AC4349 Don 6026 PAD 3 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND ' Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1932. . 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. CRUSHA & SON, Ltd., Printers, 825/7, High Road, Tottenham, N.17. Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1932. 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. CRUSHA & SON, Ltd., Printers, 825/7, High Road, Tottenham, N.17. CONTENTS. page Acute Encephalitis Lethargica 20 Acute Influenzal Pneumonia 20 Acute Polio-encephalitis 20 Acute Polio-myelitis 20 Acute Primary Pneumonia 20 Acute Rheumatism 22 Administrative Work 38 Agricultural Produce (Grading and Marking) Act, 1928 51 • Annual Cleansing 41 Ante-natal Consultation Centres 5, 30, 31 Anthrax 20 Artificial Cream Act, 1929 52 Artificial Sunlight Treatment 31 Bacteriological Work 38 Bakehouses 46 Births 8 ,, Illegitimate 8 ,, in Institution 9 ,, Notifications 9 ,, Stillbirths 8 Birth-rates 8 Canals, Canal Boats 40 Cancer 21 Cerebro-spinal Fever 20 Chicken-pox 18 Cholera 21 Common Lodging Houses 41 Compulsory Repairs 41 Compulsory removal of certain persons 53 Condensed Milk Regulations 49 Continued Fever 18 Convalescent Homes 37 ' 'Conversions,'' Housing 41 Dairies and Milkshops 48 Day Nurseries 5,33 Deaths, Causes of 9,10 ,, in Institutions 11 Death-rates 11 Diarrhœa 24 Diphtheria 16 ,, Carrier Clinic 17 ,, Schick Test17 Disinfection 38 District Inspectors' Work 55 Drainage, Combined 38 ,, House 38 ,, Reconstruction Plans 38 Dried Milk Regulations 49 Dysentery 21 Erysipelas 20 Factories and Workshops 45 Food Adulteration 48 ,, Chemical and Bacteriological Examination 49 ,, Destroyed 48 ,, Poisoning 21 ,, Purveyors 47 ,, Samples Analysed 50 ,, Supervision 46 Fouling of Footways by Dogs 40 German Measles 19 Glandera 21 Health Education 53 ,, Visiting 30 Houses Unfit for Habitation 41 Housing 41-45 ,, Acquisition of Building Site 42 ,, Paddington Houses Association 42 ,, on L.C.C. Estates 42 Hyde Park Babies' Club 37 Hydrophobia 21 Ice Cream 47 Infant Consultation Centres 5, 30-32 Infantile Mortality 12 page Infantile Mortality in Special Areas 13 Infectious Diseases, Notification of 15 ,, ,, Prevention of 38 Infective Enteritis 24 Inquests 14 Invalid Children's Aid Association 37 Legal Proceedings 53 Malaria 20 Manure, Removal of 39 Marriages 7 Massage Treatment 31 Maternal Consultations 33 ,, Mortality Investigations 37 Maternity and Child Welfare 30 Maternity Nursing 33 Measles 18 Meat Regulations 47 Merchandise Marks Act, 1926 52 Midwifery Service 33 Milk Grants 34 Milk and Dairies Order 48 Milk (Special Designations) Order 48 Mortuary 39 Nursing of cases of Infectious Illness 38 Nutritional and Physio-therapeutic Clinic 5, 32 Office Work 54 Ophthalmia Neonatorum 19 Outworkers (Homework) 46 Overcrowding 41 Paddington Infant Saving Campaign 37 Pigeons, Nuisance from 52 Plague 21 Population 6 Poultry Slaughtering 47 Pneumonia 20 Preservatives, etc., in Food Regulations 49 Puerperal Fever 19 ,, Pyrexia 20 Rag and Bone Dealers 39 Rag Flock Acts 46 Rats and Mice Destruction 52 Relapsing Fever 21 Rent and Mortgage Interest (Restrictions) Acts 42 Rent Books 42 Scarlet Fever 16 Schools and Infectious Disease 38 Sewer Connections 39 Slaughterhouses 46 Smallpox 17 Smoke Control 39 Staff 5, 38 Tenement Houses 41 Trade Nuisances 39 Tuberculosis, Artificial Pneumothorax Treatment 25 ,, Deaths from 25 ,, Dental Treatment 26 ,, Dispensary Treatment 5,26 ,, Home Visiting 25 ,, Notification 24 ,, Regulations, 1930 and 1925 24,25 ,, Shelters 25 ,, Supply of Beds and Bedding 25 Tuberculosis Care Committee 29 Typhoid Fever 18 Typhus Fever 21 Underground Rooms 41 Unhealthy Areas 41 Vaccination 17 Venereal Diseases Clinic 5 Verminous Conditions 52 Vital Statistics 4, 6 Water Supply 39 Whooping Cough 21 Workshop Supervision 46 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 1932 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 recorded infantile mortality rate for Paddington is the highest during the last ten years, and the three West End Boroughs, Paddington, Kensington and St. Marylebone show infantile mortality rates in excess of any other Boroughs in London. No precise statistical analysis is available that will completely explain this unfortunate state of things. It is certainly not due to any lack of zeal on the part of the Council or its staff. It is necessary to emphasise the fact that Paddington contains a number of densely populated streets which are amongst the poorest in London, and is increasingly the resort of migratory and poverty-stricken families from the various distressed areas of the country. Attention may be directed to the information on pages 6 and 7 of this report, which is abstracted from the Census returns of 1921 and 1931. The number of families living in tenements of one, two or three rooms shows a great increase in the ten years, and this change in the character of the population has, no doubt, had a deleterious effect on child-life. 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. 21st June, 1933. SUMMARY OF VITAL STATISTICS. 1932. Area of Borough 1,356 1 acres, including waterways 20 0 acres. Population. Census, 1931 144,923 Registrar-General's estimate of resident population for year 1932 143,600 Density of population per acre 106 Number of inhabited houses (end of 1932) according to Rate Books 22,590 Marriages 1,756 Total. M. F. Stillbirths 57 30 27 Stillbirth-rate 29 Deaths 1,904 888 1,016 Death-rate 13.26* Percentage of total deaths occurring in public institutions 54.8 Number of women dying in, or in consequence of childbirth {from sepsis 2 „ other causes 4 Maternal mortality 3.03† Deaths of Infants under 1 year of age 212 Infantile Mortality 107 Legitimate, 100t; Illegitimate, 158t Deaths from Measles (all ages) 26 ,, Whooping Cough (all ages) 13 ,, Diarrhoea (under 2 years of age) 54 ,, Pulmonary Tuberculosis 107 Death-rate from Pulmonary Tuberculosis 0.74* Deaths from all forms of Tuberculosis 122 Tuberculosis death-rate 0.85* Rateable Value £1,801,567 Product of a Penny Rate £7,127 • per 1,000 persons. t per 1,000 births. 5 PUBLIC HEALTH OFFICERS (on December 31st, 1932). (W.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. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., R. Cove-Smith, M.A., M.B., B.Ch., M.R.C.P. 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. J. McKail, M.A., M.B., B.Ch. O. Stuart Thompson, B.A., M.R.C.S., L.R.C.P. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.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). (Died February, 1933 ) Tenement Houses Inspectors, W.T. V. L. Ronchetti(2),(3), .(4),(5). C G Heron (2), (3). E. B. Wilde (2), (3), (4), (5), (10). H.D. Bailey (2), (3), (4). E. Marshall (2), (3), (4), (5). Women Sanitary Inspectors, W.T. Meat and Food Inspector, W.T. D. M. Newhall (1), (2), (8), (9). F. J. Pallet (2), (3). (One vacancy.) 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). C. Teale (7), (8), (9). 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 Road ,, ,, ,, 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 ,, ,, ,, *Congregational Institute, Third Avenue ,, ,, ,, *St. Simon's Hall, Macroom Road ,, ,, ,, Christ Church Parochial Church House, Queens borough Passage ,, ,, ,, Nutritional and Physio-therapeutic Centre *232, Harrow Road ,, ,, ,, *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 Dispensary St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. 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. 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 1932 *143,600 1,765 401 613 1,977 13.76 1,817 12.65 601 688 1,904 13.26 220 121 212 107 * Registrar-General's estimate of resident population. POPULATION. Census Returns.—The population enumerated in the Borough in 1931 consisted of 144,923 persons, 61,503 being males and 83,420 being females. In 1921, 144,261 persons were enumerated, of whom 60,491 were males and 83,770 females. From these figures it will be seen that during the intercensal period there was a slight increase in the population, the number of persons in 1931 being 662 in excess of the total recorded in 1921. A small decline occurred in the proportion of females, the ratios being 1,000 males to 1,385 females in 1921, and 1,000 males to 1,356 females in 1931. Although the population as a whole did not vary much during the ten years, striking changes occurred in certain of the Wards, Queen's Park Ward, in 1931, showing a reduction of 2,132 persons, and Harrow Road Ward a reduction of 2,039 persons. The figures for Town and Church Wards were also lower than those for 1921. On the other hand there were increases amounting to 1,176 persons in Maida Yale Ward, 1,149 persons in Westbourne Ward, 364 persons in Lancaster Gate West Ward, 1,761 persons in Lancaster Gate East Ward, and 800 persons in Hyde Park Ward. These variations are shown in the following table:— Ward. Enumerated Population. Variations as compared with 1921. 1921. 1931. Increase. Decrease. ' Queen's Park 15,754 13,622 — 2,132 Harrow Road 27,512 25,473 — 2,039 Maida Vale 22,100 23,276 1,176 — Town 7,460 7,207 — 253 Westbourne 24,102 25,251 1,149 — Church 17,492 17,328 — 164 Lancaster Gate West 9,533 9,897 364 — Lancaster Gate East 8,161 9,922 1,761 — Hyde Park 12,147 12,947 800 — borough 144,261 144,923 662 North Paddington 72,826 69,578 — 3,248 South Paddington 71,435 75,345 3,910 7 The following table illustrates the effect of the continuous fall in the birth-rate since 1921. It will be seen that the number of children under the age of 5 years had, in 1931, diminished by 1,881, and that of children between the ages of 5 and 15 years by 4,387. The higher age-groups, however, all show increased figures, those for the group 65 years and upwards especially indicating an improvement as regards the duration of life. Age-groups. Enumerated Population. 1921. 1931. Variations as compared with 1921. Increase. Decrease. 0—5 years 9,902 8,021 — 1,881 5—15 „ 20,306 15,919 — 4,387 15—25 „ 24,698 26,960 2,262 — 25—65 „ 79,760 82,602 2,842 — 65 years and upwards 9,595 11,421 1,826 — Totals 144,261 144,923 6,930 6,268 An examination of the figures relating to housing, summarised below, shows that the number of private families increased from 38,320 in 1921 to 40,714 in 1931. There were increases in all classes of tenements from 1 to 7 rooms, more especially in those consisting of 1, 2 and 3 rooms. Tenements consisting of Number of families enumerated. Variations as compared with 1921. 1921. 1931. Increase. Decrease. 1 room 6,299 7,273 974 — 2 rooms 8,269 8,868 599 — 3 „ 9,468 10,570 1,102 — 4 „ 5,480 5,847 367 — 5 „ 2,874 3,062 188 — 6 and 7 rooms 2,883 2,925 42 — 8 ,, 9 964 697 — 267 10 rooms and over 2,083 1,472 — 611 Totals 38,320 40,714 3,272 878 It is satisfactory to note that although there was a considerable increase in the number of tenements in the Borough, there was a slight fall in the average number of occupants per room, a fact due, presumably, to the smaller size of the present-day family. The following figures show the conditions recorded in each of the last two census years:— Number of occupants per Tenements consisting of 100 rooms. 1921. 1931. 1 room 160 159 2 rooms 157 146 3 rooms 117 105 4 rooms 95 86 Estimated Population.—The Registrar-General's estimate of the resident population of the Borough at the middle of 1932 is 143,600 persons. The following table shows this total distributed among the Wards in the proportions recorded at the Census of 1931. These figures have been used for calculation of the various rates in this report. The Borough 143,600 Wards— Queen's Park 13,497 Harrow Road 25,241 North Paddington Maida Vale 23,064 68,943 Town 7,141 Westbourne 25,021 Church 17,170 Lancaster Gate, West 9,806 South Paddington Lancaster Gate, East 9,831 74,657 Hyde Park 12,8297 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,756 marriages were solemnized in the Borough during 1932, being a rate of 24"4 persons per 1,000 of the population. 8 BIRTHS. The number of births registered in the Borough during 1932 was 1,765. From this total it is necessary to deduct 401 births which occurred to residents of other localities and to add 613 births which occurred to Paddington residents outside the Borough. The corrected total of 1,977 births thus obtained is equal to a rate of 13'76 per 1,000 of the population. Of the 1,977 births, 1,031 were those of males and 946 those of females, and of these 127 males and 113 females were illegitimate. The Registrar-General's final figure for the nett number of births is given as 1,982, 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:— 1932. Birth-rates. No. of Births. Birthrates . 1931 1930 1929 1928 1927 England and Wales 614,320 15.3 15.8 16.3 16.3 16.7 16.7 London 62,233 14.3 15.0 15.7 15.7 15.9 16.1 Paddington 1,977 13.76 14.79 15.12 14.90 14.99 15.53 Wards— Queen's Park 144 10.67 9.46 10.32 10.26 10.97 11.29 Harrow Road 376 14.89 15.32 17.58 14.94 15.05 15.50 Maida Vale 297 12.87 14.79 13.57 15.22 14.65 16.69 Town 130 18.20 18.19 13.40 16.52 16.78 18.70 Westbourne 418 16.70 17.58 19.78 17.22 19.25 18.58 Church 370 21.55 23.81 22.12 23.50 22.83 23.11 Lancaster Gate, West 62 6.32 5.93 5.40 8.05 5.00 6.25 Lancaster Gate, East 41 4.17 8.31 7.18 8.79 7.42 9.04 Hyde Park 139 10.83 11.17 13.30 11.81 12.75 11.56 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 1932 13.76 Illegitimate Births.—These were 240 in number, or 12.14 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 .. .. .. .. .. .. .. 6-94 Harrow Road .. .. .. .. .. .. .. 7 -44 Maida Vale .. .. .. .. .. .. .. .. 12-79 Town .. .. .. .. .. .. .. .. .. 16-15 Westbourne .. .. .. .. .. .. .. .. 10-52 Church 11-35 Lancaster Gate, West .. .. .. .. .. .. 