AC 4349 PAD 26 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1926. BY GEOFFREY EUGENE OATES, M.D., B.S. (London), M.R.C.P. (London) ; D.P.H. (Cambridge) ; Barrister-at-Law, Medical Officer of Health. LONDON: WIGHTMAN & Co., Ltd., Printers, REGENCY STREET, WESTMINSTER. S.W. 1. Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1926- BY GEOFFREY EUGENE OATES, M.D., B.S. (London), M.R.C.P. (London); D.P.H. (Cambridge); Barrister-at-Law, Medical Officer of Health. LONDON: WIGHTMAN & Co., Ltd., Printers, REGENCY STREET, WESTMINSTER. S.W. 1. CONTENTS. PAGE Acute Encephalitis Lethargica 19 Acute Influenzal Pneumonia 19 Acute Polio-encephalitis 19 Acute Polio-myelitis 19 Acute Primary Pneumonia 19 Administrative Work 34 Annual Cleansing 37 Ante-natal Consultation Centres 30 Anthrax 20 Bacteriological Work 34 Bakehouses 41 Births 5 „ Illegitimate 6 „ in Institutions 6 „ Notification 6 Birth-rates 6 Canals, Canal Boats 36 Cancer 20 Cerebro-spinal Fever 19 Chicken-pox 16 Cholera 20 Combined Drainage 34 Common Lodging Houses 37 Compulsory Repairs 36 Continued Fever 20 Convalescent Homes 32 " Conversions " 36 Cowhouse 42 Cream Regulations 44 Dairies and Milk Shops 42 Day Nurseries 31 Deaths, Causes of 7 „ in Institutions 10 Death-rates 10 Diarrhoea 20 Diphtheria 15 „ Carrier Clinic 16 Disinfection 34 District Inspectors' Work 46 Drainage, Combined 34 ,, House 34 „ Reconstruction Plans 34 Dysentery 20 Erysipelas 19 Food Adulteration 43 „ Destroyed 42 „ Purveyors 42 „ Supervision 42 Fouling of Footways by Dogs 35 Glanders 20 Health Visiting 27, 30 Homework (Outworkers) 41 Houses Unfit for Habitation 37 Housing 36 „ on L.C.C. Estates 37 Hydrophobia 20 Ice Cream 42 Infant Consultation Centres 28-30 Infantile Mortality 11 „ „ in Special Areas 12 Infectious Disease, Notification of 14 page Infectious Disease, Prevention of 34, 47 Infective Enteritis 20 Legal Proceedings 44 L.C.C. Houses 37 Malaria 19 Marriages 5 Maternity and Child Welfare 27 Maternity Nursing 30 Measles 17 Meat Regulations 42 Milk, Grants 31 ,, (Special Designations) Order 42 Mortuary 35,47 Nursing 34 Office Work 47 Ophthalmia Neonatorum 18 Outworkers (Homework) 41 Overcrowding 37,39 Plague 20 Population 5 Poultry Slaughtering 42 Pneumonia 19 Puerperal Fever 18 „ Pyrexia 19 Rag and Bone Dealers 35 Rats and Mice Destruction 44 Relapsing Fever 20 Rent and Mortgage Interest (Restrictions) Acts 37 Rent Books 37 Scarlet Fever 15 Schools and Infectious Disease 34 Sewer Connections 35 Slaughterhouses 42 Smallpox 16 Smoke Control 35 Staff 34,48 Tenement Houses 37,38 Trade Nuisances 35,47 Trench Fever 20 Tuberculosis, Artificial Pneumothorax treatment 22 „ Deaths from 20,22 ,, Dental treatment 22 ,, Dispensary treatment 23 ,, Home visiting 22 „ Notification 21 „ Regulations, 1921 and 1925 21,22 „ Supply of Beds and Bedding 22 Tuberculosis Care Committee 26 Typhoid Fever 17 Typhus Fever 20 Underground Rooms 37 Venereal Diseases 48 Verminous Conditions 44 Vital Statistics 4, 5 Water Supply 35, 47 Whooping Cough 20 Widows', Orphans' and Old Age Contributory Pensions Act, 1925 32 Workshop Supervision 40 TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1926 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good, but there is no marked improvement to record. The infantile mortality was at the rate of 86 deaths of infants under the age of 12 months for every 1,000 births. It is the highest recorded since the year 1921, when it was 92. Every endeavour should be made to reduce this figure to at least the average for the County of London, which was 64 last year. During the year the rooms previously occupied by the Public Analyst in the Town Hall were vacated. This enabled a much needed room to be added to the Public Health Department, as a Sanitary Inspectors' Office. At the same time, structural alterations were effected in the offices which have greatly increased their efficiency. During the year both I and my staff have received much support and consideration from the Council, which has facilitated our efforts. I should like to take this opportunity of thanking the staff of the Public Health Department for the loyal help I have received from them, and other members of the Council's staff for many courtesies received. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W. 2. May. 1927. SUMMARY OF VITAL STATISTICS. Area of Borough 1,356.1 acres, including waterways 20.0 acres: 1926 Population (Registrar-General's estimate) 146,700 Density of population per acre 108 Census 1921: Total number of buildings containing dwellings 17,153 (a) Dwellings occupied by non-private families 435 Population inhabiting the same 12,910 (b) Dwellings occupied by private families 38,320 (Including vacant census night, 938). Population enumerated in occupied dwellings 131,351 Occupying 141,959 rooms, averaging 1.08 persons per room, or 0.92 room per person. Marriages 1,591. Total. M. F. Births Legitimate 2,051 1,079 972 Illegitimate 197 102 95 Birth-rate 15.32* Deaths 1,857 912 945 Death-rate 12.65* Number of women dying in, or in consequence of childbirth from sepsis 5 „ other causes 4 Maternal mortality 4.00† Deaths of Infants under 1 year of age 194 Infantile Mortality 86† Legitimate, 82†; Illegitimate, 127† Deaths from Measles (all ages) 34 „ Whooping Cough (all ages) 8 „ Diarrhoea (under 2 years of age) 51 „ Pulmonary Tuberculosis 102 Death-rate from Pulmonary Tuberculosis 0.69* Deaths from all forms of Tuberculosis 125 Tuberculosis death-rate 0.85* Rateable Value £1,683,842 Product of a Penny Rate £6,731 * per 1,000 persons. †per 1,000 births. 5 VITAL STATISTICS. The Metropolitan Borough of Paddington as constituted under the London Government Act, 1899, covers an area of 1,356.1 acres, including 20.0 acres of waterway. It is co-extensive with the Civil Parish and Registration District of the same name. The Borough is divided into nine wards. General Summary of Vital Statistics. Year. Estimated Population. Births. Deaths at All Ages. Deaths under One Year. Registered Locally. Transfers. Nett. Registered Locally. Gross Mortality. Transfers. Nett. Registered Locally. Nett. Out. In. Totals. Rates. Out. In. Totals. Mortality. Number. Mortality Totals. Mortal ity. 1913 142,229 2,832 55 242 3,019 20.87 2,071 14.33 407 315 1,979 13.68 342 121 305 101 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1,895 13.33 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 T 142,169 2,378 61 372 2,689 18.91 ... ... ... ... ... ... 289 121 253 94 C 136,668 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 158 273 135 C 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 C 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 1919 T 149,941 2,016 154 454 2,316 15.44 ... ... ... ... ... ... 213 105 212 91 C 143,938 ... ... ... ... ... 1,499 10.41 310 725 1,914 13.29 1920 T 150,128 3,181 251 483 3,413 22.73 ... ... ... ... ... ... 279 87 266 78 C 149,673 ... ... ... ... ... 1,667 11.13 370 410 1,707 11.40 1921 145,600 2,653 296 502 2,859 19.63 1,784 12.25 372 346 1,758 12.07 307 115 263 92 1922 145,300 2,557 288 462 2,731 18.79 1,929 13.27 365 324 1,888 12.99 224 88 189 69 1923 146,200 2,410 275 485 2,620 17.92 1,743 11.92 338 317 1,722 11.77 207 86 180 69 1924 146,400 2,343 284 446 2,505 17.11 2,054 14.03 475 341 1,920 13.11 232 99 196 78 1925 147,100 2,206 312 443 2,337 15.88 2,011 13.67 570 339 1,780 12.10 196 88 170 72 1926 146,700 2,131 345 462 2,248 15.32 2,067 14.09 554 344 1,857 12.65 210 98 194 86 "T"=Total; "C"=Civil. POPULATION. The Registrar-General's estimate of the population of the Borough for the year 1926 was 146,700. The populations in the various wards have been estimated to be as shown in the following table:— The Borough 146,700 Wards— Queen's Park 16,020 North Paddington 74,058 Harrow Road 27,978 Maida Vale 22,474 Town 7,586 Westbourne 24,5101 South Paddington 72,642 Church 17,788 Lancaster Gate, West 9,693 Lancaster Gate, East 8,299 Hyde Park 12,352 MARRIAGES. During 1926, 1,591 marriages were solemnized in the Borough, being a rate of 21.6 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1926 was 2,131, and, in addition, 117 occurred outside the Borough to Paddington residents in excess of those occurring in Paddington to residents of other localities, making a total of 2,248 births. The birth-rate for 1926 was therefore 15.32 per 1,000 of the population. Of the 2,248 births, 1,181 were those of males and 1,067 those of females, and of these 102 males and 95 females were illegitimate. The Registrar-General's final figure for the nett number of births is given as 2,258, but this does not substantially affect the figure for the birth-rate given above. 6 The following table shows the birth-rate during each of the last six years in England and Wales, in London, in Paddington and in each of the wards of the Borough:— 1926 Birth-rates. No. of Births. Birthrates. 1925 1924 1923 1922 1921 England and Wales 694,897 17.8 18.3 18.8 19.7 20.4 22.4 London 78,825 17.1 18.0 18.6 20.1 20.9 22.1 Paddington 2,248 15.32 15.88 17.11 17.92 18.79 19.63 Wards— Queen's Park 200 12.48 12.63 13.76 15.28 17.26 18.49 Harrow Road 404 14.44 16.07 16.01 18.36 19.88 20.23 Maida Vale 356 15.84 14.09 19.35 19.95 19.00 20.89 Town 136 17.92 23.54 24.05 23.84 25.22 25.09 Church 426 23.94 Westbourne 442 18.03 18.14 19.93 21.04 20.14 22.65 Lancaster Gate, West 61 6.29 7.82 8.37 8.69 10.10 9.56 Lancaster Gate, East 73 8.79 9.49 9.05 5.68 9.49 9.59 Hyde Park 150 12.14 11.94 13.46 13.72 15.03 14.92 The following table shows the course of the birth-rate in the Borough in the past:— BIRTH-RATES. Paddington. 1881-1885 26.66 1886-1890 24.89 1891-1895 24.44 1896-1900 23.29 1901-1905 22.89 1906-1910 21.14 1911-1915 20.88 1916-1920 17.63 1921 19.63 1922 18.79 1923 17.92 1924 17.11 1925 15.88 1926 15.32 Illegitimate Births.—These were 197 in number, or 8.76 per cent. of the total number of births. The proportion of illegitimate births varies remarkably in the different wards as is shown in the table below— Rate of Illegitimate Births per 100 Total Births. Ward. Rate. Queen's Park 5.00 Harrow Road 5.19 Maida Vale 10.39 Town 8.08 Church 7.98 Westbourne 7.69 Lancaster Gate, West 21.31 Lancaster Gate, East 17.80 Hyde Park 16.00 Births in Institutions. Local. Legitimate. Illegitimate. Total. Paddington Infirmary 105 (4) 58 (5) 163 (9) St. Mary's Hospital 224 (117) 5 (2) 229 (119) Lock Hospital 19 (19) 76 (63) 95 (82) Non-residents shown in ( ) Outlying. Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 215 18 233 Other Lying-in Hospitals 11 8 19 Other Hospitals 42 7 49 Poor Law Institutions 8 4 12 Notification of Births Acts, 1907 and 1915.—These Acts require the father of a child, if actually residing in the house where a birth takes place at the time of its occurrence, and any person in attendance upon the mother at the time of, or within six hours after, the birth, to give notice in writing of the birth to the Medical Officer of Health of the district in which the child is born, in the manner provided. Notification applies in the case where a child has issued forth from its mother after the expiration of the twenty-eighth week of pregnancy, whether alive or dead. In practice, it Is almost always the doctor or midwife who notifies a birth, and not the father of the child. 7 During the year 2,116 live births were notified to the Medical Officer of Health. There were also 65 stillbirths notified. Of the 2,181 living and stillbirths notified, 47.5 per cent. were notified by medical practitioners, 34.5 per cent. by midwives, 2.9 per cent. by parents, and 15.1 per cent. by medical students or other persons. A comparison of the Notification Register with the returns supplied by the local Registrars of Births showed that 97.1 per cent. of the births occurring within the Borough were duly notified. It will be seen that only a small proportion of births are not notified and are not brought to the notice of the Medical Officer of Health until they come to be registered within the statutory period of six weeks. In nearly every case of default a cautionary letter was sent to the person responsible, and in no instance did the Maternity and Child Welfare Committee consider it necessary to institute legal proceedings DEATHS. Deaths in 1926.—The number of deaths that were registered during the year as having taken place in the Borough was 2,067. Of these, 554 were of persons whose residence was not in Paddington, 450 dying in Paddington Institutions and 104 in other places in the Borough. There were also reported to the Registrar-General 344 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,857, making an annual deathrate of 12.65. 1926. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhoea & Enteritis January 30th (4 weeks 2 days) 19 — — 3 12 23 2 17 13 4 February 27th 9 — — 2 4 14 4 10 8 3 March 27th 3 — — — 9 26 4 15 7 3 April 24th — 1 1 3 11 22 10 19 14 — May 22nd 2 — 1 2 4 20 3 9 11 4 June 19th — — — 1 3 22 4 4 12 1 July 17th 1 — — — 6 13 1 3 7 — August 14th — — — 1 6 14 1 1 1 3 September 11th — — — 1 8 21 1 4 4 10 October 9th — — — 2 6 16 — 3 6 14 November 6th — — — 1 13 14 3 17 8 5 December 4th — — — 3 10 12 2 12 14 3 31st (27 days) 6 2 10 22 2 17 12 6 Totals 34 i 8 21 102 239 37 131 117 56 8 The following tables show the deaths classified according to sex and age, cause of death and the wards of the Borough:— Deaths of Residents of the Borough, 1926. Sex-Age Distribution for Whole Borough. Causes of Death. All Ages. Deaths at Ages. In Public Institutions. 0— 1— 2— 5— 15— 25— 45— 65— P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteric Fever 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 34 13 21 3 4 5 7 5 7 ... 2 ... ... ... 1 ... ... ... ... 10 10 Scarlet Fever 1 ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 Whooping-cough 8 3 5 3 3 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... 3 2 Diphtheria, Membranous Croup 21 11 10 2 2 1 ... 3 6 5 1 ... ... ... 1 ... ... ... ... 10 8 Influenza 37 18 19 ... ... ... ... ... ... ... ... ... ... 1 3 10 2 7 14 6 1 Erysipelas 8 4 4 ... ... ... ... ... 1 ... ... ... ... 2 1 2 ... ... 2 4 4 Septicaemia 6 5 1 ... ... ... ... ... ... 1 ... ... ... 1 ... 2 ... 1 1 4 ... Pulmonary Tuberculosis 102 55 47 ... ... ... 1 ... ... ... ... 8 7 27 30 20 7 ... 2 35 27 Tuberculous Meningitis 5 1 4 ... 1 ... ... ... ... ... 1 ... 1 1 1 ... ... ... ... 1 4 Other Forms of Tuberculosis 18 8 10 ... ... ... 1 ... ... 1 2 3 1 ... 4 3 2 1 ... 7 8 Syphilis 3 3 ... 1 ... ... ... ... ... ... ... ... ... ... ... 2 ... ... ... 3 ... Cancer 239 96 143 ... ... ... ... ... ... ... ... ... ... 6 11 37 57 53 75 61 56 Rheumatic Fever 4 1 3 ... ... ... ... ... ... 1 ... ... ... ... ... ... 2 ... ... 1 1 Alcoholism 3 1 2 ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... ... 1 Inflammation & Softening of Brain 4 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 1 ... 1 1 2 Cerebro-spinal Fever 3 ... 3 ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 3 Simple Meningitis 5 4 1 1 l ... ... ... ... ... ... ... ... 1 ... ... ... ... ... 3 Cerebral Haemorrhage 73 28 45 ... l ... ... ... ... ... ... ... ... 2 ... 4 9 22 35 8 20 Convulsions 3 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 ... Endocarditis 3 2 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 1 1 ... ... 1 Heart Disease 270 130 140 ... ... ... ... ... ... ... 1 ... ... 6 10 48 34 76 94 67 52 Bronchitis 131 58 73 5 4 2 1 1 1 ... ... ... ... 5 1 15 11 30 55 21 19 Lobular (Broncho-) Pneumonia 69 35 34 10 12 5 4 2 6 1 1 ... ... 1 1 8 2 8 8 27 22 Lobar (Croupous) Pneumonia 30 22 8 1 ... ... ... 1 ... ... ... ... ... 4 2 13 2 3 4 9 3 Pneumonia 18 6 12 1 ... ... ... ... ... 1 ... ... ... 1 1 2 5 1 6 1 3 Other Diseases of Respiratory Organs 20 10 10 ... ... ... 1 ... ... ... ... ... ... ... 1 5 2 5 6 4 2 Diseases of Stomach 25 18 7 ... ... ... ... ... ... ... ... 1 ... 3 1 9 4 5 2 16 6 Diarrhcea and Enteritis 56 28 28 25 19 ... 5 ... ... ... ... ... ... 1 ... ... 2 ... ... 21 21 Appendicitis 14 7 7 ... ... ... ... ... ... 2 ... 1 1 ... ... 4 5 ... 1 6 5 Obstruction of Intestines 16 7 9 1 1 ... ... ... ... ... ... 1 1 ... 2 ... ... 5 5 3 8 Cirrhosis of Liver 16 12 4 ... ... ... ... ... ... ...... ... ... ... 1 ... 7 3 4 1 8 2 Nephritis and Bright's Disease 58 34 24 ... ... ... ... ... ... ... 1 1 ... 4 4 14 6 15 13 14 15 Tumours (Non-malignant), &c., Female Genital Organs 3 ... 3 ... ... ... ... ... ... ... ... ... 1 ... 1 ... ... ... 1 ... 3 Puerperal Fever 5 ... 5 ... ... ... ... ... ... ... ... ... ... ... 5 ... ... ... ... ... 5 Accidents and Diseases of Parturition 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... 3 Congenital Defects 15 6 9 5 8 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... 5 5 Premature Birth 46 32 14 32 14 ... ... ... ... ... ... ... ... ... ... ... ... ... 