AC4349 PAD 29' Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 19 2 9. 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 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 19 2 9. 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 29 Administrative Work 33 Agricultural Produce (Grading and Marking) Act, 1928 46 Annual Cleansing 36 Ante-natal Consultation Centres 30 Anthrax 19 Artificial Cream Act, 1929 40 Bacteriological Work 33 Bakehouses 41 Births 6 ,, Illegitimate 6 ,, in Institutions 7 „ Notifications 7 ,, Stillbirths 7 Birth-rates 6 Canals, Canal Boats 35 Cancer 19 Cerebro-spinal Fever 18 Chicken-pox 15 Cholera 19 Combined Drainage 34 Common Lodging Houses 36 Compulsory Repairs 36 Compulsory removal of certain persons 47 Condensed Milk Regulations 44 Continued Fever 16 Convalescent Homes 33 "Conversions" 36 Dairies and Milkshops 43 Day Nurseries 31 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 34 Dried Milk Regulations 44 Dysentery 19 Erysipelas 18 Food Adulteration 44 ,, Chemical and Bacteriological Examination 44 ,, Destroyed 43 ,, Purveyors 42 ,, Samples Analysed 44, 45 ,, Supervision 42 Fouling of Footways by Dogs 34 German Measles 17 Glanders 19 Health Education 47 ,, Exhibition 47 and Appendix ,, Visiting 27, 30 Homework (Outworkers) 41 Houses Unfit for Habitation 36 Housing 36 ,, on L.C.C. Estates 37 Hydrophobia 19 Ice Cream 43 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 Invalid Children's Aid Association 33 Legal Proceedings 48 L.C.C. Houses 37 Malaria 18 Marriages 5 Maternal Consultations 30 ,, Mortality Investigation 33 Maternity and Child Welfare 27 Maternity Nursing 30 Measles 16 Meat Regulations 42 Merchandise Marks Act, 1926 46 Milk Grants 31 ,, (Special Designations) Order 43 Mortuary 34, 50 Nursing 33 Office Work 50 Ophthalmia Neonatorum 17 Outworkers (Homework) 41 Overcrowding 36 Pigeons, Nuisance from 46 Plague 19 Population 5 Poultry Slaughtering 42 Pneumonia 19 Preservatives, etc., in Food Regulations 44 Puerperal Fever 17 ,, Pyrexia 18 Rag and Bone Dealers 34 Rag Flock Acts 42 Rats and Mice Destruction 46 Relapsing Fever 19 Rent and Mortgage Interest (Restrictions) Acts 37 Rent Books 36 Scarlet Fever 14 Schools and Infectious Disease 33 Sewer Connections 34 Slaughterhouses 42 Smallpox 15 Smoke Control 34 Staff 33, 51 Tenement Houses 36 Trade Nuisances 34, 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 36 Unhealthy Areas 36 Venereal Diseases Clinic 51 Verminous Conditions 46 Vital Statistics 4, 5 Water Supply 34, 50 Whooping Cough 19 Workshop Supervision 41 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 1929 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be generally good, but, in common with all parts of the country, the death-rate was somewhat higher than it had been for many years owing to the prevalence of catarrhal and respiratory diseases. For instance, 131 deaths were directly attributable to influenza and 335 to bronchitis and pneumonia, as compared with 27 and 219 deaths respectively in the previous year. A serious outbreak of whooping-cough caused 71 deaths, 69 of which were those of children under the age of five years. Cancer continues to be more prevalent year by year, and the number of deaths from this disease was greater than in any previous year. This is the more remarkable since an appreciable number of cases of cancer are now being cured by new methods of treatment. A mild type of smallpox was prevalent in London during the year, but this Borough was fortunate in having only three cases reported. The infantile mortality of the Borough still causes the greatest anxiety. It was last year the highest recorded in any of the metropolitan cities and boroughs. It is evident that all the details of administration must be perfected in their working if this condition of things is to be improved. It appears, however, impossible to point to any one reform which would of itself reduce our infantile mortality to any appreciable extent. The first Health Exhibition to be held in the Borough was an outstanding feature of the year. The general impression was that the trouble and expense involved was justified by the good resulting. 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 G.E. Oates. M.D., M.R.C.P., D.P.H . Medical Officer of Health. Town Hall, Paddington Green, W. 2. June, 1930. SUMMARY OF VITAL STATISTICS Area oi Borough 1,356.1 acres, including waterways 20.0 acres: 1929 Population (Registrar-General's estimate) 142,800 Density of population per acre 105 Census 1921: Total number of buildings containing dwellings 17,153 (a) Dwellings occupied by non-private families 435 Population inhabiting the same 12,910 (b) Dwellings occupied by private families 38,320 (Including vacant census night, 938). Population enumerated in occupied dwellings 131,351 (Occupying 141,959 rooms, averaging 108 persons per room, or 0.92 room per person). Marriages 1,684 % Total. M. F. Births Legitimate 1,891 983 908 Illegitimate 238 111 127 Birth-rate 14.90* Deaths 2,211 1,035 1,176 Death-rate 15.48* Number of women dying in, or in consequence of childbirth from sepsis 6 other causes 3 Maternal mortality 4.22† Deaths of Infants under 1 year of age 215 Infantile Mortality 101† Legitimate, 97†; Illegitimate, 130† Deaths from Measles (all ages) 2 Whooping Cough (all ages) 71 „ Diarrhoea (under 2 years of age)36 „ Pulmonary Tuberculosis 11l Death-rate from Pulmonary Tuberculosis0.78* Deaths from all forms of Tuberculosis 128 Tuberculosis death-rate 0.89* Rateable Value £1,702,842 Product of a Penny Rate £6,846 * per 1,000 persons. † per 1,000 births. 5 VITAL STATISTICS. The Metropolitan Borough of Paddington as constituted under the London Government Act, 1899, covers an area of 1,356.1 acres, including 20.0 acres of 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. 1914 142,087 2,708 49 274 2,933 20.64 1,892 13.31 347 350 1,895 13.33 312 115 281 96 1915 131,397 2,506 59 267 2,714 20.65 2,304 17.53 370 352 2,286 17.39 343 137 319 117 1916 t 142,169 2,378 61 372 2,689 18.91 ... ... ... ... ... ... 289 121 253 94 c 136,668 ... ... ... ... ... 1,924 14.72 370 326 1,880 14.38 1917 T 136,561 1,834 77 334 2,091 15.31 ... ... ... ... ... ... 290 158 273 135 c 122,507 ... ... ... ... ... 1,997 16.30 321 374 2,050 16.73 1918 T 131,673 1,798 118 337 2,017 15.31 ... ... ... ... ... ... 266 148 235 116 c 117,517 ... ... ... ... ... 1,999 17.01 345 595 2,249 19.13 1919 T 149,941 2,016 154 454 2,316 15.44 ... ... ... ... ... ... 213 105 212 91 c 143,938 ... ... ... ... ... 1,499 10.41 310 725 1,914 13.29 1920 T 150,128 3,181 251 483 3,413 22.73 ... ... ... ... ... ... 279 87 266 78 c 149,673 ... ... ... ... ... 1,667 11.13 370 410 1,707 11.40 1921 145,600 2,653 296 502 2,859 19.63 1,784 12.25 372 346 1,758 12.07 307 115 263 92 1922 145,300 2,557 288 462 2,731 18.79 1,929 13.27 365 324 1,888 12.99 224 88 189 69 1923 146,200 2,410 275 485 2,620 17.92 1,743 11.92 338 317 1,722 11.77 207 86 180 69 1924 146,400 2,343 284 446 2,505 17.11 2,054 14.03 475 341 1,920 13.11 232 99 196 78 1925 147,100 2,206 312 443 2,337 15.88 2,011 13.67 570 339 1,780 12.10 196 88 170 72 1926 146,700 2,131 345 462 2,248 15.32 2,067 14.09 554 344 1,857 12.65 210 98 194 86 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 1929 142,800 2,058 447 518 2,129 14.90 2,344 16.41 550 417 2,211 15.48 230 111 215 101 " T "=Total; "C"=Civil. POPULATION The Registrar-General's estimate of the population of the Borough for the year 1929 was 142,800. It will be noticed that there has been a reduction of 2,400 in the population according to the Registrar-General's estimates. One may venture to assert that there has been no such sudden reduction in the population. Attention has been drawn in previous Annual Reports 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 142,800 Wards— Queen's Park 15,594 North Paddington 72,090 Harrow Road 27,236 Maida Vale 21,876 Town 7,384 Westbourne 23,858 South Paddington 70,710 Church 17,315 Lancaster Gate, West 9,435 Lancaster Gate, East 8,078 Hyde Park 12,024 MARRIAGES. During 1929, 1,684 marriages were solemnized in the Borough, being a rate of 23.5 persons per 1,000 of the population. 6 BIRTHS. The number of births registered in the Borough during 1929 was 2,058, and, in addition, 71 occurred outside the Borough to Paddington residents in excess of those occurring in Paddington to residents of other localities, making a total of 2,129 births. The birth-rate for 1929 was therefore 14.90 per 1,000 of the population. Of the 2,129 births, 1,094 were those of males and 1,035 those of females, and of these 111 males and 127 females were illegitimate. The Registrar-General's final figure for the nett number of births is given as 2,138, but this does not materially 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:— 1929 Birth-rates. No. of Births. Birthrates. 1928 1927 1926 1925 1924 England and Wales 644,218 16.3 16.7 16.7 17.8 18.3 18.8 London 70,090 15.7 15.9 16.1 17.1 18.0 18.6 Paddington 2,129 14.90 14.99 15.53 15.32 15.88 17.11 Wards— Queen's Park 160 10.26 10.97 11.29 12.48 12.63 13.76 Harrow Road 407 14.94 15.05 15.50 14.44 16.07 16.01 Maida Vale 333 15.22 14.65 16.69 15.84 14.09 19.35 Town 122 16.52 16.78 18.70 17.92 23.54 24.05 Church 407 23.50 22.83 23.11 23.94 Westbourne 411 17.22 19.25 18.58 18.03 18.14 19.93 Lancaster Gate, West 76 8.05 5.00 6.25 6.29 7.82 8.37 Lancaster Gate, East 71 8.79 7.42 9.04 8.79 9.49 9.05 Hyde Park 142 11.81 12.75 11.56 12.14 11.94 13.46 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 1929 14.90 Illegitimate Births.—These were 238 in number, or 11.18 per cent. of the total number of births. The proportion of illegitimate births varies remarkably in the different wards as is shown in the table below:— Rate of Illegitimate Births Per 100 Total Births. Ward. Rate. Queen's Park 5.00 Harrow Road 6.63 Maida Vale 15.01 Town 10.65 Church 8.59 Westbourne 10.95 Lancaster Gate, West 28.94 Lancaster Gate, East 19.71 Hyde Park 16.90 7 Stillbirths.—During 1929, 94 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 24 occurred to residents of other localities; on the other hand 23 stillbirths occurred outside the Borough to Paddington residents. The nett number for the Borough was therefore 93, a figure equivalent to 4T per cent. of the total births recorded. Of the 93 stillbirths, males numbered 54 and females 39, 5 of the males and 3 of the females being illegitimate. Births in Institutions. Local. Legitimate. Illegitimate. Total. Residents Non-residents. Residents. Non-residents. Residents . Non-residents. Paddington Infirmary 177 42 73 16 250 58 St. Mary's Hospital 126 124 3 6 129 130 Lock Hospital — 17 9 72 9 89 Outlying. (Paddington residents) Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 236 26 262 Other Lying-in Hospitals 10 3 13 Other Hospitals 45 13 58 Poor Law Institutions 6 12 18 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, 2,039 live births were notified to the Medical Officer of Health. There were also 86 stillbirths notified. Of the 2,125 living and stillbirths notified, 47.2 per cent. were notified by medical practitioners, 37.5 per cent. by midwives, 2.6 per cent. by parents, and 12.7 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 97.9 per cent. of the live births and 93.6 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 so escape being brought to the notice of the Medical Officer of Health until they come to be registered within the statutory period of six weeks. In nearly every case of default a cautionary letter was sent to the person responsible, and in no instance did the Maternity and Child Welfare Committee consider it necessary to institute legal proceedings. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 2,344. Of these, 550 were of persons whose residence was not in Paddington, 452 dying in Paddington Institutions and 98 in other places in the Borough. There were also reported to the Registrar-General 417 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 2,211, making an annual death-rate of 15.45. 8 1929. 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 26th 6 12 14 6 10 7 1 February 23rd — — 21 1 13 25 55 27 59 1 March 23rd 1 31 —- 14 33 49 31 63 3 April 20th — — 3 — 11 18 8 9 21 3 May 18th — — 5 - 6 18 7 6 23 5 June 15th — — 3 1 4 15 1 1 9 4 July 13th — — 2 — 4 31 2 1 August 10th 1 — — 1 12 18 1 1 4 2 September 7th — — — - 5 21 — 2 2 4 October 5th — — — - 8 20 1 5 5 4 November 2nd — — — - 5 13 1 1 10 7 November 30th — — — - 6 14 1 4 16 5 December 31st — — — 4 9 36 1 5 15 3 Totals 2 — 71 7 109 276 131 102 236 43 The foregoing 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 below. Deaths of Residents of the Borough, 1929, 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 2211 1035 1176 119 96 32 26 24 21 8 14 19 41 125 91 313 281 238 253 157 353 Enteric Fever 2 1 1 ... ... ... ... ... ... ... ... ... 1 1 ... ... ... ... ... ... ... Smallpox ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Measles 2 1 1 ... ... ... 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 71 37 34 15 9 10 16 12 7 ... 2 ... ... ... ... ... ... ... ... ... ... Diphtheria 9 2 7 ... ... ... 1 2 2 ... 3 ... 1 ... ... ... ... ... ... ... ... Influenza 131 41 90 ... 1 ... 1 ... 1 ... 1 1 ... 11 12 8 18 14 20 7 36 Encephalitis Lethargica 4 2 2 ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 ... ... ... ... Meningococcal Meningitis 3 2 1 2 ... ... ... ... ... ... . . . ... ... ... 1 ... ... ... ... ... ... Tuberculosis of Respiratory System 111 68 43 ... ... ... ... ... ... ... ... 