C.I. AC4349 Don 5301 PAD 31 Metropolitan Borough of Paddington REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1931. 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 43 Metropolitan Borough of Paddington REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1931. BY GEOFFREY EUGENE OATES, M.D., B.S. (London), M.R.C.P. (London); D.P.H. (Cambridge) ; Banrister-at-Law, Medical Officer of Health. VAIL & Co., Printers, 170, Farringdon Road, London, E.C.I CONTENTS. page page Acute Encephalitis Lethargica 19 Infectious Diseases, Prevention of 37, 57 Acute Influenzal Pneumonia 19 Infective Enteritis 21 Acute Polio-encephalitis 19 Inquests 13 Acute Polio-myelitis 19 Invalid Children's Aid Association 36 Acute Primary Pneumonia 19 Legal Proceedings 54 Acute Rheumatism 21, 58 L.C.C. Houses 41 Administrative Work 37 Malaria 19 Agricultural Produce (Grading and Marking) Manure, Removal of 38 Act, 1928 52 Marriages 6 Annual Cleansing 41 Massage Treatment 30 Ante-natal Consultation Centres 5, 29, 30 Maternal Consultations 32 Anthrax 20 ,, Mortality Investigation 36 Artificial Cream Act, 1929 53 Maternity and Child Welfare 28 Artificial Sunlight Treatment 30 Maternity Nursing 32 Bacteriological Work 37 Measles 17 Bakehouses 46 Meat Regulations 47 Births 6 Merchandise Marks Act, 1926 53 ,, Illegitimate 7 Milk Grants 33 ,, in Institutions 7 Milk and Dairies Order 49 ,, Notifications 8 Milk (Special Designations) Order 48 ,, Stillbirths 7 Mortuary 38 Birth-rates 7 Nursing 37 Canals, Canal Boats 39 Nutritional and Physio-therapeutic Clinic 31 Cancer 20 Office Work 57 Cerebro-spinal Fever 19 Ophthalmia Neonatorum 18 Chicken-pox 16 Outworkers (Homework) 46 Cholera 20 Overcrowding 41 Combined Drainage 38 Paddington Infant Saving Campaign 30, 36 Common Lodging Houses 41 Pigeons, Nuisance from 53 Compulsory Repairs 40 Plague 20 Compulsory removal of certain persons 54 Population 6 Condensed Milk Regulations 49 Poultry Slaughtering 47 Continued Fever 17 Pneumonia 19 Convalescent Homes 36 Preservatives, etc., in Food Regulations 49 "Conversions," Housing 40 Puerperal Fever 18 Dairies and Milkshops 48 ,, Pyrexia 19 Day Nurseries 5, 32 Rag and Bone Dealers 38 Deaths, Causes of 8, 9 Rag Flock Acts 47 ,, in Institutions 10 Rats and Mice Destruction 53 Death-rates 10 Relapsing Fever 20 Diarrhoea 21 Rent and Mortgage Interest (Restrictions) Diphtheria 15 Acts 41 Diphtheria Carrier Clinic 16 Rent Books 11 ,, Schick Test 16 Scarlet Fever 15 Disinfection 37 Schools and Infectious Disease 37 District Inspectors' Work 56 Sewer Connections 38 Drainage, Combined 38 Slaughterhouses 47 ,, House 38 Smallpox 16 ,, Reconstruction Plans 38 Smoke Control 39 Dried Milk Regulations 49 Staff 5, 37 Dysentery 20 Tenement Houses 41 Erysipelas 19 Trade Nuisances 38 Factories and Workshops 45 Tuberculosis, Artificial Pneumothorax Food Adulteration 49 ment 23 ,, Chemical and Bacterological Examina- „ Deaths from 23 tion 49 ,, Dental Treatment 23, 24 ,, Destroyed 48 ,, Dispensary Treatment 5, 24 ,, Purveyors 48 „ Home Visiting 23 ,, Samples Analysed 51 ,, Notification 22 ,, Supervision 47 ,, Regulations, 1930 and 1925 22, 23 Fouling of Footways by Dogs 39 ,, Shelters 23 German Measles 18 ,, Supply of Beds and Bedding 23 Glanders 20 Tuberculosis Care Committee 27 Health Education 54 Typhoid Fever 17 ,, Visiting 28 Typhus Fever 20 Houses Unfit for Habitation 40 Underground Rooms 40 Housing 40, 44 Unhealthy Areas 40 ,, Acquisition of Building Site 41 Vaccination 16 ,, Paddington Houses Association 41 Venereal Diseases Clinic 5 ,, on L.C.C. Estates 41 Verminous Conditions 54 Hyde Park Babies' Club 36 Vital Statistics 4, 6 Hydrophobia 20 Water Supply 38 Ice Cream 48 Whooping Cough 20 Infant Consultation Centres 5, 28-30 Workshop Supervision 46 Infantile Mortality 11, 12 APPENDIX. ,, ,, in Special Areas 12 Paddington Green Rheumatism Supervisory Infectious Diseases, Notification of 14 Centre 58 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 1931 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be generally good, and no particular cause of death calls for special comment. The infantile mortality rate of 87 shows room for improvement as compared with past years and as compared with the figure for the County of London, namely, 65. Paddington contains some streets which are amongst the poorest in London, and is increasingly the resort of poverty-stricken and migratory families from other parts of the United Kingdom and Ireland. These unfortunate people tend to have large families which they cannot rear successfully, and their presence contributes appreciably to the large infantile mortality rate. Important steps were taken during the year to strengthen the maternity and child welfare services of the Borough. An agreement was concluded with the Board of Management of St. Mary's Hospital whereby the Council will be entitled, in the near future, to the use of a self-contained suite of wards in the Hospital, providing fourteen beds for lying-in mothers. It was considered desirable to transfer to the service of the Council certain health visitors and medical officers previously employed under the Paddington School for Mothers. This Society will continue to provide and equip the necessary welfare centres, and arrange for the services of voluntary workers. A nutritional and physio-therapeutic centre has been established for the supervision of delicate children, massage and ultra-violet irradiation being available for those children needing such treatment. Owing to the need for economy this report has been curtailed in some respects. 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. ls£ June, 1932. SUMMARY OF VITAL STATISTICS 1931. Area of Borough 1,356 1 acres, including waterways 20'0 acres : Population: Census, 1931 144,950 Registrar-General's estimate of resident population for year 1931 140,300 Density of population per acre 104 Number of inhabited houses (end of 1931) according to Rate Books 22,443 Marriages 1,666 Total. M. F. Live Births {Legitimate 1836 925 911 Illegitimate 239 120 119}Birth-te 14.79* Stillbirths 82 46 36 Stillbirth-rate 38† Deaths 1,831 883 948 Death-rate 13.05* Percentage of total deaths occurring in public institutions 53.8 Number of women dying in, or in consequence of childbirth {from sepsis „ other causes 6 Maternal mortality 4.63† Deaths of Infants under 1 year of age 182 Infantile Mortality 87† Legitimate, 83 † ; Illegitimate, 121 † Deaths from Measles (all ages) 15 „ Whooping Cough (all ages) 8 „ Diarrhoea (under 2 years of age) 26 „ Pulmonary Tuberculosis 117 Death-rate from Pulmonary Tuberculosis 0.83* Deaths from all forms of Tuberculosis 138 Tuberculosis death-rate 0.98* Rateable Value £1,797,816 Product of a Penny Rate £7,173 *per 1,000 persons. † per 1,000 births, 5 PUBLIC HEALTH OFFICERS (on December 31st, 1931). (VV.T. = Whole-time appointments. P.T. = Part-time appointments. See subjoined notes 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. Medical Officers of Welfare Centres, P. T. S. Denovan Adam, M.R.C.S., L.R.C.P. j. McKail, M.A., M.B„ Ch.B. R. Cove-Smith, M.A., M.B., B.Ch., M.R.C.P. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., L.R.C.P. E. Dorothy Fenwick, M.R.C.S., L.R.C.P. Maude M. Richards, M.B., B.S. H. Hodge, M.B., B.Ch. J. Thoresby-Jones, M.D., L.R.C.P., M.R.C.S. O. Stuart Thompson, B.A., M.R.C.S., L.R.C.P. Public Analyst, P.T. Sir William R. Smith, M.D., D.Sc., F.I.C. Public Vaccinators.P.T. S. Denovan Adam, M.R.C.S., L.R.C.P. (For Borough, excluding Paddington Hospital). W. G. Bendle, F.R.C.S.Ed., M.B., B.S. (For Paddington Hospital). Vaccination Officer, P.T. T. E. Rainger. District Sanitary Inspectors, W.T. Workshops Inspector and Canal Boats Inspector, W.T. T. Mitchell (1), (3), (4), (5). C. S. Wansbrough (1), (4), (5). G. J. Miners (1), (4). Tenement Houses Inspectors, W.T. V. L. Ronchetti (2), (3), (5). C. G. Heron (2 ), (3). E. B. Wilde (2), (3), (4), (5), (10). One temporary Inspector. E. Marshall (2), (3), (4), (5). Women Sanitary Inspectors, W.T. Meal and Food Inspector, W.T. L. M. O'Kell (1), (6). F. J. Pallet (2), (3). D. M. Newhall (1), (2), (8), (9). Health Visitors, W.T. E. E. Bogle (7), (9) H. Waite (7), (8), (9). E. A. S. Davies (7), (8). E. C. Jackson (7), (8), (9). F. E. Stammers, (8), (9). N. B. May (7), (8), (9). E. M. Sells (9). One vacancy. Health Visitor, P.T.—E. Elsley (7), (9). (1) Sanitary Inspector's Certificate, Royal Sanitary Institute. (2) „ „ „ Sanitary Inspectors' Examination Board, or Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (3) Meat and other Foods Certificate, Royal Sanitary Institute, or Sanitary Inspectors' Examination Board. (4) Building Construction Certificates. (5) Plumbing Certificates. (6) Tuberculosis Certificate, National Health Society. (7) Central Midwives Board Certificate. (8) Nursing Training Certificates. (9) Health Visitor's Diploma, Board of Education. (10) Smoke Inspector's Certificate, Royal Sanitary Institute. CLINICS AND TREATMENT CENTRES. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road Paddington School for Mothers, St. Simon's Hall, Macroom Rd do. 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 do. *Congregational Institute, Third Avenue do. *St. Simon's Hall, Macroom Road do. Christ Church Parochial Church House, Queensborough Passage do. *Two sessions weekly. Day Nurseries 21, Howley Place Paddington Day Nursery. 66, Lancefield Street Queen's Park Day Nursery. Tuberculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensaiy. St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place London County Council. (Male and Female) 6 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. 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 13.03 186 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 1930 142,800 2,216 524 469 2,161 15.13 1,890 13.23 482 397 1,805 12.64 174 78 169 78 1931 *140,300 2,073 462 464 2,075 14.79 2,000 14.25 589 420 1,831 13.05 228 110 182 87 *Registrar-General's estimate of resident population. POPULATION. At the census which was taken on the 26th April, 1931, 144,950 persons were enumerated in the Borough. This figure includes a number of persons whose homes were situated in other districts, and does not take into account residents of Paddington, who on the night of the census, were staying elsewhere. These factors have been taken into consideration by the Registrar-General in arriving at his estimate of the resident population of the Borough at the middle of the year 1931, which he gives as 140,300 persons. As the population figures for the various Wards of the Borough at the census of 1931 are not yet available, the estimated resident population of 140,300 persons, has in the following table, been distributed among the Wards in the proportions recorded at the previous census. The Borough 140,300 Wards— Queen's Park 15,321 Harrow Road 26,758 North Paddington Maida Vale 21,493 70,827 Town 7,255 Westbourne 23,440 Church 17,012 Lancaster Gate, West 9,270 South Paddington Lancaster Gate, East 7,937 69,473 Hyde Park 11,814 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,666 marriages were solemnized in the Borough during 1931, being a rate of 23-7 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1931 was 2,073. From this total it is necessary to deduct 462 births which occurred to residents of other localities and to add 464 births which occurred to Paddington residents outside the Borough. The corrected total of 2,075 births thus obtained is equal to a rate of 14-79 per 1,000 of the population. Of the 2,075 births, 1,045 were those of males and 1,030 those of females, and of these 120 ma'.es and 119 females were illegitimate. 7 The Registrar-General's final figure for the nett number of births is given as 2,082 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:— 1931 Birth-rates. No. of Births. Birthrates. 1930 1929 1928 1927 1926 England and Wales 632,580 15.8 16.3 16.3 16.7 16.7 17.8 London 65,684 15.0 15.7 15.7 15.9 16.1 17.1 Paddington 2,075 14.79 15.12 14.90 14.99 15.53 15.32 Wards— Queen's Park 145 9.46 10.32 10.26 10.97 11.29 12.48 Harrow Road 410 15.32 17.58 14.94 15.05 15.50 14.44 Maida Vale 318 14.79 13.57 15.22 14.65 16.69 15.84 Town 132 18.19 13.40 16.52 16.78 18.70 17.92 Church 405 23.81 22.12 23.50 22.83 23.11 23.94 Westbourne 412 17.58 19.78 17.22 19.25 18.58 18.03 Lancaster Gate, West 55 5.93 5.40 8.05 5.00 6.25 6.29 Lancaster Gate, East 66 8.31 7.18 8.79 7.42 9.04 8.79 Hyde Park 132 11.17 13.30 11.81 12.75 11.56 12.14 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 1926-1930 15.17 1931 14.79 Illegitimate Births.—These were 239 in number, or 11*51 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 9.65 Harrow Road 6.09 Maida Vale 14.15 Town 13.63 Church 10.12 Westbourne 9.71 Lancaster Gate, West 14.54 Lancaster Gate, East 25.76 Hyde Park 23.48 Stillbirths.—During 1931, 79 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 23 occurred to residents of other localities; on the other hand 26 stillbirths occurred outside the Borough to Paddington residents. The nett number for the Borough was therefore 82, a figure equivalent to 3'8 per cent, of the total births recorded. Of the 82 stillbirths, males numbered 46 and females 36, 7 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 Hospital 234 45 90 8 324 53 St. Mary's Hospital 111 165 4 1 115 166 Lock Hospital 1 30 2 55 3 85 Outlying. (Paddington residents) Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 221 24 245 Other Lying-in Hospitals 11 14 25 Other Hospitals 47 9 56 Public Assistance Committees' Institutions 11 8 19 8 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, 2,032 live births were notified to the Medical Officer of Health. There were also 80 stillbirths notified. Of the 2,112 living and stillbirths notified, 49-4 per cent, were notified by medical practitioners, 357 per cent, by midwives, 0*8 per cent, by parents, and 14*1 per cent, by medical students or other persons. A comparison of the Notification Register with the returns supplied by the local Registrars of Births shows that 98-8 per cent, of the live births and 98'7 per cent, of the stillbirths occurring within the Borough were duly notified. It will be seen that only a small proportion of 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 2,000. Of these, 589 were of persons whose residence was not in Paddington, 507 dying in Paddington Institutions and 82 in other places in the Borough. There were also reported to the Registrar-General 420 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,831, making an annual death-rate of 13 05. 1931. 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 31st — — 1 — 12 19 11 17 32 2 February 28th — — 2 3 17 20 17 10 22 7 March 28th — — — — 13 16 10 15 9 3 April 25th — — 1 2 5 22 5 3 4 2 May 23rd — — — — 11 26 — 2 11 2 June 20th — — — — 3 14 1 3 3 3 July 18th — — — — 9 14 — 2 6 5 August 15th 1 — — 1 6 16 — 2 3 — September 12th 2 — — — 7 12 1 — 2 2 October 10th 1 — — 2 6 14 — 2 4 2 November 7th 3 — 2 — 13 16 1 3 10 1 December 5th 5 — 1 1 5 15 1 5 7 3 December 31st 3 — 1 — 7 15 6 10 20 1 Totals 15 — 8 9 114 219 53 74 133 33 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 on next page. Deaths of Residents of the Borough, 1931, Sex-Age Distribution for Whole Borough. All Ages. Deaths at Ages. 0— 1— 2— 5— 15— 25— 35— 45— 65— 65— 75— P. M. F. M. f. M. F. M. F. M. f. M. f. M. F. M. F. M. F. M. F. M. F. M. F. All Causes 1831 883 948 109 73 14 11 14 4 18 10 40 43 41 42 49 42 114 98 167 120 179 208 138 297 Typhoid and Paratyphoid Fevers 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... Measles 15 13 2 4 ... 4 2 4 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Scarlet Fever ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Whooping Cough 8 5 3 4 1 ... 1 1 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Diphtheria 9 5 4 ... ... ... ... 2 1 2 2 ... ... ... ... ... ... ... ... ... 1 ... ... ... ... Influenza 54 21 33 1 ... ... ... ... ... ... ... 2 3 2 2 1 ... 6 2 4 5 4 9 1 12 Encephalitis Lethargica ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Cerebro-spinal Fever 3 1 2 ... 1 ... 1 ... ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... Tuberculosis of Respiratory System 117 73 44 ... ... ... ... ... ... ... 1 9 11 16 10 12 10 18 5 11 5 4 1 3 1 Other Tuberculous Diseases 21 14 7 ... l ... ... 2 ... 2 1 5 3 1 1 1 ... 1 1 1 ... ... ... 1 ... Syphilis 8 7 1 2 ... ... ... ... ... ... ... 1 1 ... ... ... 1 ... 3 ... ... ... ... ... General Paralysis of the Insane, Tabes Dorsalis 15 14 1 ... ... ... ... ... ... ... ... ... ... ... ... 5 ... 2 ... 6 ... 1 1 ... ... Cancer, Malignant Disease 226 96 130 ... ... ... ... ... ... 1 ... ... 1 1 5 1 6 12 29 38 26 30 38 13 25 Diabetes 18 6 12 ... ... ... ... ... ... ... 1 ... 1 ... ... ... ... ... 1 2 3 3 3 1 3 Cerebral Haemorrhage, etc. 50 14 36 ... ... ... ... ... ... ... ... ... ... ... ... 