M AC 4349 PAD 36 Metropolitan Borough of paddington. REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1936. 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 THE BOROUGH OF PADDINGTON FOR THE YEAR 1936. 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. 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 1936 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good and the improvement in infantile mortality, which was evident in the previous year, was maintained. This improvement is shared with the rest of London, but there can be no doubt that the activity of the Council in maternity and child welfare matters, in dealing with a large number of unhealthy basement rooms, and in many other directions, is now bearing fruit. Some evidence of the increased vigour of the present generation of children is afforded by the course of the measles epidemic which occurred during the year. This epidemic spent itself without causing more than nine deaths, a small number compared to what might have resulted under former conditions. The overcrowding survey of the Borough was completed during the year and the results are fully recorded in the Report. The survey of clearance areas was on its way to completion at the end of the year. The Public Health (London) Act, 1936, which came into operation in October last, has done much to simplify the law relating to public health in London. I have again to express my appreciation of the loyal help of the staff of the Public Health Department of the Council and to thank the members of the Public Health, Maternity and Child Welfare, and Special Housing Committees for the support and kind consideration which they have extended to me during the past year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, G.E. Oates. M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W.2. 12th July, 1937. 4 PUBLIC HEALTH OFFICERS (on December 31st, 1936). (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. J. McKail, M.A., M.B., B.Ch. R. Cove-Smith, M.A., M B.. B.Ch., M.R.C.P. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., *E. Dorothy Fenwick, M.R.C.S., L.R.C.P. L.R.C.P. A. S. Hall, M.R.C.S., M.R.C.P. (Resigned C. T. Potter, M.D., M.R.C.P. April, 1936.) Joyce R. Simpson, M.A., B.Ch., M.B., D.P.H. H. Hodge, M.B., B.Ch. J. Thoresby-Jones, M.D., L.R.C.P., M.R.C.S. * Also of Westbourne Day Nursery. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.I.C. Public Vaccinators, P.T. S. Denovan Adam, M.R.C.S., L.R.C.P. (For Borough, excluding Paddington Hospital.) W. J. Gill, M.D., M.B., Ch.B., F.R.C.S.(Ed.) (For Paddington Hospital.) Deputy Public Vaccinator, P.T. F. A. Bryning, M.B., B.S.(Lond-), M.R.C.S., L.R.C.P. (For Paddington Hospital.) Vaccination Officer, P.T. T. E. Rainger. Clerical Staff. T. F. Dunning (Chief Clerk). H. J. Parker (Class 4). H. Ewings (Class 1). S. W. Wordingham (Class 4). A. J. O. Sheppard (Class 1). I. D. Clarke (Class 6). R. I. Fisher (Class 1). Two Temporary Clerks. C. T. Wyatt (Class 3). T. E. Rainger (Class 1, P.T., and Vaccination R. H. Davis (Class 4). Officer, P.T.). C. H. F. Drake (Class 4). I. C. Webb (Miss), (Clerioal Assistant, Welfare Centre) Sanitary Inspectors, W.T. (In order of seniority.) C. G. Heron (2), (3). A. J. Fisher (2). V. L. Ronchetti (2), (3), (4), (5). (Also Canal A. C. Harrison (2), (3). (Food and Shops.) Boats and Child Protection.) F. L. Barker (2), (3). E. B. Wilde (2), (3), (4), (5), (10). Also Bake- J. S. Ackerman (2), (4). houses, Common Lodging Houses and Child J. J. Atkinson (2), (3). Protection.) G. Duncan (2), (3), (4). F. J. Pallet (2), (3). (Meat and Food.) A. J. Shelley (2), (3). E. Marshall (2), (3), (4), (5). Three Temporary Inspectors. H. D. Bailey (2), (3), (4). Women Sanitary Inspectors, W.T. (In order of seniority.) Miss D. M. Newhall (1), (2), (7), (8), (9). Miss E. Z. Amor (2), (6), (7), (8), (9). Health Visitors, W.T. (In order of seniority.) Miss E. A. S. Davies (7), (8). (Superintendent.) Miss N. M. Hill (7), (8), (9). (Also Maternity Wards Miss F. E. Stammers (8), (9). Almoner.) Miss E. M. Sells (9). Miss M. A. MacLean (7), (8), (9). (Also Child Miss H. Waite (7), (8), (9). Protection Visitor.) Miss E. C. Jackson (7), (8), (9). Miss H. S. Beattie (7), (9). Miss P. E. Blake (7), (8), (9). Miss D. K. Newington (7), (8), (9). Miss G. E. Stephens (6), (7), (8), (9). Masseuses P. T. Miss M. Denney, C.S.M.M.G. Miss P. Smiddy, C.S.M. M. G. Miss E. M. Suffling, C.S.M. M.G. Westbourne Day Nursery (Resident Staff). Miss D. Knott (7), (8). (Matron.) Miss E. Johnson (Staff Nurse). Miss G. Johnson (Junior Staff Nurse). Five Probationers. (Also Handyman, Cook, Housemaid, etc.) Mortuary Keeper. J. T. Lawson. Assistant Mortuary Keeper. L. W. J. Spears. Disinfectors. G. Cox. F. Webber. (1) Sanitary Inspector's Certificate, Royal Sanitary Institute. (2) ,, ,, ,, Sanitary Inspectors'Examination Board, or Royal Sanitary Institute and Sanitary Inspectors' Eaxmination 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. 5 CLINICS, TREATMENT CENTRES, ETC. Matebnity and Child Welfabe. Address. By whom provided. Ante-natal Consultation Centres.. 232, Harrow Road Paddington School for Mothers. St. Simon's Hall, Macroom Road ,, ,, ., St. Mary's Hospital, Cambridge Place. St. Mary's Hospital. Infant Consultation Centres *232, Harrow Road Paddington School for Mothers. *St. David's Church Hall, St. Mary's Terrace ,, ,, ,, *Congregational Institute, Third Avenue ,, ,, ,, *St. Simon's Hall, Macroom Road .. ,, ,, ,, Christ Church Parochial Church House, Queensborough Passage ,, ,, ,, "Toddlers" Centre 232, Harrow Road ,, ,, ,, Consultative and Physical Treatment Centre *232, Harrow Road ,, ,, ,, * Two sessions weekly. Day Nurseries "Westbourne," St. John's House, Great Borough Council. Western Road "Paddington," 21, Howley Place . Voluntary Association. "Queen's Park," 66, Lancefield Street.. Voluntary Association. Maternity Wards St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Diphtheria Immunisation. Clinics . † 232, Harrow Road Paddington School for Mothers. †St. Mary's Hospital, Cambridge Place St. Mary's Hospital. † One session weekly. TubeRculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensary St. Mary's Hospital, Cambridge Place. St. Mary's Hospital. Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. 6 SUMMARY OF VITAL STATISTICS. 1936. 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 1936 139,200 Density of population per acre 102 Number of inhabited houses (end of 1936) according to Rate Books 21,392 Marriages 1,810 Total. Males. Females. Live Births (Legitimate 1,663 795 868) Birth-rate per 1,000 of the estimated (Illegitimate 258 141 117) resident population 13.80 Stillbirths 74 42 32 Stillbirth-rate per 1,000 total (live and still) births 37 Deaths 1,783 844 939 Death-rate per 1,000 of the estimated resident population 12.81 Percentage of total deaths occurring in public institutions 59.5 Rate per 1,000 total Deaths from Puerperal Causes. (live and still) births Puerperal Sepsis 5 2.50 Other Puerperal Causes 5 2.50 Total 10 5.00 Deaths of Infants under 1 year of age 139 Death Rate of Infants under 1 year of age— All infants per 1,000 live births 72 Legitimate infants per 1,000 legitimate live births 71 Illegitimate infants per 1,000 illegitimate births 81 Deaths from Cancer (all ages) 271 ,, Measles (all ages) 9 ,, Whooping Cough (all ages) 3 ,, Diarrhoea (under 2 years of age) 31 ,, Pulmonary Tuberculosis (all ages) 66 ,, All forms of Tuberculosis (all ages) 76 Death-rate from Pulmonary Tuberculosis, per 1,000 of the estimated resident population 0.47 Tuberculosis death-rate (all forms), ,, ,, ,, ,, .. 