AC4349 PAD27 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1927. 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. VAIL & CO., Printers 170, Farringdon Road, London, E.C.1. Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1927. 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. VAIL & CO., Printers 170, Farringdon Road, London, E.C.I CONTENTS. PAGE Acute Encephalitis Lethargica 18 Acute Influenzal Pneumonia 18 Acute Polio-encephalitis 18 Acute Polio-myelitis 18 Acute Primary Pneumonia 18 Acute Rheumatism 19 Administrative Work 34 Annual Cleansing 38 Ante-natal Consultation Centres 31 Anthrax 18 Bacteriological Work 35 Bakehouses 43 Births C ,, Illegitimate 6 ,, in Institutions 7 ,, Notifications 7 Birth-rates 6 Canals, Canal Boats 36 Cancer 18 Cerebro-spinal Fever 18 Chicken-pox 15 Cholera 18 Combined Drainage 35 Common Lodging Houses 38 Compulsory Repairs 37 Continued Fever 15 Convalescent Homes 34 "Conversions" 37 Cowhouse 44 Cream Regulations 46 Dairies and Milkshops 44 Day Nurseries 32 Deaths, Causes of 7, 8 ,, in Institutions 9 Death-rates 9 Diarrhœa 21 Diphtheria 14 Diphtheria Carrier Clinic 15 Disinfection 34 District Inspectors' Work 47 Drainage, Combined 35 ,, House 35 ,, Reconstruction Plans 35 Dysentery 18 Erysipelas 17 Food Adulteration 44 „ Destroyed 44 ,, Purveyors 44 ,, Supervision 43 Fouling of Footways by Dogs 36 German Measles 16 Glanders 18 Health Visiting 28, 31 Homework (Outworkers) 43 Houses Unfit for Habitation 38 Housing 37 ,, on L.C.C. Estates 39 Hydrophobia 18 Ice Cream 44 Infant Consultation Centres 29-31 Infantile Mortality 10, 11 ,, ,, in Special Areas 12 PAGE Infectious Disease, Notification of 13 ,, ,, Prevention of 34, 48 Infective Enteritis 21 Legal Proceedings 46 L.C.C. Houses 39 Malaria 18 Marriages 5 Maternity and Child Welfare 28 Maternity Nursing 32 Measles 16 Meat Regulations 43 Milk, Grants 32 ,, (Special Designations) Order 41 Mortuary 36, 48 Nursing 34 Office Work 43 Ophthalmia Neonatorum 17 Outworkers (Homework) 43 Overcrowding 38, 40 Plague 18 Population 5 Poultry Slaughtering 44 Pneumonia 18 Puerperal Fever 17 ,, Pyrexia 17 Rag and Bone Dealers 36 Rag Flock Act 43 Rats and Mice Destruction 46 Relapsing Fever 18 Rent and Mortgage Interest (Restrictions) Acts 39 Rent Books 39 Scarlet Fever 14 Schools and Infectious Disease 34 Sewer Connections 35 Slaughterhouses 43 Smallpox 15 Smoke Control 36 Staff 34, 49 Tenement Houses 38 Trade Nuisances 36, 48 Trench Fever 18 Tuberculosis, Artificial Pneumothorax treatment 24 ,, Deaths from 22 ,, Dental Treatment 24 ,, Dispensary Treatment 25 ,, Home Visiting 23 ,, Notification 22 ,, Regulations, 1921 and 1925 23, 24 ,, Supply of Beds and Bedding 24 Tuberculosis Care Committee 27 Typhoid Fever 15 Typhus Fever 18 Underground Rooms 38 Unhealthy Areas 37 Venereal Diseases 49 Verminous Conditions 46 Vital Statistics 4, 5 Water Supply 35, 48 Whooping Cough 18 Workshop supervision 43 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 1927 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good, the death-rate being only slightly above the average for recent years. The infantile mortality was at the rate of 79 deaths of infants under the age of 12 months for every 1,000 births. This compares very favourably with the rates of 150 or 160 which were prevalent 30 years ago. The infantile mortality for the County of London in 1927 was, however, only 59, and it is therefore evident that a further decline in the Paddington mortality must be hoped for. It is difficult to point to any one cause of our somewhat high infantile mortality. Probably the most important factor is that Paddington is far too built over and overcrowded to be an ideal place for rearing children. Many families who are comfortably off from the financial point of view are compelled to live in apartments or tenements and may be without the use of a yard or garden where infants may obtain the sunlight and fresh air which are necessary for healthy development. In some of the boroughs of London the standard of living is below that of Paddington but the children thrive better owing to the larger amount of garden and yard space available. The foregoing paragraph affords a clue to the "housing problem" in Paddington. This is really a social problem due to the overcrowding and sharing by several families of dwellinghouses which were only built for one family. There are no congested areas in the Borough and the number of houses which require closing and demolition is small. There are so-called "slum areas" in Paddington but these areas were not originally slums and would not be recognised as such if the inhabitants were removed from the houses, which are generally of sound structure. During the year strenuous but unavailing efforts have been made by the Council's officers to find any area in the Borough suitable for housing development. It appears that no progress in this respect is possible without extensive demolitions of properties, and economic and financial conditions do not at present make it desirable to demolish any houses which are tolerably fit for dwelling purposes. 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, G.E. Oates. M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W. 2 June, 1928. SUMMARY OF VITAL STATISTICS. Area of Borough 1,356-1 acres, including waterways 20'0 acres: 1927 Population (Registrar-General's estimate) 142,700 Density of population per acre 105 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 108 persons per room, or 0-92 room per person. Marriages 1,602 Total. M. F. Births Legitimate Illegitimate 1,981 977 1,004 235 120 115 Birth-rate 15.53* Deaths 1,936 939 997 Dfiath-ratft 13.56* Number of women dying in, or in consequence of childbirth from sepsis „ other causes 4 5 Maternal mortality 4.06† Deaths of Infants under 1 year of age 176 Infantile Mortality 79† Legitimate, 71† ; Illegitimate, 144† Deaths from Measles (all ages) 5 „ Whooping Cough (all ages) 38 „ Diarrhoea (under 2 years of age) 16 „ Pulmonary Tuberculosis 96 Death-rate from Pulmonary Tuberculosis 0.67* Deaths from all forms of Tuberculosis 118 Tuberculosis death-rate 0.82* Rateable Value £1,683,842 Product of a Penny Rate £6,780 *per 1,000 persons. t per 1,000 births. 5 VITAL STATISTICS. The Metropolitan Borough of Paddington as constituted under the Local Government Act, 1899, covers an area of 1,356-1 acres, including 20.0 acres of waterways. 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 11.11 232 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 1927 142,700 2,064 322 474 2,216 15.53 2,006 14.05 489 419 1,936 13.56 188 91 176 79 "T"=Total; "C "=Civil. POPULATION. The Registrar-General's estimate of the population of the Borough for the year 1927 was 142,700. It will be noticed that there has been a fall of 4,000 in the population according to the Registrar-General's estimates. There has of course, in fact been no substantial change in the population and it is evident that in the opinion of the Registrar-General the population has been over-estimated since the last census in 1921. It is unfortunate that the RegistrarGeneral does not furnish estimates that are consistent one year with another. Such widely ranging estimates cause corresponding fluctuations in the death-rate arid birth-rate which are more apparent than real. The populations in the various wards have been estimated to be as shown in the following table:— The Borough 142,700 Wards— Queen's Park 15,588 North Paddington 72,042 Harrow Road 27,215 Maida Vale 21,860 Town 7,379 Westbourne 23,841 South Paddington 70,658 Church 17,302 Lancaster Gate, West 9,428 Lancaster Gate, East 8,072 Hyde Park 12,015 MARRIAGES. During 1927, 1,602 marriages were solemnized in the Borough, being a rate of 22.4 persons per 1,000 of the population. 6 BIRTHS. The number of births registered in the Borough during 1927 was 2,064, and, in addition, 152 occurred outside the Borough to Paddington residents in excess of those occurring in Paddington to residents of other localities, making a total of 2,216 births. The birth-rate for 1927 was therefore 1553 per 1,000 of the population. Of the 2,216 births, 1,097 were those of males and 1,119 those of females, and of these 120 males and 115 females were illegitimate. The Registrar-General's final figure for the nett number of births is given as 2,230, but this does not substantially affect the figure for the birth-rate given above. It will be seen on reference to the summary of vital statistics on page 5 that although the actual number of births in Paddington has declined yearly since the War there is an apparent small increase in the rate in 1927. This increase in the birth-rate is probably not a real one and due to the fact that the population of the Borough is not accurately known. The following table shows the birth-rate during each of the last six years in England anc Wales, in London, in Paddington and in each of the wards of the Borough:— 1927 Birth-rates. No. of Births. Birthrates. 1926 1925 1924 1923 1922 England and Wales 654,969 16.7 17.8 18.3 18.8 19.7 20.4 London 73,263 16.1 17.1 18.0 18.6 20.1 20.9 Paddington 2,216 15.53 15.32 15.88 17.11 17.92 18.79 Wards— Queen's Park 176 11.29 12.48 12.63 13.76 15.28 17.26 Harrow Road 422 15.50 14.44 16.07 16.01 18.36 19.88 Maida Vale 365 16.69 15.84 14.09 19.35 19.95 19.00 Town 138 18.70 17.92 23.54 24.05 23.84 25.22 Church 401 23.11 23.94 Westbourne 443 18.58 18.03 18.14 19.93 21.04 20.14 Lancaster Gate, West 59 6.25 6.29 7.82 8.37 8.69 10.10 Lancaster Gate, East 73 9.04 8.79 9.49 9.05 5.68 9.49 Hyde Park 139 11.56 12.14 11.94 13.46 13.72 15.03 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 1927 15.53 Illegitimate Births.—These were 235 in number, or 10.60per 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 5.11 Harrow Road 6.16 Maida Vale 15.06 Town 15.94 Church 8.47 Westbourne 9.25 Lancaster Gate, West 13.56 Lancaster Gate, East 21.91 Hyde Park 17.26 7 Births in Institutions. Local. Legitimate. Illegitimate. T otal. Paddington Infirmary 138 (8) 85 (9) 223 (17) St. Mary's Hospital 123 (70) 2 (1) 125 (71) Lock Hospital 17 (15) 74 (63) 91 (78) Non-residents shown in ( ). Outlying. Legitimate. Illegitimate. T otal. Queen Charlotte's Hospital 231 40 271 Other Lying-in Hospitals 4 4 8 Other Hospitals 42 10 52 Poor Law Institutions 9 6 15 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. During the year 2,043 live births were notified to the Medical Officer of Health. There were also 43 stillbirths notified. Of the 2,086 living and stillbirths notified, 43.6 per cent, were notified by medical practitioners, 38.3 per cent, by midwives, 2.7 per cent, by parents, and 15.4 per cent, by medical students or other persons. A comparison of the Notification Register with the returns supplied by the local Registrars of Births shows that 97.4 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. The number of deaths that were registered during the year as having taken place in the Borough was 2,006. Of these, 489 were of persons whose residence was not in Paddington, 377 dying in Paddington Institutions and 112 in other places in the Borough. There were also reported to the Registrar-General 419 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,936, making an annual death-rate of 13.56. Even allowing for the fluctuating estimate of population there was a real but slight rise in the death-rate of the borough in 1927. This was largely accounted for by the prevalence of influenza and respiratory diseases associated with it in the first two months of the year. 1927. 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 29th – – 19 2 11 15 35 39 36 1 February 26th 1 – 4 1 13 25 22 26 31 2 March 26th – – 6 1 7 15 8 6 8 5 April 23rd 2 1 4 – 9 15 4 9 11 – May 21st 1 – 3 1 8 19 1 8 11 – June 18th – – 1 2 7 16 1 1 6 4 July 16 th – – – 1 1 20 1 3 2 1 August 13th 1 – 1 – 2 13 – 1 6 1 September 10th – – – – 10 29 – 5 1 – October 8th – 1 – – 6 22 1 2 3 – November 5th – – – 1 5 22 1 5 5 – December 3rd – – – – 5 17 2 7 8 3 „ 31st – – – 2 10 12 5 12 15 4 Totals 5 2 38 11 94 240 81 124 143 21 8 The following table shows the deaths classified according to sex and age, and cause of death:— Deaths of Residents of the Borough, 1927. Sex-Age Distribution for Whole Borough. Cause of Death. All Ages. Deaths at Ages. 0— 1— 2— 5— 15— 25— 45— 65— 75— P. M. f. M. f. M. f. M. F. M. F. M. f. M. f. M. f. M. f. M. f. All Causes 1936 937 999 101 75 23 23 19 12 19 17 28 36 89 98 286 227 192 207 180 304 Enteric Fever 1 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 5 1 4 1 1 ... 