M AC.4349 PAD 34 Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON. FOR THE YEAR 1934. BY GEOFFREY EUGENE OATES, M.D., B.S. (London), M.R.C.P. (London); D.P.H. (Cambridge); Barrister-at-Law, Medical Officer of Health. Metropolitan Borough of Paddington. REPORT ON THE Public Health AND Vital Statistics OF TIIE BOROUGH OF PADDINGTON. FOR THE YEAR 1934. BY GEOFFREY EUGENE OATES, M.D., B.S. (London). M.R.C.P. (London); D.P.H. (Cambridge); Barrister-at-Law, Medical Officer of Health. CRUSHA & SON, Ltd., Printers, 825/7, High Road, Tottenham, N.17. CONTENTS. page Acute Encephalitis Lethargica 20 Acute Influenzal Pneumonia 20 Acute Polio-encephalitis 20 Acute Polio-myelitis 20 Acute Primary Pneumonia 20 Acute Rheumatism 21 Administrative Work 39 Agricultural Produce (Grading and Marking) Act, 1928 55 Annual Cleansing 45 Ante-natal Consultation Centres 4, 30, 31, 32 Anthrax 21 Artificial Cream Act, 1929 56 Artificial Sunlight Treatment 26, 31 Baby Hospital 34 Bacteriological Work 39 Bakehouses 50 Beauchamp Lodge Emergency Home 34 Births 6 „ Illegitimate 7 „ in Institutions 8 „ Notification 8 ,, Stillbirths 7 Birth-rates 7 Canals, Canal Boats 42 Cancer 23 Cerebro-spinal Fever 20 Chicken-pox 18 Cholera 22 Clearance Areas 43 Common Lodging Houses 45 Compulsory Repairs 43 Compulsory removal of certain persons 57 Condensed Milk Regulations 53 Continued Fever 18 Contraceptive Advice 34 Convalescent Homes 32, 38 "Conversions,'' Housing 43 Dairies and Milkshops 52 Day Nurseries 4, 34 Deaths, Causes of 8, 9 „ in Institutions 10 Death-rates 10 Dental Treatment 31 Diarrhœa 23 Diphtheria 15 „ Carrier Clinic 16 „Immunisation 4, 16 Disinfection 39 District Inspectors' Work 59 Drainage, Combined 40 „ House 40 „ Reconstruction Plans 40 Dried Milk Regulations 53 Dysentery 22 Erysipelas 20 Factories and Workshops 49 Food Adulteration 52 „ Chemical and Bacteriological Examination 53 „ Destroyed 52 „ Poisoning 22 „ Purveyors 51 „ Samples Analysed 53 „ Supervision 51 „ Unsound 51 Fouling of Footways by Dogs 41 German Measles 19 Glanders 22 Health Visiting 30 Houses Unfit for Habitation 44 Housing 43-49 ,, Brindley Street Flats 45 „ North Wharf Road Area 43 „ Paddington Houses Association 45 „ on L.C.C. Estates 48 Hydrophobia 22 Ice Cream 52 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 39 Infective Enteritis 23 Inquests 13 Invalid Children's Aid Association 38 Legal Proceedings 57 Malaria 20 Manure, Removal of 41 Marriages 6 Massage Treatment 31 Maternal Consultations 34 „ Mortality 13 „ Mortality Investigations 38 Maternity and Child Welfare 29 „ Nursing 33 „ Outfits 34 „ Wards 4, 33 Measles 18 Meat Regulations 51 Merchandise Marks Act, 1926 56 Midwifery Service 34 Milk Grants 35 Milk and Dairies Order 52 Milk (Special Designations) Order 52 Mortuary 41 Notifiable Diseases 14 Nursing of cases of Infectious Illness 39 Nutritional and Physio-therapeutic Clinic 4, 32 Office Work 58 Ophthalmia Neonatorum 19 Outworkers (Homework) 50 Overcrowding 45 Pharmacy and Poisons Act 56 Pigeons, Nuisance from 56 Plague 22 Population 6 Poultry Slaughtering 51 Pneumonia 20 Preservatives, etc., in Food Regulations 53 Puerperal Fever 20 „ Pyrexia 20 Rag and Bone Dealers 41 Rag Flock Acts 50 Rats and Mice Destruction 56 Relapsing Fever 22 Rent and Mortgage Interest (Restrictions) Acts 46 Rent Books 45 Scarlet Fever 15 Schools and Infectious Disease 39 Sewer Connections 40 Slaughter of Animals Act 51 Slaughterhouses 51 Smallpox 17 Smoke Control 41 Staff 4, 39 Tenement Houses 44 Trade Nuisances 41 Tuberculosis, Artificial Pneumothorax Treatment 25 „ Artificial Sunlight Treatment 26 „ Deaths from 24 „ Dental Treatment 25, 26 „ Dispensary Treatment 4, 26 „ Home Visiting 24 „ Notification 23, 24 „ Regulations, 1930 and 1925 24, 25 „ Shelters 25 „ Supply of Beds and Bedding 25 „ Ultra-Violet Light Treatment 25 Tuberculosis Care Committee 29 Typhoid Fever 18 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 3 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 1934 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. So far as the causes of this infantile mortality are within the control of the Council every effort is being made to combat them. The year has been one of steady progress in strengthening the various schemes for securing the health of the community, and particularly of mothers and young children. For instance, the scheme for immunising children against diphtheria infection has now been extended so as to enable private doctors to deal with children who would normally be their patients. During the year a large amount of useful work was performed in dealing with unhealthy areas and individual unfit premises. Apart from the actual measures recorded in this Report, a number of surveys were made which will result in further action in the near future. The re-housing on London County Council estates of families displaced by the clearance or demolition of houses in the Borough has proceeded smoothly and without any serious hardship to the families concerned. 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. 30th May, 1935. 4 PUBLIC HEALTH OFFICERS (on December 31st, 1934). (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. R. Cove-Smith, M.A., M.B., B.Ch., M.R.C.P. E. Dorothy Fenwick, M.R.C.S., L.R.C.P. H. Hodge, M.B., B.Ch. J. McKail, M.A., M.B., B.Ch. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.I.C. Public Vaccinators. P.T. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., L.R.C.P. J. Thoresby-Jones, M.D., L.R.C.P., M.R.C.S. Joyoe R. Simpson, M.A., B.Ch.,M.B., D.P.H. A. S. Hall, M.R.C.S., M.R.C.P. S. Denovan Adam, M.R.C.S., L.R.C.P. (For Borough, excluding Paddington Hospital). W. G. Bendle, F.R.C.S.Ed., M.B., B.S. (For Paddington Hospital). Vaccination Officer, P.T. T.E. Rainger. Sanitary Inspectors, W.T. H.D. Bailey (2), (3), (4). L.G. Brooks (2), (3), (4). A.J. Fisher (2). A.C. Harrison (2), (3). C.G. Heron (2), (3). (Senior.) Women Sanitary Inspectors, W.T. E.Z. Amor (2), (6), (7), (8), (9). Health Visitors, W.T. P.E. Blake (7), (8), (9). E.A.S. Davies (7), (8). (Superintendent.) N.M. Hill (7), (8), (9). E.C. Jackson (7), (8), (9). C.McN. Keachie (7), (8), (9). Health Visitor (P.T.). E. Elslev (7), (9). E. Marshall (2), (3), (4), (5). F.J. Pallet (2), (3). (Meat and Food.) V.L. Ronchetti (2), (3), (4), (5). (Canal Boats.) E.B. Wilde (2), (3), (4), (5), (10). Three Temporary Inspectors. D.M. Newhall (1), (2), (7), (8), (9). E.M. Sells (9). F.E. Stammers (8), (9). G.E. Stephens (6), (7), (8), (9). H. Waite (7), (8), (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 Joint Board. (4) Building Construction Certificates. (5) Plumbing Certificates. (6) Tuberculosis Certificate. (7) State Certified Midwife. (8) Nursing Training Certificates. (9) Health Visitor's Certificate. (10) Smoke Inspector's Certificate, Royal Sanitary Institute. CLINICS. TREATMENT CENTRES. ETC. Ante-natal Consultation Centres Infant Consultation Centres Nutritional and Physio-therapeutic Centre Day Nurseries Maternity Wards Clinic Dispensaries Clinic Maternity and Child Welfare. Address. 232, Harrow Road St. Simon's Hall, Macroom Road St. Mary's Hospital, Cambridge Place *232, Harrow Road *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 *232, Harrow Road * Two sessions weekly. 21, Howley Place 66, Lancefield Street St. Mary's Hospital, Cambridge Place Diphtheria Immunisation. †232, Harrow Road † Two sessions weekly. Tuberculosis. 20, Talbot Road St. Mary's Hospital, Cambridge Place Venereal Diseases. St. Mary's Hospital, Cambridge Place (Male and Female) By whom provided. Paddington School for Mothers. „ „ „ St. Mary's Hospital. Paddington School for Mothers. „ „ „ „ „ „ „ „ „ „ „ „ Paddington Day Nursery. Queen's Park, Paddington, Day Nursery. St. Mary's Hospital. Paddington School for Mothers. Paddington Tuberculosis Dispensary St. Mary's Hospital. London County Council. 5 SUMMARY OF VITAL STATISTICS. 1934. 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 1934 139,790 Density of population per acre 103 Number of inhabited houses (end of 1934) according to Rate Books 20,826 Marriages 1,860 Total. M. F. Live Births Legitimate 1,646 874 772 Illegitimate 263 134 129 Birth-rate 13.70* Stillbirths 57 36 21 Stillbirth-rate 29‡ Deaths 1,743 845 898 Death-rate12.47* Percentage of total deaths occurring in public institutions 58.7 Number of women dying in, or in consequence of childbirth from sepsis 6 „ other causes 3 Maternal mortality 4.71‡ 4.57‡ Deaths of Infants under 1 year of age 183 Infantile Mortality 95† Legitimate, 88†; Illegitimate, 140†. Deaths from Measles (all ages) 23 „ Whooping Cough (all ages) 11 „ Diarrhœa (under 2 years of age) 44 „ Pulmonary Tuberculosis 85 Death-rate from Pulmonary Tuberculosis 0.60* Deaths from all forms of Tuberculosis 97 Tuberculosis death-rate 0.69* Rateable Value £1,815,526 Product of a Penny Rate £7,031 * per 1,000 persons. †per 1,000 live births. ‡per 1,000 total births. 6 VITAL STATISTICS. The Metropolitan Borough of Paddington as constituted under the London Government Act, 1899, covers an area of 1,356.1 acres, including 20.0 acres of waterways. It is co-extensive with the Civil Parish and Registration District of the same name. The Borough is divided into nine wards. General Summary of Vital Statistics. Year. Estimated Population.* Births. Deaths at All Ages. Deaths under One Year. Registered Locally. Transfers. Nett. Registered Locally. Gross Mortality. Transfers. Nett. Registered Locally. Nett. Out. In. Totals. Rates. Out. In. Totals. Mortality. Number. Mortality Totals. ity. 1924 146,400 2,343 284 446 2,505 17.11 2,054 14.03 475 341 1,920 13.11 232 99 196 78 1925 147,100 2,206 312 443 2,337 15.88 2,011 13.67 570 339 1,780 12.10 196 88 170 72 1926 146,700 2,131 345 462 2,248 15.32 2,067 14.09 554 344 1,857 12.65 210 98 194 86 1927 142,700 2,064 322 474 2,216 15.53 2,006 14.05 489 419 1,936 13.56 188 91 176 79 1928 145,200 2,074 376 479 2,177 14.99 1,954 13.45 507 446 1,893 13.03 186 89 186 85 1929 142,800 2,058 447 518 2,129 14.90 2,344 16.41 550 417 2,211 15.48 230 111 215 101 1930 142,800 2,216 524 469 2,161 15.13 1,890 13.23 482 397 1,805 12.64 174 78 169 78 1931 140,300 2,073 462 464 2,075 14.79 2,000 14.25 589 420 1,831 13.05 228 110 182 87 1932 143,600 1,765 401 613 1,977 13.76 1,817 12.65 601 688 1,904 13.26 220 121 212 107 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 1934 139,790 2,104 589 394 1,909 13.70 1,756 12.56 580 567 1,743 12.47 185 88 183 95 * Registrar-General's estimates of resident population. POPULATION. Estimated Population.—The resident population of the Borough at the middle of 1934 was estimated by the Registrar-General to be 139,790 persons, 2,110 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 1934 quoted in this report are based on these figures. The Borough 139,790 Wards— Queen's Park13,13th Harrow Road 24,57 North Paddington Maida Vale 22,452 67,114 Town 6,9521 Westbourne 24,357 Churoh 16,715 Lancaster Gate, West 9,546 South Paddington Lancaster Gate, East 9,570 72,676 Hyde Park 12,488. MARRIAGES. According to provisional figures supplied by the Registrar-General 1,860 marriages were solemnized in the Borough during 1934, being a rate of 26.6 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1934 was 2,104. From this total it is necessary to deduct 589 births which occurred to residents of other localities and to add 394 births which occurred to Paddington residents outside the Borough. The corrected total of 1,909 births thus obtained is equal to a rate of 13.70 per 1,000 of the population. Of the 1,909 births, 1,008 were those of males and 901 those of females, and of these 134 males and 129 females were illegitimate. 7 The Registrar-General's final figure for the nett number of births is given as 1,919, 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:— 1934. Birth-rates. No. of Births. Birthrates. 1933 1932 1931 1930 1929 England and Wales 598,084 14.8 14.4 15.3 15.8 16.3 16.3 London 56,853 13.2 13.2 14.3 15.0 15.7 15.7 Paddington 1,909 13.70 13.41 13.76 14.79 15.12 14.90 Wards— Queen's Park 157 11.94 10.94 10.67 9.46 10.32 10.26 Harrow Road 418 17.01 17.44 14.89 15.32 17.58 14.94 Maida Vale 290 12.91 12.15 12.87 14.79 13.57 15.22 Town 125 17.98 17.28 18.20 18.19 13.40 16.52 Westbourne 392 16.09 15.73 16.70 17.58 19.78 17.22 Church 277 16.57 18.39 21.55 23.81 22.12 23.50 Lancaster Gate, West 66 6.91 5.67 6.32 5.93 5.40 8.05 Lancaster Gate, East 49 5.12 4.94 4.17 8.31 7.18 8.79 Hyde Park 135 10.81 9.38 10.83 11.17 13.30 11.81 The following table shows the course of the birth-rate in the Borough in the past:— BIRTH-RATES. Paddington. 1881-1885 26.66 1886-1890 24.89 1891-1895 24.44 1896-1900 23.29 1901-1905 22.89 1906-1910 21.14 1911-1915 20.88 1916-1920 17.63 1921-1925 17.86 1926-1930 15.17 1931 14.79 1932 13.76 1933 13.41 1934 13.70 Illegitimate Births.—These were 263 in number, or 13.77 per cent. of the total number of births. The proportion of illegitimate births varies remarkably in the different wards as is shown in the table below:— RATE OF ILLEGITIMATE BIRTHS PER 100 TOTAL BIRTHS. Ward. Rate. Queen's Park 5.09 Harrow Road 6.93 Maida Vale 18.62 Town 13.60 Westbourne 13.77 Church 12.63 Lancaster Gate, West 33.33 Lancaster Gate, East 24.49 Hyde Park 23.70 Stillbirths.—During 1934, 72 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 30 occurred to residents of other localities; on the other hand 15 stillbirths occurred outside the Borough to Paddington residents. The nett number for the Borough was therefore 57, a figure equivalent to 2.9 per cent. of the total births recorded. Of the 57 stillbirths, males numbered 36 and females 21, 5 of the males and 8 of the females being illegitimate. 8 Births in Institutions. Local— Legitimate. Illegitimate. Total. Residents. Non-residents. Residents. Non-residents. Residents. Non-residents. Paddington Hospital 268 46 129 26 397 72 St. Mary's Hospital 252 281 7 3 259 284 Lock Hospital 7 20 6 34 13 54 Outlying (Paddington residents)- Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 145 19 164 Other Hospitals and Maternity Homes 113 33 146 Public Assistance Committees' Institutions 31 16 47 Notification of Births Acts, 1907 and 1915.—These Acts require the father of a child, if actually residing in the house where a birth takes place at the time of its occurrence, and any person in attendance upon the mother at the time of, or within six hours after, the birth, to give notice in writing of the birth to the Medical Officer of Health of the district in which the child is born, in the manner provided. Notification applies in the case where a child has issued forth from its mother after the expiration of the twenty-eighth week of pregnancy, whether alive or dead. In practice, it is almost always the doctor or midwife who notifies a birth, and not the father of the child. During the year, 2,091 live births were notified to the Medical Officer of Health. There were also 69 stillbirths notified. Of the 2,160 living and stillbirths notified, 60.6 per cent. were notified by medical practitioners, 30.1 per cent. by midwives, 0.5 per cent. by parents, and 8.8 per cent. by medical students or other persons. A comparison of the Notification Register with the returns supplied by the local Registrars of Births shows that 98.8 per cent. of the live births and 98.6 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. In only one instance did the Maternity and Child Welfare Committee consider it necessary to institute legal proceedings, a summons being issued against a medical practitioner. The case was dismissed under the Probation of Offenders Act on payment of £2 2s. 0d. costs. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,756. Of these, 580 were of persons whose residence was not in Paddington, 499 dying in Paddington Institutions and 81 in other places in the Borough. There were also reported to the Registrar-General 567 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the nett number of deaths for Paddington as 1,743, making an annual deathrate of 12.47. The Registrar-General has recently calculated a comparability factor for each district, by the use of which differences in mortality rates due to variations in the sex and age constitution of the populations of districts selected for comparison may to a great extent be eliminated. The factor for Paddington is .99, which applied to the crude death rate of 12.47 per 1,000 persons for the year 1934, gives an adjusted death rate of 12.34 per 1,000 persons. 1934. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhœa & Enteritis January 27th 1 - 1 2 4 15 2 10 16 1 February 24th 3 - 2 1 9 17 3 9 16 4 March 24th 6 - 2 - 6 16 3 9 15 5 April 21st 4 - 3 2 3 17 4 7 18 4 May 19th 4 - 1 1 8 17 - 2 11 6 June 16th 3 - 1 2 8 16 - 1 5 4 July 14th 1 - 1 - 6 19 1 - 6 2 August 11th 1 - - 1 3 18 - 1 1 1 September 8th - - - 1 6 21 1 - 2 5 October 6th - - - 2 4 14 1 - 4 2 November 3rd - - - 1 9 12 1 4 5 2 December 1st - - - - 10 20 1 5 6 5 December 31st - - - - 7 18 2 5 8 8 Totals 23 — 11 13 83 220 19 53 113 49 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, 1934. Sex-Age Distribution for Whole Borough. All Ages. Deaths at Ages. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— 75— 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. All Causes 845 898 1743 111 72 20 12 15 8 22 16 26 25 31 38 49 43 111 82 142 124 173 205 145 273 Typhoid and Paratyphoid Fevers 1 - 1 - - - - - - - - 1 - - - - - - - - - - - - - Measles 16 7 23 3 2 7 3 1 1 5 1 - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough 7 4 11 6 1 - 1 2 2 - - - - - - - - - - - - - - - - Diphtheria 9 4 13 1 - - - 4 1 3 3 - - - - - - 1 - - - - - - - Influenza 9 12 21 - 1 1 - 1 - - - - - - 1 1 1 1 2 — 2 1 2 4 3 Encephalitis Lethargica 1 1 2 - - - - - - - - - - - - - - - - 1 - - - - 1 Cerebro-spinal Fever 2 1 3 1 - 1 - - - - - - 1 - - - - - - - - - - - Tuberculosis of Respiratory System 50 35 85 - - 1 - 2 - 1 — 5 9 7 8 11 4 13 9 8 3 2 2 - - Other Tuberculous Diseases 6 6 12 - - - - 2 - 1 2 1 3 1 - 1 1 - - - - - - - - Syphilis 7 3 10 4 1 1 - - - - - - - - - - - - - - - - - - - General Paralysis of the Insane, Tabes Dorsalis 11 - 11 - - - - - - - - - - - - - - 4 - 6 - 1 - - - Cancer, Malignant Disease 100 122 222 - - - - - - - 1 1 - 2 3 6 7 29 19 19 24 41 40 11 28 Diabetes 5 20 25 - - - - — - — — 1 — — — — 1 1 — 2 6 1 7 — 6 Cerebral Haemorrhage, etc. 17 33 50 - - - - - - - - - - - - - - 1 2 4 8 6 9 6 14 Heart Disease 192 235 427 - - - - - - 1 2 3 — — 6 4 2 23 10 34 28 58 76 69 111 Aneurysm 7 2 9 - - - - - - - - - - - - - - 1 1 3 — 2 — 1 1 Other Circulatory Diseases 25 57 82 - - - - - - - - - - - - - 1 1 2 4 10 9 18 11 26 Bronchitis 29 26 55 6 4 2 — — 1 — — 1 — — — 1 — 4 — 3 1 4 6 8 14 Pneumonia (all forms) 63 54 117 18 10 4 4 1 — — — 1 — 2 3 5 1 10 7 14 9 6 11 2 9 Other Respiratory Diseases 7 5 12 — — — — — 1 — — — — — — — — 2 1 — 2 5 — — 1 Peptic Ulcer 14 4 18 — — — — — — — — — — 2 — 2 — 4 1 1 1 4 1 1 1 Diarrhœa, etc. 24 24 48 22 20 1 1 - - - - - - - 2 - - 1 - - 1 - - - - Appendicitis 7 5 12 — — — — — — — — — 2 2 — 1 — 2 1 1 2 1 — — — Cirrhosis of Liver 1 8 9 - - - - - - - - - - - 2 — 1 1 2 — 2 — — — 1 Other Diseases of Liver, etc. 2 5 7 — — — — — — — — 1 — — — — 1 — 2 — — 1 1 — 1 Other Digestive Diseases 24 21 45 1 - - - - - 1 — 1 — 1 1 1 4 1 1 10 1 7 7 1 7 Acute and Chronic Nephritis 25 23 48 — — — — — — 1 — — — — — 2 2 3 6 5 3 8 5 6 7 Puerperal Sepsis — 6 6 — — — — — — — — — 3 — 3 — — — — — — — — — — Other Puerperal Causes — 3 3 - - - - - - - - - - - 1 - 2 - - - - - - - - Congenital debility, Premature Birth, Malformations, etc. 48 26 74 47 26 - - - - 1 - - - - - - - - - - - - - - - Senility 3 19 22 - - - - - - - - - - - - - - - - - - - 3 3 16 Suicide 18 11 29 - - - - - - - - 1 — 1 — 2 5 5 1 6 2 2 2 1 1 Other Violence 48 40 88 2 3 1 2 1 1 3 — 6 2 7 4 6 4 4 2 11 3 2 3 5 16 Other defined diseases 67 76 143 1 4 1 1 1 1 5 7 3 4 6 4 5 6 8 12 9 16 12 12 16 9 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:— 1934. Death-rates. No. of Deaths. Deathrates . 1933 1932 1931 1930 1929 England and Wales 476,853 11.8 12.3 12.0 12.3 11.4 13.4 London 51,717 11.9 12.5 12.3 12.4 11.4 13.8 Paddington 1,743 12.47 13.36 13.26 13.05 12.64 15.48 Wards— Queen's Park 163 12.40 13.34 13.93 10.64 11.54 11.67 Harrow Road 322 13.10 14.11 13.82 11.99 11.85 14.94 Maida Vale 275 12.24 12.50 13.22 13.12 13.12 14.08 Town 88 12.65 16.01 14.28 15.57 12.59 16.65 Westbourne 320 13.14 13.99 13.90 15.31 13.99 17.06 Church 235 14.06 14.44 16.65 15.69 14.43 20.61 Lancaster Gate, West 96 10.06 13.52 10.40 11.54 10.59 13.56 Lancaster Gate, East 92 9.61 10.70 9.86 9.57 12.00 13.61 Hyde Park 152 12.17 11.28 9.90 12.10 11.72 15.72 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 1934 12.47 Deaths in Institutions, 1934. Local. Total. Nonresidents. Paddington Hospital 553 95 St. Mary's Hospital 278 196 Paddington Green Children's Hospital 47 37 Hospital for Women and Children (Lock Hospital) 12 11 St. Luke's Hospital 167 160 1,057 499 Deduct Non-residents 499 558 Outlying. Padding ton Residents. Isolation Hospitals of London County Council 35 Municipal General Hospitals and Public Assistance Committees' Institutions 230 Mental Hospitals 49 Voluntary Hospitals (General) 104 Hospitals (Special, including Sanatoria.) 48 466 Total Deaths of Paddington residents in institutions 1,024 11 INFANTILE MORTALITY. During the year 1934 there were 1,909 births, and 183 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 95. The following table gives the births and the infantile deaths and death-rates for the year 1934 in England and Wales, in London, in the Borough and the various wards of the Borough. The infantile mortality rates for 1929 to 1933 are given for comparison. 1934 Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1933 1932 1931 1930 1929 England and Wales 598,084 34,785 59 64 64 66 60 74 London 56,853 3,832 67 60 66 65 59 70 Paddington 1,909 183 95 85 107 87 78 101 Wards— Queen's Park 157 5 31 96 125 55 43 44 Harrow Road 418 33 79 48 80 78 39 71 Maida Vale 290 27 93 94 84 81 97 66 Town 125 9 72 123 161 106 50 147 Westbourne 392 43 109 87 107 80 86 126 Church 277 47 169 112 138 116 122 164 Lancaster Gate, West 66 6 91 127 113 109 98 39 Lancaster Gate, East 49 — — 62 97 60 103 42 Hyde Park 135 13 96 67 79 90 62 98 Infantile Mortality Rates, 1896-1934. 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 1933 64 66 107 1933 64 60 85 1934 59 67 95 12 Infantile Mortality in Paddington—1934. 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 37 7 6 7 57 43 41 24 18 183 95.86 Common Infectious Diseases (6-10, 44) - - - - - - 1 6 4 11 5.76 Tuberculous Diseases (23-32) - - - - - - — — — — — Diarrhoea and Enteritis (119) 1 — - 1 2 14 20 5 2 43 22.52 Developmental and Wasting Diseases (157, 158, 159, 161a) 29 3 5 3 40 20 4 - 1 65 34.05 Miscellaneous Diseases (Remainder) 7 4 1 3 15 9 16 13 11 64 33.53 Measles (7) — — — — — — — 3 2 5 2.62 Whooping cough (9) — — — — — — 1 2 2 5 2.62 Diphtheria (10) - - - - - - - 1 — 1 0.52 Influenza (11) - - - - - - - - - - - Tuberculosis of nervous system (24) - - - - - - - - - - - Tuberculosis of intestines and peritoneum (25) - - - - - - - - - - - Other tuberculous diseases (23, 2632) - - - - - - - - - - - Syphilis (34) 1 — 1 - 2 1 1 — — 4 2.10 Meningitis (79) - - - - - - - 1 — 1 0.52 Convulsions (86) - - - - - - - - - - - Bronchitis (106) - — - 1 1 4 2 3 — 10 5.24 Pneumonia (107-109) — 1 — 1 2 1 9 7 10 29 15.19 Other respiratory diseases (105, 110114) - - - - - - - - - - - Inflammation of the stomach (118) - - - - - - - - - - - Diarrhœa and Enteritis (119) 1 — — 1 2 14 20 5 2 43 22.52 Hernia, intestinal obstruction (122) - - - - - - - - - - - Congenital malformations (157) 3 2 1 1 7 5 3 — 1 16 8.38 Congenital debility and sclerema (158) - - - - - 5 1 - - 6 3.15 Icterus (161b) — — — — — — — — — — — Premature birth (159) 21 1 4 2 28 10 — — — 38 19.91 Injury at birth (160) 1 2 — — 3 — — — — 3 1.57 Disease of umbilicus (161c:1) — — — — — 1 — — — 1 0.52 Atelectasis (161a) 5 — — — 5 — — — — 5 2.62 Suffocation—in bed or not stated how (182 pt.) - - - - - 1 1 0.52 Other causes 5 1 — 1 7 1 4 2 1 15 7.86 Legitimate 1,646. Legitimate Infants 146. Nett Births in the Year Illegitimate 263. Nett Deaths in the Year Illegitimate Infants 37. 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. 1934 Infantile Mortality Rates. Births. Deaths. 1934 1933 1932 1931 1930 1929 Church Ward— North Wharf 26 2 77 135 105 53 77 143 Clarendon Street 124 22 177 121 142 116 153 170 Rest of Ward 127 23 181 98 140 129 106 165 Westbourne Ward— Alfred Road 79 9 114 69 123 116 84 152 Rest of Ward 313 34 108 92 104 69 87 117 Maida Vale Ward— Amberley Road 33 5 151 166 190 48 206 87 Rest of Ward 257 22 85 81 67 87 83 62 Totals for 4 Areas 262 38 145 114 140 102 129 151 Rest of Borough 1647 145 88 80 100 85 69 90 13 In July, 1934, a special report on infantile mortality in the Borough, prepared by the Medical Officer of Health, in co-operation with Drs. R. Cove-Smith and E. Dorothy Fenwick, two of the Medical Officers of the Welfare Centres, was presented to the Council. This report contained the results of investigations made into the causes of 163 deaths of infants under the age of 12 months which occurred during the year 1933. The investigations involved, according to the varying circumstances, a survey of the home of the deceased infant, interrogation of the parents, a consultation with the doctor in attendance on the infant and a scrutiny of the post-mortem examination records. Whilst a great deal of valuable information was obtained, no definite solution of the infantile mortality problem emerged from the investigations. Certain important suggestions for the improvement of the welfare services and for the removal of conditions possibly detrimental to infant life were, however, brought forward by the medical investigators. Some of these suggestions have already received, and others are receiving, the attention of the Maternity and Child Welfare Committee. MATERNAL MORTALITY. During the year 9 deaths, attributable to childbirth, occurred among the women residents of the Borough. Of these, 6 were due to puerperal sepsis and 3 to other puerperal causes. All of the deaths occurred in institutions. The 9 deaths were equivalent to a mortality rate of 4.57 per 1,000 total (live and still) births. In the following table this rate is compared with the rates for London and England and Wales Corresponding rates for the four previous years are also given. England and Wales. London. Paddington. 1934 4.41 2.70 4.57 1933 4.32 3.55 5.00 1932 4.04 2.89 2.94 1931 3.94 3.68 4.62 1930 4.22 3.21 2.70 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:— 1934. Cities and Boroughs. Estimated Resident Population. Live Births (Rate). Death Rate. Infantile Mortality per 1,000 Births. Crude. Adjusted. West Districts. Paddington 139,790 13.7 12.4 12.3 95 Kensington 179,080 12.3 13.3 12.5 93 Hammersmith 129,170 13.8 12.9 13.3 77 Fulham 145,400 13.7 12.6 12.7 59 Chelsea 58,160 10.8 13.4 11.4 65 Westminster 124,050 9.4 11.8 12.1 66 North Districts. St. Marylebone 92,320 9.0 12.7 12.6 61 Hampstead 90,000 10.4 11.3 10.6 53 St. Pancras 187,540 13.1 12.84 13.19 65 Islington 314,200 14.7 11.8 11.9 62 Stoke Newington 50,620 13.7 11.5 11.0 60.6 Hackney 211,120 14.2 11.7 12.2 56 Central Districts. Holborn 36,000 8.58 12.2 13.08 71 Finsbury 64,970 15.1 13.4 14.6 51 City of London 9,660 6.8 10.5 11.6 121 East Districts. Shoreditch 90,630 16.1 13.1 14.4 84 Bethnal Green 102,060 14.3 11.8 13.3 72.6 Stepney 214,990 15.3 12.3 14.3 87.2 Poplar 146,370 15.5 12.3 13.7 62 South Districts. Southwark 159,930 14.9 13.5 14.4 77 Bermondsey 105,060 14.8 12.4 14.1 64 Lambeth 283 900 14.21 12.78 12.65 63.38 Battersea 150,870 14.3 12.5 12.3 61.3 Wandsworth 345,250 10.98 11.18 10.39 57 Camberwell 238,360 13.22 12.31 12.31 67 Deptford 101,380 15.8 13.1 13.6 68 Greenwich 97,250 13.71 12.23 12.47 87 Lewisham 222,180 12.2 10.0 10.1 43 Woolwich 145,520 13.7 11.3 12.0 63 INQUESTS. During 1934, 129 inquests were held on residents of the Borough, and 88 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. Glanders. Acute Influenzal Pneumonia. Hydrophobia. Acute Polio-encephalitis. Infective Enteritis or Summer Diarrhœa. Acute Polio-myelitis. Malaria. Acute Primary Pneumonia. Ophthalmia Neonatorum. Acute Rheumatism. Plague. Anthrax. Puerperal Fever. Cerebro-spinal Fever. Puerperal Pyrexia. Chicken-pox. Relapsing Fever. Cholera. Scarlatina or Scarlet Fever. Continued Fever. Smallpox. Diphtheria or Membranous Croup. Tuberculosis. Dysentery. Typhoid or Enteric Fever. Erysipelas. Typhus Fever. Food Poisoning or Suspected Food Poisoning. The following table summarises the cases of notifiable diseases notified in the years 1924 to 1934:— Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis.) 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 Acute Encephalitis Lethargica 12 7 4 4 1 5 1 - - - - „ Influenzal Pneumonia 87 88 76 107 59 135 40 97 66 102 35 „ Primary Pneumonia 369 265 184 183 202 247 168 243 184 157 155 „ Polio-encephalitis 4 3 3 1 1 1 — 1 1 — — „ Polio-myelitis 3 4 3 1 1 2 2 3 6 „ Rheumatism — — - (a)34 76 52 43 37 21 37 41 Anthrax — — 1 1 - - - 1 - - - Cerebro-spinal Fever 1 5 5 3 4 6 3 5 9 6 3 Chicken-pox 395 459 599 461 567 382 515 555 291 364 333 Continued Fever — — — 2 10 3 2 4 - 1 1 Diphtheria 278 336 462 367 302 311 366 254 194 277 245 Dysentery 1 — — — — — — 2 5 1 1 Erysipelas 69 64 76 90 90 69 74 67 60 66 66 Food Poisoning — — — — — — — — (a)11 17 45 German Measles 458 375 124 78 109 1163 86 58 77 (b)11 — Infective Enteritis or Summer Diarrhœa — — - (a) 6 20 63 30 40 103 67 70 Malaria 9 1 1 2 3 - 1 - 1 1 1 Measles 2757 879 1738 154 2862 210 1790 541 1414 (b)103 - Membranous Croup 2 1 1 2 4 6 7 6 0 - 1 Ophthalmia Neonatorum 18 23 16 15 24 9 15 18 22 21 19 Puerperal Fever 9 15 14 7 5 4 5 8 7 12 12 „ Pyrexia — — (a)17 34 32 42 37 32 31 53 36 Scarlet Fever 290 264 199 320 519 323 356 379 286 396 437 Smallpox — — — — 5 3 3 — 2 1 — Tuberculosis—Total 379 400 356 381 321 335 284 311 289 270 284 Pulmonary 242 231 218 212 196 242 196 218 213 203 199 Other Forms 137 169 138 169 125 93 88 93 76 67 85 Typhoid or Enteric Fever 15 18 12 16 25 19 10 9 4 6 9 (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:— 1934. NOTIFICATIONS. A.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne . Lancaster Gate. Hyd Park West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. Diphtheria and Memb. Croup 10 6 18 19 12 8 11 23 31 37 22 26 1 3 — 6 5 Typhoid and Continued Fever — — 1 — 4 — — 1 1 — 1 — — — 1 1 — Erysipelas 3 4 5 6 3 6 1 2 3 8 6 10 1 2 1 2 1 Ophthalmia Neonatorum — — 2 2 2 2 2 — — 5 1 2 — — — — 1 Pneumonia—A. Influenzal — — 1 1 1 7 1 6 6 2 4 4 — - — — 1 „ A. Primary 6 6 15 19 10 5 5 1 23 17 16 23 2 3 1 1 1 Puerperal Fever — — — 2 — 1 — 1 — 2 — 4 — 1 - — — „ Pyrexia — — — 6 — 6 — 2 — 7 — 10 — 2 - 2 — Scarlet Fever 21 16 29 46 26 39 9 22 31 45 47 44 8 10 7 5 12 15 B.—Sex-Age Distribution. Borough. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35— 45— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diptheria and Memb. Croup 5 1 7 4 13 13 15 12 13 17 40 29 9 13 1 16 6 26 - 3 1 2 - - Typhoid and Continued Fever — — — — — — — — — — — — — 1 2 — 2 1 — — 4 - - - Erysipelas — 1 — 1 — — — — — 1 2 2 1 1 — 1 5 7 1 8 13 12 2 8 Pneumonia—A. Influenzal — — — 1 1 — 2 1 — 1 — 2 — — 1 — 6 6 2 3 1 7 1 „ A. Primary 16 9 6 9 6 7 5 7 1 3 3 8 3 4 3 1 13 13 5 6 12 4 6 5 Scarlet Fever 2 1 9 16 11 14 17 17 23 23 75 84 21 26 5 14 21 44 3 5 3 3 — — SCARLET FEVER. During 1934 there were 437 cases of scarlet fever notified. Of the cases notified 3 were under the age of 1 year, 130 between the ages of 1 and 5 years, 206 between the ages of 5 and 15 years, 84 between the ages of 15 and 35 years, and 14 over the age of 35 years. Of the 437 cases, 383 were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. No deaths from this disease occurred 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. 