0.55 Rateable Value £1,823,582 Product of a Penny Rate £7,033 7 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 Births. Deaths at All Ages. Deaths under One Year. Estimated Population.* Registered Locally. Transfers. Nett. Registered Locally. Gross Mortality. Transfers. Nett. Registered Locally. Nett. Out. In. Totals. Rates. Out. In. Totals. Mortality. Number. Mortality Totals. Mortal ity. 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 1935 138,600 2,038 547 473 1,964 14.17 1,623 11.71 543 595 1,675 12.08 154 75 140 71 1936 139,200 2,053 640 508 1,921 13.80 1,807 12.98 606 582 1,783 12.81 160 78 139 72 * Registrar-General's estimates of resident population. POPULATION. Estimated Population.—The resident population of the Borough at the middle of 1936 was estimated by the Registrar-General to be 139,200 persons, 600 more 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 1936 quoted in this report are based on these figures. The Borough 139,200 Wards— Queen's Park 13,083 Harrow Road 24,467 North Paddington Maida Vale 22,357 66,830 Town 6,923 Westbourne 24,254 Church 16,644 Lancaster Gate, West 9,506 V South Paddington Lancaster Gate, East 9,530 72,370 Hyde Park 12,436 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,810 marriages were solemnized in the Borough during 1936, being a rate of 26.0 persons per 1,000 of the population. BIRTHS. The number of births registered in the Bo rough during 1936 was 2,053. From this total it is necessary to deduct 640 births which occurred to residents of other localities, and to add 508 births which occurred to Paddington residents outside the Rorough. The corrected total of 1,921 births thus obtained is equal to a rate of 13.80 per 1,000 of the population. Of the 1,921 births, 936 were those of males and 985 those of females, and of these 141 males and 171 females were illegitimate. 8 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:— 1936. Birth-rates. No. of Births. Birthrates. 1935 1934 1933 1932 1931 England and Wales 605,659 14.8 14.7 14.8 14.4 15.3 15.8 London 56,273 13.6 13.3 13.2 13.2 14.3 15.0 Paddington 1,921 13.80 14.17 13.70 13.41 13.76 14.79 Wards— Queen's Park 127 9.70 10.36 11.94 10.94 10.67 9.46 Harrow Road 413 16.88 18.76 17.01 17.44 14.89 15.32 Maida Vale 316 14.13 13.20 12.91 12.15 12.87 14.79 Town 135 19.50 19.00 17.98 17.28 18.20 18.19 Westbourne 435 17.93 18.22 16.09 15.73 16.70 17.58 Church 279 16.76 17.44 16.57 18.39 21.55 23.81 Lancaster Gate, West 68 7.15 5.70 6.91 5.67 6.32 5.93 Lancaster Gate, East 53 5.56 4.43 5.12 4.94 4.17 8.31 Hyde Park 95 7.64 9.85 10.81 9.38 10.83 11.17 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 1931-1935 13.96 1936 13.80 Illegitimate Births.—These were 258 in number, or 13.01 per cent of the total number of live 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 LIVE BIRTHS. Ward. Rate. Queen's Park 4.72 Harrow Road 6.77 Maida Vale 14.56 Town 17.03 Westbourne 15.86 Church 12.90 Lancaster Gate, West 19.12 Lancaster Gate, East 22.64 Hyde Park 26.31 Stillbirths.—During 1936, 86 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 31 occurred to residents of other localities. On the other hand 19 stillbirths occurred outside the Borough to Paddington residents. The net number for the Borough was therefore 74, a figure equivalent to 3.7 per cent, of the total births recorded. Of the 74 stillbirths, males numbered 42 and females 32, 5 of the males and 3 of the females being illegitimate. 