1 4 8 5 3 11 3 15 Heart Disease 436 179 257 ... ... ... 1 1 4 3 4 6 2 17 22 33 34 64 73 55 117 Aneurysm 10 8 2 ... ... ... ... ... ... 1 1 ... 1 2 1 2 2 Other Circulatory Diseases 65 24 41 ... ... ... ... ... ... ... ... 1 ... ... ... ... 1 1 2 7 2 6 12 9 24 Bronchitis 83 34 49 3 7 ... ... ... ... ... ... ... 1 ... 1 1 ... 5 2 8 2 8 10 9 26 Pneumonia (all forms) 131 71 60 25 12 6 6 1 1 1 1 2 1 1 1 2 3 10 5 6 8 9 14 8 8 Other Respiratory Diseases 17 11 6 1 ... ... ... ... ... ... ... 2 1 ... 1 1 ... 1 ... 2 1 2 ... 2 3 Peptic Ulcer 21 17 4 ... ... ... ... ... ... ... ... ... ... ... ... 4 1 5 1 3 1 2 1 3 ... Diarrhoea, etc 31 21 10 19 7 ... ... ... 1 ... ... ... ... ... ... ... ... ... ... ... ... 1 ... 1 2 Appendicitis 12 9 3 ... ... ... ... ... ... 3 ... 2 1 1 ... ... ... 1 ... ... 1 1 ... 1 1 Cirrhosis of Liver 10 2 8 ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 4 1 3 ... 1 ... ... OtherDeseases of Liver, etc. 15 7 8 ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 1 1 1 1 3 1 2 4 Other Digestive Deseases 39 18 21 2 5 1 1 ... ... ... 1 1 1 ... 1 1 2 7 5 3 ... 2 3 1 2 Acute and Chronic Nephritis 49 27 22 ... ... ... ... ... ... ... ... ... 1 2 ... 4 3 7 4 5 1 6 5 3 8 Puerperal Sepsis 4 ... 4 ... ... ... ... ... ... ... ... ... 1 ... 3 ... ... ... ... ... ... ... ... ... ... Other Puerperal Causes 6 ... 6 ... ... ... ... ... ... ... ... ... 1 ... 3 ... 2 ... ... ... ... ... ... ... ... Congenital debility, Premature Birth, Malformations, etc. 68 37 31 37 31 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... Senility 27 7 20 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 1 ... 6 19 Suicide 33 21 12 ... ... ... ... ... ... ... ... 2 ... 1 2 2 3 6 4 7 2 2 1 1 ... Other Violence 79 49 30 7 2 1 ... 1 ... 6 ... 6 2 9 1 2 1 3 1 4 6 5 6 5 11 Other defined diseases 149 72 77 4 6 1 ... 3 ... 2 2 6 9 2 4 6 7 8 5 12 11 20 17 8 16 Causes ill-defined or unknown 1 ... 1 ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 ... ... 10 The following table shows the deaths and death-rates during each of the last five years in England and Wales, in London, in Paddington and in each of the wards of the Borough:— 1931 Death-rates. No. of Deaths. Deathrates. 1930 1929 1928 1927 1926 England and Wales 491,635 12.3 11.4 13.4 11.7 12.3 11.6 London 54,288 12.4 11.4 13.8 11.6 11.9 11.6 Paddington 1,831 13.05 12.64 15.48 13.03 13.56 12.65 Wards— Queen's Park 163 10.64 11.54 11.67 11.22 12.12 12.10 Harrow Road 321 11.99 11.85 14.94 11.88 13.04 12.58 Maida Vale 282 13.12 1312 14.08 14.56 14.68 14.37 Town 113 15.57 12.59 16.65 11.98 16.94 11.60 Church 267 15.69 14.43 20.61 15.27 15.60 16.92 Westbourne 359 15.31 13.99 17.06 15.45 13.92 12.64 Lancaster Gate, West 107 11.54 10.59 13.56 10.21 9.33 11.04 Lancaster Gate, East 76 9.57 12.00 13.61 10.71 11.39 7.71 Hyde Park 143 12.10 11.72 15.72 11.61 13.64 9.55 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 1926-1930 13.47 1931 13.05 Deaths in Institutions, 1931 Local. Total Nonresidents. Paddington Hospital 622 59 St. Mary's Hospital 284 217 Paddington Green Children's Hospital 69 52 Hospital for Women and Children (Lock Hospital) 19 16 St. Luke s Hospital 169 163 1,163 507 Deduct Non-residents 507 656 Outlying. Paddington Residents. Isolation Hospitals of London County Council 31 Public Assistance Committees' Institutions 84 Lunatic Asylums 81 Voluntary Hospitals (General) 61 Hospitals (Special, including Sanatoria) 73 330 Total Deaths of Paddington residents in institutions 986 11 INFANTILE MORTALITY. During the year 1931 there were 2,075 births, and 182 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 87. The following table gives the births and the infantile deaths and death-rates for the year 1931 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1926 to 1930 are given for comparison. 1931 Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1930 1929 1928 1927 1926 England and Wales 632,580 41,648 66 60 74 65 69 70 London 65,684 4,270 65 59 70 67 59 64 Paddington 2,075 182 87 78 101 85 79 86 Wards— Queen's Park 145 8 55 43 44 28 91 45 Harrow Road 410 32 78 39 71 79 49 104 Maida Vale 318 26 81 97 66 82 96 87 Town 132 14 106 50 147 95 130 37 Church 405 47 116 122 164 99 99 108 Westbourne 412 33 80 86 126 109 76 86 Lancaster Gate, West 55 6 109 98 39 83 51 109 Lancaster Gate, East 66 4 60 103 42 82 — 115 Hyde Park 132 12 90 62 98 57 65 53 Infantile Mortality Rates, 1896-1931. 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 1926-1930 68 64 86 1931 66 65 87 12 Infantile Mortality in Paddington.—1931. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Rate per 1,000 Births. All Causes 52 7 3 5 67 26 38 26 25 182 87.71 Common Infectious Diseases (6-10, 25:2) - - - - - 1 - 4 4 9 4.33 Tuberculous Diseases (31—37) - - - - - - 1 - - 1 0.48 Diarrhœa and Enteritis (113) — 1 1 - — 1 5 11 9 3 29 13.98 Developmental and Wasting Diseases (159, 160, 161:1, 162:2) 34 6 2 3 45 7 4 3 1 60 28.92 Miscellaneous Diseases (Remainder) 18 — 1 2 21 13 22 10 17 83 40.00 Measles (7) - - - - - - - 2 2 4 1.92 Whooping cough (9) — — - - — 1 — 2 2 5 2.41 Diphtheria (10) — — - — — — — — — — — Influenza (11) — — - — — — — — 1 1 0.48 Tuberculosis of nervous system (32) - - - - - - 1 - - 1 0.48 Tuberculosis of intestines and peritoneum (33) - - - - - - - - - Other tuberculous diseases (31, 3437) - - - - - - - - - - - Syphilis (38) 1 — — — 1 1 — - - 2 0.96 Meningitis (71) — — - - — — — - - — — Convulsions (80) — — - — — - - - - — — Bronchitis (99) — — - 1 1 1 1 1 1 4 1.92 Pneumonia (100, 101) 1 — - 1 2 4 13 7 11 37 17.83 Other respiratory diseases (98, 102107) - - - - - - - - 1 1 0.48 Inflammation of the stomach (112:1) — — - — — 1 3 — - 5 2.41 Diarrhœa and Enteritis (113) — 1 - — 1 5 11 9 3 29 13.98 Hernia, intestinal obstruction (118) - - - - - 1 - - - 1 0.48 Congenital malformations (159) 1 2 - — 3 4 1 2 1 11 5.30 Congenital debility and sclerema (160:1) 2 1 - - 3 2 2 - - 7 3.38 Icterus (160:2) — 1 - — 1 — — — — 1 0.48 Premature birth (161:1) 29 2 2 3 36 1 1 1 — 39 18.80 Injury at birth (161:2) 7 — 1 — 8 — — — — 8 3.86 Disease of umbilicus (162:1) — — — - — 2 - - - 2 0.96 Atelectasis (162:2) 3 — — — 3 - — — — 3 1.45 Suffocation—in bed or not stated how (180 pt.) - - - - - - 1 - - 1 0.48 Other causes 8 — — — 8 3 4 2 3 20 9.65 Legitimate 1,836. Legitimate Infants 153. Nett Births in the Year illegitimate 239. Nett Deaths in the Year illegitimate Infants 29. 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 1931 Infantile Mortality Births. Deaths. 1931 1930 1929 1928 1927 Church Ward— North Wharf 38 2 53 77 143 148 40 Clarendon Street 189 22 116 153 170 105 138 Rest of Ward 178 23 129 106 165 75 70 Westbourne Ward— Alfred Road 95 11 116 84 152 83 165 Rest of Ward 317 22 69 87 117 117 48 Maida Vale Ward— Amberley Road 42 2 48 206 87 104 178 Rest of Ward 276 24 87 83 62 79 80 Totals for 4 Areas 364 37 102 129 151 105 139 Rest of Borough 1,711 145 85 69 90 81 65 13 The subjoined information, comparing the vital statistics for the metropolitan boroughs, has been supplied by Dr. W. Allan Young, Medical Officer of Health for Poplar:— 1931. Cities and Boroughs. Resident Population. 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 140,300 14.79 13.05 87 Kensington 174,800 14.2 14.0 76 Hammersmith 135,100 15.3 12.2 68 Fulham 151,200 15.08 12.3 67 Chelsea 57,220 12.8 14.1 42 City of Westminster 115,600 10.17 13.9 75.1 North Districts. St. Marylebone 97,620 11.4 12.4 65 Hampstead 87,740 11.2 11.7 60 St. Pancras 195,600 15.1 13.3 68 Islington 324,600 16.3 12.6 64 Stoke Newington 51,380 15.2 12.7 53.9 Hackney 217,000 15.5 11.4 60 Central Districts. Holborn 34,470 10.21 14.27 74 Finsbury 70,120 18.0 14.02 62 City of London 10,808 5.6 12.5 81 East Districts. Shoreditch 98,260 17.1 12.5 74.2 Bethnal Green 109,200 16.8 12.5 87.7 Stepney 225,800 17.5 13.1 78 Poplar 156,300 17.5 12.4 77 South Districts. Southwark 172,900 16.9 14.0 61 Bermondsey 112,400 17.4 12.5 57 Lambeth 295,900 15.28 12.66 60.35 Battersea 159,800 15.5 12.1 57.3 Wandsworth 353,200 12.27 11.30 59 Camberwell 252,100 14.7 11.9 56 Deptford 107,200 16.3 12.0 53 Greenwich 100,640 14.96 11.41 64 Lewisham 220,800 14-1 10.2 49 Woolwich 142,600 15.1 11.6 59 INQUESTS. During 1931, 142 inquests were held on residents of the Borough, and 107 deaths weie registered after the issue of certificates by the Coroner under powers conferred by the Coroneis (Amendment) Act, 1926. 14 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington : Acute Encephalitis Lethargica. Glanders. Acute Influenzal Pneumonia. Hydrophobia. Acute Polio-encephalitis. Infective Enteritis or Summer Diarrhoea. Acute Polio-myelitis. Malaria. Acute Primary Pneumonia. Measles. Acute Rheumatism. Ophthalmia Neonatorum. Anthrax. Plague. Cerebro-spinal Fever. Puerperal Fever. Chicken-pox. Puerperal Pyrexia. Cholera. Relapsing Fever. Continued Fever. Scarlatina or Scarlet Fever. Diphtheria or Membranous Croup. Smallpox. Dysentery. Tuberculosis. Erysipelas. Typhoid or Enteric Fever. German Measles. Typhus Fever. The following table summarises the cases of notifiable diseases notified in the years 1921 to 1931:— Analysis of Notification Certificates (Uncorrected for Errors in Diagnosis). 1921. 1922. 1923. 1924. 1925. 1926. 1927. 1928. 1929. 1930. 1931. Acute Encephalitis Lethargica 7 2 3 12 7 4 4 1 5 1 — „ Influenzal Pneumonia 27 72 33 87 88 76 107 59 135 40 97 „ Primary Pneumonia 105 254 302 369 265 184 183 202 247 168 243 „ Polio-encephalitis 1 — 2 4 3 3 1 1 1 - 1 „ Polio-myelitis - - - - - 3 4 3 1 1 2 ,, Rheumatism - (a) 34 76 52 43 37 Anthrax 1 1 — — — 1 1 — — — 1 Cerebro-spinal Fever 2 2 1 1 5 5 3 4 6 3 5 Chicken-pox — 22 465 395 459 599 461 567 382 515 555 Continued Fever — — — — — — 2 10 3 2 4 Diphtheria 442 401 219 278 336 462 367 302 311 366 254 Dysentery 2 — 2 1 — — — — — - 2 Erysipelas 83 77 54 69 64 76 90 90 69 74 67 German Measles 83 144 48 458 375 124 78 109 1,163 86 58 Infective Enteritis or Summer Diarrhœa — — — — - — (a) 6 20 63 30 40 Malaria 7 5 2 9 1 1 2 3 — 1 — Measles 80 1973 324 2757 879 1738 154 2862 210 1790 541 Membranous Croup 3 — 1 2 1 1 2 4 6 7 6 Ophthalmia Neonatorum 34 15 22 18 23 16 15 24 9 15 18 Puerperal Fever 16 8 5 9 15 14 7 5 4 0 8 „ Pyrexia — — — — — (a) 17 34 32 42 37 32 Scarlet Fever 827 529 323 290 264 199 320 519 323 356 379 Smallpox — — 1 — — — — 5 3 3 - Tuberculosis—Total 335 312 338 379 400 356 381 321 335 284 311 Pulmonary 244 204 222 242 231 218 212 196 242 196 218 Other Forms 91 108 116 137 169 138 169 125 93 88 93 Typhoid or Enteric Fever 13 8 13 15 18 12 16 25 19 10 9 (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:— 1931. 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 11 16 18 22 10 18 8 8 25 35 29 35 5 4 2 7 5 2 Typhoid and Continued Fever - - 1 1 2 — — — 2 — — 1 - 2 — 3 1 - Erysipelas 3 7 6 8 4 7 — 3 3 8 3 7 1 1 1 1 — 4 Ophthalmia Neonatorum 1 — 1 2 2 2 — 1 2 2 - 2 - - 1 - 2 - Pneumonia—A. Influenzal 4 1 7 8 5 21 1 3 7 11 12 7 1 4 1 2 - 2 „ A. Primary 9 6 15 14 17 16 7 10 34 43 34 22 3 2 — 4 5 2 Puerperal Fever — — — 2 — 1 — — - 2 - 3 - - - - - - „ Pyrexia — 2 — 5 — 4 — 2 - 6 - 10 - - - - - 3 Scarlet Fever 6 9 23 34 25 33 20 19 43 58 31 42 7 2 3 8 9 7 15 B.—Sex-Age Distribution. Borough. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F Diphtheria and Memb. Croup 6 2 6 7 14 16 13 15 13 11 38 33 12 20 2 8 8 27 1 5 - 2 - 1 Typhoid and Continued Fever 1 — — — — — — — — — — — 1 1 1 1 1 4 1 1 1 — - - Erysipelas 1 1 1 — — — — — — — 1 2 1 1 — 2 — 7 3 6 13 16 1 11 Pneumonia-—a. Influenzal — — 2 1 1 — — — — — 1 3 — — 3 3 10 19 10 7 8 16 3 10 „ a. Primary 27 18 14 22 12 15 8 5 8 1 13 14 4 2 4 4 10 13 8 4 10 16 6 5 Scarlet Fever 4 2 6 10 9 10 17 18 21 13 58 71 31 36 7 15 10 27 2 8 2 2 —- - SCARLET FEVER. During 1931 there were 379 cases of scarlet fever notified. Of the cases notified 6 were under the age of 1 year, 104 between the ages of 1 and 5 years, 196 between the ages of 5 and 15 years, 59 between the ages of 15 and 35 years, and 14 over the age of 35 years. Of the 379 cases, 346 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. 1931 Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Total. London 887 945 836 813 858 727 850 851 800 1,228 1,316 1,120 920 12,151 Paddington 42 39 22 26 26 22 34 30 18 40 42 20 18 378 Wards— Queen's Park 2 2 — — 2 — 2 2 2 — 2 - 1 15 Harrow Road 10 9 3 5 3 3 4 4 1 8 3 2 2 57 Maida Vale 3 5 3 2 4 3 11 5 3 10 5 1 3 58 Town 2 6 1 3 3 2 2 4 8 2 5 1 - 39 Church 12 11 4 9 11 7 7 7 3 9 14 5 2 101 Westbourne 7 5 6 5 3 5 7 7 - 8 6 9 5 73 Lancaster Gate, West 1 - 4 - — - - — - - 1 1 2 9 Lancaster Gate, East 2 1 1 - - - 1 - - - 3 - 3 11 Hyde Park 3 — — 2 — 2 - 1 1 3 3 1 — 16 DIPHTHERIA. (Including Membranous Croup). During 1931 there were 254 cases of diphtheria and 6 of membranous croup notified. Of these there were 8 cases under the age of 1 year, 95 between the ages of 1 and 5 years, 103 between the ages of 5 and 15 years, 45 between the ages of 15 and 35 years and 9 aged 35 years and upwards. Of the 260 cases, 253 were removed to Isolation Hospitals. Seven cases were treated at home, proper facilities being available for isolation and treatment. Nine deaths from this disease occurred during 1931, 4 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1921 22 deaths. 1922 25 „ 1923 14 „ 1924 14 „ 1925 11 „ 1926 21 „ 1927 11 „ 1928 7 „ 1929 9 „ 1930 12 „ 1931 8 „ 16 Seasonal prevalence.—The following table shows the numbers of cases notified in each fourweekly period during 1931. Notifications of Diphtheria and Membranous Croup. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 847 813 672 600 602 575 671 544 563 579 725 700 611 8,502 Paddington 25 20 20 27 22 15 24 10 13 17 22 27 18 260 Wards— Queen's Park 1 2 3 4 2 — 1 — 5 2 3 3 1 27 Harrow Road 5 2 4 7 3 3 3 1 1 3 3 3 2 40 Maida Vale 2 1 3 — 2 — 6 3 2 1 3 5 - 28 Town 2 1 1 1 4 — 1 — 1 1 2 - 2 16 Church 5 6 2 6 6 3 3 2 1 5 7 6 8 60 Westbourne 7 6 5 7 4 9 7 3 1 1 4 6 4 64 Lancaster Gate, West 2 — 1 — — — 1 — 1 3 — - 1 9 Lancaster Gate, East - 1 1 2 — — 1 — 1 1 - 2 - 9 Hyde Park 1 1 - - 1 - 1 1 - - — 2 — 7 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 by medical practitioners for treatment. 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 52 phials of 4,000 units and 18 phials of 500 units were distributed. Schick Test.—No use was made of this test during the year. SMALLPOX. No cases of this disease were brought to notice during the year, but a number of persons who had been exposed to risk of infection from cases which had occurred in other districts, were kept under observation until all danger of their developing the disease was over. 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. VACCINATION. There are two vaccination districts in the Borough, one consisting of the Paddington Hospital, for which the Medical Superintendent, Dr. W. G. Bendle, acts as Public Vaccinator, and the other of the rest of the Borough, the Public Vaccinator being Dr. S. Denovan Adam. Following the resignation of Mr. W. J. Hughes, Mr. T. E. Rainger was appointed Vaccination Officer as from the 1st July, 1931. The appointment is a part time one, Mr. Rainger also holding a position on the clerical staff of the Public Health Department. During the year no primary vaccinations or re-vaccinations were performed in the Paddington Hospital. In the rest of the Borough 730 infants under one year of age, and 46 persons over that age were successfully vaccinated by the Public Vaccinator, by whom also 29 persons were re-vaccinated who had been successfully vaccinated at some previous time. The latest return available as to the state of vaccination in the Borough is for the year 1930. This shows that 60-9 per cent, of the children whose births were registered during that year were successfully vaccinated, and that 20-0 per cent, were exempted on production of statutory declarations of conscientious objection. Insusceptibility, postponements, removals, deaths, and not traced, accounted for the remaining 191 per cent. No legal proceedings were taken during the year 1931 for non-compliance with the provisions of the Vaccination Acts. 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. 17 T here was a still further increase in the prevalence of the disease, the number of cases certified by medical practitioners being 555 and of those reported from other sources 377, making a total of 932 cases. The greatest prevalence occurred during the second quarter of the year. Chicken-pox is not usually nursed in an institution, but 41 cases received institutional treatment for various reasons. The District Nursing Association's nurses attended 11 patients, 6 of whom were under and 5 over 5 years of age. The number of visits paid was 81. 