24-19 Lancaster Gate, East .. .. .. .. .. .. 34-14 Hyde Park .. 20-14 Stillbirths.—During 1932, 50 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 15 occurrcd to residents of other localities; on the other hand 22 stillbirths occurred outside the Borough to Paddington residents. The nett number for the Borough was therefore 57, a figure equivalent to 2'9 per cent, of the total births recorded. Of the 57 stillbirths, males numbered 30 and females 27, 3 of the males and 4 of the females being illegitimate, RATE OF ILLEGITIMATE BIRTHS PER 100 TOTAL BIRTHS. Ward. Bate. Queen's Park 6.94 Harrow Road 7.44 Maida Vale 12.79 Town 16.15 Westbourne 10.52 Church 11.35 Lancaster Gate, West 24.19 Lancaster Gate, East 34.14 Hyde Park 20.14 Stillbirths.—During 1932, 50 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 15 occurred to residents of other localities; on the other hand 22 stillbirths occurred outside the Borough to Paddington residents. The nett number for the Borough was therefore 57, a figure equivalent to 2.9 per cent. of the total births recorded. Of the 57 stillbirths, males numbered 30 and females 27, 3 of the males and 4 of the females being illegitimate, 9 Births in Institutions. Local— Legitimate. Illegitimate. Total. Residents. Non-residents. Residents. Non-residents. Residents. Non-residents. Paddington Hospital 142 19 84 13 226 32 St. Mary's Hospital 122 157 5 4 127 161 Lock Hospital 1 14 2 28 3 42 Outlying (Paddington residents)— Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 223 17 240 Other Lying-in Hospitals 10 2 12 Other Hospitals 61 11 72 Municipal Hospitals and Public Assistance Committees' Institutions 110 50 160 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, 1,714 live births were notified to the Medical Officer of Health. There were also 45 stillbirths notified. Of the 1,759 living and stillbirths notified, 48.4 per cent. were notified by medical practitioners, 41.8 par cent. by midwives, 0.7 per cent. by parents, and 9.1 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 98.4 per cent. of the live births and 94.0 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 1,817. Of these, 601 were of persons whose residence was not in Paddington, 522 dying in Paddington Institutions and 79 in other places in the Borough. There were also reported to the Registrar-General 688 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,904, making an annual death-rate of 13.26. 1932. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhoea & Enteritis January 30th 4 - 1 6 7 16 15 8 20 1 February 27th 4 — 3 1 18 18 14 16 16 3 March 26th 4 - 1 - 10 21 8 10 20 5 April 23rd 5 - 1 - 10 16 1 5 12 4 May 21st 5 - 1 - 8 21 - 1 13 2 June 18th - - 3 - 8 19 5 4 5 6 July 16th - - 1 1 5 20 - 1 5 4 August 13th 3 - 2 - 9 18 - 1 7 4 September 10th - - - 2 7 23 - 2 7 10 October 8th - - - 1 3 16 - 5 5 11 November 5th - - - - 7 25 - 1 15 7 December 3rd - - - 1 6 21 - 5 10 5 December 31st - - - 1 7 17 2 6 15 2 Totals 25 - 13 13 105 251 45 65 150 64 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 the next page. Deaths of residents of the Borough, 1932. Sex-Age Distribution for Whole Borough. All Ages. Deaths at Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes 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. 1904 888 1016 121 91 22 11 16 12 22 16 23 33 48 47 53 50 93 100 161 140 180 230 149 286 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - - - - - - - - - - - Measles 26 16 10 5 2 7 5 3 2 1 i - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough 13 7 6 4 2 2 3 1 1 - - - - - - - - - - - - - - - - Diphtheria 13 7 6 - - 1 - 3 2 3 4 - - - - - - - - - - - - - - Influenza 46 17 29 1 1 - - - - - - - - 2 - 2 - 3 6 - 6 5 7 4 9 Encephalitis Lethargica 1 1 - - - - - - - - - - - - - - - - - - - - - - - Cerebro-spinal Fever 6 3 3 - - 1 1 1 1 - - - - - - 1 - - 1 - - - - - - Tuberculosis of Respiratory System 107 54 53 1 - - - - - - - 11 14 11 12 11 9 11 14 6 3 2 1 1 - Other Tuberculous Diseases 15 2 13 - I - - - - 1 2 - 5 1 - - 1 - - - 1 - 2 - 1 Syphilis 15 9 6 1 3 - - - - - - - - 1 - - - 1 2 3 - 3 1 - - General Paralysis of the Insane, Tabes Dorsalis 12 9 3 - - - - - - - - - - - - 3 1 3 2 3 Cancer, Malignant Disease 254 111 143 - - - - - - 1 - - - 2 6 6 8 15 24 32 36 30 36 25 33 Diabetes 19 3 16 - - - - - - - - - - - 1 1 - - 2 - 1 2 11 - 1 Cerebral Haemorrhage, etc. 57 23 34 - - - - - - - - - - - - 1 - 4 4 3 3 5 10 10 17 Heart Disease 424 184 240 - - - - - - 1 1 2 3 8 5 9 5 13 8 37 32 65 75 49 111 Aneurysm 8 3 5 - - - - - - - - - - - - - - 1 2 1 1 1 2 - - Other Circulatory Diseases 77 30 47 - - - - - - - - - - - - - - 3 1 5 8 13 18 9 20 Bronchitis 65 29 36 3 3 1 - - - - - - - 1 - - 2 1 - 6 5 10 11 7 15 Pneumonia (all forms) 149 84 65 20 16 4 - 5 1 - 1 3 2 8 3 8 - 8 7 13 9 6 9 9 17 Other Respiratory Diseases 25 11 14 - - 1 - - - 1 - - 1 - - 2 - 2 1 3 1 2 .2 - 9 Peptic Ulcer 16 14 2 - - - - - - - - - 1 - - - 4 - 7 1 1 - 1 1 Diarrhoea, etc. 63 37 26 30 21 3 - 1 - 1 1 - - - 2 - - - - - 1 2 - - 1 Appendicitis 13 4 9 - - 1 - - - - 1 - 1 - - - 2 1 2 2 - - 2 - 1 Cirrhosis of Liver 10 5 5 - - - - - - - - - - - - 1 1 - 1 3 1 1 2 - - Other Diseases of Liver, etc. 5 2 3 - - - - - - - - - - - - - - - - - - 1 2 - - Other Digestive Diseases 35 9 26 4 2 - - - 1 - - - - 2 - - 2 1 - - 10 2 8 - 3 Acute and Chronic Nephritis 48 20 28 - - - - - - - - - - 1 2 1 2 1 5 8 3 4 5 5 11 Puerperal Sepsis 2 - 2 - - - - - - - - - - - - - - - - - - - - - - Other Puerperal Causes 4 - 4 - - - - - - - - - - - - - - - - - - - - - - Congenital debility, Premature Birth, Malformations, etc. 75 42 33 41 32 - 1 - - - -- - - - - - - - - 1 - - - - - Senility 37 9 28 - - - - - - - - - - - - - - - - 1 1 3 3 5 24 Suicide 33 20 13 - - - - - - - - 1 1 3 1 1 3 5 4 6 3 4 1 - - Other Violence 67 41 26 3 4 - - 1 3 6 1 4 3 5 2 1 5 - 3 - 7 6 7 4 Other defined diseases 162 82 80 8 4 1 1 1 1 5 4 2 1 4 6 4 11 11 14 18 14 11 16 17 8 Causes ill-defined or unknown 2 - 2 - - - - - - - - - - - 1 - 1 - - - - - - - - 10 11 The following table shows the death-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:— 1932. Death-rates. No. of Deaths. Deathrates. 1931 1930 1929 1928 1927 England and Wales 484,083 12.0 12.3 11.4 13.4 11.7 12.3 London .. .. .. .. .. 53,611 12.3 12.4 11.4 13.8 11.6 11.9 Paddington 1,904 13.26 13.05 12.64 15.48 13.03 13.56 Wards— Queen's Park 188 13.93 10.64 11.54 11.67 11.22 12.12 Harrow Road.. 349 13.82 11.99 11.85 14.94 11.88 13.04 MaidaVale 305 13.22 13.12 13.12 14.08 14.56 14.68 Town 102 14.28 15.57 12.59 16.65 11.98 16.94 Westbourne 348 13.90 15.31 13.99 17.06 15.45 13.92 Church 286 16.65 15.69 14.43 20.61 15.27 15.60 Lancaster Gate, West 102 10.40 11.54 10.59 13.56 10.21 9.33 Lancaster Gate, East 97 9.86 9.57 12.00 13.61 10.71 11.39 Hyde Park 127 9.90 12.10 11.72 15.72 11.61 13.64 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 1932 13.26 Deaths in Institutions, 1932. Non- Local. Total. residents. Paddington Hospital 518 126 St. Mary's Hospital 274 215 Paddington Green Children's Hospital 62 44 Hospital for Women and Children (Lock Hospital)3 3 St. Luke's Hospital 143 134 1,000 522 Deduct Non-residents 522 478 Outlying. Paddington Residents. Isolation Hospitals of London County Council 43 Municipal Hospitals and Public Assistance Committees' Institutions 308 Mental Hospitals 82 Voluntary Hospitals (General) 65 Hospitals (Special, including Sanatoria) 68 566 Total Deaths of Paddington residents in institutions 1,044 12 INFANTILE MORTALITY. During the year 1932 there were 1,977 births, and 212 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 107. The following table gives the births and the infantile deaths and death-rates for the year 1932 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1927 to 1931 are given for comparison. 1932 Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1931 1930 1929 1928 1927 England and Wales 614,320 39,706 64 66 60 74 65 69 London 62,233 4,143 66 65 59 70 67 59 Paddington 1,977 212 107 87 78 101 85 79 Wards— Queen's Park 144 18 125 55 43 44 28 91 Harrow Road 376 30 80 78 39 71 79 49 Maida Vale 297 25 84 81 97 66 82 96 Town 130 21 161 106 50 147 95 130 Westbourne 418 45 107 80 86 126 109 76 Church 370 51 138 116 122 164 99 99 Lancaster Gate, West 62 7 113 109 98 39 83 51 Lancaster Gate, East 41 4 97 60 103 42 82 - Hyde Park 139 11 79 90 62 98 57 65 Infantile Mortality Rates, 1896-1932. 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 1932 64 66 107 13 Infantile Mortality in Paddington.—1932. Causes of Death. Under 1 week. I 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. 0 months and under 12 months. Total Deaths under 1 year. Rate per 1,000 Births. All Causes 49 3 8 10 70 37 60 24 21 212 107.23 Common Infectious Diseases (6-10, 44) - - - 1 1 - 2 3 7 13 6.57 Tuberculous Diseases (23-32) - - - - - - 1 - 1 2 1.01 Diarrhoea and Enteritis (119) 1 - 1 1 3 8 25 11 5 52 26.30 Developmental and Wasting Diseases (157, 158, 159, 161a) 38 2 5 4 49 13 6 1 - 69 34.90 Miscellaneous Diseases (Remainder) 10 1 o 4 17 16 26 9 8 76 38.46 Measles (7). - - - - - - 1 2 4 7 3.54 Whooping cough (9) - - - 1 1 - 1 1 3 6 3.03 Diphtheria (10) - - - - - - - - - - - Influenza (11) — — 1 - 1 - 1 - - 2 1.01 Tuberculosis of nervous system (24) - - - - - - 1 - 1 2 1.01 Tuberculosis of intestines and peritoneum (25) - - - - - - - - - - - Other tuberculous diseases (23, 2632) - - - - - - - - - - - Syphilis (34) 2 - - 1 3 — 1 - - 4 2.02 Meningitis (79) — - - - - - - 1 - 1 0.51 Convulsions (86) 1 - - - 1 - - - - 1 0.51 Bronchitis (106) - - - - - 2 3 1 - 6 3.03 Pneumonia (107-109) - - - - - 9 13 6 6 34 17.20 Other respiratory diseases (105, 110114) - - - - - - - - - - - Inflammation of the stomach (118) - - - - - 1 1 - - 2 1.01 Diarrhoea and Enteritis (119) 1 - 1 1 3 8 25 11 5 52 26.30 Hernia, intestinal obstruction (122) 1 - - - 1 - - - - 1 0.61 Congenital malformations (157) .. 2 - 1 - 3 4 - - - 7 3.54 Congenital debility and sclerema (158) 1 - - - 1 5 4 1 - 11 5.56 Icterus (1616) - 1 - - 1 - - - - 1 0.51 Premature birth (159) 31 2 4 4 41 4 2 - - 47 23.78 Injury at birth (160) 3 - - 1 4 - - - - 4 2.02 Disease of umbilicus (161c:l) - - - - - - - - - - - Antelectasis (161a) 4 - - - 4 - - - - 4 2.02 Suffocation—in bed or not stated how (182 pt.) - - - 1 1 - - - - 1 0.51 Other causes 3 - 1 1 5 4 7 1 2 19 9.61 Nett Births in the Year { Legitimate 1,737. Nett Deaths in the Year {Legitimate Infants 174. {Illegitimate Infants 38. {Illegitimate 240. 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, 1929. 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. 1932 Infantile Mortality Rates. 1 Births. Deaths. 1932 1931 1930 1929 1928 Church Ward— North Wharf 38 4 105 53 77 143 148 Clarendon Street 175 25 142 116 153 170 105 Rest of Ward 157 22 140 129 106 165 75 Westbourne Ward— Alfred Road 81 10 123 116 84 152 83 Rest of Ward 337 35 104 69 87 117 117 Maida Vale Ward— Amberley Road 42 8 190 48 206 87 104 Rest of Ward 255 17 67 87 83 62 79 Totals for 4 Areas 336 47 140 102 129 151 105 Rest of Borough 1641 165 100 85 69 90 81 14 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:— 1932. 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 143,600 13.76 13.26 107 Kensington 183,500 12.9 13.6 98 Hammersmith 133,700 14.5 12.8 66 Fulham 149,600 14.28 12.35 58 Chelsea 59,430 11.9 12.9 52 City of Westminster 126,400 9.1 12.3 65.9 North Districts. St. Marylebone 96,430 10.97 12.4 87.2 Hampstead 90,130 10.9 11.6 54 St. Pancras 194,000 13.8 13.1 69 Islington 324,600 15.25 12.36 68 Stoke Newington 51,680 15.0 12.9 53 Hackney 214,200 14.5 11.5 53.9 Central Districts. Holborn 36,440 9.57 14.19 71.63 Finsbury 69,030 16.0 13.4 81 City of London Figures not yet available. East Districts. Shoreditch 95,800 17.5 12.3 80 Bethnal Green 106,300 15.4 12.0 69 Stepney 223,000 16.7 12.3 61.6 Poplar 152,400 17.2 12.1 63 South Districts. Southwark 168,900 16.2 13.1 72 Bermondsey 110,100 16.6 12.0 56 Lambeth 292,300 14.7 12.5 56 Battersea 157,000 14.8 12.1 57.8 Wandsworth 353,300 11.86 11.56 62 Camberwell 248,000 14.6 12.0 65 Deptford 105,100 15.9 12.2 65 Greenwich 99,590 14.7 11.8 80 Lewisham 221,500 12.7 10.2 54 Woolwich 146,900 14.0 11.1 60 INQUESTS. During 1932, 122 inquests were held on residents of the Borough, and 92 deaths were registered after the issue of certificates by the Coroner under powers conferred by the Coroners (Amendment) Act, 1926. 15 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington : Acute Encephalitis Lethargica. Acute Influenzal Pneumonia. Acute Polio-encephalitis. Acute Polio-myelitis. Acute Primary Pneumonia. Acute Rheumatism. Anthrax. Cerebro-spinal Fever. Chicken-pox. Cholera. Continued Fever. Diphtheria or Membranous Croup. Dysentery. Erysipelas. Food Poisoning. German Measles. Glanders. Hydrophobia. Infective Enteritis or Summer Diarrhoea. Malaria. Measles. Ophthalmia Neonatorum. Plague. Puerperal Fever. Puerperal Pyrexia. Relapsing Fever. Scarlatina or Scarlet Fever. Smallpox. Tuberculosis. Typhoid or Enteric Fever. Typhus Fever. The following table summarises the cases of notifiable diseases notified in the years 1922 to 1932 Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis). 