??? 349 Metropolitian Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1928. 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 Metropolitian Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1928. 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 19 Acute Polio-encephalitis 18 Acute Polio-myelitis 18 Acute Primary Pneumonia 19 Acute Rheumatism 20 Administrative Work 33 Annual Cleansing 37 Ante-natal Consultation Centres 30 Anthrax 19 Bacteriological Work 33 Bakehouses 42 Births G ,, Illegitimate 6 ,, in Institutions 7 ,, Notifications 7 „ Stillbirths 6 Birth-rates 6 Canals, Canal Boats 35 Cancer 19 Cerebro-spinal Fever 18 Chicken-pox 15 Cholera 19 Combined Drainage 34 Common Lodging Houses 37 Compulsory Repairs 37 Compulsory removal of certain persons 47 Condensed Milk Regulations 45 Continued Fever 16 Convalescent Homes 32 " Conversions " 36 Cowhouse 44 Dairies and Milkshops 44 Day Nurseries 30 Deaths, Causes of 7, 8 „ in Institutions 9 Death-rates 9 Diarrhoea 20 Diphtheria 14 Diphtheria Carrier Clinic 15 Disinfection 33 District Inspectors' Work 49 Drainage, Combined 34 ,, House 33 ,, Reconstruction Plans 33 Dried Milk Regulations 45 Dysentery 19 Erysipelas 18 Food Adulteration 44 ,, Chemical and Bacteriological Examination 45 ,, Destroyed 44 ,, Purveyors 44 ,, Samples Analysed 46 ,, Supervision 43 Fouling of Footways by Dogs 35 German Measles 17 Glanders 19 Health Visiting 27, 30 Homework (Outworkers) 42 Houses Unfit for Habitation 37 Housing 36 ,, on L.C.C. Estates 37 Hydrophobia 19 Ice Cream 44 Infant Consultation Centres 28-30 Infantile Mortality 10, 11 ,, ,, in Special Areas 11 page Infectious Disease, Notification of 13 ,, ,, Prevention of 33, 50 Infective Enteritis 20 Inquests 12 Legal Proceedings 48 L.C.C. Houses 37 Malaria 18 Marriages 5 Maternity and Child Welfare 27 Maternity Nursing 30 Measles 16 Meat Regulations 43 Milk, Grants 31 ,, (Special Designations) Order 44 Mortuary 35, 50 Nursing 33 Office Work 50 Ophthalmia Neonatorum 17 Outworkers (Homework) 42 Overcrowding 37 Pigeons, Nuisance from 47 Plague 19 Population 5 Poultry Slaughtering 43 Pneumonia 19 Preservatives, etc., in Food Regulations 45 Puerperal Fever 17 ,, Pyrexia 18 Rag and Bone Dealers 35 Rag Flock Acts 43 Rats and Mice Destruction 47 Relapsing Fever 19 Rent and Mortgage Interest (Restrictions) Acts 37 Rent Books 37 Scarlet Fever 14 Schools and Infectious Disease 33 Sewer Connections 34 Slaughterhouses 43 Smallpox 15 Smoke Control 35 Staff 33, 51 Tenement Houses 37 Trade Nuisances 35, 50 Tuberculosis, Artificial Pneumothorax Treatment 23 ,, Deaths from 21 ,, Dental Treatment 23 ,, Dispensary Treatment 23 ,, Home Visiting 22 ,, Notification 21 ,, Regulations, 1921 and 1925 22 ,, Shelters 23 ,, Supply of Beds and Bedding 23 Tuberculosis Care Committee 26 Typhoid Fever 16 Typhus Fever 19 Underground Rooms 37 Unhealthy Areas 37 Venereal Diseases Clinic 51 Verminous Conditions 47 Vital Statistics 4, 5 Water Supply 34, 50 Whooping Cough 19 Workshop Supervision 42 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 1928 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 showing a decrease from last year's figure. In the first half of the year there was an extensive epidemic of measles which caused much mortality amongst the young. Such epidemics have occurred in the past with some regularity and at intervals of two years or so. It is evidence of the interest taken in every detail of the health of the community that the Public Health Committee devoted much time to a special consideration of the problem of preventing future epidemics of measles. As regards the infantile mortality the rate recorded was intrinsically a low one, being 85 per thousand births. This compares favourably with rates obtaining in this Borough before the Great War. In making comparison with the infantile mortality rates of other metropolitan boroughs it will, however, become evident that we cannot remain as we are, but must continue to press forward in an effort to further reduce the risks incidental to infant life in Paddington. It is not possible to record any substantial improvement in housing conditions. Paddington largely consists of houses which are occupied by several families, although they were originally constructed for the use of one family. It is difficult to see how this condition of things can be improved until there is an ample supply of houses available in the suburbs of London together with cheap and convenient means of transport. I have again to express my appreciation of the loyal help of the staff of the Public Health Department of the Council and to thank the members of the Public Health, Maternity and Child Welfare and Special Housing Committees for the support and kind consideration which they have extended to me during the past year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W. 2. June, 1929. SUMMARY OF VITAL STATISTICS. Area of Borough 1,356·1 acres, including waterways 20·0 acres: 1928 Population (Registrar-General's estimate) 145,200 Density of population per acre 107 Census 1921: Total number of buildings containing dwellings 17,153 (a) Dwellings occupied by non-private families 435 Population inhabiting the same 12,910 (b) Dwellings occupied by private families 38,320 (Including vacant census night, 938). Population enumerated in occupied dwellings 131,351 Occupying 141,959 rooms, averaging 1·08 persons per room, or 0·92 room per person. Marriages 1,724 Total. M. F. Births Legitimate 1,927 957 970 Birth-rate Births illegitimate 250 128 122 Birth-rate 14·99* Deaths 1,893 913 980 Death-rate 13·03* Number of women dying in, or in consequence of childbirth from sepsis ” other causes 3 4 Maternal mortality 3·21† Deaths of Infants under 1 year of age 186 Infantile Mortality 85† Legitimate, 75 †; Illegitimate, 160 † Deaths from Measles (all ages) 71 ,, Whooping Cough (all ages) 13 „ Diarrhoea (under 2 years of age) 23 „ Pulmonary Tuberculosis 105 Death-rate from Pulmonary Tuberculosis 0·72* Deaths from all forms of Tuberculosis 116 Tuberculosis death-rate 0·79* Rateable Value £1,695,356 Product of a Penny Rate £6.814 * per 1,000 persons. † 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 200 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 13·11 232 99 196 78 1925 147,100 2,206 312 443 2,337 15·88 2,011 13·67 570 339 1,780 12·10 196 88 170 72 86 1926 146,700 2,131 345 462 2,248 15·32 2,067 14·09 554 344 1,857 12·65 210 98 194 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 1928 145,200 2,074 376 479 2,177 14·99 1,954 13·45 507 446 1,893 1303 186 89 186 85 "T"=Total; "C"=Civil. POPULATION. The Registrar·General's estimate of the population of the Borough for the year 1928 was 145,200. It will be noticed that there has been an increase of 2,500 in the population according to the Registrar·General's estimates. One may venture to assert that there has been no such sudden increase of the population. Attention was drawn in last year's Annual Report to the varying estimates of the population of Paddington furnished by the Registrar·General from year to year and to the effect that such varying estimates have in causing corresponding fluctuations in the death·rate and 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 145,200 Wards— Queen's Park 15,856 North Paddington 73,301 Harrow Road 27,693 Maida Vale 22,244 Town 7,508 Westbourne 24,259 ·South Paddington 71,899 Church 17,606 Lancaster Gate, West 9,594 Lancaster Gate, East 8,214 Hyde Park 12,226 MARRIAGES. During 1928, 1,724 marriages were solemnized in the Borough, being a rate of 23·7 persons per 1,000 of the population. 6 BIRTHS. The number of births registered in the Borough during 1928 was 2,074, and, in addition, 103 occurred outside the Borough to Paddington residents in excess of those occurring in Paddington to residents of other localities, making a total of 2,177 births. The birth·rate for 1928 was therefore 14·99 per 1,000 of the population. Of the 2,177 births, 1,085 were those of males and 1,092 those of females, and of these 128 males and 122 females were illegitimate. The Registrar·General's final figure for the nett number of births is given as 2,178, but this does not affect the figure for the birth·rate given' above. The following table shows the birth·rate during each of the last six years in England and Wales, in London, in Paddington and in each of the wards of the Borough:— 1928 Birth·rates. No. of Births. Birthrates. 1927 1926 1925 1924 1923 England and Wales 660,267 16·7 16·7 17·8 18·3 18·8 19·7 London 72,352 15·9 16·1 17·1 18·0 18·6 20·1 Paddington 2,177 14·99 15·53 15·32 15·88 17·11 17·92 Wards— Queen's Park 174 10·97 11·29 12·48 12·63 13·76 15·28 Harrow Road 417 15·05 15·50 14·44 16·07 16·01 18·36 Maida Vale 326 14·65 16·69 15·84 14·09 1935 19·95 Town 126 16·78 18·70 17·92 23·54 24·05 23·84 Church 402 22·83 23·11 23·94 Westbourne 467 19·25 18·58 18·03 18·14 19·93 21·04 Lancaster Gate, West 48 5·00 6·25 6·29 7·82 8·37 8·69 Lancaster Gate, East 61 7·42 9·04 8·79 9·49 9·05 5·68 Hyde Park 156 12·75 11·56 12·14 11·94 13·46 13·72 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 1921·1925 17·86 1926 15·32 1927 15·53 1928 14·99 Illegitimate Births.—These were 250 in number, or 11·48 per cent, of the total number of births. The proportion of illegitimate births varies remarkably in the different wards as is shown in the table below:— Rate of Illegitimate Births Per 100 Total Births. Ward. Rate. Queen's Park 5·17 Harrow Road 5·75 Maida Vale 15·95 Town 11·11 Church 10·20 Westbourne 10·28 Lancaster Gate, West 18·74 Lancaster Gate, East 19·67 Hyde Park 26·28 7 Stillbirths.—During 1928, 59 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Births in Institutions. Local. Legitimate. Illegitimate. Total. Paddington Infirmary 172 (23) 85 (13) 257 (36) St. Mary's Hospital 212 (116) 7 (4) 219 (120) Lock Hospital 16 (13) 46 (39) 62 (52) Non·residents shown in ( ). Outlying. Legitimate. Illegitimate. T otal. Queen Charlotte's Hospital 207 42 249 Other Lying·in Hospitals 6 7 13 Other Hospitals 54 12 66 Poor Law Institutions 10 9 19 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, 2,027 live births were notified to the Medical Officer of Health. There were also 42 stillbirths notified. Of the 2,069 living and stillbirths notified, 46·0 per cent, were notified by medical practitioners, 39·5 per cent, by midwives, 2·6 per cent, by parents, and 11·9 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 live births and 88·1 per cent, of the stillbirths occurring within the Borough were duly notified. It will be seen that only a small proportion of live 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. It is of interest to mention one birth which was registered but not notified. Here the mother delivered herself and was unattended. There was no one who could be held responsible for the notification of such a birth. DEATHS. The number of deaths that were registered during the year as having taken place in the Borough was 1,954. Of these, 507 were of persons whose residence was not in Paddington, 405 dying in Paddington Institutions and 102 in other places in the Borough. There were also reported to the Registrar·General 446 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,893, making an annual death·rate of 13·03. 1928. 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 28th 3 5 19 3 7 17 1 February 25th 2 1 — — 13 23 3 7 6 2 March 24th 11 — — — 12 21 3 11 17 1 April 21st 30 — 1 — 13 16 2 4 17 2 May 19th 22 1 — — 12 24 3 5 16 2 June 16th 8 — — 1 6 14 4 5 9 1 July 14 th 1 1 — 1 2 25 — 1 10 4 August 11th — — 1 — 9 18 1 2 7 5 September 8th — — — — 7 21 1 3 3 5 October 6th — — — — 2 22 1 7 2 2 November 3rd 1 i 6 15 2 7 14 2 December 1st — — — 1 7 18 2 2 5 2 31st — — 9 — 12 20 1 3 16 6 Totals 77 4 12 3 106 256 26 64 139 35 This table gives the numbers of deaths from the various causes as classified locally. The figures differ somewhat from those supplied by the Registrar·General in the table appearing on the following page. 8 The following table shows the deaths classified by the Registrar·General according to sex and age, and cause of death:— Deaths of Residents of the Borough, 1928. 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 1891 910 981 104 82 33 27 17 26 19 12 35 40 87 84 289 251 176 205 150 254 Enteric Fever 1 ... 1 .. .. .. .. .. ... ... .. ... .. ... ... .. 1 .. ... ... ... Smallpox .. ... ... ... .. ... ... .. .. ... .. ... .. ... .. .. .. ... ... ... ... Measles 71 29 42 9 5 11 17 6 18 3 .. ... .. ... .. ... ... ... ... ... ... Scarlet Fever 4 3 1 .. ... ... ... 1 1 2 .. ... .. ... ... ... .. .. ... ... ... Whooping Cough 13 6 7 4 3 1 3 ... 1 1 .. ... .. ... ... ... ... .. ... ... ... Diphtheria 7 5 2 2 .. 1 .. 