infectious disease 2,076 Re-inspections 9,683 Smoke observations 87 Other inspections 1,184 Housing Act, 1957 Initial inspections (including preparation or revision of house-to-house cards) 690 Re-inspections 603 Initial inspections for overcrowding 247 Re-inspections 314 Underground Living Rooms Initial inspections 281 Re-inspections 2,168 Drainage Applications 492 Plans submitted 315 House drains inspected 5,300 House drains tested 467 Clean Air Act, 1956 Premises inspected (Smokeless zone) 3,086 Factories Act, 1937 Premises inspected 701 Outworkers' premises inspected 206 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 1,254 Statutory notices 426 Final notices 166 Various Factories Acts 25 Notice of intention to enter premises for inspection 8 Report of waste water to the Metropolitan Water Board 13 Report of dangerous structures to the London County Council 32 Other notices 89 - 36 - The following is a summary of works completed under the supervision of the public health inspectors during the year House drains, reconstructed or repaired 262 House drains cleansed 103 Water closets, reconstructed or repaired 111 Water closets, new provided 322 Soil pipes, vent pipes, repaired etc 80 Soil pipes, vent pipes, new provided 120 Baths, new provided 210 Sinks, new provided 293 Lavatory basins, new provided 573 Bidets, new provided 6 Waste pipes, new provided 389 Cisterns, cleansed 5 Cisterns, covered 5 Taps fixed on rising main 16 Yards and areas paved, drained etc 14 Dustbins provided 112 Accumulations of filth, etc. removed 77 Roofs repaired 223 Houses provided with water above basement level 3 Dampness in dwellings remedied 267 Houses disinfected after infectious disease (including bedding, etc.) 237 Rooms in such houses, disinfected after infectious disease 361 Houses cleansed 6 Rooms in such houses 36 Verminous houses cleansed (including bedding, clothing, etc.) 355 Verminous rooms in such houses, cleansed 701 Other sanitary works executed 689 HOUSING Inspection of dwelling houses during the year (i) (a) Dwelling houses inspected for housing defects (under Public Health or Housing Act) 5,536 (b) Inspections made for the purpose 19,488 (ii) (a) Dwelling houses (including those under sub-head (i) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 690 (b) Inspections made for the purpose 1,293 (iii) Dwelling houses found not to be in all respects reasonably fit for human habitation 1,254 Remedy of defects without service of formal notices Number of defective dwelling houses rendered fit in consequence of informal action under the Housing or Public Health Acts 861 - 37 - Action under statutory powers during the year (a) Premises repaired after service of formal notice under the Public Health (London) Act:- (i) By owners 423 (ii) By local authority in default 6 (b) Action under Sections 9, 10 and 12 of the Housing Acts 1957:- (i) Dwelling houses in respect of which notices under Section 9 were served requiring repairs - (ii) Dwelling houses which were rendered fit by owners under Section 9 1 (iii) Dwelling houses rendered fit by the Council in default of owners - (c) Action under Sections 16, 17 and 23 of the Housing Act, 1957:- (i) Dwelling houses in respect of which demolition orders were made - (ii) Dwelling houses demolished in pursuance of demolition orders 2 (iii) Dwelling houses in respect of which closing orders in lieu of demolition orders, were made 1 (iv) Dwelling houses in respect of which undertakings were accepted from owner to render premises fit for habitation 3 (v) Dwelling houses rendered fit for habitation by owners and closing order determined 2 (d) Action under Section 18 of the Housing Act, 1957 (i) Separate tenements or underground rooms in respect of which closing orders were made (14 premises (24 rooms (ii) Separate tenements or underground rooms in respect of which closing orders were determined, the tenements or rooms having been rendered fit (46 premises (86 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 for purposes other than sleeping (14 premises (22 rooms (iv) Separate tenements or underground rooms in respect of which the Council accepted undertakings from owners to render fit within specified time ( 1 premises ( 2 rooms (e) Action under Section 42 of the Housing Act, 1957:- Number of areas represented to Council for clearance 2 (77 premises) (f) Housing Act, 1957, Part IV - Overcrowding:- (i) Number of dwellings overcrowded at end of year No reliable estimate - 38 - (ii) Number of new cases of overcrowding reported during the year 94 (372 units) (iii) Number of cases of overcrowding relieved during the year 85 (325 units) (iv) Number of cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil NOTE; Units means the number of equivalent persons in the families obtained by regarding children between 1 and 10 years of age as "half-persons" and disregarding infants under the age of 12 months. Certificates of Disrepair in relation to Dwelling Houses The Council's duty to issue certificates of disrepair in respect of dwelling houses, not fit for habitation, subject to the Rent and Mortgage Interest Restrictions Acts, was governed by the Housing Repairs and Rents Act, 1954, until the 6th July, 1957, when the Rent Act, 1957, came into operation and laid down a new procedure. The following table gives a summary of the action taken under the 1954 Act during the year prior to the operation of the Rent Act, 1957:- Category Applications for certificates of disrepair Applications for certificates to be revoked No. granted No. refused No. granted No. refused (a) Dwelling houses which have been the subject of a notice of repairs increase of rent under Part II of the 1954 Act 3 1 7 - (b) Dwelling houses which have NOT been the subject of a notice of repairs increase of rent under the 1954 Act, but in respect of which permitted increases of rent are recoverable under Section 2(l)(c) and (d) of the Increase of Rent and Mortgage Interest (Restrictions) Act, 1920 Nil 1 Nil The law regarding the issue of Certificates of Disrepair was changed by the Rent Act, 1957, and the following is a short summary of the new procedure:- The provisions allowing for the increase, within limits, of the rents of houses remaining in control are coupled with machinery dealing with repairs (First Schedule). The standard of repair is to be such as will secure the remedying of defects which ought reasonably to be remedied having due regard to the age, character and locality of the dwelling. The first stage is the tenant must serve a notice on his landlord specifying the defects which he thinks should be remedied. The landlord has six weeks in which to do - 39 - the work or give an undertaking that the work will be done. If he does neither of these things, the tenant may apply to the Council for a certificate of disrepair in relation to the defects specified in his notice to the landlord. When the Council have decided whether any, or all, of these items justifies the issue of a certificate of disrepair they must notify the landlord and allow him three weeks to reconsider the giving of an undertaking. The Council have a discretion to refuse to accept such an undertaking (and to issue a certificate of disrepair) in certain circumstances. If no undertaking is given, and a certificate of disrepair is issued, the landlord may apply to the Council for cancellation of the certificate if he subsequently does the work. The Council must then ask the tenant if he objects to the cancellation. If he does not object within three weeks, the certificate must be cancelled. If he does object, it is for the Council to decide whether or not to cancel the certificate. For the tenant, the effect of the granting of a certificates or of failure to carry out an undertaking within six months of the giving of it, is an abatement of the rent. There is provision for recovery of excess rent by the tenant back to the date of application for the certificate, or the date of the undertaking if there has been no such application. A landlord can appeal to the county court against the decision of the Council to issue a certificate, and a tenant can appeal against their refusal to issue one. Similarly, if a landlord has applied to the Council for cancellation, on the ground that he has remedied the defects, he can appeal to the county court against their refusal to cancel; conversely, if the Council decide to cancel, in spite of the tenant's objection, the tenant can appeal to the county court. The following is a summary of the action taken under the Rent Act, 1957, from 6th July to the 31st December, 1957:- PART I - Applications for Certificates of Disrepair Number of applications for certificates 93 Number of decisions not to issue certificates 3 Number of decisions to issue certificates- (a) in respect of some but not all defects 79 (b) in respect of all defects 11 Number of undertakings given by landlords 46 Number of undertakings refused by Council 1 Number of Certificates issued 22 PART II - Applications for Cancellation of Certificates Applications by landlords to Council for cancellation of certificates Nil Houses in Multiple Occupation (including hostels) The provisions of the Housing Act, 1936, (Sections 6-8) and the Public Health (London) Act, 1936, (Section 155), enabling local authorities in London to make and enforce byelaws relating to houses let in lodgings and hostels respectively, have been superseded by provisions contained in Sections 36 and 90 of the Housing Act, 1957, which - 40 - apply to any house or part of a house "which is let in lodgings or occupied by members of more than one family." A general power is given to the Council to require in houses, which are in multi-occupation, an adequate provision of the following services and amenities Natural lighting; Ventilation; Water supply; Drainage and sanitary conveniences; Facilities for storage, preparation and cooking of food, and for the disposal of waste water; Overcrowding of sleeping rooms. Section 36 enables the Council to take action if in their opinion the premises are so defective in the matters set out above as not to be reasonably suitable for the number of persons or households in occupation. In such cases they may serve a notice on the person in controls (a) specifying the works required to render the premises reasonably suitable for occupation by those persons or households; (b) requiring the person in control, in default of executing these works within the prescribed period, to take such steps as are reasonably open to him (including, if necessary, the taking of legal proceedings) for securing a reduction in the number of persons accommodated or the number of households, or both, as specified in the