1934. 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 1768 1414 1435 1371 1466 1344 1322 1310 977 1433 1665 1574 1290 18369 Paddington 26 37 52 40 37 30 29 31 28 26 42 29 30 437 Wards— Queen's Park 3 4 8 — 3 — 3 1 5 1 5 3 1 37 Harrow Road 4 8 2 3 5 6 9 8 4 5 10 8 3 75 Maida Vale 5 9 5 6 3 9 4 4 4 8 3 4 1 65 Town 3 2 1 1 1 1 1 3 1 3 6 5 3 31 Church 2 2 11 6 12 4 5 7 9 2 6 2 8 76 Westbourne 7 8 16 12 7 5 1 5 4 5 7 5 9 91 Lancaster Gate, West 1 2 — 2 2 1 3 1 — 1 2 2 1 18 Lancaster Gate, East — 1 2 2 2 2 1 1 —- — — — 1 12 Hyde Park 1 1 7 8 2 2 2 1 1 1 3 - 3 32 DIPHTHERIA. (Including Membranous Croup.) During 1934 there were 245 cases of diphtheria notified, and 1 of membranous croup. Of the 246 cases, 6 were under the age of 1 year, 94 between the ages of 1 and 5 years, 91 between the ages of 5 and 15 years, 49 between the ages of 15 and 35 years, and 6 aged 35 years and upwards. Two hundred and forty-one patients were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Thirteen deaths from this disease occurred during 1934, 6 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1921 22 deaths. 1922 25 „ 1923 14 „ 1924 14 „ 1925 11 „ 1926 21 „ 1927 11 „ 1928 7 „ 1929 9 „ 1930 12 „ 1931 8 „ 1932 13 „ 1933 19 „ 1934 13 „ 16 Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1934:— 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 929 837 776 757 899 846 847 823 707 918 1196 1120 1237 11892 Paddinoton 21 16 15 12 25 19 21 12 24 16 18 14 33 246 Wards— Queen's Park — — — — 1 1 2 1 5 3 — - 3 16 Harrow Road 3 1 3 — 4 1 2 3 5 1 5 3 6 37 Maida Vale 1 1 2 1 2 3 2 2 1 1 2 2 20 Town 2 2 2 1 2 — 5 — 5 6 2 4 3 34 Church 3 5 3 8 5 5 8 5 6 4 6 1 10 68 Westbourne 10 2 4 1 9 6 1 1 1 - 3 5 5 48 Lancaster Gate, West 2 1 - - - - - - 1 - - - - 4 Lancaster Gate, East — 1 - - - - - - - - - 1 4 6 Hyde Park — 3 1 1 2 3 1 — — 1 1 — — 13 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to which 4 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 28 phials of 4,000 units and 15 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 of that year. Early in 1934 a third session was opened, this being continued until nearly the end of the year. The following report has been received from Dr. R. Cove-Smith on the work carried out at the Clinic during the year:— The Diphtheria Immunisation Clinic has dealt with over 400 cases during the past year, and of these 225 have already been fully immunised, while a further 46 will have been completed before this report appears in print; 153 of those tested have proved to possess a natural immunity of varying degrees. One of these latter children, A. K., developed a mild attack of naso-pharyngeal diphtheria due to a virulent microbe, but the natural immunity present prevented the disease from becoming serious or from developing complications; while one child, H.G., who had already been immunised also developed an attack, but in his case also owing to the immunisation it was very mild and without complications. These figures therefore show a high percentage of successes. Although what one aims to produce is 100 per cent. immunity, no doubt from time to time cases may occur in which a virulent microbe breaks down the patient's resistence and produces a mild attack, but as a result of the immunisation we can safely say that these cases will be milder than they would otherwise have been, that the rate of recovery increases and the risk of complications is reduced. In contrast to these may be mentioned the case of Mrs. W. who developed diphtheria in October but luckily had had her two children immunised in the previous May with the result that they escaped completely. As a result of the increasing demand for immunisation the Borough are making arrangements for private practitioners to carry out inoculation in conjunction with the Borough Immunisation expert, who will undertake the necessary Schick testing. From the figures presented it will be seen that the majority of cases already immunised fall into the 5 to 10 year age group. In view of the fact that immunisation lasts from about 5 to 7 years this is, of course, advantageous, but as the majority of cases of diphtheria occur between the ages of 2 and 5 years this is the time when immunisation is most essential. In order to avoid any undue reactions the immunising injections are given in 3 small doses at weekly intervals, thus no upset occurs and children are able to attend school or play with others just as usual. 17 1934. Number of Schick Tests. Pos. Neg. Ps. Pos. Ps. Neg. Unknown Result. Total. Fully Inoculated Partly Inoculated No. of Inocs. given. 263 144 4 9 6 426 225 46 781 Number or Schick Re-tests. Positive. Negative. Ps. Pos. Ps. Neg. Unknown Result. Total. After first Re-test. After further Re-test. After first Re-test. After further Re-test. After first Re-test. After further Re-test. After first Re-test. After further Re-test. 46 1 170 38 1 — 3 1 9 269 The number "Fully Inoculated" to be shown under the following age groups:— 6 to 12 months 1 1 year to 5 years 76 5—10 years 115 10—15 years 29 15 years and upwards 4 Towards the end of 1934 the Council, after consultation with local representatives of the medical profession, decided to introduce a scheme for enlisting the services of private medical practitioners in the work of diphtheria immunisation. The scheme provides for the payment to the practitioner of a fee of 10s. for immunising treatment given to any child between the ages of one year and twelve years, whose parent or guardian cannot reasonably be expected to afford a private fee for such treatment. All Schick testing for the purpose of ascertaining whether the child is susceptible to diphtheria is to be done by the Medical Officer of the Council's diphtheria immunisation clinic at the Welfare Centre, No. 232, Harrow Road. In the case of a child sent to the clinic for a pre-immunisation test, the result of which is negative, a fee of 2s. 6d. only is payable to the practitioner. The practitioner is required to bear the cost of an immunising agent specified by the Medical Officer of Health, and he is also responsible for any subsequent medical attention that may be necessary. The scheme was not fully in operation at the close of the year, and no results can therefore be recorded. SMALLPOX. No case of this disease was notified during the year, but 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 being performed by the Medical Officer of Health under the Public Health (Smallpox Prevention) Regulations, 1917. VACCINATION. There are two vaccination districts in the Borough, one consisting of the Paddington Hospital, for which the Medical Superintendent, Dr. W. G. Bendle, acts as Public Vaccinator, and the other of the rest of the Borough, the Public Vaccinator being Dr. S. Denovan Adam. The Vaccination Officer is Mr. T. E. Rainger, who was appointed to that position in 1931. The appointment is a part-time one, Mr. Rainger also holding a position on the clerical staff of the Public Health Department. The latest return available as to the state of vaccination in the Borough is for the year 1933. This shows that 59.0 per cent. of the children whose births were registered during that year were successfully vaccinated, and that 17.5 per cent. were exempted on production of statutory declarations of conscientious objection. Insusceptibility, removals, deaths, and not traced, account for the remaining 23.5 per cent. During the year 1934, 4 primary vaccinations and 4 re-vaccinations were performed in the Paddington Hospital. In the rest of the Borough 698 infants under one year of age, and 53 persons over that age were successfully 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 1,416; and the total number of statutory declarations received from Paddington and other districts was 381. Legal proceedings were taken for non-compliance with the provisions of the Vaccination Acts in 6 cases. Of these 3 were successfully vaccinated after the proceedings had been commenced. Adjournment and 2 cases not found account for the balance. 18 CHICKEN-POX. Chicken-pox has been notifiable in Paddington since November 28th, 1922, but the sections of the Public Health (London) Act, 1891, dealing with disinfection, exposure to infection, etc., are not in force as regards this disease. During 1934, 333 certificates were received from medical practitioners. In addition 224 cases were reported from other sources, making a total of 557 for the year. The greatest prevalence occurred during the first half of the year, the cases for that period numbering 352. Chicken-pox is not usually nursed in an institution, but 35 cases received institutional treatment for various reasons. TYPHOID FEVER AND CONTINUED FEVER. Nine cases of typhoid fever and one case of continued fever were notified in 1934. 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. Eight cases of typhoid fever and the case of continued fever received hospital treatment. One death from typhoid fever occurred during the year. MEASLES. This disease is no longer notifiable in the Borough, but 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. The Order enables local authorities to disinfect after measles and to safeguard the public in several ways against spread of infection. During the year 1,237 cases were brought to the knowledge of the Department through reports from schools, parents, etc. In the following table these cases are distributed among the various Wards of the Borough in four-weekly periods. 1934. Measles . Reported Cases. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals Borough 37 100 331 332 161 153 54 9 2 2 8 38 10 1237 Wards— Queen's Park 3 5 67 72 10 1 - - - - - - - 158 Harrow Road 11 51 118 63 28 48 10 3 1 1 1 1 1 337 Maida Vale 1 2 29 65 33 38 9 1 — — — 1 3 182 Town - 5 27 11 2 2 1 1 — — — 1 1 51 Church 5 6 34 73 48 17 15 2 — — 7 30 4 241 Westbourne 10 21 48 40 31 32 13 2 1 — — 5 1 204 Lancaster Gate, West 5 5 3 3 3 — 1 - - - - - - 20 Lancaster Gate, East.. — — — 3 1 2 6 Hyde Park 2 5 5 2 5 13 5 — — 1 — — — 38 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. Owing to the small number of cases reported it was not until the Spring of 1934 that an opportunity occurred for putting the scheme into operation. The results of this interesting experiment are summarised in the following extract from a report made by the Public Health Committee to the Council:— "We have considered a report submitted to us by the Medical Officer of Health on an attempt to modify or control the cause of the measles epidemic by means of the preventive inoculation of contacts. The report states that the work depends upon the fact that nearly all adults in urban populations have had measles in childhood, and that there remains in the blood, even after many years, a considerable amount of substance which is protective against the disease. "If therefore blood or serum is taken from these adults and inoculated into contacts of the disease in adequate amounts it is possible either to prevent the disease developing altogether, or to secure the occurrence of merely a mild attack. 19 "By using this method of inoculation it is not possible to afford a child permanent protection against the disease, such passive immunity only enduring for a few weeks. Permanent protection can, however, be obtained if the dose of blood or serum inoculated is just enough to allow the development of the disease in a mild form. It is this latter method which has been successfully used abroad and in some institutions in this country. "It was decided to take a working-class area in Paddington comprising 23 streets in the neighbourhood of Clarendon Street, and to endeavour to inoculate and beneficially modify the course of the disease in all measles contacts therein. Much of the previous work in this country in controlling measles has been done with the serum of convalescent patients. It was impossible to obtain such material and it was decided to use the blood of parents for the inoculation of their children. The advantage of this is that if the parents are not ill at the time, one can afford to neglect the risk of conveying any other disease to the children, and also parents would not object to the injection of their own blood, whereas they might possibly object to the use of serum of unknown origin. In no case was the blood of a parent used for a child of another family. During the epidemic 200 cases of measles occurred in the area, with 779 contacts. Of these contacts 597 had already had measles and 78 were considered too young to be inoculated. Of the 104 left, there was in 35 cases a definite refusal to allow inoculation; in 39 cases the parents pleaded illness or some other excuse; 8 parents were tubercular; and 16 other cases were not dealt with for various reasons. "Finally only six cases came to be inoculated. In two of these the disease occurred in a modified form and in four no disease followed. This may have resulted from the dose of blood being too large or the children may have been naturally immune. "This research is disappointing in the sense that little positive good resulted but it is of great value in illustrating the difficulties of applying the new knowledge of measles in actual practice. The Medical Officer of Health states he is not aware that work of this kind has been done previously in this country in a working-class area. The experience in Paddington should therefore be of much interest to other local authorities who contemplate doing such work during the next epidemic, which may be expected next year. Dr. A. B. Porteous, who has been in charge of this work will, we understand, deal with its technical aspects in a communication to the medical journals. "We consider this report of such importance that we have given directions for it to be circulated to the metropolitan boroughs for their information." Twenty-three deaths were attributed to measles, 5 of which occurred among children under the age of 1 year, 10 among children between the ages of 1 and 2 years, 2 among children between the ages of 2 and 5 years, and 6 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 74 under 5 years of age and 12 over 5 years of age. The number of visits paid by the nurses was 1,081 and 154 to each group respectively. Two hundred and seventeen cases received treatment in hospital. GERMAN MEASLES. As is the case with measles this disease is no longer notifiable in Paddington. In the course of the year 87 cases came to the knowledge of the Department through various sources of information. Five 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. Nineteen notifications relating to cases of purulent eye-discharge of the new-born were received during 1934. All of the patients recovered without any impairment of vision. As soon as a case of this disease is notified, intensive efforts are made by the Council's Staff to ensure that proper treatment is carried out. Daily visits are paid and private or charitable medical treatment is invariably enforced. Where necessary the infant and its mother are removed to a hospital, provision of this accommodation being ample. All necessary nursing attention is given by home visiting on the part of the Paddington and St. Marylebone District Nursing Association. In addition to true purulent discharge, 3 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 1934, 3 cases were referred to the District Nursing Association, 40 visits being paid. Eighteen cases of ophthalmia of the new-born were treated in hospitals as in-patients. 