2 1 ... .. ... .. .. ... ... ... ... ... ... ... Influenza 27 12 15 1 .. 2 ... ... .. ... .. ... .. 3 1 3 6 1 3 2 5 Encephalitis Lethargica .. .. ... .. .. ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Meningococcal Meningitis 3 2 1 1 1 ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... Tuberculosis of Respiratory System 105 57 48 ... 1 ... ... ... ... ... 1 7 18 19 20 30 7 ... ... ... ... ... 1 1 ... Other Tuberculous Diseases 11 6 5 ... ... 1 1 2 ... ... 1 1 1 ... 2 1 ... 1 ... ... Cancer, Malignant Disease 260 117 143 ... ... ... ... ... ... ... ... ... 2 8 12 48 69 43 37 18 23 Rheumatic Fever 6 2 4 ... ... ... ... ... ... ... 2 ... 2 1 ... 1 ... ... ... ... ... Diabetes 19 9 10 ... ... ... ... ... ... ... ... ... ... ... 1 5 6 4 3 ... ... Cerebral Haemorrhage, etc. 79 22 57 ... ... ... ... ... ... ... ... ... ... 1 ... 6 12 5 24 10 21 Heart Disease 336 142 194 ... ... ... ... ... ... ... ... 1 3 5 14 59 47 42 58 35 72 Arterio·sclerosis 113 62 51 ... ... ... ... ... ... ... ... ... ... ... ... 7 8 24 16 31 27 Bronchitis 68 30 38 3 4 1 ... ... ... ... ... ... ... 3 ... 7 5 7 8 9 21 Pneumonia (all forms) 151 87 64 20 20 13 4 1 3 3 1 7 2 20 10 16 9 4 13 Other Respiratory Diseases 15 9 6 1 ... ... 1 ... ... ... ... ... ... 1 1 6 1 1 2 ... 1 Ulcer of Stomach or Duodenum 27 14 13 ... ... ... ... ... ... ... ... ... ... 2 2 11 7 1 2 ... 2 Diarrhoea, etc 31 16 15 15 8 ... ... ... ... ... ... ... ... ... 3 1 1 ... ... ... 3 Appendicitis and Typhlitis 9 5 4 ... ... ... ... ... ... 1 ... ... 1 2 ... ... 3 2 ... ... ... Cirrhosis of Liver 7 2 5 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 ... ... 1 Acute and Chronic Nephritis 56 25 31 ... ... ... ... ... ... ... ... 1 1 2 4 14 11 3 6 5 9 Puerperal Sepsis 3 ... 3 ... ... ... ... ... ... ... ... ... ... ... 3 ... ... ... ... ... ... Other Accidents and diseases of Pregnancy and Parturition 4 .. 4 ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... Congenital debility and Malformation, Premature Birth 70 39 31 37 31 ... ... 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... Suicide 33 22 11 ... ... ... ... ... ... ... ... 5 1 4 2 12 6 1 1 ... 1 Other deaths from Violence 79 49 30 2 2 ... ... 3 ... 2 1 10 2 12 5 13 10 1 8 6 2 Other defined diseases 283 138 145 9 7 3 1 1 2 6 2 7 7 16 11 43 36 24 26 29 53 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:— 1928 Death·rates. No. of Deaths. Death· rates. 1927 1926 1925 1924 1923 England and Wales 460,440 11·7 12·3 11·6 12·2 12·2 11·6 London 52,670 11·6 11·9 11·6 11·7 12·2 11·4 Paddington 1,893 13·03 13·56 12·65 12·10 13·11 11·77 Wards— Queen's Park 178 11·22 12·12 12·10 11·39 11·94 10·71 Harrow Road 329 11·88 13·04 12·58 10·80 12·57 12·09 Maida Vale 324 14·56 14·68 14·37 11·84 12·43 12·72 Town 90 11·98 16·94 ll·60 14·73 15·79 12·69 Church 269 15·27 15·60 16·92 Westbourne 375 15·45 13·92 12·64 13·99 15·16 12·97 Lancaster Gate, West 98 10·21 9·33 11·04 10·28 10·54 9·62 Lancaster Gate, East 88 10·71 11·39 7·71 9·25 9·90 9·06 Hyde Park 142 11·61 13·64 9·55 10·57 11·68 9·99 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 1921·1925 12·41 1926 12·65 1927 13·56 1928 13·03 Deaths in Institutions. 1928. Local. Toted Nonresidents. Paddington Infirmary 553 23 St. Mary's Hospital 265 191 Paddington Green Children's Hospital 43 33 Hospital for Women and Children (Lock Hospital) 6 5 St. Luke's Hospital 164 153 1,031 405 Deduct Non·resideuts 405 626 Outlying. Paddineion Residents. Hospitals of Metropolitan Asylums Board (excluding Tuberculosis Hospitals) 37 Poor Law Institutions 59 Lunatic Asylums 68 Voluntary Hospitals (General) 111 Hospitals (Special, including Sanatoria) 65 340 Total Deaths of Paddington residents in institutions 966 10 INFANTILE MORTALITY. During the year 1928 there were 2,177 births and 186 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 85. The following table gives the births and the infantile deaths and death·rates for the year 1928 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1923 to 1927 are given for comparison. 1928 Infantile Mortality Rates. i No. of Births. No. of Deaths of children under 1 year. Infantile Mortality Rates. 1927 1926 1925 1924 1923 England and Wales 660,267 42,693 65 69 70 75 75 69 London 72,352 4,829 67 59 64 67 69 61 Paddington 2,177 186 85 79 86 72 78 69 Wards— Queen's Park 174 5 28 91 45 88 50 78 Harrow Road 417 33 79 49 104 66 87 53 Maida Vale 326 27 82 96 87 50 50 83 Town 126 12 95 130 37 91 115 71 Church 402 40 99 99 108 Westbourne 467 51 109 76 86 69 82 78 Lancaster Gate, West 48 4 83 51 109 50 93 21 Lancaster Gate, East 61 5 82 — 115 52 49 36 Hyde Park 156 9 57 65 53 74 24 59 Infantile Mortality Rates, 1896·1928. 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 1928 65 67 85 11 Infantile Mortality in Paddington.—1928. 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 51 7 6 4 68 31 30 27 30 186 85·43 Common Infectious Diseases (6·10, 25:2) — — — — — — 2 7 14 23 10·57 Tuberculous Diseases (31—37) — — — — — — 1 — 1 0·46 Diarrhoea and Enteritis (113) — — 1 — 1 6 10 7 3 27 12·40 Developmental and Wasting Diseases (159, 160, 161:1, 162:2) 34 3 5 1 43 14 4 — 61 28·01 Miscellaneous Diseases (Remainder) 17 4 — 3 24 11 14 12 13 74 33·99 Measles (7) — 4 12 16 7·35 Whooping cough (9) — — — — — 2 3 2 7 3·22 Diphtheria (10) — — — — — — — — — — Influenza (11) — — — — — 1 — 1 0·46 Tuberculosis of nervous system (32) — — — — — — — — — — Tuberculosis of intestines and toneum (33) — — — — — — Other tuberculous diseases (31, 34· 37) 1 1 0·46 Syphilis (38) — 1 — — 1 — — — 1 0·46 Meningitis (71) — — — — — — — — — — Convulsions (80) — — — — — — Bronchitis (99) — 1 — — 1 2 4 7 3·22 Pneumonia (100, 101) 3 1 — 2 6 5 8 8 11 38 17·46 Other respiratory diseases (98, 102· 107) _ 1 1 0·46 Inflammation of the stomach (112:1) 1 1 0·46 Diarrhoea and Enteritis (113) — — 1 — 1 6 10 7 3 27 12·40 Hernia, intestinal obstruction (118) — — — 1 1 0·46 Congenital malformations (159) 5 — 1 — 6 2 2 10 4·59 Congenital debility and sclerema (160:1) 2 _ 2 6 2 10 4·59 Icterus (160:2) 1 — — — 1 1 0·46 Premature birth (161:1) 23 3 4 1 31 6 37 17·00 Injury at birth (161:2) 8 — — 1 9 — — 9 4·13 Disease of umbilicus (162:1) 2 — — — 2 2 0·92 Atelectasis (162:2) 3 — — — 3 3 1·37 Suffocation—in bed or not stated how (180 pt.) 2 _ _ 2 1 1 4 1·83 Other causes 2 i — — 3 2 1 2 1 9 4·13 xt n ■ *v, /Legitimate 1,927. . /Legitimate Infants 146. Nett Births m the Year ^ Illegitimate 250. Nett Deaths in the Year \ legitimate Infants 40. Note.—The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the Detailed International List of Causes of Death, 1920. It has been customary in previous annual reports to make a note of infantile mortality in special localities. The following is a summary of the results. Infantile Mortality in Special Areas. Areas 1928 Infantile Mortality. Births. Deaths. 1928 1927 1926 1925 1924 Church Ward— North Wharf 54 8 148 40 92 59 106 Clarendon Street 189 20 105 138 148 126 160 Rest of Ward 159 12 75 70 67 ? ? Westbourne Ward— Alfred Road 108 9 83 165 107 58 112 Rest of Ward 359 42 117 48 79 77 73 Maida Vale Ward— Amberley Road 48 5 104 178 89 66 59 Rest of Ward 278 22 79 80 86 43 49 Totals for 4 Areas 399 42 105 139 121 91 123 Rest of Borough 1,778 144 81 65 78 68 67 12 The following table, comparing the vital statistics for the metropolitan boroughs, has been supplied by Dr. F. D. Ross·Keyt, Medical Officer of Health for Stoke Newington:— 1928. 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 4,458,200 15·9 — 11·6 67 West Districts. Paddington 145,200 14·99 0·87 13·03 85 Kensington 178,400 14·3 0·64 13·0 83 Hammersmith 136,300 16·6 0·5 11·4 69 Fulham 155,300 15·4 0·6 11·5 77 Chelsea 63,630 12·6 0·2 13·5 48 City of Westminster 129,700 10·3 0·21 11·5 58·39 North Districts. St. Marylebone 104,000 12·6 0·74 11·1 79 Hampstead 85,880 11·6 0·27 11·6 54 St. Pancras 205,600 15·9 1·06 12·7 80 Islington 324,700 17·8 0·73 12·8 64 Stoke Newington 50,690 15·3 0·29 12·5 61 Hackney 217,200 16·0 0·54 11·7 67 Central Districts. Holborn 39,280 120 0·35 13·5 57 Finsbury 72,010 20·4 1·36 15·1 85 City of London — — — — — East Districts. Shoreditch 101,200 20·1 1·08 13·8 80 Bethnal Green 112,200 19·0 — 11·7 73·9 Stepney Poplar 162,000 19·9 0·65 11·8 71 South Districts. Southwark 181,300 19·2 0·98 12·7 70 Bermondsey 115,200 18·1 1·19 13·2 85 Lambeth 298,100 16·82 0·56 12·30 61·19 Battersea 164,100 16·7 0·67 11 9 64·2 Wandsworth 354,948 13·0 0·27 10·58 49 Camberwell 260,400 15·8 0·76 11·9 61 Deptford 112,400 16·3 0·7 12·0 76 Greenwich B.R. 101,200 D.R. 100,200 16·42 0·59 1113 r. 5 Lewisham 199,300 15·2 0·47 10·0 52 Woolwich 141,100 16·1 0·39 110 50 *The provisional figures relating to London were supplied by the Registrar·General. Other figures supplied by Medical Officers of Health. INQUESTS. During 1928, 141 inquests were held on residents of the Borough, and 98 deaths were registered after the issue of certificates by the Coroner under powers conferred by the Coroners (Amendment) Act, 1926. 13 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington : Acute Encephalitis Lethargica. Glanders. Acute Influenzal Pneumonia. Hydrophobia. Acute Polio-encephalitis. Infective Enteritis or Summer Diarrhoea. Acute Polio-myelitis. Malaria. Acute Primary Pneumonia. Measles. Acute Rheumatism. Ophthalmia Neonatorum. Anthrax. Plague. Cerebro-spinal Fever. Puerperal Fever. Chicken-pox. Puerperal Pyrexia. Cholera. Relapsing Fever. Continued Fever. Scarlatina or Scarlet Fever. Diphtheria or Membranous Croup. Small-pox. Dysentery. Tuberculosis. Erysipelas. Typhoid or Enteric Fever. German Measles. Typhus Fever. The following table summarises the cases of notifiable diseases notified in the years 1918 to 1928:- Analysis of Notification Certificates (Uncorrected for Errors). 1918. 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. Acute Encephalitis Lethargica (a) 3 2 7 2 3 12 7 4 4 1 „ Influenzal Pneumonia — (a) 87 45 27 72 33 87 88 76 107 59 „ Primary Pneumonia — (a) 83 96 105 254 302 369 265 184 183 202 „ Polio-encephalitis — 5 2 1 — 2 4 3 3 1 1 „ Polio-myelitis 3 4 3 „ Rheumatism (a) 34 76 Anthrax — — — 1 1 — — — 1 1 — Cerebro-spinal Fever 3 7 1 2 2 1 1 5 5 3 4 Chicken-pox 207 — — — 22 465 395 459 599 461 567 Continued Fever — — — — — — — — — 2 10 Diphtheria 254 255 461 442 401 219 278 336 462 367 302 Dysentery — (a) 3 1 2 — 2 1 — — — — Erysipelas 56 76 81 83 77 54 69 64 76 90 90 German Measles 226 132 71 83 144 48 458 375 124 78 109 Infective Enteritis or Summer Diarrhoea — — — — — — — — — (a) 6 20 Malaria — (a) 64 24 7 5 2 9 1 1 2 3 Measles 778 1126 1356 80 1973 324 2757 879 1738 154 2862 Membranous Croup 4 4 3 3 — 1 2 1 1 2 4 Ophthalmia Neonatorum 22 30 29 34 15 22 18 23 16 15 24 Puerperal Fever 2 15 15 16 8 5 9 15 14 7 5 „ Pyrexia — — — — — — — — (a) 17 34 32 Scarlet Fever 150 261 502 827 529 323 290 264 199 320 519 Small-pox — — — — — 1 — — — — 5 Tuberculosis-Total 451 391 383 335 312 338 379 400 356 381 321 Pulmonary 325 284 277 244 204 222 242 231 218 212 196 Other Forms 126 107 106 91 108 116 137 169 138 169 125 Typhoid or Enteric Fever 13 10 19 13 8 13 15 18 12 16 25 (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:— 1928. Notifications. A.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne. Lancast er Gate. Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 26 29 24 29 33 19 9 9 19 21 30 34 2 4 3 1 8 6 Typhoid and Continued Fever — — 5 — 2 2 1 — — 1 5 4 3 2 — 2 3 5 Erysipelas 2 4 8 16 5 5 3 5 4 5 8 11 1 3 — 1 4 5 Ophthalmia Neonatorum — — 3 1 1 2 1 1 1 2 1 7 — — 1 — — 3 Pneumonia—A. Influenzal — 2 3 9 7 14 2 1 5 1 4 6 — 2 — 1 1 1 „ A. Primary 13 6 21 10 14 12 8 4 38 20 25 17 2 1 4 3 3 1 Puerperal Fever — 1 — — — 1 — 1 — — — 2 — — — — — — „ Pyrexia — I — 3 — 4 — 3 — 7 — 11 — 1 — — — 2 Scarlet Fever 30 30 47 48 46 38 11 12 40 54 59 54 1 5 5 10 10 19 B. —Sex—Age Distribution. Borough. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 1 5 13 6 14 10 4 12 14 11 63 45 20 16 12 18 9 20 2 6 2 3 — — Typhoid and Continued Fever — — — — — — — — 2 1 2 2 6 3 4 4 1 3 3 2 1 1 Erysipelas 1 2 1 1 2 1 1 — 2 1 1 2 3 3 2 8 6 10 10 17 6 10 Pneumonia—A. Influenzal 2 1 — — 3 — — — 2 2 4 7 1 1 3 5 2 8 1 3 4 4 — 6 „ A. Primary 24 15 14 15 6 4 12 4 5 4 9 7 5 2 7 1 16 7 12 5 12 6 6 4 Scarlet Fever 1 1 3 7 13 13 20 17 24 22 110 122 34 28 19 23 18 26 7 8 — 3 — — 14 SCARLET FEVER. During 1928 there were 519 cases of scarlet fever notified. This is the greatest incidence recorded since the years 1921 and 1922, when 827 and 529 cases respectively were notified. In the year 1927, 320 cases were notified. Of the cases notified 2 were under the age of 1 year, 119 between the ages of 1 and 5 years, 294 between the ages of 5 and 15 years, 86 between the ages of 15 and 35 years, and 18 over the age of 35 years. Of the 519 cases 491 were removed to an Isolation Hospital. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Only 4 deaths from scarlet fever occurred, the disease being usually of a mild type. The clinical picture of scarlet fever nowadays is totally different from what it was 50 years ago. It was then a dangerous disease with a high case-mortality. It is now a disease of minor importance as compared with measles, diphtheria and whooping cough. Last year these three diseases caused the death of 71, 7 and 13 persons respectively as compared with the 4 deaths from scarlet fever. In spite of the pressure upon the beds of the Metropolitan Asylums Board owing to the prevalence of measles it was not found necessary during the year to place any restriction upon the admission of scarlet fever cases. 1928. Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. s. London 991 1,074 907 939 1,060 1,125 1,154 1,068 932 1,487 1,831 1,527 1,268 15,363 Paddington 29 34 28 18 26 35 47 42 29 50 93 47 41 519 Wards— Queen's Park 9 6 9 — 1 4 8 8 — 3 6 3 3 60 Harrow Road 3 7 4 2 8 9 7 9 7 13 12 8 6 95 Maida Vale 5 4 2 5 4 3 4 7 4 9 SO 6 11 84 Town 1 1 1 4 3 1 3 — 3 2 3 1 23 Church 5 3 3 3 1 5 10 9 10 10 22 5 8 94 Westbourne 6 8 7 5 7 6 11 5 6 8 21 15 8 113 Lancaster Gate, West — 1 — — 1 1 1 — — 1 — 1 6 Lancaster Gate, East — 3 1 — — 3 2 1 1 3 1 — 15 Hyde Park 1 1 1 2 1 3 1 1 3 6 6 3 29 DIPHTHERIA. (Including Membranous Croup). During 1928 there were 302 cases of diphtheria notified. Of these there were 6 cases under the age of 1 year, 84 between the ages of 1 and 5 years, 144 between the ages of 5 and 15 years, 59 between the ages of 15 and 35 years and 13 aged 35 years and upwards. Of the 302 cases, 300 were removed to Isolation Hospitals. Two cases were treated at home, proper facilities being available for isolation and treatment. Seven deaths from this disease occurred during 1928, 6 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 1928 7 .. 15 Seasonal prevalence.—The following table shows the numbers of cases notified in each fourweekly period during 1928. 1928. 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 1,147 1,207 1,084 983 967 847 839 725 620 864 977 1,052 944 12,256 Paddington 26 23 27 25 23 26 24 7 12 17 31 39 26 306 Wards— Queen's Park 5 5 5 3 6 1 4 1 2 2 4 12 5 55 Harrow Road 8 4 6 5 — 8 3 — 1 4 1 8 5 53 Maida Vale 2 4 3 — 3 3 7 3 — 2 11 9 5 52 Town — 2 4 3 1 1 1 1 — — — 3 2 18 Church 5 4 5 6 4 5 3 1 3 2 1 — 1 40 Westbourne 4 4 3 7 6 6 5 — 5 4 11 6 3 64 Lancaster Gate, West 1 1 — 1 — 1 1 1 6 Lancaster Gate, East — — — — 1 — — 1 — 1 — 1 4 Hyde Park 1 — 1 — 3 1 1 — — 2 1 1 3 14 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, but only a small number of 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 20 phials of 4,000 units and 11 phials of 500 units were distributed. SMALLPOX. Five cases of this disease were notified during the year. Of these one proved to be a mistaken diagnosis. The remaining four occurred in Paddington Infirmary. One case (D.T.) contracted the infection in Yorkshire. Another case (D. W.) was a tramp and brought the infection with him from some unknown source. He infected in the Infirmary another man (J. B.). Subsequently a further case arose in the Infirmary, the source of infection not being ascertained. All four cases were of the mild type of smallpox prevalent at the present time. The disease might have been expected to have spread through the Infirmary under the circumstances, but in each case measures to combat the disease by vaccination of contacts and isolation of wards were energetically pursued. The authorities at the Infirmary are to be congratulated on the success which followed their efforts to prevent the disease from spreading. During the year all vaccinations of smallpox contacts were performed by the public vaccinator. None were performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. 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. Chicken-pox does not vary very much in its prevalence from year to year. The number of cases certified by medical practitioners was 567 last year and there were 354 cases reported from other sources, making a total of 921 cases. The disease was fairly uniformly distributed throughout the year with occasional localised outbreaks and a rather intensified prevalence during the last quarter of the year. Chicken-pox is not usually nursed in an institution, but 41 cases received institutional treatment for various reasons. 16 TYPHOID FEVER AND CONTINUED FEVER. Twenty-five cases of typhoid fever were notified in 1928. In a few cases no doubt, the diagnosis was subsequently revised, but no accurate information is available on this point. Ten 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. The number of cases of typhoid fever and continued fever is in excess of last year's figures, the numbers in 1927 having been 16 and 2 respectively. The excess is accounted for by the occurrence of an outbreak of infection in the west of London, mainly due to paratyphoid B. fever. This outbreak was found to have principally affected the inhabitants of Kensington and Fulham, Paddington being one of the boroughs which suffered only in a minor degree. A great deal of investigation was carried out in order to trace the source of infection, and an elaborate report has been compiled by the Medical Officer of Health of the London County Council dealing with the outbreak. Whilst the source of infection cannot be stated for a certainty there is strong presumptive evidence that it was connected with supplies of cream which had become contaminated. 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 1928, 2,862 cases of measles certified by medical practitioners, and 571 cases reported from other sources, the corresponding figures for 1927 being 154 and 116. The number of notified cases is analysed in the adjoining table in 4-weekly periods for the various wards. 1928. Measles. Notified 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 53 113 577 1,180 618 204 68 10 13 4 6 5 11 2,862 Wards— Queen's Park 5 12 64 97 29 5 2 — 2 — 1 1 — 218 Harrow Road 9 16 162 249 90 29 16 4 3 2 1 1 2 584 Maida Vale 9 26 113 205 56 18 9 — 2 — — 1 1 440 Town 1 8 30 48 21 11 8 — — — — — 1 128 Church 6 14 76 294 201 47 5 3 1 — 2 — 2 65 Westbourne 16 10 92 192 160 61 20 2 3 1 — 2 2 561 Lancaster Gate, West — 10 13 9 17 8 1 1 — — 1 — — 60 Lancaster Gate, East 3 12 13 27 12 — 2 — 1 1 — — 1 72 Hyde Park 4 6 14 59 32 25 5 — 1 1 r 2 148 17 It will be seen that a measles epidemic prevailed in the spring of the year. This epidemic was at its height during the fourth month of the year. The last measles epidemic reached its zenith in the first month of 1926, about two years and three months previously. This is what one expects with measles, which recurs at intervals of about two years. No less than 71 deaths were attributable directly to measles or its complications. Of these deaths 14 were in children under the age of 1 year, 28 were in children between the ages of 1 and 2 years, 24 between the ages of 2 and 5 years, and 5 in children between the ages of 5 and 15 years. It is probable that a few other deaths which occurred during the year were indirectly due to debilitated conditions arising after measles. The prevalence of measles and the serious mortality received the careful attention of the Public Health Committee of the Council, a sub-committee being appointed to deal with the matter. Every avenue of approach to the disease was explored and the conclusion arrived at was that in Paddington everything possible was being done to prevent and combat the disease. It was decided to inform the Ministry of Health that in the opinion of the Council further research work as to the causation of measles is necessary. The women Sanitary Inspectors visit cases of measles with few exceptions and arrange, where necessary, for the attendance of the District Nurses. During 1928 the Inspectors' visits totalled 3,388. The number of cases requiring nursing assistance was large during the year, comprising 198 cases under 5 years of age and 30 cases over 5 years of age. The number of visits paid by the nurses was 1,813 and 236 to each group respectively. Much advantage was derived from the ample provision made by the Metropolitan Asylums Board for institutional accommodation, 348 cases being removed to hospital during the year. GERMAN MEASLES. This harmless, but infectious disease, is notifiable in Paddington; 109 cases were notified in 1928, as compared with 78 in 1927, 124 in 1926, 375 in 1925 and 458 in 1924. 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. Twenty-four cases of purulent eye-discharge of the new-born were notified in 1928. Of these 24 cases 19 recovered without any impairment of vision, 2 died from other causes and the remaining three cases were untraced. 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 twenty-two 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 1928, 9 cases were referred to the District Nursing Association, 131 visits being paid. Nineteen cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 5 cases of puerperal fever notified during 1928, 2 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. Three women were certified as having died from puerperal fever. 18 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 1004 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 32 cases of puerperal pyrexia were notified, 26 of which occurred within or were removed to institutions. Two cases of puerperal pyrexia were nursed by the District Nurses at home, 36 visits being paid. ERYSIPELAS. Ninety cases were notified, 45 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. Three 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. Only one case of this disease was 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 to the after-history of all cases of this disease which are brought to notice. During the year a case of encephalitis lethargica was brought to the notice of the Medical Officer of Health, which manifested certain serious and progressive symptoms. The patient was found to have been under treatment as an in-patient in a London Hospital, and on enquiry being made as to why he had not been notified to the Medical Officer of Health, it was stated that whilst the patient was suffering from the conditions known as" postencephalitic parkinsonism" it was not considered that he was suffering from acute encephalitis lethargica. This incident revealed a defect in the Regulations applicable to the disease and in consequence the Council addressed a communication to the Ministry of Health expressing the opinion that the Regulations should be amended so as to enforce the notification of encephalitis lethargica in all its stages. CEREBRO-SPINAL FEVER. Four cases of this disease were notified in 1928. MALARIA. Three cases were notified, one being a patient suffering from general paralysis of the insane, into whom malaria was artificially inoculated as a therapeutic measure. 19 ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. 202 cases of acute primary pneumonia were notified in 1928, as compared with 183 in 1927, 184 in 1926 and 265 in 1925. Of the 202 cases, 132 were nursed in institutions. 59 cases of acute influenzal pneumonia were notified as compared with 107 in 1927, 76 in 1926 and 88 in 1925. Of the 59 cases, 18 were nursed in institutions. Ninety-nine cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council scheme for district nursing, 1,172 visits being paid. ANTHRAX, CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. No cases of these diseases were notified during 1928. 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 1928, 13 persons died of whooping-cough, 12 of these being children under the age of 5 years. The number of deaths in 1927 and 1926 were 38 and 8 respectively. CANCER. The deaths from cancer are growing in number year by year in every part of the country, including Paddington. It is now one of the commonest causes of death, and the number of deaths, 260, which occurred in Paddington last year is larger than in any previous year. Careful analysis of the figures demonstrates that the increase is a real one and is only partly accounted for by increased longevity and consequent proclivity to the disease, and by more accurate diagnosis on the part of doctors. The numbers of deaths for previous years are shown in the list following:— Numbers of Deaths in Paddington. 1928 260 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 The following table furnishes an analysis of the sites affected in the fatal cases of cancer during the year. Four cases are not included owing to absence of information. 