3 ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever 3 2 1 ... ... ... ... ... ... 1 ... 1 ... ... 1 ... ... ... ... ... ... Whooping Cough 38 17 21 7 8 7 8 3 5 ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 11 7 4 2 1 1 2 4 ... ... ... ... ... ... 1 ... ... ... ... ... ... Influenza 80 32 48 1 ... ... ... 1 ... ... ... 2 2 3 5 13 13 3 11 9 17 Encephalitis Lethargica 1 ... 1 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis 3 2 1 1 ... ... ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 96 50 46 ... 1 ... ... 1 1 ... 1 6 19 16 14 20 9 7 1 ... ... Other Tuberculous Diseases 22 10 12 ... ... ... 2 ... ... 3 4 4 4 1 ... 1 1 1 ... ... 1 Cancer, Malignant Disease 247 116 131 ... ... ... ... ... ... ... ... 1 ... 5 10 59 62 38 22 13 37 Rheumatic Fever 4 3 1 ... ... ... ... ... ... 2 ... 1 ... ... 1 ... ... ... ... ... ... Diabetes 18 4 14 ... ... ... ... ... ... ... ... ... ... ... 1 1 3 2 6 1 4 Cerebral Haemorrhage, etc. 74 32 42 ... ... ... ... ... ... ... ... ... ... 1 ... 7 9 9 14 15 19 Heart Disease 322 150 172 ... ... ... ... ... ... ... 1 2 2 10 7 54 40 34 46 50 76 Arterio-sclerosis 138 62 76 ... ... ... ... ... ... ... ... ... ... 1 1 15 8 13 25 33 42 Bronchitis 99 42 57 3 2 1 ... ... ... ... ... ... 1 ... 1 16 9 8 11 14 33 Pneumonia (all forms) 183 104 79 34 18 12 3 5 3 1 2 1 2 13 10 15 15 14 10 9 16 Other Respiratory Diseases Ulcer of Stomach or 14 8 6 ... ... ... ... 1 ... ... ... ... ... 2 ... 3 3 2 1 ... 2 Duodenum 20 11 9 ... ... ... ... ... ... ... ... ... ... 2 5 6 1 2 3 1 ... Diarrhoea, etc 22 12 10 8 7 ... 1 ... ... ... ... ... 1 ... 1 2 ... 1 ... 1 ... Appendicitis and Typhlitis 11 5 6 ... ... ... ... ... ... 1 ... ... ... 2 2 I 2 1 1 1 Cirrhosis of Liver 21 12 9 ... ... ... ... ... ... ... ... ... ... 1 2 9 5 ... 2 2 ... Acute and Chronic Nephritis 62 33 29 ... ... ... ... ... 1 ... 1 ... 1 2 1 15 9 10 10 6 6 Puerperal Sepsis 4 ... 4 ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... Other Accidents and diseases of Pregnancy and Parturition 4 ... 4 ... ... ... ... ... ... ... ... ... ... ... 4 ... ... ... ... ... ... Congenital debility and Malformation, Premature Birth 53 26 27 25 26 ... ... ... ... 1 ... ... ... ... 1 ... ... ... ... ... ... Suicide 24 19 5 ... ... ... ... ... ... ... ... ... 1 5 3 11 1 2 ... 1 ... Other deaths from Violence 70 40 30 2 4 ... ... 2 1 5 1 5 2 7 ... 9 8 8 7 2 7 Other defined diseases 286 136 150 17 7 2 4 2 1 4 5 5 ... 17 24 29 29 37 37 23 43 Causes ill-defined or unknown ... ...- ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 9 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:— 1927 Death-rates. No. of Deaths. Deathrates. 1926 1925 1924 1923 1922 England and Wales 484,636 12.3 11.6 12.2 12.2 11.6 12.8 London 54,085 11.9 11.6 11.7 12.2 11.4 13.5 Paddington 1,936 13.56 12.65 12.10 13.11 11.77 12.99 Wards— Queen's Park 189 12.12 12.10 11.39 11.94 10.71 12.03 Harrow Road 355 13.04 12.58 10.80 12.57 12.09 12.70 Maida Vale 321 14.68 14.37 11.84 12.43 12.72 13.07 Town 125 16.94 11.60 14.73 15.79 12.69 15.51 Church 270 15.60 16.92 Westbourne 332 13.92 12.64 13.99 15.16 12.97 14.21 Lancaster Gate, West 88 9.33 11.04 10.28 10.54 9.62 9.68 Lancaster Gate, East 92 11.39 7.71 9.25 9.90 9.06 10.21 Hyde Park 164 13.64 9.55 10.57 11.68 9.99 11.60 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 1927 13.56 Deaths in Institutions, 1927. . Total Nonresidents. Paddington Infirmary 607 18 St. Mary' Hospital 178 140 Paddington Green Children's Hospital 60 49 Hospital for Women and Children (Lock Hospital) 14 12 St. Luke's Hospital 172 158 1,031 377 Deduct Non-residents 377 654 Outlying. Paddington Residents. Hospitals of Metropolitan Asylums Board (excluding Tuberculosis Hospitals) 24 Poor Law Institutions 53 Lunatic Asylums 86 Voluntary Hospitals (General) 108 Hospitals (Special, including Sanatoria) 59 330 Total Deaths of Paddington residents in institutions 984 10 INFANTILE MORTALITY. During the year 1927 there were 2,216 births and 176 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 79. The following table gives the births and the infantile deaths and death-rates for the year 1927 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1922 to 1926 are given for comparison. 1927 Infantile Mortality Rates. No. of Births. No. of Deaths of children under 1 year. Infantile Mortality Rates. 1926 1925 1924 1923 1922 England and Wales 654,969 45,346 69 70 75 75 69 77 London 73,263 4,294 59 64 67 69 61 75 Paddington 2,216 176 79 86 72 78 69 69 Wards— Queen's Park 176 16 91 45 88 50 78 58 Harrow Road 422 21 49 104 66 87 53 50 Maida Vale 365 35 96 87 50 50 83 68 Town 138 18 130 37 91 115 71 83 Church 401 40 99 108 Westbourne 443 34 76 86 69 82 78 87 Lancaster Gate, West 59 3 51 109 50 93 21 51 Lancaster Gate, East 73 – – 115 52 49 36 82 Hyde Park 139 9 65 53 74 24 59 43 Infantile Mortality Rates, 1896-1927. 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 1916-1920 91 92 103 1921-1925 76 70 76 1926 70 64 86 1927 69 59 79 11 The following table provides an analysis of the causes of deaths of infants under the age 12 months in 1927. Infantile Mortality in Paddington.—1927. 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 39 3 7 3 52 35 32 40 17 176 79.42 Common Infectious Diseases (6-10, 25:2) – – – – – 2 4 8 6 20 9.02 Tuberculous Diseases (31-37) – – – – – – 1 – – 1 0.45 Diarrhoea and Enteritis (113) 1 – – – 1 4 6 3 1 15 6.77 Developmental and Wasting Diseases (159, 160, 161:1, 162:2) 25 2 1 2 30 17 2 – – 49 22.11 Miscellaneous Diseases (Remainder) 13 1 6 1 21 12 19 29 10 91 41.07 Measles (7) – – – – – – – 1 1 2 0.90 Whooping cough (9) – – – – – 1 4 7 3 15 6.77 Diphtheria (10) – – – – – 1 – – 2 3 1.35 Influenza (11) – – – – – 1 – – – 1 0.46 Tuberculosis of nervous system (32) – – – – – – – – – – – Tuberculosis of intestines and peritoneum (33) – – – – – – – – – – – Other tuberculous diseases (31, 3437) – – – – – – 1 – – 1 0.45 Syphilis (38) – – – – – – – – – – – Meningitis (71) – – – – – – 1 – – 1 0.45 Convulsions (80) – – – 1 1 – – – – 1 0.45 Bronchitis (99) – – – – – 2 2 1 – 5 2.26 Pneumonia (100, 101) 3 – 2 – 5 6 12 21 8 52 23.47 Other respiratory diseases (98, 102107) – – – – – – – – – – – Inflammation of the stomach (112:1) – – – – – – – 1 – 1 0.45 Diarrhœa and Enteritis (113) 1 – – – 1 4 6 3 1 15 6.77 Hernia, intestinal obstruction (118) – – – – – – – – – – – Congenital malformations (159) 4 1 – 1 6 6 – – – 12 5.42 Congenital debility and sclerema (160:1) 2 1 – – 3 5 2 – – 10 4.51 Icterus (160:2) – – – – – – – – – – – Premature birth (161:1) 17 – 1 1 19 6 – – – 25 11.29 Injury at birth (161:2) 4 – – – 4 – – – – 4 1.80 Disease of umbilicus (162:1) – – – – – – – – – – – Atelectasis (162:2) 2 – – – 2 – – – – 2 0.90 Suffocation—in bed or not stated how (180 pt.) 1 – – – 1 1 – – – 2 0.90 Other causes 5 1 4 – 10 2 4 6 2 24 10.83 Nett Births in the Year legitimate 1,981 Illegitimate 235 Legitimate Infants 142. Nett Deaths in the Year legitimate Infants 34. 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. 12 It has been customary in previous annual reports to make a note of infantile mortality in special localities. The following is a summary of the results. Infantile Mortality in Special Areas. Areas. 1927 Infantile Mortality. Births. Deaths. 1927 1926 1925 1924 1923 Church Ward— North Wharf 49 2 40 92 59 106 95 Clarendon Street 195 27 138 148 126 160 51 Rest of Ward 157 11 70 67 ? ? ? Town Ward— Hall Park 71 5 70 66 87 69 45 Rest of Ward 67 13 194 13 ? ? ? Alfred Road 109 18 165 107 58 112 69 Rest of Ward 334 16 48 79 77 73 81 Maida Vale Ward— Amberley Road 56 10 178 89 66 59 115 Rest of Ward 309 25 80 86 43 49 76 Queen's Park Ward— Queen s Park 108 9 83 53 88 37 94 Rest of Ward 68 7 103 34 89 71 48 Totals for 6 Areas 588 71 120 103 90 100 74 Rest of Borough 1,628 105 64 80 65 70 67 The following table, comparing the vital statistics for the metropolitan boroughs, has been supplied by Dr. W. A. Young, Medical Officer of Health for Poplar:— 1927. 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 4,541,000 161 – 11.9 59 West Districts. Paddington 142,700 15.5 0.5 13.5 79 Kensington 176,700 15.0 0.36 13.8 66 Hammersmith 132,800 15.6 0.3 13.0 61 Fulham 161,900 15.1 0.2 11.3 66 Chelsea 63,690 13.4 0.4 14.1 76 City of Westminster 136,500 10.0 0.5 12.3 68.6 North Districts. St. Marylebone 103,500 13.2 0.4 11.3 59 Hampstead 86,160 11.9 0.2 12.2 51 St. Pancras 213,200 15.5 0.4 12.3 62 Islington 334,300 18.3 0.38 12.3 53 Stoke Newington 52,130 14.0 0.27 12.2 66 Hackney 224,700 15.7 0.46 11.6 64 Central Districts. Holborn 42,209 11.96 0.14 12.5 38 Finsbury 75,500 19.2 0.5 13.4 50 City of London 13,010 8.7 0.23 11.5 10.5 East Districts. Shoreditch 105,700 20.6 0.7 12.6 74 Bethnal Green 119,900 19.6 0.6 11.1 57.7 Stepney ... 251,580 18.1 0.5 11.6 68 Poplar 167,000 19.8 0.6 11.8 66 South Districts. Southwark 184,250 19.0 0.8 13.4 61 Bermondsey 121,000 18.5 0.37 12.9 67 Lambeth 307,700 16.2 0.39 12.4 50.5 Battersea 169,000 16.6 0.3 12.2 53.5 Wandsworth 342,700 13.53 0.25 11.3 51 Camberwell 271,100 15.6 – 11.4 52 Deptford 113,800 16.8 0.3 11.5 5??? Greenwich 101,920 16.2 0.3 10.8 53 Lewisham 188,600 15.1 0.15 11.0 46 Woolwich 140,770 15.9 0.2 10.6 42 *The provisional figures relating to London were supplied by the Registrar-General. Other figures supplied by Medical Officers of Health. 18 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington : Acute Encephalitis Lethargica. Acute Influenzal Pneumonia. Acute Polio-encephalitis. Acute Polio-myelitis. Acute Primary Pneumonia. Acute Rheumatism. Anthrax. Cerebro-spinal Fever. Chicken-pox. Cholera. Continued Fever. Diphtheria or Membranous Croup. Dysentery. Erysipelas. German Measles. Glanders. Hydrophobia. Infective Enteritis or Summer Diarrhoea. Malaria. Measles. Ophthalmia Neonatorum. Plague. Puerperal Fever. Puerperal Pyrexia. Relapsing Fever. Scarlatina or Scarlet Fever. Small-pox. Tuberculosis. Typhoid or Enteric Fever. Typhus Fever. The following table summarises the cases of notifiable diseases notified in the years 1917 to 1927:— Analysis of Notification Certificates (Uncorrected for Errors). 1917. 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. Acute Encephalitis Lethargica – – (a) 3 2 7 2 3 12 7 4 4 „ Influenzal Pneumonia – – (a) 87 45 27 72 33 87 88 76 107 ,, Primary Pneumonia – – (a) 83 96 105 254 302 369 265 184 183 ,, Polio-encephalitis 1 – 5 2 1 – 2 4 3 3 1 Polio-myelitis 3 4 ,, Rheumatism – – – – – – – – – – (a) 34 Anthrax – – – – 1 1 – – – 1 1 Cerebro-spinal Fever 7 3 7 1 2 2 1 1 5 5 3 Chicken-pox – 207 – – – 22 465 395 459 599 461 Continued Fever – – – – – – – – – – 2 Diphtheria 227 254 255 461 442 401 219 278 336 462 367 Dysentery – – (a) 3 1 2 – 2 1 – – – Erysipelas 66 56 76 81 83 77 54 69 64 76 90 German Measles 571 226 132 71 83 144 48 458 375 124 78 Infective Enteritis or Summer Diarrhœa – – – – – – – – – – (a) 6 Malaria – – (a) 64 24 7 5 2 9 1 1 2 Measles 2110 778 1126 1356 80 1973 324 2757 879 1738 154 Membranous Croup 2 4 4 3 3 – 1 2 1 1 2 Ophthalmia Neonatorum 27 22 30 29 34 15 22 18 23 16 15 Puerperal Fever 7 2 15 15 16 8 5 9 15 14 7 ,, Pyrexia – – – – – – – – – (a) 17 34 Scarlet Fever 124 150 261 502 827 529 323 290 264 199 320 Small-pox – – – – – – 1 – – – – Tuberculosis—Total 502 451 391 383 335 312 338 379 400 356 381 Pulmonary 355 325 284 277 244 204 222 242 231 218 212 Other Forms 147 126 107 106 91 108 116 137 169 138 169 Typhoid or Enteric Fever 12 13 10 19 13 8 13 15 18 12 16 (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 :— 1927. 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 13 23 40 47 21 31 6 4 35 43 35 39 2 4 3 4 7 12 TyPhoid Fever – – 1 1 – 2 – 1 2 1 2 1 1 1 – 1 1 1 Erysipelas 6 8 10 9 3 11 1 – 5 14 4 11 1 1 2 1 – 3 Ophthalmia Neonatorum 1 – – 2 – 1 1 – 3 – 1 4 – – – – 1 1 Pneumonia—a. Influenzal 3 5 9 3 10 12 2 3 12 8 7 16 2 2 2 5 3 3 „ A. Primary 10 6 12 12 12 8 10 1 33 18 28 15 1 2 2 1 10 2 PurPeral Fever – 1 – 1 – 2 – – – 2 – 1 – – – – – – „ Pyrexia – 2 – 8 – 3 – 2 – 8 – 5 – 3 – – – 3 Scarlet Fever 29 41 27 32 14 15 18 7 6 21 29 50 3 5 3 1 11 8 1 I 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 10 4 50 55 83 95 15 25 2 13 – 9 – 5 1 – 1 1 TyPhoid Fever – – 1 1 2 2 1 3 2 1 1 – – 2 – – – – Erysipelas 2 1 3 3 3 4 3 7 4 6 6 9 4 11 4 12 3 5 Pneumonia—a. Influenzal 1 1 7 6 6 7 6 3 7 12 8 9 6 7 4 5 5 7 „ A. Primary 18 13 26 23 18 10 11 2 11 4 15 6 7 4 2 1 10 2 Scarlet Feve – – 24 41 98 103 6 17 9 12 2 7 1 – – – – – 14 SCARLET FEVER. During 1927 there were 320 cases of scarlet fever notified. Of these there were no cases under the age of 1 year, 65 between the ages of 1 and 5 years, 201 between the ages of 5 and 15 years, 23 between the ages of 15 and 25 years, and 31 over the age of 25 years. Of the 320 cases 304 were removed to an Isolation Hospital. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Only 3 deaths from scarlet fever occurred, the disease being usually of a mild type. There was a marked increase in the number of cases of scarlet fever notified last year, the increase being almost entirely amongst children of school age. During the year the Metropolitan Asylums Board decided to alter their policy as regards the unrestricted admission of all scarlet fever cases, and to restrict the number of admissions should the beds be required for measles cases. Although the number of measles cases admitted from the London area was considerable it was not necessary to put any restriction on the admission of scarlet fever cases during the year. Seasonal prevalence.—The following table shows the numbers of cases notified in each four-weekly period during 1927. 1927. Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. S. 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 816 739 753 851 944 1,082 1,148 974 915 1,237 1,527 1,264 1,029 13,279 Paddington 15 14 15 22 13 17 19 26 15 48 43 35 38 320 Wards— Queen's Park 1 1 2 2 – – 1 1 2 20 12 12 16 70 Harrow Road 2 2 2 3 2 i 7 2 1 9 12 6 10 59 Maida Vale 2 – 3 4 1 3 – 3 1 5 – 4 3 29 Town – 1 – 2 – 1 2 4 1 5 4 4 1 25 Church 2 3 – 1 1 1 3 5 2 4 3 1 1 27 West bourne 1 5 6 6 8 11 3 8 7 4 11 6 3 79 Lancaster Gate, West 2 – – 1 1 – 1 1 – – 1 1 – 8 Lancaster Gate, East 1 – – – – – 1 – – – – 1 1 4 Hyde Park 4 2 2 3 – – 1 2 1 1 – – 3 19 DIPHTHERIA. (Including Membranous Croup). During 1927 there were 367 cases of diphtheria notified. Of these there were 14 cases under the age of 1 year, 105 between the ages of 1 and 5 years, 178 between the ages of 5 and 15 years, 40 between the ages of 15 and 25 years, 24 between the ages of 25 and 45 years, and 8 aged 45 years and upwards. Of the 367 cases, 366 were removed to Isolation Hospitals. The remaining case was treated at home, proper facilities being available for isolation and treatment. Eleven deaths from this disease occurred during 1927, 10 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 „ 1927 11 „ 15 Seasonal prevalence.—The following table shows the numbers of cases notified in each fourweekly period during 1927. 1927. Notifications of 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 1,041 1,000 973 857 829 837 724 691 709 970 1,227 1,251 1,203 12,312 Paddington 40 22 22 19 35 29 18 20 27 41 35 27 34 369 Wards— Queen's Park 1 1 3 2 7 2 3 – 3 1 2 5 6 36 Harrow Road 6 4 6 3 9 10 7 4 6 7 11 6 8 87 Maida Vale 3 4 2 2 4 3 3 2 4 11 5 2 7 52 Town 1 1 1 – 1 1 – – 1 3 1 – – 10 Church 18 4 2 3 6 – 1 7 5 10 10 7 5 78 Westbourne 10 7 7 6 3 13 3 5 4 6 2 4 4 74 Lancaster Gate, West – – – 2 2 – – – – – – – 2 6 Lancaster Gate, East – – 1 – 2 – 1 – 1 1 1 – – 7 Hyde Park 1 1 – 1 1 – – 2 3 2 3 3 2 19 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 16 phials of 4,000 units and 10 phials of 500 units were distributed. SMALL-POX. No cases of the disease were notified during 1927. 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 does not vary very much in its prevalence from year to year. The number of cases certified by medical practitioners was 461 and there were 323 cases reported from other sources, making a total of 784 in 1927, as compared with 599 certified cases in 1926, 459 in 1925, 395 in 1924 and 465 in 1923. In 1927 the disease was fairly uniformly distributed throughout the year, with occasional localised outbreaks. Only on one occasion did the number of notifications reach 52 in a week and iri two other weeks, widely separated, the notifications reached 33 and 34 in number. Chicken-pox is not usually nursed in an institution, but 37 cases received institutional treatment for various reasons. TYPHOID FEVER AND CONTINUED FEVER. Sixteen cases of typhoid fever were notified in 1927, of whom one apparently contracted the disease abroad. Not all of the 16 cases proved to be real typhoid fever but no accurate information is available on this point. As compared with fifty years ago the number of cases of typhoid fever is only small and it is generally impossible to trace any source of infection. Two cases of continued fever were notified. In any case where the diagnosis of typhoid fever cannot be made with certainty but there is a strong likelihood of the disease being present, local doctors are encouraged to obtain early hospital treatment for these cases by notifying them as having continued fever. 16 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 all cases of measles are notifiable is the Port of London. In eight other London Boroughs only the first case of measles occurring in a family is notifiable. 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 1927, 154 cases of measles certified by medical practitioners, and 116 cases reported from other sources, the corresponding figures for 1926 being 1,931 and 549. The number of notified and reported cases is analysed in the adjoining table in 4-weekly periods for the various wards. In no one week did the numer of cases exceed 14. The Women Sanitary Inspectors visit cases of measles with few exceptions, and arrange, where necessary, for the attendance of the District Nurses. During 1927 the Inspectors' visits totalled 437. Four cases of measles in children under the age of 5 years were visited by the District Nurses, the number of visits paid being 50. No cases over the age of 5 years were visited by the District Nurses. Seventy-nine cases of measles were removed to hospital during the year. During the year the Metropolitan Asylums Board provided accommodation for increased numbers of measles patients. The number of deaths from measles was 5, all 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-health or debility. 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 46 36 34 24 14 6 9 9 12 15 10 19 36 270 Wards— Queen's Park 1 – 1 2 – – – 2 – 1 2 3 4 16 Harrow Road 4 14 3 3 5 – 1 – 1 3 2 5 3 44 Maida Vale 11 1 7 2 1 – 1 1 4 2 – 4 2 36 Town – 1 1 – 1 – 2 1 – 1 1 – 2 10 Church 14 10 11 4 3 3 5 2 2 4 2 1 3 64 Westbourne 15 8 8 10 1 1 – 3 4 3 2 4 20 79 Lancaster Gate, West – – 1 – – – – – – – – – – 1 Lancaster Gate, East 1 1 – 1 3 1 – – – 1 – 1 2 11 Hyde Park – 1 2 2 – 1 – – 1 – 1 1 – 9 GERMAN MEASLES. This harmless, but infectious disease, is notifiable in Paddington, 78 cases were notified in 1927, as compared with 124 in 1926, 375 in 1925 and 458 in 1924. 17 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. Fifteen cases of purulent eye-discharge of the new-born were notified in 1927. In no instance was there any permanent impairment of vision, so far as could be ascertained. 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. In addition to true purulent discharges some eleven cases of slight discharge from the eyes of infants reported by midwives to the London County Council were referred to this Department and received attention, no doubt preventing in a few instances the onset of the more severe form of the disease. During 1927, 10 cases were referred to the District Nursing Association, 401 visits being paid. Eight cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 7 cases of puerperal fever notified during 1927, all 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. Four women were certified as having died from puerperal fever. PUERPERAL PYREXIA. This condition 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 cause, and it may be to some cause 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. During the year the Council 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, for cases of puerperal pyrexia, but no request for his assistance was made to the Council during the year. During the year 34 cases of puerperal pyrexia were notified, 26 of which occurred within or were removed to institutions. ERYSIPELAS. Ninety cases were notified, 36 of which occurred within or were removed to hospitals. 18 ACUTE POLIO-MYELITIS. Four cases of this disease, otherwise known as Infantile Paralysis, were notified. Owing to the serious after-effects, such as deformities, which result from this disease much care is taken to keep in touch with all cases previously notified. Recent experience tends to show that most of the cases notified by doctors receive all the necessary remedial treatment. It is evident that the possibility of preventing the onset of serious deformities is now realised by parents and doctors more than formerly. ACUTE POLIO-ENCEPHALITIS. Only one case of this disease, somewhat similar in its nature to the last mentioned, was notified. ACUTE ENCEPHALITIS LETHARGICA. Four cases of this disease were notified; this disease, commonly known as "sleepy sickness," is found to be frequently the forerunner of progressive mental and physical deterioration, occasionally signalised by disorders of conduct. For this reason careful enquiry is made as tojthe after-history of all cases of this disease which are brought to notice. CEREBRO-SPINAL FEVER. Three cases of this disease were notified in 1927. MALARIA. Two cases were notified, both being patients suffering from general paralysis of the insane, into whom malaria was artificially inoculated as a therapeutic measure. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and eighty-three cases of acute primary pneumonia were notified in 1927, as compared with 184 in 1926, 265 in 1925 and 369 in 1924. Of the 183 cases, 126 were nursed in institutions. 107 cases of acute influenzal pneumonia were notified as compared with 76 in 1926, 88 in 1925 and 87 in 1924. 51 cases of pneumonia received nursing attention at home under the auspices of the Council scheme for district nursing, 988 visits being paid. ANTHRAX. One case of this disease was notified but proved to have been incorrectly diagnosed. CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TRENCH FEVER, TYPHUS FEVER. No cases of these diseases were notified during 1927. 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 1927, 38 children died from whooping-cough, all under the age of 5 years. The numbers of deaths in 1926 and 1925 were 8 and 13 respectively. There was an extensive epidemic of whooping-cough during the year but no reliable information is available as to the number of persons affected. CANCER. i 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, 247, 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 19 for by increased longevity and consequent proclivity to the disease, and by more accurate diagnosis on the part of doctors. ACUTE RHEUMATISM. This widely prevalent disease was made notifiable as from the 1st March, 1927, by virtue of the Paddington (Acute Rheumatism) Regulations, 1927. Paddington was the first area in Great Britain to make acute rheumatism notifiable and in view of this it may be considered appropriate for the Regulations to be reprinted below. It was found necessary to define the disease "acute rheumatism" as being the following conditions, occurring separately or together in a child under the age of 16 years:— (1) Rheumatic pains or arthritis, if accompanied by a rise of temperature; (2) Rheumatic chorea; (3) Rheumatic carditis. The Regulations enjoin the medical officer of health to make such enquiries and take such steps as are necessary or desirable for investigating the source of disease, for removing conditions harmful to the patient and arranging for the treatment of the patient. All these enquiries and any necessary action have been delegated to the "Rheumatism Supervisory Centre" which was opened at Paddington Green Children's Hospital on October 9th, 1926. The objects of this voluntary centre are:— (1) To meet the need shown by rheumatic cases for careful supervision during periods of apparent quiescence to prevent the development of heart disease. (2) To supervise rheumatic children when apparently well by periodical examinations, and to instruct the parents to consult their usual doctor or hospital should fresh symptoms of rheumatism develop. Treatment at the Centre itself is only given in urgent cases. (3) To instruct parents in the care of rheumatic children and to make investigations in Paddington into the causation of rheumatism. The Centre is under the personal supervision of one of the Honorary Physicians to the Hospital and there is also a salaried medical officer who devotes her whole time to visiting cases of the disease and making such enquiries as may elucidate the causes thereof. The work of the Centre lies with children who are suffering from rheumatism in any of its forms, whether slight or "acute" as defined in the Regulations. During the year some 175 children attended the Centre and a full report by the physician-in-charge has already appeared in the medical press. Thirty-eight children were notified under the Regulations during the year. All children notified are given an opportunity of attending the Supervisory Centre, and 27 did so. No great value would be served in describing the conditions found in the 27 children who attended the Centre after being notified. They only form a small group artificially delimited in the large mass of rheumatic children. The numbers of deaths for previous years are shown in the list following :— Numbers of Deaths in Paddington. 