9 Births in Institutions. Local— Legitimate. Illegitimate. Total. Residents. Non-residents. Residents. Non-residents. Residents. Non-residents. Paddington Hospital 360 76 110 43 470 119 St. Mary's Hospital 276 308 4 3 280 311 Lock Hospital 7 14 2 31 9 45 Outlying (Paddington residents) Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 172 10 182 Other Hospitals and Maternity Homes 74 19 93 Public Assistance Committees' Institutions 76 30 106 Notification of Births.—Section 255 of the Public Health (London) Act, 1936, requires 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 2,003 live births were notified to the Medical Officer of Health. There were also 87 stillbirths notified. Of the 2,090 living and stillbirths notified, 66.7 per cent, were notified by medical practitioners, 22.1 per cent, by midwives, 0.7 per cent, by parents, and 10.5 per cent, by maternity assistants or other persons. A comparison of the Notification Register with the returns supplied by the local Registrars of Births shows that 98.5 per cent, of the live births and 98.5 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 no instance did the Maternity and Child Welfare Committee consider it necessary to institute legal proceedings. DEATHS. The number of deaths registered during the year as having taken place in the Borough was 1,807. Of these, 606 were of persons whose residence was not in Paddington, 533 dying in Paddington institutions and 73 in other places in the Borough. There were also reported to the Registrar-General 582 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the net number of deaths for Paddington as 1,783, making an annual death-rate of 12.81. The Registrar-General has 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 12.81 per 1,000 persons for the year 1936, gives an adjusted death rate of 12.68 per 1,000 persons. 1936. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhoea & Enteritis January 25th 3 19 2 10 20 3 February 22nd — — — — 10 22 2 6 21 5 March 21st — — 1 1 8 22 1 8 13 4 April 18th 3 — 1 — 8 18 2 5 10 3 May 16th 3 — — 1 1 17 2 4 8 2 June 13th — — 1 1 3 16 1 2 5 4 July 11th 1 — — — 6 15 — 2 4 2 August 8th — — — — 6 21 — 1 3 2 September 5th — — — 1 2 20 — 1 2 I October 3rd 1 — — — 3 31 — — 6 4 October 31st 1 — — — 4 23 1 5 4 2 November 28th .. — — — 1 5 25 2 2 8 1 December 31st — — — — 7 19 6 10 7 — Totals 9 — 3 5 66 268 19 56 120 33 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. 10 Deaths of Residents of the Borough 1936. 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 844 939 1783 81 58 7 9 3 6 16 8 22 18 39 38 41 56 92 91 167 118 217 222 159 315 Typhoid and Paratyphoid Fevers 1 1 2 — — — — — — — — — — 1 1 — — — — — — — — — — Measles 4 0 9 — — 3 4 — — — — — 1 — — — — — — 1 — — — — — Scarlet Fever 1 1 — — — — — — — — — — — — 1 — — —— — — — — — Whooping Cough 2 1 3 — 1 — — 1 — 1 — — — — — — — — — — — — — — — Diphtheria 1 4 5 — — — — — 3 I 1 — — — — — — — — — — — — — — Influenza.. 8 11 19 — — — — — — 1 — 1 — — — 1 — — — 2 1 2 3 1 7 Encephalitis Lethargica 2 1 3 — — — — — — — 1 — — — — — — 1 — — 1 — — — Cerebro-spinal Fever 3 1 4 2 — — 1 — — — — 1 — — — — — — — — — — — — — Tuberculosis of Respiratory System 41 25 66 — — — — — — — — 5 6 10 6 6 4 8 3 5 4 7 1 — 1 Other Tuberculous Diseases 6 4 10 1 — — — — — 1 — 2 1 1 — — 1 — 1 — — 1 — — 1 Syphilis 3 2 5 — — — — — — — — — — — — 1 1 1 — 1 1 — — — — General Paralysis of the Insane, Tabes Dorsalis 9 1 10 — — — — — — — — 1 — — 1 — 3 1 2 2 — — —_ Cancer, Malignant Disease 114 157 271 — — — — — — — 1 — 1 3 4 6 9 17 30 34 28 37 47 17 37 Diabetes 9 11 20 — — — — — — 1 — — — 1 — — — — 1 2 3 3 4 2 3 Cerebral Haemorrhage, etc. 30 48 78 — — — — — — — — — — — — — 5 2 6 8 11 16 10 4 16 Heart Disease 241 272 