20 PUERPERAL FEVER. There were 12 cases of puerperal fever notified during 1934, all of which were removed to or nursed in a hospital. There is no difficulty in obtaining institutional treatment for women suffering from this disease. Cases of puerperal fever referred to the London County Council are usually sent to the North-Western Hospital, Hampstead, where a special ward is set aside for these cases and special medical and nursing staffs are provided. Excellent accommodation is also available at Queen Charlotte's Isolation Hospital, Hammersmith, where 4 cases, for which the Council accepted financial responsibility, received treatment during the year, the total cost amounting to £34 16s. 0d. Six 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 36 cases of puerperal pyrexia were notified, 34 of which occurred within or were removed to institutions. Two cases were nursed in Queen Charlotte's Hospital Isolation Block, at a cost to the Council of £19 19s. 0d. During the year the Council retained the services of Mr. Aleck W. Bourne, F.R.C.S. (England), Obstetric Surgeon to Out-patients, St. Mary's Hospital, to act in a consultative capacity, for cases of puerperal fever and puerperal pyrexia. No request for his assistance was made to the Council during the year. ERYSIPELAS. Sixty-six cases were notified, 37 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. Six cases of this disease, otherwise known as Infantile Paralysis, were notified and of these 5 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. CEREBRO-SPINAL FEVER. Three cases of this disease were notified in 1934. 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-five (155) cases of acute primary pneumonia were notified in 1934, as compared with 157 in 1933. Of the 155 cases, 88 were nursed in institutions. Thirty-five (35) cases of acute influenzal pneumonia were notified, as compared with 102 in 1933. Of the 35 cases, 15 were nursed in institutions. Forty-six (46) cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council's scheme for district nursing, 719 visits being paid. 21 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 1934, 41 cases of acute rheumatism were notified. This figure compares with 37 cases in 1933, 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. 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 1934 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge. In 1934, for the third year in succession, the rheumatism amongst children has been unusually mild. Such a sequence is very exceptional, and it will be of interest to see how the patients under the care of the Centre react in the event of a serious epidemic of the disease when that next appears. Probably the mildness of the disease in the year under review accounts for the small drop in the figures of the attendances at the Centre, but there is still evidence that full use is not yet made of the facilities offered. 22 Notifications.—During 1934 notifications of 41 cases were received. Sessions and Attendances.—The number of sessions held during 1934 was 42, and the total number of attendances of Paddington children amounted to 270. Twenty new cases attended for the first time during the year; of these 9 were referred to the Centre by other departments of the hospital, 6 by the Public Health service, 4 by the School Medical service, and 1 was brought by the mother of the child. Social Standard.—Of the 20 new cases seen in 1934 the home conditions were reported as comfortable in 11 cases, and poor in 7 cases; while in 2 instances the families had moved before they could be visited. Of the 18 cases visited 15 lived in dry rooms and 3 in damp ones. In these 3 cases one house was repaired, one condemned, and in the third instance the family removed. Discharges.—During the year 26 cases were discharged for the following reasons:— Removed 14 Recovered 2 Reached age limit 9 Died 1 Children are only discharged as "recovered" when they have been under observation for a long while and have kept not only free of rheumatism, but in robust health. Treatment.—The main line of treatment adopted at the Centre is the close supervision of the children and their periodic re-examination, with a view to preventing further attacks of rheumatism or of detecting fresh symptoms of the malady early. In 36 instances fresh infection was detected; in 7 cases this was of sufficient moment to require in-patient treatment, and the children were admitted to my beds in the hospital wards. Twenty-seven other cases were referred for out-patient treatment, and 2 were referred back to their own doctors for further treatment. It is impossible not to presume that in such cases as these, the Centre is really fulfilling a most useful part as tending to prevent the development of truly serious relapses amongst the children attending. Tonsillectomy.—With the opening of the new throat ward at the hospital, all children who are to undergo an operation for the removal of tonsils are now admitted. But in the case of the rheumatic children in whom valvular disease of the heart is already present, they are admitted to the medical ward and so given more prolonged pre-operative treatment and longer convalescence than would be possible in the routine of the throat ward itself. All this makes for greater safety, and in these circumstances the removal of infected tonsils, which may be of great importance, can be undertaken with a minimum of risk. In addition many letters of advice have been written to patient's doctors, and numerous reports have been sent to school doctors, headmasters and mistresses, and sanitary authorities. Arrangements for extra milk and free dinners have been made and advice on a choice of careers for the patients with heart disease is frequently given. Home Visiting.—The prompt co-operation of the Women Sanitary Inspectors has again proved most valuable. In addition to their reports on home conditions, they have helped in many other ways to aid the effectiveness of the Centre. They have made 359 visits in 1934 in connection with this work, and for all their help the Centre is most grateful. I beg to express my indebtedness to Dr. M. Llewellyn Davies for her able and willing assistance during 1934. CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. One case of dysentery was notified during 1934, but there were no cases of the other diseases included in the heading. WHOOPING-COUGH. This disease is notifiable in only three London Boroughs and not in Paddington. Since both the cause of the disease and effective means for treating it are unknown it would not appear that notification could assist very much in checking it. Whooping-cough is very infectious in the catarrhal stage, before the characteristic whoop develops, and this adds to the difficulty in dealing with the disease. In 1934, 11 persons died of whooping-cough, all being children under the age of 5 years. The number of deaths in 1933 and 1932 were 5 and 13 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 1934 45 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, 222, which occurred in Paddington last year is, however, smaller than that for any year since 1923. The numbers of deaths for previous years are shown in the list following:— Numbers of Deaths in Paddington. 1934 222 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. Two cases are not included owing to absence of information. 1934. 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 - - - - - - - - - - 4 - 6 - - - 10 — Digestive organs and peritoneum - - - - 2 2 5 1 13 4 9 6 22 19 8 16 59 48 Respiratory organs - - - - - - - - 4 1 3 4 6 1 1 2 14 8 Uterus — — — — — — — 3 — 7 — 4 — 7 — 1 - 22 Other female genital organs - - - - - - - - - - - 3 - 1 - 2 - 6 Breast - — — — - 1 — 2 — 6 — 6 — 7 - 4 - 26 Male genito-urinary organs - - - - - - — — 1 — 1 — 5 — 1 - 8 - Skin - - - - - - - - - 1 - - 1 1 1 2 2 4 Other or unspecified organs — 1 1 — — — — 1 3 1 1 — 4 — 1 5 8 — 1 1 — 2 3 5 7 21 19 18 24 40 40 11 28 98 122 INFECTIVE ENTERITIS. This disease is notifiable in some eight other metropolitan boroughs. On May 2nd, 1927, the Council made the disease known as "Infective Enteritis" or "Summer Diarrhoea," notifiable for a period of two years. This Order was made by virtue of the Public Health (London) Act, 1891, and is only applicable to children under the age of five years. It was extended in 1929 for a further period of three years. In 1932 the disease was made permanently notifiable. Seventy (70) cases of the disease were notified during the year. The number of deaths under the age of 5 years was 44, as compared with 33 in 1933, 103 in 1932, 29 in 1931, 29 in 1930, 37 in 1929, 23 in 1928, and 16 in 1927. Forty-four (44) 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 24 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 85 deaths in 1934, and from other tuberculous diseases there were 12 deaths. The number of deaths from tuberculosis of all kinds was 122 in 1932, 104 in 1933 and 97 in 1934, the latter figure creating a new low record. In recent years the numbers of deaths were as follows:— 1919 133 1927 118 1920 146 1928 116 1921 125 1929 128 1922 143 1930 114 1923 127 1931 138 1924 149 1932 122 1925 119 1933 104 1926 125 1934 97 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1934. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year — — — — — — 1— 5 years — — — 15 5 20 0—10 „ — 1 1 18 9 27 10—15 „ 3 3 6 1 4 5 15—20 „ 11 15 26 5 3 8 20—25 „ 13 19 32 1 5 6 25-35 „ 32 27 59 4 7 11 35—45 „ 19 13 32 - 3 3 45-55 „ 26 6 32 - 3 3 55—65 ,, 7 2 9 1 1 0 65 years and over 1 1 2 — — — Total 112 87 199 45 40 85 Cases re-notified 66 71 137 12 11 23 Total Notifications on Form A 178 158 336 57 51 108 Cases removed from Register:— 1934. By reason of— Death 107 Removal 271 Recovery of patient or variation of diagnosis 82 Total 460 Of the patients who removed from the Borough during 1934, the new addresses were obtainable in 115 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1934, 9 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 1934 was 1,200 as compared with 1,351 at the close of the year 1933. Visits Paid to Homes of Tuberculous Patients. By Council's Women Inspectors 916 By Tuberculosis Officers 492 By Dispensary Nurses— 20, Talbot Road 3,227 St. Mary's Hospital 2,057 6,692 2 5 Tuberculosis. New Cases and Mortality During 1934. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. 0 — - - - - - - - - 1 — - - 15 5 3 — 2 — 5 — — 1 19 9 1 — 1 2 10 — 3 3 2 4 15— 11 16 6 3 5 9 1 3 20 — 13 19 1 6 25 — 34 27 4 7 7 8 1 - 35 — 19 14 - 3 11 4 1 1 45 — 26 6 - 3 13 9 - - 55 — 7 2 2 1 8 3 - - 65 years and upwards 1 1 — — 2 2 — — Totals 114 89 49 41 50 35 6 6 Eighteen persons dying from tuberculosis during the year were not formally notified, this number being equal to 18.5 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 1934 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 1934 one shelter was lent, and one, lent in a previous year, was returned. Artificial Pneumothorax Treatment.—By arrangement with various Hospitals patients recommended for this treatment are given refills at a cost to the Council of 10s. 6d. per refill. During 1934. 21 patients received 173 refills, the total cost amounting to £90 16s. 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, 2 with partial dentures, and in 2 cases repairs to dentures were carried out. The total cost was £22 16s. 0d. Grants amounting to £8 15s. 0d. 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. Ultra Violet Light Treatment.—One patient received 12 treatments, the cost, £3, being borne by the Council. 26 Particulars of the dental work done during the year are shown in the subjoined table. Summary of Dental Treatment for the Year 1934. 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 129 20 — 12 — 5 19 70 6 6 — — 2 29 50 14 Children 149 46 3 4 — 13 35 97 — — — — 3 48 — 16 Men 28 — — 2 — 2 3 5 — — — 2 — 13 6 5 Total 306 66 3 18 — 20 57 172 6 6 - 2 5 90 56 35 Number of Sessions held=45 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 1934, 19 patients received treatment, 472 exposures being given. Arrangements are now in force for the X-ray examination of patients, through the services of a consulting Radiologist. During 1934, 112 examinations were made. The advantages of having an X-ray installation on the premises cannot be too strongly emphasized, early diagnosis being such an important factor in the prevention of tuberculosis. 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. The class is held every Wednesday afternoon. It is attended chiefly by patients from Paddington, but patients from Kensington are also received. Twelve patients are on the roll of the class and it is encouraging to note that there is an average attendance of eight. The standard of work is now very high and an increasing number of people are purchasing the gloves. On two occasions during 1934 parties of some 40 students from the London School of Hygiene attended the Dispensary, and lectures on the work and the Dispensary system were given by Dr. Harley 27 Williams, Medical Commissioner of the National Association for the Prevention of Tuberculosis and Dr. R. S. Walker, Tuberculosis Officer. The Executive Committee of the Dispensary have agreed to take Public Health students from Bedford College for Women and the College of Nursing for short courses of practical experience in tuberculosis work. Active steps are still being taken to raise funds for the erection of new premises on the land purchased in 1932 by a friend of the Dispensary. Return Showing the Work of the Dispensary During the Year 1934. 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 37 38 3 1 4 8 18 7 41 46 21 8 713 (b) Diagnosis not completed — — — — — — — — 2 2 4 8 (c) Non-tuberculous — — — — — — — — 74 188 129 190 B.—Contacts examined during the year:— (a) Definitely tuberculous 4 1 — — — — 7 5 4 1 7 5 240 (b) Diagnosis not completed — — — — — — — — 2 2 4 8 (c) Non-tuberculous — — — — — — — — 41 78 57 47 C.—Cases written off the Dispensary Register as (a) Recovered 6 5 — — 3 3 4 4 9 8 4 4 829 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 115 266 186 237 D.—Number of Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 177 159 3 2 42 71 147 102 219 230 150 104 719 (b) Diagnosis not completed — — — — — — — — 2 2 4 8 1. Number of cases on Dispensary Register on January 1st 767 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 145 5. Number of attendances at the Dispensary (including Contacts) 4,882 7. Number of consultations with medical practitioners:— (а) Personal 64 (b) Other 211 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,227 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above — 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 23 4. Cases written off during the year as Dead (all causes) 50 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 143 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 287 10. Number of (а) Specimens of sputum, etc., examined 275 (b) X-ray examinations made in connection with Dispensary work 112 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 170 28 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary and was subsidised by a grant of £1,085 from the Paddington Borough Council during the year 1934. A full account of this Dispensary and its activities will be found in the annual reports for 1924 and 1925, the only subsequent change being the transference of the Dispensary in April, 1933, from the old building to the newly-erected extension of the Hospital. During 1934, 98 refills were done in Artificial Pneumothorax cases. Tuberculin (bacillary emulsion) was successfully used in surgical cases such as epididymitis, glands and eye conditions, and one case of Bazin's disease. During the year beds were frequently placed at the disposal of the Tuberculosis Officer by the Inoculation Department of the Hospital. These were of great service in the diagnosis and treatment of patients. Return Showing the Work of the Dispensary During the Year 1934. Diagnosis. Pulmonary. Non-Pulmonary. Total. 