1928. Cancer. Site of Disease. Ages. All Ages. 0- 15- 25- 35- 45- 55- 65- 75- m. F. m. F. m. F. m. f. m. f. m. F. m. F. m. F. m. F. Buccal cavity — — — — — — — — 2 — 5 2 3 3 2 — 12 5 Pharynx, oesophagus, stomach, liver and annexa — — — — 1 1 4 2 4 6 14 10 19 9 3 8 45 36 Peritoneum, intestines and rectum — — — — — 1 1 — 3 4 4 5 10 8 3 7 21 25 Female genital organs — — — _ — — — 3 — 5 — 6 — 5 — 1 — 20 Breast — — — — — — — 2 — 7 — 3 — 8 — 3 — 23 Skin — — — — — — — — — — — — — — 2 — 2 — Other or unspecified organs — — — 1 1 2 1 1 6 7 9 14 10 4 7 4 34 33 — — — 1 2 4 6 8 15 29 32 40 42 37 17 23 114 142 20 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. The above Regulations remained in force for a year but have been extended up to March 31st, 1930. During 1928, 76 cases of acute rheumatism were notified. This compares with 34 cases for the ten months of the year 1927, during which the disease was notifiable. Acute rheumatism is defined in the Regulations 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 (October 1927-1928), some 119 new cases attended the Centre, but of 76 Paddington cases notified as "acute rheumatism" only 15 attended the centre. The remainder were under the care of private medical practitioners. 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 Diarrhoea" 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. Twenty cases of the disease were notified during the year. The number of deaths under the age of 5 years was 23 as compared with 16 in the year 1927 and 52 and 22 in the years 1926 and 1925 respectively. In no case was it found necessary to provide for home nursing by the district nurses, all severe 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 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 coming within the meaning of the terms "infective enteritis" or "summer diarrhoea." 21 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year 1928 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 105 deaths in 1928, and from other tuberculous diseases there were 11 deaths. The number of deaths from tuberculosis of all kinds was 125 m 1926, 118 in 1927 and 116 in 1928. 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 1928 116 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A and B received during the year 1928. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year — 1 1 — — 1— 5 years — — — 16 7 23 5—10 „ 2 1 3 28 23 51 10—15 „ 1 3 4 4 2 6 15—20 10 10 20 3 2 5 20—25 11 25 36 1 8 9 25—35 „ 20 20 40 5 4 9 35—45 16 20 36 2 2 45—55 18 8 26 2 2 4 55—65 „ 13 5 18 1 1 65 years and over 2 2 4 1 — 1 Total 93 95 188 61 50 111 Cases re-notified 70 56 126 13 8 21 Total Notifications on Form A 163 151 314 74 58 132 Primary Notifications by School Medical Officers— 0— 5 years — — — 1 1 2 5—10 „ — — — 4 1 5 10—15 „ — — — 3 3 Cares re-notified — — — 8 3 11 Total Notifications on Form B — — — 16 5 21 1928. No. of Notifications on Forms C and D. Poor Law Institutions. Sanatoria. c. d. c. d. Pulmonary Tuberculosis— Male 25 25 82 50 Female 29 30 62 48 Non-Pulmonary Tuberculosis— Male 1 2 13 12 Female 3 2 17 16 C—Upon admission. D—Upon discharge. 22 Public Health (Tuberculosis) Regulations, 1921. Cases removed from Register :— 1928. By reason of— Death 114 Removal 131 Recovery of patient or variation of diagnosis 95 Total 340 Of the patients who removed from the Borough during 1928, the new addresses were obtainable in 61 instances, and particulars of the cases were transmitted to the Medical Officers of Health of the respective districts. In 1928, 12 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 1928 was 1,570 as compared with 1,577 at the close of the year 1927. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 1,385 By Tuberculosis Officers 532 By Dispensary Nurses— 20, Talbot Road 2,862 St. Mary's Hospital 1,890 6,669 Tuberculosis. New Cases and Mortality During 1928., Age Periods. New Cases. Deaths. Pulmonary. N on-Pulmonary. Pulmonary. Non-Pulmonary M. F. M. F. M. F. M. F. 0 — — 1 — — — 1 — — 1 — ___ — 19 9 3 1 5 — 2 1 32 26 - 1 — 1 10 — 1 3 7 3 15 — 10 10 3 2 7 18 1 1 20 — 13 29 1 8 25 — 20 24 5 5 19 20 — — 35 — 19 21 — 2 45 — 19 10 2 3 30 7 2 1 55 — 14 6 2 — 65 and upwards 2 2 1 — I 1 — 1 Totals 100 107 72 58 57 48 6 5 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. 23 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 1928 and 5 sets were returned following the death or removal of the patient. Shelters.—The Council possesses three shelters, which, on the recommendation of the Tuberculosis Officers, are lent to patients who are able to make use of them. During 1928 one shelter was lent and returned. 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 1928, 1 patient received 17, another 12, another 9, another 3, and two others 2 each, the total cost being £23 12s. 6d. Dental Treatment.—The arrangement with the British Dental Hospital, outlined in previous reports, terminated at the end of November, 1928. Under a new agreement the Committee of the Paddington Tuberculosis Dispensary, 20, Talbot Road, in return for a payment by the Council of the sum of £90 per annum, provide dental treatment for tuberculous persons attending either of the Tuberculosis Dispensaries. The dental clinic is installed at 20, Talbot Road, where a Dental Surgeon attends for one half-day weekly. Arrangement have also been made for the supply of dentures by the Dispensary Committee. During 1928, 7 patients were supplied with complete dentures, 1 with partial dentures, and in 3 cases dentures were repaired or re-made. Out of a total cost of £46 5s. 0d., the Council made grants to the amount of £14 7s. 0d., 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. Summary of Dental Treatment for the Year 1928. Particulars of Patients. Number of Fillings. Number of Scalings. Extraction Cases. Dentures. No. of Dressings. No. for Advice Denture Visits. No. of New Patients. Without An aesthetic. Local Administration Gas Administration Number of teeth extracted Upper. Lower. Re-models. Repairs. Number of Attendances. Simple Root. Women 119 3 _ 7 — 17 13 73 3 3 — 3 2 37 34 18 Children 124 23 1 2 — 9 48 153 — — — — — 42 — 31 Men 81 5 3 — 9 6 44 6 6 — — — 16 46 11 Total ... 324 31 1 12 — 35 67 270 9 9 — 3 3 95 80 60 Number of Sessions held = 46. 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. 24 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. 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 1928, 40 patients received treatment, 782 exposures being given. All that can be said so far of this treatment is that the results are encouraging. Return Showing the Work of the Dispensary During the Year 1928. 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 85 33 — 1 5 5 29 27 40 38 29 28 (6) Doubtfully tuberculous — — — — — — — 30 61 32 53 (c) Non-tuberculous — — — — — — — — 58 152 122 135 b.—contacts examined during the year :— (a) Definitely tuberculous 2 1 — 1 — — 8 3 2 1 8 4 (6) Doubtfully tuberculous — — — — — — — — 9 8 9 11 (c) Non-tuberculous — — — — — — — — 44 90 42 63 c.—cases written off the Dispensary Register as (a) Cured — — — — — — — — —— — (6) Diagnosis not confirmed or non - tuberculous (including cancellation of cases notified in error) — — — — — — — — 147 327 201 260 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 187 230 1 1 48 48 207 170 235 278 208 171 (6) Diagnosis not completed — — — — — — — J 2 6 12 12 1. Number of persons on Dispensary Register on January 1st 881 2. Number of patients transferred from other area- and of " lost sight of " cases returned 30 3. Number of patients transferred to other areas and cases " lost sight of " 70 4. Died during the year 51 6. Number of observation cases under A (6) and B (6) above in which period of observation exceeded 2 months 35 6. Number of attendances at the Dispensary (including Contacts) 6,023 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for 6 treatment or supervision patients 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (a) " 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 98 10. Number of consultations with medical practitioners:— (а) At Homes of Applicants ... 88 (б) Otherwise 178 11. Number of other visits by Tuberculosis Officers to Homes 383 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,862 13. Number of (a) Specimens of sputum, &c., examined 217 (b) X-ray examinations made in connection with Dispensary work 27 14. Number of Insured Persons on pensary Register on the 31st December 361 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 154 16. Number of reports received during the year in respect of Insured Persons:— (a) Form G.P. 17 16 (6) Form G.P. 36 78 25 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,075 from the Paddington Borough Council during the year 1928. 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 1928. Diagnosis. Pulmonary. N on-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 19 11 — — 4 6 5 4 23 17 5 4 (b) Doubtfully tuberculous — — — — — — — — 10 25 8 4 (c) Non-tuberculous — — — — — — — — 8 13 9 13 b.—Contacts examined during the vear:— (a) Definitely tuberculous 4 4 (6) Doubtfully tuberculous — — — — — — — — 2 4 1 3 (c) Non-tuberculous — — — — — — — — 3 28 14 15 C.—Cases written off the Dispensary Register as (a) Cured — — — — — — — — — — — — (6) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) — — — — — — — — 20 70 34 35 d.—number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 60 39 2 3 51 48 45 33 111 87 47 36 (ft) Diagnosis not completed — — — — — — — — 1 3 — — 1. Number of persons on Dispensary Register on January 1st 271 2. Number of patients transferred from other areas and of " lost sight of" cases returned 9 3. Number of patients transferred to other areas and cases " lost sight of " 32 4. Died during the year 17 5. Number of observation cases under A (ft) and B (b) above in which period of observation exceeded 2 months 4 6. Number of attendances at the Dispensary (including Contacts) 3,951 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision 4 patients. 8. Number of attendances, at General Hospitals or other Institutions approved for the purpose, of patients for (а) " Light” treatment — (б) Other special forms of treatment — 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 6 10. Number of consultations with medical practitioners :— (a) At Homes of Applicants — (b) Otherwise 41 11. Number of other visits by Tuberculosis Officers to Homes 149 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,890 13. Number of (а) Specimens of sputum, &c., examined 109 (б) X-ray examinations made, in connection with Dispensary work 57 14. Number of Insured Persons on pensary Register on the 31st December 167 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 6 16. Number of reports received during the year in respect of Insured Persons — (a) Form G.P. 17 2 (b) Form G.P. 36 15 26 The Borough Tuberculosis Care Committee. On December 31st, 1928, the constitution of the Tuberculosis Care Committee was as follows:— Representing. Paddington Borough Council Councillor Mrs. R. M. Drury (Vice-Chairman). ,, ,,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. „ ,, ,, Miss D. B. Trayler. Paddington and St. Marylebone War Pensions Committee Mr. S. G. Last, J.P. (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, Panel Committee Dr. J. J. Gibb. St. Mary's Hospital Dr. A. B. Porteous (Tuberculosis Officer). „ „ Sister M. M. Lee. ,, ,, Miss E. Wilson (Lady Almoner). United Services Fund Miss M. M. Barthorp. Local Social Worker The Hon. Miss E. C. Godley. Paddington and St. Marylebone Employment Committee Mr. A. E. Goss. The Medical Officer of Health continued to act as Honorary Secretary to the Committee, an allowance of £50 per annum being allocated to certain members of the clerical staff for clerical assistance. The social work of the Tuberculosis Care Committee is ancillary to the work of the Public Health Committees of the Borough Council and London County Council in the sphere of the prevention and treatment of tuberculosis. The principal duties performed are: (1) The assessment of patients' contributions, who are receiving institutional treatment at the hands of the London County Council. (2) The co-ordination of the various agencies which can be invoked to assist patients and their dependants. No funds are available in the hands of the Committee for the assistance of patients. The Committee met 22 times during the year at the Town Hall, and the attendance of members has been well maintained. 