AC4349 M PAD 33 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1933. BY GEOFFREY EUGENE OATES, M.D., BS. (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 1933. BY GEOFFREY EUGENE GATES, 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 19 Acute Influenzal Pneumonia 20 Acute Polio-encephalitis 19 Acute Polio-myelitis 19 Acute Primary Pneumonia 20 Acute Rheumatism 20 Administrative Work 40 Agricultural Produce (Grading and Marking) Act, 1928 55 Annual Cleansing 44 Ante-natal Consultation Centres 4, 30, 31, 32 Anthrax 20 Artificial Cream Act, 1929 55 Artificial Sunlight Treatment 31 Baby Hospital 34 Bacteriological Work 40 Bakehouses 49 Births 6 ,, Illegitimate 7 ,, in Institutions 8 ,, Notification 8 ,, Stillbirths 7 Birth-rates 7 Canals, Canal Boats 43 Cancer 23 Cerebro-spinal Fever 20 Chicken-pox 17 Cholera 22 Clearance Areas 44 Common Lodging Houses 44 Compulsory Repairs 44 Compulsory removal of certain persons 56 Condensed Milk Regulations 52 Continued Fever 17 Convalescent Homes 38 ' 'Conversions,'' Housing 44 Dairies and Milkshops 51 Day Nurseries 4, 34 Deaths, Causes of 8, 9 ,, in Institutions 10 Death-rates 10 Diarrhoea 23 Diphtheria 15 ,, Carrier Clinic 16 ,, Immunisation 16 Disinfection 40 District Inspectors' Work 59 Drainage, Combined 41 ,, House 41 ,, Reconstruction Plans 41 Dried Milk Regulations 52 Dysentery 22 Erysipelas 19 Factories and Workshops 48 Food Adulteration 52 ,, Chemical and Bacteriological Examination 52 ,, Destroyed 51 ,, Poisoning 22 ,, Purveyors 50 ,, Samples Analysed 53 ,, Supervision 50 Fouling of Footways by Dogs 42 German Measles 18 Glanders 22 Health Visiting 30 Houses Unfit for Habitation 44 Housing 44-48 ,, Brindley Street Flats 45 ,, Paddington Houses Association 45 ,, on L.C.C. Estates45 Hydrophobia 22 Ice Cream 51 Improvement Areas 44 Infant Consultation Centres 4, 30-32 Infant Life Protection 38 Infantile Mortality 11 page Infantile Mortality in Special Areas 12 Infectious Diseases, Notification of 14 ,, ,, Prevention of 40 Infective Enteritis 23 Inquests 13 Invalid Children's Aid Association 38 Legal Proceedings 57 Malaria 20 Manure, Removal of 42 Marriages 6 Massage Treatment 31 Maternal Consultations 34 ,, Mortality Investigations 38 Maternity and Child Welfare 29 Maternity Nursing 33 Maternity Wards 4,33 Measles 17 Meat Regulations 50 Merchandise Marks Act, 1926 55 Midwifery Service 34 Milk Grants 35 Milk and Dairies Order 52 Milk (Special Designations) Order 51 Mortuary 42 Nursing of cases of Infectious Illness 40 Nutritional and Physio-therapeutic Clinic 4,32 Office Work 58 Ophthalmia Neonatorum 18 Outworkers (Homework) 49 Overcrowding 44 Pharmacy and Poisons Act 56 Pigeons, Nuisance from 56 Plague 22 Population 6 Poultry Slaughtering 50 Pneumonia 20 Preservatives, etc., in Food Regulations 52 Puerperal Fever 19 ,, Pyrexia 19 Rag and Bone Dealers 42 Rag Flock Acts 49 Rats and Mice Destruction 56 Relapsing Fever 22 Rent and Mortgage Interest (Restrictions) Acts 45 Rent Books 45 Scarlet Fever 15 Schools and Infectious Disease 40 Sewer Connections 41 Slaughter of Animals Act 50 Slaughterhouses 50 Smallpox 16 Smoke Control 42 Staff 4, 40 Tenement Houses 44 Trade Nuisances 42 Tuberculosis, Artificial Pneumothorax Treatment 25 ,, Deaths from 25 ,, Dental Treatment 25 ,, Dispensary Treatment 4, 26 ., Home Visiting 24 ,, Notification 24 ,, Regulations, 1930 and 1925 24,25 ,, Shelters 25 ,, Supply of Beds and Bedding .. 25 Tuberculosis Care Committee .. .. .. 28 Typhoid Fever 17 Typhus Fever 22 Underground Rooms 44 Vaccination 17 Venereal Diseases Clinic 4 Verminous Conditions 56 Vital Statistics 5. 6, 13 Water Supply 41 Whooping Cough 22 Workshop Supervision 49 APPENDIX 60 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 1933 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good, with the exception of the infant population, among which, judging by the experience in the other London Boroughs, the mortality was unduly high. The year has been one of great activity in the promotion of measures affecting the health of the community, particularly as regards maternity and infant welfare. Foremost amongst these must be mentioned the opening in April of the new maternity wards provided for the Council at St. Mary's Hospital, in which, during the remaining nine months of the year, 132 women were confined under ideal conditions. A commencement was made with what promises to be a large scheme, that of immunising the child population of the Borough against diphtheria. It was decided to concentrate this work for the time being at a special clinic on the premises of the Paddington School for Mothers. A number of important duties became transferred from the London County Council to the Borough Council. Amongst these were Infant Life Protection and the licensing of common lodging houses and slaughterhouses. An era of activity in housing matters was ushered in by the closing of a number of basement dwellings which were considered unfit for human habitation. I have again to express my appreciation of the loyal help of the staff of the Public Health Department of the Council and to thank the members of the Public Health, Maternity and Child Welfare, and Special Housing Committees for the support and kind consideration which they have extended to me during the past year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W.2. 19th June, 1934. 4 PUBLIC HEALTH OFFICERS (on December 31st, 1933). (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. J. Thoresby-Jenes, M.D., L.R.C.P., M.R.C.S. H. Hodge, M.B., B.Ch. Joyce R. Simpson, M.A., B.Ch., M.B., D.P.H. J. McKail, M.A., M.B., B.Ch. A. S. Hall, M.R.C.6., M.R.C.P. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.I.C. Public Vaccinators, P.T. 6. Denovan Adam, M.R.C.S., L.R.C.P. (Eor Borough, excluding Paddington Hospital). W. G. Bendle, F.R.C.S.Ed., M.B., B.S. (Eor Paddington Hospital). Vaccination Officer, P.T. T. E. Rainger. District Sanitary Inspectors, W.T. Workshops Inspector and Canal Boats Inspector, W.T. V. L. Ronchctti (2), (3), (4), (5). C. S. Wansbrough (1), (4), (5). (Senior Sanitary E. B. Wilde (2), (3), (4), (5), (10), Inspector). E. Marshall (2), (3), (4), (5). Tenement Houses Inspectors, W.T. H. D. Bailey (2), (3), (4). C. G. Heron (2), (3). A. J. Fisher (2). One Temporary Inspector. One Temporary Inspector. Women Sanitary Inspectors, W.T. Meat and Food Inspector, W.T. D. M. Newhall (1), (2), (7), <8), (0). F. J. Pallet (2), (3). E. Z. Amor, (2), (6), (7), (8), (9). Health Visitors, W.T. E. A. S. Davies (7), (8). (Superintendent). H. Waite (7), (8), (9). E. E. Bogle (7), (9). 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). P. E. Blake, (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. (7) Central Mid wives Board Certificate. (8) Nursing Training Certificates. (9) Health Visitor's Certificate. (10) Smoke Inspector's Certificate, Royal Sanitary Institute. CLINICS, TREATMENT CENTRES, ETC. 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, Queensborough 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. Maternity Wards St. Mary's Hospital, Cambridge Place St. Mary's Hospital. diphtheria immunisation. Clinic †232, Harrow Road Paddington School for Mothers. † Three sessions weekly. 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 SUMMARY OF VITAL STATISTICS. 1933. 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 1933 141,900 Density of population per acre 104 Number of inhabited houses (end of 1933) according to Rate Books 22,866 Marriages 1,722 Total. M. F. Live Legitimate 1,659 829 830) 13.41* Births illegitimate 244 114 130) Birth &-rate Stillbirths 95 54 41 Stillbirth-rate 47† Deaths 1,896 904 992 Death-rate 13.36* Percentage of total deaths occurring in public institutions 54.0 Number of women dying in, or in consequence of childbirth From sepsis 4 Maternal mortality 5 .25† Deaths of Infants under 1 year of age 163 Infantile Mortality 85† Legitimate, 74†; Illegitimate, 164†. Deaths from Measles (all ages) 7 ,, Whooping Cough (all ages) .. 5 ,, Diarrhoea (under 2 years of age) .. 33 ,, Pulmonar .. 90 Death-rate from Pulmonary Tuberculosis .. 0.63* Deaths from all forms of Tuberculosis .. 104 Tuberculosis death-rate sm .. 0.73* Rateable Value £1,809,133 Product of a Penny Rate £7,002 * per 1,000 persons. † per 1,000 births 6 VITAL STATISTICS. The Metropolitan Borough of Paddington as constituted under the London Government Act, 1899, covers an area of 1,35.1 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. tality. 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 13403 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 88 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 1933 141,900 1,855 460 508 1,903 13.41 1,864 13.13 567 599 1,896 13.36 171 92 163 85 * Registrar-General's estimates of resident population. POPULATION. Estimated Population.—The resident population of the Borough at the middle of 1933 was estimated by the Registrar-General to be 141,900 persons, 1,700 fewer than the number for the previous year. The following table shows the population distributed among the Wards in the proportions recorded at the Census of 1931. All rates for 1933 quoted in this report are based on these figures. The Borough 141,900 Wards— Queen's 13,337 Harrow Road 24,942 maida vale 22,790 Town 7,057 Westbourne 24,725 Church 16,967 Lancaster Gaate,West 9,690 Lancaster Gate, East 9,714 Hyde Park 12,678 North Paddington 68,126 South Paddington 73,774 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,722 marriages were solemnized in the Borough during 1933, being a rate of 24.3 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1933 was 1,855. From this total it is necessary to deduct 460 births which occurred to residents of other localities and to add 508 births which occurred to Paddington residents outside the Borough. The corrected total of 1,903 births thus obtained is equal to a rate of 13.41 per 1,000 of the population. Of the 1,903 births, 943 were those of males and 960 those of females, and of these 114 males and 130 females were illegitimate. 7 The Registrar-General's final figure for the nett number of births is given as 1,906, 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:— 1933. Birth-rates. No. of Births. Birthrates. 1932 1931 1930 1929 1928 England and Wales 580,850 14.4 15.3 15.8 16.3 16.3 16.7 London 56,743 13.2 14.3 15.0 15.7 15.7 15.9 Paddington 1,903 13.41 13.76 14.79 15.12 14.90 14.99 Wards—- Queen's Park 146 10.94 10.67 9.46 10.32 10.26 10.97 Harrow Road 435 17.44 14.89 15.32 17.58 14.94 15.05 Maida Vale 277 12.15 12.87 14.79 13.57 15.22 14.65 Town 122 17.28 18.20 18.19 13.40 16.52 16.78 Westbourne 389 15.73 16.70 17.58 19.78 17.22 19.25 Church 312 18.39 21.55 23.81 22.12 23.50 22.83 Lancaster Gate, West 55 5.67 6.32 5.93 5.40 8.05 5.00 Lancaster Gate, East 48 4.94 4.17 8.31 7.18 8.79 7.42 Hyde Park 119 9.38 10.83 11.17 13.30 11.81 12.75 The following table shows the course of the birth-rate in the Borough in the past:— BIRTH-RATES. Paddihoton. 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 1933 13-41 Illegitimate Births.—These were 244 in number, or 12.82 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. Rat*. Queen's Park 4.79 Harrow Road 7.88 Maida Vale 13.36 Town 11.47 Westbourns 14.14 Church 13.14 Lancaster Gate, West 21.82 Lancaster Gate, East 25.00 Hyde Park 27.73 Stillbirths.—During 1933, 93 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 20 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 95, a figure equivalent to 4.7 per cent, of the total births recorded. Of the 95 stillbirths, males numbered 54 and females 41, 10 of the males and 6 of the females being illegitimate. 8 Births in Institutions. Local— Legitimate. Illegitimate. Total. Residents. Non-residents. Residents. Non-residents. Residents . Non-residents. Paddington Hospital 237 44 98 26 335 70 St. Mary's Hospital 176 178 8 6 184 183 Lock Hospital 2 15 3 29 5 44 Outlying (Paddington residents)— Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 208 16 224 Other Lying-in Hospitals 28 8 36 Other Hospitals 73 15 88 Municipal Hospitals and Public Assistance Committees'Institutions 49 30 79 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, 1,877 live births were notified to the Medical Officer of Health. There were also 91 stillbirths notified. Of the 1,968 living and stillbirths notified, 56.4 per cent. were notified by medical practitioners, 32.8 per cent. by midwives, 0.3 per cent. by parents, and 10.5 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 99.2 per cent. of the live births and 95.7 per cent. of the stillbirths occurring within the Borough were duly notified. It will be seen that only a small proportion of births are not notified and so escape being brought to the notice of the Medical Officer of Health until they come to be registered within the statutory period of six weeks. In nearly every case of default a cautionary letter was sent to the person responsible, and in no instance did the Maternity and Child Welfare Committee consider it necessary to institute legal proceedings. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,864. Of these, 567 were of persons whose residence was not in Paddington, 497 dying in Paddington Institutions and 68 in other places in the Borough. There were also reported to the Registrar-General 599 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,896, making an annual deathrate of 13.36. 1933. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhoea & Enteritis January 28th 1 _ 1 8 18 34 16 25 5 February 25th 1 _ — 1 10 21 38 15 19 3 March 25th — _ — 1 8 17 7 5 12 2 April 22nd — _ — 3 6 19 4 3 6 1 May 20th — _ 1 1 7 20 — 2 6 1 June 17th — 1 i 1 7 14 1 1 8 1 July 15th — _ 1 2 8 24 — 3 6 4 August 12th 4 — 2 1 4 10 — — 2 2 September 9th — _ — — 4 19 — 1 6 2 October 7th — _ _ 1 7 12 — — 8 3 November 4th _ _ _ 2 5 11 _ 2 12 6 December 2nd _ 4 10 25 2 6 11 4 December 31st 1 — _ 1 6 18 1 6 15 3 Totals 7 1 5 19 90 228 87 60 136 37 The foregoing table gives the numbers of deaths from the various causes as classified locally. Some of the totals differ slightly from those supplied by the Registrar-General in the table appearing on the next page. 9 Deaths of Residents of the Borough, 1933. Sex-Age Distribution for Whole Borough. All Ages. Deaths at Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— All Causes M. F. P. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 904 992 1896 94 69 15 10 8 11 22 25 30 26 41 46 40 59 115 94 170 137 199 211 170 304 Typhoid and Paratyphoid Fevers — — — — — — — — — — — — — — — — — — — — — — — — — Measles 5 2 7 2 — 2 — 1 1 — 1 — — — — — — — — — — — Scarlet Fever 1 — 1 — — — — — — 1 — — — — — — — — — — — — — — — Whooping Cough 3 2 5 1 2 1 — 1 — — — — — — — — — — — — — — — — — Diphtheria 9 10 19 — — — — 2 — 7 10 — — — — — — — — — — — — — — Influenza 30 58 88 1 — — — 1 — — 1 1 2 2 4 2 4 5 5 7 13 4 10 7 19 Encephalitis Lethargica 2 — 2 — — — — — — — — — — — — 1 — — — 1 — — — — — Cerebro-spinal Fever 2 2 4 1 2 1 — — — — — — — — — — — — — — — — — — — Tuberculosis of Respiratory System 57 33 90 — 1 — 1 — 8 7 8 14 11 6 17 2 9 1 3 2 — — Other Tuberculous Diseases 7 7 14 1 — 1 2 2 — 1 1 1 1 2 — — 1 — 1 — — Syphilis 5 5 10 1 3 — 1 1 1 — 2 — 1 — — — General Paralysis of the Insane, Tabes Dorsalis 9 5 14 — — — — — — — — — — — — — 1 3 1 2 2 4 — — 1 Cancer, Malignant Disease 107 124 231 — — — — — — — — 3 1 — 3 1 8 22 27 28 33 39 29 14 23 Diabetes 4 11 15 — — — — — — — 1 — — — — — 3 — — 1 2 2 4 1 1 Cerebral Haemorrhage, etc. 25 31 56 — — — — — — — — — — 1 — — 1 5 5 3 4 8 12 8 9 Heart Disease 233 269 502 — — — — 1 — 3 1 — 1 3 4 3 3 18 17 56 29 75 81 74 128 Aneurysm 7 4 11 — — — — — — — — — — — — — 1 1 1 3 1 1 1 2 — Other Circulatory Diseases 27 52 79 — — — — — — — — 1 — 1 — — 1 4 5 4 4 9 14 8 28 Bronchitis 25 35 60 5 — — — — 1 1 — — — 1 2 1 1 — 4 5 7 7 6 19 Pneumonia (all forms) 66 72 138 15 12 6 4 — 1 2 2 4 1 3 4 10 8 11 7 6 12 11 19 Other Respiratory Diseases 9 9 18 — — — 2 — — — — 1 1 — 1 — — 3 1 1 — 2 2 2 2 Peptic Ulcer 14 8 22 — — — — — — — — 1 — 2 — — — 5 2 2 3 2 2 2 1 Diarrhoea, etc. 21 15 36 20 10 1 2 — — — — — — — — — — — 2 — — — — — 1 Appendicitis 5 5 10 — — — — — — 1 — — — — — 1 2 2 1 1 1 — — — 1 Cirrhosis of Liver 2 5 7 — — — — — — — — — — — — — — 1 1 1 2 — 1 — 1 Other Diseases of Liver, etc. 1 4 5 — — — — — — — — — 1 — — — — — 1 — — — 1 1 1 Other Digestive Diseases 7 21 28 1 1 — — — 1 — — — 1 1 1 — 3 1 6 2 2 2 5 — 1 Acute and Chronic Nephritis 30 15 45 — — — — 1 4 — 1 — 2 2 2 2 6 2 9 6 6 2 Puerperal Sepsis — 4 4 — — — — — — — — — 2 — 2 — — — — — — — — — — Other Puerperal Causes — 6 6 — — — — — — — — — — — — — 2 — — — — — — — — Congenital debility, Premature Birth, Malformations, etc. 31 36 67 31 35 — 1 — — — — — — — — — — — — — — — — — — Senility 10 26 36 — — — — — — — — — — — — — — — — — — — 5 10 21 Suicide 22 17 39 — 2 — 5 4 5 2 4 1 4 9 1 1 1 — Other Violence 47 40 87 6 1 1 1 1 4 3 3 5 1 7 4 4 1 3 — 8 6 7 5 2 14 Other defined diseases 81 59 140 9 2 2 1 1 4 4 3 5 5 3 4 6 7 6 14 10 17 10 15 12 Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — 10 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:— 1933. Death-rates. No. of Deaths. Deathrates. 