7 14 28 17 29 10 4 2 ... ... Other Tuberculous Diseases 17 8 9 ... l ... ... 3 1 1 2 1 2 ... 2 2 ... ... 1 1 ... Cancer, Malignant Disease 284 117 167 ... ... ... ... ... ... ... ... 1 ... 5 8 55 70 34 54 22 35 Rheumatic Fever 4 2 2 ... ... ... ... ... ... 2 1 ... ... ... 1 ... ... ... ... ... ... Diabetes 25 8 17 ... ... ... ... ... ... ... ... ... 1 ... 1 9 4 4 2 4 Cerebral Haemorrhage, etc. 74 22 52 ... ... ... ... ... ... ... ... ... ... ... 3 7 18 9 17 6 14 Heart Disease 464 208 256 ... ... ... ... ... ... ... ... ... 5 17 9 56 51 80 76 55 115 Arterio-sclerosis 62 26 36 ... ... ... ... ... ... ... ... ... ... ... ... 9 2 6 12 11 22 Bronchitis 103 38 65 7 6 ... ... ... ... ... ... ... ... 2 ... 7 10 16 12 6 37 Pneumonia (all forms) 232 136 96 26 24 20 6 4 2 ... 1 ... 1 15 7 40 23 17 16 14 16 Other Respiratory Diseases 29 9 20 ... ... ... ... ... 1 1 ... 1 1 ... 3 5 6 2 4 ... 5 Ulcer of Stomach or Duodenum 25 19 6 ... ... ... ... ... ... ... ... 2 ... 6 1 10 4 1 1 ... ... Diarrhoea, etc 40 24 16 21 14 1 ... ... 1 ... ... ... ... 1 ... 1 1 ... ... ... ... Appendicitis and Typhlitis 15 8 7 ... ... ... ... ... 1 1 ... ... ... 4 2 3 2 ... 1 ... ... Cirrhosis of Liver 6 4 2 ... ... ... ... ... ... ... ... ... ... ... ... 2 ... 1 l 1 1 Acute and Chronic Nephritis 56 26 30 1 ... ... ... ... ... ... l ... ... 1 1 14 11 7 8 3 9 Puerperal Sepsis 6 ... 6 ... ... ... ... ... ... ... ... ... 2 ... 4 ... ... ... ... ... ... Other Accidents and diseases of Pregnancy and Parturition 3 ... 3 ... ... ... ... ... ... ... ... ... 2 ... 1 ... ... ... ... ... ... Congenital debility and Malformation, . ture Birth 62 34 28 34 27 ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... Suicide 36 20 16 ... ... ... ... ... ... ... ... 1 4 7 5 10 7 1 ... 1 ... Other deaths from Violence 63 29 34 1 1 ... ... 1 1 ... 3 3 4 9 4 6 6 5 3 4 12 Other defined diseases 270 143 127 12 13 1 ... l 4 3 ... 2 3 16 10 47 30 37 21 24 46 Causes ill-defined or unknown 2 ... 2 ... ... ... 1 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... 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 1929 Death-rates. No. of Deaths. Deathrates. 1928 1927 1926 1925 1924 England and Wales 532,525 13.4 11.7 12.3 11.6 12.2 12.2 London 61,710 13.8 11.6 11.9 11.6 11.7 12.2 Paddington 2,211 15.48 13.03 13.56 12.65 12.10 13.11 Wards— Queen's Park 182 11.67 11.22 12.12 12.10 11.39 11.94 Harrow Road 407 14.94 11.88 13.04 12.58 10.80 12.57 Maida Vale 308 14.08 14.56 14.68 14.37 11.84 12.43 Town 123 16.65 11.98 16.94 ll.60 14.73 15.79 Church 357 20.61 15.27 15.60 16.92 Westbourne 407 17.06 15.45 13.92 12.64 13.99 15.16 Lancaster Gate, West 128 13.56 10.21 9.33 11.04 10.28 10.54 Lancaster Gate, East 110 13.61 10.71 11.39 7.71 9.25 9.90 Hyde Park 189 15.72 11.61 13.64 9.55 10.57 11.68 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 1929 15.48 Deaths in Institutions, 1929. Local. Total Nonresidents. Paddington Infirmary 713 28 St. Mary's Hospital 313 230 Paddington Green Children's Hospital 68 49 Hospital for Women and Children (Lock Hospital) 5 5 St. Luke's Hospital 155 140 Deduct Non-residents 1,254 452 452 802 Outlying. Paddingion Residents. Hospitals of Metropolitan Asylums Board (excluding Tuberculosis Hospitals) 30 Poor Law Institutions 33 Lunatic Asylums 70 Voluntary Hospitals (General) 102 Hospitals (Special, including Sanatoria.) 84 319 Total Deaths of Paddington residents in institutions 1,121 10 INFANTILE MORTALITY. During the year 1929 there were 2,129 births and 215 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 101. The following table gives the births and the infantile deaths and death-rates for the year 1929 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1924 to 1928 are given for comparison. 1929 Infantile Mortality Rates. No. of Births. No. of Deaths of children under 1 year. Infantile Mortality Rates. 1928 1927 1926 1925 1924 England and Wales 644,218 47,601 74 65 69 70 75 75 London 70,090 4,936 70 67 59 64 67 69 Paddington 2,129 215 101 85 79 86 72 78 Wards— Queen's Park 160 7 44 28 91 45 88 50 Harrow Road 407 29 71 79 49 104 66 87 Maida Vale 333 22 66 82 96 87 50 50 Town 122 18 147 95 130 37 91 115 Church 407 67 164 99 99 108 Westbourne 411 52 126 109 76 86 69 82 Lancaster Gate, West 76 3 39 83 51 109 50 93 Lancaster Gate, East 71 3 42 82 115 52 49 Hyde Park 142 14 98 57 65 53 74 24 Infantile Mortality Rates, 1896-1929. 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 1929 74 70 101 11 Infantile Mortality in Paddington.—1929. 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 Birth?. All Causes 40 6 3 8 57 37 56 39 26 215 100.98 Common Infectious Diseases (6-10, 25:2) — — — — — 3 5 7 10 25 11.74 Tuberculous Diseases (31-37) — — — — — — 1 — — 1 0.47 Diarrhoea and Enteritis (113) — 1 — — 1 7 12 13 2 35 16.44 Developmental and Wasting Diseases (159, 160, 161:1, 162:2) 27 5 2 7 41 11 4 1 1 58 27.23 Miscellaneous Diseases (Remainder) 13 — 1 1 15 16 34 18 13 96 45.10 Measles (7) — — — — — — — — — — — Whooping cough (9) — — — — — 3 5 6 10 24 11.27 Diphtheria (10) — — — — — — — — — — — Influenza (11) — — — — — 1 — — — 1 0.47 Tuberculosis of nervous system (32) — — — — — — — — — — — Tuberculosis of intestines and peritoneum (33) — — — — — — 1 — — 1 0.47 Other tuberculous diseases (31, 3437) — — — — — — — — — — — Syphilis (38) — — — — — 1 — — 1 0.47 Meningitis (71) — — — — 1 — 1 2 0.94 Convulsions (80) — — — — — — — Bronchitis (99) — — — 1 1 2 6 2 2 13 6.11 Pneumonia (100, 101) 2 — — — 2 7 19 14 8 50 23.49 Other respiratory diseases (98, 102107) — — — — — — — — — — — Inflammation of the stomach (112:1) — — 1 — 1 — — — - 1 0.47 Diarrhoea and Enteritis (113) — 1 - — 1 7 12 13 2 35 16.44 Hernia, intestinal obstruction (118) — — — — — 2 1 — 3 1.41 Congenital malformations (159) 2 2 1 — 5 1 — — — 6 2.81 Congenital debility and sclerema (160:1) — — — 2 2 6 4 1 1 14 6.57 Icterus (160:2) — — — — — 1 — — — 1 0.47 Premature birth (161:1) 24 3 — 4 31 3 — — — 34 15.97 Injury at birth (161:2) 5 — — — 5 — — — — 5 2.35 Disease of umbilicus (162:1) — — — — — — — — — — — Atelectasis (162:2) 1 — 1 1 3 — — — — 3 1. 41 Suffocation—in bed or not stated how (180 pt.) 1 — — — 1 — — — — — 0.47 Other causes 5 — — — 5 5 6 2 2 20 9.39 Nett Births in the Year Legitimate 1,891. Illegitimate 238. Nett Deaths in the Year Legitimate Infants 184. Illegitimate Infants 31. 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 1929 Infantile Mortality. Births. Deaths. 1929 1928 1927 1926 1925 Church Ward— North Wharf 49 7 143 148 40 92 59 Clarendon Street 170 29 170 105 138 148 126 Rest of Ward 188 31 165 75 70 67 ? Westbourne Ward— Alfred Road 105 16 152 83 165 107 58 Rest of Ward 306 36 117 117 48 79 77 Maida Vale Ward— Amberley Road 46 4 87 104 178 89 66 Rest of Ward 287 18 62 79 80 86 43 Totals for 4 Areas 370 56 151 105 139 121 91 Rest of Borough 1,759 159 90 81 65 78 68 12 The subjoined information, comparing the vital statistics for the metropolitan boroughs, has been supplied by Dr. Howell W. Barnes, Medical Officer of Health for Camberwell:— 1929. Cities and Boroughs. Births Annual rate per 1,000 persons living. Death-rate per 1,000 living. Deaths of Infants under one year to 1,000 births. West Districts. Paddington 14.9 15.4 101 Kensington 14.4 15.4 84 Hammersmith 15.8 13.7 62 Fulham 15.2 13.4 72 Chelsea 11.7 15.7 70 City of Westminster 10.4 14.8 . 77 North Districts. St. Marylebone 11.9 13.2 77 Hampstead 11.4 13.5 54 St. Pancras 15.5 15.3 83 Islington 17.2 14.8 73 Stoke Newington 16.1 13.4 47 Hackney 15.9 13.9 56 Central Districts Holborn 10.2 15.6 74 Finsbury 19.3 16.0 75 City of London 7.4 14.0 62 East Districts. Shoreditch 20.6 16.0 88 Bethnal Green 18.3 13.3 64 Stepney 17.2 13.6 89 Poplar 19.1 14.2 75 South Districts. Southwark 18.1 15.6 81 Bermondsey 19.8 14.5 71 Lambeth 15.6 14.9 67 Battersea 16.2 14.2 62 Wandsworth 13.0 12.8 61 Camberwell 15.3 13.6 68 Deptford 16.8 13.3 76 Greenwich 15.8 13.3 70 Lewisham 15.7 11.5 44 Woolwich 16.3 12.6 62 Fulham, Stepney and Bethnal Green figures not confirmed. INQUESTS. During 1929, 130 inquests were held on residents of the Borough, and 121 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. Acute Influenzal Pneumonia. Acute Polio-encephalitis. Acute Polio-myelitis. Acute Primary Pneumonia. Acute Rheumatism. Anthrax. Cerebro-spinal Fever. Chicken-pox. Cholera. Continued Fever. Diphtheria or Membranous Croup. Dysentery. Erysipelas. German Measles. Glanders. Hydrophobia. Infective Enteritis or Summer Diarrhoea. Malaria. Measles. Ophthalmia Neonatorum. Plague. Puerperal Fever. Puerperal Pyrexia. Relapsing Fever. Scarlatina or Scarlet Fever. Smallpox. Tuberculosis. Typhoid or Enteric Fever. Typhus Fever. The following table summarises the cases of notifiable diseases notified in the years 1919 to 1929:— Analysis of Notification Certificates (Uncorrected for Errors in Diagnosis). 1919. 1920. 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. Acute Encephalitis Lethargica (a) 3 2 7 2 3 12 7 4 4 1 5 „ Influenzal Pneumonia (a) 87 45 27 72 33 87 88 76 107 59 135 „ Primary Pneumonia (a) 83 96 105 254 302 369 265 184 183 202 247 „ Polio-encephalitis 5 2 1 — 2 4 3 3 1 1 1 „ Polio-myelitis 3 4 3 1 „ Rheumatism — — — — — — — (a) 34 76 52 Anthrax — — 1 1 — — — 1 1 — — Cerebro-spinal Fever 7 1 2 2 1 1 5 5 3 4 6 Chicken-pox — — — 22 465 395 459 599 461 567 382 Continued Fever — — — — — — — — 2 10 3 Diphtheria 255 461 442 401 219 278 336 462 367 302 311 Dysentery (a) 3 1 2 — 2 1 — — — — — Erysipelas 76 81 83 77 54 69 64 76 90 90 69 German Measles 132 71 83 144 48 458 375 124 78 109 1,163 Infective Enteritis or Summer Diarrhoea — — — — — — — — (a) 6 20 63 Malaria (a) 64 24 7 5 2 9 1 1 2 3 — Measles 1126 1356 80 1973 324 2757 879 1738 154 2862 210 Membranous Croup 4 3 3 — 1 2 1 1 2 4 6 Ophthalmia Neonatorum 30 29 34 15 22 18 23 16 15 24 9 Puerperal Fever 15 15 16 8 5 9 15 14 7 5 4 Pyrexia — — — — — — — (a) 17 34 32 42 Scarlet Fever 261 502 827 529 323 290 264 199 320 519 323 Small-pox — — . — — l — — — — 5 3 Tuberculosis—Total 391 383 335 312 338 379 400 356 381 321 335 Pulmonary 284 277 244 204 222 242 231 218 212 196 242 Other Forms 107 106 91 108 116 137 169 138 169 125 93 Typhoid or Enteric Fever 10 19 13 8 13 15 18 12 16 25 19 (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:— 1929. Notifications. A.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne. Lancaster Gate. Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 8 14 26 30 36 41 8 10 24 30 23 28 4 8 6 3 8 10 Typhoid and Continued Fever — 1 — 1 1 2 — 1 1 4 1 1 2 I — 4 — 2 Erysipelas 5 3 3 1 2 2 2 1 4 11 7 14 4 1 2 2 1 4 Ophthalmia Neonatorum — — — — 2 1 1 — 1 1 1 — 1 — — — 1 — Pneumonia—A. Influenzal 7 6 13 5 12 19 2 4 10 5 18 11 3 2 5 3 4 6 „ A. Primary 11 5 23 11 15 6 10 7 53 31 36 24 4 3 2 1 5 — Puerperal Fever — 1 — 1 — 1 — — '— — — — — — — 1 — — „ Pyrexia — 2 — 3 — 11 — 2 — 10 — 10 — 1 —. 1 — 2 Scarlet Fever 17 13 26 28 16 25 12 16 24 44 28 38 8 7 — 3 10 8 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 DDiphtheria and Memb. Croup 2 3 5 6 12 15 9 11 14 14 70 61 18 13 1 12 7 31 2 5 3 2 — 1 TTyphoid and Continued Fever — — — — — — — — — — — 2 1 — — 1 2 11 1 1 1 2 — iErysipelas 1 1 2 — — 1 — — — — — 1 — 3 3 2 5 7 7 5 8 13 4 6 PPneumonia—A. Influenzal ... 1 2 1 — — 2 2 2 3 1 3 7 2 — 5 1 13 14 16 9 21 15 7 8 „ A. Primary 21 14 19 11 7 11 2 5 8 4 19 14 5 2 8 1 23 2 17 7 24 13 6 4 SScarlet Fever 1 1 2 6 5 8 8 8 8 20 55 64 27 25 12 12 18 29 3 8 2 1 — — 14 SCARLET FEVER. During 1929 there were 323 cases of scarlet fever notified. Of the cases notified 2 were under the age of 1 year, 65 between the ages of 1 and 5 years, 171 between the ages of 5 and 15 years, 71 between the ages of 15 and 35 years, and 14 over the age of 35 years. Of the 323 cases, 306 were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. There were no deaths from this disease during the year. 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. 1929. 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. 18. Totals. London 1,098 1,084 1,097 1,019 1,059 918 955 949 973 1,417 2,003 1,809 1,571 15,952 Paddington 27 28 29 23 23 30 17 11 13 29 25 35 33 323 Wards— Queen's Park 3 1 2 6 1 1 2 3 1 1 3 3 3 30 Harrow Road 4 7 2 5 5 5 1 2 2 7 4 7 3 54 Maida Vale — 4 6 4 1 8 2 — — 2 2 5 7 41 Town 2 1 l — 1 2 — 1 3 3 4 7 3 28 Church 5 4 6 2 6 5 5 3 5 7 7 5 8 68 Westbourne 6 6 8 3 5 5 5 1 1 9 1 7 9 66 Lancaster Gate, West 2 3 — 1 1 2 — 1 1 — 3 1 — 16 Lancaster Gate, East 1 — — — — 1 1 — — — — — — 3 Hyde Park 4 2 4 2 3 1 1 — — — 1 — — 18 DIPHTHERIA. (Including Membranous Croup). During 1929 there were 311 cases of diphtheria and 6 of membranous croup notified. Of these there were 5 cases under the age of 1 year, 86 between the ages of 1 and 5 years, 162 between the ages of 5 and 15 years, 51 between the ages of 15 and 35 years and 13 aged 35 years and upwards. Of the 317 cases, 303 were removed to Isolation Hospitals. Fourteen cases were treated at home, proper facilities being available for isolation and treatment. Nine deaths from this disease occurred during 1929, 5 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 „ 1929 9 „ 15 Seasonal prevalence.—The following table shows the numbers of cases notified in each fourweekly period during 1929. 1929. 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. 0. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13 Totals. London 906 845 810 818 683 683 803 662 640 1,094 1,360 1,372 1,222 11,898 Paddington 19 14 18 11 31 20 22 9 17 39 38 41 38 317 Wards— Queen's Park 3 — — 3 — 1 3 1 1 4 1 2 3 22 Harrow Road 5 5 4 1 2 4 — 2 4 8 10 7 4 56 Maida Vale 5 1 1 3 14 6 5 1 — 8 10 13 10 77 Town — 1 2 — 2 — 2 — 1 2 l 1 6 18 Church 1 2 2 3 4 2 6 2 6 11 7 3 5 54 Westbourne 1 3 6 — 5 2 — 2 3 5 6 11 7 51 Lancaster Gate, West — — 1 1 — 2 4 — 1 1 — — 2 12 Lancaster Gate, East — — 1 — 1 2 1 1 — — 1 2 — 9 Hyde Park 4 2 1 — 3 1 1 — 1 — 2 2 1 18 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 30 phials of 4,000 units and 12 phials of 500 units were distributed. SMALLPOX. Six cases of this disease were brought to notice during the year. Of these three were notified, one was not notified until the case had left the borough, and the other two were residents of other areas attending a hospital in Paddington. One case was that of a woman who arrived in Paddington after a voyage on the “Tuscania,” where several smallpox cases occurred. Shortly after arrival she was found to be suffering from smallpox which was of the classical or eastern type, somewhat modified by the fact that vaccination had been performed during the incubation period of the disease. The remaining-cases were of the mild prevailing type of the disease. Two of them, occurring in Queen's Park Ward, were thought to have contracted the disease from a previous case in Willesden. In another case occurring in Westbourne Ward the source of infection was not traced. A woman in-patient of the Hospital for Women and Children, Harrow Road, was found to be suffering from smallpox after a long stay in the Hospital. She was probably infected by some visitor. Owing to the energetic measures adopted by the authorities at the Hospital, no further cases occurred. A child, living in Willesden, was found to be suffering from smallpox whilst attending the out-patient department of Paddington Green Children's Hospital. Towards the latter part of the year smallpox was prevalent in the east end of London. Very few cases, however, occurred in the western boroughs. 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. 16 Chicken-pox does not vary very much in its prevalence from year to year. The number of cases certified by medical practitioners was 382 last year and there were 186 cases reported from other sources, making a total of 568 cases. The disease was fairly uniformly distributed throughout the year with occasional localised outbreaks and a rather intensified prevalence during the first quarter of the year. Chicken-pox is not usually nursed in an institution, but 44 cases received institutional treatment for various reasons. The District Nursing Association's nurses attended 16 patients, 9 under and 7 over 5 years of age. The number of visits paid was 59 and 49 to each group respectively. In view of the prevalence of smallpox in other parts of London and the resemblance between chicken-pox and smallpox a large number of the cases of chicken-pox reported were visited by the Medical Officer of Health to verify the diagnosis. TYPHOID FEVER AND CONTINUED FEVER. Nineteen cases of typhoid fever were notified in 1929. In a few cases no doubt, the diagnosis was subsequently revised, but no accurate information is available on this point. Three 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. Of the 22 cases of typhoid fever and continued fever, 20 received hospital treatment. 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.” 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 1929, 210 cases of measles certified by medical practitioners, and 62 cases reported from other sources, the corresponding figures for 1928 being 2,862 and 571. The number of notified cases is analysed in the adjoining table in 4-weekly periods for the various wards. 1929. 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 8 24 49 32 36 21 5 7 3 3 3 4 16 210 Wards— Queen's Park 1 4 12 5 6 3 2 4 1 — 1 — 2 40 Harrow Road 1 2 3 4 8 3 1 — — — 1 2 2 27 Maida Vale 1 — 4 8 7 1 — 1 — 1 — — 3 26 Town — — 4 — 1 3 1 — — 1 — 1 1 12 Church 3 7 6 2 3 1 1 — — — — — 2 26 Westbourne 1 4 7 5 7 6 — 1 — — — 1 2 34 Lancaster Gate, West 1 2 1 1 — 1 — — — — 1 — 3 10 Lancaster Gate, East — 4 5 4 — 2 — — — — — — 1 16 Hyde Park — 1 7 3 4 1 — — 2 1 — — — 19 17 Two deaths were attributed to measles, one of a child aged between 1 and 2 years and the other of a child aged between 2 and 5 years. The Women Sanitary Inspectors visit cases of measles with few exceptions and arrange, where necessary, for the attendance of the District Nurses. The cases requiring nursing assistance during the year numbered 11 under 5 years of age and 8 over 5 years of age. The number of visits paid by the nurses was 61 and 38 to each group respectively. Thirty-eight cases received treatment in hospital. GERMAN MEASLES. This harmless, but infectious disease, is notifiable in Paddington; 1,163 cases were notified in 1929, as compared with 109 in 1928, 78 in 1927, 124 in 1926, and 375 in 1925. Nearly all the 1,163 cases occurred during the first half of 1929. Sixty-one patients received treatment in hospital. 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. Nine cases of purulent eye-discharge of the new-born were notified in 1929. Of these 8 recovered without any impairment of vision. The result of the remaining case is not known, the child having been discharged from hospital to another district. As soon as a case of this disease is notified, intensive efforts are made by the Council's staff to ensure that proper treatment is carried out. Daily visits are paid and private or charitable medical treatment is invariably enforced. Where necessary the infant and its mother are removed to a hospital, provision of this accommodation being ample. All necessary nursing attention is given by home visiting on the part of the Paddington and St. Marylebone District Nursing Association. In addition to true purulent discharges some eleven cases of slight discharge from the eyes of infants reported by midwives to the London County Council were referred to this Department and received attention, no doubt preventing in a few instances the onset of the more severe form of the disease. During 1929, 4 cases were referred to the District Nursing Association, 99 visits being paid. Six cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 4 cases of puerperal fever notified during 1929, all of which were removed to or nursed in a hospital. There is no difficulty in obtaining institutional treatment for women suffering from this disease. Cases of puerperal fever referred to the Metropolitan Asylums Board are concentrated as far as practicable in three institutions, namely, the Eastern Hospital, Homerton, the North-Western Hospital, Hampstead, and the South-Western Hospital, Stockwell, where special wards are set aside for these cases and special medical and nursing staffs provided. The Board have also provided an obstetric consultant at these three institutions. Paddington mothers go, as a rule, to the North-Western Hospital, Hampstead, which is within easy reach of the Borough. Six women were certified as having died from puerperal fever, two of them not having been formally notified. 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 100-4 degrees Fahrenheit, or more, has been sustained during a period of 24 hours or has recurred during that period.” The febrile condition referred to in the above definition may be due to any cause, and it may be to some cause quite independent of the puerperal condition. It may, however, be the precursor of the more serious condition known as puerperal fever, and it is with this in view that the numerous conditions comprised under the term puerperal pyrexia are made notifiable. During the year the Council retained the services of Mr. Aleck W. Bourne, F.R.C.S. (England), Obstetric Surgeon to Out-patients, St. Mary's Hospital, to act in a consultative capacity, for cases of puerperal pyrexia. Two requests for his assistance were made to the Council during the year. During the year 42 cases of puerperal pyrexia were notified, 40 of which occurred within or were removed to institutions. One case of puerperal pyrexia was nursed by the District Nurses at home, 80 visits being paid. ERYSIPELAS. Sixty-nine (69) cases were notified, 28 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. » One case of this disease, otherwise known as Infantile Paralysis, was 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. One case of this disease, somewhat similar in its nature to the last mentioned, was notified. ACUTE ENCEPHALITIS LETHARGICA. Five cases of this disease were notified. This disease, commonly known as " sleepy sickness," is found to be frequently the forerunner of progressive mental and physical deterioration, occasionally signalised by disorders of conduct. For this reason careful enquiry is made as to the after-history of all cases of this disease which are brought to notice. CEREBRO-SPINAL FEVER. Six cases of this disease were notified in 1929. MALARIA. No cases of this disease were notified. 19 ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. Two hundred and forty-seven (247) cases of acute primary pneumonia were notified in 1929, as compared with 202 in 1928, 183 in 1927, 184 in 1926 and 265 in 1925. Of the 247 cases, 169 were nursed in institutions. One hundred and thirty-five (135) cases of acute influenzal pneumonia were notified as compared with 59 in 1928, 107 in 1927, 76 in 1926 and 88 in 1925. Of the 135 cases, 69 were nursed in institutions. One hundred and five cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council scheme for district nursing, 1,564 visits being paid. ANTHRAX, CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. No cases of these diseases were notified during 1929. WHOOPING-COUGH. This disease is notifiable in only three 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 1929, 71 persons died of whooping-cough, 69 of these being children under the age of 5 years. The number of deaths in 1928 and 1927 were 12 and 38 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, 284, 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 m the hst following:— Numbers of Deaths in Paddington. 1929 284 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. Eight cases are not included owing to absence of information. 1929. Cancer. 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 — 1 _ 3 _ - 1 6 1 Pharynx, oesophagus, stomach, liver and annexa — — 1 — — — 2 1 8 4 13 8 7 15 10 11 41 39 Peritoneum, intestines and rectum - - - 1 1 1 1 6 6 8 6 10 7 7 21 33 Female genital organs - - — - - - - 2 — 11 - 5 - 13 - 6 — 37 Breast — — — — — - — 1 - 8 — 6 - 3 - 7 — 25 Skin — — — — — - — — — - — — 2 _ — _ 2 _ Other or unspecified organs — — - — — 1 2 2 8 1 17 7 14 13 4 2 45 26 - - i - - 2 5 7 19 30 37 34 32 54 21 34 115 161 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 1929, 52 cases of acute rheumatism were notified. This compares with 76 cases for 1928 and 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 1929 some 109 new cases attended the Centre, but of the 52 Paddington cases notified as "acute rheumatism" only 15 attended, including 9 cases notified from the Children's Hospital. The remaining patients either received treatment in institutions or 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. It was extended in 1929 for a further period of three years. Sixty-three cases of the disease were notified during the year. The number of deaths under the age of 5 years was 37 as compared with 23 in the year 1928, 16 in the year 1927 and 52 in the year 1926. 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. 21 TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number oi notification certificates received during the year 1929 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 111 deaths in 1929, and from other tuberculous diseases there were 17 deaths. The increased number of deaths from tuberculosis during the year is explained by the fact that an undue proportion of persons suffering from tuberculosis, often of long standing, succumbed to respiratory and catarrhal diseases, which were very prevalent during the year. The number of deaths from tuberculosis of all kinds was 118 m 1927, 116 m 1928 and 128 in 1929. 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 1929 128 Public Health (Tuberculosis) Regulations, 1912. Summary of Notifications on Forms A and B received during the year 1929. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year — — — — 1 1 1— 5 years — 2 2 5 9 14 5—10,, 1 1 2 21 11 32 10—15,, 1 1 2 4 1 5 15—20,, 9 12 21 4 5 9 20—25,, 20 29 49 3 2 5 25—35 „ 27 34 61 3 U 11 35—45,, 28 18 46 1 3 4 45—55,, 25 10 35 2 1 3 55—65,, 9 4 13 — — — 65 years and over,, 6 1 6 — 1 1 Total 125 112 237 43 42 85 Cases re-notified 81 78 159 14 7 21 Total Notifications on Form A 206 190 396 57 49 106 Primary Notifications by School Medical Officers— 0— 5 years - - - 1 1 2 5—10 — — — 1 — 1 10—15 2 2 Cares re-notified — — — 3 1 4 Total Notifications on Form B — — — 7 2 9 1929. No. of Notifications on Forms C and D. Poor Law Institutions. Sanatoria. c. d. c. d. Pulmonary Tuberculosis— Male 15 30 96 58 Female 16 27 79 36 Non-Pulmonary Tuberculosis— Male - 8 18 16 Female o 5 12 13 22 Public Health (Tuberculosis) Regulations, 1921. Cases removed from Register :— By reason of— 1929. Death 125 Removal 151 Recovery of patient or variation of diagnosis 39 Total 315 Of the patients who removed from the Borough during 1929, the new addresses were obtainable in 79 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1929, 16 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 1929 was 1,610 as compared with 1,570 at the close of the year 1928. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 1,610 By Tuberculosis Officers 503 By Dispensary Nurses— 20, Talbot Road 2,895 St. Mary's Hospital 1,921 6,929 Tuberculosis. New Cases and Mortality During 1929. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F M. F. M. F. M. F. 0 — - - - 1 - - - 1 1 — - 2 6 10 — — 3 1 5 — 1 1 22 12 - — 1 2 10 — 1 2 6 1 15 — 9 14 4 6 7 14 1 2 20 — 21 29 3 3 25 — 27 34 3 8 28 17 — 2 35 — 28 19 1 3 45 — 25 10 2 1 29 10 2 — 65 — 9 4 - - 65 and upwards 5 1 — 1 4 2 1 1 Totals 126 116 47 46 68 43 8 9 No notifications were received with regard to 20 persons dying from tuberculosis during the year, this number being equal to 15'6 per cent, of the total tuberculosis deaths recorded. In all cases where it appeared necessary, inquiries were made as to the reason for the absence of notification. 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 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. No use has so far been made of these regulations. 23 Supply of Beds and Bedding.—In certain instances, so that the separate sleeping oi tuberculous patients may be arranged, beds and bedding are supplied on loan by the Council. Eight sets were so supplied during 1929 and 6 sets were returned following the death or removal of the patient Shelters.—The Council possesses four shelters, which, on the recommendation of the Tuberculosis Officers, are lent to patients who are able to make use of them. During 1929 two shelters were lent and three returned. Artificial Pneumothorax Treatment.—By arrangement with Brompton Hospital patients recommended for this treatment are given refills at a cost to the Council of 10s. 6d. per refill. During 1929, 10 patients were referred to the Hospital, the number of refills received by each being respectively 23, 19, 11, 11, 10, 10, 6, 4, 3 and 1. The total cost amounted to £51 9s. Od. Dental Treatment.—Dental treatment for tuberculous persons attending either of the Tuberculosis Dispensaries is provided at 20, Talbot Road, by the Committee of the Paddington Tuberculosis Dispensary, in return for a payment by the Council of the sum of £90 per annum. A Dental Surgeon is in attendence one half-day weekly. Arrangements have also been made for the supply of dentures by the Dispensary Committee. In connection therewith 7 patients were supplied with full dentures, 4 with partial dentures and in 3 cases dentures were repaired. Out of a total cost of £47 lis. 0d., grants to the amount of £15 17s. 6d. were made by the Council, the balance being contributed by the patients, approved societies or other agencies. 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 1929. 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 165 15 - 12 — 7 32 112 8 5 - 7 — 30 67 21 Children 146 34 1 1 — 5 49 153 - — — — 1 59 — 33 Men 52 — — — — 9 7 69 4 3 — — - 16 20 5 Total 363 49 1 13 — 21 88 334 12 8 — 7 1 105 87 59 Number of Sessions held = 49. 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 ShirlandRoad 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 1929, 50 patients received treatment, 975 exposures being given. All that can be said so far of this treatment is that the results are encouraging. New arrangements are now in force for the X-ray examination of patients, through the services of a consulting Radiologist who resides close to the Dispensary. Return Showing the Work of the Dispensary During the Year 1929. 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 42 38 2 2 1 8 22 10 43 46 24 12 (b) Doubtfully tuberculous — — — — — — — — 32 65 38 35 (c) Non-tuberculous — — — — — — — — 73 188 120 168 b.—Contacts examined during the year :— (a) Definitely tuberculous 3 3 - - - 1 1 5 3 4 1 5 (6) Doubtfully tuberculous - - - - - - - - 6 2 5 9 (e) Non-tuberculous — — — — — — — — 46 61 63 47 c.—cases written ofi the Dispensary Register as (a) Cured - - - - - - - - - - - - (6) Diagnosis not confirmed or non - tuberculous (including cancellation of cases notified in error) - - - - - - - - 157 320 233 269 d.—number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 197 239 4 2 46 57 228 172 243 296 232 174 (6) Diagnosis not completed - — — — — — - — 6 5 4 2 1. Number of persons on Dispensary Register on January 1st 924 2. Number of patients transferred from other areas and of " lost sight of" cases returned 25 3. Number of patients transferred to other &.reas and cases " lost sight of " 48 4. Died during the year 56 6. Number of observation cases under A (b) and B (b) above in which period of observation exceeded 2 months 18 6. Number of attendances at the Dispensary (including Contacts) 6,409 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision - 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 46 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 99 10. Number of consultations with medical practitioners :— (а) At Homes of Applicants 69 (б) Otherwise 190 11. Number of other visits by Tuberculosis Officers to Homes 370 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,895 13. Number of (а) Specimens of sputum, &c., examined 681 (б) X-ray examinations made in connection with Dispensary work 31 14. Number of Insured Persons on pensary Register on the 31st December 370 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 160 16. Number of reports received during the year in respect of Insured Persons :— (а) Form G.P. 17 18 (б) Form G.P. 36 104 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 1929. 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 1929. 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 25 25 - - 3 7 3 1 28 32 3 1 (b) Doubtfully tuberculous — — — — — — — — 6 25 4 3 (c) Non-tuberculous - - - - - - - - 18 15 16 15 b.—Contacts examined during the year :— (a) Definitely tuberculous - - 2 - - - - - - - 2 - (6) Doubtfully tuberculous - - - - - - - - 2 4 1 — (c) Non-tuberculous - - - - - - - - 5 25 13 13 C.—Cases written off the Dispensary Register as (a) Cured - - - - - - - - - - - - (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 29 68 36 30 d.—number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 73 59 2 4 51 47 50 31 124 106 52 35 (b) Diagnosis not completed - — - - - - - - - - — - 1. Number of persons on Dispensary Register on January 1st 285 2. Number of patients transferred from other areas and of " lost sight of " cases returned 15 3. Number of patients transferred to other areas and cases " lost sight of " 34 4. Died during the year 17 6. Number of observation cases under A (6) and B (6) above in which period of observation exceeded 2 months 8 6. Number of attendances at the Dispensary (including Contacts) 3,777 7. Number of attendances of non-pulmonary cases at Orthopaedic Out-stations for treatment or supervision - 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 10 9. Number of patients to whom Dental Treatment was given, at or in connection with the Dispensary 7 10. Number of consultations with medical practitioners :— (а) At Homes of Applicants - (б) Otherwise 45 11. Number of other visits by Tuberculosis Officers to Homes 133 12. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,921 13. Number of (а) Specimens of sputum, &c., examined 104 (б) X-ray examinations made, in connection with Dispensary work 63 14. Number of Insured Persons on pensary Register on the 31st December 166 15. Number of Insured Persons under Domiciliary Treatment on the 31st December 5 16. Number of reports received during the year in respect of Insured Persons :— (a) Form G.P. 17 1 lb) Form G.P. 36 2 26 The Borough Tuberculosis Care Committee. During 1929, the constitution of the Tuberculosis Care Committee was as follows :— Representing. Paddington Borough Council Councillor Mrs. R. M. Drury (Vice-Chairman). ,, „ Dr. H. B. Morgan. ,, ,, Dr. G. E. Oates, Medical Officer of Health. ,, ,, Miss L. M. O'Kell, Sanitary Inspector. „,, Miss I. L. Buckledee, 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 Liddiard 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. M. Wetherall (Lady Almoner). United Services Fund Miss M. M. Barthorp. ,, „ Mr. J. E. Bennison. 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 Derformed 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 on 22 occasions during the year, and the attendance of members was well maintained. Two hundred and eighty-three individual cases were considered. Residential treatment was granted by the London County Council to 166 patients, 27 of whom were children under the age of 16 years. In each instance the financial circumstances of the patient were carefully considered by the Care Committee, and a recommendation was forwarded to the County Council as to whether free treatment should be granted or a contribution assessed. Of the 166 patients, 120 received free treatment, the remaining 46 patients, or their parents, paying contributions varying from 2s. 6d. to £1 a week. Payments are collected by the Committee and transmitted monthly to the County Council. During the year a total of £340 18s. Od. was dealt with in this manner. It not infrequently happens that after a case has been assessed, a revision of the rate of contribution is rendered necessary owing to a change in the circumstances of the family. During 1929, 9 assessments were revised in amount by the County Council on the recommendation of the Care Committee, and in 2 further instances payments of the contributions were excused for stated periods. Typical examples of the help rendered by the Committee in connection with the social welfare part of their work have appeared in previous Annual Reports. During 1929, the Committee were able to arrange for assistance in the form of clothing, extra nourishment or monetary grants to be given to 21 patients, or their dependants, by various charitable organisations, including the Charity Organisation Society, the United Services Fund, the British Red Cross Society, the British Legion, the Royal Naval Benevolent Society and the Distressed Widows' Fund Several patients were helped to find suitable employment, and action was taken on behalf of others with a view to obtaining settlement of difficulties connected with the payment of insurance benefit. 27 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. The Health Visitors attend several consultations weekly at the Paddington School for Mothers; they also 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 2,036 Revisits 2,375 4,411 Ante-natal— First visits 514 Revisits 419 933 OTHER VISITS. Puerperal Fever and Puerperal Pyrexia 137 Ophthalmia Neonatorum 270 Diarrhoea 313 Miscellaneous 1,136 1,856 Particulars recorded as to Method of Feeding. Breast. Artificial. Mixed. Total. Number 1,411 115 88 1,614 Percentage 87.4 7.1 5.5 AGES AT FIRST VISIT. Breast. Method of Feeding. Totals. Artificial. Mixed. Weeks fo- 15 2 2 19 1- 580 25 17 622 2- 550 30 24 604 3- 125 16 9 150 Months 0- 1,270 73 52 1,395 1— 90 12 8 110 2— 30 10 8 48 3 and upwards 21 20 20 61 DIED BEFORE END OF YEAR : 46. Breast 33 Artificial 7 Mixed 6 CAUSES OF DEATH. Diarrhceal Diseases 20 Whooping Cough ___ Respiratory „ 12 Measles Atrophy, Debility 4 Premature Birth 3 Congenital Defects 3 Other Causes 4 Institution Deaths 41 (Paddington Infirmary 24). 28 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, 2.30 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served.—Lancaster Gate East and West Wards and part of Westbourne Wards. 29 North Centres. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large double room, doctor's room and sales room, warmed by gas radiators and hot pipes. Established 1911, at Emmanuel Hall, Harrow Road. Moved June, 1916, to St. Peter's Institute, Chippenham Mews. Moved to present address, November, 1916. Two Infant Consultations weekly.—Tuesday, 2.30. Medical Officer Dr. 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. 9.—Large hall, doctor's and weighing rooms, warmed by gas radiators and gas fires. Established December 6th, 1920. Two Infant Consultations weekly.—Wednesday, 2.30. Medical Officer, Dr. J. McKail. Thursday, 2.30 (as from June 27th, 1929). Medical Officer, Dr. Hubert Hodge. Area served :—Part of Maida Vale Ward and 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. Transferred to St. Simon's Parish Hall, Macroom Road, W. 9, as from June 27th, 1929. One Infant Consultation weekly to June 20th, 1929.—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, and on Thursday mornings as from May 23rd, 1929. Sewing Classes (temporarily suspended in February, 1928) were re-opened March 1st, 1929, and are held weekly at 232, Harrow Road, except during the summer months. Dental Arrangements.—Messrs. J. Trude Fripp and F. H. Brinckley Tofts, 281, Harrow Road, and the Lissonia Dental Clinic treat mothers and children who attend Centres, on special terms. Assistance, when necessary, given from Vest Fund. Lectures.—Lectures are provided from time to time, on Health topics at all Centres. Convalescent and Holiday Homes.—Mothers and children are sent to Convalescent and Holiday Homes on recommendation of Medical Officers at Centres. All arrangements made by School workers, and assistance given when necessary, from the Vest Fund. Vest Fund.—A small Association of ladies connected with the School, knit garments and woollies which are sold to the mothers at low cost at the Centres. The stock is augmented by gifts from friends, and the money realised is spent on dentures, convalescence, etc. Artificial Sunlight Treatment can be procured for cases recommended by doctors at Centres, at St. Mary's Hospital and the Children's Hospital, Paddington Green. 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, 1929. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Randolph Gardens. Sovereign Mews. Queens- boro' Passage. Totals. Tues. Thurs. Tues. Fri. Wed. Thurs* Wed. Thurs.† Fri. Mon. Number of Sessions 50 51 50 49 50 24 50 25 50 47 446 Number of Attendances 2565 163 3364 2832 3313 870 2104 521 1012 1700 20,444 Average Attendance 51-30 42.41 67.28 57.80 66.26 36.25 42.08 20.84 20.24 36.17 45.83 Seen by Doctor 969 845 1093 796 869 455 993 274 575 952 7821 Average number seen by Doctor at each Session 19 16 22 16 17 19 20 11 11 20 17 * Opened 27th June, 1929. † Closed 20th June, 1929. Ante-Natal Clinic. Number of Sessions 48 Number of Attendances 649 by 297 expectant mothers. Average Attendance per Session 13.52 Number of cases referred by midwives in private practice 74 Home Visiting. Visits to Babies 11,960 Visits to Expectant Mothers 417 Other Visits 8,003 Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,234 9 3 Sales 1,206 0 6 Grants from Borough Council 45 17 0 Queen Charlotte's Maternity Hospital.—During the year 1929, 99 infants of mothers resident in Paddington attended the Infant Consultation Centre. Each attended about 26 times. As regards ante-natal consultations, exact figures are not available During 1929 there were received into the Hospital for confinement 270 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 4 per patient. With regard to out-patients in 1929, 397 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about 4 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 1929 was 113 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 1929, 113 confinements were attended by the nursing staff, the number of visits being 1,846. These figures compare with similar ones of 154 and 2,610 in the year 1928. The annual grant in aid of this work is now £175. Maternal Consultations.—On two occasions the Council's obstetric consultant was asked to see patients in consultation with private practitioners on account of complications associated with parturition. 31 DAY NURSERIES. At the end of the year 1929, there were two day nurseries in Paddington, situated at No. 66, Lancefield Street, Queen's Park, W.10, and No. 21, Howley Place, W.2. Statistical Summary. Queen's Park. Howley Place. Days open Full days. Saturdays- Full days. Saturdays- 243 45 238 40 Attendances 5,294 294 8,129 695 Average attendance 21 6 34 15 New Children 47 89 Cases of Infectious Disease. Diphtheria — — Scarlet Fever 4 — Measles — Whooping Cough — 2 Chicken-pox 3 — There were no Closures during the Year on account of infectious disease On April 30th, 1929, the Council accepted the assignment of the lease of the premises No. 66, Lancefield Street, occupied by the Queen's Park Day Nursery, under the bequest of the late Miss N. L. Bruce. The premises are now let to the Committee of the Queen's Park Day Nursery at an annual rental. 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 when not attending school. Before any case is considered the Medical Officer of Health must be satisfied that the supply is necessary on grounds of health. In the case of an expectant mother the existence and duration of pregnancy must be verified by the signature of a doctor or midwife. The quantity of milk authorised varies with the need of the mother or infant concerned. Usually one pint per day is granted to an expectant mother and to a nursing mother, unless she be nursing twins when one quart is allowed. The bottle-fed baby, also, normally has the same quantity up to about the sixth month of its age but thereafter this is increased to 1£ or 2 pints per day when the necessity is certified by the medical officer of a Welfare Centre. In cases where dried milk is prescribed one packet (one pound) is considered the equivalent of seven pints of milk. The " Grants" Sub-Committee has latterly made a practice of insisting on the attendance periodically of the infants on grant at one or other of the welfare centres and the issue of at least one medical certificate of necessity every three months. 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 all 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 for guidance in deciding 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. 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 dairyman usually supplying the family ; 32 (b) Dried Milk—supplied at the Welfare Centre attended by the infant; and (c) Dinners (cut from joint, two vegetables and "sweet") to expectant or nursing mothers partaken at approved restaurants. The necessary orders are despatched on the evening of the day on which the Sub-Committee sits, one copy to the tradesmen and one to the grantee. On the latter the following conditions are printed :— Milk supplied under this order is to be used only for the mother or child to whom the milk has been granted. It is not to be given to other members of the family. The Medical Officer of Health should informed at once if there be :— (1) Any change whatever in workplace or income of any member of the family ; (2) Any change of address; or (3) Any assistance received from the Relieving Officer. During the year the following quantities of milk were issued to necessitous mothers :— Fresh Milk 11,462 quarts. Dried Milk 600 lbs. The approximate cost of milk given in this way was £362 17s. 7d. Income Scale. Free. Half-Price. Number of family. Total Income less Rent. Total Income less Rent. 1 15/- 18/- 2 20/— 24/- 3 25/6 27/- 4 30/- 34/- 5 32/6 37/6 6 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 during 1929. (1928 figures in brackets). The total number of cases considered by the "Grants" Committee during the year was 1,300 of which 443 represented new applications. These latter were divided up as follows :— r of New Applications. Granted. Refused or referred to Guardians. Fresh Milk 390 Dried Milk 53 Dinners — (338) (47) (-) 288 49 (234) (39) (-) 102 4 - (104) (8) (-) 443 (385) 337 (273) 106 (112) Number of Orders for Milk 1,015 At Total Cost 979 At Half Cost 36 Number of Quarts at Total Cost 11,029 „ „ „ Half Cost 433 Total Number of Quarts 11,462 Cost of Milk at Total Cost £ s. d. 311 2 6 „ „ Half Cost 5 18 1 £317 0 7 Number of Orders for Dried Milk 152 At Total Cost 152 At Half Cost Total Cost of Dried Milk £45 17 0 Number of Orders for Dinners Number of Dinners supplied at Total Cost - Total Cost of Dinners - 33 Invalid Children's AiD Association. A grant of £10 in aid of the funds of the local branch of the Invalid Children's Aid Association was made. Convalescent Home. One nursing mother, with her baby, was admitted to St. Mary's Convalescent Home, Birchington-on-Sea, for a period of two weeks. Part of the cost was borne by the Council, and the remainder by the husband. MATERNAL MORTALITY. During the year five maternal deaths were enquired into by Dr. E. Dorothy Fenwick, the Council's medical investigator, and reports thereon were forwarded to the Maternal Mortality Committee of the Ministry of Health. ADMINISTRATION. GENERAL. Staff of the Department.—Miss I. L. Buckledee, who had been engaged in the Council's service as a temporary Sanitary Inspector since October 15th, 1928, following the resignation of Miss Nicolas, was appointed a Sanitary Inspector on the permanent staff on January 29th, 1929. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 7,610. This fig jre 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 1,310. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 156 patients (comprising 19 cases of measles, 105 of pneumonia, 28 of whooping-cough, and 4 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 2,035. Disinfection.—The rooms disinfected after infectious disease numbered 1,335, including 204 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 27 tons. One hundred and sixty library books were disinfected. Schools.—A total of 3,262 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their " contacts," 2,591 of such notices referring to cases of measles, whooping-cough and chicken-pox, and the remainder to cases of diphtheria, scarlet fever and other notifiable diseases. In addition 492 reports were sent to the medical officers of health of other boroughs in connection with cases attending outlying schools. Bacteriological Work.—The Council have arrangements with the Lister Institute of Preventive Medicine, Chelsea Bridge Road, S.W.I, and the Royal Institute of Public Health 37, Russell Square, W.C.I, 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 either Institute by special messenger. 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 during 1929 were as follows :— Disease suspected. Number of Examinations Number of Positive Results. Diphtheria 1,242 123 Tuberculosis 422 62 Typhoid Fever 5 2 House Drainage.—During the year 53 existing drains were tested and found water-tight. 97 defective drains were reconstructed and 5 made sound by special process. 34 Reconstruction Plans.—Two hundred and eighty-two (282) plans were submitted for drainage works in existing buildings. In connection therewith 601 letters were despatched. No summonses were issued for failure to supply plans. Combined, Drainage.—Orders were made under Section 74 of the Metropolis Management Act, 1855, with respect to new drainage systems to which the following groups of houses were to be connected :— Lancaster Gate, Nos. 66, 67, 68 and 69. Hyde Park Terrace, Nos. 15 and 16. Harrow Road, Nos. 512, 514 and 516. Elgin Avenue, Nos. 298 and 300. No combined systems were reconstructed by the Council during the year. Sewer Connections.—In 1929, 47 were reconstructed, either partially or wholly, 8 after Orders under Section 85 of the Metropolis Management Act, 1855, and 39 on the initiative of the owners of the properties concerned. Water Supply.—One certificate under Section 48 of the Public Health (London) Act was issued. The Metropolitan Water Board reported 8 cases of discontinuance of water supply. In six instances the supply was disconnected in consequence of non-payment of water rate, and in two instances on account of defective fittings. Three of the premises were found not to be used as dwellings. The water supply was restored to four of the five inhabited houses within a few days of the disconnection. In the remaining instance the premises were vacated shortly after the receipt of the report from the Board, the water supply being reinstated some months later when the premises were again occupied. No legal proceedings were necessary. Mortuary—Four hundred and twenty (420) bodies were deposited at the Mortuary, inquests being held on 196 of that number. Bodies deposited pending burial (all noninfectious) number 224. Trade Nuisances.—Twenty-four complaints were received during the year, those relating to manure numbering 8. 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, 1929, there were 12 rag and bone dealers in the Borough. Smoke Control.—During 1929, 18 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 138 occasions, occupying 42f hours. Smoke of all descriptions was noted during 23| hours, the duration of " black " smoke being only 2 hours. Nine complaints relating to the emission of smoke were received during the year. One Written Intimation was served together with numerous informal communications. No Statutory Notices were served. FOULING OF PUBLIC FOOTWAYS BY DOGS. The following bye-law was made by the Council on the 29th July, 1924, for the good rule and government of the Borough :— No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this bye-law shall be liable to a penalty not exceeding 40 shillings. This bye-law shall cease to be in force after the first day of August, 1926, unless a bye-law confirming and continuing its provisions has been duly made and come into force before that date. In July, 1926, the bye-law was adopted permanently by the Council. 35 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 1929 three prosecutions were instituted, resulting in two defendants being fined the sum of ten shillings each, and the other six 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, now the Grand Union Canal. 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. The following report for the year 1929 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 1929.—One hundred and fifteen inspections of canal boats were made during the year, and the following infringements of the Acts and Regulations were discovered :— Cabins leaky 9 Cabin floors defective 6 Stoves and stove pipes defective 7 Boats without certificates 6 Lettering, marking and numbering illegible 4 Painting of cabins required 13 Six formal notices were served. On no occasion was admission to a boat refused, and no legal proceedings were necessary in respect of any of the infringements discovered. There were five cases of infectious disease notified:—infective enteritis 1, diphtheria 1, whooping-cough 1, and acute primary pneumonia 2. There were six deaths reported amongst canal boat dwellers, one being that of a male aged 52, who died from drowning. No boats were registered, but the registration of one boat was cancelled in consequence of the re-registration of the boat by another authority. One hundred and eighteen children of school age were found to be living on the canal boats using the Paddington Basin (61 males, 57 females). The total number of boats in respect of which certificates of registration had been issued at the end of the year was 248 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 829 tons of mud were removed from the bed of the Basin, in addition to 838-| tons which were dredged previously. Portions of the bed of the Basin were repaired. 