notice. Thus, where a notice is served, a choice is given, either to carry out the specified works, or, alternatively, to reduce the intensity of occupation of the house, in which case possession of the house or parts of the house can be obtained by an owner notwithstanding the Rents Acts. Under Section 90, the Council may serve a notice on the occupier, or the person having the control and management of a house or part of a house, where excessive numbers of persons are accommodated, specifying in relation to any room on the premises the maximum number of persons by whom it is suitable to be occupied for sleeping purposes at any one time, or, if appropriate, that the room is unsuitable to be occupied for sleeping purposes. It will be an offence after the notice has become operative to cause or allow any rooms to be occupied otherwise than in accordance with the notice, or to cause or permit the accommodation to be so occupied that it is not possible to avoid persons of opposite sexes over the age of 12 years (excluding persons living together as husband and wife) occupying sleeping accommodation in the same room. The premises affected vary considerably and render impracticable the provision of a single rigid code of requirements applicable to all cases; indeed, such a code would appear to be contrary to the wishes of the Minister, who has expressed the view that the provision of the prescribed services and amenities should be decided on the merits of each case. The Council have adopted certain standards of the essential services and amenities which will be considered as satisfactory in appropriate cases. These standards were enumerated at length in my Report for 1955. Slum Clearance Action already taken The following table gives details of the clearance areas declared by the Council since 1950, when slum clearance work under the Housing Acts, was recommenced up to the end of the year:- - 41 - Name of Area Date of Declaration No. of houses No. of persons displaced Elgin Mews 25. 4. 1950 28 86 Lionel Mews (Nos. 1 and 2.) 3. 10. 1950 13 38 Lonsdale Mews (Nos. 1 and 2.) 2. 1. 1951 19 14 Munro Mews 2. 1. 1951 24 55 South End Row and Gardens 3. 4. 1951 10 4 East Mews Road 3. 4. 1951 14 40 Powis Mews 13. 11. 1951 13 30 St. Lukes Mews 13. 11. 1951 20 41 Portobello Road 13. 11. 1951 4 3 Kensal New Town (No. l) Area 11. 12. 1956 34 309 The Minister of Housing and Local Government has confirmed that all the above-mentioned areas may be dealt with as clearance areas with the exceptions that (a) in the case of St. Lukes Mews seven properties were excluded from the confirming order and, (b) in the case of South End Row and Gardens, the owners carried out the necessary demolition works prior to the Minister's decision. Future programme for Slum Clearance Section 1 of the Housing Repairs and Rents Act, 1954, (now Section 2 of the Housing Act, 1957), required Metropolitan boroughs, jointly with the London County Council, to submit to the Minister of Housing and Local Government proposals for dealing with unfit houses by way of demolition or clearance area procedure. A survey was made in Kensington of the houses where conditions were known to be below standard. A total of 7,416 premises were inspected and 3,293 houses were deemed to be unfit for habitation. After consultation with the London County Council, proposals were submitted to the Minister comprising the following areas thought to be suitable for clearance area procedure:- Premises Estimated population Families Persons Railway Mews 10 4 9 Kensington Park Mews 13 9 26 Stanley Gardens Mews 4 2 5 Lecky Street 5 2 4 Portland Road 16 39 110 Penelon Place, Ashley Cottages & Warwick Road 66 57 176 Kensal New Town 516 1,106 3,550 630 1,219 3,880 The Minister approved these proposals and fixed ten years as the period for securing the demolition of unfit houses- By agreement, the London County Council accepted responsibility for dealing with the Fenelon Place Area, which was declared by the County Council to be a clearance area, and was acquired by them. The detailed redevelopment of this site is the subject of discussions between - 42 - the County Council and. the Borough Council o The remaining areas listed above will be dealt with by the Borough Council, who decided that the most urgent was the Kensal New Town Area. In this connection, Sir William Holford, F.R.I.B.A., M.T.P.I., was retained by the Council to prepare and submit an architectural lay-out for the redevelopment of the area. The problems of overspill of population necessitate the decanting of persons at present living in the area while development on cleared sites proceeds, and the plan, as approved by the Council, proposes redevelopment in three phases. The first phase includes the construction of dwellings on sites which are at present cleared, comprising two 14-storey blocks, each of seventy-eight flats, and two four-storey blocks, each of ten maisonettes. At a later stage the area bounded by Golborne Gardens, Golborne Road, Southam Street and Adair Road will be redeveloped and finally the area adjacent to Kensal Road where the majority of the industry in the area is at present located, would be dealt with under the plan. The London County Council approved in outline the first stage of the lay-out of the Kensal New Town Area and permission was granted relating to the redevelopment for housing purposes at a residential density of 136 persons per acre of the area bounded by Hazlewood Crescent, Golborne Road, Southam Street, Adair Road, Appleford Road and Bosworth Road comprising in total approximately acres 0 In view of this, on the 11th December, 1956, the Council declared the first section of the Kensal New Town Area, comprising the following thirty-four houses, to be a clearance area s- Noso 10 - 18 (even) and 18a, Adair Road Nos. 26 - 56 (even) Appleford Road Nos 17, Bosworth Road Nos. 35 - 57 (odd) Golborne Gardens On the 12th February, 1957, the Council made a Compulsory Purchase Order in respect of this area, excluding those premises which were in the Council's ownership but including the vacant site of No. 59, Golborne Gardens, as adjoining land, the acquisition of which was reasonably necessary for the satisfactory development or user of the cleared area. Objections were received from certain owners and the Minister of Housing and Local Government ordered a Public Local Inquiry to be held on 11th July, 1957• The Minister confirmed the Order, but modified it by excluding two properties (No. 37, Golborne Gardens and No. 56, Appleford Road) from the clearance area and including them as land which the Council are authorised to purchase compulsorily outside the clearance area. The Minister also directed that the Council should make payments in respect of No. 44, Appleford Road and the basement of No. 54, Appleford Road, on the ground that these properties had been well-maintained. The Order became operative on the 23rd November, 1957. In addition, the Council decided to make Compulsory Purchase Orders in respect of two additional sites within the area as follows No.l. Situated on the north-east corner of the junction of Bosworth Road and Golborne Gardens and formerly occupied by No. 40, Golborne Gardens and Nos. 9, 11, 13 and 15, Bosworth Road. (The site formerly occupied by No. 42, Golborne Gardens is also within this area, but has been excluded from the Order as it is in the Council's ownership.) - 43 - NO.2. Situated on the junction of Golborne Gardens and Hazlewood Crescent and partially occupied by engineering works in the former St. Andrews and St. Philips Church Hallo The vacant portion of the site formerly occupied by No. 2, Golborne Gardens and St. Andrews and St. Philips Church. The Orders in respect of these two sites were submitted to the Minister, who confirmed them without modification Housing Act, 1949 - Improvement Grants Owners who wish to modernise and make better use of existing houses by improvement and conversion, may apply to the Council for a grant towards the cost of the works of improvement or conversion. Houses which lack modern services and amenities are well on the way to permanent unfitness and the owners have less and less incentive to maintain them properly as they fall behind modern standards. In considering a scheme of improvement or conversion submitted for grant, only one question may properly be asked, namely, whether it will produce a satisfactory modernised dwelling complying with the statutory conditions and the specified requirements. The requirements which the Minister of Housing and Local Government has specified for a dwelling in respect of which an improvement grant may be made are as follows :- The dwelling must, after improvement or conversion :- 1. be in a good state of repair and substantially free from damp; 2. have each room properly lighted and ventilated; 3. have an adequate supply of wholesome water laid on inside the dwelling; 4. be provided with efficient and adequate means of supplying hot water for domestic purposes; 5. have an internal or otherwise readily accessible water closet; 6. have a fixed bath (or shower) preferably in a separate room; 7. be provided with a sink or sinks and with suitable arrangements for the disposal of waste water; 8. have a proper drainage system; 9. be provided in each room with adequate points for gas or electric lighting (where reasonably available); 10. be provided with adequate facilities for heating; 11. have satisfactory facilities for storing, preparing and cooking food; 12. have proper provision for the storage of fuel (where required.) Applications for improvement grants received and dealt with during 1957 are summarised as follows :- Applicatons recived 17 Application granted 15 (comprising 26 separate "dwellings") Application refused 2 Total amount of grants approved £9,526. Os. Od. Applications withdrawn after approval Nil - 44 - Overcrowding Since the end of the war, it has been felt that the rigid enforcement of the overcrowding standards in the Housing Act is impracticable and, therefore, the Public Health Committee approved a scheme for dealing with the worst cases in the first place. The Committee adopted a Modified Standard which involved increasing the "permitted numbers" 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. 