14 7 Developmental Diseases 15 12 3 12 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6 2 Old Age 43 8 35 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 8 35 2 13 Suicide 24 15 9 ... ... ... ... ... ... ... ... 1 ... 2 5 9 4 3 ... 2 3 Overlaid in Bed 1 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Accidents and Violence 66 38 28 1 2 ... 1 3 1 4 2 3 1 9 5 12 4 6 12 21 l7 Homicide l ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... 1 Execution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Ill-defined Causes 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... All other Causes 329 174 155 7 4 1 1 3 3 1 3 3 20 9 51 36 89 98 90 75 All Causes 1857 912 945 114 80 18 25 15 28 19 13 23 19 99 105 281 203 343 472 497 441 Uncertified 2 ... 2 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 2 ... ... 9 Deaths of Residents of the Borough, 1926. Numbers (All Ages) in Each Ward. Causes of Death. Queen's Park. Harrow Road. Maida Vale. Town Church. Westbourne. Lancaster Gate. Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Enteric Fever ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Small-pox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 2 5 4 1 4 ... ... 4 6 1 2 ... ... ... 1 ... 1 Scarlet Fever ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Whooping-cough ... ... 2 3 1 ... ... ... ... 2 ... ... ... ... ... ... ... ... Diphtheria, Membranous Croup 2 2 3 1 3 2 ... ... ... 2 2 1 ... ... ... 1 1 1 Influenza 3 3 4 2 3 3 1 ... 1 3 4 3 1 4 1 ... ... ... Erysipelas 2 ... ... ... ... 1 ... ... 1 2 1 1 ... ... ... ... ... ... Septicaemia ... 1 2 ... 1 ... ... ... 1 ... ... ... ... ... 1 ... ... ... Pulmonary Tuberculosis 12 4 8 13 7 6 1 ... 11 12 8 5 2 2 1 ... 4 2 Tuberculous Meningitis 1 ... ... ... ... 1 ... ... ... 2 ... 1 ... ... ... ... ... ... Other Forms of Tuberculosis 1 1 1 2 ... 2 l ... 3 1 ... 1 ... 2 ... ... 2 1 Syphilis ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... 2 ... Cancer 10 11 31 28 14 35 10 ... 6 8 16 26 4 9 2 7 3 13 Rheumatic Fever 1 ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... ... ... 1 Alcoholism ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... 1 Inflammation and Soften_ ing of Brain ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... 1 ... 1 Cerebro-spinal Fever ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... ... ... Simple Meningitis ... 1 ... ... ... ... ... ... 2 ... ... ... 1 ... 1 ... ... ... Cerebral Hemorrhage 5 3 7 4 3 9 ... ... 3 11 9 10 ... 2 ... ... 1 3 Convulsions ... ... ... ... 1 ... ... ... ... ... 1 ... ... ... 1 ... ... ... Endocarditis 1 ... ... 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... Heart Disease 19 18 24 24 20 25 10 7 27 19 17 28 3 8 1 6 9 5 Bronchitis 8 5 10 11 7 13 2 1 14 15 14 16 2 6 ... 2 1 4 Lobular (Broncho-) Pneumonia 3 2 7 7 5 7 3 1 7 6 4 7 2 ... ... 3 4 1 Lobar (Croupous) Pneumonia 2 ... 6 2 5 1 1 1 4 2 1 1 ... ... 1 ... 2 1 Pneumonia ... 1 1 2 3 1 ... 1 2 ... ... ... ... 2 ... 2 ... 3 Other Diseases of Respiratory Organs 2 ... 4 2 ... 1 1 1 3 1 ... 2 ... 2 ... 1 ... ... Diseases of Stomach 1 l 1 1 4 ... 4 ... 2 2 5 1 ... 1 ... ... 1 1 Diarrhœa and Enteritis 1 l 5 6 3 4 2 ... 6 9 9 5 2 3 ... ... ... ... Appendicitis 1 l 2 1 1 2 ... 1 ... ... 2 ... ... ... 1 ... ... 2 Obstruction of Intestines 1 ... 1 ... ... 2 1 ... 1 1 3 5 ... ... ... ... ... 1 Cirrhosis of Liver 2 l 2 ... 4 1 ... ... 2 1 1 1 ... ... ... ... 1 ... Nephritis and Bright's Disease 6 2 8 3 2 6 4 ... 6 4 3 4 2 1 l ... 2 4 Tumours (Non-malignant), &c., Female Genital Organs ... ... ... ... ... 1 ... ... ... ... ... ... ... 1 ... ... ... 1 Puerperal Fever ... ... ... 2 ... 1 ... ... ... 1 ... 1 ... ... ... ... ... ... Accidents and Diseases of Parturition ... 1 ... ... ... 1 ... ... ... 1 ... ... ... 1 ... ... ... ... Congenital Defects ... 1 ... 1 2 1 ... ... 3 2 ... 2 ... 1 ... 1 1 ... Premature Birth ... 1 12 3 5 2 ... 1 5 2 4 2 1 ... 2 1 3 2 Developmental Diseases 1 ... 1 ... 3 1 1 ... 2 1 4 ... ... 1 ... ... ... ... Old Age 1 2 2 6 ... 9 ... 2 2 3 ... 1 1 6 1 2 1 4 Suicide ... ... 1 ... 4 2 1 1 4 2 1 1 2 2 1 ... 1 1 Overlaid in Bed ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... Other Accidents and lence 3 2 8 4 7 8 2 5 7 ,6 2 1 2 2 1 4 2 Homicide ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 Ececution ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... III-defined Causes ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Other Causes 26 9 33 27 31 29 6 6 22 17 26 36 11 15 9 8 10 8 All Causes 117 77 192 160 141 182 52 36 151 150 144 166 36 71 26 38 53 65 In Institutions 69 40 107 83 61 69 92 82 95 98 32 12 7 16 9 9 25 32 10 The following table shows the deaths and death-rates during each of the last five years in England and Wales, in London, in Paddington and in each of the wards of the Borough:— 1926. Death-rates. No. of Deaths. Deathrates. 1925. 1924. 1923. 1922. 1921. England and Wales 453,795 11.6 12.2 12.2 11.6 12.8 12 .1 London 52,431 11.6 11.7 12.2 11.4 13.5 12.5 Paddington 1,857 12.65 12.10 1311 11.77 12.99 12.07 Wards.— Queen's Park 194 1210 11.39 11.94 10.71 12.03 11.19 Harrow Road 352 12.58 10.80 12.57 12.09 12.70 12.35 Maida Vale 323 14.37 11.84 12.43 12.72 13.07 12.64 Town 88 ll.60 14.73 15.79 12.69 15.51 12.46 Church 301 16.92 Westbourne 310 12.64 13.99 15.16 12.97 14.21 14.34 Lancaster Gate, West 107 11.04 10.28 10.54 9.62 9.68 10.49 Lancaster Gate, East 64 7.71 9.25 9.90 9.06 10.21 7.89 Hyde Park 118 9.55 10.57 11.68 9.99 11.60 10.27 The following table shows the course of the death-rate in the Borough in the past:— DEATH-RATES—PADDINGTON. 1881-1885 16.23 1886-1890 16.19 1891-1895 17.17 1896-1900 15.51 1901-1905 15.33 1906-1910 14.52 1911-1915 14.06 1916-1920 14.62 1921 12.07 1922 12.99 1923 11.77 1924 13.11 1925 12.10 1926 12.65 Deaths in Institutions, 1926. Local. Total Nonresidents. Paddington Infirmary 627 32 St. Mary's Hospital 249 185 Paddington Green Children's Hospital 56 44 Hospital for Women and Children (Lock Hospital) 14 13 St. Luke's Hospital 185 176 1,131 450 Deduct Non-residents 450 681 Outlying. Paddington Residents. Hospitals of Metropolitan Asylums Board 31 Poor Law Institutions 24 Lunatic Asylums 59 Voluntary Hospitals (General) 86 „ ,, (Special, including Sanatoria 57 257 Total Deaths of Paddington residents in institutions 938 11 INFANTILE MORTALITY. During the year 1926 there were 2,248 births and 194 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality-rate (deaths of infants under 12 months to each 1,000 births) of 86. The following table gives the births and the infantile deaths and death-rates for the year 1926 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1921 to 1925 are given for comparison. 1926. Infantile Mortality-rates. No. of Births. No. of Deaths of children under 1 year. Infantile Mortality rate. 1925. 1924. 1923. 1922. 1921. England and Wales 694,897 48,503 70 75 75 69 77 83 London 78,825 5,008 64 67 69 61 75 81 Paddington 2,248 194 86 72 78 69 69 92 Wards— Queens Park 200 9 45 88 50 78 58 68 Harrow Road 404 42 104 66 87 53 50 67 Maida Vale 356 31 87 50 50 83 68 73 Town 136 5 37 91 115 71 83 115 Church 426 46 108 Westbourne 442 38 86 69 82 78 87 114 Lancaster Gate, West 61 7 115 52 49 36 82 130 Lancaster Gate, East 73 8 109 50 93 21 51 126 Hyde Park 150 8 53 74 24 59 43 7 Infantile Mortality Rates, 1896-1926. Period. England and Wales. London. Paddington 1896-1900 156 162 161 1901-1905 138 139 128 1906-1910 117 114 104 1911-1915 109 110 108 1916 91 89 94 1917 96 104 135 1918 97 108 116 1919 89 85 91 1920 80 75 78 1921 83 80 92 1922 77 74 69 1923 69 60 69 1924 75 69 78 1925 75 67 72 1926 70 64 86 12 The following table provides an analysis of the causes of deaths of infants under the age 12 months in 1926 . Infantile Mortality in Paddington.—1926. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Rate per 1,000 Births. All Causes— Certified 48 16 5 5 74 29 39 24 28 194 86.30 Uncertified — — — — — — — — — — — Small-pox — — — — — — — — — — — Chicken-pox — — — — — — — — — — — Measles — — — — — — — 3 4 7 3.12 Scarlet Fever — — — — — — — — — — — Whooping-cough — — — — — — 1 1 4 6 2.67 Diphtheria and Croup — — — — — 1 1 — 2 4 1.78 Erysipelas — — — — — — — — — — — Tuberculous Meningitis (32) — — — — — — — 1 — 1 0.44 Abdominal Tuberculosis (33) — — — — — — — — — — — Other Tuberculous Diseases — — — — — — — — — — — Meningitis (not Tuberculous) (71) — 1 — — 1 — 1 — — 2 0.89 Convulsions (80) 2 — — — 2 1 — — — 3 1.34 Laryngitis (98:2) — — — — — — — — — — — Bronchitis — — — 1 1 2 3 — 3 9 4.00 Pneumonia (all forms) (100; & (101) 1 1 — 1 3 3 6 5 7 24 10.68 Diarrhoea and Enteritis 1 3 1 1 6 9 14 11 4 44 19.57 Gastritis (112:1) — — — — — — — — — — — Syphilis — — — — — 1 — — — 1 0.44 Rickets (56) — — — — — — — — — — — Suffocation, overlying 1 — — — 1 — — — 1 0.44 Injury at Birth (161:2) — — — — — — — — — — — Atelectasis (162:2) 4 1 — — 5 1 — — — 6 2.67 Congenital Malformations (159) 4 — 1 — 5 4 4 — — 13 5.78 Premature Birth (161 : 1) 30 8 2 2 42 4 — — — 46 20.47 Atrophy, Debility and Marasmus (160:1) 1 1 1 — 3 2 3 — — 8 3.56 Other Causes 4 1 — — 5 1 6 3 4 19 8.45 Totals 48 16 5 5 74 29 39 24 28 194 86.30 Nett Births in the Year "Legitimate 2,051. Illegitimate 197. Nett Deaths in the Year Legitimate Infants 169. Illegitimate Infants 25. Note.—The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the Detailed International List of Causes of Death, 1920. It has been customary in previous annual reports to make a note of infantile mortality in sped, localities. The following is a summary of the results. Infantile Mortality in Special Areas. Areas. 1926. Infantile Mortality. Births. Deaths. 1926. 1925. 1924. 1923. 1922. Church Ward— North Wharf 65 6 92 59 106 95 41 Clarendon Street 196 29 148 126 160 51 116 Rest of Ward 165 11 67 ? ? ? Town Ward— Hall Park 60 4 66 87 69 45 88 Rest of Ward 76 1 13 ? ? ? ? Westbourne Ward— Alfred Road 103 11 107 58 112 69 147 Rest of Ward 339 27 79 77 73 81 66 Maida Vale Ward— Amberley Road 56 5 89 66 59 115 91 Rest of Ward 300 26 86 43 49 76 64 Queen's Park Ward— Queen's Park 112 6 53 88 37 94 60 Rest of Ward 88 3 34 89 71 48 56 Totals for 6 Areas 592 61 103 90 100 74 96 Rest of Borough 1,656 133 80 65 70 67 58 13 The following table, comparing the vital statistics for the metropolitan boroughs, has been supplied by Dr. F. W. Alexander, Medical Officer of Health for Poplar:— 1926. Cities and Boroughs. Estimated population to the middle of year. Births. Annual rate per 1,000 persons living. Zymotic Deaths. Annual rate per 1,000 persons living. Death-rate per 1,000 living. Deaths of Infants under one year to 1,000 births. London 4,605,600 17.1* ? 11*6* 64* West Districts. Paddington 146,700 15.3 0.8 12.6 86 Kensington 180,000 15.1 0.6 12.8 60 Hammersmith 134,400 16.3 0.6 11.4 66 Fulham 164,300 16.2 0.6 10.8 64 Chelsea 64,820 13.3 0.7 12.5 64 City of Westminster 138,400 11.3 0.44 11.6 59.7 North Districts. St. Marylebone 105,800 12.7 0.5 11.9 81 Hampstead 87,530 12.3 0.23 10.6 60 St. Pancras 216,800 16.7 0.8 12.4 76 Islington 339,200 19.0 0.5 12.0 66 Stoke Newington 53,080 160 0.8 10.7 48 Hackney 228,500 17.2 0.46 10.8 59 Central Districts. Holborn 43,200 12.38 0.5 12.1 90 Finsbury 77,550 21.4 0.67 12.9 66 City of London 13,230 7.1 0.07 10.4 66 East Districts. Shoreditch 106,400 23.5 0.6 12.2 66 Bethnal Green 119,600 20.9 ? 11.6 70 Stepney 256,100 19.4 0.79 11.5 65 Poplar 169,000 21.6 0.9 11.4 70 South Districts. Southwark 188,600 20.2 0.9 12.7 70 Bermondsey 123,100 19.6 0.76 12.1 60 Lambeth 311,000 17.9 0.5 11.5 38.4 Battersea 171,900 17.3 0.7 11.4 61.6 Wandsworth 342,100 14.1 0.6 10.37 64 Camberwell 275,400 16.6 ? 11.0 70 Deptford 115,700 18.2 0.7 11.3 56 Greenwich 104,300 17.7 0.4 10.8 61 Lewisham 187,800 15.3 0.2 10.0 40 Woolwich 141,900 17.4 0.3 10.2 43 * These provisional figures are taken from a table furnished by the Registrar-General. Other figures supplied by Medical Officers of Health. THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable in Paddington:— Acute Encephalitis Lethargica. Glanders. Acute Influenzal Pneumonia. Hydrophobia. Acute Polio.encephalitis. Malaria. Acute Polio-myelitis. Measles. Acute Primary Pneumonia. Ophthalmia Neonatorum. Anthrax. Plague. Cerebro-spinal Fever. Puerperal Fever. Chicken-pox. Puerperal Pyrexia Cholera. Relapsing Fever. Continued Fever. Scarlatina or Scarlet Fever. Diphtheria or Membranous Croup. Small-pox. Dysentery. Trench Fever. Erysipelas. Tuberculosis. German Measles. Typhoid or Enteric Fever. Typhus Fever. 14 The following table summarises the cases of notifiable diseases notified in the years 1917 to 1926:— Analysis of Notification Certificates (Uncorrected for Errors). 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. Anthrax — — — — 1 1 — — — 1 Cerebro-spinal Fever 7 3 7 1 2 2 i 1 5 5 Chicken-pox — 207 — — — 22 465 395 459 599 Continued Fever — — — — — — — — — — Diphtheria 227 254 255 461 442 401 219 278 336 462 Dysentery — — (a) 3 1 2 — 2 1 — — Acute Encephalitis Lethargica — — (a) 3 2 7 2 3 12 7 4 Typhoid Fever 12 13 10 19 13 8 13 15 18 12 Erysipelas 66 56 76 81 83 77 54 69 64 76 Malaria — — (a)64 24 7 5 2 9 1 1 Measles 2,701 11,004 1,258 1,427 163 2,117 372 3,215 1,254 2,480 Membranous Croup 2 4 4 3 3 — 1 2 1 1 Ophthalmia Neonatorum 27 22 30 29 34 15 22 18 23 16 Acute Influenzal Pneumonia — — (a)87 45 27 72 33 87 88 76 „ Primary Pneumonia — — (a)83 96 105 254 302 369 265 184 „ Polio-encephalitis 1 — 5 2 1 — 2 4 3 3 „ Polio-myelitis — — — — — — — — — 3 Puerperal Fever 7 2 15 15 16 8 5 9 15 14 „ Pyrexia — —. — — — — — — — (a) 17 Scarlet Fever 124 150 261 502 827 529 323 290 264 199 Small-pox — — — — — 312 1 — — — Tuberculosis—Total 502 451 391 383 335 338 379 400 356 Pulmonary 355 325 284 277 244 204 222 242 231 218 Other Forms 147 126 107 106 91 108 116 137 169 138 (a) First Year of Notification. The following table furnishes an analysis of some of the notifiable diseases according to age, sex and ward of the Borough:— 1926. Notifications. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne. Lancaster Gate. Hyde Park. West. East. A.—Ward Distribution. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 32 41 52 53 18 31 13 12 44 47 54 44 2 3 2 4 3 8 Typhoid Fever — — 1 — 1 — — 2 — 2 — — 2 — — 1 l — Erysipelas 5 7 8 10 3 3 3 1 5 9 6 8 1 — 1 — 2 4 Ophthalmia Neonatorum — 1 — 2 — 3 — — 4 2 2 1 — — — — 1 — Pneumonia—A. Influenzal 6 2 12 6 11 2 4 3 6 5 9 2 I 1 1 1 3 1 „ A. Primary 14 5 17 13 14 8 5 — 28 20 . 24 19 2 — 1 2 6 6 Puerperal Fever — 2 — 4 — 2 — — — 2 — 3 — — — 1 — — tf Pyrexia — 1 — 2 — 8 — — — 5 — — — — — 1 — — Scarlet Fever 23 22 19 14 8 17 4 5 13 14 18 13 — 4 3 3 13 6 B. —Sex-Age Distribution:Borough. 0— 1— 5— 15— 25— 35— 45— 55— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 11 5 76 61 115 123 10 35 5 12 3 4 — 3 — — — — Typhoid Fever — — — 1 1 1 1 4 2 1 — — — — 1 — — — Erysipelas — 1 3 3 7 2 2 4 7 4 7 10 3 9 4 4 1 5 Pneumonia—A. Influenzal 1 — 5 — 3 2 4 4 8 8 5 1 12 2 10 1 5 5 A. Primary 17 14 33 25 12 6 3 2 11 4 7 2 12 4 8 7 8 9 Scarlet Fever 4 — 32 33 52 46 9 13 4 5 — 1 — — — — — — 15 SCARLET FEVER. During 1926 there were 199 cases of Scarlet Fever notified. Of these there were 4 cases under the age of 1 year, 65 between the ages of 1 and 5 years, 98 between the ages of 5 and 15 years, 22 between the ages of 15 and 25 years, and 10 over the age of 25 years. Of the 199 cases 191 were removed to an Isolation Hospital. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Only 1 death from Scarlet Fever occurred, the disease being usually of a mild type. In view of the mildness of the present type of Scarlet Fever and its apparently small degree of infectiousness, it becomes a question whether it is necessary or desirable that removal to hospital should be carried out so frequently as at present. In many good-class families accommodation is available for the proper isolation of the patient, thus avoiding the heavy expense to the rates of removing the patient to hospital, and the very real risk of contracting another infectious disease by being put into a common ward. However, in order that a patient should do well when nursed at home it is essential that a large cheerful room should be available, solely reserved for the patient, and that there should be a garden available for the patient to use during convalescence. One advantage of hospital treatment is that the patient finds congenial society and is less lonely than when being treated at home. These and other considerations should be discussed between the parents or relatives of the patient and the medical attendant, and if removal to hospital is decided upon, it should be largely on the grounds of convenience and the welfare of the patient. 1926. Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 968 1,001 928 906 981 958 1,034 738 702 1,009 1,121 1,125 894 12,368 Paddington 20 15 20 15 12 16 16 9 12 9 15 21 19 199 Wards— Queen's Park 1 2 1 3 2 3 5 2 5 5 2 10 4 45 Harrow Road 3 3 — 1 5 — 5 1 3 2 3 3 4 33 Maida Vale 4 6 6 2 — 1 1 — 1 — 2 1 1 25 Town 1 — 1 2 — 2 — — 1 1 1 — — 9 Church 6 2 1 3 1 4 2 3 — — 2 1 3 27 Westbourne 3 1 6 2 9 2 1 3 1 — 1 4 5 31 Lancaster Gate, West — — — 1 — 2 — — 1 — — — — 4 Lancaster Gate, East 1 1 1 1 1 1 — — — — — — — 6 Hyde Park 2 — 4 — 1 1 2 — — 1 4 2 2 19 DIPHTHERIA. (Including Membranous Croup). During 1926 there were 463 cases of diphtheria notified. Of these there were 16 cases under the age of 1 year, 137 between the ages of 1 and 5 years, 238 between the ages of 5 and 15 years, 45 between the ages of 15 and 25 years, 24 between the ages of 25 and 45 years, and 3 aged 45 years and upwards. Of the 463 cases, 450 were removed to an Isolation Hospital. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Twenty-one deaths from this disease occurred during 1926, 14 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1919 17 deaths. 1920 25 „ 1921 22 „ 1922 25 „ 1923 14 „ 1924 14 „ 1925 11 „ 1926 21 „ Seasonal prevalence.—The following tables show the numbers of cases notified in each fourweekly period during 1926. 16 1926. Notifications. Diphtheria and Membranous Croup. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 1,214 1,280 1,215 1,133 1,017 876 899 831 724 1,055 1,239 1,138 1,040 13,661 Paddington 48 55 35 23 36 35 30 40 21 46 27 40 27 463 Wards— Queen's Park 2 7 2 — 8 10 4 13 2 9 4 8 4 73 Harrow Road 11 4 6 4 7 9 7 3 11 20 10 13 — 105 Maida Vale 4 6 6 6 6 3 4 7 2 2 1 1 1 49 Town 1 3 2 2 — — 1 1 — 3 1 8 3 25 Church 14 18 9 6 5 4 3 3 3 6 2 7 11 91 Westbourne 13 15 10 3 7 7 8 11 3 6 7 2 6 98 Lancaster Gate, West — — — 1 1 — — 1 — — — 1 1 5 Lancaster Gate, East 1 2 — — — — 2 1 — — — — — 6 Hyde Park 2 — — 1 2 2 1 — — — 2 — 1 11 Diphtheria Carriers.—There is a Clinic for Diphtheria carriers held at St. Mary's Hospital, but only a dozen or so cases attend during the course of a year. These are mostly contacts of acute diphtheria cases sent for treatment by medical practitioners. Anti-Diphtheritic Serum.—This is stocked at the Town Hall and supplied to medical practitioners on request for the use of patients who are too poor to obtain such serum privately. During the year 1 phial of 8,000 units, 34 phials of 4,000 units and 19 phials of 500 units were distributed. SMALL-POX. No cases of the disease were notified during 1926. A number of persons who had been in contact with the disease on board a ship or in another district were kept under observation. CHICKEN-POX. Chicken-pox has been notifiable in Paddington since November, 28th, 1922, but the sections of the Public Health (London) Act, 1891, dealing with disinfection, exposure to infection, etc., are not in force as regards this disease. The only other area in London in which chicken-pox is notifiable is the Port of London. Chicken-pox was widely prevalent in Paddington in 1926, the number of cases reported being 599, as compared with 459 in 1925, 395 in 1924, and 465 in 1923. The maximum incidence was during the period May-July, the " peak " being during the week ending June 26th, when 76 cases were reported. On October 9th, I reported as follows to the Public Health Committee:— The expenditure on notification fees was:— £ s. d. In 1924 66 9 6 In 1925 52 5 6 In 1926 (first 32 weeks), 52 9 6 The number of cases of the disease notified was:— In 1923 465 In 1924 395 In 1925 459 In addition to the cases notified by doctors a large number of cases are reported by the school teachers to the health department. In fact most of the cases which are not brought to my knowledge by the school teachers are either adults, children of better class families or cases occurring during school holidays. So far as concerns the bringing to my notice of poor children suffering from the disease, the school notices would be almost sufficient, without the necessity for notification by doctors. But we may now ask whether it is of importance that cases should be brought to my notice and whether any good results. Chicken-pox is a very infectious, but quite harmless complaint. It is not to be classed with the dangerous diseases such as measles and diphtheria. It has been frequently made notifiable in sanitary areas in the past, but only for temporary reasons, that is in times of smallpox prevalence, and because of its superficial resemblance to small-pox. In no other London Borough is chicken-pox permanently notifiable, and in very few localities, I believe, in England. 17 The reasons for making an infectious disease notifiable are to study its incidence and to check its prevalence. So far as the former is concerned we already know almost everything about chicken-pox that notification can teach us and the incidence of the disease as regards season, climate, age of patient, social status, etc., has been thoroughly studied already. The disease itself can neither be cured, nor do we know any method of protecting against the disease by vaccination or inoculation. It is not notification, but laboratory research which can help us to find a means to control chicken-pox. All we can do when a case of chicken-pox is notified is to send a sanitary inspector to the house to give general advice about the spread of infection. Owing to the extreme infectiousness of the disease this advice has very little effect in preventing the disease from spreading through a family. If notification were effective one would expect the disease to decline in prevalence ; such is not the case, the number of notifications being substantially the same in 1925 as in 1923. One would also expect Paddington to have less chicken-pox than neighbouring Boroughs without notification. Figures are not available for comparison, but it is evident that Paddington with notification is little or no better off than Boroughs without notification. I can see no valid reason for continuing the compulsory notification of chicken-pox, having in view the expense necessarily incurred by such a measure. The question of continuing the compulsory notification of chicken-pox was still under consideration at the end of the year. Chicken-pox is not usually nursed in an institution, but in 20 cases removal to an institution was effected for various reasons. TYPHOID FEVER. Twelve cases of this disease were notified in 1926, of whom 3 apparently contracted the disease abroad. Possibly a few of these cases proved to be mistakes in diagnosis. Two cases were certified as having died from typhoid fever. It is not often possible to trace the source of infection in typhoid fever. MEASLES. Measles has been notifiable in the Borough since 1914 under various Orders and Regulations, those at present in operation being " The Metropolitan Borough of Paddington (Measles and German Measles) Regulations, 1920." The only other part of London in which measles is notifiable is the Port of London, but sections 60-65, 68-70 and 72 of the Public Health (London) Act, 1891, were extended to measles as a dangerous infectious disease throughout the County of London by order made by the London County Council on April 1st, 1903. The effect of this order is to enable local authorities to disinfect after measles and to safeguard the public in several ways against spread of infection. In addition to the cases medically certified a number of cases come to the knowledge of the Department through reports from schools, parents, etc. There were, in 1926, 1,931 cases certified by medical practitioners, and 549 cases reported from other sources, the corresponding figures for 1925 being 1,254 and 296. The number of reported cases is analysed in the adjoining table in 4 weekly periods for the various wards. A measles epidemic commenced in November and December, of 1925, and reached its height during January, of 1926. This epidemic declined in intensity during February, and matters then slowly improved until August, when the disease had almost disappeared. Only occasional cases were reported during the rest of the year. The women Sanitary Inspectors visit cases of measles with few exceptions, and arrange, where necessary, for the attendance of the District Nurses. During 1926 the Inspectors' visits totalled 2,705. One hundred and sixty cases of measles in children under the age of 5 years were visited by the District Nurses, the number of visits paid being 1,397. Forty cases over the age of 5 years were visited by the District Nurses, the number of visits being 265. Two hundred and twenty-five cases of measles were removed to hospital during the year. It was learnt during the year that the Metropolitan Asylums Board propose to provide accommodation for increased numbers of measles patients. The number of deaths from measles was 34, 31 being of persons under the age of 5 years. Measles is a disease which is apt to be fatal to young children, and even when recovery ensues the disease is often followed by a period of ill-heath or debility. 18 1926. Measles. Notified and Reported Cases. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. Borough 932 719 343 165 136 98 50 13 6 5 5 5 3 2,480 Wards— Queen's Park 96 136 34 5 2 12 3 2 1 1 — — — 292 Harrow Road 371 111 59 22 11 7 8 2 2 — 1 1 — 595 Maida Vale 94 92 20 18 14 6 4 3 — 2 — 1 1 255 Town 35 ?5 42 17 22 19 4 2 — — — — — 166 Church 100 139 94 45 52 29 11 2 — — — — 1 473 Westbourne 149 118 55 30 6 12 12 2 3 — 1 2 — 390 Lancaster Gate, West 27 16 11 11 1 — 3 — — 1 1 — — 71 Lancaster Gate, East 22 52 17 4 6 3 2 — — — — 1 1 108 Hyde Park 38 30 11 13 22 10 3 — — 1 2 — — 130 OPHTHALMIA NEONATORUM. This disease is notifiable in London under section 55 of the Public Health (London) Act, 1891, the London County Council having by resolution in 1911 made this section applicable to the disease. By the Public Health (Ophthalmia Neonatorum) Regulations, 1914, midwives as well as doctors were required to notify the disease to the Medical Officer of Health. This duty cast upon midwives was found to be superfluous, in view of their duty to notify the local supervising authority under the Midwives Acts of the condition as well. By amending regulations made by the Minister of Health and coming into effect on October 1st, 1926, midwives were no longer called upon to notify ophthalmia neonatorum to the Medical Officer of Health. Sixteen cases of purulent eye-discharge of the new-born were notified in 1926, all by medical practitioners. In no instance was there any permanent impairment of vision, so far as could be ascertained. When one considers that this disease was at one time a common cause of life-long blindness, the above results, which are now usual, are a striking example of how much good may result from organised and persistent efforts directed against an easily controlled disease. As soon as a case of this disease is notified, intensive efforts are made by the Council's staff to ensure that proper treatment is carried out. Daily visits are paid and private or charitable medical treatment is invariably enforced. Where necessary the infant and its mother are removed to a hospital, provision of this accommodation being ample. All necessary nursing attention is given by home visiting on the part of the Paddington and St. Marylebone District Nursing Association. A few cases of slight discharge from the eyes of infants reported by midwives to the London County Council are referred to this Department and receive constant attention, no doubt preventing at times the onset of the more severe form of the disease. During 1926, 6 cases were referred to the District Nursing Association, 250 visits being paid. Seven cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 14 cases of puerperal fever notified during 1926, 12 of which were removed to or nursed in a hospital. There is no difficulty in obtaining institutional treatment for women suffering from this disease. Cases of puerperal fever referred to the Metropolitan Asylums Board are concentrated as far as practicable in three institutions, namely, the Eastern Hospital, Homerton, the North-Western Hospital, Hampstead, and the South-Western Hospital, Stockwell, where special wards are set aside for these cases and special medical and nursing staffs provided. The Board have also provided an obstetric consultant at these three institutions. Paddington mothers go, as a rule, to the North-Western Hospital, Hampstead, which is within easy reach of the Borough. Five women were certified as having died from puerperal fever. 19 PUERPERAL PYREXIA. This was brought into existence as a notifiable disease on the 1st October, 1926. It is defined as:— "Any febrile condition (other than a condition which is required to be notified as puerperal fever) occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4 degrees Fahrenheit, or more, has been sustained during a period of 24 hours or has recurred during that period. The febrile condition referred to in the above definition may be due to any condition, and it may be to some condition quite independent of the puerperal condition. It may, however, be the precursor of the more serious condition known as puerperal fever, and it is with this in view that the numerous conditions comprised under the term puerperal pyrexia are made notifiable. Maternity and Child Welfare Authorities are also empowered, with the sanction of the Minister of Health, to make provision for the special treatment of women suffering from puerperal pyrexia, for consultation with an obstetric specialist, for skilled nursing and for institutional treatment, and they are urged by the Minister of Health to do everything necessary and desirable in this respect. After a survey of the needs of the Borough the Maternity and Child Welfare Committee of the Council were of opinion that the services of an obstetric surgeon of consultant status should be available for all parturient women who are unable to engage such services privately. Accordingly, the Council, as a tentative measure retained the services of Mr. Aleck W. Bourne, F.R.C.S.(England), Obstetric Surgeon to Out-patients, St. Mary's Hospital, to act in a consultative capacity. On one occasion only during the year was the Consulting Obstetric Surgeon called in. During the year 17 cases of puerperal pyrexia were notified, 9 of which occurred within or were removed to an institution. ERYSIPELAS. Seventy-six cases were notified, 38 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. This disease, commonly known as infantile paralysis, is of uncommon occurrence. It occasionally shows evidence of being spread by personal infection and for this reason remains on the list of notifiable diseases. As a matter of fact, its chief interest lies in its after-effects, deformities such as club-foot often resulting. It is probable that many cases of this disease do not come to the knowledge of this Department, but whenever possible observation is kept on the patient for many years with a view to securing that the patient receives any necessary remedial treatment. In 1926, 3 cases of the disease were reported, 1 of them being a public-school boy who developed the disease on returning to his home after closure of the school owing to the existence of the disease at the school. ACUTE POLIO-ENCEPHALITIS. This obscure and rare disease is apparently of a similar nature to acute polio-myelitis. Only 2 cases were reported in 1924, none in 1925, and 3 in 1926. ACUTE ENCEPHALITIS LETHARGICA. Four cases of this disease were notified in 1926. This disease of the nervous system is only occasionally infectious in the ordinary sense of the word. Although uncommon, it is an important disease, in view of the fact that it is usually prolonged and progressive in its course, giving rise to physical and mental deterioration. CEREBRO-SPINAL FEVER. Five cases of this disease were notified in 1926. MALARIA. One case of this disease was notified during 1926. The man was suffering from the disease general paralysis of the insane, and was artificially inoculated with the infection of malaria as a means of combating the more serious disease. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and eighty-four cases of acute primary pneumonia were notified in the year 1926, as compared with 265 cases in the year 1925, and 369 cases in the year 1924. Seventy-six cases of acute influenzal pneumonia were notified in the year 1926, as compared with 88 cases in the year 1925 and 87 cases in the year 1S24. 