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 Acute Encephalitis Lethargica 2 3 12 7 4 4 1 5 1 - - „ Influenzal Pneumonia 72 33 87 88 76 107 59 135 40 97 66 „ Primary Pneumonia 254 302 369 265 184 183 202 247 168 243 184 „ Polio-encephalitis - 2 4 3 3 1 1 1 - I 1 „ Polio-myelitis 3 4 3 1 1 2 2 . „ Rheumatism - - - - - (a) 34 76 52 43 37 21 Anthrax 1 - - - 1 1 - - - 1 - Cerebro-spinal Fever 2 1 1 5 5 3 4 6 3 5 9 Chicken-pox 22 465 395 459 599 461 567 382 515 555 291 Continued Fever - - - - - 2 10 3 2 4 - Diphtheria 401 219 278 336 462 367 302 311 366 254 194 Dysentery - 2 1 - - - - - - 2 5 Erysipelas 77 64 69 64 76 90 90 69 74 67 60 Food Poisoning - - - - - - - - - - (a)11 German Measles 144 48 458 375 124 78 109 1163 86 58 77 Infective Enteritis or Summer Diarrhœa - - - - - (a) 6 20 63 30 40 103 Malaria 5 2 9 1 1 2 3 - 1 - 1 Measles 1973 324 2757 879 1738 154 2862 210 1790 541 1414 Membranous Croup - 1 2 1 1 2 4 6 7 6 6 Ophthalmia Neonatorum 15 22 18 23 16 15 24 9 15 18 22 Puerperal Fever 8 5 9 15 14 7 5 4 5 8 7 „ ,, Pyrexia - - - - (a) 17 34 32 42 37 32 31 Scarlet Fever 529 323 290 264 199 320 519 323 356 379 286 Smallpox - 1 - - - - 5 3 3 - 2 Tuberculosis—Total 312 338 379 400 356 381 321 335 284 311 289 Pulmonary 204 222 242 231 218 212 196 242 196 218 213 Other Forms 108 116 137 169 138 169 125 93 88 93 76 Typhoid or Enteric Fever 8 13 15 18 12 16 25 19 10 9 4 (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:— 1932. NOTIFICATIONS. A.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Churcb. 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 Memb. Croup 9 12 15 14 5 8 3 11 23 24 24 35 1 5 •- 3 3 5 Typhoid and Continued Fever - - - - - - - - - 1 - - - 2 - - - 1 Erysipelas 1 3 5 8 - 4 - 3 4 8 5 8 1 1 - 2 3 4 Ophthalmia Neonatorum 2 - - 3 2 2 1 1 2 2 4 2 1 - - - - - Pneumonia–A. Influenzal 1 4 3 8 3 11 2 6 8 3 5 4 1 2 - 1 1 3 A. Primary 8 7 19 11 15 8 9 3 23 19 26 24 2 2 - 1 3 4 Puerperal Fever - 1 - 1 - - - - - - - 3 - - - - - 2 „ Pyrexia - 1 - 8 - 3 - - - 9 - 6 - - - 1 - 3 Scarlet Fever 11 12 41 31 17 22 6 4 9 17 19 41 10 10 6 11 8 11 16 B.—Sex-Age Distribution. Borough. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— M. F. M. F. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 1 2 4 4 11 9 12 10 7 14 30 39 8 15 3 7 6 13 - 4 1 - - - Typhoid and Continued Fever - - - - - - - - - - - - - 2 - - - 1 - - - - - 1 Erysipelas 3 2 - 1 - - - - - - - - - 1 1 1 1 5 1 5 10 15 3 11 Pneumonia—A. Influenzal 1 - 1 - - 1 - 1 - - 1 2 - - 1 2 5 4 3 7 9 15 3 10 ,, A. Primary 16 17 8 11 12 8 4 3 2 0 11 8 2 - 6 3 9 7 9 3 21 10 5 4 Scarlet Fever 1 1 6 2 4 8 12 12 15 13 55 65 16 20 7 10 9 20 - 5 2 2 - 1 SCARLET FEVER. During 1932 there were 286 cases of scarlet fever notified. Of the cases notified 2 were under the age of 1 year, 72 between the ages of 1 and 3 years, 156 between the ages of 5 and 15 years, 46 between the ages of 15 and 35 years, and 10 over the age of 35 years. Of the 286 cases, 271 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. 1932. Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 899 911 1006 958 1095 1055 1034 848 792 1295 1639 1407 1270 14209 Paddington 26 14 22 28 21 17 27 16 10 18 43 25 19 286 Wards— Queen's Park 2 - 1 1 1 4 3 3 - - 3 3 2 23 Harrow Road 6 - 3 6 1 6 8 5 2 4 19 7 5 72 Maida Vale 2 4 5 5 4 2 3 - 1 3 5 3 2 39 Town 2 - - 1 - 2 - - - 2 2 1 10 Church 1 2 4 5 2 2 1 - 3 1 2 1 2 26 Westbourno 8 5 6 4 2 1 6 3 3 6 8 4 4 60 Lancaster Gate, West 1 1 - 2 7 - 2 3 1 1 1 - 1 20 Lancaster Gate, East 1 2 2 2 2 - 1 1 - 3 2 1 - 17 Hyde Park 3 - 1 2 2 - 3 1 - 1 4 2 19 DIPHTHERIA. (Including Membranous Croup). During 1932 there were 194 cases of diphtheria and 6 of membranous croup notified. Of these there were 3 cases under the age of 1 year, 71 between the ages of 1 and 5 years, 92 between the ages of 5 and 15 years, 29 between the ages of 15 and 35 years and 5 aged 35 years and upwards. Of the 200 cases, 187 were removed to Isolation Hospitals. Thirteen cases were treated at home, proper facilities being available for isolation and treatment. Thirteen deaths from this disease occurred during 1932, 6 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 12 193 8 ,, 1932 13 „ 17 Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1932:— 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 622 657 522 469 594 614 578 530 542 781 809 782 674 8174 Paddington 24 24 6 14 11 11 8 11 13 21 25 18 14 200 Wards— Queen's Park 2 1 - 5 3 - 2 - 2 i 4 1 - 21 Harrow Road 3 2 - 1 2 1 1 - 3 4 5 5 2 29 Maida Vale 3 1 - - - 1 - 1 - 1 2 4 - 13 Town 1 - 1 1 - 1 1 - 2 4 2 - 1 14 Church 4 6 2 3 3 4 3 3 1 5 5 3 5 47 Westbourne 9 9 1 4 2 3 1 4 5 5 7 4 5 59 Lancaster Gate, West - 2 1 - - - - 1 - 1 - - 1 6 Lancaster Gate, East - - - - 1 1 - - - - - 1 - 3 Hyde Park 2 3 1 - - - - 2 - - - - - 8 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 19 phials of 4,000 units and 2 phials of 500 units were distributed. Schick Test.—No use was made of this test during the year. SMALLPOX. Two cases of this disease were notified during the year, one of which was contracted in hospital. The other case was found to have resulted from contact with a patient in another Borough. A number of persons who had been exposed to risk of infection from cases occurring outside the Borough 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. The Vaccination Officer is Mr. T. E. Rainger, who was appointed to that position in 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 one primary vaccination was performed in the Paddington Hospital. In the rest of the Borough 755 infants under one year of age, and 62 persons over that age were successfully vaccinated by the Public Vaccinator, by whom also 27 persons were re-vaccinated who had been successfully vaccinated at some previous time. The total number of vaccinations actually performed in the Borough was .1,393. This number comprises children born in the Borough and transfers from other districts. The latest return available as to the state of vaccination in the Borough is for the year 1931. This shows that 63.7 per cent. of the children whose births were registered during that year were successfully vaccinated, and that 15.9 per cent. were exempted on production of statutory declarations of conscientious objection. Insusceptibility, postponements, removals, deaths, and not traced, account for the remaining 20.4 per cent. Legal proceedings were taken for non-compliance with the provisions of the Vaccination Acts in 42 cases. Of these 22 were successfully vaccinated subsequent to the proceedings being taken. Adjournments (sine die or otherwise), Magistrate's Orders for vaccination, cases withdrawn and 3 summonses not served, account for the balance. 18 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. Fewer cases were notified in 1932 than in any year since the disease became permanently notifiable in the Borough, the number of certificates received from medical practitioners being 291. In addition 104 cases were reported from other sources, making a total of 395 for the year. The greatest prevalence occurred during the fourth quarter of the year, the cases for that period numbering 181. Chicken-pox is not usually nursed in an institution, but 31 cases received institutional treatment for various reasons. In view of the prevalence of smallpox in other parts of London and the resemblance between chicken-pox and smallpox, a large number of cases of chicken-pox reported were visited by the Medical Officer of Health to verify the diagnosis. TYPHOID FEVER AND CONTINUED FEVER. Four cases of typhoid fever were notified in 1932. 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, but no notifications were received during 1932. Of the 4 cases of typhoid fever, 3 received hospital treatment. There were no deaths from the disease. 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 1932, 1,414 cases of measles certified by medical practitioners, and 293 cases reported from other sources, the corresponding figures for 1931 being 541 and 118, and for 1930, 1,790 and 438. The number of cases notified is analysed in the adjoining table in 4-weekly periods for the various wards. 1932. 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 210 174 138 232 295 204 96 37 6 2 8 2 10 1414 Wards— Queen's Park 12 16 12 17 43 15 2 1 2 - 1 - - 121 Harrow Road 111 74 41 42 14 16 11 7 - - - - 3 319 Maida Vale 31 22 29 27 9 16 12 7 2 1 1 - - 157 Town 6 1 8 21 40 20 12 9 - 1 1 1 - 120 Church 20 12 9 42 79 55 22 1 - - 1 - 1 242 Westbourne 22 42 23 43 69 32 12 2 1 - - - 1 247 Lancaster Gate, West.. 5 2 1 19 5 8 1 5 - - - - 4 50 Lancaster Gate, East.. 1 1 2 14 11 19 8 1 - - - 1 1 59 Hyde Park 2 4 13 7 25 23 16 4 1 - 4 - - 99 19 Twenty-six deaths were attributed to measles, 7 of which occurred among children under the age of 1 year, 12 among children between the ages of 1 and 2 years, 5 among children between the ages of 2 and 5 years, and 2 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 120 under 5 years of age and 17 over 5 years of age. The number of visits paid by the nurses was 1,290 and 154 to each group respectively. Two hundred and seventy-five cases received treatment in hospital. GERMAN MEASLES. This harmless, but infectious disease is notifiable in Paddington; 77 cases were notified in 1932, as compared with 58 in 1931, 86 in 1930, and 1,163 in 1929. One patient received treatment in hospital. OPHTHALMIA NEONATORUM. This disease is notifiable in London under Section 55 of the Public Health (London) Act, 1891, the London County Council having by resolution in 1911 made this section applicable to the disease. Twenty-two notifications relating to cases of purulent eye-discharge of the new-born were received during 1932. Of the 22 patients 19 recovered without any impairment of vision, 1 proceeded to another district on discharge from hospital and 2 died. As soon as a case of this disease is notified, intensive efforts are made by the Council's Staff to ensure that proper treatment is carried out. Daily visits are paid and private or charitable medical treatment is invariably enforced. Where necessary the infant and its mother are removed to a hospital, provision of this accommodation being ample. All necessary nursing attention is given by home visiting on the part of the Paddington and St. Marylebone District Nursing Association. In addition to true purulent discharge, four 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 1932, 4 cases were referred to the District Nursing Association, 60 visits being paid. Eighteen case of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 7 cases of puerperal fever notified during 1932, all of which were removed to or nursed in a hospital. There is no difficulty in obtaining institutional treatment for women suffering from this disease. Cases of puerperal fever referred to the London County Council are usually sent to the North-Western Hospital, Hampstead, where a special ward is set aside for these cases and special medical and nursing staffs are provided. Excellent accommodation is also available at Queen Charlotte's Isolation Hospital, Hammersmith. Two deaths from the disease ware recorded during the year. 20 PUERPERAL PYREXIA. This condition is defined as:— "Any febrile condition (other than a condition which is required to he 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 31 cases of puerperal pyrexia were notified, 27 of which occurred within or were removed to institutions. Two of the patients were nursed in Queen Charlotte's Hospital Isolation Block, one wholly and the other partly at the expense of the Council, the total expenditure incurred being £23 7s. 3d. 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. Two requests for his assistance were made to the Council during the year. ERYSIPELAS. Sixty (60) cases were notified, 29 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 bv 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. Nine cases of this disease were notified in 1932. All were treated in hospital. Six of the nine cases proved fatal, five of the patients dying of Cerebro-spinal fever and one of tubercular meningitis. There was a further death of a patient who had not been notified. MALARIA. One case of this disease was notified. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and eighty-four (184) cases of acute primary pneumonia were notified in 1932 as compared with 243 in 1931, 168 in 1930, 247 in 1929 and 202 in 1928. Of the 184 cases, 131 were nursed in institutions. Sixty-six (66) cases of acute influenzal pneumonia were notified as compared with 97 in 1931, 40 in 1930, 135 in 1929 and 59 in 1928. Of the 66 cases, 25 were nursed in institutions. Sixty-three (63) cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council scheme for district nursing, 1,197 visits being paid. ANTHRAX. No case of this disease was notified during the year. 21 CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. Five cases of dysentery were notified during 1932, but there were no cases of the other diseases included in the heading. 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 1932, 13 persons died of whooping-cough, all being children under the age of 5 years. The number of deaths in 1931 and 1930 were 8 and 4 respectively. FOOD POISONING. Section 7 of the London County Council (General Powers) Act, 1932, requires medical practitioners to notify cases of food poisoning or suspected food poisoning. Between the 12th July, 1932, when the Act received Royal Assent, and the end of the year, eleven cases of illness, suspected to have been caused by food poisoning, were notified in the Borough. In no case was action considered necessary as regards the source of the food supply. In most of the cases there was no doubt that the illness was not "food-poisoning," but was due to personal idiosyncracy or to the results of some dietetic indiscretion. 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, 254, which occurred in Paddington last year, whilst greater than the number for 1931, did not reach the figures recorded in 1928, 1929 and 1930. The numbers of deaths for previous years are shown in the list following: — Numbers of Deaths in Paddington. 1932 254 1931 220 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. Three cases are not included owing to absence of information. 