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 public health inspectors who try and secure abatement by persuasion. Forty-nine new cases were dealt with in 1957 by the Special Sub-Committee as follows (a) Recommended for alternative accommodation by the council 29 (b) Consideration adjourned sine die 12 (c) Warnings sent to abate overcrowding within specified period 8 The number of cases of overcrowding abated during the year was sixty-three and, in addition, twenty-two Category 4 cases were also abated. Since the war, the Special Sub-Committee have dealt with one thousand, three hundred and twenty-six cases of overcrowding under Categories 1, 2 and 3, and no fewer than one thousand and seventy-seven of these have been abated. Assessment of Housing Priorities on Medical Grounds During the year one hundred and fifty-two applications for re-housing on medical grounds were examined, and recommendations for the award of additional points were made to the Chief Housing Officer. In each case the precise medical condition and resultant disability were determined (frequently necessitating communication with the family doctor or with the hospital attended.) The premises were inspected in detail to ascertain the extent and nature of the existing accommodation; the adequacy of day and sleeping space; the risk of infection; the existence - 45 - of remediable or irremediable sanitary or structural defects, and the existence of inconveniences, such as stairs which might be prejudicial to the patient. On this information and that supplied by the Chief Housing Officer, an assessment of points to be awarded on medical grounds was made. In eight cases, recommendations for re-housing on medical grounds were also made to the London County Council, and to other local authorities in eleven cases. At the end of 1956, the London County Council notified the 165,000 applicants on their waiting lists (Categories A, B and C) that only 2,000 could expect to receive an offer of accommodation within the next three years. No further names would be added to the waiting lists, although new applicants could, if they wished, place their names on a "deferred" list. A little over a hundred houses a year would be reserved for cases of very serious medical condition, aggravated by housing circumstances, confirmed by the County Medical Officer of Health. Applications for these must be made by the family medical practitioner concerned (or by the Chest Physician) direct to the County Medical Officer. In these circumstances, the number of cases notified to the London County Council as possessing medical claims for re-housing, has been reduced. The provision of new housing accommodation The post-war housing schemes completed in Kensington by the Council have provided 1,225 flats. The total number of properties under Council management at the end of 1957 is summarized in the following table Housing Properties 1890 Act 38 Cottage Estates 220 1919 conversions 90 pre-war flats 344 Sundry Properties 75 767 Temporary bungalows 87 compulsory purchase Areas 28 1949 Act Conversions 52 Post-War flats 1,225 1,392 Other Properties Henry Dickens Court Garages 10 Ingelow House Garages 12 Requisitioned properties(In Family Units) 2 Gadsden Mews Stores and Stables 17 Lonsdale Mews Stores and Stables 17 58 Requisitioned Properties (In Family Units) 2,217 744 2,961 Other schemes for building new housing accommodation are in various stages of preparation. Accommodation for Costermongers The general condition of mews dwellings in the borough has received much attention from the public health viewpoint in recent years In connection with the Council's policy of clearing unsatisfactory mews dwellings, it was appreciated that street traders must have storage - 46 - accommodation for their horses, vehicles, barrows and goods. At the Council's request, the London County Council promoted legislation to enable them to provide and maintain storage and stabling accommodation for use by street traders and other like persons displaced by reason of the exercise of powers under the Housing Acts, or by the acquisition of lands under any other enactment. The erection of costermongers' stabling and storage accommodation in Gadsden Mews and Lonsdale Mews (which haul been cleared under Housing Act procedure) has been completed and the following places have been provided :- Gadsden Mewa Lonsdale Mews Large s tores 8 5 Small stores 3 4 Stables 6 0 17 uni t s 17 units In addition, a refuse container shed, manure stores and sanitary conveniences have been provided for the traders„ 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 1957 Inspections Premises Number on Register Number of Inspections Number of Written Notices Factories in which Sections 1, 2, 3, 4 and 6 are enforced by the Council 197 129 7 Factories in which Section 7 is enforced by the Council (not included above) 523 572 18 TOTALS 720 701 25 - 47 - Defects found Particulars No. of defects found No. of defects remedied No. of defects referred To H. M. Inspectors By H. M. Inspectors Want of cleanliness - - 2 Overcrowding - - - - Unreasonable temperature _ - - - Inadequate ventilation - - - - Ineffective drainage of floors - - - - Sanitary conveniences - - - - (a) insufficient 1 1 - - (b) unsuitable or defective 26 20 - 1 (c) not separate for sexes 2 2 - Other offences (not including offences relating to Homework) - - - - TOTALS 29 23 2 1 During 1957» no prosecutions were instituted under the Factories Acts, 1937 and 1948• Outworkers The following table shows the nature of the work carried out by the one hundred and thirty home workers on the register of outworkers during 1957:- Nature of Work Number Paper bags 8 Wearing apparel - making, etc. ... ... 81 Artificial flowers and jewellery ... 20 Carding etc.. of buttons, etc. ... ... 6 Stuffed toys 12 Lampshades 1 Basket making 1 Curtains, etc. 1 130 During the year, two hundred and six 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. Basement bakehouses The Factories Act, 1937, (Section 54), requires the Council to carry out (in every fifth year) an examination of all basement bakehouses in the borough, for which certificates of suitability have been issued and are still in force. The quinquennial inspections for the year 1953/54 were made of twenty-seven underground bakehouses in respect of which certificates still operated. - 48 - As a result, the occupiers of fourteen basement bakehouses were permitted to carry on their businesses. Since that time, however, some of these basement bakehouses have ceased to be used as such for a period exceeding twelve months, and, in accordance with Section 54 of the Factories Act, 1937. shall not be so used again. At the end of the year, the following six premises in the borough were the only basement bakehouses remaining where baking can legally be carried on:- 139, Portland Road 46, Walton Street 151, Earls Court Road 178, Fulham Road 65, Golborne Road 79, Golborne Road Register of Factories Section 8 of the Factories Act, 1937, requires the Council to keep a list of all factories within the borough with respect to which the duty of enforcing the provisions of the Factories Acts is imposed upon them. The following table gives a summary of the factories on the Council's register at the end of the year, indicating the types of business carried on, whether or not mechanical power is used, and where situated, i.e. North or South Kensington:- 49 Factory - business North Kensington South Kensington Mech. N-M. Mecho N-M. Bakers and Confectioners 6 4 7 3 Belt Manufacturers 1 1 1 - Builders and Decorators 5 6 9 18 Carpet Makers and Repairers - - 2 1 Carton Recovery Service - 2 - - Coachbuilders 2 1 - - Coffee Grinding and Roasting 1 - 5 - Cosmetics 1 - - 1 Cycle Repairs - 1 1 - Dental Mechanics 1 - 2 1 Display Works and Signwriting 4 3 - 2 Doll and Toy Manufacturers 9 4 2 1 Dressmaking 12 - 20 14 Dyers and Cleaners 6 1 11 1 Electro-Platers 2 - - - Engineering (Eleco.) 11 1 8 3 Engineering (Mech.) 31 2 12 2 Engineering (Mecho) Repair Shops - - 4 1 Film Editing and Slide Making 1 - 1 - Furriers 2 1 9 3 Glass Cutting and Polishing 2 - 3 - Handbags and Shopping Bags 2 - - 1 Jewellers and Watchmakers 3 1 4 3 Lamp Shade Manufacturers 1 2 1 l Laundries 17 - 6 - Leather Goods 2 1 1 2 Metal Merchants 3 - - 2 Milliners 2 2 1 4 Motor Car Accessories 3 1 1 — M.V.R. and Garages 36 3 61 5 Oil Blenders and Packers 2 - - - Paint Makers and Storers 2 1 - - Photographers - 1 4 3 Picture Frame Makers 1 1 3 4 Plastics 1 2 1 — Printers and Bookbinders 17 1 6 _ Radio and Television Repairs 3 1 5 1 Sausage Makers 8 5 6 - Scientific and Hospital Instruments 2 1 2 - Shoe Makers and Repairers 10 1 7 3 Silk Screen Printing and Spraying 2 - 1 - Starch and Soda Manufacturers 2 1 — - Soft Furnishings and Upholstery 7 5 11 10 Stone Masons 1 1 - 2 Sweet Making and Packing - 1 2 - Tailoring 9 7 17 14 Weaving 1 - 1 - Woodworkers (Joiners, etc.) 12 4 13 6 Miscellaneous Factories 16 6 10 9 TOTALS 262 76 261 121 Sanitary accommodation etc., in shops Certificates of Exemption Under Section 38 of the Shops Act, 1950, the Council may grant - 50 - a certificate exempting a shop from the provision of suitable and sufficient water closet accommodation if they are satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable that such a certificate should be in force, and that suitable and sufficient sanitary accommodation is otherwise conveniently available. The Council have decided that in those shops where members of both sexes are employed, separate sanitary conveniences for each sex should be required if the number of employees exceeds four, but if the number is less than four, one sanitary convenience should be regarded as suitable and sufficient, provided that the door of the convenience is fitted with a proper lock or fastener on the internal side, and an automatic indicator shows on the external side of the door whether the apartment is engaged or vacant. During the year 1957. one exemption certificate under the Shops Act was granted in respect of the provision of sanitary accommodation. In twenty-three cases it was found possible to withdraw exemption certificates issued under the Shops Act during pre-war years. In eleven of these cases the premises had been demolished in connection with the Notting Hill Gate Road Widening Scheme, in five cases the premises had ceased to be used as shops, and in the remaining seven premises proper sanitary accommodation had been provided. Similarly, under the Food Hygiene Regulations, 1955, exemption may now be granted in food shops in respect of the provision of constant water supply, washhand basins with hot and cold water, cupboard or locker accommodation for outdoor clothing and facilities for washing food and equipment, if such provision cannot reasonably be required. During 1957, two exemption certificates were issued under the Food Hygiene Regulations in respect of washing facilities in food shops. In one case a certificate previously granted was withdrawn as the premises had been demolished. SUPERVISION OF POOD SUPPLIES General There are no abattoirs or slaughterhouses in the borough and no killing of animals for human consumption is carried out. Inspection of Food Premises Premises, where food is prepared, stored or exposed for sale for human consumption, are frequently inspected. The following is a record of the inspections made by the public health inspectors engaged on this work for 1957:- - 51 - Premises registered under - No. of premises No. of inspections (l) Section 16, Food and Drugs Act, 1955 - (a) for the sale, or the manufacture for the purpose of sale, of ice-cream, or the storage of ice-cream intended for sale 294 135 + (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 112 286 (2) Milk and Dairies Regulations, 1949 - (a) as dairies 86 339 (b) where the occupier is registered for the sale of milk in sealed containers only 129 820 + Additional inspections of the premises (not primarily in connection with the sale of ice-cream) are recorded under different headings in the following table. Food premises (all categories) No. of premises No. of inspections Bakehouses - underground 6 6 " - others 11 25 Bread and cake shops 45 82 Butchers 71 205 Dairies 87 339 Fishmongers 30 87 Food factories 5 26 General stores 8 141 Greengrocers 110 186 Grocers 225 679 Ice-cream 294 135 Preserved food 21 81 Public houses and off-licences 156 148 Restaurants and cafes 260 755 Sweet shops 168 162 Street markets, stalls and storage premises 87 (licensed traders .) 