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 18 17 1 3 4 8 7 2 22 35 8 5 135 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 19 26 9 11 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — — 1 — — — 1 46 (b) Diagnosis not completed — — — — — — — — — — — — (c) Non-tuberculous — — — — — — — — 9 14 11 11 C.—Cases written off the Dispensary Register as (a) Recovered 1 2 — — 1 1 3 3 2 3 3 3 125 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — — 30 41 21 22 D.—Number or Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 65 71 4 8 24 32 26 23 89 103 30 31 253 (b) Diagnosis not completed - - - - - - - - - — — - 1. Number of cases on Dispensary Register on January 1st 329 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 119 5. Number of attendances at the Dispensary (including Contacts) 2,635 7. Number of consultations with medical practitioners:— (а) Personal 8 (b) Other - 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 2,057 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above - 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 8 4. Cases written off during the year as Dead (all causes) 21 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 14 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 205 10. Number of (а) Specimens of sputum, etc., examined 115 (b) X-ray examinations made in connection with Dispensary work 101 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 79 29 The decrease in the number of cases on the Register of each Dispensary is largely accounted for by the fact that many patients and their families have taken advantage of the increasing opportunities to obtain better housing accommodation out of the district. A large number of patients removed to houses or fiats on the London County Council Housing Estates. The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1934 was as follows:— Representing. Paddington Borough Counoil Councillor H. Thorley. „ ,, Councillor Mrs. R. M. Drury (Vice-Chairman). „ „ 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). 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. ,, ,, ,, Miss E. M. Kerr. 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. Local Social Worker 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 £40 per annum being allocated to a member 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 Committee met on 22 occasions during the year, and the attendance of members was well maintained. Three hundred and forty-two individual cases were considered. Residential treatment was granted by the London County Council to 216 patients, 36 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, where necessary, help was sought from voluntary agencies for the patient or dependants. No funds are available in the hands of the Committee for the assistance of patients. The decision of the London County Council in July, 1934, to discontinue the assessment of cases receiving residential treatment under the Tuberculosis Scheme relieved the Care Committee of that part of their functions. Where, however, the provision of dentures or spectacles is found to be necessary during the course of residential treatment, the assistance of the Care Committee is sought in the determination and collection of an appropriate charge in each case. 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, 1 Infant Protection Visitor, 9 part-time Medical Officers, 3 part-time Masseuses, and 1 Clerical Assistant. 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 1,678 Revisits „ „ „ 6,732 8,410 Visits to children between the ages of 1 and 5 years 10,163 First visits to expectant mothers 829 Revisits „ „ 462 1,291 Other Visits— Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 351 Miscellaneous (including 4,096 ineffective calls) 13,165 13,516 The total number of children on the Health Visitors' lists at the close of the year was 5,014. 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, 1934). 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 R. 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. A further weekly session was opened on 6th April and closed temporarily on 30th November, 1934.— Friday, 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 Denny, C.S.M.M.G. (who succeeded Miss Gannon on 5th June, 1934), Miss P. Smiddy, C.S.M.M.G. (from 18th January, 1934), and Miss Suffling, C.S.M.M.G., in conjunction with the Consultative and Physical Treatment Consultation under Dr. R. Cove-Smith. 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, Monday, 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. Special arrangements for toddlers once in three months. Friday, 2.15 p.m. 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. Special arrangements for toddlers once in three months. Monday, 2.15 p. m. 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. Special arrangements for toddlers once in three months. Tuesday, 2.15 p.m. 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 and 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 1934. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Queens- boro' Passage. Totals Tues. Thurs. Tues. Fri. Wed. Thurs. Wed. Fri. Mon. Number of Sessions 51 51 51 51 50 50 50 51 49 45 Number of Attendances 2349 1512 3338 2680 2123 2229 2265 2801 2814 2211 Average Attendance 46.0 29.6 65.4 52.5 42.4 44.5 44.4 54.9 57.4 48.9 Seen by Doctor 1117 820 1447 1042 766 972 805 1145 1426 954 Average number seen by Doctor at each Session 21.9 16.0 28.3 20.4 15.3 19.4 16.1 22.4 29.1 20.9 The total number of children attending the consultations was 2,235, 880 being under 1 year of age and 1,355 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 586 474 Number of Expectant or Recently Confined Mothers who Attended 304 214 Average Attendance per Session 12.2 9.3 Number of Cases Referred by Midwives in Private Practice 15 8 Consultative and Physical Treatment Centre. Number of Attendances 2,465 Number of Cases 217 (of which 167 were new) Classification of Cases— Artificial Sunlight only 59 Artificial Sunlight and Massage 83 Massage only 45 Dietetic only 30 Treatments given— Artificial Sunlight 1,455 Massage 1,535 "The Consultative Physio-Therapeutic Centre has continued its work with regard to correction of deformities, overcoming rickets and improving the standard of nutrition amongst the children of Paddington. The work is continually needed as the standard of nutrition varies considerably in different areas, while the normal is by no means a fixed one for every child. Active lively individuals are always likely to look thinner and less well-nourished than those of more placid and lethargic dispositions. Special attention has been paid during the year to catarrhal cases and the anaemia that so often goes hand in hand with malnutrition. The response to the iron tonic ration that was instituted two years ago has been very good. Mothers are gradually beginning to realise the importance of advice on diet, but details obtained from the doctor are apt to be neglected as being too theoretical, and, although quite acquiescent to the advice, they often think that the suggestions cannot be carried 33 out with the money at their disposal. Unfortunately there is much wastage of material and misuse of money due to unintelligent shopping, bad cooking and unappetising serving of food. To improve this we hope in the near future to have a series of practical lectures on these questions from the housewife's point of view, thereby linking up the practical aspect with the theoretical requirements. "The tracking down and correction of various deformities requires constant vigilance on the part of health visitors and in addition to the cases sent up by doctors many are brought to the clinic through the health visitors, who notice the defect when visiting people in their own homes. It is this constant co-operation between various workers in the Borough that helps to carry forward the work of improving the general physique of the community.'' Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, Drugs, etc. 1,217 18 4 Sales 955 15 1 Grants from Borough Council 251 1 1 Queen Charlotte's Maternity Hospital.—During the year 1934, 126 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 10.6. As regards ante-natal consultations, exact figures are not available. During 1934 there were received into the Hospital for confinement 189 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 1934, 298 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 1934 was 109, and presumably all of these received ante-natal examination and advice, as well as the 248 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 1934, 109 confinements were attended by the nursing staff, the number of visits being 1,863. These figures compare with similar ones of 136 and 2,495 in the year 1933. 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 cr 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. 0d. 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 year, 248 women were delivered in the wards, 1 of whom died subsequently in an Isolation Hospital of Haemolytic Streptococcal Septicaemia. One case of puerperal fever and 1 of puerperal pyrexia were notified. There were 11 stillbirths, and 4 deaths within 10 days of birth. The payments made by patients admitted, or accepted for admission, to the wards amounted to £694 7s. 3d. for the year. 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 at a fee of 30s. per case. Two patients were attended, and 10s. was recovered from 1 case towards the cost. 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. Od. per case, the whole or part of the cost being recovered from the patients. During 1934, 15 cases were attended, the patients' contributions collected to the end of the year amounting to £20 11s. 6d. Maternity Consultations.—On 1 occasion the services of an obstetric consultant were requisitioned on account of complications associated with a case of parturition. Baby Hospital, Ladbroke 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 in that year. Thirty-one (31) children were admitted during the year and 1 re-admitted, the periods of treatment ranging from 22 weeks to a few days. Eight (8) deaths occurred amongst these patients. 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 12 months amounted to £4 4s. 6d. Maternity Outfits.—Supplies of Maternity Outfits have been made available for confinement at home of necessitous women. In some instances the total cost (5s. 11d.) has been repaid by the recipient, but grants have been made in most cases by the appropriate Committee towards the cost. The total amount recovered from patients during the year has been £3 13s. 6d. Beauchamp Lodge Emergency Home for Children.—In 1 instance a child was admitted for two weeks to this Home whilst the mother was in hospital. The charge, therefor, was 12s. 6d. per week towards which 3s. 9d. per week was paid by the parent. Contraceptive Advice.—In June, 1934, the Council decided that arrangements be made with the North Kensington Women's Welfare Centre for the giving of contraceptive advice to expectant and nursing mothers who are married and who are already in attendance at a maternity and child welfare centre of the Council, such advice to be given only in cases where another pregnancy would be detrimental to health. The recommendations of the medical officers of the Centres are submitted to the appropriate Sub-Committee and where considered necessary, grants towards the cost of the advice (10s. 6d.) are made. During the year 7 women were referred to the Centre for advice, the cost in each case being borne by the Council. DAY NURSERIES. At the end of the year 1934, there were two Day Nurseries in Paddington, situated at No. 66: Lancefield Street, Queen's Park, W. 10, and No. 21, Howley Place, W. 2. 35 Statistical Summary. Queen's Park. Howley Place. Full days. Saturdays. Full days. Saturdays. Days open 254 48 255 47 Attendances 5,041 731 9,228 1,287 Average attendance 20 15 36 27 New Children 29 40 Cases of Infectious Disease. Scarlet Fever 1 1 Measles 6 — Impetigo — 1 Whooping Cough - 1 There were no Closures during the Year on Account of Infectious Disease. 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 1934. 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. 36 (8) In considering an application for a supply of milk at less than cost price the "Grants" Committee to adhere to the scale of incomes set out in the Schedule appended to this Scheme. Provided that where the "Grants" Committee are of opinion that a strict adherence to the Schedule would deprive any mother or child of a supply of milk really necessary on grounds of health, the Committee may take into consideration any other facts of the case, and make their decision accordingly. No grant to be made for a period exceeding four (4) weeks. (9) Where the Medical Officer of Health certifies that an immediate supply of milk at less than cost price is necessary on grounds of health to any mother or child, he may issue an Emergency Order for such supply for a period sufficient to include the interval which will elapse before the next meeting of the "Grants'' Committee. (10) Orders for the supply of milk at less than cost price to be in the prescribed form and no payment for any such supply to be made except upon production of the receipt of supply signed by the applicant. (11) Orders for the supply of milk at less than cost price to be issued only to such dairymen or ilk 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 or children who may be in receipt of milk grants from the Council, or who, in the opinion of the Superintendent of a Centre, are unable to pay for an emergency issue deemed necessary by the Medical Officer. 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.) 37 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 stalls 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. 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 1934. (1933 figures in brackets.) The total number of cases considered by the "Grants" Sub-Committee during the year was 3,226, of which 867 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 744 (937) 579 (687) 165 (250) Dried Milk 118 (117) 118 (117) — (—) Dinners 5(2) 5(2) — (—) 867 (1056) 702 (806) 166 (250) 38 Details relating to expenditure incurred are given below:— £ s. d. £ s. d. Cost of Milk at Full Price 737 15 0 (935 11 8) Cost of Milk at Half Price 6 3 10 (6 15 9) Cost of Dried Milk at Full Price 615 0 0 (692 0 0) Cost of Dried Milk at Half Price 7 0 0 (21 0 0) Cost of Dinners 7 11 3 (12 1 3) £1,373 10 1 (£1,667 8 8) The reception into the Borough of a large number of migratory necessitous families, referred to in last year's Report, would appear to persist. Three hundred and seventy-one (371) families hitherto unknown to the Department applied for grants during the year. One hundred and forty-one (141) (38 per cent.) had been resident less than six months and, including that figure, 200 (54 per cent.) less than one year. 