1932 Cancer. Site of Disease. Ages. All Ages. 0— 15— 25— 35— 45— 55— 75— M f m. f m. f m f M f M f M f M f m f Buccal cavity and pharynx - - - - 1 - - - 3 - 3 1 4 1 - 1 11 3 Digestive organs and peritoneum - - - - 1 2 5 3 10 9 20 11 14 20 19 20 69 65 Respiratory organs - - - - - - 1 1 2 - 3 1 4 3 2 - 12 5 Uterus - - - - - I - - - 4 - 3 - 3 - 2 - 13 Other female genital organs - - - - - - - - - 2 - 6 - 1 - 2 - 11 Breast - - - - - 3 - 2 - 7 - 6 - 7 - 6 - 31 Male genito-urinary organs - - - - - - - - - - 5 - 7 - 4 - 16 - Skin - - - - - - - - - - - - - - - - - - Other or unspecified organs - - - - - - - 2 - 2 - 6 1 1 1 2 2 13 - - - - 2 6 6 8 15 24 31 34 30 36 26 33 110 141 22 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 1932, 21 cases of acute rheumatism were notified. This figure compares with 37 cases in 1931, 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 1932, 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. Paddington Green Children's Hospital Rheumatism Supervisory Centre. Report for the Year 1932, by Reginald Miller, m.d., f.r.c.p., Physician-in-Charge. In my report for last year the objects and methods of the Rheumatism Supervisory Centre were fully explained. It is therefore sufficient to state that it endeavours, by preventive treatment and attention to the details of housing: and schooling, to ward off serious attacks of rheumatism in children, and thus to prevent valvular disease of the heart which will, if established, ultimately prove fatal. The work of the Centre, therefore, consists more in watching over children threatened by these dangers than in treating them in the acute phases of the disease: nevertheless facilities for the treatment of rheumatism in children in any and every phase of the disease are provided under the scheme. Sessions and Attendances.—The Centre was open on 43 Saturday mornings during1 the year. One hundred and fifty-nine children from the Paddington Borough attended, and the total number of attendances was 298. Number. Attendances. New cases 33 58 Old cases101 213 Discharged 25 27 159 298 23 To these figures must be added as an integral part of the work of the Centre the admissions to the wards of the Paddington Green Children's Hospital, and the number of operations for the removal of diseased tonsils. These are referred to later. Notifications.—-The number of new cases notified to the Medical Officer of Health during the year was 21. The notification of cases takes place during the acute stages of rheumatic infection only, and every effort is made by the Borough Health Visitors to get the children to attend the Centre when the acute symptoms have passed off. As there is necessarily an interval of some weeks or even months between the date of notification and the time when the cases become suitable for the Centre, it is difficult to ensure the ultimate attendance of all the notified cases. The small number of notified cases suggests that the incidence of juvenile rheumatism throughout the Borough has been abnormally small, owing to the mildness of last winter and the autumn of the past year. New Cases.—The number of new cases attending the Centre during the year was 33. These were referred to the Centre in the following ways:— Through Public Health Service 6 ,, School Medical Service 20 ,, the Hospital 4 ,, other means 3 Classification of New Cases.—-The classification of the new cases at their first visit was as follows:— Rheumatism. Heart disease. Early 13 0 Active 2 2 Quiescent 15 suspected 8 definite 5 Absent 3 0 A certain number of cases, both new and old, developed symptoms of active disease during the year. Social Standard.—Of the 33 new cases, the circumstances of the parents were classified as comfortable in 21, poor in 3 and very poor in 3. In 4 instances the houses were reported to the Medical Officer of Health as damp, and this was remedied. Treatment.—The following table summarises the work done amongst the 159 children attending the Centre during the year:— Referred for treatment for active rheumatism: as in-patient, Paddington Green Children's Hospital 4 as out-patient ,, „ „ ,, 36 Elsewhere 2 Removal of diseased tonsils : as in-patient, Paddington Green Children's Hospital 7 as out-patient ,, „ „ ,, 9 Elsewhere 1 Home conditions referred to Sanitary Authorities 4 Recommendations: to Physically-Defective School 3 for prolonged period in country 2 Discharged: over age 13 non-rheumatic 3 moved away 5 non-attendance 4 General Review of 1932.—Owing to the mildness of the winter 1931-32 and of the autumn of 1932, the amount of rheumatism amongst the children has been much below the average. But it seems clear that, after making allowance for this fact, the fullest use is not yet being made of the Centre. The cases combed out of the schools seem unduly small in number, and the number of notified cases which fail to make their appearance at the Centre after the acute symptoms have subsided seems unduly large. 24 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. In 1932 the disease was made permanently notifiable. One hundred and three cases of the disease were notified during the year. The number of deaths under the age of 5 years was 55, as compared with 29 in 1931, 29 in the year 1930, 37 in the year 1929, 23 in the year 1928 and 16 in the year 1927. Five cases in children under 5 years of age were nursed at home by the District Nurses, the number of visits paid being 58. Fifty-eight patients received treatment in various hospitals. TUBERCULOSIS. Tuberculosis of all kinds is notifiable, and particulars of the number of notification certificates received during the year 1932 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 107 deaths in 1932, and from other tuberculous diseases there were 15 deaths. The number of deaths from tuberculosis of all kinds was 114 in 1930, 138 in 1931, arnd 122 in 1932. In recent years the numbers of deaths were as follows:— 1919 133 1926 125 1920 146 1927 118 1921 125 1928 116 1922 143 1929 128 1923 127 1930 114 1924 149 1931 138 1925 119 1932 122 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1932. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year - - - - 1 1 1— 5 years - - - 3 4 7 5—10 ,, - 2 2 13 14 27 10—15 ,, 2 1 3 4 7 11 15—20 ,, 6 13 19 1 2 3 20—25 ,, 14 21 35 2 8 10 25—35 ,, 29 37 66 2 5 7 35—45 ,, 15 17 32 1 3 4 45—55 ,, 25 9 34 1 1 2 55—65 ,, 8 4 12 2 1 3 65 years and over 4 1 5 - - - Total 103 105 208 29 46 75 Cases re-notified 80 73 153 8 8 16 Total Notifications on Form A 183 178 361 37 54 91 Cases removed from Register:— 1932. By reason of— Death 134 Removal 181 Recovery of patient or variation of diagnosis 68 Total 383 25 Of the patients who removed from the Borough during 1932, the new addresses were obtainable in 94 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1932, 6 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 1932 was 1,360 as compared with 1,416 at the close of the year 1931. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 925 By Tuberculosis Officers 556 By Dispensary Nurses— 20, Talbot Road 3,217 St. Mary's Hospital 2,363 7,061 Tuberculosis. New Cases and Mortality During 1932. Age Periods. New Cases. Deaths . Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 — - - - 1 1 - - 1 1 — - - 3 4 - - - - 5 — - 2 13 14 - - 1 2 10 — 2 2 4 7 15 — 6 13 1 3 11 14 - 5 20 — 14 23 2 8 25 — 29 37 2 5 11 12 1 - 35 — 17 17 1 3 11 9 - 1 45 — 25 9 1 1 11 14 - - 55 — 8 4 2 1 6 3 - 1 65 years and upwards 4 1 - - 3 1 - 3 Totals 105 108 29 47 54 53 2 13 Twenty-one persons dying from tuberculosis during the year were not formally notified, this number being equal to 17.2 per cent. of the total tuberculosis deaths recorded. In all cases where it appeared necessary, inquiries were made as to the reason for the absence of notification. Public Health (Prevention of Tuberculosis) Regulations, 1925. By virtue of these regulations persons who are aware that they are suffering from tuberculosis of the respiratory tract may not enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk or the handling of vessels used for containing milk. Furthermore, if a local authority are satisfied that a person residing in their district who is engaged in any such occupation mentioned above is suffering from tuberculosis of the respiratory tract and is in an infectious state, they may by notice in writing require such person to discontinue his employment or occupation. No use has so far been made of these regulations. 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 1932 and 3 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 1932 one shelter was lent and one lent in a previous year was returned. Artificial Pneumothorax Treatment.—By arrangement with various Hospitals patients recommended for this treatment are given refills at a cost to the Council of 10s. 6d. per refill. During 1932, 20 patients were referred to the Hospitals, the number of refills received ranging from 1 to 20 per patient. The total cost amounted to £79 5s. 6d. 26 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. Arrangements have also been made for the supply of dentures by the Dispensary Committee. In connection therewith 4 patients were provided with full dentures, 7 with partial dentures, and in 4 cases repairs to dentures were carried out. The total cost was £46 9s. Grants amounting to £14 5s. 6d. were made by the Council, the balance being contributed by the patients, approved societies, or other agencies. When patients are able to contribute towards the cost of their dentures, arrangements are usually made for payment to be accepted by instalments. Particulars of the dental work done during the year are shown in the subjoined table. Summary of Dental Treatment for the Year 1932. Particulars of Patients. Number of Fillings. Number of Scalings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. ! | Number of New Patients. Number of Attendances. Simple. Root. Without Anaesthetic. Local Administration. Gas Administration. Number of teeth extracted. Upper. Lower. Re-models. Repairs. Women 126 12 - 6 - 7 25 74 7 3 - 2 1 35 38 18 Children 122 35 1 - — 3 40 93 — — — — 9 37 8 22 Men 70 1 1 1 — 3 11 47 4 4 — 2 — 18 23 6 Total .. 318 48 2 7 — 13 76 214 11 7 — 4 10 90 69 46 Number of Sessions held=46. In addition to the dentures supplied at the Talbot Road Dispensary, full dentures were supplied to two patients receiving treatment in sanatoria, the Council contributing £2 1s. towards the total cost of £11. 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 £1,438. 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 1932, 42 patients received treatment, 761 exposures being given. Arrangements are now in force for the X-ray examination of patients, through the services of a consulting Radiologist. 27 In November, 1931, a class for the manufacture of hand-made gloves by tuberculous women was opened at the Dispensary under the auspices of the Central Fund for the Industrial Welfare of Tuberculous Persons. This class, which is held every Wednesday afternoon, has proved highly successful. It is attended chiefly by patients from Paddington, but patients from Kensington and St. Marylebone are also received. There is a regular weekly attendance of 12 patients. It is now possible to report that some progress has been made in the problem of finding new premises for the Dispensary. During the year a piece of land has been bought by a friend of the Dispensary, on which to build new premises. Active steps are being taken to collect money for the erection of the proposed new buildings. Eeturn Showing the Work of the Dispensary During the Tear 1932. 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 42 44 1 1 1 8 13 11 43 52 14 12 781 (b) Doubtfully tuberculous - - - - - - - - 1 1 2 2 (c) Non-tuberculous - - - - - - - - 94 211 154 195 B.—Contacts examined during the year:- - - - - - - - - - - - - - (a) Definitely tuberculous 4 1 - - - - 4 5 4 1 4 5 237 (b) Doubtfully tuberculous - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 35 81 57 50 C.—Cases written off the Dispensary Register as (a) Cured 7 26 - - 5 10 10 1 12 36 10 1 936 (b) Diagnosis not confirmed or non - tuberculous (including cancellation of cases notified in error - - - - - - - - 129 292 211 245 D.—Number of Persons on Dispensary Register on December 31st:— 750 (a) Diagnosis completed 187 176 2 2 46 73 144 114 233 249 146 116 (b) Diagnosis not completed - - - - - - - - 1 1 2 2 1. Number of cases on Dispensary Register on January 1st 805 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 11 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 92 4. Cases written off during the year as Dead (all causes) 56 151 5. Number of attendances at the Dispensary (including Contacts) 5,742 6. Number of Insured Persons under Domiciliary Treatment on the 31st December .. .. .. .. 7. Number of consultations with medical practitioners:— (а) Personal (b) Other 51 207 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 269 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,217 10. Number of (a) Specimens of sputum, etc., examined (b) X-ray examinations made in connection with Dispensary work 297 94 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st .. 173 28 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,085 from the Paddington Borough Council during the year 1932. 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 1932. 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):— 132 (a) Definitely tuberculous 16 24 — — 3 5 3 2 19 29 3 2 (c) Doubtfully tuberculous — — — — — — — — — — 3 — (c) Non-tuberculous 16 42 8 10 B.—Contacts examined during the year 64 (a) Definitely tuberculous 1 1 — 1 — — — — 1 1 — 1 (b) Doubtfully tuberculous — — — — — — — — — — 1 — (c) Non-tuberculous — — — — — — — — 10 17 17 16 C.