1927 247 1926 239 1925 230 1924 234 1923 206 1922 191 1921 226 1920 194 1919 170 1918 164 1917 201 1916 205 1906 164 20 The Paddington (Acute Rheumatism) Regulations, 1927, dated January 25, 1927, made by the minister of health. Whereas the Minister of Health is empowered by section 130 of the Public Health Act, 1875, as extended to London by the Public Health (London) Act, 1891, and as amended by the Public Health Act, 1896, from time to time to make, alter, and revoke regulations with a view to the treatment of persons affected with any endemic or infectious disease and for preventing the spread of the disease, and to provide for the enforcement and execution of the regulations; And whereas acute rheumatism, as herein defined, is an endemic disease : Now therefore, the Minister of Health, in pursuance of the recited enactments and of all powers enabling him in that behalf, hereby makes the following regulations, that is to say:— Definitions. 1.—(1) In these regulations, unless the context otherwise requires:— (a) The expression "local authority" means the Council of the Metropolitan Borough Borough of Paddington; (b) The expression "the district" means the Metropolitan Borough of Paddington; (c) The expression "medical officer of health" means the medical officer of health of the local authority; (d) The expression "medical practitioner" means any person for the time being registered under the medical Acts, and resident or practising within the district; (e) The expression "acute rheumatism" means the following conditions, occurring separately or together in a child under the age of 16 years:— (1) rheumatic pains or arthritis, if accompanied by a rise of temperature; (2) rheumatic chorea; (3) rheumatic carditis. (2) The Interpretation Act, 1889, applies to the interpretation of these regulations as it applies to the interpretation of an Act of Parliament. Commencement of Regulations. 2. These regulations shall come into operation on the 1st day of March, One thousand nine hundred and twenty-seven, and shall continue in operation for a period of one year from that date, and shall be enforced and executed in the district by the local authority. Notice of Provisions of Regulations. 3. The local authority shall forthwith cause notice to be given to every medical practitioner of the duties imposed upon him by these regulations. Notification by Medical Practitioner. 4. Subject to the provisions of these regulations, every medical practitioner, as soon as he becomes aware that a child who is resident within the district and upon whom he is in professional attendance is suffering from acute rheumatism, shall forthwith make and sign a notification of the case in the form set forth in Schedule A to the Public Health (Notification of Infectious Diseases) Regulations, 1918, and shall transmit the notification to the medical officer of health : Provided that a medical practitioner shall not be required to notify a case of acute rheumatism under this article and shall not be paid a fee for so doing if he has reasonable grounds for supposing that the case has already been notified under these regulations. Supply of Forms of Notification. 5. For the purposes of these regulations the local authority shall provide and maintain a sufficient supply of printed copies of the prescribed form of notification, and shall as soon as practicable after these regulations come into operation, and afterwards from time to time when application is made to them, furnish printed copies of the said form to every medical practitioner. , 21 Transmission of Notifications. 6. A notification to be transmitted to the medical officer of health in pursuance of these regulations shall be enclosed in a sealed envelope addressed to that officer, and may be transmitted by being delivered to him or by being delivered at his office or residence, or may be sent by prepaid letter post addressed to him at his office or at his residence: Provided that the requirement herein contained that a notification shall be enclosed in a sealed envelope shall be deemed to be complied with if the notification is folded in such a manner that during its transmission the particulars of the notification cannot be observed. Fees for Notification. 7.—(1) The local authority shall pay to every medical practitioner a fee of two shillings and sixpence for each notification duly made, signed, and transmitted by him under these regulations except in a case occurring in his practice as a medical officer of any public body or institution, when the fee shall be one shilling. (2) The said fees shall in each case be deemed to cover all expenses, including the cost of transmission. Duties of local authority and of medical officer of health. 8.—(1) Upon the receipt of a notification under these regulations, or on becoming aware in any other way of a case or suspected case of acute rheumatism in the district, the medical officer of health, or a person acting under the instructions of the medical officer of health, shall make such inquiries and take such steps as are necessary or desirable for investigating the source of disease, for removing conditions harmful to the patient and arranging for the treatment of the patient : Provided that nothing in this article shall be deemed to authorise the medical officer of health or other person as aforesaid to take any of the steps herein mentioned at any institution other than one belonging to the local authority, except with the consent of the managers of that institution. (2) The duties assigned to the medical officer of health by the Sanitary Officers Order, 1926, shall be deemed to extend to and to include all action by a medical officer of health in the execution of these regulations. Notification not required in certain cases. 9. Where a child is an inmate of any building, ship, vessel, boat, tent, van, shed, or similar structure belonging to His Majesty the King, nothing in these regulations shall be construed as requiring a notification to be transmitted to a medical officer of health in respect of that child in any case not falling within the provisions of paragraph (b) of section 5 of the Local Government (Emergency Provisions) Act, 1916, (as made permanent by the Expiring Laws Act, 1925, and as applied to the Royal Air Force by the Air Force (Application of Enactments) (No. 2) Order, 1918). Short Title. 10. These regulations may be cited as the Paddington (Acute Rheumatism) Regulations, 1927. Given under the Official Seal of the Minister of Health, this Twenty-fifth day of January, in the year One thousand nine hundred and twenty-seven. (l.s.) R. B. Cross, Assistant Secretary, Ministry of Health INFECTIVE ENTERITIS. This disease is notifiable in some eight other Metropolitan Boroughs. On May 2nd, 1927, the Council made the disease known as "Infective Enteritis" or "Summer Diarrhœa" notifiable for a period of two years. This Order was made by virtue of the Public Health (London) Act, 1891, and is only applicable to children under the age of five years. Six cases of the disease were notified during the year. The small number of cases notified was partly due to the fact that the obligation to notify was a new one and not fully appreciated by the doctors practising in the Borough. None the less the year was an abnormal one as regards diarrhoeal diseases, the number of deaths under the age of five years being only 16 as compared 22 with 52 in the year 1926 and 22 and 33 in the years 1925 and 1924 respectively. In no case was it found necessary to provide for home nursing by the district nurses, all bad cases being treated in institutions. Provision was available in the hospitals of the Metropolitan Asylums Board but no case of the disease was removed from Paddington to such institutions. It will be noticed that the number of deaths was in excess of the number of cases notified. This is explained by the fact that the disease was only notifiable for some eight months of the complete year for which mortality is calculated and also by the fact some deaths occurred outside the Borough (not notifiable) and other deaths were from causes classified for the purpose of the death returns as diarrhoea and enteritis but not within the meaning of the terms "infective enteritis " or "summer diarrhœa." TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year 1927 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 96 deaths in 1927, and from other tuberculous diseases there were 22 deaths. The number of deaths from tuberculosis of all kinds was 125 in 1926, and 118 in 1927 In recent years the numbers of deaths were as follows :— 1919 133 1924 149 1920 146 1925 116 1921 125 1926 125 1922 143 1927 118 1923 127 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A and B received during the year 1927. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0–1 year – – – – 3 3 1–5 years – – – 17 14 31 5–10 „ – 2 2 41 25 66 10–15 „ 1 1 2 7 8 15 15–20 „ 10 13 23 5 8 13 20–25 „ 8 28 36 5 5 10 25–35 „ 30 25 55 1 3 4 35–45 „ 27 17 44 2 2 4 45–55 „ 22 10 32 2 3 5 55–65 „ 8 2 10 – 1 1 65 years and over 3 2 5 – 2 2 Total 109 100 209 80 74 154 Cases re-notified 71 62 133 13 11 24 Total Notifications on Form A 180 162 342 93 85 178 Primary Notifications by School Medical Officers— 0–5 years – – – – 1 1 5–10 „ – – – 6 5 11 10–15 – – – 1 1 2 Cases re-notified 1 1 2 4 1 5 Total Notifications on Form B 1 1 2 11 8 19 23 1927. No. of Notifications on Forms C and D. Poor Law Institutions. Sanatoria. c. d. c. d. Pulmonary Tuberculosis— Male 31 43 86 65 Female 34 27 74 46 Non-Pulmonary Tuberculosis— Male 3 6 27 15 Female 3 6 13 9 C—Upon admission. D—Upon discharge. Public Health (Tuberculosis) Regulations, 1921. Cases removed from Register:— By reason of— 1927 Death 127 Removal 314 Recovery of patient or variation of diagnosis 174 Total 615 Tuberculosis. New Cases and Mortality During 1927. Age Periods. New Cases. Deaths. Pulmonary. N on-Pulmonary. Pulmonary. N on-Pulmonary. m. f. m. f. M. f. m. f. 0– – – – 3 – 1 – – 1– – – 17 15 1 1 – 2 5– – 2 47 30 – 1 3 4 10– 1 1 8 9 15– 10 13 6 8 6 19 4 4 20– 8 28 5 5 25– 32 26 1 3 16 14 1 – 35– 27 17 2 2 45– 22 10 2 3 20 9 1 1 55– 8 2 – 1 65 and upwards 3 2 – 2 7 1 1 1 Totals 111 101 88 81 50 46 10 12 Of the patients who removed from the Borough during 1927, the new addresses were obtainable in 114 instances, and particulars of the cases were transmitted to the Medical Officers of Health of the respective districts. In 1927, 8 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 1927 was 1,577 as compared with 1,801 at the close of the year 1926. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 2,191 By Tuberculosis Officers 611 By Dispensary Nurses— 20, Talbot Road 2,989 St. Mary's Hospital 1,719 7,510 24 The Public Health (Prevention of Tuberculosis) Regulations, 1925. By virtue of these regulations 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. Three sets were so supplied during 1927 and 4 sets were returned following the death or removal of the patient. Artificial Pneumothorax Treatment.