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 45 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 £83 1s. 10d. MATERNAL MORTALITY. During the year six 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 four 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. Miss M. E. Lockington continued to act as Infant Protection Visitor. One of the Health Visitors is appointed by the Council to act as Infant Protection Visitor during the absence from duty of Miss Lockington whilst on vacation or sick leave, and the Medical Officer of Health and two of the Sanitary Inspectors are also authorised to exercise the powers and duties of Infant Protection Visitors for special purposes. During the year 1934, 2,325 visits and inspections were made, 48 new registrations of fostermothers were recorded, 122 new infants were received, and 101 infants were removed—21 to hospital and 80 elsewhere. Six deaths were reported, 3 of which occurred in hospital. At the close of the year, the Register contained the names of 91 persons who were receiving children for reward. These persons had charge of 125 children. On account of the infirmity of a foster mother, an application was made to a Magistrate for an Order for the removal of a child from her care, pursuant to Section 67 of the Act of 1932. The Order was granted and the child removed to a Public Assistance Committee's Institution, until other arrangements could be made. For publishing an advertisement which did not truly state her residence, an offence against Section 68 of the Act of 1932, a person was summoned and fined £1. 39 ADMINISTRATION. GENERAL. Staff of the Department.—The following changes occurred during the year:— Inspectorial. Mr. C. S. Wansbrough retired from the Council's service on 1st July, from which date Mr. C. G. Heron and Mr. V. L. Ronchetti, members of the existing staff, were respectively appointed Senior Sanitary Inspector and Canal Boats Inspector. Mr. A. C. Harrison was appointed Sanitary Inspector on 24th April. Mr. L. G. Brooks was appointed Sanitary Inspector on 26th June. An additional temporary Sanitary Inspector was engaged as from 20th August in connection with the housing survey of the Borough. Health Visiting. Miss C. G. Teale and Miss N. B. May resigned their positions as Health Visitors on 18th February and 17th December respectively, and Miss E. E. Bogle retired on 21st August. Miss C. McN. Keachie, Miss G. E. Stephens and Miss N. M. Hill were appointed Health Visitors on 24th April, 26th June and 18th December, respectively. Clerical. Miss I. C. Webb, previously part-time Clerical Assistant at the Welfare Centre, was appointed to a full-time position on the permanent stafE as from 26th March. Mr. S. W. Wordingham was appointed Junior Clerk on 20th March. Prevention of Infectious Disease.—Visits of enquiry after notification of infectious disease numbered 3,449. This figure excludes visits in connection with tuberculosis, puerperal fever and pyrexia, ophthalmia neonatorum and infective enteritis, which are recorded elsewhere in this report. The removals to hospitals and other institutions for various diseases other than tuberculosis numbered 1,205. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 135 patients (comprising 86 cases of measles, 46 of pneumonia and 3 of ophthalmia neonatorum) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 1,994. Disinfection.—The rooms disinfected after infectious disease numbered 960. The weight of bedding, etc., removed for disinfection at the Wood Lane Disinfecting Station, under the agreement with the Kensington Borough Council, amounted to approximately 19¾ tons. Four hundred and seventy-four library books were disinfected. Schools.—A total of 2,982 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 2,224 of such notices referring to cases of measles and chicken-pox, and the remainder to cases of diphtheria, scarlet fever and other notifiable diseases. In addition, 295 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 suffering from tuberculosis of the lungs are undertaken by the Paddington Tuberculosis Dispensary, 20, Talbot Road. The examinations made during 1934 were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 999 60 Tuberculosis 428 55 Typhoid Fever 2 — Ophthalmia Neonatorum 2 — 40 House Drainage.—During the year 10 existing drains were tested and found water-tight, and 168 defective drains were wholly or partly reconstructed. Reconstruction Plans.—Three hundred and ninety-six (396) plans were submitted for drainage works in existing buildings. In connection therewith 921 letters were despatched. Two 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:— Westbourne Grove, Nos. 74, 76, and 76a. New blocks of flats and shops, or building, on the sites of Nos. 29 to 34 (consecutive, inclusive), Spring Street, with properties immediately at the rear, abutting on the private passageway. Leinster Square, Nos. 32 and 33. Princes Square, Nos. 6 and 7; Nos. 15 and 16. Talbot Road, Nos. 43 and 45. Westbourne Tcrrace, Nos. 134 and 136, and new garage No. 134, Westbourne Terrace Mews. New Cinema on sites numbered and known as No. 331, Harrow Road; land on the east thereof, formerly part of No. 329, Harrow Road; and No. 30, Woodfield Road. Kensington Gardens Square, Nos. 13 and 14, No. 14, Kensington Gardens Square and No. 36, Princes Square, and Nos. 35 and 36, Princes Square. Hatherley Grove, Nos. 4 and 6. Little Sussex Place, Nos. 1, 2, 3 and 3a. Porchester Terrace, Nos. 11 and 13. Sussex Gardens, Nos. 1 and 3; Nos. 13 and 15. Cerney Mews, Nos. 3, 4 and 5. New shops and flats over at Nos. 415, 417 and 419, Edgware Road. Chester Place, Nos. 6 and 7. Cleveland Square, Nos. 47 and 48. Praed Street, Nos. 138 and 140. New garage, etc., premises situate on the west side of Chepstow Mews, numbered and known as Nos. 18 (part), 20 and 22 (part), Chepstow Mews; Nos. 22 (part), 24 and 26, Chepstow Mews; and Nos. 9, 11 and 13, Chepstow Place. Gloucester Square, No. 24 and No. 36, Devonport Mews. Lancaster Gate, Nos. 45 and 46. Craven Road, Nos. 32 and 34, including portion at rear, adjacent to No. 2, Upbrook Mews. Two new shops, with living accommodation over, at Nos. 121 and 123, Edgware Road. Two new houses on the sites of stable property now numbered and known as 22 and 23, Hyde Park Gardens Mews. New blocks of flats with garage on the sites now numbered and known as 193 to 217, odd, inclusive, Queens Road. New buildings for the G.W. Railway Stationery Dept., and new hostel for the G.W. Railway Refreshment Dept., situate on the east side of Westbourne Terrace, immediately south of Westbourne Bridge. New residential flats Nos. 9 and 10, Hyde Park Terrace. Blocks of flats on the site (formerly occupied by Westbourne Mansions) at the junction of Orsett Terrace and Westbourne Bridge. New Post Office premises in Market Street. Leinster Square, Nos. 8 and 9. Sussex Gardens, Nos. 5 and 7 and 9 and 11. One combined system was reconstructed by the Council during the year. Sewer Connections.—In 1934, 26 were reconstructed, either partially or wholly, 4 after Orders under Section 85 of the Metropolis Management Act, 1855, and 22 on the application of the owners of the properties concerned. Water Supply.—Four certificates under Section 48 of the Public Health (London) Act, 1891, were issued. 41 The Metropolitan Water Board reported 20 cases of discontinuance of water supply, 19 for nonpayment of rates and 1 for non-compliance with regulations as to storage cistern. Eight of the premises were unoccupied. In 11 of the remaining cases the water supply was restored after various intervals, ranging from one day to six weeks, whilst in a further case legal proceedings were instituted and a closing order obtained, such closing order being cancelled after the water supply had been reinstated some six months later. A closing order was also obtained with regard to certain garage premises which were found to be occupied as a dwelling although devoid of water supply and sanitary conveniences. Mortuary.—Five hundred and forty-nine (549) bodies were deposited at the Mortuary, inquests being held on 440 of that number. Bodies deposited pending burial (all non-infectious) numbered 11. Three hundred and ninety-six (396) post-mortem examinations were made. Early in the year a nine-cell refrigerating chamber was installed in the Mortuary at a cost of about £326. Trade Nuisances.—Eighteen (18) complaints were received during the year, those relating to manure numbering 3. 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, 1934, there were 10 rag and bone dealers in the Borough. Smoke Control.—During 1934, 26 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 47 occasions, occupying 15 hours. Smoke of all descriptions was noted during 7½ hours, the duration of "black" smoke being only 8 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 ofiences against the bye-law as come to their notice in the course of their ordinary duties. During 1934 four prosecutions were instituted, fines ranging from 2s. 6d. to 10s. being imposed. 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. 42 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 until his retirement on the 1st July, 1934, from which date the duties were performed by Mr. V. L. Ronchetti. The following report for the year 1934 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. Eighty-three (83) canal boats were inspected during the year, the following infringements of the Acts and Regulations being discovered:— Cabins leaky 11 Cabin floors defective 3 Stoves defective 3 Boats without certificates 7 Painting of cabins required 4 Numbering illegible 1 Bulkhead defective 1 Nine 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. One case of measles was reported. No deaths were recorded as occurring among canal boat dwellers. Twenty-eight (28) children of school age were found to be living on the canal boats inspected. The total number of boats on the Register at the end of the year was 249. 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. Three boats known to be conveying house refuse from Paddington Basin 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 792 tons of mud were removed from the bed of the Basin, in addition to 535 tons which were dredged previously, a total of 1,327 tons, being some 64 tons less than that removed in 1933. 43 HOUSING. Conversions.—Section 102 of the Housing Act, 1925, and Section 84 of the Law of Property Act, 1925, empower a County Court to vary the terms of a lease or other instrument so as to enable a house to be converted into tenements, notwithstanding any restrictive covenant there may be to the contrary. Two applications under these Sections were made during the year, the premises to which they related being No. 8, Palace Court and No. 8, Porchester Gate. 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 119 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.—During the year a number of areas were surveyed in the Borough with a view to their being dealt with as clearance areas if found to be suitable for such procedure. Notice of the Council's proposals was given to the London County Council with regard to several of these areas. In the case of an area in North Wharf Road the County Council suggested that it might be extended, and that the most convenient course to adopt would be for that Council to pass the necessary resolution under Section 1 of the Housing Act, 1930, and to purchase the properties in the area, together with such adjoining premises as it might be considered desirable to acquire in order to form a suitable re-housing site, and to convey the cleared site to the Borough Council, on the basis of the actual cost, for the erection of dwellings thereon for re-housing purposes. The Borough Council, having intimated their concurrence in the foregoing suggestion, the County Council passed a resolution on the 18th December, 1934, declaring the area to be a clearance area. The following is an extract from a report made to the County Council by their Housing and Public Health Committee:— North Wharf Road Area, Paddington. The area is 1.12 acres in extent and comprises 56 houses (three unoccupied) and one shop. It lies just off Harrow Road and consists of a corner site bounded on the south and west by the curve of North Wharf Road, on the north by the rear of properties (shops and business premises) in Harrow Road, and on the east by a large garage, between properties in Dudley Street and Hermitage Street. The houses in the area are two and three storeys in height, old, worn and in a state of disrepair. There is some internal bad arrangement, but not much congestion on the site. A curious feature is two groups of one-storey cottages in the rear yards of the houses in Dudley Street and approached only through these houses. For the purpose of re-development it will be necessary to acquire certain additional lands, 0.07 acres in extent, on which the buildings are in ruins, making a total area to be dealt with of 1.19 acres. The site has the disadvantage from the housing point of view of being partially surrounded on the western and southern sides by industrial and municipal undertakings, but housing accommodation in this particular locality is greatly in demand on account of its proximity to Paddington Station and the industrial undertakings referred to. We are of opinion, therefore, that the site should be utilised for the erection of working class dwellings and we shall consider, in due course, a proposal for the transfer of the cleared site to the Paddington Metropolitan Borough Council for this purpose on the basis of actual cost. The displacement of 335 persons of the working classes is involved, all of whom are in occupation of houses in the clearance area. A Compulsory Purchase Order with regard to the area was made early in 1935 and submitted to the Minister of Health for confirmation. One area was dealt with by the Borough Council. This comprised four two-storey dwelling-houses, Nos. 69, 69a, 71 and 71a, Artesian Road, of a "back-to-back" type and situated in a cul-de-sac. They were occupied by eight families consisting of 25 persons, for whom the London County Council agreed to provide accommodation in dwellings on their Housing Estates. Formal declaration of the area as a clearance area designated the Artesian Road Clearance Area, was made by the Council on the 24th July, 1934. The resultant order (the Artesian Road Clearance Order) was duly submitted to the Minister of Health for confirmation. In consequence of the receipt of objections to the order, the Minister gave notice that a Public Inquiry would be held on the 15th January, 1935. Two other small areas came under consideration, but in view of their possible inclusion in a much larger scheme which the ground landlords proposed to undertake, action with regard thereto was postponed. At the close of the year the survey of the Borough was still proceeding. 44 Improvement Areas.—In the last report reference was made to the declaration by the London County Council of an improvement area comprising 50 houses in Clarendon Street. Bye-laws with respect thereto were made by the County Council on the 23rd January, 1934, and allowed by the Minister of Health on the 27th March. These Bye-laws impose a high standard of requirements, supplementing those enforceable under the Housing and Public Health Acts. Before the owners of the houses were called upon to carry out any re-conditioning works it was considered necessary that steps should be taken to secure the closure of basement rooms and the abatement of overcrowding. The following figures show the extent of the operations in respect of these matters:— Basement Rooms. Number closed aa unfit for human habitation— In two-roomed tenements .. .. 66 In one-roomed tenements .. .. 9 Number closed for sleeping purposes only .. 11 Number found disused .. .. .. 12 Number found unoccupied or used in conjunction with above-ground rooms and no action taken .. .. .. .. 12 Total .. 100 Number of persons found to be occupying basement rooms exclusively .. 163 Overcrowding. Number of tenements found to be overcrowded .. 31 Number of persons found to be occupying overcrowded tenements .. 