1932 1931 1930 1929 1928 England and Wales 496,550 12.3 12.0 12.3 11.4 13.4 11.7 London 53,536 12.5 12.3 12.4 11.4 13.8 11.6 Paddington 1,896 13.36 13.26 13.05 12.64 15.48 13.03 Wards— Queen's Park 178 13.34 13.93 10.64 11.54 11.67 11.22 Harrow Road 352 14.11 13.82 11.99 11.85 14.94 11.88 Maida Vale 285 12.50 13.22 13.12 13.12 14.08 14.56 Town 113 16.01 14.28 15.57 12.59 16.65 11.98 Westbourne 345 13.99 13.90 15.31 13.99 17.06 15.45 Church 245 14.44 16.65 15.69 14.43 20.61 15.27 Lancaster Gate, West 131 13.52 10.40 11.54 10.59 13.56 10.21 Lancaster Gate, East 104 10.70 9.86 9.57 12.00 13.61 10.71 Hyde Park 143 11.28 9.90 12.10 11.72 15.72 11.61 Deaths in Institutions, 1933. Local . Total. No. resident. Paddington Hospital 524 83 St. Mary's Hospital 285 218 Paddington Green Children's Hospital 37 28 Hospital for Women and Children (Lock Hospital) 7 6 St. Luke's Hospital 172 162 1,025 497 Deduct Non-residents 497 528 Outlying. Paddington Residents. Isolation Hospitals of London County Council 28 Municipal General Hospitals and Public Assistance tees' Institutions 264 Mental Hospitals 68 Voluntary Hospitals (General) 69 Hospitals (Special, including Sanatoria) 68 497 Total Deaths of Paddington residents in institutions 1,025 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 1933 13.36 11 INFANTILE MORTALITY. During the year 1933 there were 1,903 births, and 163 deaths of children under the age of twelve months in the Borough. These figures give an infantile mortality rate (deaths of infants under twelve months to each 1,000 births) of 85. The following table gives the births and the infantile deaths and death-rates for the year 193.3 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1928 to 1932 are given for comparison. 1933 Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1932 1931 1930 1929 1928 England and Wales 580,850 36,760 64 64 66 60 74 65 London 56,743 3,377 60 66 65 59 70 67 Paddington 1,903 163 85 107 87 78 101 85 Ward«— Queen's Park 146 14 96 125 55 43 44 28 Harrow Road 435 21 48 80 78 39 71 79 Maida Vale 277 26 94 84 81 97 66 82 Town 122 15 123 161 106 50 147 95 Westbourne 389 34 87 107 80 86 126 109 Church 312 35 112 138 116 122 164 99 Lancaster Gate, West 55 7 127 113 109 98 39 83 Lancaster Gate, East 48 3 62 97 60 103 42 82 Hyde Park 119 8 67 79 90 62 98 57 Infantile Mortality Rates, 1896-1933. 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 1933 64 60 85 12 Infantile Mortality in Paddington—1933. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Rate per 1,000 Births. All Causes 50 2 8 4 64 25 39 19 16 163 85-65 Common Infectious Diseases (6-10, 44) — — — — — 1 2 2 1 6 3.15 Tuberculous Diseases (23-32) — — — — — — 1 1 — 2 1.05 Diarrhœa and Enteritis (119) — — — — — 7 12 6 6 31 16.29 Developmental and Wasting Diseases (157, 158, 159, 161a) 37 2 6 1 46 6 4 — — 56 29.43 Miscellaneous Diseases (Remainder) 13 — 2 3 18 11 20 10 9 68 35.73 Measles (7) — — — 1 1 2 1.05 Whooping cough (9) — — — — — 1 2 — — 3 1.57 Diphtheria (10) — — — — — — — — — — — Influenza (11) — — — — — — 1 — — 1 0.53 Tuberculosis of nervous system (24) — — — — — — 1 — — 1 0.53 Tuberculosis of intestines and peritoneum (25) — — — — — — — — — — — Other tuberculous diseases (23, 2632) — — — — — — — 1 — 1 0.53 Syphilis (34) 1 — — — 1 1 2 — — 4 2.10 Meningitis (79) — — — — — — — — 1 1 0.53 Convulsions (86) — — — — — — — 1 — 1 0.53 Bronchitis (106) — — — — — 2 3 — — 5 2.62 Pneumonia (107-109) — — — — — 6 9 6 3 24 12.61 Other respiratory diseases (105, 110114) — — — — — — — — — — — Inflammation of the stomach (118) — — — 1 1 1 — — — 2 1.05 Diarrhoea and Enteritis (119) — — — — — 7 12 6 6 31 16.29 Hernia, intestinal obstruction (122) — — — — — — — — — — — Congenital malformations (157) 1 — 1 1 3 1 2 — — 6 3.15 Congenital debility and sclerema (158) 1 — — — 1 3 2 — — 6 3.15 Icterus (1616) — — — 1 1 — — — — 1 0.53 Premature birth (159) 32 2 5 — 39 2 — — — 41 21.55 Injury at birth (160) 6 — — — 6 — — — — 6 3.15 Disease of umbilicus (161c:l) — — — — — — — — — — — Atelectasis (161a) 3 — — — 3 — — — — 3 1.57 Sufiooation—in bed or not stated how (182 pt.) 1 — 1 — 2 — 1 — — 3 1.57 Other causes 5 — 1 1 7 1 4 4 6 21 11.04 Nett Births in the Year Legitimate 1,659. Illegitimate 244. Nett Deaths in the Year Legitimate Infants 123. Illegitimate Infants 40. Note.—The numbers given in brackets after certain causes of death indicate the numbers of the corresponding headings in the Detailed International List of Causes of Death, 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. 1933 Infantile Mortality Rates. Births. Deaths. 1933 1932 1931 1930 1929 ###] Church Ward— North Wharf 37 5 135 105 53 77 143 148 Clarendon Street 132 16 121 142 116 153 170 105 Rest of Ward 143 14 98 140 129 106 165 75 Westbourne Ward— Alfred Road 86 6 69 123 116 84 152 83 Rest of Ward 303 28 92 104 69 87 117 117 Maida Vale Ward— Amberley Road 42 7 166 190 48 206 87 104 Rest of Ward 235 19 81 67 87 83 62 79 Totals for 4 Areas 297 34 114 140 102 129 151 105 Rest of Borough 1606 129 80 100 85 69 90 81 13 Infantile Mortality and Migratory Population. During recent years it has become obvious that in certain parts of the Borough a change is taking place in the composition of the population. The increasing number of furnished rooms and one and two-roomed tenements now offered for occupation in the larger houses formerly inhabited by single families, is attracting a class of resident whose stay in the Borough is, in many cases, only of short duration. Coincident with the increase in this transitory portion of the population has occurred a marked increase in the rate of infantile mortality. With the object of ascertaining, if possible, whether any relationship existed between these two facts, a special investigation was undertaken in the early part of the year. The results were summarised in a report to the Maternity and Child Welfare Committee, which is reproduced as an appendix to this report. Further information regarding the migratory population of the Borough, obtained from another source, will be found on page 38 of this report. VITAL STATISTICS. Metropolitan Boroughs. 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:— 1933. 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 141,900 13.41 13.36 85 Kensington 181,100 12.0 12.9 72 Hammersmith 131,400 13.9 12.9 65 Fulham 148,200 13.07 13.00 65 Chelsea 58,850 10.6 13.6 78 City of Westminster 126,300 8.7 12.4 68 North Districts. St. Marylebone 94,080 9.71 12.2 56 Hampstead 90,380 9.6 11.0 38 St. Panoras 190,900 13.6 13.7 68 Islington 319,100 14.35 12.40 63 Stoke Newington 61,120 12.6 12.3 46 Hackney 214,300 14.0 11.5 50.6 Central Districts. Holborn 36,050 9.49 13.48 70 Finsbury 66,640 15.1 12.8 50 City of London 9,830 7.7 10.9 65 East Districts. Shoreditch 93,550 16.0 13.0 74 Bethnal Green 104,200 14.3 12.5 66 Stepney 219,100 15.1 12.9 65.3 Poplar 149,300 15.4 12.4 54 South Districts. Southwark 164,700 14.2 13.9 63 Bermondsey 107,300 14.0 12.5 61 Lambeth 289,000 13.6 13.1 63 Battersea 154,000 14.7 12.49 49.49 Wandsworth 350,200 10.93 11.49 50 Camberwell 243,700 13.32 12.33 49 Deptford 102,800 14.8 12.1 54 Greenwich 97,830 13.7 11.9 66 Lewisham 221,100 12.2 10.2 39 Woolwich 146,200 12.6 11.18 62 INQUESTS. During 1933, 149 inquests were held on residents of the Borough, and 126 deaths were registered after the issue of certificates by the Coroner under powers conferred by the Coroners (Amendment) Act, 1926. 14 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 or Suspected Food Poisoning. Glanders. Hydrophobia. Infective Enteritis or Summer Diarrhoea. Malaria. 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 1923 to 1933 Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis.) 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 Acute Encephalitis Lethargica 3 12 7 4 4 1 6 1 — — — ,, Influenzal Pneumonia 33 87 88 76 107 59 135 40 97 66 102 ,, Primary Pneumonia 302 369 265 184 183 202 247 168 243 184 157 ,, Polio-encephalitis 2 4 3 3 1 1 1 — 1 1 — ,, Polio-myelitis 3 4 3 1 1 2 2 3 ,, Rheumatism — — — (a)34 76 52 43 37 21 37 Anthrax — — 1 1 — — — 1 — — Cerebro-spinal Fever 1 1 5 5 3 4 6 3 5 9 6 Chicken-pox 465 395 459 599 461 567 382 515 555 291 364 Continued Fever — — 2 10 3 2 4 — 1 Diphtheria 219 278 336 462 367 302 311 366 254 194 277 Dysentery 2 1 — — — — — — 2 5 1 Erysipelas 54 69 64 76 90 90 69 74 67 60 66 Food Poisoning — — — — — — — — — (a)11 17 German Measles 48 458 375 124 78 109 1163 86 58 77 (b)11 Infective Enteritis or Summer Diarrhoea — — — — (a) 6 20 63 30 40 103 67 Malaria 2 9 1 1 2 3 — 1 — 1 1 Measles 324 2757 879 1738 154 2862 210 1790 541 1414 (6)103 Membranous Croup 1 2 1 1 2 4 6 7 6 6 — Ophthalmia Neonatorum 22 18 23 16 15 24 9 15 18 22 21 Puerperal Fever 5 9 15 14 7 5 4 5 8 7 12 ,, Pyrexia — — — (a)17 34 32 42 37 32 31 53 Scarlet Fever 323 290 264 199 320 519 323 356 379 286 396 Smallpox 1 — — — — 5 3 3 — 2 1 Tuberculosis—Total 338 379 400 356 381 321 335 284 311 289 270 Pulmonary 222 242 231 218 212 196 242 196 218 213 203 Other Forms 116 137 169 138 169 125 93 88 93 76 67 Typhoid or Enterio Fever 13 15 18 12 16 25 19 10 9 4 6 (а) First Year of Notification. (b) Not notifiable after 19th March, 1933. The following table furnishes an analysis of some of the notifiable diseases according to age, sex and ward of the Borough:— 1933. NOTIFICATIONS. A.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne. Lancaster Gate. Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 10 19 31 23 13 24 8 5 27 31 30 32 1 — 4 4 9 6 Typhoid and Continued Fever 2 — 1 — — 1 1 — — — — 1 — 1 — — — — Erysipelas 3 2 5 12 4 5 3 1 3 6 4 9 — 6 — 2 — 1 Ophthalmia Neonatorum — — — 2 — 4 1 — 3 I 1 2 1 I — — 1 4 Pneumonia—A. Influenzal 4 8 3 6 8 21 7 4 8 6 9 4 1 4 — 4 — 5 ,, A. Primary 2 1 12 16 7 7 6 2 35 21 22 16 3 1 1 1 4 — Puerperal Fever — 1 — 5 — — — 1 — 4 — 1 — — — — — — ,, Pyrexia — 2 — 12 — 7 — 4 — 8 — 13 — 1 — 4 — 2 Scarlet Fever 25 22 38 58 28 25 10 15 25 39 29 42 4 6 3 3 7 17 15 B.—Sex-Age Distribution. Borough. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— ##] M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 1 3 7 4 13 5 12 11 18 8 61 54 10 26 9 10 18 1 1 — 3 2 Typhoid and Continued Fever 1 3 1 1 1 Erysipelas 1 _ 1 2 1 1 1 6 11 2 8 10 16 3 3 Pneumonia—A. Influenzal 1 _ — 2 5 1 1 1 4 13 12 6 9 9 18 9 11 ,, A. Primary 5 8 12 7 5 1 3 4 3 2 13 7 2 2 2 5 13 11 9 6 21 7 4 5 Scarlet Fever — 4 10 9 10 11 21 15 14 25 58 75 27 38 9 9 15 36 4 4 1 1 — — SCARLET FEVER. During 1933 there were 396 cases of scarlet fever notified. Of the cases notified 4 were under the age of 1 year, 115 between the ages of 1 and 5 years, 198 between the ages of 5 and 15 years, 69 between the ages of 15 and 35 years, and 10 over the age of 35 years. Of the 396 cases, 365 were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment . There was one death 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. 1933. 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 1091 1116 1322 1299 1267 1466 1745 1593 1324 2166 2825 2647 2146 22006 Paddinoton 19 25 31 35 26 25 39 23 31 33 45 35 29 396 Wards— Queen's Park 1 — 5 8 7 3 5 2 4 5 1 2 4 47 Harrow Road 7 11 8 7 8 5 11 6 2 4 10 10 7 96 Maida Vale 1 2 3 5 3 4 5 4 6 3 8 5 4 53 Town 1 — 3 2 2 4 2 1 5 1 2 1 1 25 Church 2 4 4 5 3 5 5 2 3 6 8 11 6 64 Westbourne 3 6 5 4 2 2 6 5 9 11 10 4 4 71 Lancaster Gate, West 1 — 1 1 2 1 1 3 10 Lancaster Gate, East — 1 _ 1 1 1 1 1 6 Hyde Park 3 2 2 3 — 2 2 2 1 2 2 1 2 24 DIPHTHERIA. (Including Membranous Croup.) During 1933 there were 277 cases of diphtheria notified, but none of membranous croup. Of the 277 cases 4 were under the age of 1 year, 78 between the ages of 1 and 5 years, 151 between the ages of 5 and 15 years, 37 between the ages of 15 and 35 years, and 7 aged 35 years and upwards. Two hundred and seventy-two patients were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Nineteen deaths from this disease occurred during 1933, 2 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1921 22 deaths 1922 25 ,, 1923 14 ,, 1924 14 ,, 1925 11 .. 1926 21 ,, 1927 11 ,, 1928 7 ,, 1929 9 .. 1930 12 ,, 1931 8 ,, 1932 13 „ 1933 19 „ 16 Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1933:— 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 597 544 647 593 677 658 708 627 668 904 1079 1018 942 9662 Paddington 10 14 20 21 21 28 23 28 19 24 25 24 20 277 Wards— Queen's Park 1 3 10 3 1 2 1 2 2 3 1 29 Harrow Road 3 2 6 5 2 2 4 7 4 1 8 6 4 54 Maida Vale 2 1 1 3 8 2 4 3 5 1 4 3 37 Town — 1 — — — 3 3 1 2 — 1 2 13 Church 1 2 2 6 2 2 5 9 3 7 8 7 4 58 Westbourne 2 5 2 6 10 9 6 4 2 7 4 1 4 62 Lancaster Gate, West — _ 1 1 Lancaster Gate, East 1 1 1 2 1 1 1 8 Hyde Park 1 — — — 2 2 1 2 1 1 3 1 1 15 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to which 9 cases were referred by the Public Health Department during the past year. 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 21 phials of 4,000 units and 8 phials of 500 units were distributed. Diphtheria Immunisation .—In June, 1933, a clinic for the immunisation of children against diphtheria was inaugurated at the Welfare Centre, 232, Harrow Road, Dr. R. Cove-Smith being appointed Medical Officer. At first one session weekly was held, but the increasing numbers of children presenting themselves for treatment, following the distribution of leaflets at the various schools in the Borough, necessitated the provision of additional facilities, and a second session weekly was accordingly started in December. The following figures show the extent of the work carried out during the part of the year the arrangements were in operation. Owing to the shortness of the period to which they relate, it has been deemed advisable to submit them without comment. Preliminary Tests 169 Results:— Positive 58 Negative 83 Pseudo-positive 5 Pseudo-negative 16 Unknown 7 Inoculations given 155 Re-Tests 43 Results:— Positive 8 Negative 28 Unknown 7 By the end of the year 34 persons (33 under 15 and 1 over 15 years of age) had been fully inoculated, i.e., protected against attacks of diphtheria. In 18 further cases treatment was still being given. In addition to the immunisation carried out at 232, Harrow Road, 20 children were tested at the Orphanage of Mercy by the Medical Officer of that institution. Positive results were obtained in 15 cases, and the children subsequently rendered immune by inoculation. SMALLPOX. One case of this disease was notified during the year. It was contracted by the patient through contact with another worker at the same place of employment. 