308 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:— On the admission of a patient to sanatorium, his wife was left with the insurance benefit as the sole source of income for the support of herself and two children. The Charity Organisation Society were appealed to for help, and made a weekly grant to the family, which was continued until the patient returned home and resumed his former occupation. A woman, deserted by her husband, obtained a situation in domestic service. Nine months later she became ill with pulmonary tuberculosis, and was admitted to sanatorium. She was badly in need of clothing, which, owing to lack of means, she was unable to purchase. Application was made to the Charity Organisation Society, who readily supplied all the garments that were necessary. The widow of a patient was unable to continue the employment she had obtained before her husband's death, owing to the poor state of her health. A voluntary society, on being appealed to, arranged to send her to a convalescent home, whence she returned fit to take up the task of supplementing, by her earnings, the widow's pension she was receiving for herself and her two children. A domestic servant, some years before being taken ill with tuberculosis, had lost touch with her Approved Society, and consequently was unable to claim sickness benefit. She had, however, in her possession a certain number of stamped insurance cards. Enquiries made on her behalf resulted in the discovery that the Society to which she had belonged had ceased to exist, and that its engagements had been transferred to another Society. The facts were communicated to the Ministry of Health, and eventually information was received to the effect that the patient's position in insurance had been regularised, and that she would be entitled to benefit. 27 A patient who had been working as a gardener was found not to be insured under the National Health Insurance Acts. As he had worked regularly for several employers, the circumstances were reported to the Ministry of Health. The arrears of insurance contributions were subsequently made up, and, on the death of the patient, which shortly afterwards occurred, his widow became entitled to a pension for herself and children under the Widows' and Orphans' Pensions Act. 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 and puerperal pyrexia. (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 2,033 Revisits 2,684 4,717 Ante-natal— First visits 471 Revisits 349 820 OTHER VISITS. Puerperal Fever and Puerperal Pyrexia 100 Ophthalmia Neonatorum 520 Diarrhœa 89 Miscellaneous 1,849 2,564 Particulars recorded as to Method of Feeding. Breast. Artificial. Mixed. Total. Number 1,448 104 95 1,647 Percentage 87.9 6.3 5.8 AGES AT FIRST VISIT. Breast. Method of Feeding. Totals. Artificial. Mixed. Weeks 0— 22 1 1 24 1— 486 11 19 516 2— 518 29 25 572 3— 203 12 12 227 Months 0— 1,229 53 57 1,339 1— 150 18 20 188 2— 32 8 4 44 3 and upwards 37 25 14 76 28 DIED BEFORE END OF YEAR: 48. Breast 25 Artificial 11 Mixed 4 CAUSES OF DEATH. Diarrhœal Diseases 6 Whooping Cough 4 Respiratory „ 12 Measles — Atrophy, Debility 3 Premature Birth 7 Congenital Defects 4 Other Causes 4 Institution Deaths 26 (Paddington Infirmary 19). 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. 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 Westboume Wards. 29 North Centres. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large double room, doctor's room and sales room, warmed by gas radiators and hot pipes. Established 1911, at Emmanuel Hall, Harrow Road. Moved June, 1916, to St. Peter's Institute, Chippenham Mews. Moved to present address, November, 1916. Two Infant Consultations weekly.—Tuesday, 2.30. Medical Officer Dr. 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. A second Masseuse, Miss Pinkerton, C.S.M.M.G., was appointed to attend on Tuesday mornings, as from July 17th, 1928. Sewing Classes were held weekly at 232 Harrow Road, until February, 1928, when they were temporarily suspended. They are shortly to be re-opened on different lines. Dental Arrangements.—Messrs. J. Trade 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. 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, Children's Hospital, Paddington Green, 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. 30 Consultation Centres. Summary of Work for the Year, 1928. 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 Sessions 50 51 50 50 50 51 51 50 47 450 Number of Attendances 2788 1975 3612 2596 3648 2267 1137 1049 1503 20575 Average Attendance 55.76 38.72 72.24 51.92 72.96 44.45 22.29 29.80 31.98 45.72 Seen by Doctor 1090 807 1296 702 907 1066 580 533 838 7819 Average number seen by Doctor at each Session 22 15 26 14 18 20 11 10 17 17 Ante-Natal Clinic. Number of Sessions 48 Number of Attendances 610 by 283 expectant mothers. Average Attendance per Session 12.70 Home Visiting. Visits to Babies Visits to Expectant Mothers Other Visits 13,881 477 9,110 Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,361 12 1 Sales 1,307 15 3 Grants from Borough Council 37 17 3 Queen Charlotte's Maternity Hospital.—During the year 1928, 109 infants of mothers resident in Paddington attended the Infant Consultation Centre. Each attended about 14 times. As regards ante-natal consultations, exact figures are not available. During 1928 there were received into the Hospital for confinement 268 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 3 per patient. With regard to out-patients in 1928, 387 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about 3 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 1928 was 154 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 1928, 154 confinements were attended by the nursing staff, the number of visits being 2,610. These figures compare with similar ones of 189 and 3,019 in the year 1927. The annual grant in aid of this work is now £175. DAY NURSERIES. At the end of the year 1928, there were two day nurseries in Paddington, situated at No. 66, Lancefield Street, Queen's Park, W.10, and at No. 21, Howley Place, W.2, the latter nursery having been transferred from No. 13, Hasborough Street, during the month of April. 31 Statistical Summary. Queen's Park. Hasborough Street and Howley Place. Days open 287 245 Attendances 5,333 5,157 New Children 55 95 Cases of Infectious Disease. Diphtheria — — Scarlet Fever — — Measles 21 — Whooping Cough 3 2 Chicken Pox — — There were no Closures during the Year on account of infectious disease. PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. Milk is given in the following cases:— (a) Expectant mothers during the last three months of pregnancy. (b) Nursing mothers. (c) Children up to three years, also in exceptional cases children over three and under five years of age. The quantity of milk authorised does not exceed one pint per day except in the case of children between 3 months and 18 months where a special medical certificate is furnished, and in which case as much as 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. 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. 32 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 8,251 quarts. Dried Milk 513½ lbs. The approximate cost of milk given in this way was £262 16s. 8d. Income Scale. Free. Half-Price. Number of family. Total Income less Rent. Total Income less Rent. 1 16/- 18/- 2 20/- 24/- 3 25/6 27/- 4 30/- 34/- 5 32/6 37/6 6 36/- 42/- 7 40/- 47/6 8 44/- 51/6 9 48/- 55/6 10 52/— 60/- 11 56/— 65/- 12 60/- 70/- Particulars of Milk Grants. 1928. Number of New Applications. Granted. Refused or referred to Guardians, Fresh Milk 338 234 104 Dried Milk 47 39 8 Dinners — — — 385 273 112 Number of Orders for Milk i 314 At Total Cost 793 At Half Cost 21 Number of Quarts at Total Cost 8,039 „ ,, „ Half Cost 212 Total Number of Quarts 8,251 £ s. d. Cost of Milk at Total Cost 221 12 9 „ ,, Half Cost 3 6 8 £224 19 5 Number of Orders for Dried Milk 149 At Total Cost 145 At Half Cost 4 Total Cost of Dried Milk £37 17 3 Number of Orders for Dinners - Number of Dinners supplied at Total Cost - Total Cost of Dinners - Convalescent Home. One nursing mother, with her baby, was admitted to St. Mary's Convalescent Home, Birchington-on-Sea, for a period of three weeks. Part of the cost was borne by the Council, and the remainder by the husband. 33 MATERNAL MORTALITY. Towards the end of the year the Council engaged Dr. E. Dorothy Fenwick to enquire, when necessary, into maternal deaths. One case was referred to her and reported on under this arrangement. ADMINISTRATION. GENERAL. Staff of the Department.—Miss F. M. Nicolas, Sanitary Inspector, retired from the Council's service on October 13th. Miss I. L. Buckledee was engaged to fill the vacant position pending the appointment of a permanent Officer, which did not take place until after the close of the year. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 8,431. 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 1,551. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 346 patients (comprising 228 cases of measles, 96 of pneumonia, 13 of whooping-cough, and 9 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 3,484. Disinfection.—The rooms disinfected after infectious disease numbered 2,023, including 175 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 30 tons. Two hundred and eighty library books were disinfected. Schools.—A total of 2,850 notices relating to cases of infectious disease were despatched to the Head Teachers of the various schools attended by patients or their " contacts," 1,879 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 439 reports were sent to the Medical Officers of Health of other boroughs in connection with cases attending outlying schools. Bacteriological Work.—The Council have an arrangement with the Lister Institute of Preventive Medicine, Chelsea Bridge Road, S.W.1, for the bacteriological examination, at the expense of the Council, of specimens sent by medical practitioners of Paddington patients suspected to be suffering from diphtheria or typhoid fever. All specimens are collected at the Town Hall and transmitted to the Lister Institute by special messenger the same evening. The results are generally available the next morning, and are telephoned to the medical practitioner concerned. Examinations of sputa from patients suspected to be suffering from tuberculosis of the lungs are undertaken by the Paddington Tuberculosis Dispensary, 20, Talbot Road. The examinations made were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 1,202 131 Tuberculosis 411 59 Typhoid Fever 13 Anthrax 1 — House Drainage.—During the year 95 existing drains were tested and found water-tight, 124 defective drains were reconstructed and 6 made sound by special process. Reconstruction Plans.—Three hundred and ten (310) were submitted for drainage works in existing buildings. In connection therewith 703 letters were despatched. One summons was issued for failure to supply plans. The plans having been deposited before the hearing of the case, the summons was withdrawn on payment of one guinea costs. 34 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 :— Amberley Road, Nos. 1 and 2 Wharves. Three lock-up garages on the East side of Lancefield Street, adjoining St. Jude's Hall, and sanitary accommodation in the adjacent yard at present in occupation of Metropolitan Water Board. Hotel premises on East side of London Street, between Praed Street and Arthur Mews, and numbered and known as No. 144, Praed Street (" The Load of Hay " Public House) and Nos. 29 and 30, London Street. Garage with open area on South and East sides, on the West side of Edgware Road, at the rear of Nos. 21-43 (odd) Edgware Road and Nos. 72 to 86 (even) Seymour Street. New business and residential premises on the South side of Praed Street and North side of Market Street, and at present numbered and known as Nos. 19 and 21, Praed Street, Nos. 1, 2, 3 and 4, James Place, and Nos. 12 and 13, Market Street. New sports pavilion on the East side of Delaware Road, and at the rear of and between Delaware and Castellain Mansions, and Nos. 73-82, Delaware Mansions. New Warehouse premises on the South and West sides of Irongate Wharf Road, and numbered and known as Nos. 19 to 23 (odd) Wharves, Irongate Wharf Road, together with No. 25, Irongate Wharf Road. Garage on West side of Bark Place at the rear of the "Moscow Arms" Public House No. 51, Moscow Road and No. 53, Moscow Road. Clarendon Mews, No. 1 and Clarendon Place, No. 6. Gloucester Square, Nos. 26 and 27. Westboume Grove, Nos. 37 and 39. Upper Brook Mews, Nos. 7, 8 and 9. Lancaster Gate, Nos. 25 and 26, 58 and 59, 64 and 65, and 72, 73 and 74. No combined systems were reconstructed by the Council during the year. Before the London County Council (General Powers) Act, 1928, came into force it occasionally happened that, without the knowledge of the borough council, a drain would be connected to a common drain already serving several houses and authorised by an order of the Council. Such an unauthorised connection had the effect, as between the Council and a purchaser for value without notice, of converting the combined drain into a sewer, repairable by the Council. Section 32 of the above Act now provides that such a combined drain shall not cease to be a drain by reason only of such an unauthorised connection, at whatever time it may have been made. This provision will be useful in the uncommon instances where it is applicable, but does not affect the general responsibility of the Council for combined drains not constructed under their order. Sewer Connections.