185 Housing accommodation for the families to be displaced was offered by the London County Council, chiefly in flats on the Wormholt Estate. Such accommodation was accepted by 46 families, the remaining 30 families finding accommodation through their own efforts. Altogether 363 persons were displaced out of a total of 777 living in the area. Of the 363 persons, 256 were re-housed by the London County Council. Following the removal of the persons referred to in the preceding paragraphs, notices were served requiring the execution of repairs and re-decorations, and the provision of additional water-closets, sinks, water supply, food storage, cooking accommodation, artificial lighting of staircases, etc. Owing to the amount of work required to be done very few houses were completed before the close of the year. A full account of the results achieved in this area must, therefore, be reserved for a future report. Houses Unfit for Habitation.—In addition to the basement rooms dealt with in the Clarendon Street Improvements Area recorded above, action was taken with regard to similar rooms in 96 houses in other parts of the Borough, 56 rooms being closed for human habitation and 84 for sleeping purposes only. In lieu of making closing orders the Council, in 34 instances, after consultation with owners, accepted undertakings from them as empowered by Section 19 (2) of the Housing Act, 1930. Such undertakings possess the advantage of expediting procedure, whilst securing the closure of the parts of the premises to which they refer as effectively as though closing orders had been made. Undertakings that dwelling-houses or parts of dwelling-houses (other than basement rooms) would not be used for human habitation, were also accepted with regard to 13 premises. Underground Rooms.—The use of this term in this report is restricted to rooms dealt with under Section 96 of the Public Health (London) Act, 1891. Particulars of basement rooms in regard to which action was taken under the Housing Act, 1930, will be found in the preceding paragraphs. During the year special attention was given to the inspection of underground rooms which did not appear to possess the requisites specified in the above-mentioned section and therefore could not lawfully be occupied separately as dwellings. As a result of the inspections made, 145 underground rooms were discovered which did not fulfil the conditions essential for separate occupation. Not only were occupied rooms inspected for this purpose, but also any empty rooms which appeared to have been recently occupied as separate tenements. In every case a communication was addressed to the owner either calling upon him to terminate the unlawful occupation, or, where empty rooms were concerned, warning him not to re-let them except in conjunction with a room or rooms on another floor of the same house. In this way the illegal occupation of 131 of the 145 rooms above referred to was either terminated or prevented. Further action will, if necessary, be taken during the current year with regard to the remaining 14 rooms. Tenement Houses.—The number of houses on the register at the close of the year was 1,416. Inspections totalled 4,479, and legal proceedings were instituted with respect to nuisances or 45 contraventions of the Bye-laws in four instances. Particulars of the defects, etc., discovered and remedied will be found on page 46. Bye-law 17 of the Bye-laws made by the London County Council with respect to lodging-houses (i.e., houses intended or used for occupation by the working-classes and let in lodgings or occupied by members of more than one family), requires every owner of a lodging-house to provide and maintain for the use of each family by whom any part of the house is occupied, and so far as is practicable on the storey or one of the storeys in which are situate the rooms or lodgings in the separate occupation of the family— (а) Water-closet accommodation; (b) Accommodation for washing clothes; (c) Accommodation for the storage of food in a reasonably cool position with proper ventilation from the external air wherever practicable, and with protection from dust and flies; (d) Accommodation for the preparation and cooking of food; and, where reasonably necessary, and so far as practicable, the owner shall provide separate accommodation as specified in (a), (b), (c) and (d) for each such family. For the present, however, this Bye-law is applicable only to a house which is decontrolled throughout. During 1934 steps were taken to enforce the Bye-law in the case of every decontrolled tenement house which came under the notice of the sanitary inspectors in the ordinary course of their duties, notices being served with respect to 24 premises. In addition to the action thus taken, wherever there appeared to be any likelihood of an empty house being re-let in separate tenements to persons of the working classes, a letter was sent to the owner calling attention to the Bye-law. Overcrowding.—During the year 48 cases of overcrowding were discovered, 31 being in houses situated in the Clarendon Street Improvement Area (see page 44). The overcrowding was abated either by removal of the families or by re-arrangement of the occupants of the rooms in all but 3 instances; these will be dealt with during 1935. One summons was issued. This resulted in the Magistrate making an Order for the abatement of the overcrowding, which was duly obeyed. Annual Cleansing.—In consequence of the pressure of work in connection with the administration of the Housing Acts, the staff were unable to inspect, for annual cleansing purposes, more than 484 of the registered tenement houses. Notices were served for the cleansing and other work which was found to be necessary. It is anticipated that the arrears of inspection will, to a great extent, be made up during 1935. Common Lodging Houses.—There are 2 common lodging houses in Kilburn Lane and 1 (Cecil Louse) 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. During the year 59 inspections (including 12 night inspections) were made by the two Sanitary Inspectors responsible for the supervision of these houses. Two cases of infectious illness and six deaths occurred among the occupants. Housing Act: Rent Books.—-Two reports were received as to rent books not containing the required particulars. A cautionary letter was sent to each owner. Brindley Street Flats.— These flats were erected by the Council in 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 8s. 6d. and 6s. 0d. respectively for each class of tenement. Accommodation is provided for 33 persons. All tenements are occupied by families displaced from basement 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. 46 In May, 1932, the Minister of Health sanctioned the provision of a further sum of £1,500 for this purpose. No money was subscribed during 1934, the total remaining at £5,500 as at the end of 1933. Rent and Mortgage Interest (Restrictions) Acts, 1920-1933. Two applications for certificates were made, both of which were granted. In the case of a house for which a certificate was issued in 1933, 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. Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. 1934. Drain defective 6 ,, choked 22 ,, not properly ventilated or ventilating pipe defective 12 Manhole cover defective 6 Gully choked 2 Soil pipe defective 2 Water-closet defective 26 ,, choked 5 ,, without sufficient flush 1 ,, flushing apparatus defective 18 ,, foul 1 ,, improperly constructed 1 ,, accommodation insufficient 3 „ without door, door defective, or without proper fastenings 9 Rain-water pipe defective 14 ,, choked 2 Guttering defective 3 Waste pipe defective 12 ,, choked 7 ,, untrapped 24 ,, not provided or missing 8 Sink defective or not provided 44 Other drainage defects 6 Cistern defective — ,, dirty 2 ,, without proper cover or cover defective 1 Dustbin defective 132 ,, not provided — ,, insufficient 27 ,, disused and not abolished — Paving of yard or area defective 25 ,, washhouse defective 7 Premises damp 44 Rooms, etc., dirty (including staircases, washhouses, water-closets, yards, areas, etc.) 931 „ verminous 342 ,, contents, bedding, etc., dirty 22 ,, not provided with a window opening directly to the external air — Chimney smoky 5 Food cupboards not provided 2 Windows defective including cords and fastenings out of repair 213 Roof defective 114 Common staircases out of repair 17 Staircases without sufficient handrail 7 Animals improperly kept 2 Accumulation of refuse (not offensive) 11 Premises without water, or supply insufficient 36 Any other defects, etc. 63 Notices Issued. Written Intimations 343 Statutory Notices 85 Bye-law ,, 460 Notices under L.C.C. (G.P.) Acts— Verminous rooms 198 Additional taps 54 47 Items of Dilapidation for which Letters were sent to the Owners (Section 17 of the Housing Act, 1930). Wall-plaster broken, bulging, or defective 95 Matchboarding defective — Wall-paper loose 1 Skirting defective 3 Doors defective or missing 14 Locks defective 20 Ceiling plaster defective 30 Ceiling paper loose 2 Floors broken or badly worn 21 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 54 Stove settings defective 5 Flues defective 1 Hearths defective 7 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 16 Cupboard doors defective or missing and shelves missing — Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 86 Window-frames loose or defective (including oak sills worn or rotten) 27 Window-glass broken 48 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 29 Steps to front entrance or area defective 4 Bailing to area or area steps defective 1 Guard rails to addition roofs defective, broken or rotten 2 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. — Vault doors missing or defective 2 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 1,762 Inspections made 15,790 (b) Registered tenement houses inspected 484 ,, ,, 4,479 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 7 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-heading) found not to be in all respects reasonably fit for human habitation — 2 —Remedy of Defects during the Year without Service of formal Notices. Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers No record. 3.—Action under Statutory Powers during the Year. A. Proceedings under Sections 17, 18 and 23 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *135 (2) Number of dwelling-houses which were rendered fit— (a) by owners 119 (6) 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 1,433 (2) Number of dwelling-houses in which defects were remedied after service of formal notices— (a) by owners 1,467 (b) by Local Authority in default of owners — C. Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made or undertakings accepted 7 (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 or undertakings accepted 146 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit — * Informal notices. 48 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. Beeontree 11 4 6 1 — — Castelnau — — — — — — Downham 2 —_ 2 — — — Old Oak Common 37 9 18 5 4 1 Roehampton 4 — 4 — — — St. Helier 39 10 4 18 4 3 Watling 17 3 13 1 — — Wormholt 98 71 27 — — — Central Dwellings 10 4 3 2 — 1 ,, Estates 76 — 30 44 2 — 294 101 107 71 10 5 In addition to the above figure of 101 housed, 23 families were housed on the different Estates on applications submitted to the London County Council previously to 1934. This figure brings the total number of Paddington applicants housed during the year to 124. 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 521 for all Estates. (See Table No. 2.) During the year 411 new applications were accepted, and over 2,783 interviews were held. The number of Paddington families housed by direct application to the London County Council was 53. 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 1934. Table No. 2 (Housing). Estate. Number of Applications Recived. Number Housed. Waiting. Withdrawn. Refused by L.C.C. Offered, not accepted. Becontree 473 137 10 231 64 31 Castelnau 29 13 15 1 — — Downham 223 103 4 72 12 32 Old Oak Common 92 29 30 11 15 7 Roehampton 54 27 5 20 2 — St. Helier 479 86 51 284 30 28 Tottenham 34 13 12 — 5 4 Watling 658 136 63 422 22 15 Wormholt 699 263 64 329 22 21 Central Dwellings 22 7 11 4 — — ,, Estates 268 — 256 12 — — 3031 814 521 1386 172 138 The following Estates on which 584 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. The original building scheme for Becontree was completed in April, 1934, but the London County Council decided to continue building on ground which had not previously been scheduled for that purpose. 49 There is a total of 449 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 7 vacancies occurred and new tenants were admitted at once from the waiting list. On the 30th October, 1934, the Council entered into an Agreement with the London County Council in respect of the provision of re-housing accommodation for families displaced as a result of the Council's operations under the Housing Act, 1930, in connection with clearance or improvement areas, or the demolition of insanitary houses or the closing of parts of buildings by which the Borough Council shall pay the sum of £1 17s. 6d. per dwelling a year for the period of 40 years. The Agreement in the first instance to be for one year from the 1st April, 1934. In the event of a dwelling occupied by a re-housed tenant becoming vacant, the Borough Council is empowered to nominate further tenants for such dwelling for the whole of the 40 years, but not one that has been displaced by the operations of the Council under the Housing Act, 1930. The tenants must comply with and satisfy the County Council's regulations for the acceptance of tenants. During the year 36 families were provided with accommodation under this Agreement, and one dwelling was re-let to an applicant nominated by this Council. In connection with the Council's operations under the Clarendon Street Improvement Area Scheme, 46 families were displaced (21 families from basements to which closing orders or undertakings applied, 24 families to which the Area By-laws relating to overcrowding were applicable, and one family on medical grounds) and re-housed on London County Council Estates. 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 have 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. FACTORIES AND WORKSHOPS. 1934. Inspection of Factories, Workshops and Workplaces. Number of Premises. Inspections. Written Notices. Occupiers prosecuted. Factories (including factory laundries) 811 8 Workshops (including workshop laundries) 585 7 Workplaces (other than outworkers'premises) 217 — — Total 1,613 15 — 50 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 120 120 Want of ventilation 4 4 Overcrowding — — — — Want of drainage of floors 1 1 — — Other nuisances 28 28 Sanitary accommodation insufficient unsuitable or defective not separate for sexes 5 5 _ 8 8 2 2 — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 3 2 — 1 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 171 170 — 1 * 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 1933 there were 986 premises on the Register. During 1934, 38 premises were removed from the Register and 53 added, making the total at the end of the year 1,001. The Department reported to the Home Office 7 cases in which the prescribed abstract of the Factory and Workshop Act, 1901, was not displayed, and received from that Office notice of 11 workshops, 4 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 16 lists in February and 16 in August. These lists contained 220 names and addresses of which 175 were forwarded to other districts. From other districts 258 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 1,613 inspections, comprising 811 of factories, 585 of workshops and 217 of workplaces. There were 168 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 6 complaints, which comprised:— Sanitary conveniences not separate for sexes 1 Other offences 5 Bakehouses.