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. 17 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. The latest return available as to the state of vaccination in the Borough is for the year 1932. This shows that 60.1 per cent. of the children whose births were registered during that year were successfully vaccinated, and that 16.6 per cent. were exempted on production of statutory declarations of conscientious objection. Insusceptibility, postponements, removals, deaths, and not traced, account for the remaining 23.3 per cent. During the year 1933 no primary vaccinations were performed in the Paddington Hospital. In the rest of the Borough 743 infants under one year of age, and 70 persons over that age were successfullv vaccinated by Dr. Denovan Adam, by whom also 34 persons were re-vaccinated who had been successfully vaccinated at some previous time. Of children born in the Borough and those transferred from other districts the total number vaccinated by Public Vaccinators and other Medical Practitioners was 1377. Legal proceedings were taken for non-compliance with the provisions of the Vaccination Acts in 19 cases. Of these 14 were successfully vaccinated after the proceedings had been commenced. Adjournment (sine die), penalties and cases withdrawn, account for the balance. 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. During 1933, 364 certificates were received from medical practitioners. In addition 178 cases were reported from other sources, making a total of 542 for the year. The greatest prevalence occurred during the second quarter of the year, the cases for that period numbering 212. Chicken-pox is not usually nursed in an institution, but 40 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. Six cases of typhoid fever and one case of continued fever were notified in 1933. 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. Five cases of typhoid fever and the case of continued fever received hospital treatment. There were no deaths from either of these diseases. MEASLES. On the application of the Council, the Regulations providing for the notification of cases of measles were revoked by the Minister of Health, the Rescission Order coming into operation on 20th March, 1933. The disease had been notifiable in the Borough since 1914 under various Orders and Regulations. The Order made by the London County Council on 1st April, 1903, applying to measles, Sections 60-65, 68-70 and 72 of the Public (Health) London Act, 1891, still remains in force. This Order enables local authorities to disinfect after measles and to safeguard the public in several ways against spread of infection. From 1st January to 19th March, 1933, 103 cases of measles were certified by medical practitioners, and iu addition 24 cases came to the knowledge of the Department through reports from schools, parents, etc. The number of cases reported during the remainder of the year was 158, bringing the total for the year to 285 cases, as compared with 1,707 cases in 1932 and 659 cases iu 1931. In the following table the 285 cases are distributed among the various wards of the Borough in four-weekly periods, 18 1933. Measles . Notified and Reported Cases. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. i. 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 12 83 32 15 19 12 25 41 13 — 2 3 28 285 Wards— Queen's Park — 3 3 1 — — — — — — — 1 1 9 Harrow Road 3 51 7 — 3 2 1 5 1 — — — — 73 Maida Vale 2 23 5 3 1 2 2 10 3 — — — — 51 Town 1 — — — — — 2 3 1 — — — — 7 Church 3 4 3 7 5 16 17 3 — 1 1 1 61 Westbourne 3 3 9 7 5 1 4 6 3 — 1 1 25 68 Lancaster Gate, West 2 — 1 — 1 — — — 1 — — — — 5 Lancaster Gate, East — — — — — — — — — — — — — 3 Hyde Park 1 — 1 1 2 1 — — 1 — — — 1 8 On 28th February, 1933, the Council authorised the Public Health Committee to make arrangements for the prevention of measles by the method of sero-therapy. The small number of cases reported made it impracticable for the scheme to be put into operation during the year. This method of prevention will, however, be utilised as soon as an opportunity occurs. Seven deaths were attributed to measles, 2 of which occurred among children under the age of 1 year, 2 among children between the ages of 1 and 2 years, 2 among children between the ages of 2 and 5 years, and 1 among children over 5 years of age. The Women Sanitary Inspectors visit cases of measles with few exceptions and arrange, where necessary, for the attendance of the District Nurses. The cases requiring nursing assistance during the year numbered 21 under 5 years of age and 8 over 5 years of age. The number of visits paid by the nurses was 285 and 73 to each group respectively. Seventy-three cases received treatment in hospital. GERMAN MEASLES. This harmless, but infectious disease, was notifiable in Paddington, together with measles, until the Regulations were revoked in March, 1933. In the course of the year 58 cases came to the knowledge of the Department through various sources of information, as compared with 82 cases in 1932, and 64 cases in 1931. Twenty patients received treatment in hospital. OPHTHALMIA NEONATORUM. This disease is notifiable in London under Section 55 of the Public Health (London) Act, 1891, the London County Council having by resolution in 1911 made this section applicable to the disease. Twenty-one notifications relating to cases of purulent eye-discharge of the new-born were received during 1933. Of the 21 patients 17 recovered without any impairment of vision, 2 proceeded to other districts on discharge from hospital, 1 was not traced after removal, and 1 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. 19 In addition to true purulent discharge, 8 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 1933, 2 cases were referred to the District Nursing Association, 49 visits being paid. Nineteen cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 12 cases of puerperal fever notified during 1933, 10 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, where 1 case received treatment during the year at a cost to the Council of £13 13s. 0d., of which sum £1 10s. Od. was received from the patient. Four deaths from the disease were recorded during the year. PUERPERAL PYREXIA. This condition is defined as:— "Any febrile condition (other than a condition which is required to be notified as puerperal fever) occurring in a woman within 21 days after childbirth or miscarriage in which a temperature of 100.4 degrees Fahrenheit, or more, has been sustained during a period of 24 hours or has recurred during that period." The febrile condition referred to in the above definition may be due to any cause, and it may be to some cause quite independent of the puerperal condition. It may, however, be the precursor of the more serious condition known as puerperal fever, and it is with this in view that the numerous conditions comprised under the term puerperal pyrexia are made notifiable. During the year 53 cases of puerperal pyrexia were notified, 49 of which occurred within or were removed to institutions. One case was nursed in Queen Charlotte's Hospital Isolation Block, the patient contributing £1 11s. 6d. towards the total cost of £3 3s. Od. incurred by the Council. 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. Three requests for his assistance were made to the Council during the year. ERYSIPELAS. Sixty-six (66) cases were notified, 40 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. Three cases of this disease, otherwise known as Infantile Paralysis, were notified and received treatment in hospital. Owing to the serious after-effects, such as deformities, which result from this disease, much care is taken to keep in touch with all cases previously notified. Recent experience tends to show that most of the cases notified by doctors receive all the necessary remedial treatment. It is evident that the possibility of preventing the onset of serious deformities is now realised by parents and doctors more than formerly. ACUTE POLIO-ENCEPHALITIS. No case of this disease, somewhat similar in its nature to the last-mentioned, was notified. ACUTE ENCEPHALITIS LETHARGICA. No case of this disease was notified. 20 CEREBRO-SPINAL FEVER. Six cases of this disease were notified in 1933. All were treated in hospital. Four of the cases proved fatal. MALARIA. One case of this disease was notified. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and fifty-seven (157) cases of acutc primary pneumonia were notified in 1933, as compared with 184 in 1932. Of the 157 cases, 79 were nursed in institutions. One hundred and two (102) cases of acute influenzal pneumonia were notified, as compared with 66 in 1932. Of the 102 cases, 42 were nursed in institutions. Fifty-four (54) cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council's scheme for district nursing, 790 visits being paid. ANTHRAX. No case of this disease was notified during the year. 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 1933, 37 cases of acute rheumatism were notified. This figure compares with 21 cases in 1932, 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 1933, a grant of £100 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. 21 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 1933. by Reginald Miller, M.D., F.R.C.P.,. Physician-in-Charge . The aims and methods of this Centre have been explained in previous reports, and before giving the details of the last year's work it may be of interest to express an opinion of the value of the work as a whole. The Centre was opened in l926, and as I have been in charge from the inception there has been time to form some definite impressions of the value of the work done. On the encouraging side several points may be mentioned. First, this Centre was the earliest to be started in London, and since that date over a dozen other Centres run on the same lines have been inaugurated; this shows that the medical profession regard the work as certainly worth while. Secondly the number of serious relapses and fatalities appears to be growing less, probably owing to the fact that we are now getting our cases earlier and before they are badly affected with heart disease. Thirdly, it is noticeable now that when, a really severe case of rheumatic heart disease comes under observation, of the type known as "cardiac cripple," it is almost invariably a child who has not come under any efficient scheme of supervision. Lastly, it is encouraging that the Centre appeals so. much to the mothers of the patients that the number of cases lapsing is always very low; during 1933 there were none. On the other hand it must be recalled that both of the last two years have been, exceptionally mild as regards rheumatic infection in children; it is not yet likely that) this milder form of the malady will become permanent. The Centre's work would be still more useful if more notified cases attended, and if more acute cases for in-patient treatment were referred to> it. Every effort would be made to accommodate such cases, and.' it need' not be said that the Hospital has every possible facility for treating the worst cases. Sessions and Attendances.—Owing to rebuilding in July, the number of sessions was reduced to 39 during, the year 1933. The following, numbers refer to Paddington children only:— Number. Attendances. New cases 22 38 Old cases 139 236 Discharged 17 27 178 301 Notifications.—The number of notifications during 1933 amounted to 37. As has already been mentioned the number of cases coming to the Centre by this means is too small. We have therefore traced what has happened to the 16 cases notified during the first six months of 1933, with the following result:— Attending own doctor 6 Attending other hospitals 3 Attending tuberculosis dispensary 2 Attending Centre 2 Over age 3 16 Though probably some of these cases will ultimately come on to the Centre when convalescent, the above figures cannot be regarded as satisfactory. New Cases.—Of the 22 new cases, 5 were referred through the Public Health service, 15 through the School Medical service, and 2 through hospitals. It will be seen that the private practitioners who notify cases of rheumatism are not transferring their patients when convalescent to the care of the Centre for supervision as a rule. 22 Discharged, Cases.—The number of cases discharged during the year numbered 17. The reasons for their discharge were as follows:— Removal 2 Recovered permanently, after observation 1 Regarded as non-rheumatic after observation 1 Lapsed 0 Reached age limit 13 17 Social standard.—Of the 22 new cases, the circumstances of the home were reported as comfortable in 18, and poor in 3. In 8 instances the presence of damp was reported to the Medical Officer of Health. Treatment.—The following table summarises the work done amongst the 178 children attending the Centre during the year:— Referred for treatment for active rheumatism:— As In-patient, Paddington Green Children's Hospital 3 As Out-patient, „ „ „ „ 39 To own doctor 1 Removal of diseased tonsils:— As In-patient, Paddington Green Children's Hospital 6 As Out-patient, „ „ „ „ 2 Advised in new cases 8 Home conditions referred to Sanitary Authorities 8 Reports to School Medical Service 15 Reports to Public Health Department 18 Recommended free dinners 2 Recommended and arranged convalescence 2 Discharged See above Home Visitors.—Much valued assistance has been rendered to the Centre by the work of the Women Sanitary Inspectors. By means of their visits a closer touch is kept with the children than would otherwise be possible. They are also responsible for the reports on the home circumstances which are of great value to the Centre in its research work into the environmental causes of juvenile rheumatism. During the year the Visitors have paid no less than 452 visits amongst the rheumatic children in Paddington. In conclusion I beg to express my great indebtedness to Dr. M. Llewellyn Davies for the very able and willing assistance rendered during the year 1933. CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. One case of dysentery was notified during 1933, but there were no cases of the other diseases included in the heading. WHOOPING-COUGH. This disease is notifiable in only two London Boroughs and not in Paddington. Since both the cause of the disease and effective means for treating it are unknown it would not appear that notification could assist very much in checking it. Whooping-cough is very infectious in the catarrhal stage, before the characteristic whoop develops, and this adds to the difficulty in dealing with the disease. In 1933, 5 persons died of whooping-cough, all being children under the age of 5 years. The number of deaths in 1932 and 1931 were 13 and 8 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. During 1933 17 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. 23 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, 231, which occurred in Paddington last year, whilst greater than the number for 1931, did not reach the figures recorded in 1932 and 1930. The numbers of deaths for previous years are shown in the list following:— Numbers of Deaths in Paddington. 1933 231 1932 254 1931 226 1930 278 1929 284 1928 260 1927 247 1926 239 1925 230 1924 234 1923 206 1922 191 1921 226 1920 194 1919 170 1918 164 1917 201 1916 205 1906 164 The following table furnishes an analysis of the sites affected in the fatal cases of cancer during the year. Three cases are not included owing to absence of information. 