—In 1928, 58 were reconstructed, either partially or wholly, 12 after Orders under Section 85 of the Metropolis Management Act, 1855, and 46 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 4 premises. The Metropolitan Water Board reported 4 cases of discontinuance of water supply. In three instances the supply was disconnected in consequence of non-payment of water rate, and in one instance on account of defective fittings. One house was found on inspection to be unoccupied. The water supply was restored to each of the remaining premises within a few days of the disconnection of the supply. No legal proceedings were necessary. 35 Mortuary.—Three hundred and forty-seven (347) bodies were deposited at the Mortuary, inquests being held on 160 of that number. Bodies deposited pending burial (all non-infectious) numbered 93. Trade Nuisances.—Twenty-four complaints were received during the year, those relating to manure numbering 9. Notice was given by the Council under Section 36 (2) of the Public Health (London) Act, 1891, requiring the removal of manure or other refuse matter from mews, stables, etc., twice in every week during the months of May to September. No difficulty was found to arise in connection with such periodical removal. Rag and Bone Dealers.—In December, 1928, there were 12 rag and bone dealers in the Borough, 2 having closed down during the year. On the 20th of June new London County Council bye-laws came into operation. These regulated the sale or distribution of articles of food, toys or balloons in connection with the operations of a rag and bone dealer. Smoke Control.—During 1928, 29 trade premises were kept under observation for the detection of black smoke. These premises were watched on 343 occasions, occupying 131 hours. Smoke of all descriptions was noted during 63½ hours, the duration of " black " smoke being only 3¼ hours. Fifteen complaints relating to the emission of smoke were received during the year. Two Statutory Notices were served and four Written Intimations, together with 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. Active assistance is given by the police, the Home Secretary having intimated in June, 1928, as a result of representations from the Council, that the police had been instructed to report to the Council such offences against the bye-law as come to their notice in the course of their ordinary duties. During 1928 one prosecution was instituted, which resulted in the defendant being fined the sum of ten shillings. Numerous verbal warnings to offenders were also 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. Mr. C. S. Wansbrough acted as Canal Boats' Inspector during the year. 36 The following report for the year 1928 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 1928.—One hundred and' ten inspections of canal boats were made during the year, and the following infringements of the Acts and Regulations were discovered:— Cabins leaky 3 Cabin floors defective 2 Stoves and stove pipes defective 5 Boats without certificates 5 Lettering, marking and numbering illegible 1 Painting of cabins required 3 Formal notices were served. 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. There were five cases of infectious disease notified, 3 males and 1 female suffering from measles. One male suffered from acute primary pneumonia. There were three deaths reported amongst canal boat dwellers, one being a male of 4 years, who died from shock following sudden immersion. One boat was registered. No boats propelled by steam or motor power were registered during the year. There are some 78 children of school age known to be living on canal boats registered in Paddington. The total number of boats in respect of which certificates of registration had been issued at the end of the year was 249, one being a motor-boat. It is practically certain that a number of boats, registered many years ago, have changed ownership, been registered with another authority or been broken up. It is under the circumstances impossible to trace a number of registered boats or to know the exact number of " live " certificates of registration. The annual cleansing and repairing operations at Paddington Basin were carried out during the Easter holidays. About 873 tons of mud were removed from the bed of the Basin, in addition to 536 tons which were dredged previously. Portions of the bed of the Basin were repaired and about 543 square yards of concreting laid. 60 square yards of pointing to brickwork was also done. 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. During the year, of the 25 inhabited boats known to be conveying house refuse and registered in Paddington, eight were fitted with double bulkheads. The remaining 18 boats will be refitted as circumstances permit. 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. One application under this Section was made during the year relative to the conversion into flats of No. 19, Palace Court. 37 Plans were submitted to the Council under the drainage bye-laws, relative to the conversion of 12 premises into 44 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 491 communications were sent to owners drawing attention to defects liable to be dealt with under the section. These communications in most instances resulted in the defects being remedied. Unhealthy Areas.—No representations were made to the Council during 1928. In the course of the year business and residential premises were erected on the site of Nos. 12 and 13 Market Street and Nos. 1, 2, 3 and 4, James Place, Market Street, to which reference was made in the report for 1927. The reconstruction also included Nos. 19 and 21, Praed Street. Houses Unfit for Habitation.—No representations were received or Closing Orders made during the year. 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 two basement rooms, which were allowed to be reoccupied after certain work had been carried out by the owner. 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 7,204. Particulars of the defects, etc., discovered and remedied will be found on pages 39 and 40. Overcrowding.—No formal reports were received with regard to overcrowding in registered houses. Owing to existing social conditions only extreme 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 1,004 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 8 deaths from various causes occurred among the occupants of these houses. Housing Act : Rent Books.—At one house the rent books were found not to contain the required particulars. A cautionary letter was addressed to the owner. RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-1925. Three applications for certificates were made, all of which were granted. In one instance a certificate was subsequently issued to the owner of the premises, under Section 5 (2) of the 1923 Act, on the completion of the necessary repairs. HOUSING ON THE LONDON COUNTY COUNCIL ESTATES. The arrangement made with the London County Council in 1924 continues in force, whereby the Borough Council recommends to the London County Council cases of urgency and special hardship for accommodation on the several Estates up to a limit of 15 houses per 1,000 built. The following Table (No. 1) shows the number of applications submitted to the London County Council for accommodation on the different Estates, during the year, and how they were dealt with. 38 Table No. 1 (Housing). Estate. Submitted. Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 37 22 1 8 2 4 Castelnau 15 11 4 — — — Downham 97 40 19 8 8 22 Watling 52 34 3 1 9 5 Wormholt 2 2 — — — 203 109 27 17 19 31 In addition to the above figure of 109 housed, 87 families were housed on the different Estates on applications submitted to the London County Council previously to 1928. This figure brings the total number of Paddington applicants housed during the year to 196. The Table refers to the number of applications submitted to the London County Council only ; it gives no indication of the number remaining on the " waiting lists," which is over 1,100 for all Estates. (Compare Tables Nos. 1 and 2). Neither does it show the number of Paddington residents who have made application direct to the London County Council, many of whom have been accommodated. During the year 309 new applications were accepted, and over 3,000 interviews were held. The next Table (No. 2) will give some idea of the amount of housing already achieved for Paddington, showing as it does the total number of applications received and how dealt with since the inception of the Scheme up to the end of 1928. Table No. 2 (Housing). Estate. Number of Applications Received. Number Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 295 91 110 45 32 17 Castelnau 30 11 19 — — — Downham 219 85 84 9 12 29 Old Oak Common 6 3 — 1 2 — Roehampton 46 23 19 2 2 — Tottenham 35 13 13 — 5 4 Watling 642 101 477 38 16 10 Wormholt 573 152 390 17 13 1 1,846 479 1,112 112 82 61 On the Becontree Estate (Essex) accommodation can be obtained practically at once for all sizes of families. The Castelnau Estate (Barnes) is a comparatively small one, consisting of 643 houses. The list was opened in January, and by July, 11 Paddington residents had been accommodated. The Estate is now complete. There is no " waiting list " for the Downham Estate, suitable applications being forwarded to the London County Council directly received. The allocation of houses proceeds at a normal rate (i.e., about 7 a month). 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 heavy one : the allocation proceeds at much the same rate as for Downham. The Estate is nearing completion. In November, 1927, and July, 1928, agreements were completed between the London County Council and the Borough Council whereby provision was made for the housing of 150 families on the Wormholt Estate at Hammersmith, the Borough Council to pay the sum of £1 per annum for a period of 20 years for each house occupied. The 150 families are in occupation. During the year only 2 vacancies occurred, which were at once filled by nomination. 39 A new Estate, the St. Helier, is being built at Morden, Surrey, consisting of approximately 843 acres. The estate is served by the City and South London Tube, which will afford quick travel and ease of access for the earning members of Paddington families whose work, in most cases, lies in the West of London. It is anticipated that a large number of applications will be received. The following analysis of 350 of the cases awaiting accommodation on the Watling Estate, Hendon, gives 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 46 27 — — — 4 43 47 — — — 5 22 42 11 — — 6 5 34 10 — — 7 4 19 10 — — 8 — 5 6 2 — 9 — 4 7 2 — 10 — 1 1 1 — 13 — — — — 1 Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. r 1928 Drain defective 1 „ choked 44 „ not properly ventilated or ventilating pipe defective 11 Manhole cover defective 14 Gully choked 35 Soil pipe defective 5 Water-closet defective 50 „ choked 51 „ without sufficient flush 34 „ flushing apparatus defective 77 „ foul 17 „ improperly constructed 6 „ accommodation insufficient 2 „ without door, door defective, or without proper fastenings 100 Rain-water pipe defective 40 ,, choked 47 Guttering defective 53 Waste pipe defective 28 „ choked 23 „ untrapped 1 „ not provided or missing — Sink defective or not provided 19 Other drainage defects — Cistern defective 6 „ dirty 30 „ without proper cover or cover defective 16 Dustbin defective 126 „ not provided 3 „ insufficient 19 „ disused and not abolished 1 Paving of yard or area defective 114 „ washhouse defective 100 Premises damp 65 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 3,836 „ verminous 56 „ contents, bedding, etc., dirty 3 „ not provided with a window opening directly to the external air 4 Chimney smoky 30 Food cupboards not provided 1 Windows defective including cords and fastenings out of repair 1,120 Roof defective 272 Common staircases out of repair 153 Staircases without sufficient handrail 56 Animals improperly kept — Accumulation of refuse (not offensive) 32 Premises without water or supply insufficient 2 Any other defects, etc. 42 Rooms without proper cooking range — 40 Overcrowding. 