—By arrangement with Brompton and other Hospitals patients recommended for this treatment are given refills at a cost to the Council of 10s. 6d. per refill. During 1927 1 patient received 24, another 11, another 9, and another 3 refills, the total cost being £24 13s. 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. During 1927, 3 patients were supplied with complete dentures, 2 with partial dentures, and in 6 cases dentures were repaired or re-made. Out of a total cost of £26 lis. 6d., the Council made grants to the amount of £6 12s. 6d., 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 1927. Part iculars of Patients, Number of Fillings. Number of Scalings. Extraction Cases. Dentures. No. of Dressings. No. for Advice Denture Visits. No. of New Patients. Without Anaesthetic. Local Administration Gas Administration Number of teeth extracted Upper. Lower. Re-models. Repairs. Number of Attendances. Simple Root. Women 111 34 – 5 – 9 13 67 3 3 – 6 7 20 26 17 Children 110 21 1 2 – 18 37 148 – – – – 2 34 – 30 Men 53 – – 1 – 9 8 64 1 1 – 1 1 16 17 13 Total 274 55 1 8 – 36 58 279 4 4 – 7 10 70 43 60 Number of Sessions held = 44. 25 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, and Shirland Road to its junction with 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 Tuberculosis Dispensary, 20, Talbot Road. This is a voluntary agency supported by voluntary subscriptions and a grant from the Paddington Borough Council usually amounting to £1,288. During 1927, however, a supplemental grant of £300 was made by the Council. A full account of the Dispensary and its activities will be found in the annual reports for 1924 and 1925. In 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 1927, 468 specimens of sputum were examined and reported upon. Artificial sunlight treatment of patients was carried on during the year but such treatment is not recognised as part of the approved scheme by the Ministry of Health and the London County Council. During the year 6 adults and 30 children received altogether 920 exposures. In view of the small number of cases receiving treatment no opinion can be expressed yet as to its value. Paddington Tuberculosis Dispensary. Return Showing the Work of the Dispensary During the Year 1927. 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 45 47 - — 3 3 42 38 48 50 42 38 (b) Doubtfully tuberculous — — — — — — — - 45 91 81 68 (c) Non-tuberculous — — — — — — — — 52 131 83 106 B.—Contacts examined during the year:— (a) Definitely tuberculous 1 1 — — — 2 9 4 1 3 9 4 (b) Doubtfully tuberculous - - - - - - - - 6 18 29 24 (c) Non-tuberculous — — — — — — — — 34 96 56 63 C.—Cases written off the Dispensary Register as (a) Cured — — - - - - - - - - - - (b) Diagnosis not confirmed or non - tuberculous (including cancellation of cases notified in error) - - - - - - - - 133 331 245 258 D.—Number of Persons on Dispensary Register on December 31st: (a) Diagnosis completed 186 215 2 — 45 44 191 153 231 259 193 153 (b) Diagnosis not completed - - - - - - - - 8 19 8 10 26 1. Number of persons on Dispensary Register on January 1st 762 2. Number of patients transferred from other areas and of "lost sight of " cases returned 43 3. Number of patients transferred to other areas and cases "lost sight of " 92 4. Died during the year 43 5. Number of observation cases under A (6) and B (b) above in which period of observation exceeded 2 months 62 6. Number of attendances at' the Dispensary (including Contacts) 7,396 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for 3 treatment or supervision patients 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (а) "Light " treatment - (b) Other special forms of treatment 6 patients 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 93 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants 38 (b) Otherwise 203 11. Number of other visits by Tuberculosis Officers to Homes 438 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,989 13. Number of (a) Specimens of sputum, &c., examined 710 (b) X-ray examinations made in connection with Dispensary work 34 14. Number of Insured Persons on pensary Register on the 31st December 345 15. Number of Insured Persons under Domiciliary Treatment on the 31st December150 16. Number of reports received during the year in respect of Insured Persons:— (а) Form G.P. 17 12 (б) Form G.P. 36 94 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,100 from the Paddington Borough Council during the year 1927. A full account of this dispensary and its activities will be found in the annual reports for 1924 and 1925. Return Showing the Work of the Dispensary During the Year 1927. 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 23 16 — 1 6 5 6 3 29 21 6 4 (b) Doubtfully tuberculous — — — — — — — — 11 17 11 7 (c) Non-tuberculous — — — — — — — — 6 19 15 7 B.—Contacts examined during the year:— (a) Definitely tuberculous — 1 — — — — - 2 — 1 2 (b) Doubtfully tuberculous — — — — — — — — 3 10 4 1 (c) Non-tuberculous — — — — — — — — 13 25 37 21 C.—Cases written off the Dispensary Register as (a) Cured 1 — — — 2 — — — 3 — — - (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 28 68 64 40 D.—Number of Persons on Dispensary Register on December 31st: (a) Diagnosis completed 51 42 2 3 50 45 45 28 101 87 47 31 (b) Diagnosis not completed - - - - - - - - 1 3 - 1 27 1. Number of persons on Dispensary Register on January 1st 266 2. Number of patients transferred from other areas and of "lost sight of" cases returned 13 3. Number of patients transferred to other areas and cases " lost sight of " 56 4. Died during the year 19 5. Number of observation cases under A (b) and B (6) above in which period of observation exceeded 2 months 6 6. Number of attendances at the Dispensary (including Contacts) 4,349 7. Number of attendances of non-pulmonary 3 cases at Orthopaedic Out-stations for patients, treatment or supervision 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (а) "Light treatment — (b) Other special forms of treatment — 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 19 10. Number of consultations with medical practitioners:— (a) At Homes of Applicants — (b) Otherwise 6 11. Number of other visits by Tuberculosis Officers to Homes 173 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes1,719 13. Number of (а) Specimens of sputum, &c., examined 129 (b) X-ray examinations made, in connection with Dispensary work 55 14. Number of Insured Persons on pensary Register on the 31st ber 169 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 15 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 8 (b) Form G.P. 36 21 The Borough Tuberculosis Care Committee. On December 31st, 1927, 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 Dr. R. S. Walker (Tuberculosis Officer). „ „ „ Nurse C. Griffin. „ „ „ Nurse A. B. Munro. Paddington and St. Marylebone War Pensions Committee Mr. S. G. Last, J.P. (Vice-Chairman). Kensal House School Care Committee ,, „ „ „ „ „ Miss F. Alston. 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. 28 No funds are available in the hands of the Committee for the assistance of patients. The Committee met 23 times during the year at the Town Hall, and the attendance of members has been well maintained. 311 individual cases were considered. During the year the Committee were instrumental in a number of cases in procuring through local charities financial or other assistance for patients and their dependants. The following may be regarded as typical examples of the help so rendered:— A man aged 47 years was recommended for sanatorium treatment. He had a wife and four children, two of whom had gained scholarships. Before the case came under notice the patient had been unable to work for several weeks. In consequence of the reduction of income from £3 to 8s. 0d. a week, debts had accumulated, and the family had reached a position of acute distress. The Charity Organisation Society were appealed to for help, which was readily granted in the form of monetary relief for the family and clothing for the patient. The Society continued their allowance to the family after the patient's admission to sanatorium, where he was still receiving treatment at the close of the year. A mother was unable to accept sanatorium treatment until provision had been made for the care of her three children, aged respectively 8 years. 4½ years, and 14 months. The difficulty of placing them was increased by the fact that the parents insisted upon the eldest child going to a Convent Home The Charity Organisation Society undertook to make the necessary arrangements, and eventually found suitable homes for all three children, leaving the mother free to go away for treatment. A Signalman in the Royal Navy developed pulmonary tuberculosis and was discharged from the Service being transferred from a Naval Hospital to a sanatorium for treatment under the London County Council's Tuberculosis Scheme. Whilst in the Navy he had allotted a portion of his pay to his widowed mother, who with that aid had been just able to make ends meet. The stopping of the allotment money would have caused much hardship to the mother had not the Charity Organisation Society, who had already been made aware of the circumstances, undertaken to make an allowance until other help for her could be obtained. A 'Bus Conductor, obliged to give up work on account of tuberculosis, had only National Health Insurance Benefit to look to for the maintenance of himself and his wife, who, suffering from an ulcerated leg, was unable to do anything towards supplementing their meagre income. It was ascertained that the man had served in the Army during the War. Application was therefore made to the United Services Fund, with the result that help was immediately given and a weekly allowance made to the wife when, shortly afterwards, her husband went away for santaorium treatment. One of the chief difficulties that the Committee have to contend with is the finding of employment for patients who have undergone a course of sanatorium treatment and are certified to be fit for work. It is regretted that the efforts made in this direction during the year met with but little success. 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 2,050 Revisits 2,478 4,528 Ante-natal— First visits 485 Revisits 328 813 29 OTHER VISITS. Puerperal Fever and Puerperal Pyrexia 179 Ophthalmia Neonatorum 347 Diarrhoea 43 Miscellaneous 2,131 2,700 Particulars recorded as to Method of Feeding Breast. Artificial. Mixed. Total. Number 1,529 82 93 1,704 Percentage 89.7 4.8 5.5 AGES AT FIRST VISIT. Method of Feeding. Breast. Artificial. Mixed. Totals Weeks 0— 17 3 — 20 1— 517 10 9 536 2— 583 15 16 614 3— 199 16 18 233 Months 0- 1,316 44 43 1,403 1- 170 18 20 208 2— 20 7 9 36 3 and upwards 23 13 21 57 DIED BEFORE END OF YEAR : 48. Breast 38 Artificial 7 Mixed 3 CAUSES OF DEATH. Diarrhœal Diseases 6 Measles 2 Respiratory „ 20 Premature Birth 5 Atrophy, Debility 4 Meningitis 1 Congenital Defects 3 Other Causes 6 Whooping Cough 1 Institution Deaths 38 (Paddington Infirmary 29). 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, owing 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. J. 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. 30 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. J. A. B. Hammond. Area served :—Hyde Park Ward. Christ Church Parish Rooms, Queensborough Passage, Porchester Terrace, W. 2.—Two large rooms and doctor's room, 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 Wards and part of Westbourne Wards. 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. J. A. B. 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.—Messrs. J. Trude Fripp and F. H. Brinckley Tofts, 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. 31 Convalescent and Holiday Homes.—Mothers and children are sent to Convalescent and Holiday Homes on recommendation of Medical Officers at Centres. All arrangements made by School workers, and assistance given when necessary, from 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, and from private operators. 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. Consultation Centres. Summary of Work for the Year, 1927. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Randolph Gardens. Sovereign Mews. *Queens- boro' Passage. Totals. Tues. Thurs. Tues. Fri. Wed. Wed. Thurs. Fri. Mon. Number of science 50 51 50 49 50 51 51 50 38 440 Number of Attendances 2231 2786 2525 3787 3508 1918 1209 1203 1495 20662 Average Attendance 44.62 54.63 55.00 77.26 70.16 37.61 23.71 24.06 39.34 46.96 Seen by Doctor 889 1109 858 1341 1053 979 635 674 8908 8428 Average number seen by Doctor at each Session 18 22 17 27 21 19 12 13 22 19 * Opened in March, 1927. Ante-Natal Clinic. Number of Sessions 48 Number of Attendances 544 by 287 expectant mothers. Average Attendance per Session 11.32 Home Visiting. Visits to Babies 13,198 Visits to Expectant Mothers 415 Other Visits 9,013 Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,463 10 9 Sales 1,410 4 11 Grants from Borough Council 29 7 10 Queen Charlotte's Maternity Hospital.—During the year 1927, 98 infants of mothers resident in Paddington attended the Infant Consultation Centre. Each attended about 12 times. As regards ante-natal consultations, exact figures are not available; During 1927 there were received into the Hospital for confinement 283 women from Paddington. This number is approximately equal to the number of women from Paddington attending the ante-natal department during the year, and the average number of attendances was 2\ per patient. 32 With regard to out-patients in 1927, 301 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about times on the average. St. Mary's Hospital.—There is no Infant Consultation Centre at this Hospital, but Antenatal 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 1927 was 189 and presumably all of these received ante-natal examination and advice. Maternity Nursing.—The arrangement whereby the Paddington and St. Marylebone District Nursing Association provides 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, continued in operation throughout the year. The results of this arrangement are excellent although it is not possible to adduce any figures in support of this statement. During the year 1927, 189 confinements were attended by the nursing staff, the number of visits being 3,019. These figures compare with similar ones of 179 and 2,881 in the year 1926. The annual grant in aid of this work is now £175. DAY NURSERIES. At the end of the year 1927, there were 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 220 281 Attendances 3,091 4,938 New Children 19 63 Cases of Infectious Disease. Diphtheria — — Scarlet Fever — — Measles — — Whooping Cough — 3 Chicken Pox 1 — 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 1½ 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. 33 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. During the year the following quantities of milk were issued to necessitous mothers:— Fresh Milk 9,306½ quarts. Dried Milk 388 1bs. The approximate cost of milk given in this way was £276 5s. 7d. 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 86/— 42/- 7 40/- 47/6 8 44/— 51/6 9 48/— 55/6 10 52/- 00/- 11 56/- 65/- 12 60/- 70/- Particulars of Milk Grants. Number of New Applications. 1927. Refused or referred to Guardians. Granted. Fresh Milk 327 231 96 Dried Milk 41 37 4 Dinners 3 3 — 371 271 100 34 Number of Orders for Milk 776 At Total Cost 729 At Half Cost 47 Number of Quarts at Total Cost 8,689 „ „ „ Half Cost 617½ Total Number of Quarts 9,306½ £ s. d. Cost of Milk at Total Cost 238 5 11 „ „ Half Cost 8 11 10 £246 17 9 Number of Orders for Dried Milk 113 At Total Cost 112 At Half Cost 1 Total Cost of Dried Milk £29 7 10 Number of Orders for Dinners 6 Number of Dinners supplied at Total Cost 103 Total Cost of Dinners £6 8 9 Convalescent Home. One nursing mother, with her twins aged 3 months, was admitted to St. Mary's Convalescent Home, Birchington-on-Sea on the 29th July, for a period of two weeks. The total cost was borne by the Council. ADMINISTRATION. GENERAL. Staff of the Department.—Mr. E. J. Potter, Chief Sanitary Inspector and Canal Boats Inspector retired from the Council's service on March 31st. No further appointment as Chief Sanitary Inspector was made but Mr. J. W. Webster was designated Senior Sanitary Inspector as from April 1st. Mr. C. S. Wansbrough was appointed Canal Boats Inspector as from April 1st. Mr. E. J. Grivell, Sanitary (Meat and Food) Inspector, retired from the Council's service on March 12th and Mr. F. J. Pallet was appointed to that position as from June 11th. Mr. E. B. Wilde was appointed Sanitary Inspector as from March 2nd. Mr. G. Frost, Junior Clerk, resigned on August 27th, and Mr. R. H. Davis, Junior Clerk, was appointed as from December 5th. Prevention of Infectious Disease.—Visits of inquiry after notification of infectious disease numbered 4,200. 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 1,104. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 82 patients (comprising 4 cases of measles, 61 of pneumonia, 7 of whooping-cough, and 10 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 1,537. Disinfection.—The rooms disinfected after infectious disease numbered 1,705, including 255 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 25f tons. One hundred and one library books were disinfected. Schools.—A total of 3,334 notices relating to cases of infectious disease were despatched to the Head Teachers of the various schools attended by patients or their "contacts," 1,646 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 203 reports were sent to the Medical Officers of Health of other boroughs in connection with cases attending outlying schools. 35 Bacteriological Work.—The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Bridge Road, SAV.l, 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 in the year 1926. The examinations made were as follows:— Number of Number of Disease suspected. Examinations. Positive Results. Diphtheria 1,154 150 Tuberculosis 496 49 Typhoid Fever ... ... ... ... ... 11 1 House Drainage.—During the year 124 existing drains were tested and found water-tight, 100 defective drains were reconstructed and 8 made sound by special process. Reconstruction Plans.—Two hundred and ninety plans (290) were submitted for drainage works in existing buildings. In connection therewith 702 letters were despatched. No summonses were issued for failure to supply plans. 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:— Maida Vale, No. 235 and premises in rear. Fulton Mews, Nos. 9 and 10. Ranelagh Road, No. 26 and St. Mary Magdalene's Home. Elgin Avenue, Garage at rear of No. 81. Portsea Mews, Nos. 5 and 6. Porchester Road, Nos. 15 and 17. Beethoven Street, Staff mess-room at rear of No. 23. New garage at rear of Nos. 20 to 25 (inclusive), Hermitage Street, and Nos.9 to 14 (inclusive) Church Place with Nos. 13 and 14, Church Place and No. 20, Hermitage Street respectively. Wharves, North Side, New workshops, stables, etc. Ashworth Road, Nos. 30 and 32, Nos. 34 and 36, and Nos. 38 and 40. Buildings comprising portion of the premises of Carter Paterson & Co., Ltd., on the East side of Harrow Road, opposite Bishop's Road Bridge and the adjoining roofs immediately South of the covered-in yard. New garages within the curtilage of Moscow and Windsor Courts, connected to the existing drainage system of the adjacent warehouse building. No combined systems were reconstructed by the Council during the year. Sewer Connections.—In 1927, 63 were reconstructed, either partially or wholly, 14 after Orders under Section 85 of the Metropolis Management Act, 1855, and 49 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 11 premises. The Metropolitan Water Board reported 7 cases of discontinuance of water supply. In each instance the supply was disconnected in consequence of 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 2 instances after the service of notices. No legal proceedings were necessary. 36 Mortuary.—Three hundred and thirty-one (331) bodies were deposited at the Mortuary, inquests being held on 177 of that number. Bodies deposited pending burial (all non-infectious) numbered 154. Trade Nuisances.—Seventeen complaints were received during the year, those relating to manure numbering 11. Rag and Bone Dealers.—In December, 1927, there were 14 rag and bone dealers in the Borough. Smoke Control.—During 1927 23 trade premises were kept under observation for the detection of black smoke. These premises were watched on 378 occasions, occupying 172½ hours. Smoke of all descriptions was noted during 75¾ hours, the duration of "black" smoke being only 4¾ hours. Eighteen complaints relating to the emission of smoke were received during the year. No Statutory Notices were served, but numerous informal communications were made. 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 1927 no prosecutions were instituted, 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. 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. For the first three months of the year Mr. E. J. Potter was Canal Boats' Inspector and for the remaining nine months Mr. C. S. Wansbrough. The following report for the year 1927 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 1927.—Seventy inspections of canal boats were made during the year, and the following infringements of the Acts and Regulations were discovered:— Cabins leaky 3 Stoves and stove pipes defective 2 Boats without certificates 4 Lettering, marking and numbering illegible 3 Painting of cabins required 3 37 Boats unregistered 2 Inhabited boats conveying foul and offensive cargoes being without two bulkheads 25 On no occasion was admission to a boat refused, and no legal proceedings were found to be necessary in respect of any of the infringements discovered. Thirteen formal notices were served. There were six cases of infectious disease notified:—Diphtheria 4 (3 females), Acute Primary Pneumonia 2 (1 female). There were 4 deaths:—Acute Primary Pneumonia 2 (1 female), Diphtheria 1, Street Accident 1 (female). Five boats were registered, three being new boats, and two owing to change of ownership. No boats propelled by steam or motor power were registered during the year. 107 children are known to be living on canal boats registered in Paddington, of whom 58 are of school age. The total number of boats in respect of which certificates of registration had been issued at the end of the year 1927 was 248, 1 being a motor boat. The annual cleansing and repairing operations at Paddington Basin were carried out during the Easter holidays. About 822 tons of mud were removed from the bed of the Basin, in addition to 490 tons which were dredged previously. Portions of the bed of the Basin were repaired and about 611 square yards of concreting laid. 288 cubic feet of brickwork were repaired on the wall of the waterway. One of the requisites for an inhabited canal boat is that if ordinarily used for the conveyance of any foul or offensive cargo, it shall contain between the space occupied by such cargo and the interior of any cabin used as a dwelling, two bulkheads of substantial construction, separated by a space not less in any part than four inches, open throughout to the external air. Such space must be furnished with a pump for the removal of any liquid and the bulkhead next to the cargo is to be watertight. It has not hitherto been considered in this Borough that house refuse comes within the scope of the term "foul or offensive" cargo. Steps are now being taken, however, that double bulkheads shall be fitted to all inhabited canal boats conveying house refuse and the owners of such boats are taking all necessary action to comply with this interpretation of the regulations. 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 6 premises into 21 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 436 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. Unhealthy Areas.