20 ANTHRAX, CHOLERA, CONTINUED FEVER, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TRENCH FEVER, TYPHUS FEVER. No cases of these diseases were notified during 1926. WHOOPING-COUGH. This disease is notifiable in only two London boroughs and not in Paddington. Since both the cause of the disease and effective means for treating it are unknown it would not appear that notification could assist very much in checking it. Whooping-cough is very infectious in the catarrhal stage, before the characteristic whoop develops, and this adds to the difficulty in dealing with the disease. In 1926, 8 children died from whooping-cough, all under the age of 5 years. The numbers of deaths in 1924 and 1925 were 9 and 13 respectively. CANCER. The deaths from cancer are growing in number year by year in every part of the country, including Paddington. It is now one of the commonest causes of death, and the number of deaths, 239, which occurred in Paddington last year is larger than in any previous year. Careful analysis of the figures demonstrates that the increase is a real one and is only partly accounted for by increased longevity and consequent proclivity to the disease, and by more accurate diagnosis on the part of doctors. The number of deaths for previous years is shown in the list following Numbers of Deaths in Paddington. 1926 239 1925 230 1924 234 1923 206 1922 191 1921 226 1920 194 1919 170 1918 164 1917 201 1916 205 1906 164 INFECTIVE ENTERITIS. This disease was notifiable during 1926 in 7 London boroughs, but not in Paddington. The question of making the disease notifiable was under consideration at the end of the year. In the absence of a system of notification information as to the existence of the disease is obtained by informal methods and cases of the disease known to the staff of St. Mary's Hospital, Paddington Green Children's Hospital and Paddington Infirmary are notified informally to the Health Department of the Council. By this means a large proportion of the worst cases of the disease are brought to notice. During the year the number of cases reported was 176 under the age of 2 years, and 36 over the age of 2 years. The deaths numbered 56, 55 of these occurring in children under the age of 2 years, The disease was more than usually prevalent during the year, the number of deaths being about double the number which occurred in 1924 and 1925 respectively. TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year 1926 are set out in the tables appended hereto. Owing to the fact that a case of tuberculosis may be notified in several boroughs or districts, the number of notification certificates received is only a very imperfect guide to the amount of tuberculosis in the Borough. There is also the consideration that notification is more strictly enforced in some districts than in others. However, recent alterations in procedure tend to make the number of cases on the tuberculosis register serve as a guide as to the real prevalence of the disease. One can also take the annual number of deaths as being a measure of prevalence. This is probably the most exact method which can be used at the present time. From pulmonary tuberculosis there were 102 deaths in 1926. From tuberculous meningitis there were 5 deaths, and from other tuberculous diseases there were 18 deaths in 1926. The number of deaths from tuberculosis of all kinds was 116 in 1925, and 125 in 1926. In recent years the number of deaths was as follows:— 1919 133 1923 127 1920 146 1924 149 1921 125 1925 116 1922 143 1926 125 21 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A and B received during the year 1926. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year — — — — — — 1— 5 years — — — 11 11 22 5—10 „ 3 — 3 26 27 53 10—15 „ 2 2 4 9 10 19 15—20 „ 8 20 27 5 3 8 20—25 „ 11 19 28 3 5 8 25—35 „ 30 37 64 4 9 13 35—45 „ 26 13 39 3 2 5 45—55 „ 16 13 28 — 1 1 55—65 „ 14 3 17 2 — 2 65 years and over 4 4 8 1 — 1 Total 114 111 218 64 68 132 Cases re-notified 61 55 116 12 13 25 Total Notifications on Form A 170 164 334 76 81 157 Primary Notifications by School Medical Officers— 0— 5 years — — . — — 2 2 5—10 — — — — — — 10—15 — — — 1 3 4 Cases re-notified — — — 4 2 6 Total Notifications on Form B — — 5 7 12 1926. No. of Notifications on Forms C and D. Poor Law Institutions. Sanatoria. C. D. C. D. Pulmonary Tuberculosis— Male 33 26 93 57 Female 36 38 79 38 Non-Pulmonary Tuberculosis— Male 4 6 27 14 Female 3 3 31 19 C—Upon admission. D—Upon discharge. Public Health (Tuberculosis) Regulations, 1921. Cases removed from Register:— 1926. By reason of— Death 130 Removal 156 Recovery of patient or variation of diagnosis 91 Total 377 Of the patients who removed from the Borough during 1926, the new addresses were obtainable in 73 instances, and particulars of the cases were transmitted to the Medical Officers of Health of the respective districts. In 1926, 9 cases of patients who had removed into the Borough from other districts were added to the register. The number of cases remaining on the Tuberculosis Register at the close of 1926 was 1,801. 22 Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 1,829 By Tuberculosis Officers 727 By Dispensary Nurses— 20, Talbot Road 2,113 St. Mary's Hospital 1,612 6,281 Tuberculosis. New Cases and Mortality During 1926. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 — 1 1 — — — 11 13 — 1 — 1 5 — 3 — 27 30 — — — 2 10 — 2 2 10 10 — — 1 1 15 — 8 20 5 3 1 3 2 2 20 — 11 19 3 5 7 4 1 — 25 — 30 38 4 9 12 21 1 2 35 — 26 13 3 2 15 9 — 3 45 — 16 13 — 1 10 5 1 1 55 — 14 3 2 — 10 2 2 1 65 and upwards 4 4 1 — — 2 1 — Totals 114 112 66 73 55 47 9 14 The Public Health (Prevention of Tuberculosis) Regulations, 1925. These regulations came into force on July 31st, 1925. By their provisions persons who are aware that they are suffering from tuberculosis of the respiratory tract may not enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk or the handling of vessels used for containing milk. Furthermore, if a local authority, on the report in writing of their Medical Officer of Health, are satisfied that a person residing in their district who is engaged in any such occupation mentioned above is suffering from tuberculosis of the respiratory tract and is in an infectious state, they may by notice in writing require such person to discontinue his employment or occupation on or before the date specified in the notice, such date being not less than seven days after the service of such notice, and such person shall thereupon comply with the said notice. Aggrieved persons have the right of appeal to a court of summary jurisdiction, and in every case adequate compensation has to be paid to every person who suffers damage from the exercise of the powers of the regulations in any matter as to which he is not himself in default. No use has so far been made of these regulations. Supply of Beds and Bedding.—In certain instances, so that the separate sleeping of tuberculous patients may be arranged, beds and bedding are supplied on loan by the Council. Eight sets were so supplied during 1926 and 5 sets were returned following the death or removal of the patient. New articles were purchased during the year at a cost of £6. Artificial Pneumothorax Treatment.—By arrangement with Brompton Hospital patients recommended for this treatment are given refills at a cost to the Council of 10s. 6d. per refill. During 1926 1 patient received 23 refills, another 16, and another 10 refills, the total cost being £25 14s. 6d. Dental Treatment.—Dental treatment is provided for tuberculous persons attending either of the Tuberculosis Dispensaries, by arrangement with the British Dental Hospital, of 31, Camden Road, N.W. 1. The agreement provides for the payment by the Paddington Borough Council of £120 per annum, and in return for this the British Dental Hospital provide the services of a Dental Surgeon for one half-day weekly, together with the necessary equipment, drugs, etc. The dental clinic is installed at the Paddington Tuberculosis Dispensary, 20, Talbot Road, where a room and the necessary attendance is provided by the Dispensary Committee. Arrangements have also been made for the supply of dentures by the Dental Hospital. 23 During 1926, 5 patients were supplied with complete dentures, 2 with partial dentures, and in 4 cases dentures were repaired or re-made. Out of a total cost of £35 8s. Od., the Council made grants to the amount of £21 19s. Od., patients, approved societies or voluntary agencies contributing the balance. When patients are able to contribute towards the cost of their dentures, arrangements are usually made for payment to be accepted by instalments. Particulars of the dental work done during the year are shown in the subjoined table. BRITISH DENTAL HOSPITAL. Summary of Dental Treatment for the Year 1926. Particulars of Patients. Number of Attendances. Number of Fillings. Number of Scalings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. Number of NewPatients. Simple. Root. Without Anaesthetic. Local Administration. Gas Administration. Number of Teeth Extracted. Upper. Lower. Re-models. Repairs. Women 82 9 — 3 — 21 8 82 3 3 — 3 3 10 27 14 Children 65 27 4 — — 11 17 75 — — — — — 20 2 13 Men 40 3 — 5 — 2 6 30 3 3 — — — 8 14 15 Total 187 39 4 8 — 34 31 187 6 6 — 3 3 38 43 42 DISPENSARY TREATMENT OF TUBERCULOSIS. For administrative purposes the Borough is divided into two dispensary areas, the line of division passing down Inverness Terrace, Porchester Road, Ranelagh Road, Formosa Street (to its junction with Shirland Road), Shirland Road (to its junction with Kilburn Park Road), and Kilburn Park Road. The portion of the Borough to the east of this line is served by the St. Mary's Hospital Dispensary, and the portion to the west of the line by the Paddington Tuberculosis Dispensary. Paddington Tuberculosa Dispensary, 20, Talbot Road. This is a voluntary agency supported by voluntary subscriptions and a grant from the Paddington Borough Council amounting to £1,288 in 1926. A full account of the Dispensary and its activities will be found in the annual reports for 1924 and 1925. In April, 1926, the Dispensary extended its scope by appointing an assistant for bacteriological purposes to work under the supervision of the Tuberculosis Officer. By this means the Dispensary was able to carry out the examination of all sputums from its patients as well as sputums from private medical practitioners sent for examination and report at the cost of the Borough Council. During the year 367 specimens of sputum were examined and reported upon. During the year an arc-light apparatus for supplying patients with irradiation with ultra-violet light was installed. The results of this treatment will be awaited with interest. Dr. Walker, the Tuberculosis Officer, calls attention to the need for X-ray apparatus to assist in diagnosis. At present cases requiring examination by an X-ray screen or photograph have to be referred to other institutions for this purpose. New premises are urgently needed for the Dispensary. The present accommodation is inadequate and the vibration and noise of passing traffic seriously affect the efficiency of the work. This question is having the unremitting attention of the Executive Committee of the Dispensary. 24 Paddington Tuberculosis Dispensary, 20, Talbot Road. Return Showing the Work of the Dispensary During the Year 1926. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. M. f. M. f. M. f. M. f. M. f. M. f. a.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 49 51 — 1 7 6 23 20 56 57 23 21 (b) Doubtfully tuberculous — — — — — — — — 20 43 18 18 (c) Non-tuberculous — — — — — — — — 30 43 43 35 B.—Contacts examined during the year:— (a) Definitely tuberculous 6 7 — 1 2 2 13 14 8 9 13 15 (b) Doubtfully tuberculous — — — — — — — — 8 5 9 10 (c) Non-tuberculous — — — — — — — — 33 73 53 48 C.—Cases written off the Dispensary Register as (a) Cured — 2 — — — 1 — 3 — 3 — 3 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 91 165 122 107 D.—Number of Persons on Dispensary Register on December 31st (a) Diagnosis completed 173 193 6 4 34 36 159 128 207 229 165 132 (b) Diagnosis not completed — — — — — — — — 7 8 7 7 1. Number of persons on Dispensary Register on January 1st 626 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 71 2. Number of patients transferred from other areas and of "lost sight of" cases returned 39 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 28 (b) Otherwise 102 3. Number of patients transferred to other areas and cases "lost sight of " 46 11. Number of other visits by Tuberculosis Officers to Homes 438 4. Died during the year 57 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,113 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 33 13. Number of (a) Specimens of sputum, &c., examined 210 (b) X-ray examinations made in connection with Dispensary work 24 6. Number of attendances at the Dispensary (including Contacts) 6,540 14. Number of Insured Persons on Dispensary Register on the 31st December 278 7. Number of non-pulmonary cases attending Orthopaedic Out-stations for treatment or supervision 4 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 110 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 30 (a) "Light" treatment (b) Form G.P. 36 15 (b ) Other special forms of treatment (c) Form G.P. 35 35 25 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,070 from the Paddington Borough Council for the year 1926. A full account of this dispensary and its activities will be found in the annual reports for 1924 and 1925. There was nothing in the dispensary arrangements during the year calling for special notice except that arrangements were made available for the ultra-violet irradiation of certain patients in the Light Department of the hospital. St. Mary's Hospital Tuberculosis Dispensary. Return Showing the Work of the Dispensary During the Year 1926. Diagnosis. Pulmonary. Non-Pulmonary. Total. Adults. Children. Adults. Children. Adults. Children. m. f. M. f. M. f. M. f. M. f. M. f. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 24 16 1 — 6 6 7 10 30 22 8 10 (b) Doubtfully tuberculous — — — — — — — — 12 29 6 2 (c) Non-tuberculous — — — — — — — — 6 9 10 9 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — 6 2 — — 6 2 (b) Doubtfully tuberculous — — — — — — — — — 5 — 1 (c) Non-tuberculous — — — — — — — — 38 27 7 28 C.—Cases written off the Dispensary Register as (a) Cured 1 — — — — 1 1 1 1 1 1 1 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 59 88 29 42 D.—Number of Persons on Dispensary Register on December 31st (a) Diagnosis completed 52 35 3 1 39 39 49 32 91 74 52 33 (b) Diagnosis not completed — — — — — — — — 3 7 5 1 1. Number of persons on Dispensary Register on January 1st 251 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 7 2. Number of patients transferred from other areas and of "lost sight of" cases returned 27 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 11 (b) Otherwise 3 3. Number of patients transferred to other areas and cases "lost sight of " 38 11. Number of other visits by Tuberculosis Officers to Homes 250 4. Died during the year 19 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,612 5. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 14 13. Number of (a) Specimens of sputum, &c., examined 128 (b) X-ray examinations made in connection with Dispensary work 45 6. Number of attendances at the Dispensary (including Contacts) 5,130 14. Number of Insured Persons on Dispensary Register on the 31st December 180 7. Number of non-pulmonary cases attending at Orthopaedic Out-stations for treatment or supervision 2 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for 7 16. Number of reports received during the year in respect of Insured Persons :— (a) "Light" treatment 15 (b) Other special forms of treatment 87 (a) Form G.P. 17 3 (b) Form G.P. 36 14 26 The Borough Tuberculosis Care Committee. On December 31st, 1926, the constitution of the Tuberculosis Care Committee was as follows:— Representing. Paddington Borough Council Councillor Mrs. R. M. Drury. ,, ,, Councillor Miss G. L. Kemp-Welch, J.P. ,, ,, Dr. G. E. Oates, Medical Officer of Health. ,, ,, Miss F. M. Nicolas, Sanitary Inspector. ,, ,, Miss L. M. O'Kell, Sanitary Inspector. British Red Cross Society Miss A. V. Edden. Charity Organisation Society Mrs. G. S. Warren. Miss P. Bethell. Insurance Committee Miss R. Russen. Invalid Children's Aid Association Miss E. M. Barber. London County Council Dr. A. W. Sikes (Divisional Medical Officer). ,, ,, Miss D. Whitmore (District Organiser of School Care Committees). Paddington Tuberculosis Dispensary Mrs. B. Freyberg. ,, ,, ,, Miss E. J. McGaw (Vice-Chairman). ,, ,, ,, Miss E. Lewis. ,, ,, ,, Dr. R. S. Walker (Tuberculosis Officer). ,, ,, ,, Miss T. Hall (Secretary to the Dispensary). ,, ,, ,, Nurse C. Griffin. ,, ,, ,, Nurse A. B. Munro. Paddington and St. Marylebone War Pensions Committee Mr. S. G. Last, J.P. Paddington and St. Marylebone District Nursing Association Miss Bennett. Paddington Board of Guardians Miss H. C. Davidson, (Chairman). Panel Committee Dr. J. J. Gibb. St. Mary's Hospital Dr. A. B. Porteous (Tuberculosis Officer). ,, ,, Sister M. M. Lee. ,, ,, Miss E. Wilson (Lady Almoner). United Services Fund Miss M. M. Barthorp. Local Social Worker The Hon. Miss E. C. Godley. Paddington and St. Marylebone Employment Committee Mr. A. E. Goss. The Medical Officer of Health continued to act as Honorary Secretary to the Committee, an allowance of £50 per annum being allocated to certain members of the clerical staff for clerical assistance. The social work of the Tuberculosis Care Committee is ancillary to the work of the Public Health Committees of the Borough Council and London County Council in the sphere of the prevention and treatment of tuberculosis. The principal duties performed are : (1) The assessment of patients' contributions, who are receiving institutional treatment at the hands of the London County Council. (2) The co-ordination of the various agencies which can be invoked to assist patients and their dependants. No funds are available in the hands of the Committee for the assistance of patients. The Committee met 25 times during the year at the Town Hall, and the attendance of members has been well maintained. 