—Cases written off the Dispensary Register as 146 (a) Cured — — 1 — — 1 4 3 — 1 5 3 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error — — — — — — — — 26 60 25 26 D.—Number or Persons on Dispensary Register on December 31st:— 316 (a) Diagnosis completed 76 80 2 5 43 50 31 25 119 130 33 30 (b) Diagnosis not completed — — — — — — — — — — 4 — 1. Number of cases on Dispensary Register on January 1st 312 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 17 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 44 4. Cases written off during the year as Dead (all causes) 19 5. Number of attendances at the Dispensary (including Contacts) 3,804 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 3 7. Number of consultations with medical practitioners:— (a) Personal — (b) Other 17 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 287 9. Number of visits by Nurses or Health Visitors to Homos for Dispensary purposes 2,363 10. Number of (а) Specimens of sputum, etc., examined 109 (b) X-ray examinations made in connection with Dispensary work 108 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 72 29 The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1932 was as follows: — Representing. Paddington Borough Council Councillor W. H. Crook (Chairman, Public Health Committee). „ „ Councillor Mrs. R. M. Drury (Vice-Chairman). „ „ Councillor Mrs. M. E. Gerrett. „ „ Dr. G. E. Oates, Medical Officer of Health. „ „ Miss L. M. O'Kell, Sanitary Inspector. „ „ Miss D. Newhall, 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 A. M. 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 23 occasions during the year, and the attendance of members was well maintained. Three hundred and twenty individual cases were considered. Residential treatment was granted by the London County Council to 162 patients, 32 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 162 patients, 117 received free treatment, the remaining 45 patients, or their parents, paying contributions varying from 2s. 6d. to 30s. a week. Payments are collected by the Committee and transmitted monthly to the County Council. During the year a total of £239 2s. 9d. 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 1932 a number of assessments were revised by the County Council for this reason, following recommendations made by the Care Committee. In the course of the year the Committee were successful in obtaining from charitable organisations help of various kinds for necessitous patients or their dependants. 30 MATERNITY AND CHILD WELFARE. The staff engaged in maternity and child welfare work 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 1,934 Revisits „ „ „ 6,239 8,173 Visits to children between the ages of 1 and 5 years 11,258 First visits to expectant mothers 609 Revisits „ „ „ 534 1,143 Other Visits— Sickness (including Puerperal Fever, Puerppral Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 462 Miscellaneous (including 3,398 ineffective calls) 11,556 12,018 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. An annual contribution of £500 is made by the Council to the Paddington School for Mothers. This is provided for in the Scheme made by the Minister of Health under Section 101 (6) of the Local Government Act, 1929. 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. Centres (as in December, 1932). 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. 0. 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.—Monday, 10 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served:—South Paddington. 31 One Nutritional and Physio-Therapeutic Consultation weekly. 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. Two Infant Consultations weekly.—Wednesday, 2.15. Medical Officer, Dr. Maude Richards. Friday, 2.15. Medical Officer, Dr. Evelyn Maclagan. 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. 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. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large double room, doctor's room and sales room warmed by gas radiators and hot pipes. 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. 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. Two Infant Consultations weekly.—Wednesday, 2.15. Medical Officer, Dr. J. McKail. Thursday, 2.15. Medical Officer, Dr. Hubert Hodge. Area served:—Maida Yale Ward and part of Harrow Road Ward. One Maternity (Ante- and Post-Natal) Consultation weekly.—Thursday, 10 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Area served:—North Paddington. Massage Sessions are held at 232, Harrow Road on Tuesday and Thursday mornings from 10.0 to 12.30, by Miss Gannon, C.S.M.M.G., 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 Nutritional Consultation. Dental Arrangements.—-Messrs. J. Trude Fripp and F. H. Brinckley Tofts, 281, Harrow Road, treat mothers and children who attend Centres, on special terms. Financial assistance is given in many cases. Dental Treatment can also be obtained for mothers and children from Paddington Centres, at the local Hospitals, and at the Eastman Dental Clinic, Royal Free Hospital, Gray's Inn Road. Instruction in Invalid Cookery, Knitting, etc., is given at Christ Church Centre on Monday at 2.15 p.m. by a qualified Yoluntary 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. Financial assistance is given in many cases. 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. 32 Consultation Centres. Summary of Work for the Year 1932. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Queens- boro' Passage. Totals. Tues. Thurs. Tues. Fri. Wed. Thurs. Wed. Fri. Mon. Number of Sessions 51 51 51 51 51 49 51 51 48 454 Number of Attendances 1845 2470 3093 2278 2151 2204 1506 2619 2831 20997 Average Attendance 36.1 48.4 60.6 44.6 42.1 44.9 29.5 51.3 58.9 46.2 Seen by Doctor 824 1005 1285 941 749 853 637 1121 1339 8754 Average number seen by Doctor at each Session 16 19.7 25 18.4 14.6 17.4 12.4 21.9 27.8 19.2 The total number of children attending the consultations was 2,295, 1,157 being under 1 year of age and 1,138 between the ages of 1 and 5 years. Ante-Natal and Post-Natal Clinics. Harrow Road. Macroom Road. Number of Sessions 48 51 Number of Attendances 558 394 Number of Expectant or Recently Confined Mothers who Attended 255 173 Average Attendance per Session 11.6 7.7 Number of Cases Referred by Midwives in Private Practice 6 31 Nutritional and Physio-therapeutic Clinic. Report for the Year 1932, by R. Cove Smith, h.a., m.b., b.ch., m.r.c.p., d.p.h. The total number of attendances at the Clinic for the year 1932 was 2,066. The number of cases under observation was 195, and of these 147 were new cases during the year. During the second six months, when a special figure analysis was carried out, 883 treatments of artificial sunlight and 552 massage treatments were given, but in addition the mothers are instructed how to carry out simple massage and follow up treatment at home in order to increase the effectiveness of the masseuses' work. The main function of the Centre is dietetic and remedial, with Ultra-Violet Light and Massage available as adjuvants. Owing to the large number of basement dwellings and tenement houses in Paddington the need for ultra-violet light is great, and I glad to say that the results are very encouraging. 109 cases required light in addition to dietetic advice; 80 required massage as well; 5 were on massage alone and 1 case did satisfactorily on altered diet without anything further. The consultative nature of the Clinic is evidenced by the fact that 13 cases have been discharged during the year and returned to their ordinary Welfare Centres either cured or well on the road to recovery, while one patient discharged herself. Many of the cases treated are by no means as simple as they first appear, and much good work has been done in correcting deformities, advising hospital treatment where necessary and improving general health. The following instances are of interest:—C. S. was brought up for bowed legs, but X-rays showed hip deformity as the cause, which is now being corrected. F. J. C. and J. O. were both sent up as anaemic, but this was found to be secondary to septic tonsils; operation was advised, and during the convalescent period artificial sunlight was administered with satisfactory results. S. S., another anaemic child, was found to be suffering from a blood disease and enlarged spleen, so was admitted to Great Ormond Street Hospital. Of two cases who walked badly one was found to have flat foot and another Coxa Vara. J. McK. had a stiff neck that had been caused by birth injury; this has been improved by massage and is to be freed by operation later. J. W., another anæmic child, proved to have infected urine that required hospital treatment. Several cases referred for unsatisfactory nutrition were found to have congenital deformity of the heart. Two cases of erythroedema, a rare disease with neuritis and dislike of light were seen and treated by Vitamin B added to the diet, while numerous cases of Rickets have been considerably improved. Faulty feeding, both of the expectant mother and child, seems to be at the root of much of the infantile trouble in Paddington, and this centre certainly has a contribution to make in correcting and preventing this from spreading, though its scope is not yet as large as it might be. 33 During November and December research was carried out with Vitamin A concentrate on 14 children with chronic chest trouble; 4 of these showed excellent improvement, 6 were good, 3 satisfactory, and 1 showed no improvement at all. Observations are still being carried out over a more prolonged period, but the preliminary work is extremely encouraging. Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,252 4 4 Sales 989 8 6 Grants from Borough Council 257 15 10 Queen Charlotte's Maternity Hospital.— During the year 1932 105 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 11. As regards ante-natal consultations, exact figures are not available. During 1932 there were received into the Hospital for confinement 261 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 8 per patient. "With regard to out-patients in 1932, 356 Paddington women were delivered in their own homes by midwives from the hospital; each of these would have attended the ante-natal department about 8 times on the average. St. Mary's Hospital.—There is no Infant Consultation Centre at this Hospital, but Ante-natal Consultations are held. There are no figures available as to the number of Paddington mothers who attended such consultations, but the number of Paddington mothers delivered at their own homes during 1932 was 113, and presumably all of these received ante-natal examination and advice. Maternity Nursing.—The arrangement whereby the Paddington and St. Marylebone District Nursing Association provides the services of trained maternity nurses in connection with lying-in cases attended by the students and the Medical Officer of the Extern Midwifery Department of St. Mary's Hospital, continued in operation throughout the year. The results of this arrangement are excellent although it is not possible to adduce any figures in support of this statement. During the year 1932, 113 confinements were attended by the nursing staff, the number of visits being 2,102. These figures compare with similar ones of 177 and 2,832 in the year 1931. The annual grant in aid of this work is now £175. Midwifery Service.—In March, 1932, the Council authorised the Maternity and Child Welfare Committee to make arrangements for the provision of a qualified midwife to attend emergency maternity cases at an estimated cost of £10 per annum. Arrangements were accordingly made for the Paddington and St. Marylebone District Nursing Association to undertake this service. One case was attended during the year. Maternity Consultations.—On no occasion was it necessary to requisition the services of an obstetric consultant on account of complications associated with parturition. DAY NURSERIES. At the end of the year 1932, 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 50 254 51 Attendances 5,011 380 8,481 814 Average attendance 20 7 33 16 New Children 40 84 Cases of Infectious Disease. Diphtheria — 3 Measles 20 20 Whooping Cough 5 — Infective Enteritis 3 — There were no Closures during the Year on Account of Infectious Disease. 34 The premises of the Queen's Park Day Nursery at No. 66, Lancefield Street, are owned by the Council, and a new boiler flue was constructed during the year. The Scheme made by the Minister of Health under section 101 (6) of the Local Government Act, 1929, provides for the annual payment of contributions from the Council, to the Paddington Day Nursery, £377, and to the Queen's Park Day Nursery, £252. PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. Scheme adopted by the 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. 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. 35 (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 Milk and Dairies Order, 1926. 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 foe Geants. 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. Free. Half-Price. Number of family. Total Income less Rent. Average Per Head. Total Income less Rent. Average Per Head. s. d. s. d. 8. d. 8. 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. 