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 36 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 31 inhabited boats known to be conveying house refuse from Paddington Basin, nine were found to be fitted with double bulkheads. The remaining 22 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. Two applications under this Section were made during the year relative to the conversion into flats of Nos. 9 and 16 Palace Court. An application was also made under Section 84 of the Law of Property Act, 1925, with respect to the conversion into flats of No. 39, Queensborough Terrace. Plans were submitted to the Council under the drainage bye-laws, relative to the conversion of 29 premises into 87 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 411 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 1929. 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, or under Section 96 of the Public Health (London) Act, 1891. Tenement Houses.—There were no additions to the Register, the total remaining the same as at the close of the previous year, viz., 1,406. The inspections made by the two Special Inspectors numbered 6,904. Particulars of the defects, etc., discovered and remedied will be found on pages 38 and 39. Overcrowding.—During 1929 six tenements in registered houses were reported to be overcrowded. In only two instances was it possible to secure the abatement of 4he overcrowding before the close of the year, the occupants of the remaining four tenements being unable to find other accommodation. 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 983 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 7 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. 37 RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, ;1920-1925. Four applications for certificates were made, all of which were granted. 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. Table No. 1 (Housing). Estate. Submitted. Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 41 3 25 5 8 Downham 7 6 — 1 St. Helier 6 — 6 — — - Watling 6 — 6 - — - Wormholt 17 4 12 1 — - 77 13 49 7 8 — In addition to the above figure of 13 housed, 17 families were housed on the different Estates on applications submitted to the London County Council previously to 1929. This figure brings the total number of Paddington applicants housed during the year to 30. The Table refers only to the number of applications submitted to the London County Council: it gives no indication of the number remaining on the " waiting lists," which is over 1,150 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 187 new applications were accepted, and over 1,750 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 they were dealt with since the inception of the Scheme up to the end of 1929. Table No. 2 (Housing). Estate. Number of Applications Received. Number Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 355 99 130 57 48 21 Castelnau 28 11 17 — — Downham 225 99 71 10 12 33 Old Oak Common 6 3 — 1 2 Roehampton 46 23 19 2 2 — St. Helier 124 — 124 — — — Tottenham 34 13 12 — 5 4 Watling 629 105 454 39 20 11 Wormholt 568 156 362 36 13 1 2,015 509 1,189 145 102 70 The following Estates on which 410 Paddington residents have obtained accommodation are now completed, the Borough receiving the full quota of houses :—Castelnau, Downham, Old Oak Common, Roehampton, Tottenham, Watling and Wormholt. There is a total of 935 Paddington applicants remaining on the several lists for these Estates awaiting accommodation. The development of the new St. Helier Estate at Morden is proceeding and applications are now being forwarded as and when required to the London County Council. 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 38 150 families on the Wormholt Estate, Hammersmith, the Borough Council to pay to the London County Council the sum of £7 per annum for a period of 20 years for each house occupied. The 150 families are now in occupation. During the year 4 vacancies occurred and new tenants were admitted at once from the waiting list. The following analysis of 200 cases of overcrowding remaining on the list after completion of the Watling Estate, and, similarly, 150 cases for the Wormholt Estate, gives some indication of the urgent need for the provision of further housing accommodation for the Boroughs Number in family, including Parents. Number of Rooms Occupied. 1. 2. 3. 4. 5. 3 48 - 4 65 - — — 5 32 43 - — — 6 9 50 - — — 7 3 24 14 — — 8 1 13 13 — — 9 9 8 4 — 10 1 4 2 1 — 11 — 1 2 — — 13 — 2 — — 1 Defects,Nuisances and Contraventions of Bye-laws (other than items of Dilapidation Discovered and Remedied in Registered Tenement Houses. - 1929 Drain defective 1 „ choked 49 „ not properly ventilated or ventilating pipe defective 4 Manhole cover defective 16 Gully choked 37 Soil pipe defective — Water-closet defective 52 „ choked 72 „ without sufficient flush 77 „ flushing apparatus defective 65 „ foul 24 „ improperly constructed — „ accommodation insufficient 1 „ without door, door defective, or without proper fastenings 85 Rain-water pipe defective 48 „ choked 27 Guttering defective 44 Waste pipe defective 19 „ choked 14 „ untrapped 1 „ not provided or missing 1 Sink defective or not provided 9 Other drainage defects 2 Cistern defective 13 „ dirty 16 „ without proper cover or cover defective 8 Dustbin defective 150 „ not provided 4 „ insufficient 31 „ disused and not abolished 1 Paving of yard or area defective 81 „ washhouse defective 53 Premises damp 56 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 3,427 „ verminous 54 „ contents, bedding, etc., dirty 10 „ not provided with a window opening directly to the external air — Chimney smoky 26 Food cupboards not provided — Windows defective including cords and fastenings out of repair 804 Roof defective 304 Common staircases out of repair 87 Staircases without sufficient handrail 8 Animals improperly kept — Accumulation of refuse (not offensive) 21 Premises without water or supply insufficient 5 Any other defects, etc. 76 Rooms without proper cooking range — 39 Overcrowding. 19-9 Tenements overcrowded 6 Rooms overcrowded 9 •Occupants, total 46 Under 10 16 10 and upwards 30 Overcrowding abated— By re-arrangement 1 By voluntary removal — Under notice 1 Cases held over 4 Notices Issued. Written Intimations 704 Statutory Notices 171 Bye-law „ 746 Notices under L.C.C. (G.P.) Acts— Verminous rooms 25 Additional taps — Abolition of old dustbins — 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 130 Matchboarding defective 3 Wall-paper loose 19 Skirting defective 3 Doors defective or missing 35 Locks defective 39 Ceiling plaster defective 68 Ceiling paper loose 23 Floors broken or badly worn 72 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 307 Stove settings defective 5 Flues defective — Hearths defective 44 Chimney-pieces loose or defective (including jambs, frieze, or mantle broken, loose, or missing) 70 Cupboard doors defective or missing and shelves missing 22 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 123 Window-frames loose or defective (including oak sills worn or rotten) 30 Window-glass broken 183 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 138 Steps to front entrance or area defective 7 Railing to area or area steps defective 9 Guard rails to addition roofs defective, broken or rotten 9 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 10 Vault doors missing or defective 13 HOUSING (Ministry of Health Table ) Number of New Houses Erected During the Year. (a) Total 1 (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 2,396 (b) Registered tenement houses inspected 983 (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. 40 III.—Action under Statutory Powers. (A) Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *411 (2) Number of dwelling-houses which were rendered fit— (a) by owners 350 (approx.) (b) by Local Authority in default of owners — (3) Number of dwelling-houses in respect of which Closing Orders became operative in pursuance of declarations by owners of intention to close — (B) Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,613 (2) Number of dwelling houses in which defects were remedied— (a) by owners ... ... 1,403 (b) by Local Authority in default of owners — (C) Proceedings under Sections 11, 14 and 15 of the Housing Act, 1925— (1) Number of representations made with a view to the making of Closing Orders — (2) 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. 1929. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 951 — — Workshops (including workshop laundries) 1,716 — — Workplaces (other than outworkers' premises) 219 — — Total 2,886 — — 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 97 93 — — Want of ventilation 2 2 — — Overcrowding 2 2 — — Want of drainage of floors — — — — Other nuisances 27 25 — — Sanitary accommodation insufficient — — — — unsuitable or defective 15 15 — — not separate for sexes 2 2 — — 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 145 139 — — * Including those specified in sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 41 Outwork in Unwholesome Premises, Section 108 Nature of work. Instances. Notices served. Prosecutions. Wearing Apparel— Making, &c. — — — 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, &c. — — — Stuffed toys — — — Basket making — — — Chocolates and sweetmeats — — — Cosaques, Christmas crackers, Christmas stockings, &c. — — — Textile weaving — — — Total — — — At the end of the year 1928, 1,165 premises were on the Register as compared with 1,148 at the end of the year 1927. During the year 1929, 42 premises were removed from the Register and 49 added, making the total at the end of the year, 1,172. The Department reported the opening of 10 workshops to the Home Office, and received from that Office, notice of 24, 21 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 25 lists in February and 24 lists in August. These lists contained 306 names and addresses of which 228 were forwarded to other districts. From other districts 221 addresses within the Borough were received. Supervision.—There were during the year, 2,886 inspections, comprising 951 of factories, 1,716 of workshops and 219 of workplaces. There were 145 nuisances or defects found upon registered premises, 139 of which were remedied during the year, the majority being remedied by verbal request. The defects found comprised:— Want of cleanliness 97 „ ventilation 2 Overcrowding 2 Sanitary accommodation—insufficient — „ „ unsuitable or defective 15 „ „ not separate for sexes 2 Other offences 27 The Home Office forwarded 7 complaints, which comprised:— Overcrowding 1 Sanitary conveniences not separate for sexes 1 Other offences 5 Bakehouses.—During the year one "underground" bakehouse was closed, the total number on the Register at the end of the year being 59, of which 51 were factory bakehouses. The number of "level" bakehouses was 16 (13 being factories) and of "underground" 43 (38 being factories) 42 The number of persons working in bakehouses was 309, including 3 women and 25 individuals under the age of 18. The bakehouses were inspected on 942 occasions during the year. RAG FLOCK ACTS, 1911 and 1928. The rag flock in use in the Borough appears to be well washed and free from dust. Six samples were taken and were found to comply with the regulations applicable. FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1929, two slaughterhouses within the Borough licensed by the London County Council:— 275, Edgware Road; 249, Maida Vale. There were 300 inspections made during the year. The number of animals slaughtered, so far as is known, was 3,372, comprising 218 bullocks, and 3,154 sheep, being an increase of 28 bullocks and 462 sheep, as compared with 1928. The following Table shows the number of organs destroyed and the disease with which they were affected. Bullocks. Sheep. Heads. Tongues Lungs. Livers. Mesenteries. Lungs. Livers. Tuberculosis 8 8 9 5 6 — — Actinomycosis 4 4 — — — — — Pleurisy — — 7 — — 18 — Abscess 1 1 19 3 — — — Distomum Hepaticum — — 1 61 — — — Parasitic Invasion — — — — — 37 15 Pneumonia — — — — — 5 — 13 13 36 69 6 60 15 1 Shin of Beef—Injury, 1 Breast of Mutton—Pleurisy. Total weight, 1,522 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 1929 the number of carcases was 534. On examination it was found necessary to destroy— 1 pig weighing 45 lbs. affected with tuberculosis; 10 heads „ 100 lbs. „ „ „ Offal „ 88 lbs. „ „ „ 1 pig „ 56 lbs. „ „ pyaemic abscess Pieces of pork 50 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 8,645 head of poultry were slaughtered. Food Purveyors.—At the end of the year there were some 814 purveyors of food in the Borough, classified as follows:—Butchers 83, Fishmongers 25, Fried Fish 34, Refreshments 115, Greengrocers 88, Milk 113, Margarine 19, General 57, Confectioners 115, Provisions 45, Grocers 112, Ham and Beef 8. 43 In addition to the above premises there are 81 licensed Street Traders selling food within the Borough, namely:—Fruit and Vegetables 52, Ice Cream 12, Light Refreshments 13, Fish 3, Poultry 1. These, with the storage premises of 15 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 1,929. Ice-Cream.