—The following representation was made to the Council on June 14th, 1927:— Housing Act, 1925. To the Paddington Borough Council. I, Geoffrey Eugene Oates, Medical Officer of Health for the Metropolitan Borough of Paddington, do hereby report that in my opinion the closeness, narrowness and bad arrangement of the buildings comprised in the area described in the schedule hereto, and 38 the want of light, air and ventilation are prejudicial to the health of the inhabitants of the said buildings, and that the demolition of the said buildings is necessary to remedy the said evils. (Signed) G. E. Oates, Medical Officer of Health. Schedule. Nos. 12 and 13, Market Street, W. 2. Nos. 1, 2, 3 and 4, James Place, Market Street, W. 2, with the adjoining yard." The area covers some 1,980 square feet. It comprised six houses, four of which were occupied by a total of ten adults; one was empty and one was used by a builder as a store house and office. The area was congested, dark and lacking in ventilation, and the houses thereon were old and worn out. The following resolutions were passed by the Council. (a) That the Council, is of opinion the closeness, narrowness, and bad arrangement of the buildings and want of light, air and ventilation of the dwellings and buildings comprising the area Nos. 12 & 13, Market Street, W. 2 and Nos. 1, 2, 3 and 4, James Place, Market Street, W. 2, with the adjoining yard, are prejudicial to the health of the inhabitants thereof; that the most satisfactory method of dealing with the said evils is by the demolition or re-construction or re-arrangement of the said buildings, and that the area comprising the said buildings, yard, outhouses and appurtenances thereof and the site thereof is too small to be dealt with by an improvement scheme. (b) That the Special Housing Committee be directed to prepare a scheme for the construction and improvement of the area above-mentioned for submission to the Council in due course. With a view to facihtating the clearing of the site it was considered necessary to make Closing Orders in respect of certain houses on the site, that is Nos. 2, 3 and 4, James Place and No. 13, Market Street. These Closing Orders duly became operative and at the end of the year the site had been partly cleared. Houses Unfit for Habitation.—Closing and Demolition Orders made in 1919 in respect of No. 4 Desborough Street were determined upon the completion of the works necessary to make the premises 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 both houses the illegal occupation of the rooms was discontinued. Tenement Houses.—There were no additions to the Register, the total remaining the same as at the close of the previous year, viz., 1,406. The inspections made by the two Special Inspectors numbered 6,926. Particulars of the defects, etc., discovered and remedied will be found on pages 40 and 41. Overcrowding.—Sixteen tenements in registered houses were reported to be overcrowded. In only four 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 Cleansing.—The usual practice with regard to the selection of special streets for inspection was followed, a total of 1,011 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 diphtheria and 8 deaths from various causes occurred among the occupants of these houses. 39 Housing Act: Rent Books.—Rent books at four houses were found not to contain the required particulars. Cautionary letters were addressed to the landlords. Rent and Mortgage Interest (Restrictions) Acts 1920-1925. Three (3) applications were made, certificates being issued in all cases. Housing on the London County Council Estates. The arrangement made with the London County Council in 1924 still obtains. The Borough Council recommends cases of urgency and special hardship for accommodation on the several Estates up to a limit of 15 houses per 1,000 built, the quota for the Borough. The following analysis of 500 of the cases awaiting accommodation on the Watling Estate, Hendon, will give some indication of the urgent need for the provision of further housing accommodation. Number in family, including Parents. Number of Rooms Occupied. 1. 2. 3. 4. 5. 3 40 35 - - - 4 48 60 38 - — 5 28 55 31 3 — 6 6 39 12 2 2 7 4 23 15 6 —, 8 - 16 7 4 2 9 — 7 8 5 — 10 - 1 1 — — 12 - — 1 — 1 On the Becontree Estate accommodation can be obtained practically at once. There is no "waiting list" for the Downham Estate, and the allocation of houses proceeds slowly as far as the "quota " permits. The Roehampton and Tottenham Estates are now filled. There is a "waiting list" for casual vacancies in each case. The "waiting list" for the Watling Estate is a very heavy one: the allocation proceeds at much the same rate as for Downham. In November, 1927, an agreement was completed between the London County Council and the Borough Council whereby provision was made for the housing of 100 families on the Wormholt Estate at Hammersmith, the Borough Council to pay the sum of £7 per annum for a period of 20 years for each house provided. The following Table shows the number of applications submitted to the London County Council during the year and how they were dealt with. Number Submitted. Housed. Offered— not accepted. Refused by L.C.C. Withdrawn. Waiting. Becontree 27 8 2 10 4 3 Downham 42 18 3 3 — 18 Roehampton 2 2 — — — — Tottenham 22 9 2 4 — 7 Watling 45 34 3 5 1 2 Wormholt 136 94 2 10 6 24 274 165 12 32 11 54 In addition to the above, 21 families were housed on the different Estates on applications made previously to 1927. This figure brings the total number of Paddington applicants housed during the year to 186. The table refers to the number of applications forwarded to the London County Council only; it gives no indication of the number remaining on the "waiting lists." It is well over 1,000. At the time of writing the Wormholt Estate, so far as Paddington is concerned, is completed. It will be seen therefore, that the only Estates available are Becontree and Downham, both of which are far removed from Paddington. During the year 1,067 new applications were received by the Department and over 3,000 interviews were held. 40 Defects, Nuisances and Contraventions of Byelaws (other than items of Dilapidation) Discovered and Remedied in Tenement Houses. Drain defective 7 „ choked 59 „ not properly ventilated or ventilating pipe defective 24 Manhole cover defective 20 Gully choked 47 Soil pipe defective 13 Water-closet defective 64 „ choked 50 „ without sufficient flush 50 „ flushing apparatus defective 100 „ foul 15 „ improperly constructed 4 ,, accommodation insufficient 8 „ without door, door defective, or without proper fastenings 155 Rain-water pipe defective 72 „ choked 37 Guttering defective 63 Waste pipe defective 49 „ choked 61 „ untrapped — „ not provided or missing 3 Sink defective or not provided 34 Other drainage defects 20 Cistern defective 15 „ dirty 58 „ without proper cover or cover defective 33 Dustbin defective 123 „ not provided 1 „ insufficient 76 „ disused and not abolished — Paving of yard or area defective 134 „ washhouse defective 100 Premises damp 74 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc. 4,109 „ verminous 76 „ contents, bedding, etc., dirty 3 „ not provided with a window opening directly to the external air 12 Chimney smoky 17 Food cupboards not provided — Windows defective including cords and fastenings out of repair 1,249 Roof defective 285 Common staircases out of repair 203 Staircases without sufficient handrail 6 Animals improperly kept 4 Accumulation of refuse (not offensive) 12 Premises without water or supply insufficient 4 Any other defects, etc. 51 Rooms without proper cooking range 2 Overcrowding. Tenements overcrowded 16 Rooms overcrowded 20 Occupants, total 89 Under 10 45 10 and upwards 44 Overcrowding abated— By re-arrangement 2 By voluntary removal — Under notice 2 Cases held over — Notices Issued. Written Intimations 593 Statutory Notices 311 Bye-law „ 1,135 Notices under L.C.C. (G.P.) Acts— Verminous rooms 67 Additional taps — Abolition of old dustbins — Provision of cooking ranges 2 Items of Dilapidation for which Letters were sent to the Owners (Section 3 of the Housing Act, 1925). Wall-plaster broken, bulging, or defective 181 Matchboarding defective 17 Wall-paper loose 24 Skirting defective 37 Doors defective or missing 73 Locks defective 92 Ceiling plaster defective 40 41 Ceiling paper loose 12 Floors broken or badly worn 118 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 347 Stove settings defective 1 Flues defective 12 Hearths defective 65 Chimney-pieces loose or defective (including jambs, frieze, or mantle broken, loose, or missing) 74 Cupboard doors defective or missing 46 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 147 Window-frames loose or defective (including oak sills worn or rotten) 12 Window-glass broken 164 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 128 Steps to front entrance or area defective 40 Railing to area or area steps defective 20 Guard rails to addition roofs defective, broken or rotten 26 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 8 HOUSING (Ministry of Health Table.) Number of New Houses Erected During the Year. (a) Total 11 (i>) With State assistance under Housing Acts:— (i.) By the Local Authority Nil (ii.) By other bodies or persons 11 Unfit Dwelling Houses. 1925. 1926. 1927. 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 2,373 2,531 2,443 (b) Registered tenement houses inspected 951 796 1,011 (c) Houses inspected under Housing Acts 1 - 6 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 1 - 6 (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. II.—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 *354 *457 *8,436 (2) Number of dwelling-houses which were rendered fit— (а) by owners 284 360 349 (approx.) (approx.) (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 2,177 2,508 1,982 (6) Number of bye-law notices served 1,967 1,684 1 406 (2) Number of dwelling houses in which defects were remedied— (a) by owners Not available. 1,327 (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 1 - 1 (2) Number of dwelling-houses in respect of which Closing Orders were made 1 - 4 (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit - 2 1 (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. 42 FACTORIES AND WORKSHOPS. 1927. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 574 - - Workshops (including workshop laundries) 1,939 6 — Workplaces (other than outworkers' premises) 73 — — Total 2,586 6 — 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 107 96 - - Want of ventilation 9 9 - - Overcrowding 1 1 — - Want of drainage of floors — — — - Other nuisances 34 32 — - Sanitary accommodation insufficient 2 2 — - unsuitable or defective 10 10 — - 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 167 154 — - * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. Outwork in Unwholesome Premises, Section 108 Nature of work. Instances. Notices served. Prosecutions. Wearing Apparel— Making, &c. 13 — — Cleaning and washing 3 — — Household linen — — - Lace, lace curtains and nets -— — - Curtain and furniture hangings — — - Furniture and upholstery 2 — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — - Umbrellas, &c. 1 — - Artificial flowers — — - Nets, other than wire nets — — - Tents — — - Sacks — — - Racquet and tennis balls — — - Paper, etc., boxes, paper bags 1 — — Brush making — — — Pea picking — — — Feather sorting — — — Carding, &c., of buttons, &c. — — — Stuffed toys — — — Basket making 1 — — Chocolates and sweetmeats — — - Cosaques, Christmas crackers, Christmas stockings, &c. — — — Textile weaving — — — Total 21 — - 43 At the end of the year 1926, 1,143 premises were on the Register as compared with 1,446 at the end of the year 1914. During the year, 52 premises were removed from the Register and 57 added, n.aking the total at the end of the year 1927, 1,148. The Department reported the opening of 19 workshops to the Home Office, and received from that Office, notice of 17, 13 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 34 lists in February and 26 lists in August. These lists contained 372 names and addresses of which 339 were forwarded to other districts. From other districts 278 addresses within the Borough were received. Supervision.—There were during the year, 2,586 inspections, comprising 574 of factories, 1,939 of workshops and 73 of workplaces. There were 167 nuisances or defects found upon registered premises, 155 of which were remedied during the year, the majority being remedied by verbal request. There were 6 notices served during the year. The defects found comprised:— Want of cleanliness 107 „ ventilation 9 Overcrowding 1 Sanitary accommodation—insufficient 2 „ „ unsuitable or defective 10 „ „ not separate for sexes 4 Other offences 34 The Home Office forwarded 19 complaints, which comprised:— Overcrowding 1 Inadequate ventilation 5 Sanitary conveniences not screened 1 Sanitary conveniences not separate for sexes 4 Other offences 8 Bakehouses.