182 Food and Drugs Act, 1955 The Food and Drugs Act, 1955» which came into operation on 1st January, 1956, is now the principal Act for controlling the composition, labelling, fitness and hygienic handling of food; and the Food Hygiene Regulations, 1955.the principal instrument for enforcing good food hygiene practice. The new Act repealed the Act of 1938, and made changes affecting the work of the Council as follows (a) The power given to an authorised officer to examine food, is extended to include the power to examine and detain containers and vehicles transporting food other than thoae belonging to certain transport undertakings. (b) A Magistrate's Court may disqualify a caterer from - 52 - carrying on business if he is convicted of a serious offence against the Food Hygiene Regulations. (c) Requirements relating to the registration of certain types of food premises (ice-cream, or manufacture of sausages and potted, pressed, pickled or preserved food) were re-enacted in a different form. Applications for registration must now specify the particular part or parts of the premises it is desired to use for the purpose of the registered trade, and new registrations will not in future include any part of the premises not specified in the application. (d) Cream substitutes are divided into two categories"imitation cream" and "reconstituted cream". It is an offence to sell any substance which resembles cream in appearance, but is not cream, under a description which includes the word "cream". It is also an offence to sell any article of food containing such a substance unless it is not intended for use as cream or as a substitute for cream. Ice-cream, however, is not affected by these new provisions. (e) Changes in sampling procedure were effected, but these are mainly of a minor character. Food Hygiene Regulations, 1955 The title of these Regulations emphasises the changing trend whereby a national policy is slowly developing along the lines of clean food handling to safe food. The Regulations replace the former Section 15 of the Food and Drugs Act, 1958, and whilst they may be thought capable of varying interpretation, they constitute a considerable improvement. A brief summary of the main requirements is as follows Requirements affecting food handlers Persons handling food must - (a) keep their hands and clothing clean; (b) cover open cuts and abrasions with a water-proof dressing; (c) refrain from spitting; (d) refrain from smoking or taking snuff when handling food or when in any room where there is open food; (e) not place food so as to involve risk of contamination; (f) not allow unclean or printed wrapping material to come into contact with food; (g) notify the occupier (and owner) if suffering from, or becoming a carrier of, certain infectious conditions. Requirements relating to food premises (a) No room which communicates with a sanitary convenience may be used for the handling of food or the cleaning of equipment; (b) notices requesting users to wash their hands must be displayed in every sanitary convenience; (c) a constant, clean and wholesome water supply must be provided; - 53 - (d) suitable and sufficient washbasins must be provided, together with a supply of hot and cold water, soap, nailbrush and clean towels; (e) in premises where open food is handled, suitable and sufficient sinks, together with an adequate supply of hot and cold water, soap or suitable detergent, and of clean cloths must be provided, and in addition adequate and suitable cleaning and drying facilities; (f) lighting and ventilation of food rooms must be adequate and satisfactory; (g) walls, floors, doors, windows, ceiling, woodwork, and all other parts of structure of every food room, must be kept clean, and in such good order, repair and condition, as to enable them to be effectively cleaned and prevent risk of infestation by rats, mice, insects and birds» Requirements relating to food stalls Every stall - (a) must bear the name and address of the person carrying on the business; (b) must be kept clean and in good repair; (c) when used for meat and fish, must be covered over and screened at the aides and back, and a covered metal refuse bin must be provided for all waste trimmings; (d) when used for open food, for immediate consumption, must be provided with suitable and sufficient sinks for washing food and equipment, together with a supply of hot and cold water, soap, nailbrush, clean towels and drying cloths. Generally Suitable and sufficient bandages, dressings and antiseptic must be provided and maintained in food premises. Sufficient and suitable cupboard or locker accommodation for clothing and footwear must be provided for persons engaged in or about food premises. In premises where the business consists wholly or partly of the supply of food for immediate consumption, food consisting of meat, fish, gravy or imitation cream, or prepared from or containing these substances, or any egg or milk, must be kept in accordance with the specified temperatures. Pood in or about any forecourt,, yard, market or stall must not be placed lower than 18 inches from the ground. A person guilty of an offence against any of these regulations shall be liable to a fine not exceeding £100 or to imprisonment for a term not exceeding three months, or to both, and, in the case of a continuing offence, to a further fine not exceeding £5 for each day during which the offence continues after conviction. The Council, in considering these new Regulations, decided to send to every person, in charge of a food business in the borough, a copy of the Regulations with a summary of their main provisions. It was also decided to request the local newspapers to give publicity to the new Regulations. During the year, the public health inspectors have been engaged - 54 - on surveying food premises in the borough and a total of 3,239 inspections was made. In 164 cases it was necessary to send informal letters pointing out deficiencies under the Regulations and, generally speaking, the food traders are complying with the requirements in a co-operative manner. In a few cases it was found necessary to take legal proceedings for contraventions of the Regulations in respect of- (i) smoking whilst engaged in handling food; (ii) exposing food to contamination; (iii) lack of cleanliness of equipment; and (iv) lack of cleanliness and repair of food rooms. Fines totalling £53. 0s. 0d. with £9. 17s. 6d. costs were imposed. Milk (Special Designations)(Raw Milk) Regulations, 1949/54 During the year licences under these Regulations were granted as follows:- Principal Supplementary Dealers licensed to sell Tuberculin Tested Milk; 124 25 Ninety samples of Tuberculin Tested Milk were submitted for examination during the year. Twenty-three failed to pass the prescribed tests and in each case particulars were forwarded to the Ministry of Agriculture, Fisheries and Food. The following table summarises the details of the samples taken Designation No. of samples Methylene blue test Passed Failed Tuberculin Tested (Farm bottled) 90 67 23 Tuberculin Tested - - - Milk (Special Designations)(Pasteurized and Sterilized Milk) Regulations, 1949/53 Details of licences granted during 1957 are as follows Principal Supplementary Dealers' licences to sell Pasteurized Milk; 145 25 Dealers' licences to sell Sterilized Milk; 146 27 The following table shows the number of samples of processed, milk taken during the year, together with results of the examinations - 55 - Designation No. of samples Methylene blue test Phosphatase test Turbidity test Passed Failed Passed Failed Passed Failed Tuberculin tested (Pasteurized) 20 20 - 20 - - Pasteurized +54 53 - 54 - - - Sterilized 2 - - - - 2 - + One sample was not submitted to the methylene blue test as the atmosphere shade temperature exceeded 65°F, which is the limit specified in the Regulations. Milk and Dairies Regulations, 1949/53 (a) Registrations The number of persons registered under these Regulations at the end of the year, to sell milk in the borough (including the sale of milk in sealed containers) was 199° (b) Unclean milk containers It is an offence under the Regulations for any dairy farmer or distributor to use for holding milk any vessel that is not in a state of thorough cleanliness immediately before use. During the year, five contraventions were reported. In two of these the Public Health Committee authorised legal proceedings; the Court hearings are pending. In the remaining three cases investigations failed to reveal sufficient evidence to justify legal action. Composition of Milk During the year a total of three hundred and forty-six samples of milk (all grades) was submitted to the Public Analyst. Ten were found to be below the legal and presumptive standards laid down, and the results of these were sent to the Ministry of Agriculture, Fisheries and Food. Warnings were given to the producer and vendor in seven of these cases, and in two cases legal proceedings were taken. In the remaining one case of deficiency, it was decided to take no action. The following table shows the percentages of milk-fat and non-fat solids of the genuine samples of milk, other than Channel Islands and South Devon Milk, taken during each month. It should be mentioned that, included in these, are thirteen samples certified by the Analyst to be genuine, although the percentage of solids not fat was slightly below the presumptive standard of 8.5%. - 56 - Month No. of samples taken Average percentages Milk fats Non-fat solids January 24 5.71 8.60 February 25 5.66 8.58 March 12 3.53 8.54 April 23 3.54 8.62 May 27 3.47 8.76 June 14 3.6l 8.83 July 8 3.93 8.70 August 20 3.60 8.69 September 18 3.78 8.74 October 12 3.68 8.81 November 18 3.88 8.80 December 12 3.93 8.75 Average for whole year 3.69 8.70 Legal minimum standards 3.00 8.5O Milk and Dairies (Channel Islands and South Devon Milk) Regulations, 1956 These Regulations require that all milk for human consumption sold under the specific description of- Channel Islands Milk Jersey Milk Guernsey Milk or South Devon Milk must contain not less than 4% by weight of milk fat. This compares with the presumptive milk fat standard of 3% specified for ordinary milk by the Sale of Milk Regulations, 1939. During the year, 127 samples of these milks have been taken and four were found to be below the standard laid down. In two cases legal proceedings were taken, and the defendants were granted conditional discharges on payment of £3. 