36 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. All new cases are considered by the "Grants" Sub-Committee, and in addition expiring grants are brought forward for re-consideration, together with 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 " Sub-Committee 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 restaurant; (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 grantee's copy 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 1932. (1931 figures in brackets). The total number of cases considered by the "Grants" Sub-Committee during the year was 4,185, of which 1,342 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 1198 (852) 955 (712) 243 (140) Dried Milk 144 (132) 144 (130) — (2) Dinners — (9) - (8) - (1) 1342 (993) 1099 (850) 243 (143) Details relating to the numbers of orders issued and the expenditure incurred are given below. Number of Orders for Milk 3,721 (2,633) At Total Cost 3,707 (2,552) At Half Cost 14 (81) Number of Quarts at Total Cost 34,003 (28,358) „ „Half Cost 200 (882) Total Number of Quarts 34,203 (29,240) £ s. d. £ s. d. Cost of Milk at Total Cost 916 19 5 (749 15 9) „ „Half Cost 3 1 10 (11 13 1) £920 1 3 (£761 8 10) Number of Orders for Dried Milk, etc. 922 (619) At Total Cost 906 (615) At Half Cost 16 (4) Total Cost of Dried Milk, etc. £257 15 10(£166 10 1) No Dinners were provided. 37 THE HYDE PARK BABIES' CLUB. 94, Lancaster Gate, W.2. This is an infant welfare centre on a contributory basis for better-class mothers and "nannies." It has completed its second year's work with an increase of membership and a steady extension of the Club's activities. Weekly weighing and consultation sessions have been held as heretofore on Monday afternoons, with test-feeding for breast fed infants at 2 p.m. Evening lectures for mothers and nurses have been held in each session, in houses lent by members, and have been attended by an increasing circle of friends who, becoming interested in this way, have in many cases joined the Club. An intensive class in infant hygiene and dietetics, covering the care of the infant in the first year of life, was held for expectant and other inexperienced young mothers by the medical officer of the Club, and is to be followed by further courses dealing with the care of toddlers and older children. The Club is managed by an Executive Committee consisting mainly of mothers of members of the Club, and the Countess of Limerick and Mrs. Laura Henderson are respectively Club President and Chairman. Dr. Margaret Emslie is the medical officer in charge of consultations. The Centre works in co-operation with the Medical Officer of Health. 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. No cases of nursing mothers with babies were referred to St. Mary's Convalescent Home, Birchington-on-Sea, for convalescence. In 22 instances the Council made grants towards the cost of children convalesced by the Invalid Children's Aid Association, the total amount being £43 9s. 7d. MATERNAL MORTALITY. During the year eight maternal deaths were enquired into by Dr. E. Dorothy Fenwick, the Council's medical investigator, and reports thereon forwarded to the Ministry of Health. THE PADDINGTON INFANT SAVING CAMPAIGN. This campaign, to which allusion was made in last year's report, came to an end on August 31st, 1932, owing to lack of funds. 38 ADMINISTRATION. GENERAL. Staff of the Department.—Following the decease of Six William R. Smith, Mr. Alan W. Stewart, D.Sc., A.I.C., of the Royal Institute of Public Health, was appointed Public Analyst by the Council on the 31st May, 1932. Miss L. M. O'Kell and Mr. G. J. Miners, Sanitary Inspectors, retired from the Council's service on the 25th September and the 31st December, respectively. The positions vacated by them were unfilled at the close of the year. Mr. H. D. Bailey was appointed Sanitary Inspector, and Miss C. Teale, Health Visitor, on the 20th January, 1932, to fill vacancies which had arisen during the previous year. Mr. L. Spears was appointed Assistant Mortuary Keeper on the 31st May, 1932. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 5,561. 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 1,159. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 209 patients (comprising 137 cases of measles, 63 of pneumonia, 5 of whooping-cough, and 4 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 2,752. Disinfection.—The rooms disinfected after infectious disease numbered 852, including 152 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 20¾ tons. Four hundred and seventy-six library books were disinfected. Schools.—A total of 3,397 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 2,850 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, 608 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, 23, Queen 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 1932 were as follows:— Disease suspected. Number of Examinations. Number of Positive Results Diphtheria 1,016 102 Tuberculosis 414 83 Typhoid Fever 10 2 Ophthalmia Neonatorum 1 — Cerebro-spinal Meningitis 1 — House Drainage.—During the year 2 existing drains were tested and found water-tight, and 67 defective drains were reconstructed. Reconstruction Plans.—Two hundred and fifty-six (256) plans were submitted for drainage works in existing buildings. In connection therewith 451 letters were despatched. One summons was 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:— Princes Square, Nos. 6 and 7; Nos. 8, 9 and 10; Nos. 17, 18 and 19. 39 Shops and residential premises on sites of Nos. 3 and 4, Bouverie Street. Shops and residential flats on the S.W. side of Edgware Road, between Star Street and Cambridge Terrace, on the sites of No 177, 179, 181, 183, 185, 187,189, 191 and 193, Edgware Road, Nos. 108 and 109, Star Street, and No. 2, Cambridge Terrace. New Cinema or building on the east side of Queen's Road and the north side of Bishop's Road, extending to the London County Council Eire Brigade Station northwards, and to Pickering Mews (private), on the east, on the sites of premises formerly numbered and known as 96 and 98, Bishop's Road, 192 to 202 (even), Queen's Road, and the stable and other buildings at the rear in Pickering Mews. New business and garage (car park) premises or building on the west side of Queen's Road on the sites of Nos. 183 to 191 (odd, inclusive), Queen's Road. Amberley Wharves, Nos. 9 and 10. Edgware Road, No. 407, and Hyde Mansions. Eastbourne Mews, No. 91, and Westbourne Terrace, No. 91. Ilchester Gardens, Nos. 1 to 5. Three new residential houses or buildings situate on the west side of Hyde Park Street, and on the site of premises numbered and known as 5 and 6, Chester Mews, the kitchen and laundry at the rear of 15, Hyde Park Terrace, and the rear portion of 16, Hyde Park Terrace, and land formerly the eastern end of Chester Mews carriageway. New business premises on the sites of Nos. 3, 3a and 5, Praed Street, and Nos. 3, 3a and 4, Market Street. Two combined systems were reconstructed by the Council during the year. Sewer Connections.—In 1932, 41 were reconstructed, either partially or wholly, 8 after Orders under Section 85 of the Metropolis Management Act, 1855, and 33 on the application of the owners of the properties concerned. Water Supply.—One certificate under Section 48 of the Public Health (London) Act, 1891 was issued. The Metropolitan Water Board reported 20 cases of discontinuance of water supply, 19 on account of non-payment of rates, and 1 on account of defective fittings. Eleven of the premises were unoccupied. In the remaining 9 cases the supply was restored after intervals varying from 2 days to 2 months. One summons was issued, but as the water supply was reinstated before the date of hearing, the case was disposed of on payment of costs. Mortuary.—Five hundred and thirty-three (533) bodies were deposited at the Mortuary, inquests being held on 389 of that number. Bodies deposited pending burial (all noninfectious) numbered 35. Three hundred and seventy-two (372) post-mortem examinations were made. Trade Nuisances.—Twenty complaints were received during the year, those relating to manure numbering 7. 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 difficulty is experienced in securing compliance with the notice. Rag and Bone Dealers.—In December, 1932, there were 9 rag and bone dealers in the Borough. Smoke Control.—During 1932, 21 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 155 occasions, occupying 45¼ hours. Smoke of all descriptions was noted during 23 hours, the duration of "black" smoke being only 22 minutes. Nine complaints relating to the emission of smoke were received during the year. 40 FOULING OF PUBLIC FOOTWAYS BY DOGS. The following bye-law was made by the Council on the 29th July, 1924, for the good rule and government of the Borough:— No person being in charge of a dog in any street or public place and having the dog on a lead shall allow or permit such dog to deposit its excrement upon the public footway. Any person offending against this bye-law shall be liable to a penalty not exceeding 40 shillings. This bye-law shall cease to be in force after the first day of August, 1926, unless a bye-law confirming and continuing its provisions has been duly made and come into force before that date. In July, 1926, the bye-law was adopted permanently by the Council. This bye-law is enforced by the Medical Officer of Health and his staff. Active assistance is given by the police, the Home Secretary having intimated in June, 1928, as a result of representations from the Council, that the police had been instructed to report to the Council such offences against the bye-law as come to their notice in the course of their ordinary duties. During 1932, six prosecutions were instituted, small fines being imposed in all cases. 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 purposes of the Regulations. Mr. C. S. Wansbrough acted as Canal Boats Inspector during the year. The following report for the year 1932 was made to the Council by the Medical Officer of Health, and was adopted by the Council as their statutory report to the Minister of Health as required by the Canal Boats Act, 1884. One hundred and fifteen canal boats were inspected during the year, the following infringements of the Acts and Regulations being discovered:— Cabins leaky 6 Cabin floors defective 5 Stoves and stove pipes defective 8 Boats without certificates 6 Painting of cabins required 15 No formal notices were served. On no occasion was admission to a boat refused, and no legal proceedings were necessary in respect of any of the infringements discovered. There was one case of infectious disease notified, viz.:—measles. There were two deaths reported amongst canal boat dwellers. Two boats were registered, and one re-registered. One hundred and five children of school age were found to be living on the canal boats using the Paddington Basin (50 males, 55 females), the decrease on the figure reported last year being due to more families living ashore and also to fewer "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 255. 41 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 it 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, 2 inhabited boats known to be conveying house refuse from Paddington Basin, were fitted with double bulkheads. Six 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 729½ tons of mud were removed from the bed of the Basin, in addition to 622 tons which were dredged previously. 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. No applications under these Sections were made during the year. 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 17 of the Housing Act of 1930, but 93 communications were sent to owners drawing attention to defects liable to be dealt with under this Section. These communications in most instances resulted in the defects being remedied. Unhealthy Areas.—No representations were made to the Council during 1932. Houses Unfit for Habitation.—Two Closing Orders were made during the year with regard to parts of premises (basement rooms) which were unfit for human habitation. 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. 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 5,363. Particulars of the defects, etc., discovered and remedied will be found on pages 43 and 44. Overcrowding.—During 1932 six tenements in registered houses were reported to be overcrowded. In five instances the overcrowding was abated. The occupants of the remaining tenement 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 675 houses being inspected during the year. Notices were served for the cleansing and other work which was found to be necessary. Common Lodging Houses.—There are 2 common lodging houses in Kilburn Lane and 1 (Cecil House) in Harrow Road. During the year 7 deaths from various causes occurred among the occupants of these houses. 42 Housing Act: Rent Books.—No instances of rent books not containing the required particulars were reported during the year. 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 the operation of Closing Orders in the Borough. The scheme provides for the erection of a building containing four tenements of three rooms, and four tenements of two rooms. At the close of the year bills of quantities and other documents were in course of preparation, prior to the issue of advertisements inviting tenders for the execution of the necessary works. 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 2½% 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. In May, 1932, the Minister of Health sanctioned the provision of a further sum of £1,500 for this purpose. Up to the end of 1932, a total of £5,500 had been subscribed. Rent and Mortgage Interest (Restrictions) Acts, 1920-1925. Three applications for certificates were made, all of which were granted. In one instance a certificate was subsequently issued to the owner of the premises, under Section 5 (2) of the 1923 Act, on the completion of the necessary repairs. Housing on the London County Council Estates. The arrangement 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. Table No. 1 (Housing). Estate. Submitted. Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 18 7 1 3 3 4 Castelnau 3 1 2 — — — Old Oak Common 5 3 1 — 1 — Roehampton 4 2 2 — — — St. Helier 34 18 3 3 7 3 Watling 21 4 13 — 2 2 Wormholt 11 3 2 — 4 2 Central Dwellings 4 2 — — 1 1 100 40 24 6 18 12 In addition to the above figure of 40 housed, 5 families were housed on the different Estates on applications submitted to the London County Council previously to 1932. This figure brings the total number of Paddington applicants housed during the year to 45. The Table refers only to the number of applications submitted to the London County Council; it give no indication of the number remaining on the " waiting lists," which is over 353 for all Estates. (Compare Tables Nos. 1 and 2). During the year 115 new applications were accepted, and over 1,691 interviews were held. 43 The number of Paddington families housed by direct application to the London County Council is 59. 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 1932. Table No. 2 (Housing). Estate. Number of Applications Received. Number Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 442 127 7 220 61 27 Castelnau 29 12 16 1 — — Downham 220 102 3 71 12 32 Old Oak Common 41 11 10 4 10 6 Roehampton 48 26 — 20 2 — St. Helier 411 60 159 166 17 9 Tottenham 33 13 11 — 5 4 Watling 621 114 56 419 20 12 Wormholt 566 174 90 282 16 4 Central Dwellings 3 2 1 — — — 2414 641 353 1183 143 94 The following Estates on which 452 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 186 Paddington applicants on the several waiting lists for these Estates, but this figure in no way represents the large number of persons who have applied here for accommodation on completed Estates. Only the most pressing applications are accepted. The London County Council is giving preferential treatment to these cases as vacancies occur. The houses being erected on the quota Estates at St. Helier, Carshalton, Surrey, and Becontree, Essex, will not relieve overcrowding and insanitary conditions in the Borough to any appreciable extent, as the houses are inaccessible for many local workers whose qualifications in these respects appear most urgent, whilst the rents and fares make the Estates prohibitive for the average man with a wage varying from 45s. to 60s. per week. 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 7 vacancies occurred and new tenants were admitted at once from the waiting list. Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. 1932 Drain defective 10 „ choked 42 „ not properly ventilated or ventilating pipe defective 75 Manhole cover defective 6 Gully choked 8 Soil pipe defective 6 Water-closet defective 69 „ choked 18 „ without sufficient flush — „ flushing apparatus defective 64 foul 5 „ improperly constructed — „ accommodation insufficient 1 „ without door, door defective, or without proper fastenings 85 Rain-water pipe defective 47 „ choked 12 Guttering defective 26 Waste pipe defective 29 „ choked 4 „ untrapped 9 „ not provided or missing 6 Sink defective or not provided 15 44 Other drainage defects 13 Cistern defective 13 „ dirty 40 „ without proper cover or cover defective 20 Dustbin defective 190 „ not provided 1 „ insufficient 42 „ disused and not abolished 4 Paving of yard or area defective 105 „ washhouse defective 46 Premises damp 55 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 2,968 „ verminous 120 „ contents, bedding, etc., dirty 2 „ not provided with a window opening directly to the external air — Chimney smoky 29 Food cupboards not provided 2 Windows defective including cords and fastenings out of repair 839 Roof defective 283 Common staircases out of repair 47 Staircases without sufficient handrail 3 Animals improperly kept 1 Accumulation of refuse (not offensive) 45 Premises without water, or supply insufficient 141 Any other defects, etc. 58 Notices Issued. Written Intimations 624 Statutory Notices 155 Bye-law 674 Notices under L.C.C. (G.P.) Acts— Verminous rooms 49 Additional taps 141 Abolition of old dustbins — Provision of cooking ranges — Items of Dilapidation fob which Letters were sent to the Owners (Section 17 of the Housing Act, 1930). Wall-plaster broken, bulging, or defective 223 Matchboarding defective 14 Wall-paper loose — Skirting defective 16 Doors defective or missing 78 Locks defective 36 Ceiling plaster defective 110 Ceiling paper loose — Floors broken or badly worn 136 Stoves defeotive (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 221 Stove settings defective 9 Flues defective 10 Hearths defective 19 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 13 Cupboard doors defective or missing and shelves missing 8 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 428 Window-frames loose or defective (including oak sills worn or rotten) 47 Window-glass broken 178 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 69 Steps to front entrance or area defective 15 Railing to area or area steps defective 5 Guard rails to addition roofs defective, broken or rotten 14 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 49 Vault doors missing or defective 22 HOUSING. (Ministry of Health Table.) 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 or in course of "house-to-house" inspections 1,565 Inspections made 13,377 (b) Registered tenement houses inspected 675 „ „5,363 (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 — 45 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 *93 (2) Number of dwelling-houses which were rendered fit— (а) by owners 129 (b) by Local Authority in default of owners — B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,349 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 1,215 (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 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — E. Proceedings under Section 3 of the Housing Act, 1925— (1) Number of dwelling-houses in respect of which notices requiring repairs became operative — (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 became operative — (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 became operative — (4) Number of dwelling-houses demolished in pursuance of Demolition Orders — * Informal notices. FACTORIES AND WORKSHOPS. 1932. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 989 — Workshops (including workshop laundries) 1,397 4 — Workplaces (other than outworkers' premises) 386 — Total 2,772 4 46 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 157 157 — — Want of ventilation 6 6 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 10 10 — — Sanitary accommodation insufficient .. — — — — unsuitable or defective 11 11 — — not separate for sexes 2 2 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) — — — — Other offences — — — — (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) Total 186 186 — — *Including those specified in Sections 2,3,7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. At the end of the year 1931, 1,250 premises were on the Register as compared with 1,212 at the end of the year 1930. During the year 1932, 210 premises were removed from the Register and 62 added, making the total at the end of the year, 1,102. The Department reported the opening of 3 workshops to the Home Office, and received from that Office, notice of 18, 15 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 20 lists in February and 19 lists in August. These lists contained 242 names and addresses of which 219 were forwarded to other districts. From other districts 292 addresses within the Borough were received. No instances were discovered during the year of outwork being carried on in unwholesome premises (Section 108). Supervision.—There were during the year, 2,772 inspections, comprising 989 of factories, 1,397 of workshops and 386 of workplaces. There were 186 nuisances or defects found upon registered premises, all of which were remedied during the year, the majority being remedied on verbal request. The defects found are shown in the above Table. The Home Office forwarded 8 complaints, which comprised:— Overcrowding 0 Sanitary conveniences not separate for sexes 2 Other offences 6 Bakehouses.—During the year four level bakehouses were opened, and 1 level and three underground bakehouses were closed, the total number on the Register at the end of the year being 62 of which 51 were factory bakehouses. The number of level bakehouses was 23 (13 being factories), and of underground 39 (37 being factories). The. total number of persons working in bakehouses was 299, including 14 women and 25 individuals under the age of 18. The bakehouses were inspected on 861 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. Two samples were taken and were found to comply with the regulations applicable. FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1932, two slaughterhouses within the Borough licensed by the London County Council:— 275, Edgware Road; 249, Maida Vale 47 There were 254 inspections made during the year. The number of animals slaughtered, so far as is known, was 3,994, comprising 200 bullocks, and 3,794 sheep, being an increase of 903 sheep, as compared with 1931. The number of bullocks slaughtered was the same as in 1931. The following Table shows the number of organs destroyed and the diseases with which they were affected. Bullocks. Sheep. Heads. Tongues. Lungs. Livers. Mesenteries. Hearts. Spleens. Lungs. Livers. Hearts. Tuberculosis 9 9 11 7 3 — — — — — Pleurisy — — 9 — — — — — — — Abscess — — 12 9 — 1 2 10 15 8 Distomum Hepaticum — — 1 79 — — — — 7 — Parasitic Invasion — — — — — — — 121 66 43 Cyst — — — — — — — — 1 — Injury — I — — — — — — — — 9 10 33 95 3 1 2 131 89 51 Total weight, 1,572 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 1932, the number of carcases was 142. On examination it was found necessary to destroy one head and pieces weighing 10lbs. affected with tuberculosis. Public Health (Meat) Regulations, 1924.—It was not found necessary to take any legal proceedings under these Regulations during the year. Occasional defaults were dealt with by means of a caution. Poultry Slaughtering.—This business is dealt with by special bye-laws. The only poultry slaughterhouse in the Borough is situated at No. 51, Shirland Road. During the year 54 inspections were made and approximately 4,900 head of poultry were slaughtered. Unsound Food.—Summonses were issued against three vendors for exposing for sale various articles of food which were unfit for human consumption. Fines were indicted and costs awarded in all cases. (See Legal Proceedings. page 53.) Food Purveyors.—At the end of the year there were some 870 purveyors of food in the Borough, classified as follows:—Butchers 84, Fishmongers 26, Fried Fish 35, Refreshments 129, Greengrocers 105, Milk 122, General 68, Confectioners 121, Provisions 63, Grocers 117. In addition to the above premises there are 88 licensed Street Traders selling food within the Borough, namely:—Fruit and Vegetables 61, Ice Cream 12, Light Refreshments 12, Fish 1, Poultry 1, Sweets 1. These with the storage premises of 20 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. The number of visits of inspection paid to premises occupied by food purveyors was 2,009. Section 5 of the London County Council (General Powers) Act, 1932, provides that any premises (other than premises used as a club, hotel or restaurant) used or proposed to be used for the preparation or manufacture of sausages, potted, pressed, pickled or preserved meat, fish or other food intended for sale shall be registered by the owner or occupier, or intending occupier, thereof with the sanitary authority. At the close of the year the Register contained the addresses of 48 premises. Ice Cream.—There were 144 shops at which ice-cream was known to be sold, comprising the following kinds of businesses:—Bakers 9, General 16, Milk 12, Confectioners 58, Refreshments 42, Wholesale 3, Newsagents 2, Greengrocer 1, Fancy Goods 1. One hundred and fifty (150) inspections of premises were made. Ice-cream was sold from 25 barrows stored within the Borough and from 35 barrows stored outside the Borough. 48 Section 29 of the London County Council (General Powers) Act, 1928, rendered it necessary for the owner or occupier to register with the sanitary authority any premises 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. This Section was repealed in 1932, the provisions being incorporated in Section 5 of the Act of that year, referred to on page 47. At the end of 1932 there were 112 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 2 tons, 2 cwts., 2 qrs., 25 lbs., comprising the following varieties:—Fruit and Vegetables 1579 lbs., Meat 184 lbs., Offal 1572 lbs., Rabbits and Poultry 1449 lbs., Sweets 1 lb. Dairies and Milksluops.