—During the year two "underground" bakehouses were closed, the total number on the Register at the end of the year being 62, of which 43 were factory bakehouses. The number of "level" bakehouses was 16 (12 being factories) and of " underground " 46 (31 being factories). The number of persons working in bakehouses was 314, including 3 women and 16 individuals under the age of 18. The bakehouses were inspected on 939 occasions during the year. RAG FLOCK ACT, 1911. Nine samples were taken under this Act and submitted to the Public Analyst, who reported that they all complied with the Rag Flock Regulations of 1912. The proportions of soluble chlorine in the samples ranged from 5.0 to 30.7 parts per 100,000. 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 269 inspections during the year. The animals slaughtered, so far as is known were 3,752 head, comprising 37 bullocks, 8 calves and 3,207 sheep. This number exceeded last year's total by more than a thousand. It was found necessary to destroy the following organs on account of their being diseased:— Bullocks' livers 12, lungs 6, tongues 2, head 1, heart 1, mesentery fats 3. Sheeps' plucks 3, livers 10, lungs 7. In addition to the animals slaughtered at the above mentioned premises, during the period June to December, the carcases of 501 pigs, which had not been previously inspected, were brought into the Borough. On examination it was found necessary to destroy 1 carcase and 28 heads and pieces, all being affected with tuberculosis. Public Health (Meat) Regulations, 1924.—These regulations were fully discussed in the report for the years 1924 and 1925. 44 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 inspections were made during the year, approximately 6,781 poultry being slaughtered. Food Purveyors.—At the end of the year, there were some 853 purveyors of food in the Borough, classified as follows:—Butchers 76, Fishmongers 24, Fried Fish 31, Refreshments 93, Game and Poultry 15, Greengrocery 85, Margarine 13, Milk 101, General 105, Confectioners 116, Provisions 42, Grocery 94, Sweets 53, Ham and Beef 5. There were 8 premises on which fish-curing was performed, this business, as well as fishfrying, being regulated by special bye-laws. There were also 40 premises on which sausages were made. The Inspector paid 1,986 visits of inspection to the above-mentioned premises. Ice-Cream.—There were 125 shops at which ice cream was known to be sold. These comprised the following kinds of business:—Sweets 38, General 19, Confectioners 23, Milk 7, Bakers 4, Refreshments 29, Wholesale 3, Fishmonger 1, Newsagent 1. Two hundred inspections of premises were made during the year. Ice cream was also sold from 22 barrows stored within the Borough and from 30 barrows stored outside the Borough. Food Destroyed.—The weight of food-stuffs surrendered by tradesmen and dealers for destruction by the Council was about 2 tons, 14 cwts. Dairies and Milkshops.—At the end of the year 1926 there were 97 names on the register. During the year 1927 2 premises were closed and 6 opened, making 101 on the register at the end of the year. Seven of the businesses were transferred to new proprietors during the year. There were 453 inspections made during the year. Sterilised milk in bottles was found to be on sale at 73 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 twelve times during the year. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. Licences issued for sale of— "Certified" Milk 19 "Grade A (Tuberculin Tested)" Milk 19 "Pasteurised" Milk 25 Samples taken and submitted to bacteriological examination— "Certified" Milk 53 "Grade A (Tuberculin Tested)" Milk 2 "Pasteurised" Milk — In 9 instances the samples taken were found not to comply with the bacteriological standard appropriate to the kind of milk. SALE OF FOOD AND DRUGS ACTS, 1875-1927. Of the 600 samples taken during the year, 33 (5.5 per cent.) were found to be not "of the nature, substance and quality demanded." This compares with 3 2 per cent. in 1926 and 5.l per cent. in 1925. Thirty-eight of the samples were taken on Sundays and Bank Holidays. None of these was adulterated. One hundred and seven samples of milk were taken at Paddington Station on delivery by rail. Twenty of these samples were found to be adulterated. Twelve 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. 45 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 47. 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 gennerally speaking, of average natural strength. Genuine Milk Samples, 1927. Average Monthly Figure for Percentage. Fat Content and Non-Fattv solids. January 3.75 8.83 February 3.56 8.82 March 3.49 8.85 April 3.47 8.77 May 3.36 8.92 June 3.38 8.96 July 3.43 8.78 August 3.62 8.89 September 3.79 8.93 October 3.80 8.91 November 3.97 9.03 December 4.03 8.90 Average for Year. Samples taken at Paddington Station 3.85 8.89 „ „ elsewhere 3.58 8.87 1927.—Samples Submitted to Public Analyst. Total. Found adulterated. Percentage adulterated. Almonds, Ground 1 — — Apples 1 — — Apricots, Tinned 1 — — Arrowroot 2 — — Beef Tea 1 — — Brawn 3 — — Bread 11 — — Butter 26 — — Cake 4 — — Carbolic Powder 1 — — Calomel Ointment 3 — — Cheese 4 — — Chocolate Cream 2 — — Cocoa 13 — — Coffee 6 — — Cream 8 2 25.0 Cream, Preserved 6 — — Cream, Salad 1 — — Custard Powder 2 — — Dripping 5 — — Fish, Tinned 4 — — Fish Paste 2 — — Flour 12 — — Fruit Cordial 2 — — Fruit, Dried 10 — — Honey 1 — — Jam 10 — — Lard 5 — — Lemonade Powder 2 — — Lemon Curd 4 — — Lime Juice Cordial 2 — — Margarine 11 — — Marmalade 2 — — Milk 332 28 8.4 Milk, Tinned 12 — — Mineral Waters 5 — — Mincemeat 6 — — Mustard 11 — — Olive Oil 2 — — Peas, Dried 1 — — Peel, Candied 1 — — Peel, Cut 1 — — Pepper 1 — — Pheasant and Biscuit 1 — — Pickles 1 — — Prik and Beans 1 — — Rhubarb, Stewed 1 - — Rice 2 — — Sago 1 — — Sausages 21 2 9.5 Sponge Cakes 1 — — Sugar 7 — — Suet 5 — — Sweets 2 — — Tapioca 1 — — Vinegar 14 1 7.1 White Precipitate Ointment 2 — — 600 33 5.5 46 PUBLIC HEALTH (MILK AND CREAM) REGULATIONS, 1912 AND 1917. Milk.—Three hundred and thirty-two samples of milk were submitted to the Public Analyst during the year. All were reported to be free from preservative. Cream.—Eight samples of fresh cream and six samples of preserved cream were submitted for analysis. Two samples of fresh cream contained 0 31 per cent. and 0 33 per cent. respectively of boric acid. Both were supplied by the same vendor, to whom a cautionary letter was sent. 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. Seventy-one (71) complaints were received. In practically every case the usual procedure was followed of requesting an examination by the Borough Engineer and Surveyor of the sewer connections of the infested house and the two premises immediately adjacent. In several instances defects were found and these received the requisite attention of either the owner or, where only a minor trouble, the Borough Engineer and Surveyor. Five (5) Notices were served on persons responsible under the Act in respect of rat-infested premises. Rat Week.—This was held from 31st October to 5th 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 9,771 baits to be laid in 654 different positions, 214 rats eventually being found dead. This number is of course only a small proportion of the number killed. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Eleven (11) 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 109 premises, the verminous rooms numbering 142. The owners of 51 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 71 rooms being so treated at a charge to the owners of 7s. 6d. per room. LEGAL PROCEEDINGS—1927. 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. 66, Chippenham Road Drain defective Order made l 1 0 ,, ,, Soil pipe defective, rooms, etc., dirty and dilapidated l 1 0 .,, ,, Failing to comply with Magistrate's Order requiring amendment of drain 10 0 0 3 3 0 (51 days' imprisonment in default) ,, ,, Failing to comply with Magistrate's Order requiring amendment of soil-pipe and cleansing of rooms 10 0 0 - (51 days' imprisonment in default) 7, Albert Street Addition gutter and main roof defective, rooms and washhouse dirty, staircase defective Work done 2 2 0 37, Bristol Gardens Rooms dirty, walls of lower staircase dilapidated Order made 1 1 0 40, Chippenham Road Ground floor slip room damp, other rooms, etc., dirty Work done 1 0 0 2, Hall Place Staircase dirty Work done 1 1 0 83, Hall Place Staircase, washhouse and watercloset dirty ,, 1 1 0 1, Chichester Road Roof, attic windows, ceiling of second floor front room and roof or pipe over scullery defective, bathroom dirty and dilapidated ,, 1 1 0 2, Elgin Mews North Roof defective ,, 1 1 0 47, Clarendon Street Rooms, etc., dirty; washhouse paving and rain water pipe defective „ 1 1 0 Bye-Laws. Warrington Lodge Executing sanitary work without giving the requisite notice Summons withdrawn 2 2 0 48, Norfolk Square do. do. do. Summons dismissed 1 1 0 15 & 16, North Wharf Rd Yard paving defective Work done 1 1 0 2, Hall Place Staircase nosings and window sash cords defective ,, 1 1 0 83, Hall Place Stair nosings worn ; sink waste defective ,, 2 2 0 3, Portsdown Road Basement watercloset without proper water supply; top watercloset defective Work done 2 2 0 (13 days' imrpisonment in default) 47 Summary of Legal Proceedings under Sale of Food and Drugs Acts, 1875-1927. Offence. Fines. Costs. £ s. d. £ s. d. Milk.—6 33% deficient in fat Summons 5 5 0 dismissed „ 5 to 10.33% deficient in fat (5 samples) 25 0 0 7 7 0 „ 7 64 to 2024% added water (6 samples) 12 0 0 „ 13 33% deficient in fat 2 0 0 — Report of the Work of the District Inspectors, 1927. 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. 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. 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 1927 1,043 - 2,443 - 11,573 20 62 23 10 838 18 357 76 30 29 1 1 1 24 140 3 74 278 1 - 7 137 6 29 1 48 1927. Prevention of Infectious Disease. All Diseases, Enquiries by— District Inspectors 1,329 Women Inspectors and Health Visitors 5,062 Tuberculosis—Included in above— Women Inspectors 2,191 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 1,104 Rooms disinfected after- Tuberculosis 255 Other Diseases 1,450 Weight of Bedding, etc., disinfected (tons) 25¾ School Notices issued— Measles, Whooping Cough, Chicken Pox 1,646 Other Diseases 1,688 Bacteriological Examinations for— Diphtheria 1,154 Typhoid Fever 11 Tuberculosis 496 Sanitary Work—Cutting-off of Water Supplies. Notices received 7 Referring to Inhabited Premises 4 Empty „ 2 Other „ 1 Reasons for—Rates unpaid 7 Defective fittings — Mortuary. Bodies deposited, total 331 ,, „ for inquests 177 „ „ pending burial, infectious — „ „ „ „ other 154 P.M. examinations made 120 Trade Nuisances. Offensive Smells—Complaints 17 Accumulations of Manure 11 Smoke—Complaints 18 „ Premises watched 23 „ „ „ Hours of observation 172¼ „ Duration of smoke (hours), including 75¾ „ „ black smoke 4¾ Office (Clerical) Work. Letters received 5,562 „ despatched 6,020 Entries in Postage Book 12,243 Certificates dealt with relating to Infectious Disease (including Tuberculosis) 3,083 Notices sent re above 7,473 Entries in Birth Register 2,175 Complaints received 1,206 Plans dealt with 290 New openings in Journals 230 Disinfection Orders 1,411 Notices to abate nuisances, etc. 1,011 49 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road Paddington School for Mothers. St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Infant Consultation Centres ... *232, Harrow Road Paddington School for Mothers. 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. Day Nurseries *21, Howley Place Paddington Day Nursery. 66, Lancefield Street Queen's Park Day Nursery. * Transferred from 13 Hasborough Street, April, 1928. Tuberculosis. Dispensaries 20, Talbot Road. Paddington Tuberculosis Dispensary. St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place (Male London County Council. and Female) PUBLIC HEALTH STAFF (on December 31st, 1927). (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. District Sanitary Inspectors, W.T. Workshops Inspector and Canal Boats Inspector, W.T. J. W. Webster (1). C. S. Wansbrough (1). (4), (5). T. Mitchell (1), (3). (4), (5). Tenement Houses Inspectors, W.T. G. J. Miners (1), (4). C. Lawrence (1), (3), (4), (5). V. L. Ronchetti (2), (3), (5). C. G. Heron (2 ), (3). E. B. Wilde (2), (3), (4), (5). (10). Meat and Food Inspector, W.T. Health Visitors, W.T. F. J. Pallet (2), (3). 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. (10) Smoke Inspector's Certificate, Royal Sanitary Institute.