—This substance is an inexpensive and nourishing food, and a short description of the method of preparation in use by small dealers may be of interest. Ice-cream is usually prepared in four quart batches and a special ice-cream powder is used. This powder is made by wholesale dealers and sold in tins to ensure dryness. It contains eggs, sugar and cornflour, with vanilla or other flavouring substance. To make ice-cream, a pound and a half of the powder is placed in a basin and made into a smooth paste with some milk. About four quarts of milk, after being boiled in a double saucepan to prevent burning, is then added to the contents of the basin whilst hot and quickly stirred until the mixture thickens. The mixture is then allowed to cool and is then frozen in a specially constructed freezer. The principle on which these freezers work is generally the same, there being a central metal container in which the mixture is placed and the contents of which are stirred during the freezing period by means of rotating fans. These fans serve the purpose both of ensuring a uniform consistency and of aerating the mixture. The central container is placed in a wooden tub, the space between the two being filled with a freezing mixture, usually a mixture of crushed ice and coarse salt. The fans are rotated by hand or by electric power, the freezing process taking about twenty minutes. It is the usual custom to make the mixture over-night to allow it to cool and to freeze it the next morning. There were 116 shops at which ice-cream was known to be sold, comprising the following kinds of businesses:—Bakers 9, General 7, Milk 12, Confectioners 43, Refreshments 40, Wholesale 3, Newsagent 1, Greengrocer 1. Two hundred and thirty (230) 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, 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. At the end of 1929 there were 80 entries in the Register. 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 4 tons, 10 cwts., 1 qr., 27 lbs., comprising the following varieties:—Fish 889 lbs., Fruit and Vegetables 7,036 lbs., Poultry 100 lbs., Meat 236 lbs., Offal 1,580 lbs., Tinned Food 294 lbs. Dairies and Milkshops.—At the end of the year 1928 there were 107 names on the Register. During the year 1929, 7 names were added and one removed (premises closed), making a total of 113. Eight of the businesses were transferred to new proprietors. There were 423 inspections made. Sterilised milk in bottles was found to be on sale at 85 premises. Milk (Special Designations) Order, 1923. During the year 62 licences were issued by the Council pursuant to this Order, 15 being for "Certified," 21 for "Grade A (Tuberculin Tested)," and 26 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, two for pasteurising establishments. The samples taken by the Council's Inspector numbered 31, and included 25 of "Certified" and 6 of "Pasteurised" milk. All the samples were found to be in compliance with the bacteriological standard appropriate to the kind of milk. 44 Eleven churns of "Grade A (Tuberculin Tested)" milk in course of delivery at Paddington Station were found not to be sealed in accordance with the requirements of the Order. The facts were reported to the Ministry of Health. Food and Drugs (Adulteration) Act, 1928. Of the 600 samples taken during the year, 18 (3 per cent.) were found to be "not of the nature, or not of the substance, or not of the quality demanded by the purchaser." This compares with 1.8 per cent. in 1928 and 5.5 per cent. in 1927. Thirty of the samples were taken on Sundays and Bank Holidays. None of these was adulterated. One hundred and forty samples of milk and three samples of separated milk were taken at Paddington Station on delivery by rail. Eleven of the milk samples and the three separated milk samples were found to be adulterated. Seventeen samples of milk were obtained at Paddington Station at the request of other Boroughs. PUBLIC HEALTH (PRESERVATIVES, &c., IN FOOD) REGULATIONS, 1925 TO 1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined for the presence of preservatives. No offences were reported. PUBLIC HEALTH (CONDENSED MILK) REGULATIONS, 1923 AND 1927. During the year one sample of full cream unsweetened, three samples of full cream sweetened condensed milk, and ten samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. PUBLIC HEALTH (DRIED MILK) REGULATIONS, 1923 AND 1927. One sample was taken of full cream dried milk, and five of dried skimmed milk, all of which complied with the Regulations. CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Analyses for the purposes of the Food and Drugs (Adulteration) Act, 1928, 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.1, 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., and also by the Royal Institute of Public Health. During 1929 one sample of ham was submitted for bacteriological examination following complaint 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 45. 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, 1929 Average Monthly Figure for Percentage. Fat Content and Non-Fatty solids January 3.46 8.78 February 3.44 8.72 March 3.34 8.74 April 3.31 8.62 May 3.45 9.02 June 3.38 8.75 August 3.62 8.62 September 3.58 8.74 October 3.58 8.71 November 3.76 8.87 December 3.76 8.81 No samples were taken during the month of July. Average for Year. Samples taken at Paddington Station 3.54 8.74 „ ,, elsewhere 3.54 8.75 45 Samples Submitted to Public Analyst—1929. Total. Found adulterated. Percentage adulterated. Ale 4 — — Ammoniated Tincture of Quinine 2 — — Baking Powder 6 — — Beef a nd Tongue 1 — — Blue Pills 1 — — Boracic Ointment 2 — — Borax 1 — — Brandy 1 — — Bread 3 — — Breakfast Tongue 2 — — Butter 11 — — Cake 4 — — Calomel Ointment 1 — — Camphorated Oil 2 — — Cheese 9 — — Chocolate 3 — — Cocoa 4 — — Coffee 6 — — Compound Mustard 1 — — Corned Beef 1 — — Cream 7 — — Crystallised Fruit 2 — — Crystallised Ginger 2 — — Custard Powder 6 — — Dried Coffee Extract 1 — — Dried Coffee and Chicory Extract 1 — — Dripping 2 — — Egg Substitute Powder 1 — — Essence of Coffee 1 — — Essence of Coffee and Chicory 5 — — Fish Paste 2 — — Fish, Tinned 3 — — Flour 4 — — Fruit Cordial 1 — — Fruit, Dried 3 — — Fruit, Tinned 4 — — Galantine 1 — — Gin 4 2 50.0 Golden Syrup 1 — — Gravy Salt 1 — — Ground Ginger 1 — — Honey 4 — — Ice Cream 3 — — Iodine Ointment 1 — — Iodine, Strong Tincture of 1 — — Iodine, Weak Tincture of 1 — — Iron Pills 1 — — Iron Wine 1 — — Jam 12 — — Lard 2 — — Lemonade Powder 3 — — Lemon Squash 2 — — Lime Juice 1 — — Liniment of Turpentine 1 — — Margarine 13 — — Meat Extract 5 — — Meat Paste 5 — — Mercury Ointment (Strong) 1 — — Milk 316 12 3.8 Milk, Condensed Skimmed Sweetened 10 — — Milk, Dried Skimmed 5 — — Milk, Dried Full Cream 1 — — Milk, Full Cream Condensed Sweetened 3 — — Milk, Full Cream Condensed Unsweetened 1 — — Milk, Full Cream Dried and Virol 1 — — Milk, Separated 3 3 100.0 Mincemeat 3 — — Mineral Waters 4 — — Mustard 3 — — Orange Quinine Wine 1 — — Peas 1 — — Peas, Tinned 4 — — Pepper 4 — — Pickles 3 — — Port Wine 1 — — Prescription 1 — — Rum 3 — — Rice 2 — — Sago 2 — — Salad Cream 2 — — Sauce 5 — — Sausages 11 — — Semolina 2 — — Sherry 1 — — Shredded Suet with Flour 5 — — Sponge Cakes 2 — — Stout 4 — — Sugar 3 — — Sulphur Ointment 1 — — Sweets 2 — — Tomatoes, Tinned 1 — — Tea Siftings 1 — — Tapioca 2 — — Veal 1 — — Vinegar 2 — — Vinegar of Squills 1 — — White Precipitate Ointment 2 1 50.0 Whisky 2 — — Yellow Mercury Oxide Ointment 1 — — Zinc Ointment 2 — — 600 18 3.0 46 Agricultural Produce (Grading and Marking) Act, 1928. The Council is responsible for enforcing the provisions of this Act and the Medical Officer of Health and the male Sanitary Inspectors have been authorised to act as officers for this purpose. At the end of the year regulations were in force applicable to— Apples and Pears; Beef; Eggs; Malt Flour and Malt Extract; Potatoes; Tomatoes and Cucumbers; Wheat Flour. Merchandise Marks Act, 1926. The Council is responsible for executing the provisions of this Act, so far as relates to any goods being foodstuffs to which an Order in Council under the Act applies, and excepting any provisions relating to the importation of goods. At the end of the year Orders were in force relating to— Honey; Fresh Apples; Raw Tomatoes; Currants, Sultanas and Raisins; Eggs in shell and Dried Eggs; Oat Products. Artificial Cream Act, 1929. This Act which regulates the manufacture and sale of artificial cream, came into force on May 10th, 1929. 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. Thirty pigeons were trapped and destroyed. It is estimated that there are some 2,000 pigeons at large in the Borough. RATS AND MICE (DESTRUCTION) ACT, 1919. Seventy-two (72) 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. One Notice was served under the Act in respect of rat-infested premises. Rat Week.—This was held from 4th to 9th November inclusive. The usual circular letter was sent out to principal wharfingers, railway companies, tradesmen, etc., and an intensive campaign in sewers, etc., carried out by the Borough Engineer and Surveyor, who caused 9,185 baits to be laid in 634 different positions, 198 rats eventually being found dead. This number is of course only a small proportion of the number killed. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Ninteeen (19) 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 100 premises, the verminous rooms numbering 160. The owners of 52 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 83 rooms being so treated at a charge to the owners of 7s. 6d. per room. Section 26 of the London County Council (General Powers) Act, 1928, 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. No use was made of this Section during the year. 47 COMPULSORY REMOVAL OF AGED, INFIRM OR DISEASED PERSONS. By virtue of Section 28 of the London County Council (General Powers) Act, 1928, it is 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. One case was dealt with under this Section during the year, the Magistrate at the Marylebone Police Court, on the application of the Medical Officer of Health, making an order for the removal of an elderly woman to the Paddington Infirmary for a period of three months. HEALTH EXHIBITION. The first Health Exhibition to be organised by the Council was held on June 6th, 7th and 8th at the new Porchester Hall in Porchester Road.. Exhibits for twenty-three stands were provided by the following organisations and trading firms. Public and Voluntary Organisations. Paddington Borough Council, Public Health Department. National Council for Maternity and Child Welfare. Paddington School for Mothers. Invalid Children's Aid Association. National Institute for the Blind. Barclay Workshops for Blind Weavers and Knitters. National Association for Prevention of Tuberculosis. Paddington Tuberculosis Dispensary. St. Mary's Hospital Tuberculosis Dispensary. Paddington Day Nursery. Queen's Park Day Nursery. St. Mary's Hospital. Paddington and St. Marylebone District Nursing Association Ministry of Agriculture and Fisheries. Metropolitan Water Board. Health and Cleanliness Council. Dental Board of the United Kingdom. British Social Hygiene Council. Cremation Society of England. Institute of Hygiene. National Milk Publicity Council. New Health Society. National Baby Week Council (Inc.). Metropolitan Asylums Board. Eugenics Society (Inc.). London County Council, Public Health Department. British Red Cross (Paddington District). Traders. Glaxo, Ltd. (Food preparations). Fruit Trades Federations (Propaganda). United Dairies, Ltd. (Milk and milk products). A. Wander, Ltd. (Food preparations). John Knight, Ltd. (Soaps, etc.). Daren, Ltd. ("Daren" Bread, Biscuits, etc.). Cow & Gate, Ltd. (Food preparations). Broad & Co., Ltd. (Sanitary fittings and appliances). Virol, Ltd. (Virol products). British Vacuum Cleaner & Engineering Co., Ltd. (Vacuum cleaner). The Parozone Co., Ltd. (Bleaching and disinfecting agent). The Gas Light & Coke Company (Gas fittings and appliances). R. Brightwell, Ltd. (Electrical, etc., fittings). A full account of the Exhibition will be found in the report made by the Medical Officer of Health to the Public Health Committee which forms an appendix to this Report. HEALTH EDUCATION. A subscription of £5 was paid to the Central Council for Health Education, a body which concerns itself with rendering assistance to local authorities in the organisation of health education work. 48 LEGAL PROCEEDINGS—1929. The results of the Summonses taken out during the year are summarised in the following tables:— Premises. Offence. Fines. Costs. £ s. d. PUBLIC HEALTH (LONDON) ACT, 1891. Section 4. 27, Ashmore Road Walls of basement front room, walls and ceiling of ground floor front room dirty. Ground floor slip room and first floor rooms dirty. Order made 0 10 6 227, Shirland Road Gutter on main roof defective; basement scullery walls and ceiling dirty, ceiling dilapidated; basement back room floor defective; walls of passage and ceiling of back attic dirty; front attic window defective. Order made 1 1 0 „ „ „ Soil and ventilation pipe defective Order made 1 1 0 251, Shirland Road Walls of basement front and back rooms damp; wall of ground floor front room dilapidated; walls and ceilings of first floor rooms and water-closet and basement scullery and watercloset dirty; ceiling of first floor water-closet dilapidated; main roof defective. Order made 1 1 0 84, Talbot Road Water-closet and roof defective Work done 1 1 0 8, Tavistock Crescent Staircases, passages, first floor back room, second floor front rooms and attic dirty; basement food cupboard, passage walls and scullery dirty and dilapidated; basement back room damp and dilapidated; ground floor scullery dirty; drain and waste stack foul; first half landing water-closet dirty and woodwork broken. Order made 2 2 0 Section 37. 