299 individual cases were considered. The following summaries illustrate a few of the beneficial social activities of the Care Committee during the last two years:— A (aged 26 years).—This young woman returned home after a long period of institutional treatment and became dependent on her mother and two sisters, whose earnings were not sufficient to provide her with extra nourishment. The case was brought to the notice of the Charity Organisation Society, who at once made a grant of milk and eggs. The Society also provided a bath chair for the use of the patient. B (aged 20 years) .—Shortly after discharge from institutional treatment this patient was certified fit for work and ceased to receive sickness benefit. She registered at the Employment Exchange, but was refused unemployment benefit on the ground that she was not genuinely seeking work. The aunt with whom she lived depended on a small allowance from her husband who had separated from her, and the fact that there was no income to replace the patient's sickness benefit caused real hardship. The Tuberculosis Care Committee, from their intimate knowledge of the case, felt convinced that a misunderstanding had arisen. Representations were made to the Ministry of Labour, and a member of the Care Committee, who is also a member of a Committee of the Employment Exchange, gave the matter his personal support. After inquiry the young woman's claim to unemployment benefit was substantiated, and the arrears were duly paid. Mr. and Mrs. C (aged 29 and 27 years).—Husband and wife both consumptive. The wife was away at a sanatorium when her husband was taken ill with haemoptysis. She returned home immediately. Later on the husband was admitted to Brompton Hospital. During the absence of Mrs. C. the baby had been boarded with friends for payment, but that arrangement could not be continued owing to the loss of Mr. C.'s income. The London County Council were unable to accept the baby for boarding out under the contact scheme, and as Mr. and Mrs. C. were unwilling to place the child in charge of the Guardians, it seemed probable that Mrs. C. would have to remain at home. Mr. C., being an ex-soldier, the case was referred by the Tuberculosis Care Committee to the United Services Fund. Within a short time satisfactory arrangements were made for the care of the child, and Mrs. C. then consented to go away for further treatment. 27 D (aged 33 years).-—This patient, a single man living in furnished lodgings, had for a considerable period neglected to forward his stamped insurance cards to the Approved Scciety. When taken ill he took the cards to a local agent, who told him that his membership had lapsed, and that he was not eligible for sickness benefit. The Tuberculosis Care Committee communicated the facts to the Chief Office of the Approved Society. On production of the cards, the man's claim was admitted, and he was immediately granted full benefit of 17/- a week. This money was badly needed, as the patient had been obliged to leave work some weeks previously, and had exhausted his savings. A loan of £2 was granted by the Charity Organisation Society to enable him to purchase clothing before entering sanatorium. E (aged 27 years).—On account of having to wear a spinal jacket, this patient, after discharge from institutional treatment, was unable to resume his former occupation as chauffeur. The Tuberculosis Care Committee communicated with the Ministry of Pensions suggesting that he should be trained as a clerk. The Divisional Director of Industrial Training eventually agreed to make the necessary arrangements. On completion of the course of training, the co-operation of the Employment Exchange was sought, and a suitable situation found for the man. F (aged 41 years).—This man and his family were specially recommended for accommodation on one of the Estates of the London County Council. A house became available just after his discharge from sanatorium, but he was unable to pay the cost of removal. The Tuberculosis Care Committee applied to the Red Cross Emergency Fund, and the desired assistance was granted. G (aged 34 years).—This patient, a single woman living with her sister-in-law, was without the means to provide herself with clothing for sanatorium. Application was made to the Charity Organisation Society, who made a grant of clothing and money to meet the difficulty. H (aged 68 years).—A widow. No income of her own, but an adopted daughter and an aunt paid the rent of the room she occupied. Application was made to the Charity Organisation Society, and temporary assistance given. The Society afterwards obtained a pension of 10/- a week for the patient, which will continue until she becomes eligible for the Old Age Pension. MATERNITY AND CHILD WELFARE. Health Visitors. These officers, two in number, work under the control of the Maternity and Child Welfare Committee of the Council. Their duties are :— (1) To visit the homes of all newly-born children where considered necessary. (2) To make enquiries concerning stillbirths and deaths of infants and young children. (3) To visit and give advice to parents in cases of ophthalmia of the new-born, infective enteritis and other important diseases. (4) To investigate all cases of puerperal fever. (5) To investigate applications for the supply of milk to necessitous families. The Health Visitors do not attend any consultations at the Paddington School for Mothers, but attend alternately once a fortnight at the Infant Consultation Centre at Queen Charlotte's Maternity Hospital. The work performed by the Health Visitors is summarised in the appended tables, which also show how many infants were breast-fed and other interesting information. HEALTH VISITING. Births— First Visits 2,107 Revisits 2,008 4,115 Ante-natal— First visits 521 Revisits 504 1,025 VISITS re SICKNESS, Puerperal Fever and Puerperal Pyrexia 89 Ophthalmia Neonatorum 178 Diarrhœa 584 Miscellaneous 1,786 2,637 INFANTS VISITED: 1,658. Method of Feeding. Breast. Artificial Mixed Number 1,481 88 89 Percentage 89.2 5.4 5.4 28 AGES AT FIRST VISIT. Months Weeks Method of Feeding. Breast. Artificial. Mixed. Totals. 0— 38 1 1 40 1— 523 14 10 547 2—* 433 12 29 474 3— 218 11 10 239 0— 1,212 38 50 1,300 1- 208 24 22 254 2— 43 8 5 56 3 and upwards 18 18 12 48 DIED BEFORE END OF YEAR: 64. Breast 57 Artificial 3 Mixed 4 CAUSES OF DEATH. Diarrhœal Diseases 22 Premature Birth 4 Respiratory ,, 18 Convulsions 1 Atrophy, Debility — Meningitis 1 Congenital Defects 6 Other Causes 6 Whooping Cough 6 Institution Deaths 51 (Paddington Infirmary 43). Maternity and Child Welfare Centres. These are provided by the Paddington School for Mothers, which is a voluntary society financed by voluntary contributions and by grants from the Paddington Borough Council and the Ministry of Health. The following is a brief account of the activities of the Paddington School for Mothers. Headquarters : 232, Harrow Road, W. 2. Established 1910, when the Paddington Health Society was divided into two distinct bodies for dealing with Tuberculosis and Infant Welfare, the latter being the Paddington School for Mothers. The Birth Visiting was performed by the School's qualified Visitors until 1913, when, owirlg to the great increase in the work, for which only voluntary funds were then available, the Birth Visiting was taken over by the Borough Council, who appointed their first Health Visitor for that purpose. South Centres. 232, Harrow Road, W. 2.—Nine good rooms warmed by gas fires, bathroom and basement. Two Infant Consultations weekly.—Tuesday, 2.30. Medical Officer, Dr. O. Stuart Thompson. Thursday, 2.30. Medical Officer, Dr. Thoresby Jones. Area served:—Parts of Church, Harrow Road, Westbourne and Maida Vale Wards. One Maternity Consultation weekly (Ante- and Post-Natal).—Established January, 1918, monthly. March, 1919, weekly. Monday, 10.30 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served :—All Paddington. St. David's Welsh Church Hall, St. Mary's Terrace, W. 2.—-Large hall, electrically heated, and doctor's room, guarded coal fire. Established November, 1914, at Paddington Wharves' Mission Hall, Church Place, W. 2. Moved to present address, June, 1921. One Infant Consultation weekly.—Wednesday, 2.30. Medical Officer, Dr. Maude Richards. Area served :—Church and Town Wards. St. John's Boys' Club, Sovereign Mews, Cambridge Street, W. 2.—Three rooms warmed by gas radiators and guarded coal fire. Established November, 1918. Moved to All Saints' Church House, Norfolk Mews South, London Street, W. 2, April 22nd, 1919. Returned to present address, July, 30th, 1926. One Infant Consultation weekly.—Friday, 2.30. Medical Officer, Dr. Hammond. Area served.—Hyde Park Ward. Christ Church Parish Rooms, Back of 36, Porchester Terrace, W. 2.—Two large rooms and doctor'sroom, warmed by gas fires, radiators and oil stove. One Infant Consultation weekly.—Monday, 2 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served.—Lancaster Gate East and West and part of Westbourne Wards. 29 North Centres. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large double room, doctor's room and sales room, warmed by gas radiators and hot pipes. Established 1911, at Emmanuel Hall, Harrow Road. Moved June, 1916, to St. Peter's Institute, Chippenham Mews. Moved to present address, November, 1916. Two Infant Consultations weekly.—Tuesday, 2.30. Medical Officer, Dr. Hammond. Friday, 2.30. Medical Officer, Dr. J. Thoresby Jones. Area served :—Queen's Park Ward and part of Harrow Road Ward. St. Simon's Parish Hall, Macroom Road, Saltram Crescent, W. 10.—Large hall, doctor's and weighing rooms, warmed by gas radiators and gas fires. Established December 6th, 1920. One Infant Consultation weekly. Wednesday, 2.30. Medical Officer, Dr. J. McKail. Area served :—Part of Harrow Road Ward. Orphanage of Mercy, Randolph Gardens, Kilburn Park Road, N.W. 6.—Room for weighing, etc., warmed by guarded coal fire, and doctor's room, warmed by gas fire. Established February 8th, 1921. One Infant Consultation weekly.—Thursday, 2.30. Medical Officer, Dr. Hubert Hodge. Area served :•—Part of Maida Vale Ward and part of Harrow Road Ward. Massage Sessions are held at 232, Harrow Road on Tuesday and Thursday mornings from 10.0 to 12.30, by Miss Gannon, C.S.M.M.G., for children referred by Medical Officers at all Paddington Centres. These children continue to attend the Centres in order that progress may be noted by the doctors. Sewing Classes are held on Monday afternoons at 232, Harrow Road, under the management of Voluntary Workers, who obtain materials and provide patterns. A cutter-out is paid 2s. 6d. for the afternoon. Mothers pay cost price for materials. Dental Arrangements.—The Dental Dispensary, 281, Harrow Road, and the Lissonia Dental Clinic treat mothers and children who attend Centres on special terms. Assistance, when necessary, given from Vest Fund. Lectures.—Lectures are provided from time to time, on Health topics at all Centres. Convalescent and Holiday Homes.—Mothers and children are sept to Convalescent and Holiday Homes on recommendation of Medical Officers at Centres. All arrangements made by School workers, and assistance given when necessary, by the Vest Fund. Vest Fund.—A small Association of ladies connected with the School, knit garments and woollies which are sold to the mothers at low cost at the Centres. The stock is augmented by gifts from friends, and the money realised is spent on dentures, convalescence, etc. Artificial Sunlight Treatment can be procured for cases recommended by doctors at Centres, at St. Mary's Hospital. Arrangements are being made for the local treatment of suitable cases. Home Visiting. Home visiting is carried on systematically from the time of receiving the Borough Health Visitor's Birth Card, until the child goes to school. Each Health Visitor has her appointed area. Staff. The salaried staff consists of the Superintendent, Assistant Superintendent, one part-time and four whole-time Visitors. 30 Consultation Centres. Summary of Work for the Year 1926. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Randolph Gardens. * West Centre. Totals. Tues. Thurs. Tues. Fri. Wed. Wed. Thurs. Fri. Number of Sessions 50 51 50 50 50 51 51 50 403 Number of Attendances 2,848 2,396 3,358 2,601 3,018 1,979 1,378 1,514 19,092 Average Attendance 56.96 46.98 67.16 52.00 60.36 38.82 27.02 30.28 47.37 Seen by Doctor 1,149 1,027 1,226 923 1,044 1,102 817 897 8,185 Average number seen by Doctor at each Session 22 20 24 18 21 21 16 18 20 * Centre transferred from Norfolk Mews South to Sovereign Mews on 30th July, 1926. Ante-Natal Clinic. Number of Sessions 48 Number of Attendances 466 by 262 expectant mothers. Average Attendance per Session 9.71 Home Visiting. Visits to Babies 14,531 Visits to Expectant Mothers 460 Other Visits 8,503 Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,595 15 3 Sales 1,529 1 5 Grants from Borough Council 42 5 10 Queen Charlotte's Maternity Hospital.—During the year 1926, 120 infants of mothers resident in Paddington attended the Infant Consultation Centre. Each attended about 30 times. As regards ante-natal consultations, exact figures are not available. During 1926 there were received into the Hospital for confinement 259 women from Paddington. This number is approximately equal to the number of women from Paddington attending the antenatal department during the year, and the average number of attendances was 2½ per patient. With regard to out-patients in 1926, 450 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about 2½ times on the average. St. Mary's Hospital.—There is no Infant Consultation Centre at this Hospital, but Ante-natal Consultations are held. There are no figures available as to the number of Paddington mothers who attended such consultations, but the number of Paddington mothers delivered at their own homes during 1926 was 179, and presumably all of these received ante-natal examination and advice. Maternity Nursing.