3s. 0d. costs. In the other two cases, the Public Health Committee decided to issue warnings. The following table shows the average percentages of milk fat and non-fat solids of the genuine samples of these milks taken during each month Month No. of samples taken Average percentages Milk fats Non-fat solids January 10 4«58 8.90 February 12 4*33 8.88 March 16 4.54 8.77 April 4 4.29 8.93 May 6 4.16 9.03 June 10 4.27 9.01 July 10 4.24 8.98 August 11 4.43 8.95 September 13 4.46 9.00 October 6 4.78 9.18 November 11 4.66 9.19 December 14 4.59 9.04 Average for whole year 4.44 8.99 Legal minimum standards 4.00 8.50 - 57 - Unsound food Seizure Under Part 1 of the Food and Drugs Act, 1955. it is an offence to sell, offer, or expose for sale, or to be in possession for the purpose of sale or preparation for sale, food intended for human consumption which is in an unfit condition Such food can be seized and taken before a Justice of the Peace who can condemn it, and order it to be destroyed or disposed of for purposes other than human consumption. During 1957 there were two occasions when it was found necessary to enforce this procedure. One was in the case of a grocers shop. The premises were very congested, with little space to stand, there being no orderly method of storage of food. Altogether 18-cwt. of foodstuffs comprising canned goods, butter, margarine, tins of biscuits, packets and bottles of sweets, etc., were moved from the premises and taken before a Justice of the Peace who condemned it as being unfit for human consumption and ordered it to be destroyed. Most of the food appeared not to have been disturbed for a considerable time and was unfit by reason of the rusty and perforated condition of the tins, and the mouldy and general unfit condition of the food. Legal proceedings were instituted, and on a plea of not guilty the occupier of the shop was discharged conditionally for twelve months. The other case was a grocery and delicatessen shop found to be in an unsatisfactory condition. The floors, shelves and utensils were dirty and there was evidence of mice infestation. A tray containing a quantity of bread crumbs was found to be contaminated with mice faeces. The bread crumbs were seized and taken before a Justice of the Peace, who gave the necessary order for them to be condemned and destroyed. Legal proceedings were instituted against the occupier of the food premises, and upon conviction he was fined £20 plus 10s. 6d. costs. 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, 1956, surrender it to the Council for destruction or other suitable method of disposal. During the year the following amounts of food were surrendered and condemned as unfit for human consumption Food Tons Cwt. Qrs. Lb. Meat(raw) 7 13 Meat (tinned - 9 1 - Ham 1 4 1 1 Sausages • — 2 25½ Pish (wet and dry - 3 3 26 Cheese <_ 6 3 22 Dried fruit — 1 2 8 Chickens - 1 3 1 Rabbits • - 2 4 Sugar - - 1 7 Salami - 11 3 - Cucumbers in brine - 2 2 - TOTAL 3 10 2 23½ Tins, jars, packets or cartons of fruit, vegetable and miscelleneous foodstuffs 8,192 - 56 - All food condemned as unfit for human consumption is collected by the Council, taken to their refuse destructor in Wood Lane and destroyed. In no instance were large quantities of food involved, necessitating special examination of stocks of food. Damaged foodstuffs In March, 1957.a large water main burst in a roadway in Kensington. Three foodshops were flooded, one badly, and a large amount of food was rendered unsaleable and unfit for human consumption and had to be destroyed. A summary of the damaged food is as follows :- Food Cwt. Qtrs. Lb. Dried fruits, etc. - 2 19 Cooking fats and butter - 3 2 Cheese - 1 2 Syrups and sugar 1 1 19 Flour, custard powder, etc. - 2 13 Tea, coffee and cocoa - 1 11 Nuts, various - 1 10 Fruit - 2 15 Vegetables 6 - 6 Soup powders and mixes - 1 23 Jams, various - 1 12 TOTAL 11 3 20 Tins, packets and cartons of various foodstuffs 257 Pickles and sauces 1 gallon Complaints by purchasers of unfit food During the year eighteen complaints were received from members of the public who alleged the unsatisfactory condition of food purchased by them. The complaints generally related to the presence of foreign matter in foods, mouldy condition of meat pies, bread and cakes, and the unsatisfactory condition of chicken, cream, meat, butter and lemonade. In two of the cases it was decided to take legal proceedings. One was in respect of pork pies found to be mouldy. The vendor pleaded guilty and was fined £2. Os. Odo with £2. 2s. Od. costs. The other case was in respect of a malt loaf in which was found embedded the remains of a cockroach. The vendor pleaded guilty and was fined £5. Os. Od. with £2. 2s. Od. costs. In four further cases concerned with the presence of brick dust in a loaf of bread, brush bristles in a loaf of bread, a wrapped malt currant loaf which was mouldy and a Danish pastry in which was found embedded a piece of wire, the Public Health Committee decided to send warnings to the manufacturers. The remaining twelve complaints were dealt with by informal action either owing to lack of detailed evidence or to the complaint not being substantiated. Adulteration of Pood During the year five hundred and eighty-three formal samples of - 59 - food, and drugs were purchased, of which nineteen (3.3%) were either adulterated or otherwise unsatisfactory. Pour hundred and seventeen informal samples were also purchased, of which twenty-two (5.3%) were either adulterated or otherwise unsatisfactory. The following table summarises the action taken in respect of the defective samples:- Unsatisfactory sample No. of prosecutions No. of warnings to Producers, Manufacturers or Vendors No further action Total Milk 2 7 1 10 Pork sausages - 1 4 5 Beef sausages - 1 - 1 Tomato Juice (canned) - - 2 2 Tomato Paste - - 1 1 Creamed Tomato Soup - - 1 1 Spaghetti in Tomato Sauce - 1 - 1 Pilchards in Tomato Sauce - - 1 1 Meat Soup (canned) - 1 - 1 Cayenne Pepper - 1 - 1 Ground Black Pepper - - 1 1 Butter - 1 - 1 Margarine - 1 - 1 Cream Cheese - - 1 1 Sterilized Cream - - 1 1 Condensed Milk (Sweetened) - - 1 1 Blackcurrant Syrup - - 1 1 Blackcurrant Juice - - 1 1 Orange Colouring - - 1 1 Raspberry Colouring - - 1 1 Marzipan - - 2 2 Pickles - 2 - 2 Glace Cherries - 1 - 1 Rice Pudding (canned) - 1 - 1 Savoury Spread - - 1 1 TOTALS 2 18 21 ++ 41 ++ In all cases the results of these unsatisfactory samples were brought to the notice of the producers, manufacturers, or vendors as the case may be. Ice Cream The Food Standards (Ice Cream) Order, 1953, specifies a minimum standard for ice cream of 3% fat, 10% sugar and 7½% milk solids other than fat. The following table shows the number of samples taken during -957 for chemical analysis compared with the previous year:- - 60 -  1957 1956 Number of samples 30 32 Variation of fat content per cent 7.8 to 13.0 4.6 to 13.6 Variation of non-fat content per cent 21.0 to 34.4 21.2 to 31.6 Average fat content per cent 10.32 9.99 Average non-fat solids content per cent 25.87 24.90 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 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 taken to decolourize 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 the year thirty-five samples of ice-cream were taken and submitted to the methylene blue test. The results are as follows Grade No. of samples 1 7 2 5 3 5 4 18 Premises in the borough where ice cream is manufactured, stored or sold were frequently inspected during the year and generally were found to be in a satisfactory condition, having regard to the Ice Cream (Heat Treatment, etc.) Regulations, 1947/52. FOOD POISONING The Food and Drugs Act, 1955, requires any medical practitioner, on becoming aware that a person is suffering, or is suspected to be suffering from food poisoning, to notify the Medical Officer of Health. The following table shows particulars of notifications received in 1957:- Food poisoning notifications (corrected) First 10 Second quarter 16 Third quarter 18 Forth quarter 8 TOTAL 52 Outbreaks due to identified agents 2 ( 5 cases) Outbreaks of undiscovered cause 5 (13 cases) Single cases - Unknown cause 19 Agent identified 15 Total cases 34 - 61 - Outbreaks due to identified agents (2 outbreaks; (a) The first outbreak involved two young children- The first child, a girl aged nine months, fell ill with fairly severe diarrhoea, and a few days later her sister, aged 2 years, had similar symptoms. Faecal specimens were obtained from the sufferers and their parents; those from the sufferers showed the presence of salmonella newport. The Public Health Department first became aware of these cases when the reports of the bacteriological examinations were received, and by that time it was impossible to obtain clear evidence of a source of infection. It seemed clear, however, that the first patient had contracted the infection from some unknown source and passed it on to her sister. Both children were treated at home and soon recovered. (b) The second of these outbreaks involved three members of a family of five persons. The first patient was a boy of 3 years of age who suffered symptoms of diarrhoea, vomiting and fever. At intervals of about five days, a brother aged 8 years and the father aged 47 years, suffered similar symptoms. The whole family submitted faeces specimens and those from the sufferers were reported positive for salmonella typhi-murium. The pattern of spread of the infection within this family was fairly clear, but investigations did not reveal the source of infection in the first patient. Outbreaks