1933. Cancer. Site of Disease. Ages. All Ages. 0— 15— 25— 35— 45— 55— 65— 75— M. F. M. F. M. F. M. F. M. F. M. F. M F. M. F. M. F. Buccal cavity and pharynx — — - - — - - - - - 2 - 3 - - - 5 - Digestive organs and peritoneum - - 1 - - 1 1 2 9 3 15 19 23 17 12 16 61 58 Respiratory organs - - - - - - - - 7 4 4 - 5 - - 1 16 5 Uterus — — — — — 1 — 5 - 8 - 4 — 2 - 3 - 23 Other female genital organs - - - - - - - 1 - 1 - 3 - 2 - 1 - 8 Breast - - - - - - - - - 7 - 5 - 5 - 1 - 18 Male genito-urinary organs - - - - - - - - 2 - 2 - 4 - 2 - 10 - Skin - — — — — — — - - - — 1 — — — 1 - 2 Other or unspecified organs - — 9 1 — 1 — — 3 2 5 2 2 2 — 2 12 10 — — 3 1 — 3 1 8 21 25 28 34 37 28 14 25 104 124 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 period of three years. In 1932 the disease was made permanently notifiable. Sixty-seven (67) cases of the disease were notified during the year. The number of deaths under the age of 5 years was 33, as compared with 103 in 1932, 29 in 1931, 29 in 1930, 37 in 1929, 23 in 1928, and 16 in 1927. Twenty-four (24) 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 1933 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 34 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 90 deaths in 1933, and from other tuberculous diseases there were 14 deaths. The number of deaths from tuberculosis of all kinds was 138 in 1931, 122 in 1932, and 104 in 1933, the lowest figure on record. 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 1933 104 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1933. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0—1 year — — —- — — — 1—5 years — 1 1 12 3 15 5—10 „ 1 1 2 10 9 19 10—15 „ 1 2 3 3 1 4 15—20 „ 8 8 16 3 5 8 20—25 „ 11 24 35 1 7 8 25—35 „ 23 39 62 5 3 8 35—45 „ 19 7 26 2 2 4 45—55 „ 32 4 36 1 - 1 55—65 „ 12 6 18 — — — 65 years and over 1 3 4 — — — Total 108 95 203 37 30 67 Cases re-notified 83 73 156 14 4 18 Total Notifications on Form A .. 191 168 359 51 34 85 Cases removed from Register:— 1933. By reason of— Death 102 Removal 172 Recovery of patient or variation of diagnosis 24 Total 298 Of the patients who removed from the Borough during 1933, the new addresses were obtainable in 97 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1933, 11 cases of patients who had removed into the Borough from other districts were added to the register. The number of cases remaining on the Tuberculosis Register at the close of 1933 was 1,351 as compared with 1,360 at the close of the year 1932. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 914 By Tuberculosis Officers 553 By Dispensary Nurses— 20, Talbot Road 3,398 St. Mary's Hospital 2,032 6,897 Propaganda.—During the month of September, the National Association for the Prevention of Tuberculosis gave two very successful demonstrations of films in Queens Road, near the Baths, 150 persons being present continuously at each performance. 25 Tuberculosis. New Cases and Mortality During 1933. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0— - - - - - 1 1 - 1— - 1 12 3 - - 1 2 5- 1 1 10 9 1 — 2 - 10— 2 2 3 1 16— 8 8 3 5 8 7 1 1 20— 11 24 1 8 25— 24 40 5 3 8 14 1 - 35— 19 7 2 2 11 6 1 2 45— 32 4 1 — 17 2 — — 55— 12 6 — - 9 1 - 1 65 years and upwards 1 3 — — 3 2 — 1 Totals 110 96 37 31 57 33 7 7 Fourteen persons dying from tuberculosis during the year were not formally notified, this number being equal to 13.4 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 1933 and three sets Were returned following the removal or 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 1933 no shelters were lent or returned, but one lent in a previous year remained in use. 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 1933, 26 patients received refills varying in number from 1 to 21 per patient. The total cost amounted to £104 14s. 6d. 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 3 patients were provided with full dentures, 3 with partial dentures, and in 2 cases repairs to dentures were carried out. The total cost was £25. Grants amounting to £15 7s. 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. 26 Particulars of the dental work done during the year are shown in the subjoined table. Summary of Dental Treatment for the Year 1933. 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 105 10 1 9 2 10 33 53 5 3 — 1 5 18 36 17 Children 114 43 — 2 — 1 32 70 — — — — 8 40 — 16 Men 26 2 — 2 1 1 5 11 1 1 — — — 9 7 6 Total 245 55 1 13 3 12 70 134 6 4 — 1 13 67 43 39 Number of Sessions held=42. 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 1933, 31 patients received treatment, 512 exposures being given. Arrangements are now in force for the X-ray examination of patients, through the services of a consulting Radiologist. The advantages of having an X-ray installation on the premises cannot be too strongly emphasized. The importance of an X-ray examination in assisting the diagnosis where the lung lesion is very early or deep seated is now generally accepted. There is little doubt that many patients who willingly undergo this form of examination here, would refuse it if they had to spend time and money making a special visit to another institution for the purpose. 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 are also received. There is a regular weekly attendance of 10 patients, 5 of whom joined the class at its inception. During 1932 a piece of land was bought by a friend of the Dispensary, on which to build new premises for the Dispensary. Active steps are being taken to collect money for the erection of the proposed new buildings. 27 Return Showing the Work of the Dispensary During the Year 1933. 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 53 41 — 1 4 6 13 8 57 47 13 9 736 (b) Doubtfully tuberculous - - - - - - - - 2 2 4 8 (c) Non-tuberculous - - - - - - - - 78 194 137 185 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — — 1 — — — 1 150 (b) Doubtfully tuberculous - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 32 51 33 33 C.—Cases written off the Dispensary Register as (a) Cured - 2 - - - 1 6 4 - 3 6 4 756 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error - - - - - - - - 110 245 170 218 D.—Number of Persons on Dispensary Register on December 31st:— (a) Diagnosis completed 193 184 — 1 49 73 139 111 242 251 139 112 767 (b) Diagnosis not completed - - - - - - - - 2 2 4 9 1. Number of cases on Dispensary Register on January 1st 750 2. Number of cases transferred from other areas and oases returned after dis- charge under Head 3 in previous years 14 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of. 73 4. Cases written off during the year as Dead (all causos) 54 5. Number of attendances at the Dispensary (including Contacts) 5,303 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 157 7. Number of consultations with medical practitioners:— (a) Personal 70 (b) Other 210 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 287 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,398 10. Number of (a) Specimens of sputum, etc., examined 280 (b) X-ray examinations made in connection with Dispensary work 127 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above — 12. Number of "T.B. plus" cases on Dispensary Register on December 31st ., 181 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 1933. A full account of this dispensary and its activities will be found in the annual reports for 1924 and 1925. In April, 1933, the Dispensary was transferred from the old building to the newly-erected extension of the Hospital. During the year 90 refills were done in Artificial Pneumothorax cases. 28 Return Showing the Work of the Dispensary During the Year 1933. 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 24 28 2 1 3 3 5 — 27 31 7 1 138 (b) Doubtfully tuberculous — - - - - — — — 3 1 - - (c) Non-tuberculous - - - - - - - - 20 27 10 11 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — — — — — — - 29 (b) Doubtfully tuberculous - - - - - - - - - - - - (c) Non-tuberculous - - - — — — — — 1 11 5 12 C.—Cases written off the Dispensary Register as (a) Cured — 1 - - 4 — — 1 4 1 — 1 103 (b) Diagnosis not confirmed or non-tuberculous (including cancellation of cases notified in error - - - - - - - - 21 38 15 23 D.—Number or Persons on Dispensary Register on December 31st:- (a) Diagnosis completed 81 90 3 7 39 49 29 27 120 139 32 34 329 (b) Diagnosis not completed - - - - - - - - 2 1 1 — 1. Number of cases on Dispensary Register on January 1st 316 3. Number of cases transferred to other areas, cases not desiring further assistance underthe scheme, and oases "lost sight of '' 36 5. Number of attendances at the Dispensary (including Contacts) 2,916 7. Number of consultations with medical practitioners:— (а) Personal 6 (b) Other — 9. Number, of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,032 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and. A (b) above — 2. Number of cases transferred from otherareas and cases returned after discharge under Head 3 in previous years 11 4. Cases written off during the year as Dead (all causes) 26 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 7 8. Number of visits by Tuberculosis Officers to. homes (inoluding personal consultations) 266 10. Number of (a) Specimens of sputum, etc., examined 104 (b) X-ray examinations made in connection with Dispensary work 85 l2. Number of "T.B. plus" cases on Dispensary Register on December 31st 93 The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1933 was as follows:— Representing. Paddington Borough Council Councillor W. H. Crook „ „ Councillor Mrs, R.M. Drury (Vice-Ghairman). „ „ Councillor Mrs, M.E. Gerrett. „ „ Dr. G.E. Oates, Medical Officer of Health. „ „ Miss D. Newhall, Sanitary, Inspector. „ „ Miss E.Z. Amor, Sanitary Inspector. British Red Cross Society Miss A.V. Edden. Charity Organisation Society Mrs. G.S. Warren. „ „ Miss Hugh Smith. Insurance Committee Miss L. Sherman. 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). 29 Representing. 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 E.M. Phillips. 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-three individual cases were considered. Residential treatment was granted by the London County Council to 201 patients, 20 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 201 patients, 163 received free treatment, the remaining 38 patients, or their parents, paying contributions varying from 2s. 6d. to 50s. a week. Payments are collected by the Committee and transmitted monthly to the County Council. During the year a total of £195 19s. 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 1933 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. In consequence of administrative changes made by the London County Council between the Central Public Health and Public Assistance Committees, the Tuberculosis Care Committee, since the 1st April, 1933, have been entrusted with the assessment of cases receiving treatment under the Tuberculosis Scheme in the County Council's general hospitals, as well as of those receiving residential treatment elsewhere. The effect of the new arrangement is that the Care Committee are now brought into direct contact with, and are able to give attention to the welfare of, all tuberculous patients receiving residential treatment provided by the County Council, a distinct advantage compared with the former arrangement under which the assessment of cases at different stages of treatment, and even of two patients in the same family, often fell to separate Committees. MATERNITY AND CHILD WELFARE. The staff engaged in maternity and child welfare work consists of a Superintendent Health Visitor, 8 whole-time Health Visitors, 1 part-time Health Visitor, 9 part-time Medical Officers, 3 part-time Masseuses, and 1 part-time Clerical Assistant. During the year the staff was strengthened by the appointment of the Superintendent Health Visitor and an additional Masseuse. 30 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 1,758 Revisits „ „ „ 5,810 7,568 Visits to children between the ages of 1 and 5 years 10,241 First visits to expectant mothers 775 Revisits „ „ 439 1,214 Other Visits— Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhœa) 489 Miscellaneous (including 3,175 ineffective calls) 10,455 10,944 The total number of children on the Health Visitors' lists at the close of the year was 5,065. 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, 1933). 232, Harrow Road, W.2.—Nine good rooms and Health Visitors' rest room, warmed by gas fires. Bath room. Two Infant Consultations weekly.—Tuesday, 2.15 p.m. Medical Officer, Dr. Joyce It. Simpson. Thursday, 2.15 p.m. 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 Consultative and Physical Treatment Consultation weekly. Tuesday, 10 a.m. A second Consultation weekly was opened on 27th April, 1933, with the addition of Schick Testing and Diphtheria Immunisation Treatment.—Thursday, 10 a.m. A special session weekly for Schick Testing and Diphtheria Immunisation Treatment was opened on 6th December, 1933.—Wednesday, 2 p.m. Medical Officer, Dr. R. Cove-Smith. Artificial Sunlight Treatment and Massage are given twice weekly, Tuesday and Thursday, 10 a.m., by Miss Gannon, C.S.M.M.G., and Miss Suffling, C.S.M.M.G., in conjunction with the Consultative and Physical Treatment Consultation under Dr. R. Cove-Smith. An additional Masseuse, Miss P. Smiddy, C.S.M.M.G., was appointed as from 18th January, 1934. Instruction in Maternal Hygiene (Ante-and Post-Natal), and in cutting out and making babies' clothes, together with a stall for the sale of babies' garments and woollies, Wednesday, 10 a.m. 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 p.m. Medical Officer, Dr. Alexander S. Hall. Friday, 2.15 p.m. 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 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Instruction in Invalid Cookery, Knitting, etc., is given by a qualified Voluntary Worker, with stall for the sale of babies' woollies, etc. Monday, 2.15 p.m. Area served:—Lancaster Gate East and West Wards and part of Westbourne Ward. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large room, doctor's room and sales room warmed by gas radiators and hot pipes. Large outer room for perambulators, etc. Two Infant Consultations weekly.-—Tuesday, 2.15 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Friday, 2.15 p.m. 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 p.m. Medical Officer, Dr. J. McKail. Thursday, 2.15 p.m. Medical Officer, Dr. Hubert Hodge. Area served:-—Maida Vale 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. 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. 32 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. Lectures on Health Topics are provided from time to time. Co-operation with Personal Service League.—Grants of clothes for cases recommended by Health Visitors are received at No. 232, Harrow Road, W.2, for distribution. Convalescent and Holiday Homes.—Mothers and children are sent to Convalescent end Holiday Homes on recommendation of Medical Officers at Centres. Financial assistance is given in many cases. The Vest Fund is maintained by a small Association of Ladies connected with the School, who knit garments and woollies which are sold at low cost to mothers at the Centres. The stock of clothing and the financial balance are augmented by gifts from friends, and the money realised is spent on dentures, convalescence, etc. Consultation Centres. Summary of Work for the Year 1933. 