—In December, 1924, the Council decided to ask the Minister of Health to sanction an arrangement with the Paddington and St. Marylebone District Nursing Association providing for the services of trained maternity nurses in connection with lying-in cases attended by the students and the Medical Officer of the Extern Midwifery Department of St. Mary's Hospital. An agreement subsequently entered into with the Association came into operation in April, 1925. During the 9 months to the end of 1925 rather more than 100 women were attended in their homes by the nursing staff. During the year 1926, 179 confinements were attended by the nursing staff, the number of visits paid being 2,881. Up to March 31st, 1926, the grant made by the Council to the Paddington and St. Marylebone District Nursing Association was at the rate of £150 per annum. The grant was increased to £175 per annum as from this date. 31 DAY NURSERIES. There are two day nurseries in Paddington, situated at No. 66, Lancefield Street, Queen's Park, W. 10, and at No. 13. Hasborough Street, W. 2 Statistical Summary. Hasborough Street. Queen's Park. Days open 222 298 Attendances 3,259 5,649 New Children 23 42 Cases of Infectious Disease. Diphtheria — — Scarlet Fever — — Measles — 8 Whooping Cough — — Chicken Pox — — There were no Closures during the Year on account of infectious disease. PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. Milk is given in the following cases :— (a) Expectant mothers during the last three months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also in exceptional cases children over three and under five years of age. The quantity of milk authorised does not exceed one pint per day except in the case of children between 3 months and 18 months where a special medical certificate is furnished, and in which case as much as 1£ pints per day may be authorised. One pound of dried milk is considered to be the equivalent of 7 pints of fresh milk. Applications are made at the Public Health Department at any time, when particulars of the circumstances of the family are obtained. Whenever considered necessary wages, etc., are verified from the employer, and other enquiries instituted by the Investigation Officer. Close touch is also maintained with the Board of Guardians and other sources of assistance. A scale of income is appended which is used for the purpose of determining whether applicants are to be regarded as necessitous, and as to whether milk shall be supplied free or at half price. Where considered necessary, however, the Sub-Committee reserve the right to deviate from such scale. Before any case is recommended to the Committee, the Medical Officer of Health must be satisfied that the supply is necessary on grounds of health. A special medical certificate is also required in the case of children between 3 months and 18 months where more than 1 pint per day is required or where any milk is required for children between 3 and 5 years of age. The existence and duration of pregnancy must be verified by the signature of a doctor or midwife. Applications for grants are considered in detail by the full Maternity and Child Welfare Committee sitting as a " Grants " Sub-Committee, meetings being held practically every fortnight. Pending the sitting of the Sub-Committee the Chairman may authorise emergency grants. Grants take one or other of the following forms :— (a) Fresh milk to Expectant or Nursing Mother or a child under 5 years of age (see first paragraph) on an order issued on the usual dairyman supplying family ; (b) Dried Milk—supplied at the Welfare Centre attended by the infant; and (c) Dinners (cut from joint, two vegetables and " sweet ") to expectant or nursing mothers partaken at approved restaurants. The necessary orders are despatched on the evening of the day on which the Sub-Committee sits, one copy to the tradesmen and one to the grantee. On the latter the following conditions are printed :—Milk supplied under this order is to be used only for the mother or child to whom the milk has been granted. It is not to be given to other members of the family. The Medical Officer of Health should be informed at once if there be (1) Any rise of wages of any member of the family ; (2) Any increase of pension ; or (3) Any assistance received from the Relieving Officer. 32 During the year the following quantities of milk were issued to necessitous mothers Fresh Milk 10,459 quarts. Dried Milk 572 lbs. The approximate cost of milk given in this way was £323 8s. lOd. Income Scale. Free. Half-Price. Number of family. Total Income less Rent. Total Income less Rent. 1 15/- 18/- 2 20/- 24/- 3 25/6 27/- 4 30/- 34/- 5 32/6 37/6 6 36/- 42/- 7 40/- 47/6 8 44/— 51/6 9 48/- 55/6 10 52/- 60/- 11 56/- 65/- 12 60/- 70/- Particulars of Milk Grants. Number of New Applications. 1926. Refused or referred to Guardians. Granted. Fresh Milk 403 313 90 Dried Milk 58 46 12 Dinners 6 6 — 467 365 102 Number of Orders for Milk 904 At Total Cost 860 At Half Cost 44 Number of Quarts at Total Cost 9.906½ Half Cost 552½ Total Number of Quarts 10,459 £. s. d. Cost of Milk at Total Cost 273 12 8 Half Cost 7 10 4 £281 3 0 Number of Orders for Dried Milk 149 At Total Cost 147 At Half Cost 2 Total Cost of Dried Milk £42 5 10 Number of Orders for Dinners 19 Number of Dinners supplied at Total Cost 422 Total Cost of Dinners £26 7 6 Convalescent Homes. There were no "Convalescent Home" applications, but a grant was made towards the cost of maintenance of a child in a special hospital. The Widows', Orphans' and Old Age Contributory Pensions Act, 1925. This Act came into force on January 4th, 1926. In the County of London the local authority for the purpose of the Act is the London County Council, who may make arrangements for a Metropolitan Borough Council to execute and perform all their powers and duties under the Act. The London County Council have duly delegated their powers and duties to the Paddington Borough Council, who have decided that all these matters shall stand referred to the Maternity and Child Wei- 33 fare Committee for consideration and report. Also, for the purpose of section 6(2) of the Act the Maternity and Child Welfare Committee is to be the body to which an aggrieved widow or other person, to whom an additional allowance or orphan's pension is payable, may present her case. The following is a summary of the parts of the Act affecting this Council:— Widows' pensions are payable to certain widows of insured men at the rate of ten shillings per week, with an additional allowance in respect of children at the rate of five shillings per week for the eldest or only child, and three shillings per week for each other child. Orphans' pensions are payable to the orphan children of insured men or widows at the rate of 7s. 6d. per week. The age-limit for children is the age of 14 or the age not exceeding 16, up to which the child remains under full-time instruction in a day school. An orphan's pension is payable to the guardian or other person having the charge of the child. Section 6(2) Where a representation is made to the Minister by the local authority or otherwise :— (a) With reference to an additional allowance payable in respect of a child, tfiat the widow or other person to whom the additional allowance is payable has deserted or abandoned or ceased to support the child, or has become disqualified for the time being from receiving a widow's pension, and that it would be in the interests of the child that the additional allowance should be administered by the local authority or some other person for the benefit of the child ; (.b) With reference to an orphan's pension payable in respect of a child, that it would be in the interests of the child that it should be administered by the local authority or some other person for the benefit of the child ; the Minister, if satisfied that the allegations of the representation are true, and that it would be in the interests of the child so to do, may direct that the additional allowance or orphan's pension shall be paid to the person having the charge of the child or to any other person approved by the Minister or to the local authority, to be administered by such person or by the local authority for the benefit of the child. Provided that, where the widow or other person to whom the additional allowance or orphan's pension is payable has not had an opportunity of presenting her case personally, or through some person appointed by her, to the local authority or a person appointed for the purpose by the local authority, the Minister (except where the widow or other person cannot be found, or is in prison, or in an asylum or other similar institution) shall, before giving any such direction, give the widow or such other person as aforesaid an opportunity of so presenting her case to a person appointed by him. Where the Minister is satisfied, on the application of a woman in receipt of an additional allowance as part of a widow's pension, or of any other person having the charge of a child in respect of whom an additional allowance or orphan's pension is payable, that the child is or is about to be placed in the temporary custody of some other person and that the additional allowance or orphan's pension should be paid to that other person so long as such temporary custody continues, he may direct that the additional allowance or orphan's pension shall be paid accordingly, subject to such terms and conditions as he may think fit to impose. The duties and powers of the Council are:— (1) To represent to the Minister of Health that the mother of a child in respect of whom an additional allowance is payable should no longer receive such allowance, but that it should be administered by the Council or some other person for the benefit of the child. (2) To make a similar representation concerning an orphan's pension. (3) To administer such additional allowance or orphan's pension if the Minister so decides. (4) To investigate and report to the Minister of Health on any matter referred to the Council and relating to a widow or child to or in respect of whom a widow's or orphan's pension or additional allowance is payable. (Section 41(5).) At the time the Act came into operation it was impossible to foretell the amount of work which would devolve on the Council. As a matter of fact there was no occasion during the year for the Council to take any action. As there were at the Census of 1921, 2,423 children of living widows, 109 orphans under the age of 15, as well as 501 children of whose parents no information was obtainable, the absence of any need for interference on the Council's part is very satisfactory to record. 34 ADMINISTRATION. GENERAL. Staff of the Department.—Mr. C. Binding resigned from the office of Sanitary Inspector on December 31st, 1926. Mr. G. Frost was appointed Junior Clerk on May 3rd, 1926. Prevention of Infectious Disease.—Visits of inquiry after notification of infectious disease numbered 8,148. This figure excludes visits in connection with tuberculosis, which are recorded elsewhere in this report. The removals to hospitals and other institutions for various diseases other than tuberculosis numbered 1,125. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 272 patients (comprising 200 cases of measles, 62 of pneumonia, 4 of whooping-cough, and 6 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 2,822. Disinfection.—The rooms disinfected after infectious disease numbered 2,029, including 245 rooms disinfected after tuberculosis. The weight of bedding, etc., removed for disinfection at the Wood Lane Disinfecting Station, under the agreement with the Kensington Borough Council, amounted to 23 tons. One hundred and fifty-one library books were disinfected. Schools.—A total of 5,037 notices relating to cases of infectious disease were despatched to the Head Teachers of the various schools attended by patients or their "contacts," 4,277 of such notices referring to cases of measles, whooping-cough and chickenpox, and the remainder to cases of diphtheria, scarlet fever and other notifiable diseases. In addition 345 reports were sent to the Medical Officers of Health of other boroughs in connection with cases attending outlying schools. Bacteriological Work.—The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Bridge Road, S.W. 1, for the bacteriological examination, at the expense of the Council, of specimens sent by medical practitioners of Paddington patients suspected to be suffering from diphtheria or typhoid fever. All specimens are collected at the Town Hall and transmitted to the Lister Institute by special messenger the same evening. The results are generally available the next morning, and are telephoned to the medical practitioner concerned. Examinations of sputa from patients suspected to be suffering from tuberculosis of the lungs are undertaken by the Paddington Tuberculosis Dispensary, 20, Talbot Road, under an arrangement which came into operation early in the year. The examinations made were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 1,208 208 Tuberculosis 452 59 Typhoid Fever 7 None. House Drainage.—During the year 210 existing drains were tested and found water-tight, 164 defective drains were reconstructed and 14 made sound by special process. Reconstruction Plans.—Three-hundred and twenty-three plans (323) were submitted for drainage works in existing buildings. In connection therewith 792 letters were despatched. One summons was issued for failure to supply plans, but the plans were received before the date of hearing, and the case was disposed of by the defendant being ordered by the magistrate to pay £1 Is. Od. costs. Combined Drainage.—Orders were made under Section 74 of the Metropolis Management Act, 1855, with respect to new drainage systems to which the following groups of houses were to be connected:— Portsea Mews, Nos. 5 and 6. Hyde Park Place, Nos. 22 and 23. Wharves, North Side, 3 new sheds at rear of Nos. 11 and 12. Elgin Avenue, Garage at rear of No. 131. Harrow Road, Nos. 107 and 109, and Nos. 498 and 500. 35 Frederick Mews, Nos. 3, 4, 5 and 6. Queen's Road, Nos. 167, 169 and 171. Edgware Road, Nos. 203 and 205. Amberley Wharves, Nos. 1, 2, 2a, 3, 3a and 4. Chester Mews, No. 2, Hyde Park Terrace, No. 20, and new private residence on south side of Chester Mews abutting on east side of Clarendon Place and immediately in rear of No. 20, Hyde Park Terrace. Westbourne Park Road, Nos. 43 and 45. Praed Street, Nos. 163 and 165. Caroline Place, Nos. 39, 40 and 41. The Council recognised as a sewer and reconstructed a combined system serving:— Westbury Road, rear of Nos. 17 and 19. Sewer Connections.—In 1926, 41 were reconstructed, either partially or wholly, 14 after Orders under section 85 of the Metropolitan Management Act, 1855, and 27 on the initiative of the owners of the properties concerned. Water Supply.—Certificates under section 48 of the Public Health (London) Act were issued with respect to 14 premises. The Metropolitan Water Board reported 16 cases of discontinuance of water supply. In 4 instances the supply was disconnected in consequence of defective fittings, the reason given in the remaining instances being non-payment of water rate. Two of the premises were found on inspection to be unoccupied. The water supply was restored to the remaining premises, in 6 instances after the service of notices. No legal proceedings were necessary. Mortuary.—Three hundred and fifteen (315) bodies were deposited at the Mortuary, inquests being held on 227 of that number. Bodies deposited pending burial (all non-infectious) numbered 88. Trade Nuisances.—Thirty complaints were received during the year, those relating to manure numbering 15. Rag and Bone Dealers.—In December, 1926, there were 13 rag and bone dealers in the Borough, 7 dealers having closed down during the year. Smoke Control.—During 1926 12 trade premises were kept under observation for the detection of black smoke. These premises were watched on 104 occasions, occupying 73½ hours. Smoke of all descriptions was noted during 36 hours, the duration of "black" smoke being only 4¾ hours. Thirteen complaints relating to the emission of smoke were received during the year. Two Notices were served. FOULING OF PUBLIC FOOTWAYS BY DOGS. The following bye-law was made by the Council on the 29th July, 1924, for the good rule and government of the Borough:— No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this bye-law shall be liable to a penalty not exceeding 40 shillings. This bye-law shall cease to be in force after the first day of August, 1926, unless a bye-law confirming and continuing its provisions has been duly made and come into force before that date. In July, 1926, the bye-law was adopted permanently by the Council. This bye-law is enforced by the Medical Officer of Health and his staff. During 1926 no prosecutions were instigated, but numerous verbal warnings to offenders were given. The publicity which has been given to the bye-law has had good effect in causing many dog-owners to be more careful. One minor difficulty in enforcing the bye-law is that an offender cannot be compelled to divulge his identity, and cannot be given in charge as the police do not enforce the bye-law. Notices concerning the bye-law were frequently posted on shingle-bins throughout the Borough. 36 CANAL BOATS ACTS, 1877 AND 1884. By virtue of the Local Government Board Regulations of May 17th, 1878, the Paddington Borough Council is one of the Registration Authorities for the Regent's and Grand Junction Canals. The Medical Officer of Health is the Examining Officer for the purpose of the Regulations, and during the year 1926 Mr. E. J. Potter was Inspector of Canal Boats. Canal Boat Children.