—At the end of the year 1931 there were 118 names on the Register. During the year 1932, 6 names were added and 2 removed, making a total of 122. Twenty-live of the businesses were transferred to new proprietors. There were 413 inspections made. In addition to the above-mentioned registrations there are 21 persons, registered as purveyors of milk, whose premises are situated in other districts, but who come into the Borough to trade. Sterilised milk in bottles was found to be on sale at 95 premises. Milk (Special Designations) Order, 1923. The licences issued by the Council during the year in pursuance of this Order numbered 126, but of these 8 were issued consequent upon changes of ownership of businesses. The mumbei of licences in force at the end of the year was 118, comprising 14 for "Certified" milk, 35 for "Grade A" (Tuberculin Tested) milk, 1 for "Grade A" milk, and 68 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, 4 for pasteurising establishments. The samples taken by the Council's Inspector numbered 47, comprising 17 of "Certified" milk, 6 of "Grade A (Tuberculin Tested)" milk, 1 of "Grade A Pasteurised" milk and 23 of "Pasteurised" milk. Of the 23 samples of "Pasteurised" milk, 9 were taken on delivery at the Paddington Hospital and 2 at Schools. One sample of "Grade A (Tuberculin Tested)" milk was found not to comply with the bacteriological standard appropriate to that kind of milk. The milk had been supplied by a bottling establishment in the Borough, and suitable action was taken in the matter. Milk and Dairies Order, 1926. Proceedings were instituted against two dealers for contraventions of this Order, one defendant being fined £1 for carrying on the trade of dairyman without being registered, and the other £2 with £1 1s. costs for bottlingmilk elsewhere than on the registered premises. Food and Drugs (Adulteration) Act, 1928. Of the 600 samples taken during the year, 18 (3 per cent.) were found to be "not of the nature, or not of the substance, or not of the quality demanded by the purchaser." This compares with 3.9 per cent, in 1931 and 3.8 per cent, in 1930. Fourteen of the samples were taken on Sundays and Bank Holidays. None of these were adulterated. Thirty-eight samples of milk and 3 of cream were taken at Paddington Station on delivery by rail. Six were found to be adulterated. Eight samples of milk were obtained at Paddington Station at the request of other Boroughs. Sampling of Milk Supplies to Public Institutions.—There are 11 institutions and 19 Schools from which samples of milk are taken periodically. Forty-nine samples were taken during 1932, 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 1932, nine samples were taken for chemical analysis. All were reported to be genuine. 49 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. Five samples of pepper were found to contain respectively 107, 144, 225, 235 and 240 parts per million of sulphur dioxide. No formal action against the vendors was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year two samples of full cream unsweetened, three samples of full cream sweetened, and seven samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. One sample of dried milk was taken during 1932, 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, until his death in March, 1932, and then by Mr. Alan Stewart who succeeded to the appointment. The work is performed at the Royal Institute of Public Health, 23, Queen Square, W.C.I, where also bacteriological examinations are made of food suspected of being deleterious, and of samples of milk procured under the provisions of the Milk (Special Designations) Order, 1923. During 1932 the following samples were submitted for special examination, viz.:— Sausages, suspected to have caused food poisoning. Result—Cultures failed to show the presence of any organisms of the food poisoning group. Stout, suspected to contain harmful substances. Result—No injurious organisms or poisonous metals detected. Condensed milk, suspected to have caused enteritis. Result—Small numbers of a gram positive coccus of staphylococcal type and of a gram negative bacillus of coliform type were discovered, neither of which organisms are regarded, under ordinary conditions, as being causative of gastro-enteritis. Coffee with milk, presence of poisonous substances suspected. Result—No metallic poison detected. 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 50 and 51. The results of legal proceedings are summarised on page 54. 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 table is that the milk sold in Paddington is, generally speaking, of average natural strength. Genuine Milk Samples, 1932. Average Monthly Figure fob Percentage. Fat Content and Non-Fattv Solids. January 3.66 8.76 February 3.65 8.83 March 3.58 8.99 April 3.34 8.68 May 3.37 8.73 June 3.40 8.65 July 3.68 8.75 August 3.51 8.81 September 3.77 8.88 October 3.86 8.84 November 4 03 8.87 December 3.77 8.73 Average for Year. Samples taken at Paddington Station 3.36 8.94 „ „ elsewhere 3.72 8.78 50 Samples submitted to Public Analyst—1932. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 1 — — — — Ammoniated Tincture of Quinine — 1 — — — — Aspirin — 1 — — — — Baking Powder — 2 — — — — Blackcurrant Gums — 1 — — — — Boracic Ointment 1 — — — — Bottled Cherries — 1 — — — — Brandy — 1 — — — — Brawn — 1 — — — — Bread 4 — — — — — Breakfast Sausage 1 1 — — — — Brine — 1 — — — — Butter — 17 — — — — Cake, etc. — 5 — — — — Calomel Ointment — 2 — — — — Camphorated Oil — 2 — — — — Cheese — 8 — — — — Chocolate — 2 — — — — Cider — 1 — — — —. Cocoa — 3 — — — — Coffee — 4 — — — — Compound Bismuth Lozenges — 1 — — — — Cooking Oil — 1 — — — — Cornflour — 2 — — — — Cream 3 15 — — — — ' Cream Pastry — 1 — — — — Curry Powder — 1 — — — — Custard Powder — 2 — — — — Dough — 1 — — — — Dried Coffee Extract — 1 — — — — Dried Fruit — 14 — — — — Dripping — 4 — — — — Essence of Coffee and Chicory — 2 — — — — Extract of Milk — 3 — — — — Extract of Malt and Cod Liver Oil — 1 — — — — Extract of Malt — 3 — — — — Figs — 1 — — — — Fish Paste — 8 — — — — Flaked and Shredded Suet — 4 — — — — Flour 1 2 — — — — Fruit Sweets — 1 — — — — Gin 2 7 — 2 — 28.57 Ginger Beer — 1 — — — — Ginger Beer Powder — 1 — — — — Grape Fruit Butter Preserve — 1 — — — — Ground Cinnamon — 1 — '— — — Ground Rice — 1 — — — — Ham and Chicken Pate — 1 — — — — Ham Rissole — 1 — — — — Honey — 6 — — — — Ice Cream — 1 — — — — Iodine Ointment — 1 — — — — Jam — 9 — — — — Lard — 3 — — — — Lead Iodide Ointment — 1 — — — — Lemon Squash — 1 — — — — Lemonade Powder — 3 — — — — Linseed Oil — 1 — — — — Liquid Eggs 2 — — — — — Liver Sausage — 1 — — — — Luncheon Sausage — 1 — — — — Macaroni — 1 — — — — Malt Vinegar — 3 — — — — Margarine — 4 — — — — Meat Paste — 1 — — — — Meat Pie — 1 — — — — Mercury Ointment — 1 — — — — Milk 290 1 9 — 3.10 — Milk, Full Cream, Sweetened Condensed — 5 — — — — Milk, Skimmed Dried 1 — — — — — Milk, Skimmed Sweetened Condensed — 7 — — — — Mincemeat — 5 — — — — Mince Pudding — 1 — — — — Mixed Dried Fruit — 1 — — — — Mustard — 3 — — — — Mustard Sauce — 1 — — — — Olive Oil — 1 — — — — Orange Powder — 1 — — — Orange Squash — 1 — — — Pastry — 1 — — — — Pepper 4 1 4 1 100.00 100.00 Petroleum Jelly — 1 — — — ~~~ 51 Samples submitted to Public Analyst—1932—continued. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Pickles — 4 — — — — Pork Pie — 1 — — — — Port Wine — 1 — — — — Potted Meat — 1 — — — — Prawns — 1 — — — — Preserved Sausages 3 — — — — — Raisin Wine — 1 — — — — Raspberry Powder — 1 — — — — Rice Flakes — 1 — — — — Rock Cakes — 1 — — — — Ruby Wine — 1 — — — — Rum — 2 — — — — Sausages 8 — — — — — Sausage Fritter — 1 — — — — Sausage Roll — 4 — — — — Saveloy — 1 — — — — Scones — 1 — — — — Semolina — 2 — — — — Stout — 2 — — — — Sugar — 1 — — — — Sulphur Ointment — 2 — — — — Tapioca — 1 — — — — Tea — 1 — — — — Tincture of Iodine — 2 — — — — Tinned Crab — 1 — — — — Tinned Fish — 1 — — — — Tinned Fruit — 7 — — — — Tinned Galantine Meat, etc. — 6 — — — — Tinned Lamb Tongues . — 1 — — — — Tinned Soup — 1 — — — — Tinned Vegetables — 8 — — — — Veal, Ham and Egg Pie — 1 — — — — Vinegar — 5 — — — — Vinegar of Squills — 1 — — — — Vitacream — 1 — — — — Welsh Rarebit — 1 — — — — Whisky 1 2 1 1 100.00 50.00 White Precipitate Ointment — 1 — — — Wiltshire Patty — 1 — — — — Yellow Mercury Oxide Ointment — 1 — — — — Zinc Ointment — 1 — — — — 320 280 14 4 4.37 1.43 600 18 3.00 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; Dressed Poultry; Beef; Eggs; Bottled Fruits; Glasshouse grown Tomatoes and Cucumbers; Bottled Vegetables; Honey; Broccoli; Malt Flour and Malt Extract; Canned Fruits; Plums; Canned Vegetables; Potatoes; Cherries; Strawberries; Cider; 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. Seven samples of canned fruit were procured during the year, comprising raspberries 2, golden plums 2, strawberries 1, Morello cherries 1, gooseberries 1. All were found to comply with the Regulations applicable. 52 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— Butter; Eggs in shell and Dried Eggs; Honey; Oat Products; Fresh Apples; Malt Products; Raw Tomatoes; Salmon and Sea Trout. Currants, Sultanas and Raisins; The following purchases were made with a view to ascertaining whether the requirements of the Orders had been complied with, viz.:—Apples 3, Tomatoes 3, Sultanas 5, Butter 5, Currants 5. Proceedings were taken against three persons in respect of offences against the Orders relating to imported tomatoes, apples, currants, raisins and sultanas. Fines were imposed in each case. (See page 54.) 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 (Adul teration) 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. Complaints concerning 24 premises 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. No Notices were served under the Act in respect of rat-infested premises. Rat Week.—This was held from 7th to 12th November inclusive. The usual circular letter was Bent out to principal -wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Twenty-eight (28) 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 91 premises, the verminous rooms numbering 135. Legal proceedings were taken in one instance. (See page 53.) The owners of 45 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 63 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. 63 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 formal action was taken under this Section during the year, but several cases iij which the removal of persons to hospital was considered necessary, were dealt with by means of persuasion. HEALTH EDUCATION, A subscription of £3 3s. 0d. 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, 1932. The results of the Summonses taken out during the year are summarised in the following tables:— Preamises. Offience Fine. Costs. Public Health (London) Act, 1891. £ s. d. Suction 4. 13, Jonson Mews Failing to reinstate water supply Summons withdrawn 1 1 0 Bye-laws. 5, Chichester Street Carrying out sanitary work without giving the Requisite notice and submitting plans Summons withdrawn 2 2 0 81, Chippenham Road Failing to provide a proper cover to the drinking water cistern £2 5 5 0 „ „ Failing to place the cistern in a convenient position to enable the same to be cleansed £2 — 21, Clifton Road Failing to provide permanent openings to the external air for the ventilation of kitchen used for fish frying £2 — 59, Lancaster Mews Failing to give notice of alterations to watercloset and executing work in manner contrary to the bye-laws Summons dismissed 0 15 0 8, Woodfield Place Constructing waste pipe in a manner contrary to the bye-law Bye-law complied with 1 1 0 Public Health (London) Act, 1891, Section 47. Offence. Fine. Costs.[/##] £ s. d. Exposing for sale two pigs' heads which were diseased and unfit for food of man £2 2 2 0 Exposing for sale four pieces of lamb and being in possession of five chickens which were unsound £10 3 3 0 Exposing for sale six rabbits which were unsound and unfit for food of man £3 3 3 0 London County Council (General Powers) Act, 1922, Section 10. Premises. Offence. Fine. Costs. £ s. d. 16, Walterton Road Top floor bedroom verminous Work done Summons withdrawn 1 1 0 54 Food and Drugs (Adulteration) Act, 1928. Offence. Fine. Costs. £ s. d. Milk—12.58 per cent. of added water £5 5 5 0 9.88 ,, ,, ,, ,, 21.17 „ „ ,, Summonses withdrawn — ,, 14.7 ,, ,, ,, ,, 6.47 ,, ,, ,, Summons withdrawn 4 4 0 ,, 11.33 ,, deficient in fat £7 3 3 0 ,, 5.33 ,, ,, Grade "A" (Tuberculin Tested) Milk—2.0 per cent. of added water and £2 2 2 0 Summons withdrawn 15 15 0 5 per cent, deficient in fat Milk—28.0 per cent. deficient in fat Summons withdrawn 3 3 0 Milk and Dairies Order, 1926. Offence. Fine. Costs. £ s. d. Carrying on trade of dairyman without being registered in pursuance of Article 6 (3) £1 - Bottling milk elsewhere than on registered premises £2 1 1 0 Merchandise Marks Act, 1926. Offence. Fine. Costs. Exposing for sale Canary tomatoes without marking their country of origin Selling currants, raisins and sultanas incorrectly marked as "Empire" produce Exposing for sale imported tomatoes and apples without the appropriate show tickets © © © £ s. d. 1 1 0 OFFICE (CLERICAL) WORK. 1932. Letters received 4,803 ,, despatched 6,454 Entries in Postage Book 11,538 Certificates dealt with relating to Notifiable Diseases 3,651 Notices sent re above 7,364 Entries in Birth Register 1,788 Complaints received Plans dealt with 256 New openings in Journals Disinfection Orders 965 Notices to abate nuisances, etc 624 55 Report of the Work of the District Inspectors, 1932. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals.' Drainage, etc. 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. 1 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, etc. Soil Pipes, New Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New Provided. Cisterns, Cleansed, Repaired, etc. New Provided. Repaired, etc. Drains, Cleared, Flushed, etc. Houses or Rooms Cleansed, Whitewashed, etc. Cases of Overcrowding Abated. Cellar Dwellings Closed. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, etc. Accumulations Removed. Improperly kept, Removed. 1927 .. 1,043 — 2,443 — 11,573 20 62 23 10 838 18 357 76 30 29 1 1 1 24 140 3 74 278 1 7 137 6 29 1 1928 .. 1,086 — 2,453 — 13,254 32 109 15 25 1269 3 481 119 66 27 — 4 — 31 148 8 85 349 2 — 27 199 6 30 — 1929 .. 1,196 6 2,390 — 10,055 27 70 15 6 1485 1 546 116 49 16 3 46 2 13 151 2 91 288 — — 12 115 2 28 1 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 .. 970 — 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 1932 .. 1,191 91 1,474 1 13,377 1 66 60 11 1470 6 308 38 22 42 6 24 4 19 299 7 69 636 3 — 11 231 6 41 —