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 50 51 50 52 51 48 455 Number of Attendances 2036 2187 3234 2501 2378 2074 1995 2947 2937 22289 Average Attendance 39.9 42.8 63.4 50.2 46.6 41.4 38.3 57.7 61.1 48.9 Seen by Doctor 955 962 1374 1124 854 877 756 1068 1373 9343 Average number seen by Doctor at each Session 18.7 18.8 26.9 22.4 16.7 17.5 14.5 20.9 28.6 20.5 The total number of children attending the consultations was 2,262, 998 being under 1 year of age and 1,264 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 502 385 Number of Expectant or Recently Confined Mothers who Attended 245 153 Average Attendance per Session 10.4 7.5 Number of Cases Referred by Midwives in Private Practice 3 20 Consultative and Physical Treatment Centre. Number of Attendances 2,832 Number of Cases 239 (of which 159 were new) Classification of Cases— Artificial Sunlight only 80 Artificial Sunlight and Massage 94 Massage only 53 Dietetic only 12 Treatments given— Artificial Sunlight 1,804 Massage 1,670 Dr. Cove-Smith reports:— "The diet of most of the children attending this Centre calls for careful consideration and frequent . revision, as the parents find starchy foods and cereals the cheapest to give, without realising that thereby they neutralise the good effect of what vitamin containing food they can afford. Lack of appetite through insufficient variation in the diet or a deficiency in Vitamin B has always to be in our minds. The research on vitamin concentrates that was mentioned in last year's report has been persevered with and it is found that mixed concentrates of A and D are less effective in combating catarrhal conditions than when used alone. This is apparently due to the necessity for preserving a proportionate balance between these accessory food factors. 33 The general level of improvement has been maintained, while in some cases the results have been dramatic. Of these the most significant is perhaps that of little G. C. who was removed from hospital by his despairing parents with the pathetic label of "paralysis." Intensive ultra-violet light radiation and massage has restored much function and with the co-operation of a devoted "granny" he has learnt to use what was previously a lifeless left hand. While to crown our efforts at Christmas-time the little fellow suddenly found out what his legs were for, and before this report is due next year we hope to have him walking. It is not in every case of course that results are as obvious as this, but the list of advantageous results is long and with the addition of an extra masseuse our scope should be still greater in the future." Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, etc. 1,240 9 11 Sales 970 2 4 Grants from Borough Council 245 3 2 Queen Charlotte's Maternity Hospital.—During the year 1933, 99 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 8. As regards ante-natal consultations, exact figures are not available. During 1933 there were received into the Hospital for confinement 241 women from Paddington. This number is approximately equal to the number of women from Paddington attending the antenatal department during the year, and the average number of attendances was 8 per patient. With regard to out-patients in 1933, 299 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 1933 was 136, and presumably all of these received ante-natal examination and advice, as well as the 132 women who were admitted to the Borough Council's Maternity Wards. (See below.) 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 1933, 136 confinements were attended by the nursing staff, the number of visits being 2,495. These figures compare with similar ones of 113 and 2,102 in the year 1932. The annual grant in aid of this work is now £175. Maternity Wards.—Under an agreement made with the Board of Management of St. Mary's Hospital, a suite of wards containing 14 beds became available in the Hospital on the 1st April, '1933, for patients accepted for admission by the Borough Council. The agreement is for a period of five years and provides for payment to be made to the Board at the rate of 9s. per day for each bed, whether occupied or not, the annual amount being approximately £2,300. The following scale has been adopted by the Council for the assessment of cases for admission to the maternity wards, subject to such variation as the Maternity and Child Welfare Committee deem necessary or desirable, having regard to the financial position of the family. The charges specified are based on the assumption that the applicant will receive one maternity benefit only, and that the family consists of not more than one child:— Where the amount of family income (after deducting rent and insurance) is under £2 0s. 0d. the charge to be fixed by the Committee. ,, ,, is between £2 0s.0d. and £2 10s. 0d. the minimum charge per case to be £3 0s. 0d. ,, ,, ,, £2 10s. 0d. and £3 0s. 0d. ,, ,, ,, £4 0s.0d. ,, ,, ,, £3 0s. 0d. and £3 10s. 0d. ,, ,, ,, £5 0s. 0d. ,, ,, ,, £3 10s. 0d. and £4 0s. 0d. ,, ,, ,, £6 0s.0d. Where there are two maternity benefits and the father is in regular employment, an endeavour will be made to recover a maximum fee of £8 8s. Od. per case. A booking fee of 10s. will be charged in each case which will be taken in part payment of the scale fee. 34 In consideration of a further payment at the rate of £100 per annum, the Hospital Authorities have agreed to provide the part-time services of an almoner for duties in connection with the assessment and collection of charges for the use of the maternity wards. During the nine months, 1st April to 31st December, 132 women were delivered in the wards, 2 of whom died following difficult labour. One case of puerperal fever and 4 cases of puerperal pyrexia were notified. There were 9 stillbirths, and 1 child died within 10 days of birth. The payments made by patients admitted, or accepted for admission, to the wards amounted to £456 17s. Od. for the 9 months. 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. This service is undertaken by the Paddington and St. Marylebone District Nursing Association. No cases were attended during 1933. Under a further arrangement the midwifery staff of the Nursing Association attend, on behalf of the Council, certain women in their own homes who, for various reasons, are unable to go to an institution for their confinements. Payment is made at the rate of £3 3s. 0d. per case, the whole or part of the cost being recovered from the patients. During 1933, 2 cases were attended, the patients' contributions collected to the end of the year amounting to £2 17s. 0d. Maternity Consultations.—On 2 occasions the services of an obstetric consultant were requisitioned on account of complications associated with cases of parturition. Baby Hospital, LadbroJce Square.—The Council, on the 21st March, 1933, decided to make provision of four beds at the Baby Hospital, Ladbroke Square, for the reception of ailing infants recommended for treatment there by the Medical Officers of the Council's Welfare Centres, at a cost of £400 per annum. The beds became available on the 1st May, and on the following day 4 specially selected children were admitted. The beds were occupied in unbroken sequence during the 8 months until the end of the year by 17 babies, 3 of whom unfortunately died there. The longest stay in Hospital was 23 weeks, the shortest about 3 weeks. Special attention is paid by the Health Visitors, etc., to children after their discharge, and periodical reports are submitted to the Maternity and Child Welfare Committee. Every case admitted is reported to the Grants Sub-Committee and where considered necessary the parents are assessed to pay a small weekly sum towards the cost of maintenance, etc., in Hospital. The total sum recovered during the 8 months amounted to £8 2s. 6d. DAY NURSERIES. At the end of the year 1933, there were two Day Nurseries in Paddington, situated at No. 66, Lancefield Street, Queen's Park, W.10. and No. 21, Howlev Place. W.2. Statistical Summary. Queen's Park. Howley Place. Full days. Saturdays. Full days. Saturdays. Days open 253 49 253 50 Attendances 5,574 982 9,718 1,093 Average attendance 22 20 38 22 New Children 31 35 Cases of Infectious Disease. Diphtheria 2 Measles — 7 German Measles — 7 Infective Enteritis 1 Chicken Pox — 16 Impetigo 4 — There were no Closures during the Year on Account of Infectious Disease. 35 The premises of the Queen's Park Day Nursery at No. 66, Lancefield Street, are owned by the Council. 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. A supplemental contribution of £50 was made by the Council to the Queen's Park Day Nursery in respect of the year 1933. 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 fifth 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. 30 (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 reoeipt of milk grants from the Council. Schedule. Scale of Income for Grants. Basis.—Total income of family, less rent, divided by number of persons living on said income. In determining the number living on income include dependants living at home in addition to man, wife and their children. Free. Half-Price. Number of family. Total Income less Rent. Average Per Head. Total Income less Rent. Average Per Head. s. d. s. d. s. d. s. d. 1 15 0 15 0 18 0 18 0 2 20 0 10 0 24 0 12 0 3 25 6 8 6 27 0 9 0 4 30 0 7 6 34 0 8 6 5 32 6 6 6 37 6 7 6 6 36 0 6 0 42 0 7 0 Families of more than six persons to be dealt with according to their circumstances. (Paragraph 8 of Scheme.) The arrangements for administering the Scheme are as follows:— Applications for Grants.—Applicants for grants are referred to the Town Hall by, amongst others, medical practitioners, the staffs of the welfare centres, the health visitors, relieving officers, maternity and general hospitals and various public and charitable institutions. Procedure.—Before any case is considered the Medical Officer of Health must be satisfied that the supply is necessary on grounds of health. In the case of an expectant mother the existence and duration of pregnancy must be verified by the signature of a doctor or midwife. The quantity of milk authorised varies with the need of the mother or infant concerned. Usually, one pint per day is granted to an expectant mother and to a nursing mother, unless she be nursing twins, when up to 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. 37 Applications are made at the Public Health Department, 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 1933. (1932 figures in brackets.) The total number of cases considered by the "Grants" Sub-Committee during the year was 4,325, of which 1,056 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 937 (1198) 687 (955) 250 (243) Dried Milk 117 (144) 117 (144) — (—) Dinners 2 (—) 2 (—) — (—) 1056 (1342) 806 (1099) 250 (243) Details relating to the numbers of orders issued and the expenditure incurred are given below:— Number of Orders for Milk 3,708 (3,721) At Total Cost 3,687 (3,707) At Half Cost 21 (14) Number of Quarts at Total Cost 34,936 (34,003) „ ,, Half Cost 248 (200) Total Number of Quarts 35,184 (34,203) £ s. d. £ s. d. Cost of Milk at Full Price 935 11 8 (916 19 5) Half Price 6 15 9 (3 1 10) £942 7 6(£920 1 3) Number of Orders for Dried Milk, etc. 713 (922) At Total Cost 692 (906) At Half Cost 21 (16) Total Cost of Dried Milk, etc. £245 3 2(£257 15 10) Number of Orders for Dinners 22 (—) Number of Dinners 193 (—) Cost of Dinners £12 1 3 (—) 38 In connection with Maternity and Child Welfare work generally, mention has recently been made of the increasing number of necessitous families taking up residence in the Borough. The records for the past year have been carefully analysed and show the immigration—taking only the families coming within the purview of the Maternity and Child Welfare "Grants" Scheme— to be somewhat extensive. Of the 452 new families applying for grants during 1933, 188 (over 40 per cent.) had been in the Borough less than six months; a further 96—-total 284 (60 per cent.) less than one year, and an additional 37, total 321 (70 per cent.) less than two years. One of the prime factors accounting for this incidence would seem to be the unduly large number of one and two-roomed tenements available for letting in the Borough due to the "breaking-up" of larger tenements and premises hitherto used as apartment and boarding houses. There, too, has been a considerable exodus of families of the artizan type to new housing estates in suburban areas. To emphasise this point it can be stated that not for many years has there been such a large number of removals amongst the type of family usually associated with these grants. Over one-third of 200 families now on grant have changed their residences within the past eighteen months, some more than once. 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 for convalescence. In 29 instances the Council made grants towards the cost of children convalesced by the Invalid Children's Aid Association, the total amount for the year being £69 5s. Od. A supplemental grant of £24 was made in March, 1933, towards the extra cost of convalescence provided during the previous year. MATERNAL MORTALITY. During the year seven maternal deaths were enquired into by Dr. E. Dorothy Fenwick, the Council's medical investigator, and reports thereon forwarded to the Ministry of Health. Particulars of five other deaths on which inquests had been held were also transmitted to the Ministry. INFANT LIFE PROTECTION. In pursuance of the Transfer of Powers (London) Order, 1933, the duties of the London County Council in connection with infant life protection were transferred to the Borough Council as from the 1st April, 1933. These duties are laid down in Part I of the Children Act, 1908, as amended by Part V of the Children and Young Persons Act, 1932, and relate to:— (а) Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of infants; (b) Inspection of premises by Infant Protection Visitors, or other persons appointed by the Council for that purpose; (c) Fixing the number of infants to be kept in a dwelling in which any infant is received for reward. (d) Application to a Court or Justice for an Order directing the removal of an infant to a place of safety. The Council were fortunate in being able to secure the services of Miss M. E. Lockington, who for many years had carried out the duties of Infant Protection Visitor in Paddington as an officer of the London County Council. The work in the Borough therefore proceeded without interruption. 39 One of the Health Visitors was appointed by the Council to act as Infant Protection Visitor during the absence from duty of Miss Lockington owing to illness or whilst on vacation, and the Medical Officer of Health and two of the Sanitary Inspectors were also authorised to exercise the powers and duties of Infant Protection Visitors for special purposes. During the nine months, 1st April to 31st December, 1,723 visits and inspections were made, 28 new registrations of foster-mothers were recorded, 74 new infants were received, and 86 infants were removed—12 to hospital and 74 elsewhere. No deaths were reported. At the close of the year, the Register contained the names of 100 persons who were receiving children for reward. These persons had charge of 129 children. Proceedings were taken against a person for failing to give notice of the reception of two children for reward. The Magistrate found the case proved and bound the defendant over in the sum of £5 for 12 months to come up for judgment if called upon. One of the children in question was removed by the parent and the other by the Infant Protection Visitor to a place of safety under an Order granted by the Magistrate pursuant to Section 67 of the Act of 1932. 40 ADMINISTRATION. GENERAL. Staff of the Department.