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. Nine cases of typhoid fever were notified in 1931. In a few cases no doubt, the diagnosis was subsequently revised, but no accurate information is available on this point. Four cases of continued fever were notified. In cases 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 the patients by notifying them as having continued fever. Of the 13 cases of typhoid fever and continued fever, 11 received hospital treatment. One death occurred from typhoid fever. MEASLES. Measles has been notifiable in the Borough since 1914 under various Orders and Regulations those at present in operation being " The Metropolitan Borough of Paddington (Measles and German Measles) Regulations, 1920." 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 1931, 541 cases of measles certified by medical practitioners, and 118 cases reported from other sources, the corresponding figures for 1930 being 1790 and 438, and for 1929, 210 and 62. The number of notified cases is analysed in the adjoining table in 4-weekly periods for the various wards. 1931. 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 20 9 6 12 9 14 34 31 15 27 114 140 110 541 Wards— Queen's Park - 2 - 1 - 4 18 10 2 9 7 2 3 58 Harrow Road 3 1 - 2 1 8 9 6 1 1 8 8 27 75 Maida Vale 6 2 - 2 - — 1 4 2 1 28 22 16 84 Town — — — — — — 1 - - - - 2 1 4 Church 1 1 1 — — — 2 6 6 2 54 53 28 163 Westbourne 5 — 1 2 3 — — 4 1 2 13 42 30 103 Lancaster Gate, West — - 1 1 1 - - - 2 - - - 4 9 Lancaster Gate, East 2 1 2 o 1 1 1 - - - - 1 1 12 Hyde Park 3 2 1 2 3 1 2 2 1 12 4 — — 33 18 Fifteen deaths were attributed to measles, 4 of which occurred among children under the age of 1 year, 6 among children between the ages of 1 and 2 years, 4 among children between the ages of 2 and 5 years, and 1 among children over 5 years of age. 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 87 under 5 j'ears of age and 10 over 5 years of age. The number of visits paid by the nurses was 880 and 81 to each group respectively. One hundred and twenty-eight cases received treatment in hospital. GERMAN MEASLES. This harmless, but infectious disease, is notifiable in Paddington; 58 cases were notified in 1931, as compared with 86 in 1930, 1,163 in 1929, 109 in 1928 and 78 in 1927. Six 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 ±o the disease. Eighteen notifications relating to cases of purulent eye-discharge of the new-born were Teceived during 1931. Of the 18 patients 17 recovered without any impairment of vision. In the remaining case the sight of one eye was affected. As soon as a case of this disease is notified, intensive efforts are made by the Council's jiaff 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 discharge three 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 the onset of the more severe form of the disease. During 1931, 6 cases were referred to the District Nursing Association, 89 visits being paid. Eleven cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 8 cases of puerperal fever notified during 1931, 7 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 London County Council 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 nursmg staffs provided. The Council have also provided an obstetric consultant at these three institutions. Paddington mothers go, as a rule, to the North-Western Hospital, Hampstead, which is within easy reach of the Borough. Four deaths from the disease were recorded during the year. 19 PUERPERAL PYREXIA. This condition is defined as s— "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 32 cases of puerperal pyrexia were notified, 26 of which occurred within or were removed to institutions. Two cases of puerperal pyrexia were nursed by the District Nurses at home, 47 visits being paid. 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 fever and puerperal pyrexia. No requests for his assistance were made to the Council during the year. ERYSIPELAS. Sixty-seven (67) cases were notified, 35 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. Two cases of this disease, otherwise known as Infantile Paralysis, were notified and received treatment in hospital. 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, and received treatment in hospital. ACUTE ENCEPHALITIS LETHARGICA. No case of this disease was notified. CEREBRO-SPINAL FEVER. Five cases of this disease were notified in 1931. All were treated in hospital. Two of the five cases proved fatal, as well as another case which had not been notified. MALARIA. No case of this disease was notified. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. Two hundred and forty-three (243) cases of acute primary pneumonia were notified in 1931 as compared with 168 in 1930, 247 in 1929, 202 in 1928 and 183 in 1927. Of the 243 cases, 168 were nursed in institutions. Ninety-seven (97) cases of acute influenzal pneumonia were notified as compared with 40 in 1930, 135 in 1929, 59 in 1928, and 107 in 1927. Of the 97 cases, 46 were nursed in institutions, Seventy-eight (78) cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council scheme for district nursing, 951 visits being paid. 20 ANTHRAX. One case of this disease was notified during the year, the patient being a woman 71 years of age. The source of infection could not be traced. CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. No cases of these diseases were notified during 1931. 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 1931, 8 persons died of whooping-cough, all being children under the age of 5 years. The number of deaths in 1930 and 1929 were 4 and 71 respectively. CANCER. The deaths from cancer are growing in number year by year in every part of the country. It is now one of the commonest causes of death. The number of deaths, 226, which occurred in Paddington last year was, however, considerably lower than that recorded in the previous year. The numbers of deaths tor previous years are shown in the list following:— Numbers of Deaths in Paddington. 1931 226 1930 278 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. Seven cases are not included owing to absence of information. 1931 Cancer. Site of Disease. Ages. All Ages. 0- 15- 25- 35- 45- 55- 65- 75- M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal cavity - - - - - - - - 2 2 2 1 3 - - 1 7 4 Pharynx, oesophagus, stomach, liver and annexa - - - - - 1 - - 4 4 8 7 11 12 5 3 28 27 Peritoneum, intestines and rectum - - - - - 1 - 1 4 4 7 6 5 6 2 5 18 23 Female genital organs - - - - - 1 - 3 - 9 - 2 - 6 - 1 - 22 Breast - - - - - 1 - 1 - 8 - 5 - 6 - 9 - 30 Skin - - - - - - - - - 1 - - - 1 - 2 - Other or unspecified organs 1 - - 1 1 1 1 - 2 2 19 5 10 6 4 5 38 20 1 - 1 1 5 1 5 12 29 37 26 29 36 12 24 93 126 21 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 and were extended to March 31st, 1930, from which date the disease, under further Regulations, became permanently notifiable in the Borough. During 1931, 37 cases of acute rheumatism were notified. This figure compares with 43 cases in 1930 52 cases in 1929, 76 cases in 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. During the year 1931 a grant of £150 was made by the Council towards the cost of the maintenance of the centre. The objects of this voluntary centre are:— (1) To meet the need shown by rheumatic cases for careful supervision during periods of apparent quiescence to prevent the development of heart disease. (2) To supervise rheumatic children when apparently well by periodical examinations, and to instruct the parents to consult their usual doctor or hospital should fresh symptoms of rheumatism develop. Treatment at the Centre itself is only given in urgent cases. (3) To instruct parents in the care of rheumatic children and to make investigations in Paddington into the causation of rheumatism. The Centre is under the personal supervision of one of the Honorary Physicians to the Hospital and there is also a salaried medical officer who devotes her whole time to visiting cases of the disease and making such enquiries as may elucidate the causes thereof. The work of the Centre lies with children who are suffering from rheumatism in any of its forms, whether slight or " acute " as defined in the Regulations. During the year 44 sessions were held, the 152 Paddington children on the register making 335 attendances. Forty-two new cases from Paddington attended the Centre, but of the 37 notified as " acute rheumatism," only 13 attended, including 5 cases notified from the Children's Hospital. The remaining patients either received treatment in institutions or were under the care of private medical practitioners. A full account of the work of the Centre will be found in the Report of the Physicianin-Charge which appears as an Appendix to this Report. (See page 58). INFECTIVE ENTERITIS. This disease is notifiable in some eight other metropolitan boroughs. On May 2nd, 1927, the Council made the disease known as "Infective Enteritis" or "Summer Diarrhœa" notifiable for a period of two years. This Order was made by virtue of the Public Health (London) Act, 1891, and is only applicable to children under the age of five years. It was extended in 1929 for a further period of three years. Forty cases of the disease were notified during the year. 22 The number of deaths under the age of 5 years was 27 as compared with 29 in the year 1930, 37 in the year 1929, 23 in the year 1928 and 16 in the year 1927. Four cases in children under 1 year of age were nursed at home by the District Nurses, the number of visits paid being 22. Thirty-one patients received treatment in various hospitals. Provision was available in the isolation hospitals of the London County Council but no cases of the disease were removed from Paddington to such institutions. TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year 1931 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 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 117 deaths in 1931, and from other tuberculous diseases there were 21 deaths. The number of deaths from tuberculosis of all kinds was 128 in 1929, 114 in 1930 and 138 in 1931. In recent years the numbers of deaths were as follows:- 1919 133 1925 119 1920 146 1926 125 1921 125 1927 118 1922 143 1928 116 1923 127 1929 128 1924 149 1930 114 1931 138 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1931. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0- 1 year - - - 2 1 3 1- 5 years - - - 5 8 13 5-10 „ 2 1 3 19 11 30 10-15 „ - 1 1 5 9 14 15-20 „ 6 12 18 3 2 5 20-25 „ 17 19 36 3 6 9 25-35 „ 35 32 67 2 6 8 35-45 „ 29 16 45 1 2 3 45-55 „ 14 8 22 - 2 2 55-65 „ 12 - 12 - - - 65 years and over 8 1 9 - - - Total 123 90 213 40 47 87 Cases re-notified 98 72 170 5 6 11 Total Notifications on Form A 221 162 383 45 53 98 Public Health (Tuberculosis) Regulations, 1930. Cases removed from Register:— 1931. By reason of— Death 140 Removal 186 Recovery of patient or variation of diagnosis 110 Total 436 Of the patients who removed from the Borough during 1931, the new addresses were obtainable in 99 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1931, 11 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 1931 was 1,416 as compared with 1,522 at the close of the year 1930. 23 Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 1,632 By Tuberculosis Officers 495 By Dispensary Nurses- 20, Talbot Road 3,105 St. Mary's Hospital 2.279 7,511 Tuberculosis. New Cases and Mortality During 1931. Age Periods New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pu lmonary. M F. M. f. M. f. M. f. 0 - - - 2 1 - - - 1 1 - - - 6 8 - - 2 - 5 - 2 1 20 11 - 1 2 1 10- - 1 5 10 15- 6 12 4 3 9 11 5 3 20- 17 21 3 7 25- 38 32 2 6 16 10 1 1 35- 29 16 1 2 12 10 1 - 45- 14 8 - 2 18 5 1 1 65- 12 - - - 11 5 1 - 65 years and upwards 8 1 - - 7 2 1 - Totals 126 92 43 50 73 44 14 7 Sixteen persons dying from tuberculosis during the year were not formally notified, this number being equal to 11.6 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 taberculosis 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. Supply of Beds and Bedding.—In certain instances, so that the separate sleeping of tuberculous patients may be arranged, beds and bedding are supplied on loan by the Council. Three sets were so supplied during 1931 and 2 sets were returned following the decease of the patients. 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 1931 one shelter was lent and one lent in a previous year was 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 1931, 9 patients were referred to the Hospital, the number of refills received by each being respectively 32, 22, 19, 18, 17, 16, 7, 6 and 3. The total cost amounted to £73 10s. 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 attendance one half-day weekly. 24 Arrangements have also been made for the supply of dentures by the Dispensary Committee. In connection therewith 3 patients were supplied with partial dentures, and in 2 cases repairs to dentures were effected. Out of a total cost of £13 14s. 0d., grants to the amount of £4 3s. Od. 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 1931. 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 126 64 1 8 — 4 16 50 1 1 — 2 3 25 15 17 Children 141 32 1 2 — 9 44 107 —- — 3 57 — 16 Men 30 - - - — 5 2 19 2 1 — 1 — 13 8 9 Total 297 96 2 10 - 18 62 176 3 2 - 3 6 95 23 41 Number of Sessions held = 43. In addition to the dentures supplied at the Talbot Road Dispensary, full dentures were supplied to a patient receiving treatment in a sanatorium, the cost, amounting to £5 10s 0d., being borne in equal shares by the patient's approved Society and the Council. DISPENSARY TREATMENT OF TUBERCULOSIS. For administrative purposes the Borough is divided into two dispensary areas, the line of division passing down Inverness Terrace, Porchester Road, Ranelagh Road, Formosa Street to its junction with Shirland Road, and Shirland Road to its junction with Kilburn Park Road. The portion of the Borough to the east of this line is served by the St. Mary's Hospital Dispensary, and the portion to the west of the line by the Paddington Tuberculosis Dispensary. Paddington Tuberculosis Dispensary, 20,Talbot Road. This is a voluntary agency supported by voluntary subscriptions, and a grant from the Paddington Borough Council which last year amounted to £1438. 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 1931, 45 patients received treatment, 994 exposures being given. All that can be said so far of this treatment is that the results are encouraging. 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. In November, 1931 a class for the manufacture of hand-made gloves by tuberculous woman was opened at the Dispensary under the auspices of the Central Fund for the Industrial Welfare of Tuberculous Persons. The class is held every Wednesday afternoon and is attended by suitable patients from Kensington and St. Marylebone in addition to those from Paddington. At the close of the year this new venture showed every sign of proving a success. 25 Return Showing the Work of the Dispensary During the Year 1931 Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 47 29 - 1 2 5 20 17 49 34 20 18 843 (6) Doubtfully tuberculous - - - - - - - - 4 2 4 6 (e) Non-tuberculous - - - - - - - - 194 202 138 172 b.-Contacts examined during the year :— (a) Definitely tuberculous 4 5 - - - - 3 6 4 5 3 6 185 (6) Doubtfully tuberculous - - - - - - - - - 1 1 1 (c) Non-tuberculous - - - - - - - - 27 63 42 32 C.-Cases written oil the Dispensary Register as (a) Cured 2 4 - - 3 8 11 5 6 12 11 5 903 (b) Diagnosis not confirmed or non - tuberculous (including cancellation of cases notified in error) - - - - - - - 221 265 180 204 D.-Number of Persons on Dispensary Register on December 31st :— 805 (a) Diagnosis completed 195 196 2 2 36 66 167 122 231 262 169 124 (b) Diagnosis not completed - - - - - - - - 4 3 5 7 I. Number of cases on Dispensary Register on January 1st 831 3. Number of cases transferred to other areas, cases not desiring further assistance under | the scheme, and cases "lost sight of." 102 5. Number of attendances at the Dispensary (including Contacts) 5,697 7. Number of consultations with medical practitioners:— (а) Personal 46 (б) Other 210 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,105 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above - 2. Number of cases transferred from other areas and cases returned after dis- charge under Head 3 in previous years 18 4. Cases written off during the year as Dead (all causes) 67 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 147 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 280 10. Number of (a) Specimens of sputum, &c„ examined 364 (b) X-ray examinations made in connection with Dispensary work ... 90 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 166 26 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,105 from the Paddington Borough Council during the year 1931. 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 1931. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand 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 21 22 - 2 2 4 1 2 23 26 1 4 130 (b) Doubtfully tuberculous - - - - - - - - - 2 - - (c) Non-tuberculous - - - - - - - - 19 33 11 11 B.