513 — — — — — — 1 — 2 — 4 4 7 11 22 11 50 28 78 67 77 151 Aneurysm 3 12 15 — — — — — — — — — — — 2 — 1 1 3 2 1 — 3 — 2 Other Circulatory Diseases 29 48 77 — — — — — — 1 — — — — — — — 1 3 6 6 10 14 11 25 Bronchitis 26 33 59 4 2 — — — — — — 1 — — 1 2 4 3 — 3 2 8 9 5 15 Pneumonia (all forms) 60 64 124 12 11 1 3 — — — — — — 2 6 3 4 8 4 14 4 10 16 10 16 Other Respiratory Diseases 8 13 21 — — — — — — — — — — 1 — 1 1 2 1 — 3 2 6 2 2 Peptic Ulcer 16 1 17 — — — — — — — — — — — — 2 — 3 — 5 — 4 — 2 1 Diarrhoea, etc. 16 20 36 15 15 1 — — — — — — — — 1 — — — 1 — 1 — 1 — 1 Appendicitis 7 6 13 — — — — 1 2 1 2 1 — 1 — — — 2 1 — 1 — — 1 — Cirrhosis of Liver 4 3 7 — — — — — — — — — — — — — 1 1 1 — — 1 I 2 — Other Diseases of Liver, etc. 2 6 8 — — — — — — — — — — — — 1 2 1 2 — 2 Other Digestive Diseases 12 19 31 2 1 — — 1 — 2 1 — — — 2 — 1 2 2 2 1 2 7 1 4 Acute and Chronic Nephritis 24 22 46 — — — — — — — — 1 1 1 — — 1 1 3 7 5 7 7 7 5 Puerperal Sepsis — 5 5 — — — — — — — — — 1 — 4 — — — — — — — — — — Other Puerperal Causes — 5 5 — — — — — — — — — 2 — 2 — 1 — — — — — — — — Congenital debility, Premature Birth, Malformations, etc. 33 23 56 33 23 — — — — — — — — — — — — — — — — — — — — Senility 3 8 11 — — — — — — — — — — — — — — — — — — 2 3 1 5 Suicide 27 13 40 — — — — — — — — 1 2 5 — 3 4 5 4 8 1 4 1 1 1 Other Violence .. 29 26 55 2 3 — 1 — I 4 1 2 1 4 2 1 — 3 1 2 3 6 2 5 11 Other defined diseases 70 66 136 10 2 2 — — — 2 2 2 2 5 3 6 6 7 13 13 12 13 18 10 8 Causes ill-defined or unknown 1 1 2 — — — — — — — — 1 — — — — — — — — — — — — 1 11 The following table shows the death-rate during each of the last six years in England and Wales, in London, in Paddington, and in each of the wards of the Borough:— 1936. Death-rates. No. of Deaths. Deathrates . 1935 1934 1933 1932 1931 England and Wales 495,798 12.1 11.7 11.8 12.3 12.0 12.3 London 51,142 12.3 11.4 11.9 12.5 12.3 12.4 Paddington 1,783 12.81 12.08 12.47 13.36 13.26 13.05 Wards— Queen's Park 206 15.74 11.89 12.40 13.34 13.93 10.64 Harrow Road 302 12.34 12.97 13.10 14.11 13.82 11.99 Maida Vale 269 12.03 11.81 12.24 12.50 13.22 13.12 Town 101 14.58 13.63 12.65 16.01 14.28 15.57 Westbourne 334 13.77 13.25 13.14 13.99 13.90 15.31 Church 209 12.55 11.76 14.06 14.44 16.65 15.69 Lancaster Gate, West 124 13.04 10.88 10.06 13.52 10.40 11.54 Lancaster Gate, East 106 11.12 10.12 9.61 10.70 9.86 9.57 Hyde Park 132 10.61 10.74 12.17 11.28 9.90 12.10 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 1931-1935 12-85 1936 12-81 Deaths in Institutions, 1936. Local. Total. Nonresidents. Paddington Hospital 643 161 St. Mary's Hospital 244 180 Paddington Green Children's Hospital 42 28 Hospital for Women and Children (Lock Hospital) 6 6 St. Luke's Hospital 165 158 1,100 533 Deduct Non-residents 533 -- 567 Outlying. Padding ton Residents. Isolation Hospitals of London County Council 28 Municipal General Hospitals and Public Assistance Commit tees' Institutions .. 267 Mental Hospitals 62 Voluntary Hospitals (General) 92 Hospitals (Special, including Sanatoria) 35 484 Total deaths in institutions of Paddington residents ,. 1,051 12 INFANTILE MORTALITY. During the year 1936 there were 1,921 births, and 139 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 live births) of 72. One hundred and forty-six deaths of children under one year of age, reported as occurring in the Borough or taking place in other districts, were allocated to us by the Registrar-General. As a result of enquiries it was found possible to obtain transfer of seven of the deaths as not belonging to Paddington. Of the one-hundred and thirty-nine deaths investigated, fifty-one, or nearly 37 per cent., had not resided in the Borough one year. These can bo sub-divided as follows :— Under 1 month 4 Between 1 and 3 months 12 ,, 3 ,, 6 months 11 ,, 6 ,, 12 months or unknown 24 Five deaths were allocated to the Borough for the following reasons:— " Newly-born "—found in Canal 3 "No fixed abode" of mother 1 Died in Paddington but parents resident in British West Indies 1 The following table gives the births and the infantile deaths and death-rates for the year 1936 in England and Wales, in London, in the Borough and in the various wards of the Borough. The infantile mortality rates for 1931 to 1935 are given for comparison. 