—On the 31st January, 1933, Miss E. Z. Amor was appointed Sanitary Inspector in succession to Miss L. M. O'Kell, whose retirement from the Council's service was recorded in the last report. Mr. T. Mitchell, Senior Sanitary Inspector, died on the 16th February, 1933. He had been in the service of the Council for 34 years. The vacancy on the stall was filled by the appointment of Mr. A. J. Fisher on the 25th July, 1933. Mr. C. S. Wansbrough, Workshops and Canal Boats Inspector, was designated Senior Sanitary Inspector. Miss M. E. Lockington, an Infant Protection Visitor on the staff of the London County Council, was transferred to the service of the Borough Council on the 1st April, 1933. Miss E. A. S. Davies, Health Visitor, was promoted to the newly created position of Superintendent Health Visitor on the 30th May, 1933, and Miss P. E. Blake was appointed Health Visitor on the 25th July, 1933. With a view to expediting a survey of the Borough for purposes of the Housing Act, 1930, two temporary Sanitary Inspectors were engaged in November, 1933. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 3,048. 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 1,124. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 93 patients (comprising 29 cases of measles, 54 of pneumonia, 8 of whooping-cough, and 2 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 1,290. Disinfection.—The rooms disinfected after infectious disease numbered 969. The weight of bedding, etc., removed for disinfection at the Wood Lane Disinfecting Station, undel the agreement with the Kensington Borough Council, amounted to just over 23¼ tons. Four hundred and fifty-five library books were disinfected. Schools.—A total of 1,758 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 874 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, 173 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.1, for the bacteriological examination, at the expense of the Council, of specimens sent by medical practitioners from 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 suSering from tuberculosis of the lungs are undertaken by the Paddington Tuberculosis Dispensary, 20, Talbot Road. The examinations made during 1933 were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 1,091 98 Tuberculosis 365 47 Typhoid Fever 12 5 41 House Drainage.—During the year 7 existing drains were tested and found water-tight, and 85 defective drains were reconstructed. Reconstruction Plans.—Three hundred and fifty-two (352) plans were submitted for drainage works in existing buildings. In connection therewith 619 letters were despatched. Four summonses were issued for failure to supply plans. Combined Drainage.—Orders were made under Section 74 of the Metropolis Management Act, 1855, with respect to new drainage systems to which the following groups of houses were to be connected:— New residential aud business premises on the sites of Nos. 55 to 69 (odd, inclusive), Queen's Road, and sites at the rear with frontages to Poplar Place. Nos. 12a, 14a, 14 and 16, Westbourne Grove; Nos. 3 and 5, Hatherley Grove; and Nos. 22 and 25, Westbourne Grove Terrace. Lancaster Gate, Nos. 12 and 13. St. Petersburgh Place, Nos. 26, 28 and 30. Cambridge Terrace, No. 46, and private roadway in front of Nos. 39 to 53. St. Stephen's Road, Nos. 2 and 4. Bayswater Terrace, Nos. 18, 19 and 20. Gloucester Terrace, Nos. 79 and 81. New residential flats or buildings situate on the sites numbered and known as 7 to 27 (odd. inclusive) Hatherley Grove, and 15 to 21 (consecutivc, inclusive), Westbourne Grove Terrace. New petrol filling station and office premises, or building, situate on the west side of Harrow Road, numbered and known as 169 and 171, Harrow Road, and Wharf. New blocks of flats and shops, or building, on the sites of premises formerly numbered and known as 25 to 43 (odd, inclusive), Porchester Road; 212 to 230 (even, inclusive), Queen's Road, and portion of Pickering Mews, with properties therein immediately at the rear of the firstmentioned properties. New block of tenements situate on the south side of Brindley Street, on the sites formerly numbered and known as 61, 63 and 65, Brindley Street. Princes Square, Nos. 30 and 31. Monmouth Road, Nos. 22 and 24. St. Stephen's Crescent, Nos. 8 and 9. New block of residential flats, or building, or rebuilding of existing building, situate on the northern side of Seymour Street, and numbered and known as Grosvenor Court Mansions, 74 to 86 (even), Seymour Street, and right of way at rear. Elgin Avenue, No. 89, and building in yard of No. 97. Polygon Mews South, Nos. 25 and 26. Westbourne Grove, Nos. 36 and 38. Kensington Gardens Square, Nos. 4, 5, 6 and 7. Leinster Terrace, Nos. 35 and 36. Leinster Square, Nos. 53 and 54. New business premises or building, situate on the east side of Chepstow Place, numbered and known as 9, 11 and 13, Chepstow Place. No combined systems were reconstructed by the Council during the year. Sewer Connections.—In 1933, 55 were reconstructed, either partially or wholly, 13 after Orders under Section 85 of the Metropolis Management Act, 1855, and 42 on the application of the owners of the properties concerned. Water Supply.—Nine certificates under Section 48 of the Public Health (London) Act, 1891, were issued. 42 The Metropolitan Water Board reported 21 cases of discontinuance of water supply, all on account of non-payment of rates. Eight of the premises were either unoccupied or used for business purposed only. In the remaining 13 cases the supply was restored after intervals varying from one day to six weeks. No legal proceedings were necessary. Mortuary.—Five hundred and ninety (590) bodies were deposited at the Mortuary, inquests being held on 440 of that number. Bodies deposited pending burial (all non-infectious) numbered 29. Four hundred and fourteen (414) post-mortem examinations were made. Trade Nuisances.—Thirty-two (32) complaints were received during the year, those relating to manure numbering 8. 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 accumulation 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, 1933, there were 10 rag and bone dealers in the Borough. Smoke Control.—During 1933, 29 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 137 occasions, occupying 36¾ hours. Smoke of all descriptions was noted during 14 hours, the duration of "black" smoke being only 14 minutes. Eleven complaints relating to the emission of smoke were received during the year. 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 1st 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 1933, eight prosecutions were instituted, small fines being imposed in seven cases; the remaining case was dismissed under the Probation of Offenders' Act. The publicity which has been given to the bye-law has had good effect in causing many dogowners 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. 43 CANAL BOATS ACTS, 1877 and 1884. By virtue of the Local Government Board Regulations of 17th May, 1878, the Paddington Borough Council is one of the Registration Authorities for the Regents 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 1933 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 ten (110) canal boats were inspected during the year, the following fringements of the Acts and Regulations being discovered:— Cabins leaky 13 Cabin floors defective 15 Stoves defective 9 Boats without certificates 8 Painting of cabins required 23 Numbering illegible 7 Four 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 was one death reported amongst canal boat dwellers. No boats were registered. Eighty-four (84) children of school age were found to be living on the canal boats using the Paddington Basin, the decrease in comparison with the figure reported last year (105) being due to more families living ashore. The total number of boats in respect of which certificates of registration had been issued at the end of the year was 255. It is practically certain that a number of boats, registered many years ago, have changed ownership, been registered with another authority or been broken up. It is under the circumstances impossible to trace a number of registered boats or to know the exact number of "live" certificates of registration. One of the requisites for an inhabited canal boat is that if ordinarily used for the conveyance of any foul or offensive cargo, it shall contain between the space occupied by such cargo and the interior of any cabin used as a dwelling, two bulkheads of substantial construction, separated by a space not less in any part than four inches, open throughout to the external air. Such space must be furnished with a pump for the removal of any liquid and the bulkhead next to the cargo is to be watertight. Until recent years it had not been considered in this Borough that house refuse came within the scope of the term "foul or offensive" cargo. Steps are now being taken, however, to ensure that double bulkheads shall be fitted to all inhabited canal boats conveying house refuse, and the owners of such boats are taking all necessary action to comply with this interpretation of the Regulations. During the year, 3 inhabited boats known to be conveying house refuse from Paddington Basin, were fitted with double bulkheads. Three 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 730 tons of mud were removed from the bed of the Basin, in addition to 661½ tons which were dredged previously, a total of l,391½tons, being 40 tons more than that removed in 1932. 44 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 90 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. Clearance Areas.—No areas in the Borough were declared as clearance areas either by the Borough Council or the London County Council, but towards the close of the year a survey of the whole of the Borough was begun with a view to obtaining detailed information for the submission of suitable schemes. Improvement Areas.—On the 18th July, 1933, the London County Council passed a resolution declaring Clarendon Street area to be an Improvement Area under Section 7 (1) of the Housing Act, 1930. The area comprises Nos. 2a, 2b and 2 to 50 (even numbers), la and 1 to 49 (odd numbers), Clarendon Street. It is the intention of the County Council to provide accommodation on the Wormholt Estate for the persons to be displaced, either by the operation of closing orders relating to parts of premises (basements) or for the abatement of overcrowding. The bye-laws for dealing with the area were still under consideration by the London County Council at the close of the year. When these come into operation they will be enforced by the Borough Council. Houses Unfit for Habitation.—Ten Closing Orders were made during the year with regard to parts of premises (basement rooms) which were unfit for human habitation. Eight of the families affected were provided with accommodation in the block of flats newly erected by the Borough Council in Brindley Street, one family was housed by the London County Council on the Old Oak Estate, and the remaining family found other accommodation through their own efforts. A Closing Order made in 1932 in regard to a tenement consisting of three basement rooms was determined, the tenement having been made fit for human habitation. Underground Rooms.—No rooms were dealt with under the Council's Regulations pursuant to Section 18 of the Housing Act, 1925, but action was taken under Section 96 of the Public Health (London) Act, 1891, with respect to the illegal occupation of underground rooms at seven premises. In three instances the illegal occupation was discontinued; the remaining four cases were still under observation at the end of the year. Tenement Houses.—Two houses were added to the Register during the year, making a total of 1,408.. The inspections made numbered 2,726. Particulars of the defects, etc., discovered and remedied will be found on pages 47 and 48. Overcrowding.—During 1933 five tenements in registered houses were reported to be overcrowded. In three 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 230 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. The number of beds for which each is licensed is as follows:— 268 and 270, Kilburn Lane, 60 beds for men. 272, 274 and 276, Kilburn Lane, 105 beds for men. Cecil House, 179, Harrow Road, 69 beds for women and children. 45 Under the Transfer of Powers (London) Order, 1933, the duties previously performed by the London County Council in connection with Common Lodging Houses were transferred to the Borough Council as from the 1st April, 1933. Between that date and the 31st December, 66 inspections (including 21 at night time) were made by the respective Sanitary Inspectors. The licences issued by the London County Council expired on the 30th June, when fresh licences were granted by the Borough Council for the period ending 30th June, 1934. During the year 2 deaths occurred among the occupants of these houses. Housing Act: Rent Books.—No instances of rent books not containing the required particulars were reported during the year. Brindley Street Flats.—The erection of these fiats, to which reference was made in the last report, was completed early in September, 1933. They contain four tenements each with living room, kitchen and two bedrooms, and four tenements each with living room, kitchen and one bedroom, the rents being 10s. 6d. and 7s. 6d. respectively for each class of tenement. Accommodation is provided for 33 persons. All tenements are occupied by families displaced from basements rooms through the operation of Closing Orders made by the Council. 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 cent. 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, re-conditioning 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 1933, a total of £5,500 had been subscribed. Rent and Mortgage Interest (Restrictions) Acts, 1920-1933. Nine 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, allocate 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 22 1 10 5 2 4 Oastelnau 1 - 1 - - - Downham 1 - 1 - - - Old Oak Common 13 4 3 2 2 2 Roehampton 1 — 1 - — — St. Helier 41 10 5 7 7 12 Watling 31 4 23 1 1 2 Wormholt 54 8 27 7 4 8 Central Dwellings 6 1 5 — — — 170 28 76 22 16 28 46 In addition to the above figure of 28 housed, 23 families were housed on the different Estates on applications submitted to the London County Council previously to 1933. This figure brings the total number of Paddington applicants housed during the year to 51. The Table refers only to the number of applications submitted to the London County Council; it gives no indication of the number remaining on the "waiting lists," which is 277 for all Estates. (See Table No. 2.) During the year 206 new applications were accepted, and over 1,564 interviews were held. The number of Paddington families housed by direct application to the London County Council was 55. 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 1933. Table No. 2 (Housing). Estate. Number of Applications Received. Number Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 464 130 10 230 64 30 Castelnau 29 13 15 1 - - Downham 221 102 3 72 12 32 Old Oak Common 55 17 15 6 11 6 Roehampton 50 27 1 20 2 — St. Helier 442 75 40 279 25 23 Tottenham 33 13 11 - 5 4 Watling 637 125 55 421 21 l5 Wormholt 607 185 58 325 20 19 Central Dwellings 12 3 7 2 — — ,, Estates 70 — 62 8 — — 2620 690 277 1364 160 129 The following Estates on which 482 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 220 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, and whose financial circumstances and place and hours of work will not permit of them living on the outlying quota Estates at St. Helier, Carshalton (Surrey), and Becontree (Essex). Only the most pressing applications are accepted. The London County Council are giving preferential treatment to these cases as vacancies occur. 