—Contacts examined during the year :— (a) Definitely tuberculous - - - - - - 1 - - - 1 - 48 (b) Doubtfully tuberculous - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 6 20 10 11 C.—Cases written off the Dispensary Register as (a) Cured - - - - - 1 6 1 - 1 6 1 129 (6) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error) - - - - - - - - 25 53 21 22 d.—number of Persons on Dispensary Register on December 31st:— 1 (a) Diagnosis completed 79 75 3 4 41 45 38 25 120 120 41 29 312 (b) Diagnosis not completed - - - - - - - - - 2 - - 1. Number of cases on Dispensary Register on January 1st 317 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of." 51 3. Number of attendances at the Dispensary (including Contacts) 3,455 7. Number of consultations with medical practitioners:- (a) Persona - (b) Other 30 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,279 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above - 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 12 4. Cases written off during the year as Dead (all causes) 15 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 6 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 215 10. Number of (а) Specimens of sputum, &c., examined 104 (b) X-ray examinations made, in connection with Dispensary work 66 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 69 27 The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1931 was as follows:- Representing. Paddington Borough Council Councillor W. H. Crook (Chairman, Public Health Committee). ,, ,, Councillor Mrs. R. M. Drury (Vice-Chairman). „ „ Councillor Mrs. A. E. Lambert. „ „ 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 N. Clive. Invalid Children's Aid Association Miss L. C. Streatfeild London County Council Dr. A. W. Sikes (Divisional Medical Officer). „ „ Miss K. Marriott (District Organiser of School Care Committees). Paddington Tuberculosis Dispensary Dr. R. S. Walker (Tuberculosis Officer). „ „ ,, Nurse C. Griffin. „ „ „ Nurse A. B. Munro. ,, „ „ Miss C. Milner. 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. Public Assistance Committee Area VI Miss H. C. Davidson, Panel Committee Dr. S. Crown. St. Mary's Hospital Dr. A. B. Porteous (Tuberculosis Officer). „ „ Sister M. M. Lee. Red Cross Emergency Fund Miss M. M. Barthorp. British Legion and United Services Fund Benevolent Committee Mr. J. E. Bennison. Paddington and St. Marylebone Employment Committee Mr. A. E. Goss. The Medical Officer of Health continued to act as Honorary Secretary to the Committee, an allowance of £50 per annum being allocated to certain members of the clerical staff for clerical assistance. The social work of the Tuberculosis Care Committee is ancillary to the work of the Public Health Committees of the Borough Council and London County Council in the sphere of the prevention and treatment of tuberculosis. The principal duties performed are : (1) The assessment of patients' contributions, who are receiving institutional treatment at the hands of the London County Council. (2) The co-ordination of the various agencies which can be invoked to assist patients and their dependants. No funds are available in the hands of the Committee for the assistance of patients. The Committee met on 22 occasions during the year, and the attendance of members was well maintained. Two hundred and ninety-one individual cases were considered. Residential treatment was granted by the London County Council to 159 patients, 19 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 159 patients, 120 received free treatment, the remaining 39 patients, or their parents, paying contributions varying from 2s. 6d. to 25s. a week. Payments are collected by the Committee and transmitted monthly to the County Council. During the year a total of £217 3s. 6d. 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 1931, 9 assessments were revised by the County Council for this reason, following recommendations made by the Care Committee. 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 1931, the Committee were able to arrange for assistance in the form of clothing, extra nourishment or monetary grants to be given to a number of patients, or their dependants, by various charitable organisations, including the Charity Organisation Society, the British Red Cross Emergency Fund, the British Legion and United Services Benevolent Fund and the Royal Naval Benevolent Trust. 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. 28 MATERNITY AND CHILD WELFARE. Prior to the 1st July, 1931, there were two Health Visitors in the service of the Council, their work being supplemented by that of the Health Visiting Staff of the Paddington School for Mothers, a voluntary society receiving an annual grant from the Council. With a view to improving the general efficiency of the maternity and child welfare work in the Borough, the Council, towards the close of the year 1930, decided to take into its service the whole of the Salaried Staff of the School, together with the part-time Medical Officers and Masseuses attending the various consultations. The transfer was effected on the above-mentioned date. The full staff now consists of 8 whole-time Health Visitors, 1 part-time Health Visitor, 9 part-time Medical Officers, 2 part-time Masseuses and 1 part-time Clerical Assistant. Health Visitors. The duties of these officers are:— (1) To visit the homes of children from birth up to the age of 5 years where considered necessary. (2) To make enquiries concerning stillbirths and deaths of infants and young children. (3) To visit and give advice to parents in cases of ophthalmia of the new-born, infective enteritis and other important diseases. (4) To investigate all cases of puerperal fever and puerperal pyrexia. (5) To attend the maternity and infant consultations at the Centres provided by the Paddington School for Mothers. The home visiting work performed by the Health Visitors during the year is summarised in the appended table. HEALTH VISITING. First Visits to children under 1 year of age 2,399 Revisits „ ,, ,, 6,152 8,551 Visits to children between the ages of 1 and 5 years 12,357 First visits to expectant mothers 748 Revisits „ „ 532 1,280 Other Visits. Puerperal Fever and Puerperal Pyrexia 106 Ophthalmia Neonatorum 310 Diarrhoea 176 Miscellaneous (including ineffective calls) 13,890 14,482 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 before April 1st, 1930, from the Ministry of Health. The scheme made by the Minister of Health under section 101 (6) of the Local Government Act, 1929, provided for an annual contribution of £2,750 to be made by the Council to the Paddington School for Mothers, as from April 1st, 1930. In July, 1930 the Executive Committee of the Paddington School for Mothers offered to arrange for the transfer to the Council's service of the Salaried Officers of the School, namely:—Medical Officers, Health Visitors, Masseuses and Clerical Assistant, in order to unify the Maternity and Child Welfare Service of the Borough. 29 This amendment to the Scheme, with the approval of the Minister of Health, was accepted, and provides for an annual contribution of £500 to be made by the Council to the Paddington School for Mothers as from July 1st, 1931, the date of the transfer of the Salaried Staff to the service of the Council. 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, bath room and basement. Two Infant Consultations weekly.—Tuesday, 2.15. Medical Officer, Dr. O. Stuart Thompson. Thursday, 2.15. Medical Officer, Dr. J. Thoresby Jones. Area served:—Parts of Church, Harrow Road, Westbourne and Maida Vale Wards. One Maternity (Ante- and Post-Natal) Consultation weekly.—Established January, 1918, monthly. March, 1919, weekly. Monday, 10 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served:—All Paddington, until July 30th, 1931, when a consultation for North Paddington was established at St. Simon's Parish Hall, Macroom Road, Saltram Crescent, W.9. One Nutritional and Physio-Therapeutic Consultation weekly.—Established September 8th, 1931. Tuesday, 10 a.m.' Medical Officer, Dr. R. Cove-Smith. 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. Two Infant Consultations weekly.—Wednesday, 2.15. Medical Officer, Dr. Maude Richards. Friday, 2.15. Medical Officer, Dr. Evelyn Maclagan. The Friday Consultation was established at St. John's Boys' Club, Sovereign Mews, Cambridge Street, W.2, November, 1918. Moved to All Saints' Church House, Norfolk Mews South, London Street, W.2, April 22nd, 1919. Returned to St. John's Boys' Club, July 30th, 1926. Transferred to present address, February 27th, 1931. Area served :—Church, Town and Hyde Park Wards. Christ Church Parish Rooms, Queensborough Passage, Porchester Terrace, W.2.—Two large rooms, doctor's room and sales room warmed by electricity and coal fires. Established, March 7th, 1927. One Infant Consultation weekly.—Monday, 2.15. Medical Officer, Dr. E. Dorothy Fenwick Area served :—Lancaster Gate East and West Wards and part of Westbourne Ward. 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, 2.15. Medical Officer, Dr. E. Dorothy Fenwick. Friday, 2.15. Medical Officer, Dr. S. Denovan Adam. Area served.—Queen's Park Ward and part of Harrow Road Ward. 30 St. Simon's Parish Hall, Macroom Road, Saltram Crescent, W. 9.—Large hall, doctor's room and weighing room warmed by gas radiators and gas fires. Established December 6th, 1920. Two Infant Consultations weekly.—Wednesday, 2.15. Medical Officer, Dr. J. McKail. Thursday, 2.15. Medical Officer, Dr. Hubert Hodge. The Thursday Consultation was established February 8th, 1921, at the Orphanage of Mercy, Randolph Gardens, Kilburn Park Road, N.W.6. Transferred to present address, June 27th, 1929. Area served :—Maida Vale Ward and part of Harrow Road Ward. One Maternity (Ante- and Post-Natal) Consultation weekly.—Established July 30th, 1931. Thursday, 10 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served:—North Paddington. Massage Sessions, established March 17th, 1925, 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., and Miss Pinkerton, 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. Artificial Sunlight Treatment.—A lamp has been installed at 232, Harrow Road, by the Borough Council, and Artificial Sunlight Treatment has been given since September 8th, 1931, by Miss Gannon, under Dr. Cove Smith, on Tuesday mornings, in conjunction with Massage and the Nutrition Centre. Dental Arrangements.—Messrs. J. Trude Fripp and F. H. Brinckley Tofts, 281, Harrow Road, treat mothers and children who attend Centres, on special terms. Assistance, when necessary, given from Vest Fund. Dental Treatment can also be obtained for children from Paddington Centres, at the Eastman Dental Clinic, Royal Free Hospital, Gray's Inn Road. 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. Instruction in Invalid Cookery, Knitting, etc, is given at Christ Church Centre on Monday at 2.15 p.m. by a qualified Voluntary Worker. Lectures on Health Topics are provided from time to time. Convalescent and Holiday Homes.—Mothers and children are sent to Convalescent and Holiday Homes on recommendation of Medical Officers at Centres. Assistance, when necessary, given from 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. Home Visiting. Until July 1st, 1931, Home Visiting was carried out systematically by the School's Health Visitors to children up to School age, from the time of receiving the Borough Health Visitor's Birth Card. This work then passed under the direct control of the Borough Council. Paddington Infant Saving Campaign. Office accommodation and other facilities are provided at 232, Harrow Road, for the Paddington Infant Saving Campaign. 31 Consultation Centres. Summary of Work for the Year, 1931. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. * Sovereign Mews. Qaeens- boro' Passage. Totals. Tues. Thurs. Tues. Fri. Wed. Thurs Wed. Fri. Mon. Number of Sessions 52 52 52 51 52 51 53 51 48 462 Number of Attendances 2543 3074 2916 2270 2239 2534 2387 1807 2745 22,515 Average Attendance 48.9 59.1 56.0 44.5 43.0 49.7 45.0 35.4 57.2 48.7 Seen bv Doctor 859 1072 1091 838 840 1080 968 870 1294 8912 Average number seen by Doctor at each Session 16 20 21 16 16 21 18 17 27 19 * Consultations transferred to St. Mary's Terrace, February, 27th, 1931. The total number of children attending the consultations was 2,468, 1,128 being under 1 year of age and 1,340 between the ages of 1 and 5 years. Ante-Natal and Post-Natal Clinics. Harrow Road. Macroom Road. (Opened 30th July, 1931) Number of Sessions 49 22 Number of Attendances 643 125 Number of Expectant or Recently Confined Mothers who Attended 254 56 Average Attendance per Session 13 6 Number of Cases Referred by Midwives in Private Practice 39 13 Nutritional and Physio-therapeutic Clinic.—This clinic was established on September 8th, 1931, at 232, Harrow Road, and is open one morning a week. During the three months ending December 7th the number of individual cases attending was 68, divided as regards treatment into the following groups 38 Irradiation 26 Irradiation and massage 4 Dietetic The total attendances were 356. The first installation of the Mercury Vapour Lamp was not entirely satisfactory, and the resistance transformer became overheated owing to a fault in the tungsten terminal of the burner. In October, however, the makers supplied a new burner, which was more powerful in its output of actinic rays, and has given complete satisfaction. Dr. R. Cove-Smith, the medical officer in charge, reported as follows at the end of the first three months:— " Although the greater number of cases are due to defective diet and rickets, several very interesting clinical conditions have been discovered and dealt with. In the first fortnight of the clinic's existence, a child which was walking badly was found to have a congenital dislocation of the hip that had been overlooked elsewhere. An X-ray examination was made, and the child has been operated upon with the result that it is now making an excellent recovery. Two cases of infantile hemiplegia due to birth injury, have made great strides since irradiation and dietetic treatment were added to their massage, not only as regards their weights, but the mothers state that their sleep is more restful. That, I may say, is the general consensus of opinion of the mothers, and the importance of restful sleep to the growing child cannot be over-emphasized. A case of purpura with an enlarged spleen is also doing excellently. There is a great tendency amongst the mothers of Paddington to start cereal feeding of the infant too soon. Rusks and other cereals are added to the infant's diet in the early months, in spite of the fact that these contain a toximin that is definitely inhibitory to vitamin activity. Such actions lead to rickets, and the clinic is having to clear up the consequences of ignorance. On the whole I think that those responsible for the inauguration of this clinic can feel that their confidence has been justified, and that even in such a short period as three months, there has been a positive achievement." Owing to the small number of cases which have completed treatment so far, it would not be profitable at this stage, to make any detailed analysis of the results. 32 Supply of Dried Milk, Etc., at Consultation Centres. £ s d. Purchases of Dried Milks, etc. 1,284 6 9 Sales 1,160 14 9 Grants from Borough Council 166 10 1 Queen Charlotte's Maternity Hospital.—During the year 1931, 138 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 10.5. As regards ante-natal consultations, exact figures are not available. During 1931, there were received into the Hospital for confinement 265 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 9 per patient. With regard to out-patients in 1931, 404 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about 9 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 1931 was 177 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 1931, 177 confinements were attended by the nursing staff, the number of visits being 2,832. These figures compare with similar ones of 155 and 2,710 in the year 1930. The annual grant in aid of this work is now £175. Maternal Consultations.—On one occasion the services of an obstetric consultant were needed on account of complications associated with parturition. The usual fee was paid by the Council. Accommodation for maternity cases in St. Mary's Hospital.