1928 Tenements overcrowded — Rooms overcrowded — Occupants, total — Under 10 — 10 and upwards — Overcrowding abated— By re-arrangement — By voluntary removal — Under notice — Cases held over — Notices Issued. Written Intimations 775 Statutory Notices 168 Bye-law ,, 677 Notices under L.C.C. (G.P.) Acts— Verminous rooms 26 Additional taps — Abolition of old dustbins 1 Provision of cooking ranges — Items of Dilapidation for which Letters were sent to the Owners (Section 3 of the Housing Act, 1925). Wall-plaster broken, bulging, or defective 151 Matchboarding defective 6 Wall-paper loose 27 Skirting defective 18 Doors defective or missing 44 Locks defective 61 Ceiling plaster defective 52 Ceiling paper loose 21 Floors broken or badly worn 110 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 223 Stove settings defective 2 Flues defective 13 Hearths defective 51 Chimney-pieces loose or defective (including jambs, frieze, or mantle broken, loose, or missing) 39 Cupboard doors defective or missing and shelves missing 28 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 151 Window-frames loose or defective (including oak sills worn or rotten) 16 Window-glass broken 124 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 140 Steps to front entrance or area defective 18 Railing to area or area steps defective 5 Guard rails to addition roofs defective, broken or rotten 4 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. — Vault doors missing or defective 3 HOUSING (Ministry of Health Table.) Number of New Houses Erected During the Year. (a) Total 4 (b) With State assistance under Housing Acts:— (i.) By the Local Authority Nil (ii.) By other bodies or persons Nil Unfit Dwelling Houses. 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 2,453 (b) Registered tenement houses inspected 1,004 (c) Houses inspected under Housing Acts — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (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. 41 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 *491 (2) Number of dwelling-houses which were rendered fit— (a) by owners 393 (approx.) (6) 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 1,452 (2) Number of dwelling houses in which defects were remedied— (a) by owners 1,249 (6) by Local Authority in default of owners — (C) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders — (2) Number of dwelling-houses in respect of which Closing Orders were made — (3) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (4) Number of dwelling-houses in respect of which Demolition Orders were made — (5) Number of dwelling-houses demolished in pursuance of Demolition Orders — * Informal notices. FACTORIES AND WORKSHOPS. 1928. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 778 Workshops (including workshop laundries) 1,510 — — Workplaces (other than outworkers' premises) 208 — — Total 2,496 — — 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 104 96 — — Want of ventilation 3 3 —__ — Overcrowding 3 3 — — Want of drainage of floors — — — — Other nuisances 39 39 — — Sanitary accommodation insufficient — — — — unsuitable or defective ... 8 8 — — not separate for sexes 1 1 — — 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 158 150 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 42 Outwork in Unwholesome Premises, Section 108 Nature of work. Instances. Notices served. Prosecutions. Wearing Apparel— Making, &c. — — — Cleaning and washing — — — Household linen — — — Lace, lace curtains and nets — — — Curtain and furniture hangings — — — Furniture and upholstery — — — Electro-plate — — — File making — — — Brass and brass articles — — — Fur pulling — — — Cables and chains — — — Anchors and grapnels — — — Cart gear — — — Locks, latches and keys — — — Umbrellas, &c. — — — Artificial flowers — — — Nets, other than wire nets — — — Tents — — — Sacks — — — Racquet and tennis balls — — — Paper, etc., boxes, paper bags — — — Brush making — — — Pea picking — — — Feather sorting — — — Carding, &c., of buttons, See,. — — — Stuffed toys — — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, &c. — — — Textile weaving — — — Total — — — At the end of the year 1927, 1,148 premises were on the Register as compared with 1,143 at the end of the year 1926. During the year 1928, 25 premises were removed from the Register and 42 added, making the total at the end of the year, 1,165. The Department reported the opening of 26 workshops to the Home Office, and received from that Office, notice of 21, 14 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 25 lists in February and 31 lists in August. These lists contained 355 names and addresses of which 222 were forwarded to other districts. From other districts 382 addresses within the Borough were received. Supervision.—There were during the year, 2,496 inspections, comprising 778 of factories, 1,510 of workshops and 208 of workplaces. There were 158 nuisances or defects found upon registered premises, 141 of which were remedied during the year, the majority being remedied by verbal request. The defects found comprised:— Want of cleanliness 104 „ ventilation 3 Overcrowding 3 Sanitary accommodation—insufficient - „ „ unsuitable or defective 8 ,, „ not separate for sexes ... ... ... 1 Other offences 39 The Home Office forwarded 11 complaints, which comprised:— Overcrowding 3 Sanitary conveniences not separate for sexes 3 Other offences 5 Bakehouses.—During the year two " underground " bakehouses were closed, the total number on the Register at the end of the year being 60, of which 49 were factory bakehouses. The number of " level " bakehouses was 16 (13 being factories) and of " underground " 44 (36 being factories). 43 The number of persons working in bakehouses was 314, including 3 women and 18 individuals under the age of 18. The bakehouses were inspected on 718 occasions during the year. RAG FLOCK ACTS, 1911 and 1928. The quality of rag flock in use in the Borough appeared to be well washed and free from dust. No complaints of rag flock were received and no samples were taken. On August 3rd the Rag Flock Act (1911) Amendment Act, 1928, came into operation. This Act merely defines the expression " flock manufactured from rags." FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1927 three slaughterhouses within the Borough licensed by the London County Council:— 18, Chippenham Mews; 275, Edgware Road; 249, Maida Vale. In June, 1928, one of these, namely, 18, Chippenham Mews, was closed, the premises being converted for use as a Motor Garage. There were 243 inspections made during the year. The number of animals slaughtered so far as is known, was 2,890, comprising 190 bullocks, 8 calves and 2,692 sheep, being an increase of 153 bullocks and a decrease of 515 sheep, as compared with 1927, the number of calves slaughtered being the same. The following Table shows the number of organs destroyed and the disease with which they were affected. Bullocks. Calves. Sheep. Heads. Tongues Lungs. Livers. Mesenteries. Stomachs. Lungs. Livers. Lungs. Livers. Tuberculosis 3 3 5 3 1 — 1 1 — — Actinomycosis 4 4 1 1 — — — — — Pleurisy — — 13 — — — — — 15 —_ Abscess — — 15 6 1 1 4 Strongylus Micrurus — — 1 — — — — — Distomum Hepaticum — — Cavernous Angioma — — — 1 — — — — Pentastomum Denticulatum — — Parasitic Invasion — — — — — — — — 16 10 7 7 35 55 4 1 1 1 31 14 Total weight, 1,361 lbs. In addition to the animals slaughtered in the licensed slaughterhouses, a number of pig carcases arrive in the Borough which have not been previously inspected. During 1928 the number was 863 carcases and 1 side, an increase of 362 carcases over last year. On examination it was found necessary to destroy— 23 heads weighing 254 lbs. affected with tuberculosis ; Offal „ 20 lbs. Pieces of pork „ 13 lbs. bruised. Public Health (Meat) Regulations, 1924.—It was not found necessary to take any legal proceedings under these regulations during the year. Occasional defaults were dealt with by means of a caution. Poultry Slaughtering.—This business is dealt with by special bye-laws. The only poultry slaughterhouse in the Borough is situated at No. 51, Shirland Road. During the year 58 inspections were made and approximately 8,280 head of poultry were slaughtered. One seizure of meat was made by Mr. Inspector Pallet, that of a shoulder of mutton exposed for sale retail and affected with caseous lymphadenitis. The butcher was prosecuted and fined twenty-five pounds, with five guineas costs. 44 Food Purveyors.—At the end of the year there were some 800 purveyors of food in the Borough, classified as follows:—Butchers 81, Fishmongers 25, Fried Fish 34, Refreshments 113, Greengrocers 87, Milk 107, Margarine 17, General 56, Confectioners 113, Provisions 47, Grocers 112, Ham and Beef 8. In addition to the above premises there are 83 licensed Street Traders selling food within the Borough, namely:—Fruit and Vegetables 56, Ice Cream 11, Light Refreshments 12, Fish 3, Poultry 1. These, with the storage premises of 13 Street Traders licensed by other Boroughs, are under constant supervision. There were 7 premises on which fish curing was performed, this business as well as fish frying, being regulated by special bye-laws. There were also 42 premises on which sausages were made. The number of visits of inspection paid to premises occupied by food purveyors was 1,937. Ice-Cream.—There were 170 shops at which ice cream was known to be sold, comprising the following kinds of businesses:—Bakers 9, General 30, Milk 11, Confectioners 80, Refreshments 38, Wholesale 1, Newsagent 1. Two hundred and fifteen (215) inspections of premises were made. Ice-cream was sold from 25 barrows stored within the Borough and from 32 barrows stored outside the Borough. Section 29 of the London County Council (General Powers) Act, 1928, which came into operation on August 3rd, 1928, renders it necessary for the owner or occupier to register with the sanitary authority any premises which are used or proposed to be used for the sale or the manufacture for the purpose of sale of ice-cream or other similar commodity or the storage of ice-cream or other similar commodity intended for sale. Registration is not necessary as regards premises which are occupied as factories or workshops or used as hotels, restaurants or clubs. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was:—3 tons, 8 cwts, 2 qrs., 24 lbs., comprising the following varieties:—Fish 1,724 lbs., Fruit and Vegetables 3,940 lbs., Poultry 384 lbs., Meat 287 lbs., Offal 1,361 lbs. Dairies and Milkshops.—At the end of the year 1927 there were 101 names on the register. During the year 1928 6 names were added, making a total of 107. Four of the businesses were transferred to new proprietors. There were 421 inspections made. Sterilised milk in bottles was found to be on sale at 80 premises. Cowshed.—At the beginning of the year there was one cowshed, situated at 39, Star Street, licensed by the County Council for six cows. Only one cow was stalled there and in June the cow was sold and the premises ceased to be used as a cowshed. This was one of the few remaining cowsheds in the West End of London. MILK (SPECIAL DESIGNATIONS) ORDER, 1923. During the year 63 licences were issued by the Council pursuant to this Order, 19 being for " Certified," 16 for " Grade A (Tuberculin Tested) " and 28 for " Pasteurised " milk. The licences in respect of " Grade A (Tuberculin Tested) " milk included one for a bottling establishment, and those in respect of " Pasteurised" milk, three for pasteurising establishments. The samples taken by the Council's Inspector numbered 55, and included 41 of " Certified," 4 of " Grade A (Tuberculin Tested) " and 10 of " Pasteurised " milk. Five samples of the " Certified " and six samples of the " Pasteurised " milk 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, 11 (1.8 per cent.) were found to be not " of the nature, substance and quality demanded." This compares with 5 5 per cent. in 1927 and 3.2 per cent. in 1926. 45 Thirty-three of the samples were taken on Sundays and Bank Holidays. None of these was adulterated. One hundred and seventeen samples of milk were taken at Paddington Station on delivery by rail. Six of these samples were found to be adulterated. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 TO 1927. With few exceptions all samples taken under the Sale of Food & Drugs Acts were examined for the presence of preservatives. Two offences were reported, viz.:—Butter containing 0.04 per cent. of boric acid and Sausages containing 0'0246 per cent. (or 246 parts per million) of sulphur dioxide, and not bearing the prescribed declaratory label. In each instance the vendor was cautioned. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927. During the year one sample of full cream unsweetened condensed milk and four samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927. Four samples were taken of full cream dried milk, all of which complied with the Regulations. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Analyses for the purposes of the Sale of Food and Drugs Acts and the various Food Regulations are made by the Public Analyst, Sir William R. Smith, at the Royal Institute of Public Health, 37, Russell Square, W.C.I, where also bacteriological examinations of food are made when required. Bacteriological examinations of samples of milk procured under the provisions of the Milk (Special Designations) Order, 1923, are made by the Clinical Research Association, Ltd., Watergate House, York Buildings, Adelphi, W.C.2. During 1928 two samples of cheese and one sample of sardines were submitted for bacteriological examination following complaints of suspected poisoning. No injurious organisms were found. The results of other samples analysed or bacteriologically examined are recorded elsewhere in this Report under the appropriate headings. Summaries of the results of analyses made by the Public Analyst during the year are given on page 46. The results of legal proceedings are summarised on page 48. In connection with the analysis of milk samples, the Public Analyst furnishes the result of his analysis and the following table is of interest. It may be noted that the Ministry of Agriculture standards for presuming milk to be adulterated are 3 per cent. for fat and 8.5 per cent. for non-fatty solids. These standards are generally considered to be rather unfair to the consumer and the deduction to be made from the tables is that the milk sold in Paddington is, generally speaking, of average natural strength. Genuine Milk Samples, 1928. Average Monthly Figure for Percentage. Fat Content and Non-Fatty solids. February 3.52 8.79 March 3.47 8.68 April 3.24 8.71 May 3.29 8.88 June 3.28 8.82 July 3.32 8.74 August 3.55 8.84 October 3.62 8.82 November 3.66 8.84 December 3.56 8.66 No samples were taken during the months of January and September. Average for Year. Samples taken at Paddington Station 3.50 8.77 „ „ elsewhere 3.49 8.77 46 1928.—Samples Submitted to Public Analyst. Total. Found adulterated. Percentage adulterated. Ale 5 Ammoniated Quinine Tablets 1 — — Ammoniated Tincture of Quinine 4 — — Aspirin Tablets 5 — — Brawn 5 — — Bread 9 — — Beef, Tinned 1 — — Butter 28 1 3.6 Cake 3 — — Camphorated Oil 4 — — Castor Oil 4 — — Cheese 8 — — Cherries, Tinned 1 — — Chocolate 2 — — Cider 2 — — Claret 2 — — Cocoa 5 — — Cod Liver Oil Tablets 1 — — Coffee 4 — — Cream 17 — — Cream Ice 3 — — Cream Pastry 2 — — Cream, Salad 1 — — Custard Powder 4 — — Desiccated Coconut 1 — — Dried Fruit 5 — — Dripping 5 — — Fish Paste 7 — — Fish, Tinned 3 — — Flour 10 — — Gin 1 — — Ginger Wine Essence 1 — — Ground Ginger 1 — — Gooseberries, Bottled 1 — — Honey 1 — — Hydrogen Peroxide 1 — — Ice Cream 2 — — Jam 5 — — Lard 6 — — Lemonade Powder 4 — — Lemon Crush 1 — — Loganberries, Tinned 1 — — Margarine 5 — — Meat Paste 2 — — Milk 292 6 2.0 Milk Food 1 — — Milk, Full Cream Dried 4 — — Milk, Full Cream Unsweetened Condensed 1 — — Milk, Skimmed Sweetened Condensed 4 — — Mincemeat 5 — — Mustard 5 — — Olive Oil 5 — — Peas, Tinned 3 — — Pepper 6 — — Pepper Compound 1 — — Pickles 4 — — Port 2 — — Preserved Ginger 1 — — Rice, Flaked 1 — — Rice, Ground 1 — — Rum 1 — — Rum and Coffee 1 — — Sardines in Tomato 1 — — Sauce 2 — — Sausages 28 1 3.0 Semolina 1 — — Sherbet 2 — — Shredded Suet 2 — — Shredded Suet with Flour 2 — — Sherry 2 — — Stout 5 — — Suet Flakes 1 — — Sugar 5 — — Tea 6 — — Tincture of Iodine 2 1 50.0 Tincture of Iodine (Strong) 6 1 16.6 Toffee 1 — — Treacle 1 — — Tomatoes, Tinned 2 — — Vinegar 7 1 14.3 Vinegar, Malt 1 — — Whisky 2 — — 600 11 1.8 47 LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1927, SEC. 52. Nuisance Caused by Pigeons.—The number of complaints received arising from the above cause was eight. Fifty pigeons were trapped and destroyed. RATS AND MICE (DESTRUCTION) ACT, 1919. Seventy-six (76) 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. It was not found necessary to serve any Notices under the Act in respect of rat-infested premises. Rat Week.—This was held from 5th to 10th 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 8,610 baits to be laid in 629 different positions, 189 rats eventually being found dead. This number is of course only a small proportion of the number killed. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Seventeen (17) 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 75 premises, the verminous rooms numbering 108. The owners of 49 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 78 rooms being so treated at a charge to the owners of 7s. 6d. per room. During the year Section 26 of the London County Council (General Powers) Act, 1928, came into force. This authorises the cleansing of verminous persons by the exercise of powers granted by a petty sessional court in cases where the verminous person does not consent to being removed to a cleansing station. COMPULSORY REMOVAL OF AGED, INFIRM OR DISEASED PERSONS. By virtue of Section 28 of the London County Council (General Powers) Act, 1928, which came into force on August 3rd, 1928, it became possible in London to remove to a hospital or infirmary, by compulsion and under certain circumstances, aged, infirm, sick or physically incapacitated persons. The circumstances which may enable an order for removal to be obtained are somewhat involved. Unless the person concerned is suffering from disease it is necessary for the premises to be insanitary. It is in all cases necessary as well to prove that the person is not receiving proper attention and that removal is necessary in the interests of the affected person and of other persons. During the latter part of the year a number of cases were referred to the Medical Officer of Health by the Relieving Officers for any necessary action to be taken. In no case was it found that all the circumstances existed which would enable removal to be effected. It does not appear that the section will be put into effect very often in view of the attendant legal difficulties. This does not mean that the section has not its uses, since the very existence of such dormant powers may enable the Poor Law officers to overcome the reluctance of many neglected and aged persons who are in unsuitable surroundings and who would be much happier in the workhouse or infirmary. 48 LEGAL PROCEEDINGS—1928. The results of the Summonses taken out during the year are summarised in the following tables:— Premises. Offence. Fines. Costs. PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. £ s. d. 6, Blomfield Place Roof defective Work done 1 1 0 16, Cuthbert Street Roof defective Work done Summons withdrawn. 9, Elcom Street Roof defective Work done „ 94, Fernhead Road Walls and ceiling of ground floor back room and walls of first floor front room dirty. Order made - 96, Fernhead Road Roof and ceiling of scullery and ceiling of watercloset defective. Order made 2 2 0 “ “ Failing to comply with Magistrate's Order to make good the ceilings of scullery and watercloset. Work done 1 1 0 102, Fernhead Road Walls of basement front room and second floor back room damp. Brickwork of front inspection chamber defective. Work done 1 1 0 231, Shirland Road Ceiling of top floor back room and walls and ceiling of first floor water-closet defective. Work done 1 1 0 ,, „ Back addition roof defective Work done 1 1 0 16, Walterton Road Drain defective Order made — “ “ Failing to comply with Magistrate's Order to amend the defective drain. £38 0s. 0d. 5 5 0 - Section 47. Exposing for sale a diseased shoulder of mutton £25 0s. 0d. 5 5 0 19, Andover Place Bye-laws. Annual Cleansing not carried out in washhouse Work done 1 1 0 39, Clarendon Street and yard. Ground floor back room inadequately ventilated Work done Summons withdrawn 1 1 0 13, Norfolk Mews, Norfolk Crescent Failing to deposit plans of alterations to sanitary fittings. Plans deposited Summons withdrawn 1 1 0 — Removing offensive refuse during prohibited hours. £0 8s. 0d. 2 2 0 — Permitting a dog on a lead to foul the footway £0 10s. 0d. — — — Sale of Food and Drugs Acts, 1875-1927. Offence. Fines. Costs. £ s. d. £ s. d. Milk.—13.88 per cent, added water 5 0 0 5 5 0 „ 12.1 per cent. „ „ Summons 0 2 0 dismissed „ 10.35 per cent. „ „ 10 0 0 5 5 0 (or 51 days' imprisonment in default). „ 6.35 per cent. „ „ Summons withdrawn 5 5 0 „ 9.05 per cent. „ „ 5 0 0 5 5 0 „ 10 per cent. „ „ Summon dismissed 5 5 0 „ 11.33 per cent. deficient in fat 5 5 0 „ 8 per cent. „ „ 5 5 0 Vinegar.—32.5 per cent. deficient in acetic acid Summons dismissed 1 1 0 MILK AND DAIRIES ORDER, 1926. Offence. Fines. Costs. £ s. d. £ s. d. Bottling milk elsewhere than on registered premises 1 0 0 1 1 0 “ “ “ “ 0 10 0 — — — “ “ “ “ 0 10 0 — — — 49 Report of the Work of the District Inspectors, 1928 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. 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 1928 1,086 — 2,453 — 13,254 32 109 15 25 1269 3 481 119 66 27 — 4 — 31 148 8 85 349 2 — 27 199 6 30 — 50 1928. Prevention of Infectious Disease. All Diseases, Enquiries by— District Inspectors 2,624 Women Inspectors and Health Visitors 7,192 Tuberculosis—Included in above— Women Inspectors 1,385 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 1,551 Rooms disinfected after— Tuberculosis 175 Other Diseases 1,848 Weight of Bedding, etc., disinfected (tons) 30 School Notices issued— Measles, Whooping Cough, Chicken Pox 1,879 Other Diseases 971 Bacteriological Examinations for— Diphtheria 1,202 Typhoid Fever 13 Anthrax 1 Tuberculosis 411 Sanitary Work—Cutting-off of Water Supplies. Notices received 4 Referring to Inhabited Premises 3 Empty „ 1 Other „ — Reasons for—Rates unpaid 3 Defective fittings 1 Mortuary. Bodies deposited, total 347 „ „ for inquests 160 „ „ pending burial, infectious — other 93 P.M. examinations made 128 Trade Nuisances. Offensive Smells—Complaints 24 Accumulations of Manure 9 Smoke— Complaints 15 „ Premises watched 29 „ „ „ Hours of observation 131 ,, Duration of smoke (hours), including 63½ „ „ black smoke 3¼ Office (Clerical) Work. Letters received 5,412 „ despatched 6,232 Entries in Postage Book 12,037 Certificates dealt with relating to Infectious Disease (including Tuberculosis) 6,646 Notices sent re above 7,710 Entries in Birth Register 2,113 Complaints received 1,311 Plans dealt with 310 New openings in Journals 258 Disinfection Orders 1,836 Notices to abate nuisances, etc. 711 51 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road St. Mary's Hospital, Cambridge Place ... Paddington School for Mothers. St. Mary's Hospital. Infant Consultation Centres *232, Harrow Road St. David's Church Hall, St. Mary's Terrace St. John's Mission Room, Sovereign Mews *Congregational Institute, Third Avenue Orphanage of Mercy, Randolph Gardens St. Simon's Hall, Macroom Road Christ Church Parochial Church House, Queensborough Passage * Two sessions weekly. Paddington School for Mothers. (To be closed end of June, 1929). (Two sessions weekly after June, 1929). Day Nurseries 21, Howley Place 66, Lancefield Street Paddington Day Nursery. Queen's Park Day Nursery. Tuberculosis. Dispensaries 20, Talbot Road ... St. Mary's Hospital, Cambridge Place ... Paddington Tuberculosis Dispensary 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, 1928). (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. J. W. Webster (1). T. Mitchell (1), (3), (4), (5). G. J. Miners (1), (4). V. L. Ronchetti (2), (3), (5). E. B. Wilde (2), (3), (4), (5), (11). Workshops Inspector and Canal Boats Inspector, W.T. C. S. Wansbrough (1), (4), (5). Tenement Hocuses Inspectors, W.T. C. Lawrence (1), (3), (4), (5). C. G. Heron (2)),,(3). Meat and Food Inspector, W.T. F. J. Pallet (2), (3). Health Visitors, W.T. D. A. M. NewhaU (1), (2), (8), (9). E. A. S. Davies (8), (9). Women Sanitary Inspectors, W.T. L. M. O'Kell (1), (7). I. L. Buckledee (2), (8), (9), (10). (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. (o) Plumbing Certificates. (6) Diploma, National Health Society. (7) Tuberculosis Certificate, National Health Society. (8) Central Midwives Board Certificate. (9) Nursing Training Certificates. (10) Health Visitor's Diploma, Board of Education. (11) Smoke Inspector's Certificate, Royal Sanitary Institute.