61, Hall Place Dustbin insufficient Notice complied with Summons withdrawn 0 10 6 Bye-laws. 10, Clarendon Street Annual cleansing not carried out Work done 5 15 6 10, „ „ Window sash cords and water-closet door defective. Work done Summonses withdrawn — 12, „ „ Annual cleansing not carried out. Staircase and window sash cords defective. 21, „ „ Annual cleansing not carried out. Staircase and window sash cords defective. 22, „ „ Annual cleansing not carried out. Staircase and water-closet door defective. 27, Cuthbert Street Dustbin and cords of staircase window defective Work done Summonses withdrawn 1 1 0 61, Hall Place Staircase and cords of staircase windows defective. Work done Summonses withdrawn 1 1 0 4, Paignton Street Annual cleansing not carried out Work done 0 10 6 70b, Portsdown Road Improperly constructing a water-closet £0 10s. 6d. — 227, Shirland Road Yard paving defective £2 2s. 0d. 2 2 0 84, Talbot Road Water-closets without proper water supplies Work done 1 1 0 10, Warwick Crescent Annual cleansing not carried out Work done 1 1 0 4, Woodchester Street Window sash cords broken in first floor front room and top floor back room. Work done 0 10 6 75, Woodchester Street Nosings and treads of staircase out of repair Work done Summons withdrawn — 75, „ „ Annual cleansing not carried out £2 0s. 0d. 1 1 0 77, „ „ Window cords broken in first floor front room. Window cords defective on first landing; staircase out of repair. Annual cleansing not carried out. Work done Summonses withdrawn — London County Council (General Powers) Act, 1922. 4, Paignton Street Section 10. Basement front room verminous Work done 0 10 6 Food and Drugs (Adulteration) Act, 1928. Offence. Fines. Costs. £ s. d. £ s. d. Milk.— 8.94 per cent. of added water 10 0 0 3 0 0 ,, 16.23 per cent. ,, ,, 3 0 0 2 2 0 „ 17.53 per cent. of added water and deficient in fat to the extent of 23 per cent. 3 0 0 2 2 0 49 Report of the Work of the District Inspectors, 1929. 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. 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 — 1929 1,196 6 2,390 — 10,055 27 70 15 6 1485 1 546 116 49 16 3 46 2 13 151 2 91 288 — — 12 115 2 28 1 50 1929. Prevention of Infectious Disease. All Diseases, Enquiries by— District Inspectors 2,362 Women Inspectors and Health Visitors 6,858 Tuberculosis—Included in above— Women Inspectors 1,610 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 1,310 Rooms disinfected after— Tuberculosis 204 Other Diseases 1,131 Weight of Bedding, etc., disinfected (tons) 27 School Notices issued— Measles, Whooping Cough, Chicken-pox 2,591 Other Diseases 671 Bacteriological Examinations for— Diphtheria 1,242 Typhoid Fever 5 Tuberculosis 422 Sanitary Work—Cutting-off of Water Supplies. Notices received 8 Referring to Inhabited Premises 5 Empty „ 1 Other „ 2 Reasons forr—Rates unpaid 6 Defective fittings 2 Trade Nuisances. Offensive Smells—Complaints 24 Accumulations of Manure 8 Smoke—Complaints 9 „ Premises watched 18 „ „ „ Hours of observation 42¾ „ Duration of smoke (hours), including 23¼ „ „ black smoke 2 Office (Clerical) Work. Letters received 4,741 „ despatched 5,897 Entries in Postage Book 11,950 Certificates dealt with relating to Infectious Disease (including Tuberculosis) 4,112 Notices sent re above 8,278 Entries in Birth Register 2,170 Complaints received 1,478 Plans dealt with 282 New openings in Journals 347 Disinfection Orders 1,046 Notices to abate nuisances, etc. 824 Mortuary. Bodies deposited, total 420 „ „ for inquests 196 „ „ pending burial, infectious — „ „ „ „ other 224 P.M. examinations made 150 51 CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road Paddington School for Mothers St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Infant Consultation Centres *232, Harrow Road Paddington School for Mothers. St. David's Church Hall, St. Mary's Terrace St. John's Mission Room, Sovereign Mews *Congregational Institute, Third Avenue *St. Simon's Hall, Macroom Road Christ Church Parochial Church House, Queensborough Passage * Two sessions weekly. Day Nurseries 21, Howley Place Paddington Day Nursery. 60, Lancefield Street Queen's Park Day Nursery. Tuberculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensary. St. Mary's Hospital, Cambridge Place ... St. Mary's Hospital Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. PUBLIC HEALTH STAFF (on December 31st, 1929). 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 Houses 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. Newhall (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. (5) 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. 52 APPENDIX. METROPOLITAN BOROUGH OF PADDINGTON. HEALTH EXHIBITION, JUNE 1929. REPORT OF THE MEDICAL OFFICER OF HEALTH. To the Chairman and Members of the Public Health Committee. Ladies and Gentlemen, It will be remembered that towards the end of last year your Committee considered the advisability of holding a Health Exhibition on the lines of those held in other Cities and Boroughs. It was felt that it would attract the attention of the inhabitants of the Borough to the various phases of work carried out by the Council through its Public Health and Maternity and Child Welfare Committees, and a recommendation to hold the Exhibition at Porchester Hall on June 6th, 7th and 8th, 1929, was endorsed by the Council on the 29th January last. A sum of £500 was voted towards the expenses and at that time it was expected there would be an income of approximately £250 from standholders. As the scheme developed, however, it was felt that to make its educational value of the highest possible character more space would have to be allotted to voluntary organisations who were anxious to give practically unlimited assistance. There was a consequent drop in the estimated income and the deficit was accentuated by unforeseen extras in fitting up the Exhibition owing to the unfinished state of the Hall. The ultimate nett cost was £412 4s. 6d.* (See the Borough Treasurer's Account at end hereof). Opening Ceremony. The opening ceremony, in the presence of a large and distinguished gathering including the Mayors and Medical Officers of Health of many other districts, was performed by His Worship the Mayor (Alderman L. T. Snell, J.P.), the Chairman of the Public Health Committee (Councillor W. H. Crook) being in the Chair. It is estimated that 1,500 persons were present at the time. Exhibits. The standfitting and lighting contract was let to Messrs. The Springvale Exhibition Standfitting Co., Masboro' Road, W., whose tender was the lowest. The total cost amounted to £437 0s. 9d. The firm are to be complimented on the character of their work and the expeditious and careful manner in which it was carried out. The Borough Engineer reported as a result of his inspection with the Architect after the holding of the Exhibition that great credit was due to the contractors for having caused so little damage. Voluntary organisations, including the officers of the Public Health Department, provided 23 exhibits of a most diverse and instructive character. Trading concerns—more or less interested in health and sanitary affairs— took 13 stands and, incidentally, provided a revenue of £181 11s. 11d. From the point of view of space allotted it is estimated that about 75% was for voluntary and 25% for trade organisations. Having regard to the comprehensive nature of the Handbook (about 10,000 copies of which were issued to visitors, etc.) it is unnecessary for me to describe the various exhibits. I feel, however, that special mention should be made of the Departmental exhibit which was of a most original and instructive character and reflected great credit on the members of the Staff concerned. The proceedings were interspersed with cookery demonstrations undertaken by the Gas Light and Coke Company and the National Milk Publicity Council. Each evening, too, pupils from either Beethoven Street, Moberly or Amberley Road Schools rendered musical items and gave demonstrations of drill, dancing and remedial exercises—much appreciated interludes. Brochure. These were supplied gratis by a firm of publicity agents. Music. Music was broadcast throughout the Hall by means of the "Orkestrola" apparatus kindly loaned by the British Thomson-Houston Company and fitted by Messrs. R. Brightwell, Limited, of Queen's Road, Bayswater, in conjunction with their electrical, etc., exhibit on the stage. Refreshments. Mr. F. H. Lloyd of Formosa Street, Maida Vale, was entrusted with the catering arrangements and the general public were enabled to obtain light refreshments at popular prices in the Buffet organised for the purpose. A Lounge and Rest Room on the Balcony for the members of the Council and their friends and a Retiring Room for the Exhibitors' staffs were provided, and refreshments were also available there when necessary. School Children's Visits and Competitions. With the approval of the London County Council and with the kindly assistance of the Education Officer's staff and the teachers concerned, organised visits were paid by parties of children from the schools of the Borough. Owing to the short duration of the exhibition only two mornings (during which time the general public was excluded) were available for these tours and the visits consequently had to be confined to children in the final year of their school-life. Altogether some 550 scholars visited, in four parties, and were given short lectures at the following Exhibits:—Blind Institution, Maternity and Child Welfare, Dental Board, New Health Society or Institute of Hygiene and the Public Health Department. A final address was given by myself on the subject of cleanliness and all the children who constituted these parties were, during the following week whilst at school, invited to write an essay on " The advantages of Clean Home Surroundings." Previous to the opening of the Exhibition invitations were sent to all schools asking for Poster Designs for a Health Exhibition to be submitted for competition and posting in the Hall. A prize fund was inaugurated and was liberally subscribed to by members of the Council and other friends. The prize fund reached £25 and therefrom five prizes for boys and four for girls in the Poster Competition and four each for boys and girls in the Essay Competition were provided. In addition Certificates of Merit were awarded for all the selected essays and posters—in all 68. His Worship The Mayor, further to evince his interest in the children, invited all competitors to the Town Hall to a Tea and thereafter in the presence of many members of the Council and of the local teaching staff, distributed personally to each child the various awards. Attendance. The number of visitors exceeded all expectations. A careful computation was made each day by a door-steward and it is estimated that the total attendance, including the Mayoral party on the opening day and the school children, was approximately 14,500. The necessity of publicity was apparent and was met by means of street-banners, posters and handbills—the latter distributed through the Child Welfare Centres, local hospitals, schools and Boy Scouts. * This amount was subsequently reduced to £384 11s. 1d. 53 APPENDIX continued. Staff. The staff for the exhibition had, of necessity, to be a temporary one and as regards the five stewards and three cleaners consisted of local residents known to the Department. The Borough Engineer provided units for labour, etc., as and when required and the co-operation of the Baths Superintendent (Mr. H. Leadbeater) was cordially appreciated in times of pressure. A word of thanks is due to the local Boy Scouts organisation who through their District Scoutmaster (Mr. D. G. Turner) provided relays of boys for the many duties for which they were peculiarly adapted. The main object of the Exhibition appears to have been achieved. There is no doubt about its having proved of value from the point of view of interest as well as that of education. In many instances repeat visits were paid by persons in search of knowledge on certain topics and the visits by school children resulted in the bringing of parents in the evenings. It is felt, however, that should the Exhibition be repeated in the future facilities for participation by school children must be considerably extended so as to enable all children of 12 years and over to join the organised tours. As these must take place during the time of exclusion of the general public more mornings must be available and, therefore, a run of probably five days will be desirable. Consideration must be given, too, to the desirability of having accommodation for lectures, addresses, film-showing, etc., for a large amount of propaganda on health subjects can be effected by these means. I have the honour to be, Ladies and Gentlemen, Your obedient servant, G. E. OATES, Medical Officer of Health HEALTH EXHIBITION. June 6th, 1th and 8th, 1929. Expenditure. £. s. d. £ s. d. Standfitting 437 0 9 Hire of exhibits, lecturers' fees, etc. 28 12 6 Signboards, billposting, etc. 24 11 11 Materials for Public Health Department's exhibits 6 2 ] Printing, etc. 13 16 0 Honorarium to member of Staff 25 0 0 Wages of attendants, cleaners and labourers 17 1 0 Electric current, fittings, etc. 11 6 1 Sundry expenses 27 12 8 .. 591 3 0 Income. Hire of stands by trade exhibitors 174 5 11 Contributions by other exhibitors 7 6 0 Grant from Ministry of Health towards cost of Maternity and Child Welfare exhibits 25 0 0 206 11 11 Nett Cost £384 11 1 .