of undiscovered cause (5 outbreaks) (a) The first outbreak of this kind affected a mother aged 21 years and her two children aged 2 years and 8 months respectively. Only the father remained well. The mother fell ill first with symptoms of pain, slight diarrhoea and vomiting, severe headache and fever. Two days later the children were similarly affected. Faeces specimens submitted by all members of the family were reported negative. Over a week elapsed between the date of onset and the notification to the Public Health Department. The consequent lapse of time made it impossible to detect any specific source of infection. The patients quickly recovered with treatment from their own doctor. (b) In this small outbreak, three persons were affected but only two of them were Kensington residents. A woman aged 72 years, her son aged 19 years and his fiancee aged 19 years from Mitcham fell ill with severe symptoms of pain and diarrhoea twenty-four hours after eating a meal in common at home in Kensington. Faeces specimens obtained from the sufferers were reported negative. From the investigations made at the home it was considered that the vehicle of infection may have been a reheated steak pie eaten by all the patients. Unfortunately, none of the food remained for bacteriological examination. Although the faecal specimens were negative, the pattern of the outbreak suggested an infection by a heat-resistant organism. (c) In this outbreak, three cases, comprising a single family, were notified as food poisoning. A woman aged 65 years was the first sufferer with symptoms of diarrhoea, vomiting and fever. A day later her grand-daughter aged 16 years suffered from milder symptoms, but twenty-four hours later, the girl's mother, aged 38 years, suffered more severe symptoms. Bacteriological examination of the patients' faeces, however, revealed nothing. Investigations showed no definite source of infection. The patients quickly recovered from their illnesses. (d) This outbreak involved only two persons out of a family of five persons. The mother aged 35 years and a boy aged 5 years suffered - 62 - moderately severe symptoms of diarrhoea and vomiting. A specimen of faeces was obtained from each member of the family, but all were reported negative. The source of infection was not established as all meals consumed by the two patients were eaten in common with some other members of the family who remained unaffected. (e) The last outbreak of this type involved a family of three persons, comprising a man aged 55 years, his wife aged 45 years and the wife's sister aged 50 years. All suffered symptoms of pain, diarrhoea, vomiting, headache, fever, drowsiness and prostration. Faeces specimens submitted were reported negative. The family concerned were found to be food hygiene conscious and no article of food consumed prior to onset appeared to be worthy of suspicion. The possibility of other types of poisoning was investigated, but nothing significant was found. Single cases In addition to the outbreaks referred to above, there were thirty-four single cases of food poisoning notified. In nineteen of these, no causative agent was identified, but in the remaining fifteen cases, the identified agents were as follows s- Agent Cases Salmonella typhi-murium 12 Salmonella Stanleyville 1 Salmonella virchow 1 Salmonella heidelberg 1 Ten of the notified cases were admitted to hospital for treatment. All of them were single cases in which the causative agent was identified. Salmonellosis - Cross infection in hospitals Occasionally outbreaks of infection occur in hospitals due to salmonella organisms. Such outbreaks arise sometimes where a symptomless carrier has been admitted for treatment or where such a carrier is employed in hospital. Although the causative agent is one normally associated with food poisoning such outbreaks are not generally food-borne. The point is dealt with in a recent Ministry of Health memorandum on Food Poisoning and provision has been made for an annual return of such cases as distinct from food-borne infections. During 1957.two hospitals were affected with cross infection due to salmonella typhi-murium. In the first instance, ten patients were involved to an explosive outbreak which was quickly brought under control. The source here was a symptomless carrier admitted for treatment. In the second instance, eighteen cases were recorded over a period of nine months, although these covered several small outbreaks. The sources in this instance were mixed; one outbreak at least was probably due to a symptomless carrier on the nursing staff whilst the others were due to the admission of symptomless carriers for treatment of other conditions. INFECTIOUS DISEASE Smallpox No case of smallpox was notified in the borough during the year 1957. - 63 - 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 revaccinated at not more than yearly intervals. During year thirty 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 1957 was thirty-three and, of this total, six were treated in hospital. There was no fatal case during the year; in fact, there has been no death from scarlet fever in Kensington since 1940. Diphtheria No case of diphtheria was notified during the year. Only twice before, in 1952 and in 1954, has this record been achieved. 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 is as follows Number of pre-school children immunised 1,186 " " school " " 481 " " re-inforcing injections given 1,790 " " children attending for pre-Schick tests 421 " which gave a positive reaction 321 " " " " negative reaction 77 " of children attending for post-Schick tests 815 " proving negative 765 " proving positive 23 " who failed to attend for reading 50 Enteric Fever During the year there were five cases of paratyphoid fever and none of typhoid fever. The first case of paratyphoid fever was a boy of 5 years of age who was the third member of a West Indian family to be involved in a small outbreak which was mentioned in my Annual Report for last year. The second and third cases were two baby boys, aged eight and ten months respectively, living in the same house in North Kensington. It was quickly established that the mother of one of the children was a carrier who had first contracted the disease in Wales in 1951 and had remained a symptomless excretor since. The type of organism was the same in the carrier as in the two infected children. The patients and the carrier received treatment in hospital; the organism was eradicated from the children but the mother remained a carrier. She has since moved from Kensington and the Medical Officer of Health for her new address has been informed of the circumstances. The fourth case involved a young lady aged 20 years who was admitted to hospital four days after returning from a holiday in Spain. Her address in Kensington was a hostel, her own home being in Kent. The patient became seriously ill and died in hospital thirteen days after admission. Contacts of the patient, including a young lady who accompanied her to Spain, remained well and submitted specimens for bacteriological examination which were reported negative. The fifth case occurred in a young man of 23 years of age who bad returned from a holiday in Italy a week before admission to hospital. He remained in hospital less than a week and faecal specimens submitted there, and at home after discharge, were consistently negative. The - 64 - diagnosis rested on the evidence of clinical signs and a suspicious blood specimen. However, in view of a history of T.A.B. inoculation two years previously, which may have clouded the blood picture, this case may be regarded as a doubtful one. Puerperal Pyrexia During 1957, the number of cases of this disease notified was one hundred and twenty-three, of whom ninety-one were persons normally resident outside the borough. Three of the cases occurred after home confinements; the remaining one hundred and twenty cases occurred in hospital. In order to show some perspective in reviewing this disease (defined as any febrile condition occurring in a woman in whom a temperature of 100.4°F or more has occurred within fourteen days after childbirth or miscarriage), the following table sets out an analysis of the cause of pyrexia of the cases notified in 1957:- Cause Number of cases Flushed breast, breast abcess, mastitis 6 Respiratory infections:- Chest infection 2 Influenza 3 5 Skin ulceration 1 Urinary infection 9 Cystitis 2 Pyrexia associated with abnormal delivery:- Birth on way to hospital 1 Forceps delivery 2 Transfusion reaction 1 Caesarian section 9 13 Uterine infection 26 Causes unknown after investigation 43 Not stated 18 In addition to the above one hundred and twenty-three cases, information was received concerning sixty-five patients normally resident in Kensington, who were notified as suffering from puerperal pyrexia in other London districts. No deaths occurred under this heading. Pneumonia There are various forms of pneumonia, but the only types notifiable are (i) acute primary and (ii) acute influenzal pneumonia. During the year, seventy-five notifications were received, thirty-six being acute primary pneumonia and thirty-nine being acute influenzal pneumonia. Of the total, twenty-five cases were removed to hospital for treatment. The number of deaths from pneumonia (all forms) was ninety-four, and the number of deaths from influenza was fourteen during 1957. Dysentery Seventy-seven cases of dysentery were notified during 1957, all except one of which were bacillary in origin, the majority being due to Sonne bacillus. One case of ameobic dysentery occurred in a young woman recently immigrated from the Far East. Generally speaking the cases were of a mild type and there were no deaths. Erysipelas Seven cases were notified during the year; three were treated at home, and four were admitted to hospital. There were no deaths. - 65 - Meningococcal infection Three cases of this disease were notified during the year and all were removed to hospital. No deaths were reported. Malaria Five cases of malaria were reported during the year, but investigations showed that the patients had all recently returned from abroad, and presumably had contracted the infection overseas. Poliomyelitis There were fifteen cases of acute poliomyelitis notified and confirmed during the year; thirteen of the cases showed symptoms of paralysisc There was one death from this disease during the year. The figures for the past five years are as follows:- Year Confirmed cases Deaths 1956 21 Nil 1955 30 Nil 1954 5 Nil 1953 14 1 1952 21 2 Contacts of all cases notified were kept under surveillance for twenty-one days, (or until the diagnosis was changed in