1936 Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1935 1934 1933 1932 1931 England and Wales 605,659 35,236 59 57 59 64 64 66 London 56,273 3,714 66 58 67 60 66 65 Paddington 1,921 139 72 71 95 85 107 87 Warda— Queen's Park 127 10 79 37 31 96 125 55 Harrow Road 413 22 53 74 79 48 80 78 Maida Vale 316 22 69 71 93 94 84 81 Town 135 14 103 107 72 123 161 106 Westbourne 435 31 71 73 109 87 107 80 Church 279 30 107 83 169 112 138 116 Lancaster Gate, West 68 2 29 18 91 127 113 109 Lancaster Gate, East 53 4 75 48 62 97 60 Hyde Park 95 4 42 57 96 67 79 90 Infantile Mortality Rates, 1896-1936. 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 1931-1935 62 62 89 1936 59 66 72 13 Infantile Mortality in Paddington—1936. 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 44 5 4 2 55 24 32 21 7 139 72 36 Common Infectious Diseases (6-10, 44) - - - - - - - - 1 1 0.52 Tuberculous Diseases (23-32) Diarrhoea and Enteritis (119) - - - - - 8 13 5 2 28 14.57 Developmental and Wasting Diseases (157, 158, 159, 161a) 30 5 2 2 39 7 4 3 1 54 28.11 Miscellaneous Diseases (Remainder) 14 — 2 — 16 9 15 13 3 56 29.15 Measles (7) - __ Whooping cough (9) — — — — — — - - 1 1 0.52 Diphtheria(10) - - - - - - - - - - - Influenza(11) - - - - - - - - - - - Tuberculosis of nervous system (24) - - - - - - - - - - Tuberculosis of intestines and peri- toneum(25) - - - - - - - - - - Other tuberculous diseases (23, 2632) - - - - - - - - - - - Syphills(34) - - - - - - - - - - - Meningitis (79) — — — — — — — — Convulsions(86) - - - - - - - - - - - Bronchitis (106) — — — — — 1 1 - 4 2.08 Pneumonia (107-109) — — 1 — 1 3 11 3 2 20 10.41 Other respiratory diseases (105, 110— 114) _ - _ _ _ - __ 1 - 1 0.52 Inflammation of the stomach (118) — — — — — 8 - 1 - 9 4.68 Diarrhoea and Enteritis (119) - - - - - - 13 5 2 20 10.41 Hernia, intestinal obstruction (122) - - - - - - - 1 — 1 0.52 Congenital malformations (157) 3 1 2 — 6 2 1 1 — 10 5.20 Congenital debility and sclerema (158) - - - - - 3 3 2 1 9 4.68 Icterus (1616) 2 — — — 2 — — — — 2 1.04 Premature birth (159) 24 4 — 1 29 2 — — — 31 16.14 Injury at birth (160) 5 — — — 5 — — — — 5 2.60 Disease of umbilicus (161c: 1) 2 — — 1 3 — — — — 3 1.56 Atelectasis (161a) 3 — — — 3 — — — — 3 1.56 Suffocation—in bed or not stated how (182 part) - - - - - - - - - - - Other causes 5 — 1 — 6 4 3 6 1 20 10.41 (Legitimate 1,663. /Legitimate Infants 118. Nett Births in the Year |Illegitimate 258. Nett Deaths 111 the Year {illegitimate Infants 21. 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. 1936 Infantile Mortality Rates. Births. Deaths. 1936 1935 1934 1933 1932 1931 Church Ward— North Wharf 27 3 111 57 77 135 105 53 Clarendon Street 101 9 89 82 177 121 142 116 Rest of Ward 151 18 119 90 181 98 140 129 Westbourne Ward— Alfred Road 79 8 101 72 114 69 123 116 Rest of Ward 356 23 65 73 108 92 104 69 Maida Vale Ward— Amberley Road 30 3 100 27 151 166 190 48 Rest of Ward 286 19 66 78 85 81 67 87 Totals for 4 Areas 237 23 97 68 145 114 140 102 Rest of Borough 1684 116 69 72 88 80 100 85 14 MATERNAL MORTALITY. During the year 10 deaths, attributable to childbirth, occurred among the women residents of the Borough. Of these, 5 were due to puerperal sepsis and 5 to other puerperal causes. Nine of the deaths occurred in institutions. The 10 deaths were equivalent to a mortality rate of 5.00 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. 