—During the year an agreement was concluded with the Board of Governors of St. Mary's Hospital for the provision in the Hospital, and at the disposal of the Council, of a self contained suite of 14 beds for confinements of Paddington women, It is anticipated that the new wards will be ready for use early in 1933. DAY NURSERIES. At the end of the year 1931, 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. Full days. Saturdays. Full days. Saturdays- Days open 255 50 240 47 Attendances 5,985 257 7,675 748 Average attendance 23 5 32 16 New Children 62 55 Cases of Infectious Disease. Diphtheria - - Scarlet Fever 1 - Measles 1 - Whooping Cough 3 - Chicken-pox - 14 Mumps - 7 There were no Closures during the Year on account of infectious disease 33 The Scheme made by the Minister of Health under section 101 (6) of the Local Government Act, 1929, provides for the annual payment as from April 1st, 1930 of contributions from the Council, to the Paddington Day Nursery, £322, and to the Queen's Park Day Nursery, £252. An additional sum of £75 was paid by the Council during the year to the Paddington Day Nursery. PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. Scheme adopted by Borough Council. (1) The supply of milk at less than cost price to be limited to necessitous cases of (a) Nursing mothers, actually feeding their children; (b) Expectant mothers after the sixth month of pregnancy; and (c) Children under the age of three years. Provided that where specially certified by the Medical Officer of Health to be necessary on grounds of health, such supply may be granted in respect of a child between the ages of three and five years. (2) The amount of milk to be supplied to any mother or child not to exceed one pint per day, but if specially certified by the Medical Officer of Health to be necessary for the child's health the amount supplied to a child aged from three to eighteen months may be increased to one and a half pints per day. (3) All applications for a supply of milk at less than cost price to be made on the prescribed Form known as " M.C.W.3," such Form to be signed by both parents whenever practicable. (4) Any application for the supply of milk at less than cost price which is not supported by a medical certificate in the prescribed form signed by a Medical Officer of one of the Consultation Centres maintained by the Paddington School for Mothers on behalf of the Borough Council, to be approved by the Medical Officer of Health. (5) On the receipt of an application for the supply of milk at less than cost price, a visit to be made to the home of the applicant. If the applicant be attending at any of the Consultation Centres maintained by the Paddington School for Mothers, such visit will be made by one of the Staff of Visitors attached to the School. In all other cases, the visit will be made by an Officer of the Public Health Department, who will advise attendance at a Consultation Centre. A report of the home conditions, health of children, etc., will be entered on Form " M.C.W.3." (6) Where deemed necessary the income of the applicant's family as stated in Form " M.C.W.3 " to be verified in the usual manner by the Investigation Officer. (7) The " Grants " Committee—being a Sub-Committee of the Maternity and Child Welfare Committee—to meet at least once in each week. All applications for supply of milk at less than cost price to be reserved for consideration by the " Grants " Committee and, except as hereafter provided, no supply to be granted until the application has been considered by the " Grants " Committee. (8) In considering an application for a supply of milk at less than cost price the " Grants " Committee to adhere to the scale of incomes set out in the Schedule appended to this Scheme ; Provided that where the "Grants" Committee are of opinion that a strict adherence to the Schedule would deprive any mother or child of a supply of milk really necessary on grounds of health, the Committee may take into consideration any other facts of the case, and make their decision accordingly. No grant to be made for a period exceeding four (4) weeks. (9) Where the Medical Officer of Health certifies that an immediate supply of milk at less than cost price is necessary on grounds of health to any mother or child, he may issue an Emergency Order for such supply for a period sufficient to include the interval which will elapse before the next meeting of the "Grants" Committee. (10) Orders for the supply of milk at less than cost price to be in the prescribed form and no payment for any such supply to be made except upon production of the receipt of supply signed by the applicant. (11) Orders for the supply of milk at less than cost price to be issued only to such dairymen or milk purveyors as maintain their premises in accordance with the Regulations pursuant to 34 the Dairies, Cowsheds and Milkshops Orders. The names of all purveyors of milk who are warned or prosecuted by order of the Public Health Committee for breaches of the Milk and Dairies Order, 1926, or for offences against the law as regards adulteration, etc., shall be reported to the Maternity and Child Welfare Committee, who will decide whether orders shall be placed with such purveyors of milk. (Samples will be taken periodically of the milk supplied under any order issued under this Scheme.) (12) Stock books showing orders for the disposal of all forms of dried milk and of other preparations of milk to be kept by the Public Health Department, and stock to be taken monthly at each Consultation Centre maintained by the Paddington School for Mothers which acts as the distributing agent for the Borough Council. (13) No grants of milk or milk substitutes at less than cost price to be made to families in receipt of Poor Law Relief. (14) "Pasteurised" milk to be supplied to recipients of milk grants, provided that the medical officers engaged at the several infant welfare centres of the Paddington School for Mothers shall be authorised in special cases, to recommend the supply of "Grade A (Tuberculin tested)" milk, such supplies of "Pasteurised" and "Grade A (Tuberculin tested)" milk to be in accordance with the terms and conditions prescribed in the Milk (Special Designations) Order, 1923. (15) Grants of oil and malt, etc., to be supplied to necessitous mothers in receipt of milk grants from the Council. Schedule. Scale of Income for Grants. Basis—Total income of family, less rent, divided by number of persons living on said income. In determining the number living on income include dependants living at home in addition to man, wife and their children. Number of family. Free. Half-Price. Total Income less Rent. Average Per Head. Total less Income Rent Average Per Head. •• s. d. s. d. s. d. s. d. 1 15 0 15 0 18 0 18 0 2 20 0 10 0 24 0 12 0 3 25 6 8 6 27 0 9 0 4 30 0 7 6 34 0 8 6 5 32 6 6 6 37 6 7 6 6 36 0 6 0 42 0 7 0 Families of more than six persons to be dealt with according to their circumstances. (Paragraph 8 of Scheme.) The arrangements for administering the Scheme are as follows:— Applications for Grants.—Applicants for grants are referred to the Town Hall by, amongst others, medical practitioners, the staffs of the welfare centres, the health visitors, relieving officers, maternity and general hospitals and various public and charitable institutions. Procedure.—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 1½ or 2 pints per day when the necessity is certified by the medical officer of a Welfare Centre. The "Grants" Sub-Committee now make 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. 35 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. The "Grants" Sub-Committee meet weekly and all new cases (applications made during the previous seven days) are considered. In addition other expiring grants are brought forward for re-consideration and with them is a report by the health visitor on the condition of the mother or child in receipt of the grant and a note by the investigation officer dealing with financial or other circumstances at that juncture. Generally, renewals are made for four weeks, discretion being given to the investigation officer to issue orders up to that period for one, two or three weeks as he may consider advisable. Pending a sitting of the "Grants" SubCommittee the Medical Officer of Health 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 ; (b) Dried Milk—supplied at the Welfare Centre attended by the infant; (c) Dinners (cut from joint, two vegetables and milk pudding) to expectant or nursing mother partaken at approved restaurants ; (d) Accessory Foods—Oil and malt, etc. The necessary orders are despatched direct to the tradesman and a copy sent or handed to the grantee. On the latter the following conditions are printed:— Milk supplied under this order is to be used only for the mother or child to whom the milk has been granted. It is not to be given to other members of the family. The Medical Officer of Health should be informed at once if there be:— (1) Any change whatever in workplace or income of any member of the family; (2) Any change of address ; (3) Any assistance received from the Relieving Officer. Particulars of Milk Grants during 1931. (1930 figures in brackets). The total number of cases considered by the "Grants" Committee during the year was 3,047 of which 993 represented new applications. These latter were divided up as follows :— Number of New Applications. Granted. Refused, withdrawn or referred to Public Assistance Committee. Fresh Milk 852 (561) 712 (489) 140 (72) Dried Milk 132 (87) 130 (82) 2 (5) Dinners 9 (4) 8 (4) 1 (-) 993 (652) 850 (575) 143 (77) Details relating to the numbers of orders issued and the expenditure incurred are given below. Number of Orders for Milk 2,633 (1,761) At Total Cost 2,552 (1,730) At Half Cost 81 (31) Number of Quarts at Total Cost 28,358 (21,594) „ „ Half Cost 882 (402) Total Number of Quarts 29,240 (21,996) £ s. d. £ s. d. Cost of Milk at Total Cost 749 15 9 (597 2 6) Half Cost 11 13 1 (5 8 7) £761 8 10 (£602 11 1) Number of Orders for Dried Milk 619 (361) At Total Cost 615 (361) At Half Cost 4 (-) Total Cost of Dried Milk £166 10 1 (£105 3 0) Number of Orders for Dinners 22 (8) Number of Dinners supplied at Total Cost 312 (107) Total Cost of Dinners £18 4 5 (£6 6 2) 36 THE HYDE PARK BABIES' CLUB. During the year a welfare centre on a contributory basis, for dealing with the class of mother who does not attend a municipal centre, was opened, and I am indebted to Dr. Emslie, the Medical Officer in charge, for the following note of the Club's activities. The Hyde Park Babies' Club was opened in June, 1931, for a trial period of two months, and re-opened in October on the basis of annual membership at a fixed subscription. The Club meets in part-time premises very bright and airy, and overlooking the Park at 94, Lancaster Gate, W.2. It holds one medical consultation and weighing session per week, conducted exactly as in the ordinary Infant Welfare Centre with home visiting by arrangement, and lectures and practical classes for mothers and nurses at specified times. The Staff consists of a Medical Officer of specialist infant welfare experience and a Sister-Superintendent with very varied training in maternity and children's work. The fees vary from 3 guineas for a child under one year to 2½ guineas for children over one year, 2 guineas for a second child in the same family, and 1 guinea for any other child in one family. Home visits are available on the suggestion of the doctor or by direct application to the Sister-Superintendent, and are paid for separately except the first which is free. Lectures are charged for at a nominal rate, and are open (partly as a mode of interesting newcomers) to non-members of the Club. These have been very largely attended and have been of particular use in attracting " nannies " who have no previous knowledge of infant welfare work. The attendances at the Club sessions are arranged by appointment and either mothers or " nannies" or both are present. No medical treatment is given and the Club doctor may not be called in privately in case of illness unless in consultation with the private practitioner. No foods or drugs are on sale at the Club, but there is a clothing stall from which garments may be purchased or patterns obtained, and a bookstall and lending library for which an extra fee of 5s. per annum is charged, and from which a large range of modern child health literature is obtainable. Club visits to institutions of special interest to mothers, such as sun-bathing centres, milk depots, nursery schools, etc., occasionally take place. The Club has attained a child membership of 30 in the part year it has been open, and members are being attracted at an increasing rate. It aims at being self-supporting in a brief period, but at present receives some help in the form of private donations. The Governing Committee is largely composed of mothers who are members. The lack of funds limits the possibilities of making the Club known except by private recommendation and at present too high a proportion of the babies are not brought under supervision till late in their first year. Some method of getting into touch with the mother nearer her confinement is required, and before her confinement, since classes are provided for expectant mothers. The regular attendances of older children are very gratifying, and the Club is useful in many behaviour problems as well as for physical supervision. The Club receives the hearty co-operation of the Medical Officer of Health of Paddington and his staff, and is grateful for opportunities of getting into touch with local births, THE PADDINGTON INFANT SAVING CAMPAIGN. The year was notable for the initiation of a new and unprecedented scheme for combating infantile mortality. The Council is debarred by statute from establishing any form of general domiciliary service by medical practitioners for infants and young children. The Paddington Infant Saving Campaign seeks to make good this link in the chain by providing the services of a doctor for any infant up to the age of twelve months, whose parents are unable to afford a private doctor. Infants are taken into the scheme from the age of ten days up to the age of three months, and the parents choose a doctor. The payment of the doctor is at the rate of 16s. a year and in return for this he furnishes domiciliary attendance to the infant and makes a report on its health to the medical officer of health twice a year. The Campaign is financed entirely by voluntary contributions. On December 10th, 1931, there were 98 infants enrolled and some fifty doctors had signified their willingness to co-operate. 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. CONVALESCENCE. Six nursing mothers with their babies were admitted to St. Mary's Convalescent Home, Birchington-on-Sea, for varying periods of convalescence. In two cases the Council paid the whole cost, in the other four contributions were made by the head of the family. In sixteen instances the Council made grants towards the cost of children convalesced by the Invalid Children's Aid Association, the total amount being £43 10s. 8d. MATERNAL MORTALITY. During the year twelve maternal deaths were enquired into by Dr. E. Dorothy Fenwick, the Council's medical investigator, and reports thereon forwarded to the Maternal Mortality Committee of the Ministry of Health. 37 ADMINISTRATION. GENERAL. Staff of the Department.—Mr. C. Lawrence, Sanitary Inspector, retired from the Council's service on November 7th, 1931. In consequence of his illness earlier in the year, and that of Mr. F. J. Pallet, Meat and Food Inspector, it became necessary in the month of August to engage two temporary Sanitary Inspectors, who at the close of the year were still working in the Department. Miss I. L. Buckledee resigned her appointment as Sanitary Inspector on November 30th. The vacancy was filled by the transfer of Miss D. Newhall from the Council's health visiting staff. From July 1st, Miss E. E. Bogle, Miss F. E. Stammers, Miss M. Sells, Miss H. Waite, Miss E. C. Jackson and Miss N. B. May, who had previously been in the service of the Paddington School for Mothers, became Health Visitors on the permanent staff of the Council, and the services of Miss E. Elsley were retained as a temporary part-time Health Visitor. At the close of the year there was one vacancy on the health visiting staff occasioned by the transfer of Miss D. Newhall to the inspectorial staff. A temporary Visitor was engaged pending the appointment of a permanent officer. The appointment of Mr. T. E. Rainger as Vaccination Officer necessitated the addition to the staff of a Junior Clerk. Mr. H. J. A. Parker was appointed to that position as from August 4th. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 5,405. This figure excludes visits in connection with tuberculosis, which are recorded elsewhere in this report. The removals to hospitals and other institutions for various diseases other than tuberculosis numbered 1,180. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 187 patients (comprising 97 cases of measles, 78 of pneumonia, 6 of whooping-cough, and G of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 2,076. Disinfection.