unconfirmed cases,,) There were twenty-nine suspected cases removed to hospital, where the diagnosis was not confirmed. In each instance an advisory pamphlet was issued setting out the elementary precautions to be taken. Kensington residents, who were contacts of cases occurring outside the borough, were also kept under observation. During the year, no multiple cases within single families occurred. Although the proportion of paralytic cases appears high, it should be remembered that paralysis is defined as muscular weakness however transient or slight. In general this year, the cases were mild in character. However, one woman aged 45 years died of paralytic poliomyelitis five days after onset of the disease and three days after admission to hospital. Investigation in the field concerning the possible association between inoculation against other diseases and the contraction of poliomyelitis was discontinued by the Medical Research Council. However, with the advent of inoculations against poliomyelitis itself, the public health department has been working closely with the London County Council. One case of paralytic poliomyelitis, (slight transient muscular weakness only), who fell ill in January, had been inoculated six months earlier. It was clear that the inoculation was not responsible for the disease. Acute encephalitis Three cases of this disease were notified in the borough during 1957. No deaths occurred. Measles Of the nine hundred and eighty-two cases notified during 1957, nineteen were admitted to hospital for treatment. The death of an elderly person from myocarditis associated with measles occurred during the year. Ophthalmia neonatorum Only one case of this disease was notified. The patient was treated in hospital and recovered without injury to sight. - 66 - Gastro-enteritis This disease is notifiable in children up to the age of five years. The number of cases reported during the year was ten. Three were removed to hospital for treatment. Three deaths of children under five years of age were recorded as due to gastritis, enteritis or diarrhoea. Scabies The number of cases of scabies notified during 1957 was fifty-two, which compares with four hundred and sixty-three notified in the peak year of 1946. Tuberculosis During the year two hundred and eight new cases of tuberculosis were notified, of which one hundred and ninety-two were respiratory and sixteen 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 Non Respiratory Total M F M P On register of notifications on 1st January, 1957 826 688 71 95 1,680 Notified for the first time during the year 101 91 7 9 208 Brought to notice other than by notification 90 67 5 5 167 Removed from register on account of having- (a) recovered from the disease 24 16 3 4 47 (b) removed from district lost sight of, etc. 166 127 8 17 318 (c) died 21 5 2 1 29 Remaining on register on 31st December, 1957 806 698 70 87 1,661 The system of investigation into the environmental conditions of tuberculous patients continued during the year. All newly notified cases and those cases transferring into Kensington or changing their address in the borough, have been visited by the public health inspectors with the objects of tracing the source of infection, preventing the spread of infection and removing conditions favourable to infection. Particular attention was given to the home conditions in addition to the dissemination of advice to prevent the transmission of infection to contacts. During the year, three hundred and forty-five visits were paid to the homes of tuberculous patients. In two hundred and nine of these, the environmental conditions were such as to require no further action on the part of the public health department; in a further fifty-one cases, it was found that the patients had moved away, and in forty-one other cases the investigations were postponed as the patients were away in hospital or had not been contacted by the end of the year. The action taken in the remaining forty-four cases is summarised as follows:- - 67 - Action taken Cases Investigation or supervision undertaken in respect of:- (a) re-arrangement of existing accommodation 11 (b) occupation of patients 3 (c) tracing of contacts 7 (d) prevention of spread of infection 10 Recommended for priority re-housing 13 Action was taken under the Public Health and Housing Acts in respect of insanitary or unhealthy conditions in three cases. Incidence of tuberculosis amongst Kensington residents who originated from areas outside England, Scotland and Wales In my Annual Report for 1951, attention was drawn to what appeared to be a disturbing trend in the incidence of tuberculosis amongst immigrants. Since 1952, a more detailed investigation of this problem has taken place and the following table sets out the information found in 1957:- Country of origin Period (in years) between entry to United Kingdom and notification of disease Total 123456789 Australia l - - - - - - - - 1 Argentine 1 - - - - - - - - 1 British East Africa - - l - - - - - - 1 British West Africa l - - - - - - - 1 2 British West Indies 8 3 - - - - - - - 11 Cyprus l - - - - - - - - 1 Hong-Kong l - - - - - - - - 1 Hungary 1 - - - - - - 1 - 2 Ireland 3 - 1 2 2 1 1 - - 10 Italy - - 3 - - 1 - - - 4 Malaya - - - - - 1 - - - 1 Poland - - 3 2 - - 1 - 1 7 South Africa 1 - - - - 1 - - - 2 Spain - - - - 1 - - - - 1 U.S.S.R. - 1 - 1 -1 - 1 - 4 TOTALS 18 4 8 5 3 5 2 2 2 49 - 68 - Patients who had resided in London all their lives or for at least 10 years 61 Patients who had resided in other parts of the country all their lives prior to coming to Kensington 49 Patients from whom information concerning origin was not obtained but where it is believed to be this country 17 Patients from Ireland who resided here at least 10 years prior to notification 8 Patients notified abroad before coming this country (Ireland 4, Egypt 1, S.Africa 1, France 1, New Zealand l) 8 Patients from Poland who resided here at least 10 years prior to notification 2 Patients who resided here at least 10 years prior to notification: (Ethiopia 1, Nepal 1, Hungary 1, West Africa l) 4 Patients from whom information concerning origin could not be obtained 99 TOTAL 248 The investigation only covered patients newly notified or transferring into the borough from other areas. The total of two hundred and ninety-seven cases surveyed differs from the total of tuberculous patients visited in the year. The difference consisted of old cases changing residence within the borough. In 1951, a full survey was not made, but it was estimated that 20% of the tuberculous patients visited for the first time in that year were immigrants who contracted the disease within ten years of arrival in this country. A more accurate investigation showed that the proportion for 1952 was 16%, whilst the comparable figures for 1953, 1954, 1955, 1956 and 1957 were 10%, 16%, 17% 15% and 16% respectively. From the statistics this year, it is perhaps worth noting that 37% of the immigrants contracted the disease within one year of arrival in this country; 61% contracted it within three years of arrival. Persons born in the Republic of Ireland were regarded as immigrants for this purpose. The 1951 Census figures showed that out of a total Kensington population of 168,160, there were 29,353 residents (or just over 17%) who were born outside the United Kingdom and the Republic of Ireland. Whooping Cough One hundred and thirty cases were notified during the year, five of which were treated in hospital. No death was reported from this disease. International certificates In order to prevent the spread of infectious diseases, certain countries require that visitors should be vaccinated or inoculated against specified diseases. International certificates have been prescribed for smallpox, yellow fever and cholera. When completed by the medical practitioner, the certificate must be authenticated by the Medical Officer of Health. During the year, three thousand, two hundred and thirty-nine of these certificates were authenticated in Kensington. In addition, twenty-seven special exemption certificates were issued to travellers for use in the United States of America. - 69 - Notifications The following tables show (l) the number of cases of infectious disease notified during the year 1957, with comparative figures for the previous seven years; (2) the number of notifications divided into age groups; and (3) the number of cases notified in each ward of the borough. TABLE 1 Notifiable disease Number of cases notified 1957 1956 1955 1954 1953 1952 1951 1950 Scarlet fever 33 45 50 52 78 108 68 100 Diphtheria (including membranous croup) - 1 2 - 2 - 1 2 Enteric fever 5 10 7 5 5 2 7 12 Puerperal pyrexia 123 117 125 96 65 83 22 18 Acute primary pneumonia and acute influenzal pneumonia 75 65 105 54 93 71 149 69 Dysentery 77 88 99 68 131 31 81 18 Erysipelas 7 5 9 14 11 11 13 17 Meningococcal infection 3 6 2 1 6 4 8 5 Malaria 5 1 6 4 5 1 2 2 Acute poliomyelitis Paralytic 13 14 10 5 9 17 8 7 Non-paralytic 2 7 20 - 5 4 4 6 Acute encephalitis 3 2 4 1 - 3 1 - Tuberculosis (all forms) 208 258 218 243 256 251 238 278 Measles 982 358 1425 94 740 839 1314 696 Ophthalmia neonatorum 1 1 4 2 7 2 2 12 Enteritis + 10 14 13 20 27 30 25 63 Food poisoning 52 63 53 58 79 20 18 23 Scabies 52 40 54 42 42 26 34 72 Whooping cough 130 236 116 136 485 228 484 316 Typhus fever - - - 1 - - - - TOTALS 1781 1331 2322 896 2046 1731 2479 1716 + Notifiable only in children under the age of 5. NOTE: Cases of mistaken diagnosis are excluded from above table. - 70 - TABLE 2 Notifiable disease Number of Cases Notified in 1957 Age Groups in Years Under 1 1 to 2 3 to 4 5 to 9 10 to 14 15 to 24 25 & over Scarlet fever - 4 6 18 2 2 1 Diphtheria (including membranous croup) - - - - - - - Enteric fever 2 — — 1 - 2 - Puerperal pyrexia - - - - - 59 64 Acute primary pneumonia and acute influenzal pneumonia 2 4 3 5 2 7 52 Dysentery 4 14 7 14 8 6 24 Erysipelas - - - - - - 7 Meningococcal infection 1 - — — - 1 1 Malaria — — - - - 1 4 Acute poliomyelitis Paralytic - - 2 2 - 3 6 Non-paralytic - - - - - 2 - Acute encephalitis - - — — - 2 1 Tuberculosis (all forms) - 4 - 5 2 39 158 Measles 29 223 268 415 10 15 22 Ophthalmia neonatorum 1 - - • • - - Enteritis 5 5 - - - - - Food poisoning 7 5 3 4 2 7 24 Scabies 1 3 1 5 - 18 24 Whooping Cough 14 42 26 45 2 - 1 TOTALS: 66 304 316 514 28 164 389 TABLE 3 Total Cases notified, in each Ward Notifiable disease StoCharles Golborne Norland Pembridge Holland Earls Court Queens Gate Redcliffe Brompton Scarlet fever 8 4 6 4 2 3 3 1 2 Diphtheria (including membranous croup) - - - - - - - - - Enteric fever - 2 1 - - - 1 - 1 Puerperal pyrexia 7 1 8 - 3 7 91 6 - Acute primary pneumonia and acute influenzal pneumonia 11 7 10 9 8 3 4 21 2 Dysentery 14 5 4 8 2 11 3 24 6 Erysipelas - - 1 2 2 2 — — - Meningococcal infection 1 - - 1 - - - 1 - Malaria - - 1 - - 1 2 1 - Acute poliomyelitis Paralytic 1 2 3 2 - - 2 1 2 Non-paralytic - - - - — - 1 1 - Acute encephalitis - - - - - 1 1 1 - Tuberculosis (all forms) 28 22 21 30 20 36 19 18 14 Measles 196 182 85 109 138 111 41 93 27 Ophthalmia neonatorum - - - 1 - - - - - Enteritis 3 6 - 1 - - - - - Food poisoning 3 4 8 4 5 8 1 17 2 Scabies 6 6 9 10 4 10 - 6 1 Whooping Cough 32 24 14 15 12 14 5 11 3 - 71 - LEGAL PROCEEDINGS Public Health (London) Act, 1956 Nuisances During the year, 124 summonses were issued for various nuisances under the Public Health (London) Act, 1936. In 40 cases Abatement Orders were secured and costs amounting to £43. l6s. Od. were awarded to the Council. In 28 cases the summonses were withdrawn, the nuisances having been abated prior to the Court hearings. In 54 cases the summonses were adjourned as the necessary works were being carried out by the defendants. In one case the summons was dismissed and the defendant was awarded £2. 