—During the year the Medical Officer of Health, in co-operation with the School Medical Officer of the London County Council, carried out an investigation into the health and welfare of children living on canal boats. It was found that as regards general health, physique, nutrition, cleanliness, foot-gear and clothing, the children were below the standard of children of similar social status living in houses. It appeared that the Council had very little power to effect any improvement in these conditions, largely due to the confined and overcrowded conditions in which these children live. Possibly the school medical service of the County Council might effect some improvement by the further exercise of their powers. A copy of the Medical Officer's report was sent to the Minister of Health and the London County Council. The Medical Officer of Health reported further as to the presence of children upon canal boats engaged in the transport from Paddington of street and house refuse and other offensive cargoes. These boats are no longer horse-drawn, but steam-towed the whole distance, seldom more than a dozen miles from London. There appears to be no need for children to be on board such boats. In October, 1926, the Council passed the following resolution:— " That the Minister of Health be informed that the presence of children on canal boats carrying offensive cargoes should be prohibited by regulation." The following report was made to the Council by the Medical Officer of Health, and was adopted by the Council as their statutory report to the Minister of Health as required by the Canal Boats Act, 1884. Report for 1926.—Sixty-eight inspections of canal boats were made during the year, and the following infringements of the Acts and Regulations were discovered:— Cabins leaky 3 Boat without certificate 1 Lettering, marking and numbering illegible 2 Painting of cabin required 6 Cabin illegally occupied 1 On no occasion was admission to a boat refused, and no legal proceedings were necessary against either the owner or occupier of any boat. Six notices were served and 4 letters sent relating to registration of boats, etc. One case of acute influenzal pneumonia (male, aged 13) and 1 of pulmonary tuberculosis (male, aged 25) were notified during the year. Two boats were registered owing to change of ownership. There were no registrations of boats propelled by steam or motor power. Sixty-two children were found to be living on the boats inspected, 36 being of school.ages The boats on the Register at the end of 1926 totalled 243, 1 being a motor-boat. Of this number only about half can be traced. The annual cleansing and repairing operations at Paddington Basin were carried out during the Easter holidays. About 745 tons of mud were removed, 560 square yards of concreting laid, 279 cubic feet of brickwork repaired, and 195 feet of concrete coping were done by the Grand Junction Canal Company. HOUSING. Conversions.—Section 102 of the Housing Act 1925 empowers a County Court to vary the terms of a lease or other instrument so as to enable a house to be converted into tenements, notwithstanding any restrictive covenant there may be to the contrary. No applications under this Section were made during the year. Plans were submitted to the Council under the drainage bye-laws, relative to the conversion of 28 premises into 88 tenements. It is probable that a number of other conversions were carried out in which no interference with existing drainage was involved. Such conversions would not come within the purview of the department. Compulsory Repairs.—No notices were served under section 3 of the Housing Act 1925, but 457 letters were sent to owners drawing attention to defects liable to be dealt with under the section. These letters in most instances resulted in the defects being remedied. 37 Houses Unfit for Habitation.—No representations were received or Closing Orders made during the year. Two Closing Orders made in 1919 were determined upon the completion of the works necessary to make the houses fit for human habitation. Underground Rooms.—No rooms were dealt with under the Council's Regulations pursuant to section 18 of the Housing Act 1925. Action, however, was taken under section 96 of the Public Health (London) Act 1891, with respect to basement rooms at two houses. At one house the illegal occupation of the rooms was discontinued, the other case being still outstanding at the close of the year. Tenement Houses.—Two houses were added to the Register, making a total of 1406 at the close of the year. The inspections made by the two Special Inspectors numbered 6,635. Particulars of the defects, etc. discovered and remedied will be found on pages 38 and 39. Overcrowding.—Fifteen tenements in registered houses were reported to be overcrowded. In only three instances was the overcrowding abated before the end of the year, the occupiers of the remaining twelve tenements being unable to find other accommodation. Owing to existing social conditions only bad cases of overcrowding are dealt with by official action. Annual Pleansing.—The usual practice with regard to the selection of special streets for inspection was followed, a total of 796 houses being inspected during the year. Notices were served for the cleansing and other work which was found to be necessary. Common Lodging Houses.—The customary inspection was made by the Sanitary Inspector of the district of the 5 common lodging houses in Kilburn Lane, prior to the annual licensing by the London County Council. During the year one case of pneumonia and 8 deaths from various causes occurred among the occupants of these houses. Rent and Mortgage Interest (Restrictions) Acts 1920-1925. Five (5) applications were made, four certificates being issued and one deferred (apparently dropped). Housing Act: Rent Books.—One rent book was found not to contain the required particulars. A cautionary letter was addressed to the landlord. Housing on London County Council Estates. There still operates the scheme inaugurated in 1924, whereby the London County Council allocates preferentially up to 15 per 1,000 houses available for letting, to families from this Borough recommended by the Medical Officer of Health on grounds of overcrowding or other special hardship. Very little alleviation of conditions accrues apparently, judging by the number of persons interviewed in the department with housing difficulties. The difficulty has been accentuated hitherto by the fact that the available Estates have been too distant from the Borough to be accessible from a financial point of view to residents working in the vicinity of Paddington. At the time of writing the County Council's Watling Estate at Edgware is becoming available for tenants, and this should prove a boon to this quarter of the Metropolis. As evidence of this is the fact that over four hundred names of persons willing to take up accommodation there have been registered in the Public Health Department to date. These are being passed on to the London County Council—with due regard to priority and urgency—as and when that Council signifies its willingness to accept further applications. The following summary of some of the cases noted will direct attention to the urgent need of further housing provision on this side of London: Number in family, including Parents. Number of Rooms Occupied. 1. 2. 3. 4. 5. 3. 23 — — — — 4. 34 — — — — 5. 17 39 — — — 6. 4 33 — — — 7. 3 21 9 — — 8. — 10 8 — — 9. — 6 6 5 — 10. — 1 2 1 — 12. — 1 — — 1 38 In addition to the above instances of overcrowding there also operates as a ground for preferential treatment by the London County Council the presence of tubercular patients in families, and there are many cases where it is impossible to provide satisfactory living and sleeping conditions for the patient owing to the limited accommodation available. One hundred and five applications have been remitted to the London County Council during the year for accommodation on the County Estates at Becontree (Essex), Tottenham, Downham(Lewisham) and Roehampton, though at the time of writing the number of houses allotted to Paddington has been practically exhausted. The following Table indicates how the 105 " recommended " applications have been dealt with during 1926. Accommodated—Becontree 26 Tottenham 2 Downham 7 Roehampton 17 52 Waiting accommodation 38 Refused by L.C.C. 4 Application withdrawn 3 Application transferred to " Watling " List 8 105 It will be absolutely impossible for even a small proportion of the five hundred families at present noted for accommodation on the County Estates to be provided with habitations for some time at the present rate of progress and with the existing "quota" operating. The Wormholt (Hammersmith) Estate now in course of construction may tend to alleviate the difficulty as that is an even better residential location than Edgware for Paddingtonians whose work lies in the Borough or its vicinity. The above figures account for only those families whose names were submitted through this department. A certain number of families obtained accommodation by direct application to the London County Council. Defects, Nuisances and Contraventions of Byelaws (other than items of Dilapidation) Discovered and Remedied in Tenement Houses. Drain defective 6 ,, choked 44 „ not properly ventilated or ventilating pipe defective 44 Manhole cover defective 78 Gully choked 81 Soil pipe defective 18 Water-closet defective 129 „ choked 50 ,, without sufficient flush 57 „ flushing apparatus defective 124 „ foul 51 „ improperly constructed 4 „ accommodation insufficient 1 „ without door, door defective, or without proper fastenings 173 Rain-water pipe defective 98 „ choked 66 Guttering defective 97 Waste pipe defective 65 „ choked 80 „ untrapped 1 ,, not provided or missing 9 Sink defective or not provided 9 Other drainage defects 61 Cistern defective 22 „ dirty 47 „ without proper cover or cover defective 69 Dustbin defective 168 „ not provided 17 ,, insufficient 52 „ disused and not abolished 1 Paving of yard or area defective 173 „ washhouse defective 129 Premises damp 82 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc. 3,532 „ verminous 139 „ contents, bedding, etc., dirty 3 ,, not provided with a window opening directly to the external air 7 Chimneys smoky 43 Food cupboards not provided 1 Windows defective including cords and fastenings out of repair 792 Roof defective 267 Common staircases out of repair 146 Staircases without sufficient handrail 6 Animals improperly kept 4 Accumulation of refuse (not offensive) 26 Premises without water or supply insufficient 1 Any other defects, etc. 82 39 Overcrowding. Tenements overcrowded 15 Rooms overcrowded 16 Occupants, total 84 Under 10 49 10 and upwards 35 Overcrowding abated— Byre-arrangement — By voluntary removal 1 Under notice 2 Cases held over 12 Notices Issued. Written Intimations 808 Statutory Notices 383 By-law ,, 1,279 Notices under L.C.C. (G.P.) Acts— Verminous rooms 98 Additional taps — Abolition of old dustbins 1 Items of Dilapidation for which Letters were sent to the Owners (Section 3 of the Housing Act, 1925). Wall-plaster broken, bulging, or defective 165 Matchboarding defective 1 Wall-paper loose 6 Skirting defective 12 Doors defective or missing 39 Locks defective 65 Ceiling plaster defective 38 Ceiling paper loose 2 Floors broken or badly worn 122 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 308 Stove settings defective 7 Flues defective 4 Hearths defective 80 Chimney-pieces loose or defective (including jambs, frieze, or mantle broken, loose, or missing) 69 Cupboard doors defective or missing 82 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 84 Window-frames loose or defective (including oak sills worn or rotten) 15 Window-glass broken 213 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 162 Steps to front entrance or area defective 12 Railing to area or area steps defective 0 Guard rails to addition roofs defective, broken or rotten 8 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 7 HOUSING. (Ministry of Health Table.) Number of New Houses Erected During the Year. (a) Total 6 (b) With State assistance under Housing Acts:— (i.) By the Local Authority Nil (ii.) By other bodies or persons Nil Unfit Dwelling Houses. 1924. 1925. 1926. I.—Inspection. - (1) Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) (2) Number of dwelling-houses which were inspected and recorded under the Housing Consolidated Regulations,. 1925— (a) Houses inspected on complaint or after illness 2,108 2,373 2,531 (b) Registered tenement houses inspected 1,007 951 796 (c) Houses inspected under Housing Acts 2 1 — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation *2 1 — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation II.—Remedy of Defects without Service of Notice. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers No record. * Underground rooms only. 40 III.—Action under Statutory Powers. (A) Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *532 *354 *457 (2) Number of dwelling-houses which were rendered fit—- (a) by owners 426 (approx.) 284 (approx.) 360 (approx.) (b) by Local Authority in default of owners — — — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — — — (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied—- (a) Number of notices under Public Health (London) Act, 1891, and London County Council (General Powers) Acts 2,040 2,177 2,508 (b) Number of bye-law notices served 2,110 1,967 1,684 (2) Number of dwelling houses in which defects were remedied— (a) by owners Not available. (b) by Local Authority in default of owners — — — (C) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders 2 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 2 1 — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — — 2 (4) Number of dwelling-houses in respect of which Demolition Orders were made (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — — — * Informal notices. FACTORIES AND WORKSHOPS. 1926. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 619 — — Workshops (including workshop laundries) 1,990 10 — Workplaces (other than outworkers' premises) 76 — — Total 2,685 10 — Defects found in Factories, Workshops and Workplaces. Particulars Number of Defects. Number of offences in respect to which Prosecutions were instituted. Found Remedied Referred to H.M. Inspector. Nuisances under the Public Health Acts:—* Want of cleanliness 145 131 — — Want of ventilation 11 11 — — Overcrowding 3 3 — — Want of drainage of floors — — — — Other nuisances 37 31 — — Sanitary accommodation insufficient 1 1 — — unsuitable or defective 9 9 — — not separate for sexes 4 4 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) Total 210 190 — — *Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 41 Outwork in Unwholesome Premises, Section 108. Nature of work. Instances. Notices served. Prosecutions Wearing Apparel— Making &c. 19 19 — Cleaning and washing — — — Household linen — — — Lace, lace curtains and nets — — — Curtain and furniture hangings — — — Furniture and upholstery 3 3 — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, &c. — — — Artificial flowers — — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags 1 1 — Brush making — — — Pea picking —- — — Feather sorting — — — Carding, &c., of buttons, &-c. — — — Stuffed toys — — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, &c. — — — Textile weaving — — — Total 23 23 — At the end of the year 1925, 1,145 premises were on the Register as compared with 1,446 at the end of the year 1914. During the year, 89 premises were removed from the Register and 87 added, making the total at the end of the year 1926, 1,143. The Department reported the opening of 20 workshops to the Home Office, and received from that office, notice of 23, 14 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 36 lists in February and 34 lists in August. These lists contained 400 names and addresses of which 315 were forwarded to other districts. From other districts 378 addresses within the Borough were received. Supervision.—There were during the year, 2,685 inspections, comprising 619 of factories, 1,990 of workshops and 76 of workplaces. There were 210 nuisances or defects found upon registered premises, 190 of which were remedied during the year, the majority being remedied by verbal request. There were 10 notices served during the vear. The defects found comprised:— Want of cleanliness 145 „ ventilation 11 Overcrowding 3 Sanitary accommodation—insufficient 1 ,, ,, unsuitable or defective 9 ,, ,, not separate for sexes 4 Other offences 37 The Home Office forwarded 9 complaints, which comprised:— Overcrowding 1 Inadequate ventilation 2 Sanitary conveniences not screened 3 Other offences 3 Bakehouses.—During the year one "level" bakehouse was closed, the total number on the Register at the end of the year being 64, of which 43 were factory bakehouses. The number of "level" bakehouses was 17 (13 being factories) and of "underground" 47 (30 being factories). The number of persons working in bakehouses was 319, including 5 women and 17 individuals under the age of 18. The bakehouses were inspected on 791 occasions during the year. 42 FOOD SUPERVISION. Slaughterhouses.