—The rooms disinfected after infectious disease numbered 1,080, including 213 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 nearly 25 tons. Four hundred and twenty-one library books were disinfected. Schools.—A total of 3,028 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their " contacts," 2,271 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 292 reports were sent to the medical officers of health of other boroughs in connection with cases attending outlying schools. Bacteriological Work.—The Council have an arrangement with the 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 the 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 1931 were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 1,202 137 Tuberculosis 392 56 Typhoid Fever 18 2 38 House Drainage.—During the year 6 existing drains were tested and found water-tight, 99 defective drains were reconstructed and 3 made sound by special process. Reconstruction Plans.—Three hundred and twenty-seven (327) plans were submitted for drainage works in existing buildings. In connection therewith 580 letters were despatched. Three 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:— Bayswater Terrace, Nos. 18 and 19. Wharves, North Side, Paddington Basin, Nos. 16, 17, 18 and 19. Inverness Terrace, Nos. 12, 14, 16 and 18; Nos. 1 and 3; and Nos. 36, 38, 40 and 42. Cottages and garages on the east side of Porchester Gardens Mews, and dwelling house immediately to the east of this building, all on the north side of Porchester Gardens, and on part of the site formerly occupied by No. 48, Porchester Terrace, at the junction of Porchester Terrace and Porchester Gardens. New garage in Leinster Terrace, at the rear, and within the curtilage of No. la, Porchester Terrace, and the premises No. la, Porchester Terrace. New business (brewery) premises, or building, or re-building of existing building, situate on the north-east side of Church Place, on the sites of premises now numbered and known as 19, 20 and 21, Church Place; 11, 12, 13, 14 and 15, Wellings Place; 5, 6 and 6a, Rents Place, and the stables or garage premises immediately at the rear of 14, 15, 16 and 17, North Wharf Road. New shops and flats, or building, situate on the west side of Edgware Road, on the sites numbered and known as 19 (part) and 21 to 43 (odd, inclusive) and the entrance way between 35 and 37, Edgware Road. Droop Street School, and Nos. 1 and 3, Enbrook Street. New premises on the sites of Nos. 1, 2 and 3, Star Street; and the existing Telephone Exchange at the rear thereof. One combined system was reconstructed by the Council during the year. Sewer Connections.—In 1931, 33 were reconstructed, either partially or wholly, 11 after Orders under Section 85 of the Metropolis Management Act. 1855, and 22 on the application of the owners of the properties concerned. Water Supply.—Four certificates under Section 48 of the Public Health (London) Act, 1891 were issued. The Metropolitan Water Board reported 8 cases of discontinuance of water supply, all in consequence of non-payment of rates. In 7 instances the supply was restored after intervals varying from one day to seven weeks. The remaining premises were unoccupied. Mortuary.—Five hundred and thirty (530) bodies were deposited at the Mortuary, inquests being held on 405 of that number. Bodies deposited pending burial (all noninfectious) numbered 29. Three hundred and thirty-five (335) post mortem examinations were made. Trade Nuisances.—Twenty-four complaints were received during the year, those relating to manure numbering 6. Removal of Manure.—Section 36 (2) of the Public Health (London) Act, 1891, empowers the local authority to give notice requiring the periodical removal of manure from stables, etc. With a view to the prevention of an increase in flies as well as other nuisances arising from accumulations of manure, it has been the practice of the Council for some years past to require stable refuse to be removed twice weekly during the months of May to September, public notice of such requirement being given by means of posters displayed in the various Mews in the Borough. Very little difiiculty is experienced in securing compliance with the notice. Rag and Bone Dealers.—In December, 1931, there were 9 rag and bone dealers in the Borough. 39 Smoke Control.—During 1931, 23 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 197 occasions, occupying 61J hours. Smoke of all descriptions was noted during 35 hours, the duration of " black " smoke being only 51 minutes. Thirteen complaints relating to the emission of smoke were receive d 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 or a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this bye-law shall be liable to a penalty not exceeding 40 shillings. This bye-law shall cease to be in force after the first day of August, 1926, unless a bye-law confirming and continuing its provisions has been duly made and come into force before that date. In July, 1926, the bye-law was adopted permanently by the Council. This bye-law is enforced by the Medical Officer of Health and his staff. Active assistance is given by the police, the Home Secretary having intimated in June, 1928, as a result of representations from the Council, that the police had been instructed to report to the Council such offences against the bye-law as come to their notice in the course of their ordinary duties. During 1931 three prosecutions were instituted, resulting in two defendants being fined the sum of ten shillings each and the other five shillings. 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 1931 was made to the Council by the Medical Officer oi 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 1931.—One hundred and fifteen canal boats were inspected during the year, the following infringements of the Acts and Regulations being discovered:— Cabins leaky 10 Cabin floors defective 7 Stoves and stove pipes defective 11 Boats without certificates 7 Lettering, marking and numbering illegible 5 Painting of cabins required 15 Five formal notices were served. 40 On no occasion was admission to a boat refused, and no legal proceedings were necessary in respect of any of the infringements discovered. There was one case of infectious disease notified, viz.:—scarlet fever. There were two deaths reported amongst canal boat dwellers. Four boats were registered. One hundred and twenty-three children of school age were found to be living on the canal boats using the Paddington Basin (57 males, 66 females), an increase on the figure reported last year, due to a larger number of " sand " boats entering the Basin. The total number of boats in respect of which certificates of registration had been issued at the end of the year was 253. 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. One of the requisites for an inhabited canal boat is that if ordinarily used for the conveyance of any foul or offensive cargo, it shall contain between the space occupied by such cargo and the interior of any cabin used as a dwelling, two bulkheads of substantial construction, separated by a space not less in any part than four inches, open throughout to the external air. Such space must be furnished with a pump for the removal of any liquid and the bulkhead next to the cargo is to be watertight. It has not hitherto been considered in this Borough that house refuse comes within the scope of the term " foul or offensive " cargo. Steps are now being taken, however, that double bulkheads shall be fitted to all inhabited canal boats conveying house refuse and the owners of such boats are taking all necessary action to comply with this interpretation of the Regulations. During the year, 3 inhabited boats known to be conveying house refuse from Paddington Basin, were fitted with double bulkheads. Eight boats still remain to be dealt with. These will be refitted as circumstances permit. The annual cleansing at Paddington Basin was carried out during the Easter holidays. About 1,411 tons of mud were removed from the bed of the Basin, in addition to 730 tons which were dredged previously. Later in the year the Lagoon was dredged and cleared of 1,525 tons of mud, and 692i tons of mud were removed from the canal, between Westbourne Terrace Road Bridge and Ranelagh Road Bridge. HOUSING. Conversions.—Section 102 of the Housing Act, 1925, and Section 84 of the Law of Property Act, 1925, empower 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 these Sections were made during the year relative to the conversion into flats of No. 13, Palace Court and No. 108, Lancaster Gate. The latter, however, was subsequently withdrawn. Plans continue to be submitted to the Council under the drainage bye-laws, relative to the conversion of premises into 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, or Section 17 of the Act of 1930, but 211 communications were sent to owners drawing attention to defects liable to be dealt with under these sections. These communications in most instances resulted in the defects being remedied. Unhealthy Areas.—No representations were made to the Council during 1931. Houses Unfit for Habitation.—No representations were received or Closing or Demolition 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, but action was taken under Section 96 of the Public Health (London) Act, 1891, with respect to the illegal occupation of underground rooms at three premises. In each instance the illegal occupation was discontinued. 41 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 6,013. Particulars of the defects, etc., discovered and remedied will be found on pages 43 and 44. Overcrowding.—During 1931 thirteen tenements in registered houses were reported to be overcrowded. In ten instances the overcrowding was abated. The occupants of the remaining three tenements were unable to find other accommodation before the close of the year. 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 644 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 9 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. Acquisition of a site for building purposes.—On July 22nd, 1930, the Council made an Order for the compulsory acquisition of a site formerly comprising Nos. 61, 63 and 65, Brindley Street, pursuant to Part III. of the Housing Act, 1925 and the Housing Consolidated Regulations, 1925, and application was made to the Minister of Health for confirmation of the Order. The site consists of an area of approximately 2,088 feet super and is suitable for the erection of working-class tenement dwellings. It is intended that the tenements to be provided shall be self-contained flats and shall be used for re-housing families displaced by other housing schemes to be undertaken in the Borough. The details of the scheme continued to receive attention during 1931, but owing to the necessary sanctions not being obtained it was not possible to proceed with the erection of the dwellings before the year closed. Purchasing and re-conditioning of houses.—In August, 1930, the consent of the Minister of Health was obtained to the Council's subscribing an amount not exceeding £5,000 in respect of debentures, bearing interest at 2|% per annum, secured by a Trust Deed and issued by a public utility society known as The Paddington Houses Association, Ltd. The money subscribed will be utilised in purchasing, reconditioning and improving working-class houses in the Borough, which will be let in tenements. Up to the end of 1931, £2,500 had been subscribed. Rent and Mortgage Interest (Restrictions) Acts, 1920-1925. Five applications for certificates were made, all of which were granted. In one instance a certificate was subsequently issued to the owner of the premises, under Section 5 (2) of the 1923 Act, on the completion of the necessary repairs. HOUSING ON THE LONDON COUNTY COUNCIL ESTATES. The arrangement with the London County Council made in 1924 continues in force whereby the County Council under Part III of the Housing Act, 1890, allocates preferentially to suitable applicants recommended by Borough Councils, 50 per cent of new accommodation. The quota for Paddington is 15 houses per 1,000 built. The cases are selected on the grounds of overcrowding, unhealthy conditions, urgency and special hardship. 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 only, and how they were dealt with. 42 Table No. 1 (Housing). Estate. Submitted. Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 36 7 3 16 8 2 Downham — — — — — — Roehampton 1 1 — — — — St. Helier 34 14 6 3 5 6 Watling — — — — — — Wormholt 11 2 8 1 — — 82 24 17 20 13 8 In addition to the above figure of 24 housed, 25 families were housed on the different Estates on applications submitted to the London County Council previously to 1931. This figure brings the total number of Paddington applicants housed during the year to 49. 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 1,077 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 159 new applications were accepted, and over 1,645 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 1931. Table No. 2 (Housing). Estate. Number of Applications Received. Number Housed. Waiting. Withdrawn. Refused by L.C.C Offered, not accepted. Becontree 421 120 5 215 58 23 Castelnau 28 11 16 1 — — Downham 220 102 64 10 12 32 Old Oak Common 38 8 10 4 10 6 Roehampton 46 24 18 2 2 — St. Helier 330 42 213 56 9 10 Tottenham 33 13 11 — 5 4 Watling 619 110 435 42 20 12 Wormholt 564 167 305 76 12 4 2,299 597 1,077 406 128 91 The following Estates on which 434 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 859 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 being foi warded 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 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 in occupation. During the year 8 vacancies occurred and new tenants were admitted at once from the waiting list. 43 The following analysis of 179 cases of overcrowding remaining on the list after completion of the Watling Estate, and, similarly, 145 cases for the Wormholt Estate, gives some indication of the urgent need for the provision of further housing accommodation for the Borough. Number in family, including Parents. Number of Rooms Occupied. 1. 2. 3. 4. 5. 3 43 — — — — 4 53 — — — — 5 26 58 — — — 6 7 50 — — — 7 2 19 16 — — 8 1 12 10 — — 9 — 5 6 3 — 10 1 5 3 1 — 11 — 1 1 — — 13 — — — — 1 Defects,Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. 1931 Drain defective — „ choked 16 „ not properly ventilated or ventilating pipe defective 67 Manhole cover defective 2 Gully chokcd 15 Soil pipe defective 3 Water-closet defective 16 „ choked 15 „ without sufficient flush 11 „ flushing apparatus defective 27 „ foul 9 „ improperly constructed 77 „ accommodation insufficient 2 „ without door, door defective, or without proper fastenings 110 Rain-water pipe defective 31 „ choked 6 Guttering defective 36 Waste pipe defective 22 „ choked 5 „ untrapped 2 ,, not provided or missing 3 Sink defective or not provided 8 Other drainage defects 4 Cistern defective 4 „ dirty 22 „ without proper cover or cover defective 21 Dustbin defective 130 „ not provided 4 „ insufficient 34 „ disused and not abolished — Paving of yard or area defective 45 „ washhouse defective 34 Premises damp 51 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 2,617 „ verminous 80 „ contents, bedding, etc., dirty — „ not provided with a window opening directly to the external air — Chimney smoky 25 Food cupboards not provided — Windows defective including cords and fastenings out of repair 848 Roof defective 225 Common staircases out of repair 47 Staircases without sufficient handrail 11 Animals improperly kept 1 Accumulation of refuse (not offensive) 21 Premises without water or supply insufficient 97 Any other defects, etc. 17 Notices Issued Written Intimations 555 Statutory Notices 182 Bye-law „ 774 Notices under L.C.C. (G.P.) Acts— Verminous rooms 37 Additional taps 97 Abolition of old dustbins — Provision of cooking ranges — 44 Items of Dilapidation for which Letters were sent to the Owners (Section 17 of the Housing Act, 1930). Wall-plaster broken, bulging, or defective 112 Matchboarding defective 4 Wall-paper loose 5 Skirting defective 7 Doors defective or missing 77 Locks defective 55 Ceiling plaster defective 101 Ceiling paper loose 2 Floors broken or badly worn 74 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 168 Stove settings defective Flues defective 2 Hearths defective 20 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 31 Cupboard doors defective or missing and shelves missing 15 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 211 Window-frames loose or defective (including oak sills worn or rotten) 10 Window-glass broken 216 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective. Cue smoky or defective 81 Steps to front entrance or area defective 18 Railing to area or area steps defective 20 Guard rails to addition roofs defective, broken or rotten 13 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 3 Vault doors missing or defective 17 HOUSING. (Ministry of Health Table.) Number of New Houses erected during the Year. 1.