—During the year 3 level bakehouses were opened, the total number on the Register at the end of the year being 66, of which 49 were factory bakehouses. The number of level bakehouses was 28 (14 being factories), and of underground 38 (35 being factories). At 3 premises underground bakehouses were found to be in use, contrary to the provisions of Section 101 of the Factory and Workshop Act, 1901. In 2 cases alterations were carried out, so that the baking could be done on the ground floor, whilst in the remaining case legal proceedings were instituted against the proprietor of the business. The summons, however, was dismissed on technical grounds, £2 2s. Od. costs being awarded against the Council. The bakehouses were inspected on 596 occasions during the year. RAG FLOCK ACTS, 1911 and 1928. Little, if any, rag flock is used in the Borough, and no samples were taken during the year. 51 FOOD SUPERVISION. Slaughterhouses.—There were, at the end of the year 1934, two slaughterhouses within the Borough:— 275, Edgware Road; 249, Maida Vale. There were 250 inspections made during the year. The number of animals slaughtered, so far as is known, was 3,961, comprising 200 bullocks and 3,761 sheep, an increase of 16 bullocks and 76 sheep as compared with 1933. 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. Tuberculosis 4 4 4 4 1 — — — — Actinomycosis 6 6 — 6 — — — — — Abscess — — 10 — — 1 2 2 2 Distomum Hepaticum — — 2 74 — — — — — Parasitic Invasion — — 10 — — — 611 151 65 Pentastomum Denticulatum — — — — 2 — — — — 10 10 26 84 3 1 613 153 67 Total weight, 2,549 lbs. A lamb carcase and pieces of meat, weighing in all 106 lbs., were also destroyed for various reasons. 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 1934 the number of carcases was 96. On examination it was found necessary to destroy 12 heads and offal, weighing 268 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. Licences were granted 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 4,420 head of poultry were slaughtered. Unsound Food.—No proceedings were necessary in regard to food unfit for human consumption. Food Purveyors.—At the end of the year there were some 887 purveyors of food in the Borough, classified as follows:—Butchers 84, Fishmongers 26, General 68, Grocers 117, Fried Fish 37, Refreshments 130, Confectioners 123, Greengrocers 108, Milk 129, Provision 65. In addition to the above, there were at the end of 1934 74 licensed Street Traders selling food within the Borough, namely:—Fruit and Vegetables 50, Ice Cream 10, Light Refreshments 10, 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. There were 7 premises on which fish curing was performed, this business, as well as fish frying, being regulated by special bye-laws. The number of visits of inspection paid to premises occupied by food purveyors was 2,259. 52 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 155 premises. Ice Cream.—There were 178 shops at which ice cream was known to be sold, comprising the following kinds of businessesBakers 9, General 26, Milk 12, Confectioners 79, Refreshment 44, Wholesale 4, Newsagents 2, Greengrocer 1, Fancy Goods 1. One hundred and sixty-one (161) 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 1934 there were 148 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 4 tons 10 cwts. 3 qrs 3 lbs., comprising the following varieties:—Meat and Offal, 3,058 lbs. ; Fish, 242 lbs. ; Bacon, 150 lbs. ; Tinned Goods, 4,256 lbs. ; Poultry, 24 lbs. ; Fruit, 2,352 lbs. ; Jellies (30 packets), 15 lbs.; Cauliflower, 10 lbs. ; Lobster, 60 lbs. Dairies and Milkshofs.—At the end of the year 1933 there were 127 names on the Register. During the year 1934 3 names were added and 2 removed, making a total of 128. Twelve of these businesses were transferred to new proprietors. There were 333 inspections made. In addition to the above-mentioned, there are 31 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 100 premises. Milk (Special Designations) Order, 1923. The licences issued by the Council during the year in pursuance of this Order numbered 109, but of these 7 were issued consequent upon changes of ownership of businesses. The number of licences in force at the end of the year was 102, comprising 10 for "Certified" milk, 29 for "Grade A (Tuberculin Tested)" milk, 3 for "Grade A (Pasteurised)" milk, and 61 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, 2 for pasteurising establishments. The samples taken by the Council's Inspector numbered 33, comprising 10 of "Certified" milk, and 23 of "Pasteurised" milk. The samples included 9 of "Pasteurised" milk taken at Paddington Hospital, and 2 of "Pasteurised" milk taken at Schools. Three samples of ' 'Certified'' milk were reported not to comply with the appropriate bacteriological standards. A communication was addressed to the vendors concerned. 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, 15 (2.5 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 3.1 per cent. in 1933 and 3.0 per cent, in 1932. Thirty-five of the samples were taken on Sundays and Bank Holidays. All were reported to be genuine. Fifteen samples of milk and 4 of skimmed milk were taken at Paddington Station on delivery by rail. All were reported to be genuine. Fifteen samples of milk were obtained at Paddington Station at the request of other Boroughs. 53 Sampling of Milk Supplies to Public Institutions.—There are 11 institutions and 18 Schools from which samples of milk arc taken periodically. Thirty samples were taken during 1934, 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 1934, 8 samples were taken for chemical analysis, 1 of which was reported to be deficient in fat to the extent of 25.33 per cent. A warning letter was sent to the vendor. 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. Two informal samples of jam were found to contain respectively 15 parts and 100 parts per million of sulphur dioxide in excess of the Regulations. No action was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year 2 samples of full cream unsweetened, 3 of full cream sweetened, and 7 samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. Two samples of dried milk were taken during 1934 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 1934, 2 samples of ice cream mix were submitted for special examination. In each of these the coliform bacillus was absent in 1 c.c. 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 58. 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, 1934. Average Monthly Figure for Percentage. Fat Content and Non-Fatty Solids. January 3.90 8.90 February 3.58 8.80 March 3.53 8.78 April 3.70 8.73 May 3.52 8.85 June 3.51 8.72 July 3.46 8.59 August 3.56 8.66 September 4.27 8.88 October 3.87 8.69 November 4.02 8.84 December 3.81 8.66 Average for Year. Samples taken at Paddington Station 3.45 8.72 ,, ,, elsewhere 3.67 8.74 54 Samples Submitted to Public Analyst—1934. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 3 — — — — Ammoniated Quinine Capsules — 2 — — — — Aspirin Tablets — 1 — — — — Baking Powder — 2 — — — — Bicarbonate of Soda — 1 — — — — Boracic Ointment — 2 — — — — Bread 7 — — — — — Bread and Butter (cut) — 6 — 1 — 16.66 Butter — 14 — — — — Cake — 5 — — — — Calomel Ointment — 1 — — — — Camphorated Oil — 1 — — — — Carbolic Powder — 3 — — — — Cascara Tablets — 1 — — — — Cheese — 2 — — — — Chicken Broth Cubes — 1 — — — — Chocolate — 2 — — — — Cocoa — 5 — — — — Cod Liver Oil Capsules — 1 — — — — Coffee — 9 — — — — Coffee and Chicory — 2 — — — — Coffee and Milk — 1 — — — — Cream — 17 — — — — Custard Powder — 3 — — — — Dried Fruit — 7 — — — — Dripping — 3 — — — — Essence of Coffee and Chicory — 2 — — — — Fish Paste — 4 — — — — Flavourings — 5 — — — — Flour — 4 — — — — Fruit Beverages — 2 — — — — Fruit Powder Crystals — 4 — — — — Gin 6 5 1 4 16.66 80.00 Glycerin — 2 — — — — Glycerin, Lemon and Ipecacuanha — 1 — — — — Golden Syrup — 1 — — — — Honey — 4 — — — — Ice Cream — 8 — — — — Iodine Ointment — 1 — — — — Iodised Salt — 2 — — — — Jam 1 7 — 2 — 28.57 Lamb Tongues — 1 — — — — Lard — 4 — — — — Lemonade Powder — 1 — — — — Liquid Eggs 4 — — — — — Malt Vinegar — 1 — — — — Margarine — 3 — — — — Marmalade — 1 — — — — Meat Paste — 5 — — — — Meat Yeast Drink — 1 — — — — Milk 270 3 4 1 1.48 33.33 Milk, Full Cream, Dried — 2 — — — — Milk, Full Cream, Sweetened Condensed.. — 3 — — — — Milk, Full Cream, Unsweetened Condensed — 2 — — — — Milk, Separated 4 — — — — — Milk, Skimmed, Sweetened Condensed .. — 7 — — — — Mincemeat — 6 — — — — Mint Sauce — 1 — — — — Mustard — 4 — — — — Mustard Sauce — 1 — — — — Olive Oil — 4 — — — — Orange Wine — 1 — — — — Pepper — 6 — — — — Pickles — 3 — — — — Port — 5 — — — — Potted Mussels — 1 — — — — Potted Shrimps — 1 — — — — Prepared Chocolate — 1 — — — — Preserved Ginger — 2 — — — — Pudding Mix — 1 — — — — Rice — 2 — — — — Sago — 2 — — — — Salad Cream — 2 — — — — Salad Oil 2 — — — — Sausages 17 - - —- - — Semolina - 2 - —- - — Sponge Fingers — 1 — — — — Stout — 2 — — — — 55 Samples submitted to Public Analyst—1934—continued. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Suet — 2 — — — — Suet with Flour — 3 — — — — Sugar — 2 — — — — Sulphur Ointment — 1 — — — — Sweets — 2 — — — — Tapioca — 2 — — — — Tea — 2 — — — — Tincture of Iodine — 5 — — — Tinned Beans — 1 — — — Tinned Fish — 7 — — — — Tinned Fruit — 7 — — — — Tinned Meat and Vegetables — 2 — — — — Tinned Peas — 3 — — — — Tinned Soup — 1 — — — — Tinned Tomatoes — 5 — — — — Tomato Purée — 4 — 1 — 25.00 Vinegar 2 1 — 1 — 100.00 Whisky — 5 — — — — White Precipitate Ointment — 1 — — — Wild Duck Paste — 1 — — Zinc Ointment — 1 — — — — 311 289 5 10 1.61 3.46 600 15 2-50 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; Honey; Asparagus; Horseradish; Beef; Hothouse Grapes; Blackcurrants; Jam; Bottled Fruits; Kidney and Runner Beans; Bottled Vegetables; Leeks; Broccoli; Loganberries; Brussels Sprouts; Malt Extract and Malt Flour; Bunched Carrots; Mushrooms; Cabbage Greens and Cabbages; Natural Rhubarb; Cabbage Lettuce; Parsnips; Canned Fruits; Pears; Canned Vegetables; Plums; Carrots; Potatoes; Cauliflower; Radishes; Celery; Raspberries; Cherries; Red Beet; Cheshire Cheese; Red Currants; Cider; Ripe Onions and Shallots; Dressed Poultry; Salad (Spring) Onions; Eggs; Stilton Cheese; Forced Rhubarb; Strawberries; Glasshouse-grown Tomatoes and Cucumbers; Turnips and Swedes; Gooseberries; Watercress; Green Peas; 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. Eight samples of canned fruit and vegetables were procured during the year comprising strawberries 1, blackcurrants 1, peas 2, plums 2, loganberries 1, raspberries 1. All were found to comply with the regulations applicable. 56 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; Bacon and Ham; Honey; Maize Starch; Fresh Apples; Frozen Mutton, Lamb, Pork, Beef Raw Tomatoes; and Veal; Currants, Sultanas and Baisins; Edible Offals. Eggs in shell and Dried Eggs; Dead Poultry; Oat Products; Chilled Beef; Malt Products; Boneless Beef and Veal; Salmon and Sea Trout. Salted Beef and Pork; The following purchases were made with a view to ascertaining whether the requirements of the Orders had been complied with, viz. :—Honey 4, Butter 14, Apples 5, Tomatoes 5, Sultanas 5, Currants 5, Raisins 5. Oat products 5. 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. As yet no premises in the Borough have been registered under the Act for the manufacture or sale of Artificial Cream. 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 88 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 5th to 10th November inclusive. The usual circular letter was sent out to principal wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Fifty (50) 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 349 premises, the verminous rooms numbering 661. 57 The owners of 83 premises accepted the Council's offer with regard to the spraying of infested rooms with a special vermicidal solution, 139 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 two cases orders of the Court were obtained for the removal of elderly persons to the Paddington Hospital. Several other cases were dealt with by means of persuasion. LEGAL PROCEEDINGS, 1934. The results of the Summonses taken out during the year are summarised in the following tables:— Premises. Offence. Fine. Costs. Public Health (London) Act, 1891. Section: 4. £ s. d. 1, Albion Mews East Garage premises, occupied as a dwelling, without a water supply Closing Order made by Magistrate — 12, Chippenham Mews Roof defective, walls and ceilings of back room, kitchen and water-closet dirty and dilapidated Orders made for requisite work to be executed' in 21 days 0 6 0 39, Clarendon Street Roof defective Work done. Summons withdrawn — 138, Harrow Road Failing to reinstate water supply Order made for water supply to be reinstated forthwith — " " Failing to reinstate water supply as required by Magistrate's Order £2 — " " Failing to reinstate water supply Closing Order made by Magistrate — Bye-laws Pursuant to Above and Other Acts. 56, Clarendon Street Constructing a waste-pipe so as to discharge in a manner contrary to the Bye-laws 10s. Defective work remedied 0 10 6 29, Cornwall Road Failing to cleanse water storage cistern Summons dismissed under Probation of Offenders' Act 0 2 0 405, Edgware Road Failing to give notice of intention to execute sanitary work 10s. 0 10 6 " " Constructing a sink with an untrapped waste- pipe 10s. — " " Constructing the waste-pipe from such sink so as to discharge in a manner contrary to the Bye-laws 10s. — 82, Lancefield Street Failing to abate overcrowding of two anterooms on first floor Order made for overcrowding to be abated — 114, Ledbury Road Staircase defective Work done. Summons dismissed under Probation of Offenders Act 0 2 0 15, Northumberland Place Failing to amend defective water-closet £2 0 10 6 181, Sutherland Avenue Dustbin in a defective condition New dustbin provided 1 1 0 4, Warrington Gardens Failing to give notice of intention to execute sanitary work 5s. 0 10 6 57, Woodchester Street Absence of means for carrying off waste water from upper tap, sashcord of upper staircase window broken Work done 2 2 0 - Collecting offensive refuse during prohibited hours £1 — London County Council (General Powers) Act, 1922. Section 10. 114, Ledbury Road Second floor front and back rooms verminous.. £1 0 10 6 58 Food and Drugs (Adulteration) Act, 1928. Offence. Fine. Costs. £ s. d. Selling whiskey containing 14.37 per cent. excess water Summons dismissed under Probation of Offenders Act 5 5 0 Selling milk 26.33 per cent. deficient in fat Summons dismissed under Probation of Offenders Act 1 1 0 Milk and Dairies Order, 1926. Offence. Fine. Costs. Bottling milk on the public highway £1 — Factory and Workshops Act, 1901. Section 101. Address. Offence. Fine. Costs. 127, Queens Road Illegal occupation of underground bakehouse Summons dismissed Council ordered to pay £2 2s. 0d. costs. OFFICE (CLERICAL) WORK. 1934. Letters received 5,976 ,, despatched 9,147 Entries in Postage Book 14,342 Certificates dealt with relating to Notifiable Diseases 2,360 Notices sent re above 7,015 Entries in Birth Register 2,209 Complaints received 1,960 Plans dealt with 374 New openings in Journals 400 Disinfection Orders 1,014 Notices to abate nuisanoes, etc 875 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. 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 1934 1,521 27 1,735 14,028 4 164 61 66 3487 9 741 139 54 23 — 16 9 25 642 7 76 983 8 19 226 2 23 1