—There are three slaughterhouses within the Borough, licensed by the London County Council: 18, Chippenham Mews; 275, Edgware Road; 249, Maida Vale (rear of). There were 200 inspections during the year. The animals slaughtered, so far as is known, were 2,661 head, comprising 3 bullocks and 2,658 sheep. This number is four times as great as in each of the two previous years. It is only found necessary to destroy two sheep's livers, for parasitic conditions. Public Health (Meat) Regulations, 1924.—These regulations were fully discussed in last year's annual report. No serious breach of the regulations was discovered but occasional defaults were dealt with by means of a caution. Poultry Slaughtering.—This business is dealt with by special bye-laws. The only poultryslaughterhouse in the Borough is situated at No. 51, Shirland Road. Sixty-five inspections were made during the year, approximately 6,500 poultry being slaughtered. Food Purveyors.—At the end of the year, there were some 836 purveyors of food in the Borough, classified as follows:—Butchers 79, Fishmongers 28, Fried Fish 33, Refreshments 76, Game and Poultry 15, Greengrocery 95, Margarine 16, Milk 97, General 102, Confectioners 115, Provisions 49, Grocery 78, Sweets 53. There were 8 premises on which fish-curing was performed, this business, as well as fish-frying, being regulated by special bye-laws. There were also 12 premises on which sausages were made. The Inspector paid 1,080 visits of inspection to the above-mentioned premises. Ice Cream.—At the beginning of 1926 there were 152 shops at which ice cream was known to be sold. These comprised the following kinds of business :—Sweets 36, General 33, Confectioners 34, Milk 7, Bakers 6, Greengrocer 1, Refreshments 32, Wholesale 2, Fishmonger 1. Two hundred and six inspections of premises were made during the year. Ice cream was also sold from 22 barrows stored within the Borough and from 23 barrows stored outside the Borough. Food Destroyed.—The weight of food-stuffs surrendered by tradesmen and dealers for destruction by the Council was about 6 tons, 17 cwt. Dairies and Milk Shops.—At the end of the year 1925 there were 100 names on the register. During the year 1926 5 premises were closed and 2 opened, making 97 on the register at the end of the year. Twenty-nine of the businesses were transferred to new proprietors during the year. There were 404 inspections made during the year. On October 1st, 1926, the Milk and Dairies Order 1926 came into force and abstracts of the Order were distributed to all members of the trade concerned. Sterilised milk in bottles was found to be on sale at 51 premises. The registration of dealers in sterilised milk as purveyors of milk is not enforced owing to the uncertain effect of the law. Cowshed.—There is one cowshed in the Borough, licensed by the London County Council for 6 cows. It is situated at the rear of No. 39, Star Street and was visited ten times during the year. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. Licences issued for sale of— "Certified" Milk 20 "Grade A (Tuberculin Tested)" Milk 18 "Pasteurised" Milk 22 Samples taken and submitted to bacteriological examination— "Certified" Milk 34 "Grade A (Tuberculin Tested)" Milk 4 "Pasteurised" Milk 4 With one exception, all the samples taken were found to be in compliance with the bacteriological standard appropriate to the kind of milk. In several instances it was observed that churns of "Grade A (T.T.)" milk in course of delivery at Paddington Station were either not sealed or improperly sealed. Such a condition of things is an infringement of the terms of the license granted to the producer of the milk. This is a matter which does not concern this authority and the observations and Teports were transmitted to the Minister of Health. 43 SALE OF FOOD AND DRUGS ACTS, 1875-1907. Of the 600 samples taken during the year, 19 (3.2 per cent.) were found to be not "of the nature, substance and quality demanded." This compares with 5.1 per cent, in 1925 and 6.5 per cent, in 1924. One hundred of the samples were taken on Sundays and Bank Holidays and only one of these was adulterated. Twenty-two samples of milk were taken at Paddington Station on delivery by rail. Five of these samples were found to be adulterated. Eleven other samples of milk were taken on delivery at Paddington station at the request of other boroughs and forwarded to their medical officers of health to be dealt with. Summaries of the results of analyses made by the Public Analyst during the year are given below. The results of legal proceedings are summarised on page 45. In connection with the analysis of milk samples, the Public Analyst furnishes the result of his analysis and the following table is of interest. It may be noted that the Ministry of Agriculture standards for presuming milk to be adulterated are 3 per cent, for fat and 8.5 per cent, for non-fatty solids. These standards are generally considered to be rather unfair to the consumer and the deduction to be made from the tables is that the milk sold in Paddington is, generally speaking, of average natural strength. Genuine Milk Samples, 1926. Average Monthly Figure for Percentage. Fat Content and Non-fatty solids January 3.65 8.95 February 3.52 8.83 March 3.60 8.75 April 3.63 8.73 May 3.48 8.95 June 3.43 8.93 July 3.60 8.93 August 3.49 8.84 September 3.65 8.80 October 3.77 8.89 November 3.86 8.90 December 3.43 8.77 1926.—Samples Submitted to Public Analyst. Total. Found adulterated. Percentage adulterated. Apples 3 — — Aspirin Tablets 6 — — Beer 5 — — Brandy 3 — — Brawn 4 — — Bread 15 — — Butter 33 1 3.0 Cake 6 — — Camphorated Oil 1 — — Cheese 11 — — Cocoa 10 — — Coffee 10 — — Cream 7 — — Cream, Preserved 6 — — Dripping 4 — — Flour 13 — — Flour, Self-raising 3 — — Gin 3 — — Glycerine 1 — — Honey 7 — — Ice Cream 5 — — Jam 14 — — Lard 13 — — Lime Juice 1 — — Lime Juice Cordial 2 — — Margarine 29 10 34.4 Marmalade 1 — — Milk 269 6 2.2 Milk, Dried 8 — — Milk, Tinned 19 — — Mincemeat 3 — — Mustard 6 2 33.3 Olive Oil 4 — — Pepper 10 — — Pie, Fruit 1 — — Pie, Pork 5 — — Pie, Veal and Ham 1 — — Rice 3 — — Rum 3 — — Sago 1 — — Sausages 20 — — Soda Water 3 — — Soup 1 — — Tapioca 4 — — Vinegar 21 — — Whiskey 2 — — 600 19 3.2 44 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. Milk.—Two hundred and sixty-nine samples of milk were submitted to the Public Analyst during the year. All were reported to be free from preservative. Cream.—Seven samples of fresh cream and six samples of preserved cream were submitted for analysis. The fresh cream was in each instance free from any preservative and in no case did the amount of boric acid in the preserved cream exceed the percentage disclosed on the declaratory label. RATS AND MICE (DESTRUCTION) ACT, 1919. Number of complaints received of rat-infestation of premises 67 Action taken. Sewer connections and frontages examined In all cases of houses complained of and premises adjacent. Frontages re-constructed or repaired 33 House drains re-constructed or repaired 6 Notices served under the Act — Rat Week.—This was held from 1st to 6th November, inclusive. The usual circular letter was sent out to principal wharfingers, railway companies, tradesmen, etc., and an intensive campaign in sewers, etc. carried out by the Borough Engineer and Surveyor, who caused 7,757 baits to be laid in 569 different positions, 119 rats eventually being found dead. This number is of course only a small proportion of the number killed. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Thirteen (13) cases were referred by the department to the Kensington Medicinal Baths for treatment under the scheme arranged with the Kensington Borough Council. Cleansing of Verminous Rooms.—Notices under section 10 of the London County Council (General Powers) Act, 1922 were served with respect to 154 premises, the verminous rooms numbering 214. The owners of 77 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 108 rooms being so treated at a charge to the owners of 7s. 6d. per room . LEGAL PROCEEDINGS—1926. The results of the Summonses taken out during the year are summarised in the following table:— Premises. Offence. Fines. Costs. PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. £ s. d. £ s. d. 2, Cuthbert Street Branch drain, fresh air inlet and ventilating pipe defective; washhouse roof and ceiling defective Work done 1 1 0 2, Modena Street Rooms, etc., dirty; water-closet roof defective Order made 0 10 6 Failing to comply with Magistrate's Order 2 0 0 1 1 0 61, Lydford Road Soil pipe defective Work done 1 1 0 235, Maida Vale Rooms, etc., dirty and dilapidated Order made 1 1 0 74, Star Street Room dirty Work done 1 1 0 99, Star Street Basement passage dirty Work done 1 1 0 56, Warrington Crescent Water-closet roof defective; flooring of scullery and kitchen defective; basement and first floor rooms damp Order made 1 1 0 ,, ,, Failing to comply with Magistrate's Order — 1 1 0 2a, Kilburn Park Road Roof and guttering defective Order made 2 2 0 95, Cirencester Street Rooms, etc., dirty ,, 1 1 0 96 Fernhead Road Soil-pipe defective Work done 1 1 0 33, Fermoy Road Drain defective ,, Summons withdrawn 74, Sutherland Avenue Roof defective; walls and ceiling of top floor front room dilapidated Order made 1 1 0 6, Burlington Mews West Roof defective Order made 1 1 0 Section 37. 20 Star Street Failing to provide dustbin Dustbin provided 1 1 0 102 Star Street Premises without proper dust receptacle 0 10 0 0 10 6 Section 38. 235, Harrow Road Failing to provide suitable and sufficient sanitary accommodation for persons employed in workshop Work completed Summons withdrawn 0 4 0 By-Laws. 2, Modena Street Sashcords defective 2 0 0 0 10 6 Yard paving defective 2 0 0 0 10 6 8, Amberley Mews Defective dust receptacle New dustbin provided 0 2 0 9, „ ,, ,, „ ,, ,, 0 2 0 10 Warwick Crescent Water-closet accommodation insufficient 3 0 0 1 1 0 5, Lanark Mews Failing to deposit plans of drainage works Plans deposited 1 1 0 45 Summary of Legal Proceedings Under Sale of Food and Drugs Acts, 1875-1907. Offence. Fines. Costs. £ s. d. £ s. d. Milk.—7 to 10% added water (10 samples) 50 0 0 10 10 0 „ 4.35% „ „ 10 0 0 6.82% „ „ 15 0 0 5 5 0 3.53% „ „ 10 0 0 8.23% „ „ 20 0 0 „ 8.66 % deficient in fat 3 0 0 2 0 0 Mustard.—10% of wheat flour and coloured with turmeric Summons withdrawn Margarine.—Sold in unstamped wrapper 0 10 6 0 10 6 ,, ,, ,, 0 10 6 0 10 6 ,, ,, ,, 0 10 6 0 10 6 ,, ,, ,, 0 15 0 0 10 6 ,, ,, ,, Summons dismissed 0 10 6 ,, ,, ,, „ 0 10 6 ,, ,, ,, ,, 0 10 6 ,, ,, ,, ,, 0 10 6 ,, Exposed for sale without the requisite label 0 15 0 0 10 6 ,, ,, ,, ,, Summons dismissed 0 10 6 ,, ,, ,, ,, - „ Sold from unlabelled bulk ,, 0 10 6 „ Sold from bulk not properly labelled ,, 0 10 6 MILK AND DAIRIES (CONSOLIDATION) ACT 1915. MILK AND DAIRIES ORDER, 1926. Bottling milk on the public pavement Defendant discharged 1 1 0 DAIRIES, COWSHEDS & MILKSHOPS ORDERS, 18 85 and 1886. Trading as a purveyor of milk without being registered Summons dismissed. - MILK AND DAIRIES (AMENDMENT) ACT, 1 922, and the MILK (SPECIAL DESIGNATIONS) ORDER, 1923. Selling " Certified " milk without holding the prescribed licence 1 0 0 2 2 0 Report of the Work of the District Inspectors, 1926. ]] Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, &c. Water Supply. Dust Receptacles Miscellaneous. YEARS. Number of Complaints received. "House-to-House." On Complaint or after Illness. Cellar Dwellings. Re-Inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C.'s, New, Provided, Repaired, &c. Soil Pipes, New, Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New, Provided. J Cisterns, Cleansed, Repaired, &c. New, Provided. Repaired, &c. Drains Cleared, Flushed, &c. Houses or Rooms Cleansed, Whitewashed, &c. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, &c. Accumulations Removed. i Improperly kept, Removed. 1921 1,401 — 2,332 — 10,467 36 51 28 40 450 37 350 7 13 38 6 19 2 17 74 6 86 265 3 1 19 137 2 11 — 1922 1,139 — 2,020 — 10,875 58 52 49 11 410 52 449 66 26 28 8 9 — 36 111 5 90 619 1 2 34 180 1 12 3 1923 1,029 — 2,074 — 11,127 35 41 22 13 704 31 465 51 31 22 — 6 4 17 51 2 85 197 — — 15 107 13 51 — 1924 1,114 — 2,108 — 11,017 31 87 13 4 717 27 429 62 20 18 1 11 — 14 62 6 59 175 1 6 25 134 4 13 — 1925 1,044 49 2,373 — 12,232 38 88 46 60 1008 41 495 103 31 34 2 9 27 46 128 6 87 517 2 — 19 145 — 41 5 1926 1,194 — 2,531 — 13,815 40 123 56 149 1394 35 702 155 70 72 5 6 25 62 169 21 94 793 6 3 75 195 3 28 17 46 47 Prevention of Infectious Disease. 1926. All Diseases, Enquiries by— District Inspectors 1,285 Women Inspectors and Health Visitors 8,692 Tuberculosis—Included in above— Women Inspectors 1,829 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 1,125 Rooms disinfected after— Tuberculosis 245 Other Diseases 1,784 Weight of Bedding, etc., disinfected (tons) 23 School Notices issued— Measles, Whooping Cough, Chicken Pox 4,277 Other Diseases 760 Bacteriological Examinations for— Diphtheria 1,208 Typhoid Fever 7 Tuberculosis 452 Sanitary Work—Cutting-off of Water Supplies. Notices received 16 Referring to Inhabited Premises 13 Empty „ 2 Other ,, 1 Reasons for—Rates unpaid 12 Defective fittings 4 Mortuary. Bodies deposited, total 315 „ „ for inquests 227 ,. „ pending burial, infectious — „ ,, „ „ other 88 P.M. examinations made 98 Trade Nuisances. Offensive Smells—Complaints 30 Accumulations of Manure 15 Smoke—Complaints 13 „ Premises watched 12 „ „ „ Hours of observation 73½ ,, Duration of smoke (hours), including 36 „ „ black smoke 4¾ Office (Clerical) Work. Letters received 6,140 ,, despatched 6,110 Entries in Postage Book 12,710 Certificates dealt with relating to Infectious Disease (including Tuberculosis) 4,861 Notices sent re above 8,181 Entries in Birth Register 2,266 Complaints received 1,479 Plans dealt with 323 New openings in Journals 257 Disinfection Orders 1 888 Notices to abate nuisances, etc. 758 48 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante natal Consultation Centres Infant Consultation Centres Day Nurseries Dispensaries Clinics 232, Harrow Road St. Mary's Hospital, Cambridge Place *232, Harrow Road St. David's Church Hall, St. Mary's Terrace St. John's Mission Room, Sovereign Mews * Congregational Institute, Third Avenue Orphanage of Mercy, Randolph Gardens St. Simon's Hall, Macroom Road Christ Church Parochial Church House, Queensborough Passage * Two sessions weekly. West House, 13, Hasborough Street 66, Lancefield Street Tuberculosis. 20, Talbot Road St. Mary's Hospital, Cambridge Place Venereal Diseases. Lock Hospital, 283, Harrow Road (Women and Children) St. Mary's Hospital, Cambridge Place (Male and Female) Paddington School for Mothers. St. Mary's Hospital. Paddington School for Mothers. Paddington Day Nursery. Queen's Park Day Nursery. Paddington Tuberculosis Dispensary St. Mary's Hospital. London County Council, do. PUBLIC HEALTH STAFF (on December 31st, 1926). (W.T. Whole-time appointments. P.T. = Part-time appointments. See footnote for explanation of figures in parentheses.) Medical Officer of Health, Administrative Tuberculosis Officer, W.T. G. E. Oates, M.D., B.S., M.R.C.P., D.P.H., Barrister-at-Law. Assistant Medical Officers of Health, P.T. (For purposes of the Public Health (Tuberculosis) Regulations). R. S. Walker, M.R.C.P., L.R.C.S.Ed., L.R.F.P.S.Glas., D.P.H., Tuberculosis Officer, Paddington Tuberculosis Dispensary. A. B. Porteous, M.D., D.P.H., Tuberculosis Officer, St. Mary's Hospital Tuberculosis Dispensary. Public Analyst, P.T. Sir William R. Smith, M.D., D.Sc., F.I.C. Chief Sanitary Inspector and Canal Boats Inspector, W.T. E. J. Potter (1), (4). District Sanitary Inspectors, W.T. J. W. Webster (1). T. Mitchell (1), (3), (4), (5). G. J. Miners (1), (4). C. Binding (1), (2), (3), (4). V. L. Ronchetti (2), (3), (5). Meat and Food Inspector, W.T. E. J. Grivell (1), (3). (4), (5). Workshops Inspector, W.T. C. S. Wansbrough (1), (4), (5). Tenement Houses Inspectors, W.T. C. Lawrence (1), (3), (4), (5). C. G. Heron (2), (3). Health Visitors, W.T. D. A. M. Newhall (1), (2), (8), (9). E. A. S. Davies (8), (9). Women Sanitary Inspectors, W.T. F. M. Nicolas (2), (6), (7). L. M. O'Kell (1), (7). (1) Sanitary Inspector's Certificate, Royal Sanitary Institute. (2) „ „ „ Sanitary Inspectors' Examination Board. (3) Meat and other Foods Certificate, Royal Sanitary Institute, or Sanitary Inspectors' Examination Board. (4) Building Construction Certificates. (5) Plumbing Certificates. (6) Diploma, National Health Society. (7) Tuberculosis Certificate, National Health Society. (8) Central Midwives Board Certificate. (9) Nursing Training Certificates.