—Inspection of Dwelling-houses during the Year. (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— (а) Houses inspected on complaint or after illness 1,536 Inspections made 14,922 (b) Registered tenement houses inspected 644 „ „ 6,013 (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 — 2.—Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers No record. 3.—Action under Statutory Powers during the Year. A Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *211 (2) Number of dwelling-houses which were rendered fit— (а) by owners 190 (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 1,231 (2) Number of dwelling houses in which defects were remedied after service of formal notices— (a) by owners 1,177 (b) by Local Authority in default of owners — C Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made - (2) Number of dwelling-houses demolished in pursuance of Demolition Orders - D Proceedings under Section 20 of the Housing Act, 1930—- (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made — (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit - 45 E Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices were served requiring repairs — (2) Number of dwelling-houses which were rendered fit after service of formal notices— (а) By owners — (б) 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 — F Proceedings under Sections 11, 14 and 15 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Closing Orders were made — (2) Number of dwelling-houses in respect of which Closing Orders were determined, the dwelling-houses having been rendered fit — (3) Number of dwelling-houses in respect of which Demolition Orders were made — (4) Number of dwelling-houses demolished in pursuance of Demolition Orders — * Informal notices FACTORIES AND WORKSHOPS. 1931. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 983 1 - Workshops (including workshop laundries) 1,384 1 - Workplaces (other than outworkers' premises) 443 - - Total 2,810 2 - 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 126 126 - - Want of ventilation 4 4 - - Overcrowding 1 1 - - Want of drainage of floors 1 1 - - Other nuisances 15 15 - - Sanitary accommodation insufficient 1 1 - - unsuitable or defective 9 9 - — not separate for sexes 1 1 - - Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences (Excluding offences relating to outwork and ogences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) - - - - Total 158 158 — — * Including those specified in fcectious 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 46 Outwork in Unwholesome Premises, Section 103 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 — — — Lampshades — — — Total — — — At the end of the year 1930, 1,212 premises were on the Register as compared with 1,172 at the end of the year 1929. During the year 1931, 31 premises were removed from the Register and 69 added, making the total at the end of the year, 1,250. The Department reported the opening of 13 workshops to the Home Office, and received from that Office, notice of 20, 16 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 23 lists in February and 23 lists in August. These lists contained 291 names and addresses of which 239 were forwarded to other districts. From other districts 279 addresses within the Borough were received. Supervision.—There were during the year, 2,810 inspections, comprising 983 of factories, 1,384 of workshops and 443 of workplaces. There were 158 nuisances or defects found upon registered premises, 158 of which were remedied during the year, the majority being remedied on verbal request. The defects found comprised :— Want of cleanliness 126 „ ventilation 4 Overcrowding 1 Sanitary accommodation—insufficient 1 „ „ unsuitable or defective 9 „ „ not separate for sexes 1 Other offences 16 The Home Office forwarded 11 complaints, which comprised :— Overcrowding 1 Sanitary conveniences not separate for sexes 2 Other offences 8 Bakehouses.—During the year three level bakehouses were opened, and one underground was closed, the total number on the Register at the end of the year being 62 of which 50 were factory bakehouses. 47 The number of "level" bakehouses was 20 (13 being factories) and of "underground" 42 (37 being factories). The number of persons working in bakehouses was 289, including 8 women and 17 individuals under the age of 18. The bakehouses were inspected on 873 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. Four samples were taken and were found to comply with the regulations applicable. FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1931, two slaughterhouses within the Borough licensed by the London County Council :— 275, Edgware Road ; 249, Maida Vale. There were 254 inspections made during the year. The number of animals slaughtered, so far as is known, was 3,091, comprising 200 bullocks, and 2,891 sheep, being an increase of 4 bullocks and a decrease of 219 sheep, as compared with 1930. The following Table shows the number of organs destroyed and the disease with which they were affected. Bullocks. Sheep. Heads. Tongues Lungs. Livers. Mesenteries. Hearts. Spleens. Lungs. Livers. Hearts. Tubeiculosis 3 2 7 3 4 — 1 — — — Actinomycosis 1 2 — — — — — — — — Pleurisy — — 8 — — — — — — Abscess — — 7 12 — — 1 7 — — Distomum Hepaticum — — — 15 — — — — — — Parasitic Invasion — — — — 2 — — 59 14 — Pneumonia — — — — — — — 2 — — Cyst — — 3 4 — — — — 1 — 4 4 25 34 6 2 68 15 — Total weight, 905½ 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 1931 the number of carcases was 166. On examination it was found necessary to destroy— 8 heads and pieces weighing 48 lbs. affected with tuberculosis. Public Health {Meat) Regulations, 1924.—Proceedings were taken against a vendor for exposing meat for sale without taking steps to protect it from contamination. Two summonses were issued, the defendant being fined £1 with £1 Is. Od. costs upon each. Other 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 54 inspections were made and approximately 6,149 head of poultry were slaughtered. 48 Food Purveyors.—At the end of the year there were some 835 purveyors of food in the Borough, classified as follows :—Butchers 85, Fishmongers 25, Fried Fish 34, Refreshments 123, Greengrocers 89, Milk 118, Margarine 19, General 60, Confectioners 115, Provisions 45, Grocers 112, Ham and Beef 10. In addition to the above premises there are 75 licensed Street Traders selling food within the Borough, namely :—Fruit and Vegetables 49, Ice Cream 12, Light Refreshments 12, Fish 1, Poultry 1. These, with the storage premises of 21 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 1,986. Ice Cream.—There were 127 shops at which ice-cream was known to be sold, comprising the following kinds of businesses :—Bakers 9, General 13, Milk 12, Confectioners 48, Refreshments 40, Wholesale 3, Newsagent 1, Greengrocer 1. Two hundred and fifty (250) inspections of premises were made. Ice-cream was sold from 25 barrows stored within the Borough and from 35 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 1931 there were 91 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 2 tons, 4 cwts., 2 qrs., 11 lbs., comprising the following varieties :—Fish 615 lbs., Fruit and Vegetables 3,282 lbs., Meat 128 lbs., Offal 900 lbs., Rabbits 56 lbs., Sweets 14 lbs. Dairies and Milkshops.—At the end of the year 1930 there were 115 names on the Register. During the year 1931, 3 names were added, making a total of 118. Five of the businesses were transferred to new proprietors. There were 397 inspections made. Sterilised milk in bottles was found to be on sale at 90 premises. Milk (Special Designations) Order, 1923. During the year 66 licences were issued by the Council pursuant to this Order, 11 being for " Certified" milk, 23 for "Grade A (Tuberculin Tested)" milk, 1 for "Grade A "milk and 31 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, four for pasteurising establishments. The samples taken by the Council's Inspector numbered 40, comprising 20 of " Certified " milk, 3 of " Grade A (Tuberculin Tested) " milk, 1 of " Grade A " milk, 1 of " Grade A Pasteurised " milk, and 15 of " Pasteurised " milk. Of these samples, 1 of " Certified " milk and 2 of " Pasteurised " milk were taken on delivery at institutions maintained by the London County Council. One sample of " Certified " milk was found not to comply with the bacteriological standard appropriate to that kind of milk. The result of the examination was reported to the Ministry of Health. 49 Milk and Dairies Order, 1926. Proceedings were instituted against two purveyors for bottling milk on the public highway in contravention of the provisions of this Order. A fine of 15s. Od. was imposed by the Magistrate in each case. Food and Drugs (Adulteration) Act, 1928. Of the 604 samples taken during the year, 24 (3.9 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 3.8 per cent, in 1930 and 3 per cent, in 1929. Twenty-eight of the samples were taken on Sundays and Bank Holidays. None of these was adulterated. Forty-six samples of milk were taken at Paddington Station on delivery by rail. Eleven were found to be adulterated. Twelve samples of milk were obtained at Paddington Station at the request of other Boroughs. Sampling of milk supplies to Public Institutions.—There are eleven institutions from which samples of milk are taken periodically. Twenty-five samples were taken during 1931, all of which were returned as genuine. Sampling of milk from Automatic Machines.—Automatic machines for supplying milk are in use at eight premises in the Borough. From these, during 1931, six samples were taken for chemical analysis and two for bacteriological examination. One sample was found to be deficient in fat to the extent of 32 per cent. Proceedings were instituted against the vendor. The samples examined bacteriologically were reported to be of a good type of loose milk, comparing favourably, as far as the count was concerned, with Graded milks. 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. One sample of sausages, sold without proper declaration of the presence of preservative, was found to contain 5.5 parts per million of sulphur dioxide, and one sample of jam 52 parts per million of sulphur dioxide. Two samples of fish paste contained respectively 0.037 per cent, and 0.03 per cent, of boric acid. No formal action against the vendors was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year three samples of full cream unsweetened, four samples of full cream sweetened, and eight samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. Four samples of dried milk were taken during 1931, 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 were made by the Public Analyst, Sir William R. Smith, at the Royal Institute of Public Health, 37, Russell Square, W.C.I, where also bacteriological examinations of food are made when required. Bacteriological examinations of samples of milk procured under the provisions of the Milk (Special Designations) Order, 1923, are also made at the Royal Institute of Public Health. 50 During 1931 the following samples were submitted for special examination, viz. :— Butter, suspected to contain a parasite (maggot). Result—A particle of a suspicious nature proved to be structureless—probably inspissated (dried) debris. Oranges, suspected to contain poisonous substances. Result.—No poisonous substance could be detected which could account for the symptoms complained of. Mutton, raw and cooked, dripping and chocolate pudding suspected to contain food-poisoning bacilli. Result.—The presence of a member of the Salmonella group was revealed in the raw meat. 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 pages 51 and 52. The results of legal proceedings are summarised on page 55. 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, 1931. Average Monthly Figure for Percentage. Fat Content and Non-Fattv solids. January 3.65 8.78 February 3.78 8.59 March 3.52 8.77 April 3.58 8.78 May 3.41 8.75 June 3.55 8.81 July 3.61 8.71 August 3.75 8.75 September 3.77 8.84 October 3.90 8.80 November 3.94 8.77 December 3.78 8.72 Average for Year. Samples taken at Paddington Station 3.65 8.67 „ „ elsewhere 3.72 8.78 51 Samples Submitted to Public Analyst—1931. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 1 — — — — Ammoniated Tincture of Quinine — 3 — — — — Baking Powder — 3 — — — — Bismuth Tablets — 1 — — — — Blancmange Powder — 1 — — — — Boracic Acid Powder — 1 — — — — Borax — 1 — — — — Boric Ointment — 2 — — — — Bread 3 — — — — — Bread and Butter 1 — — — — — Breakfast Sausage — 1 — — — — Butter — 11 — — — — Cake — 1 — — — — Calomel Ointment — 1 — — — — Camphorated Oil — 1 — — — — Cheese — 8 — — — — Cheese and Tomato Paste — 1 — — — — Chocolate — 3 — — — — Cocoa — 5 — — — — Cod Liver Oil — 1 — — — — Coffee — 4 — — — — Coffee and Chicory — 1 — — — — Coffee and Chicory Extract — 2 — — — — Coffee and Milk — 1 — — — — Cooking Fat — 1 — — — — Cornflour — 1 — — — — Cream — 7 — — — — Crystal Jelly Powder — 1 — — — — Currants 1 1 — — — — Curry Powder — 1 — — — — Custard Powder — 4 — — — — Desiccated Cocoanut — 2 — — — — Doughnut — 1 — — — — Dried Bananas — 1 — — — — Dried Fruit — 4 — — — — Dried Vegetables — 3 — — — — Dripping — 7 — — — — Egg Substitute Powder — 1 — — — — Essence of Ginger Wine — 1 — — — — Fish Cake — 1 — — — — „ Paste 1 12 1 1 100.0 8.33 Flour 1 7 — — — — Gin 2 1 1 1 60.0 100.0 Glycerin — 1 — — — — Gravy Salt — 2 — — — — Groats — 1 — — — — Ground Almonds — 1 — — — — Ground Cinnamon — 1 — — — — Ground Rice — 2 — — — — Honey — 4 — — — — Honey of Squills — 1 — — — — Ice Cream — 2 — — — — Iodine Ointment — 1 — — — — Iodised Salt — 2 — — — — Iodoform Ointment — 1 — — — — Jam 4 9 — 1 — 11.11 Jam Sandwich — 1 — — — — Lard — 4 — — — — Lead Iodide Ointment — 1 — — — — Lemon Squash — 2 — — — — Lemon Cheese — 2 — —. — — Lemonade Powder — 4 — — — — Liquid Eggs 1 — — — — — Lobster in Jelly — 1 — — — — Macaroni — 1 — — — — Margarine — 6 — — — — Meat Paste — 2 — — — — Meat Rissole — 1 — — — — Mercury Ointment — 1 — — — — Mercury Pills — 1 — — — — Milk 270 2 13 — 4.81 — Milk, Full Cream Sweetened Condensed — 4 — — — — „ , „ „ Unsweetened „ — 3 — — — — „ , Skimmed Sweetened ,, — 8 — — — — „ , Full Cream Dried — 2 — — — — Milk Food — 2 — — — — Mincemeat — 2 — — — — Mint Sauce — 1 — — — — 52 Samples Submitted to Public Analyst—1931—(continued). Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Mixed Herbs — 1 — — — — Mixed Spice — 1 — — — — Mustard — 5 — — — — Oatmeal — 1 — — — — Olive Oil — 2 — — — — Orange Quinine Wine — 1 — — — — Orange Squash — 2 — — — — Pastry maker — 1 — — — — Pearl Barley — 1 — — — — Peel — 1 — — — — Pepper — 3 — — — — Phenacetin Compound Tablets — 1 — — — — Pickles — 7 — — — — Potted Meat — 2 — — — — Preserved Ginger — 1 — — — — Puree au fois — 1 — — — — Raisins 1 1 — — — — Rice — 3 — — — — Rice Flakes — 1 — — — — Rum 2 1 1 1 50.0 100.0 Sago — 3 — — — — Sandwich Spread — 1 — — — — Sauces — 5 — — — — Sausages 7 — 1 — 14.28 — Saveloy — 1 — — — — Semolina — 3 — — — — Soup Powder — 2 — — — — Sponge Cakes — 1 — — — — Steak and Kidney Pie — 1 — — — — Stout — 1 — — — — Stuffed Olives — 1 — — — — Sultana Pudding — 1 — — — — Sultanas 1 2 — — — — Sugar — 1 — — — — Sulphur Ointment — 1 — — — — Sweets — 3 — — — — Table Jelly — 1 — — — — Tapioca — 1 — — — — Tea — 14 — — — — Tincture of Iodine — 1 — — — — Tinned Fish — 9 — — — — Tinned Fruit — 3 — — — — Tinned Meat — 3 — — — — Tinned Vegetables — 7 — — — — Treacle — 1 — — — — Turpentine Liniment — 2 — — — — Vinegar — 4 — — — — Vinegar of Squills — 1 — — — — Weak Mercury Ointment — 1 — — — — Whisky 2 1 2 1 100.0 100.0 White Precipitate Ointment — 1 — — — — Yellow Mercury Oxide Ointment — 1 — — — — Zinc Ointment — 2 — - — — 297 307 19 i — 5 6.40 1.62 604 24 3.97 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. During the year certain articles were added to the list of those which may be graded and marked. At the end of the year regulations were in force applicable to :— Apples and Pears; Beef ; Broccoli; Canned Fruits ; Canned Vegetables ; 53 Cherries ; Cider; Dressed Poultry ; Eggs; Glasshouse grown Tomatoes and Cucumbers ; Malt Flour and Malt Extract; Potatoes ; Strawberries ; Wheat Flour. No premises used by way of trade or for purposes of gain for the cold storage or chemical storage of eggs were registered during the year. Three samples of graded eggs which were procured were found to comply with the regulations applicable. 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. The Medical Officer of Health and the Sampling Officer have been authorised to act as officers in this respect. 