2s. Od. costs against the Council. In one case the summons was withdrawn as the defendant died before the Court hearing. Sixteen prosecutions were undertaken for failure to comply with Justices' Orders to abate statutory nuisances. In six cases fines amounting to £28. 4s. Od. were imposed and costs amounting to £35. 14s. Od. were awarded to the Council. The remaining ten cases were withdrawn or adjourned sine die as the necessary works had been, or were being, carried out. Obstruction of Council's officers Three summonses under the Public Health (London) Act, 1936, were issued against an owner for unlawfully obstructing one of the Council's public health inspectors from entering premises. On two counts fines amounting to £1. Os. Od. with £3. 3s. Od. costs were imposed and the third summons was adjourned sine die. The defendant appealed against his convictions to the Quarter Sessions, but the appeal was dismissed on 20th November, 1957, and costs of £21. Os. Od. were awarded to the Council. The restoration of the third summons was effected on 6th May, 1958, when a fine of £5. 0s. Od. with £4. 48. Od. costs were imposed. London County Council (General Powers) Act, 1951 Ten summonses were issued under Section 6 of this Act in respect of deficient or defective dustbin accommodation. Convictions were obtained in three cases and fines amounting to £1. 10s. Od. with £1. 11s. 6d. costs were imposed. In three cases the summonses were withdrawn as the dustbins had been renewed. Three cases were adjourned sine die, and in the last case the summons was withdrawn as the defendant died before the Court hearing. Council's Byelaws Dog nuisances One summons was issued under this byelaw. A conviction was obtained and a fine of 10s. Od. was imposed. Housing Act, 1957 Overcrowding Summonses were taken out against the landlord and occupier of overcrowded premises, but the hearings were adjourned sine die. food and Drugs Act, 1955 Seven summonses were issued in respect of the sale of food not - 72 - being of the nature, substance or quality demanded. Convictions were obtained in all cases. In four, the defendants were fined a total of £29. Os. Od. with £9. 19s. 6d. costs. In the other three cases the defendants were discharged conditionally on payment of £3. 3s. Od. costs. Food Hygiene Regulations, 1955 Seventeen summonses were taken out against various defendants for contravention of these Regulations. The contraventions included smoking whilst engaged in handling food, exposing food to contamination, lack of cleanliness of equipment, and lack of cleanliness and repair of food rooms. In seven cases fines totalling £53. Os. Od. with £8. 16s. 6d. costs were imposed. Four summonses were adjourned sine die; three were dismissed, and the remaining three were discharged conditionally on payment of £1. 1s. Od. costs to the Council. CONCLUSION In presenting this Report, I should like to express my grateful appreciation of the kind co-operation which I have received from The Worshipful the Mayor, the Chairmen and Vice-Chairmen of the various Committees and all members of the Council. My sincere thanks are also given 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 ready willingness to co-operate at all times. I have the honour to be Your obedient Servant, J. H. WEIR Medical Officer of Health. - 73 - PARTICULARS OF THE STAFF OF THE PUBLIC HEALTH DEPARTMENT AT THE END OF 1957 (As requested by Ministry of Health Circulars l/54 and 28/54) Medical Officer of Health Year of Appointment James H. Weir, M.D., B.S., B.Hy., DoP.H. 1950 Deputy Medical Officer of Health Hastings E. A. Carson, M.D., B.S., D.P.H., S.M. 1956 Public Analyst H. Amphlett Williams, Ph.D.(Lond)., A.C.G.F.C., F.R.I.C. 1952 Administrative and Clerical Staff 1.2. John S. Wheeler, Chief Clerk 1924 Francis W. Gascoyne 1919 Miss Elizabeth Howarth 1951 George W. Churcher, B,Sco(Econ.) 1935 Alan Rogers 1953 John H. Gillett 1938 Mrs. B. Hennessey 1954 Digby A. Smith 1939 Harry Gibbs 1955 Miss Vera F, Osborne 1941 Stanley C. Nottingham 1956 Mrs. S. Scott 1943 Miss Phyllis Schifreen 1957 Miss D. Gibbs 1944 Victor W. Waymark 1946 Mrs. B. Beesley 1948 Public Health Inspectors 2.3. Henry W, Walters, F.R.S.H., Chief Inspector 1925 2.3. Cecil R. Webb 1925 1.2.4. Joseph G. Tompkins 1951 1. Arthur L. Vague 1934 1. Reginald G. Weedon 1952 1.2. Ronald D.Callis,B.Sc.(Econ.) D.P.A. 1935 1.2.4. Leslie E. Bowskill 1954 1.2. Kenneth Bell 1955 1. Dennis C. Draper 1938 1.2.4. Leslie A. Palmer 1956 1. Harold Hind 1939 1.2. David A. McLaren 1957 1.2. Arthur F. Standish 1947 1.2. Edward Wall 1957 1. Arthur E. Sills 1949 1.2. Frederick H. Canton 1950 Student Public Health Inspectors Raymond J. Grinsted 1957 Derek H. Vincent 1957 Women Health Officers Mis s Anne Bar leer, S.R.N., S.C.M., H.V. 1949 Mrs. E. I. Gudde, Dip.Soc.Science (Lond.)., 1952 Other Officers James W. Noble, Chief Disinfector 1935 William G. Gauntlett, Mortuary Keeper 1939 Joseph A. Newman, Rodent Assistant 1945 Aubrey E. Sole, Rodent Assistant 1945 Edward Sellwood, Rodent Assistant 1946 George Connor, Rodent Assistant 1947 Frank Beak, Drainage Assistant 1953 1. Certificate of the Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. 2. Certificate for Inspectors of Meat and Other Foods. 3. Certificate of London Sanitary Inspectors' Examination Board. 4. Smoke Inspectors' Certificate. - 74 - SUMMARY OF COMMITTEES CONTROLLING MATTERS OF PUBLIC HEALTH (As requested by Ministry of Health Circulars l/54 and. 28/54) Public Health Committee Sanitary administration generally Overcrowding, repair, closure and demolition of houses Clearance areas Nuisances under Public Health (London) Act, 1936 House drainage Food and drugs and sampling of foods Factories and Shops Baths and washhouses and public mortuary Open spaces Infectious diseases Prevention of damage by pests Care of old people Cemeteries and burial of the dead Works Committee Public cleansing Collection and disposal of house and trade refuse Sewerage (including street drainage) Streets and highways Public lavatories Housing and Town Planning Committee Provision of housing accommodation and control and management of Council's houses Acquisition of land for housing Provision of open spaces Acquisition, improvement and conversion of houses Finance Committee Improvement grants and mortgages under Housing Acts INDEX Page Acute Encephalitis 65 Adulteration of Food 58 Atmospheric Pollution 14,23 Bacteriological Work 17 Bakehouses 47 Birth Rate 1 Burial of the Dead 27 Cancer of the Lung 3 Certificates of Disrepair 38 Chiropody for Aged Persons 31 Clean Air Act, 1956 23 Clearance Areas 37,41 Cleansing of Aged Persons 30 Committees 74 Costermongers' Accommodation 45 Cremation Service 28 Deaths, Causes of 9 Death Rate 1 Diphtheria 63 Diphtheria Immunisation 63 Disinfection & Disinfestation 18 Dog Nuisances 28 Drainage 35 Dysentery 64 Enteric Fever 63 Erysipelas 64 Factories 46-49 Food- 5,50 Adulteration 58 Hygiene Regulations 5,15,52 Ice Cream 59 Inspections 50 Milk 54,55 Poisoning 60 Unsound 57 Castro Enteritis 66 Health Education 16,22 Holidays for Aged Persons 30 Home Safety 15 Houses in multiple-occupation 39 Housing- 3,14 Clearance Areas 37,41 Improvement grants 43 Inspections 34,36 Medical Priorities 44 New Housing Accommodation 45 Overcrowding 37,40,44 Slum Clearance 40,41 Underground Rooms 35,37 Housing Repairs and Rents Act, 1954 38 Ice Cream 59 Improvement Grants 43 Infant Death Rate 2 INDEX Page Infectious Diseases 2,62 Acute Encephalitis 65 Diphtheria 63 Dysentery 64 Enteric Fever 63 Erysipelas 64 Gastro Enteritis 66 Malaria 65 Measles 65 Meningococcal Infections 65 Notifications 69 Ophthalmia Neonatorum 65 Poliomyelitis 65 Pneumonia 64 Puerperal Pyrexia 64 Scabies 18,66 Scarlet Fever 63 Smallpox 62 Tuberculosis 2,66 Whooping Cough 68 Institutional Care of Aged Persons 30 International Certificates 68 Kensal New Town 3,11,42 Laundry Facilities for Aged Persons 31 Legal Proceedings- Defective dustbins 71 Dog Nuisances 71 Food and Drugs Acts 71 Food Hygiene Regulations, 1955 72 Nuisances 71 Library Facilities for Aged Persons 31 Lung Disease 3 Malaria 65 Mass Radiography 23 Maternal Death Rate 2 Meals for Aged Persons 32 Measles 65 Medical Examination of Staff 28 Medicinal Baths 17 Mental Health 15 Meningococcal Infections 65 Milk 54,55 Milk - Channel Islands, etc. 56 Milk & Dairies Regulations, 1949/53 55 Milk, Special Designations 54 Mortuary 27 National Assistance Acts, 1948/51 27 New Housing Accommodation 45 Notification of Infectious disease 69 Nuclear Radiation Hazards 16 Nuisances 71 Old People's Welfare 14,28 Advice Leaflets 29 Chiropody 31 Cleansing 30 Grants 29 Holidays 30 Institutional Care 30 INDEX Page Old People's Welfare (cont'd) Laundry Facilities 31 Library Facilities 31 Meals Service 32 Removals 33 S.O.S. Cards 29 Visiting 32 Ophthalmia Neonatorum 65 Outworkers 47 Overcrowding 37,40,44 Pests, Prevention of Damage by 19 Pet Animals Act, 1951 22 Pharmacy & Poisons Act, 1933 21 Poliomyelitis 65 Population 1 Pneumonia 64 Puerperal Pyrexia 64 Rag Flock & Other Filling Materials Act, 1951 21 Removal of Aged Persons 33 Rent Act - Certificates 38 "Retrospect and Prospect" 10-17 Rodent Control 19 Sanitary Inspection - Drainage 35 Dwelling Houses 36 Inspections 35 Legal Proceedings 71 Sanitary Notices served 35 Supervision of Work 36 Scabies 18 Scarlet Fever 63 Shops, Sanitary Accommodation 49 Slum Clearance 40,41 Smallpox 62 Smoke Measuring Stations 23 S.O.S. Cards 29 Staff 73 Student Public Health Inspectors 5 Tuberculosis 2,66 Underground Rooms 35,37 Unsound Food 57 Vaccination 63 Vital Statistics 5-7 Water Supply 17 Whooping Cough 68