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 11 vacancies occurred and new tenants were admitted at once from the waiting list. In addition to dealing with cases on the grounds mentioned in the first paragraph of this section of the report, the London County Council are providing rehousing accommodation in connection with operations under Section 20 of the Housing Act, 1930. Only one family was provided with such accommodation during 1933; it is anticipated, however, that a large number of cases will be dealt with in future years. A number of two-roomed flats for aged persons have been erected on the St. Helier Estate, Carshalton. The accommodation consists of living room, bedroom, separate kitchenette and combined bathroom and water-closet at inclusive weekly rentals of 8s. 4d. and 8s. 7d., and is suitable for an old married couple or two aged persons of the same sex. 47 The Council are co-operating with the London County Council in improving the home conditions of certain families, who, at first view, do not appear to come up to the standard it is desired to maintain on London County Council Estates. If at the end of a period of, say, three months the families haave improved their standard of living to such an extent that they would appear to prove satisfactory tenants, an opportunity is given them of making further application for accommodation. Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. 1933 Drain defective 10 ,, choked 23 ,, not properly ventilated or ventilating pipe defective 18 Manhole cover defective 6 Gully choked 4 Soil pipe defective 1 Water-closet defective 41 ,, choked 8 ,, without sufficient flush 4 ,, flushing apparatus defective 42 ,, foul 11 ,, improperly constructed — ,, accommodation insufficient — ,, without door, door defective, or without proper fastenings 50 Rain-water pipe defective 17 ,, choked 3 Guttering defective 21 Waste pipe defective 18 ,, choked 7 ,, untrapped 2 ,, not provided or missing 6 Sink defective or not provided 3 Other drainage defects — Cistern defective 6 ,, dirty 16 ,, without proper cover or cover defective 14 Dustbin defective 93 ,, not provided — ,, insufficient — ,, disused and not abolished Paving of yard or area defective 39 ,, washhouse defective 19 Premises damp 35 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 1,372 ,, verminous 134 ,, contents, bedding, etc., dirty - ,, not provided with a window opening directly to the external air - Chimney smoky 13 Food cupboards not provided — Windows defective including cords and fastenings out of repair 296 Roof defective 150 Common staircases out of repair 51 Staircases without sufficient handrail — Animals improperly kept — Accumulation of refuse (not offensive) 34 Premises without water, or supply insufficient 16 Any other defects, etc. 50 Notices Issued. Written Intimations 342 Statutory Notices 104 Bye-law ,, 474 Notices under L.C.C. (G.P.) Ants— Verminous rooms 75 Additional taps 16 Items of Dilapidation for which Letters were sent to the Owners (Section 17 or the Housing Act, 1930). Wall-plaster broken, bulging, or defective.. 59 Matchboarding defective 2 Wall-paper loose — Skirting defective 3 Doors defective or missing 40 Locks defective 8 Ceiling plaster defective — Ceiling paper loose — Floors broken or badly worn — Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 66 Stove settings defective — Flues defective 7 48 Hearths defective 7 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 15 Cupboard doors defective or missing and shelves missing 6 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) .. 49 Window-frames loose or defective (including oak sills worn or rotten) 7 Window-glass broken 100 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 47 Steps to front entrance or area defective 4 Railing to area or area steps defective 5 Guard rails to addition roofs defective, broken or rotten 2 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 9 Vault doors missing or defective 12 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— (a) Houses inspected on complaint or after illness or in course of "house-to-house" inspections 1,220 Inspections made 14,131 (4) Registered tenement houses inspected 230 2,726 (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 ably fit for human habitation — 2.—Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers No record. 3.—Action under Statutory Powers during the Year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs •90 (2) Number of dwelling-houses which were rendered fit— (a) by owners 78 (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 1,108 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 1,205 (6) 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 10 (2) Number of separate tenements of underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit.. 1 * Informal notices. FACTORIES AND WORKSHOPS. 1933. Inspection of Factories, Workshops and Workplaces. Premises. Number of Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 927 2 - Workshops (including workshop laundries) 1,055 2 - Workplaces (other than outworkers' premises) 338 — — Total 2,320 4 — 49 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 149 149 - - Want of ventilation 5 5 - - Overcrowding — — — — Want of drainage of floors 2 2 — — Other nuisances 11 11 - — Sanitary accommodation 'insufficient .. - - - - unsuitable or defective 25 25 — — not separate for sexes — — — — 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 192 192 — — * 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 1932, 1,102 premises were on the Register as compared with 1,250 at the end of the year 1931. During the year 1933, 159 premises were removed from the Register and 43 added, making the total at the end of the year, 986. The Department reported the opening of 11 workshops to the Home Office, and received from that Office, notice of 9, 5 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 17 lists in February and 15 lists in August. These lists contained 243 names and addresses of which 202 were forwarded to other districts. From other districts 302 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 2,320 inspections, comprising 927 of factories, 1,055 of workshops and 338 of workplaces. There were 192 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 3 complaints, which comprised:— Sanitary conveniences not separate for sexes 1 Other offence 2 Bakehouses.—During the year 5 level bakehouses were opened, and 4 underground bakehouses were closed, the total number on the Register at the end of the year being 63, of which 49 were factory bakehouses. The number of level bakehouses was 25 (14 being factories), and of underground 38 (35 being factories). The total number of persons working in bakehouses was 311, including 26 women and 29 individuals under the age of 18. The bakehouses were inspected on 740 occasions during the year. RAG FLOCK ACTS, 1911 and 1928. No rag flock was used in the Borough during the year. 60 FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1933, two slaughterhouses within the Borough:— 275, Edgware Road; 249, Maida Vale. These slaughterhouses were formerly licensed by the London County Council, but on the coming into operation of the Transfer of Powers (London) Order, 1933, that duty devolved upon the Borough Council, together with other duties relating to the supervision of slaughterhouses. There were 250 inspections made during the year. The number of animals slaughtered, so far as is known, was 3,869, comprising 184 bullocks and 3,685 sheep, a decrease of 16 bullocks and 109 sheep as compared with 1932. The following Table shows the number of organs destroyed, and the disease with which they were affected:— Bullocks. Sheep. Heads. Tongues. Lungs. Livers. Mesenteries. Stomachs. Lungs. Livers. Hearts. Pieces. Tuberculosis 7 7 4 10 5 2 - - - - Actinomycosis 1 1 - — — - - - - — Abscess - - 17 - - - 20 20 20 - Distomum Hepaticum — - 2 90 - - - 1 — — Parasitic Invasion — - - — - - 384 50 36 — Cyst - - - 1 - - - - — — Pneumonia - - - — - - 4 3 3 16 1bs. Pentastomum Denticulatum - - - - 1 - - - - - Not identified — — — - — — 49 27 19 — 8 8 23 101 6 2 457 101 78 — Total weight, 2,284 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 1933 the number of carcases was 101. On examination it was found necessary to destroy two heads and three plucks, weighing 50 lbs., all affected with tuberculosis. Slaughter of Animals Act, 1933.—The purpose of this Act is to provide for the humane and painless slaughter of animals and for the licensing of slaughtermen. Prior to its coming into operation on the 1st January, 1934, the Council passed a resolution extending to sheep, ewes, wethers, rams and lambs, the provisions of Section I relating to instantaneous slaughtering or stunning, and granted licences to the three slaughtermen who follow that occupation in the Borough. 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 50 inspections were made and approximately 4,830 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 inflicted and costs awarded as shown in the summary of Legal Proceedings. (See page 57.) Food Purveyors.—At the end of the year there were some 885 purveyors of food in the Borough, classified as follows:—Butchers 84, Fishmongers 26, General 68, Grocers 117, Fried Fish 36, Refreshments 131, Confectioners 123, Greengrocers 108, Milk 127, Provision 65. In addition to the above, there are 90 licensed Street Traders selling food within the Borough, namely:—Fruit and Vegetables 65, Ice Cream 10, Light Refreshments 11, Rabbits and Poultry 2, Fish 1, Sweets 1. These, with the storage premises of 25 Street Traders licensed by other boroughs, are under constant supervision. 51 There were 7 premises on which fish curing was performed, this business, as well as fish frying, being regulated by special bye-laws. Proceedings were taken against the proprietor of an establishment for failing to provide adequate ventilation to the kitchen used for fish frying. The result is recorded on page 57. The number of visits of inspection paid to premises occupied by food purveyors was 2,141. 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 134 premises. Ice Cream.—There were 157 shops at which ice cream was known to be sold, comprising the following kinds of businesses:—Bakers 9, General 10, Milk 12, Confectioners 69, Refreshment 43, Wholesale 4, Newsagents 2, Greengrocer 1, Fancy Goods 1. One hundred and sixty (160) inspections of premises were made. Ice cream was sold from 27 barrows stored within the Borough and from some 30 barrows stored outside the Borough. The above-quoted section of the London County Council (General Powers) Act, 1930, also makes 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. At the end of 1933 there were 127 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 2 tons 14 cwts. 1 qr. 12 lbs., comprising the following varieties:—Meat, 405 lbs.; Fish, 204 lbs.; Offal, 2,247 lbs.; Bacon, 14 lbs.; Tinned Goods, 2,252 lbs.; Sausages, 6 lbs.; Rabbits, 224 lbs.; Poultry, 24 lbs.; Fruit, 44 lbs.; Potatoes, 672 lbs. Dairies and Milkshops.—At the end of the year 1932 there were 122 names on the Register. During the year 1933 7 names were added and 2 removed, making a total of 127. Twenty of these businesses were transferred to new proprietors. There were 344 inspections made. In addition to the above-mentioned, there are 25 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 98 premises. Milk (Special Designations) Order, 1923. The licences issued by the Council during the year in pursuance of this Order numbered 123, but of these 8 were issued consequent upon changes of ownership of businesses. The number of licences in force at the end of the year was 115, comprising 12 for "Certified" milk, 33 for '"Grade A (Tuberculin Tested)" milk, 1 for "Grade A" milk, 3 for "Grade A (Pasteurised)" milk, and 66 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 44, comprising 6 of "Certified" milk, 20 of "Grade A (Tuberculin Tested)" milk, 1 of "Grade A (Pasteurised)" milk, and 17 of "Pasteurised" milk. The samples included 1 of "Grade A (Tuberculin Tested)" milk and 4 of "Pasteurised" milk taken at Paddington Hospital, and 1 of "Pasteurised" milk taken at a School. Five samples of "Grade A (Tuberculin Tested)" milk and 1 sample of "Pasteurised" milk were reported not to comply with the appropriate bacteriological standards, and 6 samples of ' 'Grade A (Tuberculin Tested)" milk, the sample of "Grade A (Pasteurised)'' milk and 1 sample of ' 'Pasteurised'' milk were stated to be not quite in conformity with the prescribed conditions. In cases where it appeared necessary, communications were addressed to the persons concerned. 52 Milk and Dairies Order, 1926. No contraventions of the provisions of this Order were reported during the year. Food and Drugs (Adulteration) Act, 1928. Of the 600 samples taken during the year, 19 (3.1 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 3.0 per cent. in 1932 and 3.9 per cent. in 1931. Forty-five of the samples were taken on Sundays and Bank Holidays. Of these, 2 were adulterated. Thirty-nine samples of milk were taken at Paddington Station on delivery by rail. Seven were found to be adulterated. Twenty 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 18 Schools from which samples of milk are taken periodically. Thirty-one samples were taken during 1933, 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 1933 eight samples were taken for chemical analysis, one of which was reported to be deficient in fat to the extent of 5 per cent. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined for the presence of preservatives. One sample of pepper and one of sausages were found to contain respectively 55 parts per million of sulphur dioxide and 0.24 per cent. of boric acid. No formal action, other than a caution to the vendor of the sausages, was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year one sample of full cream unsweetened, one of full cream sweetened, and nine 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 simple of dried milk was taken during 1933, 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, Dr. Alan Stewart. The work is performed at the Royal Institute of Public Health, 23, Queen Square, W.C.1, 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 1933 the following samples were submitted for special examination, viz.:— Beef, suspected to have caused food poisoning. Report—Organism isolated which gave the cultural and fermentative reactions approximating to B. Morgan No. 1. Apple pie, suspected to have caused food poisoning. Bacteriological Report.—Cultures showed the pie to have been heavily contaminated by coliform bacteria. No organisms of the Salmonella or Dysentery groups observed. Chemical Report.-—No arsenic or other poisonous substance detected to account for the symptoms complained of. 53 "Certified" milk. Report.—Animal inoculations with respect to one of the two samples submitted gave a positive result for Brucella Abortus. The facts concerning the sample of "Certified" milk which was found to contain the Brucella Abortus organism were transmitted to the Ministry of Health and to the Medical Officers of Health of the Metropolitan Boroughs. 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 below. The results of legal proceedings are summarised on page 57. 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, 1933. Average Monthly Figure for Percentage. Fat Content and Non-Fatty Solids January 3.50 8.80 February 3.48 8.78 March 3.48 8.70 April 3.28 8.70 May 3.41 8.72 June 3.43 8.20 July 3.53 8.59 August 3.58 8.73 September 3.60 8.76 October 3.78 8.77 November 3.82 8.80 December 4.00 8.12 Average tor Year. Samples taken at Paddington Station 3.49 8.70 ,, ,, elsewhere 3.68 8.57 Samples submitted to Public Analyst—1933. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Aerated Beverages - 6 - - - - Ale - 6 - - - - Ammoniated Tincture of Quinine - 2 - - - - Boracic Acid - 1 - - - - Borax - 2 - - - - Brandy - 2 - - - - Brawn - 1 - - - - Bread 1 - - - - - Bread and Butter (cut) - 4 - - - - Butter - 16 - - - - Cake - 3 - - - - Camphorated Oil - 2 - - - - Castor Oil - 1 - - - - Cheese - 6 - - - - Chocolate Spread - 1 - - - - Cocoa - 4 - - - - Coffee - 6 - - - - Compound Liquorice Powder - 1 - - - - Cream - 13 - - - - Cream Ice - 2 - - - - Custard Mixture - 2 - - - - Custard Powder - 2 - - - - Dried Fruit - 2 - - - - Dried Milk and Chocolate - 1 - - - - Dried Mint - 1 - - - - Dripping - 3 - - - - Epsom Salts - 1 - - - - Essence of Brandy - 1 - - - - Essence of Coffee and Chicory - 4 - - - - Essence of Ginger - 1 - - - - Eucalyptus Oil - 1 - - - - Extract of Coffee - 1 - - - - 54 Samples submitted to Public Analyst—1933—continued. M umber examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Fillets of Anchovy - 1 - - - - Fish Paste - 12 - - - - Flour - 4 - - - - Fruit Junket Crystals — 1 - - - - Galantine — 2 - - - - Gin 1 4 1 1 100.00 25.00 Glauber Salts - 1 - - - - Glycerin of Borax — 1 - - - - Grape Fruit Powder - 1 - - - - Ham - 5 - - - - Honey — 4 - - - - Hydrogen Peroxide — 1 - - - - Ice Cream - 6 - - - - Ice Cream Powder - 1 - - - - Jam - 8 - - - - Lard - 1 - - - - Lemonade Cubes - 1 - - - - Lemonade Powder - 2 - - - - Linseed Oil - 1 - - - - Liquid Extract of Cascara - 1 - - - - Luncheon Sausage — 2 - — — - Malt Vinegar — 2 - — — - Margarine — 9 - — — - Meat Paste - 3 - - - - Meat Pie - 1 - - - - Milk 295 1 10 - 3.39 - Milk, Full Cream, Dried. - 1 - - — - Milk, Full Cream, Sweetened Condensed.. - 1 - - - - Milk, Full Cream, Unsweetened Condensed - 1 — — — - Milk, Skimmed Sweetened Condensed - 9 — — — - Minced Beef - 3 - - — - Mincemeat - 3 - - — Mint Sauce - 1 - - — - Mixed Dried Herbs - 1 - - — - Mustard - 1 - - — - Olive Oil - 2 - - - - Orange Cubes — 1 — — — - Orange Quinine Tonic — 1 — — — - Orangeade Powder — 1 — — — - Ox Tongue Pate — 1 — — — - Paraffin Wax - 1 — — — - Pears - 1 — — — - Pepper — 7 — 1 — 14.28 Pickles — 3 — — — — Pork Pie - 1 - — — — Powdered Rhubarb - 2 - — — — Preserved Sausages 5 — 1 — 20.00 — Red Currant Jelly — 1 — — — — Red Port — 3 — — — — Rhubarb and Magnesia Powder — 1 — — — — Rice - 2 — — — — Rum — 2 — — — — Sago — 2 — — — — Salad Cream — 1 — — — — Sausages 7 — — — — — Sausage Meat 2 — — — — — Sauces — 5 — — — — Seidlitz Powder — 1 — — — — Semolina — 2 — . — — — Sherry — 2 — — — — Shredded Suet and Flour — 6 — — — — Sponge Cakes — 2 — — — — Steak — 1 — — — — Stout — 3 — — — — Sugar — 2 — — — — Sweets — 1 — — — — Syrup of Senna — 1 — — — — Tapioca — 2 — — — — Tea — 3 — — — — Tincture of Iodine — 5 — — — — Tinned Fish - 3 — — — — Tinned Fruit - 2 — — — — Tinned Vegetables — 6 — — — — Tomato Juice — 1 — — — — Vegetable Fat — 1 — — — — Vinegar 1 1 1 1 100.00 100.00 Whisky 2 4 1 2 50.00 50.00 White Port — 3 — — — — 314 286 14 5 4.46 1.75 600 19 3.16 55 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; Asparagus; Beef; Blackcurrants; Bottled Fruits; Bottled Vegetables; Broccoli; Brussels Sprouts; Bunched Carrots; Cabbage Lettuce; Canned Fruits; Canned Vegetables; Cauliflower; Celery; Cherries; Cheshire Cheese; Cider; Dressed Poultry; Eggs; Glasshouse-grown Tomatoes and Cucumbers; Gooseberries; Green Peas; Honey; Jam; Loganberries; Malt Extract and Malt Flour; Pears; Plums; Potatoes; Raspberries; Red Currants; Strawberries; Wheat Flour. No premises used by way of trade or for purposes of gain for the cold storage or chemical storage of eggs were registered during the year. Ten samples of canned fruit and vegetables were procured during the year comprising strawberries 1, blackcurrants 1, peas 2, plums 2, loganberries 1, raspberries 1, new potatoes 1, gooseberries 1. All were found to comply with the Regulations applicable. Merchandise Marks Act, 1926. The Council is responsible for executing the provisions of this Act, so far as relates to any goods being foodstuffs to which an Order in Council under the Act applies, and excepting any provisions relating to the importation of goods. The Medical Officer of Health and the Sampling Officer have been authorised to act as officers in this respect. At the end of the year Orders were in force relating to— Butter; Honey; Fresh Apples; Raw Tomatoes; Currants, Sultanas and Raisins; Eggs in shell and Dried Eggs; Oat Products; Malt Products; Salmon and Sea Trout. The following purchases were made with a view to ascertaining whether the requirements of the Orders had been complied with, viz.:—Honey 5, Butter 15, Apples 5, Tomatoes 5, Sultanas 5, Currants 5, Malt products 3. Artificial Cream Act, 1929. This Act, which came into force on May 10th, 1929, is intended to regulate the manufacture and sale of what is commonly known as reconstituted cream, usually prepared by emulsifying butter with dried skimmed milk and water. This substance gives the same analytical results as natural cream and cannot therefore be dealt with under the Food and Drugs (Adulteration) Act, 1928. During the year no premises were registered under the Act for the manufacture or sale of Artificial Cream. 56 Pharmacy and Poisons Act, 1933. This Act received Royal Assent on the 28th June, 1933, but will not come into operation until the appointed day to be fixed by Order in Council. It places upon the local authority the duty of keeping a list of persons who, not being entitled to sell poisons referred to in Part I of the Poisons List, will, under the Act, be entitled to sell certain other poisons, i.e., those included in Part II of the Poisons List. Powers of inspection and of enforcing the provisions are also conferred on the local authority, who may remove a name from or refuse to enter a name on the list. The Medical Officer of Health and the Sanitary Inspectors are authorised by the Council to act as Inspectors for the purposes of this Act. LONDON COUNTY COUNCIL (GENERAL POWERS) ACT, 1927, SEC. 52. Nuisance Caused by Pigeons.—The number of complaints received arising from the above cause was seven. 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 61 premises were received. In a number of cases the Borough Engineer and Surveyor was asked to cause examinations to be made of the sewer connections of the infested house and the two premises immediately adjacent. In several instances this procedure resulted in the discovery of defects which received the requisite attention of either the owner or, where only a minor trouble, the Borough Engineer and Surveyor. One notice was served under the Act in respect of rat-infested premises. Rat Week.—This was held from 6th to 11th November inclusive. The usual circular letter was sent out to principal wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Forty-four (44) 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 123 premises, the verminous rooms numbering 204. The owners of 46 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 69 rooms being so treated at a charge to the owners of 7s. 6d. per room. Section 26 of the London County Council (General Powers) Act, 1928, authorises the cleansing of verminous persons by the exercise of powers granted by a petty sessional court in cases where the verminous person does not consent to being removed to a cleansing station. No use was made of this Section during the year. COMPULSORY REMOVAL OF AGED, INFIRM OR DISEASED PERSONS. By virtue of Section 28 of the London County Council (General Powers) Act, 1928, it is possible in London to remove to a hospital or infirmary, by compulsion and under certain circumstances, aged, infirm, sick or physically incapacitated persons. The circumstances which may enable an order for removal to be obtained are somewhat involved. Unless the person concerned is suffering from disease it is necessary for the premises to be insanitary. It is in all cases necessary as well to prove that the person is not receiving proper attention and that removal is necessary in the interests of the affected person and of other persons. In one case an order of the Court was obtained for the removal of an elderly person to the Paddington Hospital. Several other cases were dealt with by means of persuasion. 57 LEGAL PROCEEDINGS, 1933. The results of the Summonses taken out during the year are summarised in the following tables:— Premises. Offence. Fine. Costs. Public Health (London) Act, 1891. £ s. d. Section 4. 56, Shirland Road Basement, scullery walls and ceiling dirty and ceiling plaster defective Work done. Summons Withdrawn — 12, Walterton Road Failing to unstop choked drain £10* 25 0 0* Bye-laws pursuant to Above and Other Acts. 9, Carlton Vale Failing to give notice of alterations to sanitary fittings £1 — 46, Cleveland Square.. Failing to give notice of intention to execute sanitary work £1 2 2 0 ,, ,, Executing work in a manner contrary to the Defects remedied — Bye-laws Summons withdrawn 21, Clifton Road Failing to provide adequate ventilation to kitchen used for fish frying Summons adjourned sine die. Proceedings abandoned on payment of £5 5s. costs after completion of necessary works 3, Hyde Park Place Failing to submit plans of drainage works executed Summons withdrawn 0 10 6 175, Maida Vale Failing to give notice and submit plans of alterations to sanitary fittings, and executing work in a manner contrary to the Bye-laws Summons withdrawn 2 12 6 22 and 24, Monmouth Road Failing to give notice of intention to commence combined drainage work £1 2 2 0 ,, ,, Executing work in a manner contrary to Byelaws Defects remedied Summons withdrawn — 5, Senior Street Failing to carry out annual cleansing Work done Summons withdrawn — 91, Warrington Crescent Failing to submit plans of drainage works executed £1 1 1 0 11, Westbourne Terrace Road Failing to give notice and submit plans of alterations to sanitary fittings, and executing work in a manner contrary to the Bye-laws Summonses withdrawn 2 2 0 *Appeal against conviction allowed by Quarter Sessions, without costs. Public Health (London) Act, 1891, Section 47. Offence. Fine. Costs. £ s. d. Selling one meat pie and exposing for sale four meat pies which were unsound and unfit for food of man Summons in respect of the sale of one pie withdrawn. No conviction recorded in respect of remaining summons, but defendant ordered to pay £1 costs. Having in possession certain articles of food (viz., mutton, beef, beef fat and a rabbit) which were unsound £3 3 3 0 Exposing for sale 71 rabbits which were unsound 10s. — Food and Drugs (Adulteration) Act, 1928. Offence. Fine. Costs. £ s. d. Milk—9.53 per cent. of added water .. - 2 2 0 ,, 18.33 per cent., 12 per cent., and 14 per cent. deficient in fat - 5 5 0 Vinegar—9.5 per cent. deficient in acetic acid — 10 0 0 Milk—25.66 per cent. deficient in fat £1 2 2 0 58 OFFICE (CLERICAL) WORK. 1933. Letters received 5,295 ,, despatched 6,353 Entries in Postage Book 11,163 Certificates dealt with relating to Notifiable Diseases 2,686 Notices sent re above 5,595 Entries in Birth Register 1,994 Complaints received 1,476 Plans dealt with 352 New openings in Journals 321 Disinfection Orders 1,036 Notices to abate nuisances, etc. 487 59 Report of the Work of the District Inspectors. 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. Re-Inspection of all kinds. Entire Reconstruction. Drains Relaid, Trapped or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C.'s, New Provided, Repaired, 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. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, etc. Accumulations Removed. Improperly kept, Removed. 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 13,753 22 106 36 38 1551 2 638 104 46 23 1 3 — 55 142 2 62 517 — 22 252 — 25 1 1931 970 — 1,607 13,386 15 84 55 11 1179 12 436 92 61 39 3 6 9 27 168 4 97. 516 2 18 183 5 29 2 1932 1,191 91 1,474 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 — 1933 1,253 25 1,195 12,911 3 82 79 22 2383 10 443 83 22 24 3 14 2 18 359 3 98 908 4 30 303 3 59 1 60 APPENDIX. Public Health Department, Town Hall, Paddington Green, W.2. 10 th April, 1933, and further amended 7th July, 1933. To the Chairman and Members of the Maternity and Child Welfare Committee. Ladies and Gentlemen, I have to report that during the fourth quarter of the year 1932, 485 births were registered as belonging to Paddington. Of these, 269 occurred within the Borough and 216 in other districts. A special inquiry was instituted with a view to ascertaining in each instance how long the parents had been resident in the Borough before the birth of the child. Information was obtained with regard to the parents of 457 children, leaving 28 cases in which the period of residence was doubtful. In the following statement the 28 doubtful cases have been divided proportionately between the two groups:— Group A Group B Length of residence. . Under 1 year Over 1 year No. of Births. 149 336 485 Percentage of total births. 30.7 69.3 100.0 During the same period, there were 59 deaths of children under the age of 1 year. In all cases information was obtained as to the period of the parents' residence in Paddington, with the following results, viz.:— Group A Group B Length of residence. Under 1 year Over 1 year No. of deaths. 29 30 59 Percentage of total deaths. 49.1 50.9 100.0 The mortality rates calculated on the above figures are shown below:— Group A Group B Length of residence. Under 1 year Over 1 year Mortality rate per 1,000 births. 194 89 Combined groups 121* *(the Registrar-General's figure is 119) The foregoing figures make it evident that the excessive infantile mortality in Paddington is to a great extent due to the migratory or floating population. This factor has an influence in other Boroughs of London, but possibly in Paddington more than any other. For instance, the Medical Officer of Health of Southwark informs me that only 11 per cent. of the births in his Borough are to mothers who have resided less than one year in the Borough. This investigation has an important bearing on work undertaken by the Council in combating infantile mortality. The major part of this work is educational in nature, the health visitors in their home visiting and the visiting doctors at the welfare centres all contributing their share. It appears that about one-third of the Paddington mothers who have babies, if indeed they become known to the staff, are only under their educational influence for a short time. The migrant type of family is frequently below the average economic standard of life owing to unemployment and to the paying of excessive rent. The children are, in consequence, often of poor physique and resist disease badly. Certainly the health visitors and doctors cannot be blamed if their efforts in this direction do not meet with much success. The elucidation of these facts serves to explain some of the high infantile mortality in Paddington and assists in absolving the Council from any charge of neglecting their duties. It should, however, determine the Council in a resolve to perfect its organisation for maternity and child welfare work and not to hesitate in the wise spending of money in further developments. The plight of the children in these migrant families must excite our sympathy, and so long as they live in Paddington it should be Paddington's concern to do the best possible for them. This investigation has been made by Mr. Gower, the Chief Clerk, and the health visitors. Owing to the labour involved it extended over a period of three months only, but there is no reason to suppose that the results would differ very much if it had been extended over a longer period. In my opinion the results are trustworthy and of social importance. I am, Ladies and Gentlemen, Your obedient Servant, G. E. OATES, Medical Officer of Health. JP2/68