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; Malt Products; Salmon and Sea Trout. Proceedings were instituted against four persons in respect of offences against the Orders relating to imported apples and tomatoes, fines being imposed in each case (See page 55). One of the defendants was also summoned and fined for obstructing the Council's Sampling Officer in the execution of his duties. Artificial Cream Act, 1929. This Act which came into force on May 10th, 1929, is intended to regulate the manufacture and sale of what is commonly known as reconstituted cream, usually prepared by emulsifying butter with dried skimmed milk and water. This substance gives the same analytical results as natural cream and cannot therefore be dealt with under the Food and Drugs (Adulteration) Act, 1928. During the year no premises were registered under the Act for the manufacture or sale of Artificial Cream. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1927, SEC. 52. Nuisance Caused, by Pigeons.—The number of complaints received arising from the above cause was six. On investigation no action on the part of the Council appeared to be necessary. It is estimated that there are some 2,000 pigeons at large in the Borough. RATS AND MICE (DESTRUCTION) ACT, 1919. Fifty-seven (57) 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. Two Notices were served under the Act in respect of rat-infested premises. 54 Rat Week.—This was held from 2nd to 7th 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 9,602 baits to be laid in 689 different positions, 168 rats eventually being found dead. This number is of course only a small proportion of the number killed. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Thirty-three (33) 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 73 premises, the verminous rooms numbering 113. The owners of 49 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 80 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. 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. No cases were dealt with under this Section during the year. HEALTH EDUCATION. A subscription of £3 3s. Od. 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. LEGAL PROCEEDINGS—1931. The results of the Summonses taken out during the year are summarised in the following tables :— Premises. Offence. Fine. Costs. Public Health (London) Act, 1891. Section 4. £ s. d. 13, Andover Place Roof defective Work done Summons withdrawn — 15 „ „ Ground floor back room damp „ — 17, „ Roof defective „ - 18, Burlington Road Basement scullery and front and back rooms dirty ; waste stack and ground floor sink defective Work partly done. Order made for remaining work to be done within 28 days. - 16, Campbell Street Staircase, washhouse, water-closet, yard, ground floor back room, and first floor front room dirty Work done Summons withdrawn 2 2 0 34, Cornwall Road Drain, soilpipe and rainwater pipes defective; rainwater pipe connected to drain Order made — 27, Cuthbert Street Ground floor front room damp Work done Summons withdrawn — 16, Delamere Terrace Main roof defective Order made 1 1 0 308, Harrow Road Ceiling of second floor back bedroom dilapidated Work done Summons withdrawn - 55 Premises. Offence. Fine. Cost. £ s. d. 14, Walterton Road Flooring of basement passage and washhouse defective; ground floor slip room damp; addition roof defective Work done Summons withdrawn - 123, Westbourne Terrace Premises without a water supply Section 96. Supply reinstated Summons withdrawn - 63, Goldney Road Permitting an underground room to be occupied separately as a dwelling Bye-laws. £4 — 112, Clarendon Street Annual cleansing not carried out; window cords broken in basement front room ; floor boards defective on landing ; baluster rails missing Work done Summons withdrawn — 28, Craven Hill Gardens Plans not deposited in respect of drainage works carried out Plans deposited Summons withdrawn 1 1 0 16, Cuthbert Street Annual cleansing not carried out £2 — „ „ „ Dust receptacle defective £2 — „ „ „ Staircase defective ; window cords on staircase and in first floor back room defective Work done Summones withdrawn - 27, Cuthbert Street Staircase defective; annual cleansing not carried out Work done Summonses withdrawn - 39, Devonport Mews Plans not deposited in respect of drainage works carried out £1 2 2 0 61, Hall Place Water-closet accessories defective £2 1 1 0 14, Netley Street Annual cleansing not carried out; dust receptacle defective Work done 1 1 0 46, St. Petersburgh Place Flushing cistern out of order Work done 1 1 0 48, Westmoreland Road Plans not deposited, and drainage works executed without notice being given Plans submitted Summonses withdrawn 2 2 0 — Removing offensive refuse during prohibited hours. £1 - Food and Drugs (Adulteration) Act, 1928. Offence. Fine. Costs. £ s. d. Milk—14.7 per cent. of added water £5 „ 13.06 „ „ „ Summons withdrawn „ 6.58 „ „ „ £5 5 5 0 „ 13.53 „ „ „ and 21 per cent. deficient in fat £5 „ 24.82 „ „ „ £5 „ 9.3 „ „ „ and 30 per cent. deficient in fat £5 „ 24.12 „ „ „ £3 5 5 0 „ 14.7 „ „ „ and 35.66 per cent. deficient in fat £3 — „ 11.88 „ „ „ £3 — „ 32.0 per cent. deficient in fat £2 2 2 0 Milk and Dairies Order, 1926. Offence. Fine Costs £ s. d. Bottling milk on public highway 15s. — „ „ „ 15s. - Public Health (Meat) Regulations, 1924. Offence Fine Costs £ s. d. Exposing meat for sale without taking steps to protect it from contamination £1 1 1 0 „ „ „ „ „ £1 1 1 0 Merchandise Marks Act, 1926. Offence Fine Costs £ s. d. Obstructing the Council's Inspector in the execution of his duties £2 2 2 0 Exposing for sale imported apples without the appropriate show ticket £2 - Exposing for sale Canary tomatoes without marking their country of origin 10s. 1 1 0 Exposing for sale u.s.a. apples and Canary tomatoes without marking their country of origin £ 1 1 0 Exposing Canary tomatoes for sale without marking their country of origin £3 1 1 0 56 Report of the Work of the District Inspectors, 1931. 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. 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 — 13,264 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 1930 1,076 — 2,084 1 13,753 22 106 36 38 1551 2 638 104 46 23 1 3 — 55 142 2 62 517 — 3 22 252 — 25 1 1931 97 0 — 1,607 1 13,386 15 84 55 11 1179 12 436 92 61 39 3 6 9 27 168 4 97 516 2 6 18 183 5 29 2 57 1931. Prevention of Infectious Disease. All Diseases, Enquiries by— District Inspectors 1,376 Women Inspectors and Health Visitors 5,661 Tuberculosis—Included in above— Women Inspectors 1,632 Patients removed to Hospital—All Diseases (excluding Tuberculosis) 1,180 Rooms disinfected after— Tuberculosis 213 Other Diseases 867 Weight of Bedding, etc., disinfected (tons) 25 School Notices issued— Measles, Whooping Cough, Chicken-pox 2,271 Other Diseases 757 Bacteriological Examinations for— Diphtheria 1,202 Typhoid Fever 18 Tuberculosis 392 Sanitary Work—Cutting-off of Water Supplies. Notices received 8 Referring to Inhabited Premises 7 „ Empty „ 1 Reasons for—Rates unpaid 8 Defective fittings Mortuary. Bodies deposited, total 530 „ „ for inquests 405 „ „ pending burial, infectious — „ ,, ,, ,, other 29 P.M. examinations made 335 Trade Nuisances. Offensive Smells—Complaints 24 Accumulations of Manure 6 Smoke— Complaints 13 „ Premises watched 23 „ „ „ Hours of observation 61½ „ Duration of smoke (hours), including 35 „ „ black smoke 51 minutes Office (Clerical) Work. Letters received 4,759 „ despatched 5,251 Entries in Postage Book 10,934 Certificates dealt with relating to Infectious Disease (including Tuberculosis) 4,107 Notices sent re above 7,244 Entries in Birth Register 2,143 Complaints received 1,270 Plans dealt with 327 New openings in Journals 298 Disinfection Orders 1,093 Notices to abate nuisances, etc. 719 58 APPENDIX. PADDINGTON GREEN RHEUMATISM SUPERVISORY CENTRE. Report for the Year 1931. The objects of the Rheumatism Supervisory Centre which was established at the Paddington Green Children's Hospital in October, 1926, fall under two headings :— (1) The main object is to diminish the appalling death-rate due to valvular disease of the heart amounting to something between 15 and 25 thousand annually in England and Wales. This type of heart disease in young subjects is invariably due to the rheumatic infection and in the vast majority of instances the heart disease is established in childhood although death does not occur from it until 10, 20 or more years have passed. It is the peculiar tragedy of rhuematic heart disease that it kills so many thousands of middle-aged people, often the parents of young families; yet the disease of the heart which leads inevitably to premature death is established during childhood, usually the school-age, and is due to the infection which is termed " juvenile rheumatism." (2) The subsidiary object is to try to solve the problem of the causation of juvenile rheumatism. It is known that it is essentially a disease of faulty social environment, for it is practically entirely confined to the children of the poor, and does not appear in them if they are taken out of their homes and educated in residential poor-law schools. The exact factors in the lives of poor children which so strongly predispose to rheumatism and rheumatic heart disease are not known. All that can be said is that it is extremely common in, and almost confined to, the children of the poor, living in their own homes, and attending the State elementary day-schools under compulsion. Scheme of work.—That a special scheme to deal with rheumatic children is necessary has been largely accepted. There are now about 14 such Centres in London, of which the one at Paddington Green was the first established. Two attributes of juvenile rheumatism make special supervisory systems essential : first, that once a child is tainted with the disease relapses are extremely frequent, and in any of these heart disease may appear or increase in severity; and secondly, that it is often very difficult for a parent to detect that the child's heart is getting worse, so that periodic medical examinations, irrespective of the parent's opinion of the child, are essential. The ideal of the Centre is, therefore, to try to get all the rheumatic children of hospital class to attend, to obtain for them treatment in order to diminish the likelihood of further attacks, and by repeated re-examinations to give warning of harm developing in the heart. At the same time investigations into the social environment of the patients are made. General review of 1931.—Of the work of the Centre in 1931 taken as a whole, two preliminary remarks must be made. In the first place the incidence of rheumatism during the year has been comparatively light, due probably to climatic influence. Secondly, since the association of the Centre with the Borough authorities, the work has gained much from the assistance of the Women Sanitary Inspectors of the Borough. Through them there has been an improvement in getting notified cases to present themselves at the Centre, in tracing cases whose attendance had lapsed, and in obtaining the details of the social environment of each child. Although their assistance only began in the middle of the year's work under review, it gives promise of being of great value in the future and has already done much for which we are very grateful. Sessions and attendances.—The Centre has been open every Saturday morning throughout the year, except during the holiday periods when it is found impossible to get attendances. The total number of visits paid by Paddington children to the Centre in the 44 sessions held during the year was 321.* New Cases.—During the year 42 cases from the Paddington area attended the Centre for the first time. They were referred there by the following agencies :— Notifications 10 cases School authorities 24 „ Other departments of hospital 7 „ Parents 1 case These bring the total number of Paddington children on the register (December 31st, 1931) "to 335. * The numbers given throughout refer to Paddington cases : these constitute rather more than half the cases attending the Centre. 59 The number of children referred to us by the School Medical Officers shows a considerable increase on former years. This is very welcome to us as the efficient combing out of the schools of cases of heart disease is essential to the plan of the anti-rheumatism campaign. Notifications.—During 1931 there were 37 cases of juvenile rheumatism notified as such. Of these, 12 cases have already attended the Centre. Doubtless, many more will do so in time, as there is always a considerable delay in attendance, pending recovery from the acute attack for which the patient was notified. Owing to legal difficulties notification can only be made during an acute attack of rheumatism, a fact which very severely limits the use of this process. Classification.—On admission to the Centre the new cases were classified as under :— f with heart disease 6 Rheumatism with suspected heart disease 15 without heart disease 8 Suspected rheumatism 13 Non-rheumatic 0 Social environment.—Inquiries have been made in each case into the social environment of the rheumatic children received at the Centre. Particular care has been taken in the matter of general financial status, questions of crowding, and the character of the housing, especially as regards damp. As during the last months of the year under review these details have been given us by the Sanitary Inspectors of the Borough instead of by our own visitor as formerly, we have no comparable figures to cover the whole year of work. The figures given here refer therefore only to the new cases investigated for us by the Sanitary Inspectors; they are as follows :— Number of new cases investigated 38 Circumstances comfortable 19 Circumstances poor 15 Circumstances very poor 4 Overcrowding 12 No overcrowding 26 Rooms damp 5 Rooms not damp 33 Living in basements 7 The total number of visits paid for us by the Sanitary Inspectors since taking over the work was 38 first visits and 50 re-visits. Supervision and treatment.—By the method of regular re-examination every few weeks the effort is made to detect as early as possible any recrudescence of active rheumatism such as might endanger the heart. Where such evidence is found the child is either admitted to the wards of the hospital, or in milder cases is referred for treatment to its original private or hospital doctor. Sometime, unfortunately, serious relapses occur without our knowledge, the child being moved into some other hospital : of this we only hear later. Special attention is paid to the condition of the throat, particularly of the tonsils, since chronic disease in them is well recognised as predisposing to acute rheumatic attacks. Many cases have their tonsils removed at hospital : some as out-patients, but where the condition of the heart demands it, they are admitted to the wards for the operation. Other cases, again, are operated on by the L.C.C. School throat clinic at St. Mary's Hospital. In certain cases we report unsatisfactory hygienic conditions in the home to the Medical Officer of Health and gratefully acknowledge the ready assistance given to us in matters of this kind. We make very considerable use of the Special Day Schools for Physically Defective Children, and our experience of their value for cases of rheumatic heart disease is extensive and most encouraging. In many cases we have seen great improvement in the general physical condition of the children : this tends to heighten their resistance to further attacks, and to allow the damaged heart to become as strong as its valvular disease permits. At present, we think it preferable to keep these children under supervision at home and get them admitted to the P.D. Day School, rather than send them to special " heart-homes." Whether the attendance at the P.D. School is itself of positive value, or whether the good accrues by escaping the compulsory attendance at an ordinary Elementary school, is a difficult problem; both factors probably are at work. 60 The following Table summarises the work done among the children attending the Centre during 1931 :— Referred for treatment for active rheumatism : as in-patient, P.G.C.H 3 as out-patient, P.G.C.H. 32 elsewhere 5 Removal of diseased tonsils : as in-patient, P.G.C.H. 7 as out-patient, P.G.C.H. 6 elsewhere 1 Referred home conditions to Sanitary authorities 2 Recommendations : to P. D. Schools 2 to Convalescent Homes 2 to long period in country 2 Kept under observation 81 Discharged : over age 16 non-rhuematic 1 died 0 lapsed 5 gone away 3 REGINALD H„ MILLER, m.d., f.r.c.p., (London). Physician in Charge. Discharges.—The chief causes of discharges from the Centre are over-age and removal tO other districts. The number which lapse out of slackness is surprisingly small and hardly ever occurs in such cases as have actual heart disease.