1936 3.65 1.91 5.00 1935 3.93 2.50 3.95 1934 4.41 2.70 4.57 1933 4.32 3.55 5.00 1932 4.04 2.89 2.94 VITAL STATISTICS. Metropolitan Boroughs. The subjoined information, comparing the vital statistics for London and the metropolitan boroughs, has been supplied by Dr. W. Allan Young, Medical Officer of Health of Poplar:— 1936. London and Cities and Boroughs. Estimated Resident Population. Live Births (Rate). Death Rate. Infantile Mortality per 1,000 Births. Crude. Adjusted. London 4,141,000 14.8 12.3 66 West Districts. Paddington 139,200 13.8 12.81 12.68 72 Kensington 176,100 12.7 12.5 11.7 73 Hammersmith 127,700 15.1 12.5 12.9 60 Fulham 141,300 14.9 12.6 12.7 64 Chelsea 56,500 11.3 13.7 11.6 53 Westminster 124,100 8.5 11.1 11.4 65.8 North Districts. St. Marylebone 92,400 9.78 12.6 12.5 75 Hampstead 90,700 10.4 10.2 9.6 65.8 St. Pancras 183,900 13.0 13.5 13.8 79 Islington 304,100 15.24 12.44 12.56 61 Stoke Newington 50,350 13.7 11.4 10.9 44.6 Hackney 209,100 14.4 12.0 12.6 62.9 Central Districts. Holborn 34,850 8.29 11.99 12.83 62 Finsbury 60,800 13.8 14.0 15.3 81 City of London 9,100 7.5 11.4 12.65 147 East Districts. Shoreditch 85,400 14.9 12.8 14.1 75 Bethnal Green 96,900 13.5 12.7 14.3 98 Stepney 207,800 14-7 12-6 14-7 100-09 Poplar 140,300 15-0 12-5 13-8 72 South Districts. Southwark 152,200 14-8 13-1 — 59 Bermondsey 100,400 15-4 12-8 14-6 60 Lambeth 277,500 13-9 12-5 12-4 59 Battersea 145,500 14-63 13-06 12-93 59-21 Wandsworth 343,000 11-46 11-79 10-96 58 Camberwell 229,300 13-93 12-64 12-64 58-86 Deptford 98,900 15-7 12-2 12-6 50 Greenwich 95,900 13-82 11-36 11-58 49 Lewisham 224,000 13-0 10-8 10-9 55 Woolwich 146,500 13-8 11-2 11-8 59 INQUESTS. During 1936, 121 inquests were held on residents of the Borough, and 121 deaths were registered after the issue of certificates by the Coroner under powers conferred by the Coroners (Amendment) Act 1926. 15 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington:— Acute Encephalitis Lethargica. Glanders. Acute Influenzal Pneumonia. Hydrophobia. Acute Polio-encephalitis. Infective Enteritis or Summer Diarrhoea. Acute Polio-myelitis. Malaria. Acute Primary Pneumonia. 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 Suspeoted Food Poisoning. The following table shows the number of cases of infectious disease (excepting tuberculosis), notified during the year, the number admitted to hospital, and the number of deaths :— Disease. Total Cases Notified. Cases Admitted to Hospital. Total Deaths. Acute Encephalitis Lethargica 3 ,, Influenzal Pneumonia 29 11 6 ,, Primary Pneumonia 92 55 8 ,, Polio-encephalitis ,, Polio-myelitis I 1 ,, Rheumatism 29 20 1 Anthrax Cerebro-spinal Fever 3 3 3 Chicken-pox 285 42 Continued Fever 1 1 Diphtheria 215 207 5 Dysentery 8 7 Erysipelas 50 34 4 Food Poisoning or Suspected Food Poisoning 44 5 Infective Enteritis or Summer Diarrhoea 71 46 6 Malaria .... 5 5 Membranous Croup Ophthalmia Neonatorum 14 10 Puerperal Fever .. 13 13 2 Puerperal Pyrexia 42 39 1 Scarlet Fever 261 239 1 Smallpox .. __ Typhoid or Enteric Fever 7 7 9. ihe following table summarises the cases of all notifiable diseases notified in the years 1926 to 1936 Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis.) 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 Acute Encephalitis Lethargica .. 4 4 1 5 1 ,, Influenzal Pneumonia 76 107 59 135 40 97 66 102 35 33 29 i, Primary Pneumonia 184 183 202 247 168 243 184 157 155 99 92 h Polioencephalitis 3 1 1 1 1 1 - - - - t, Polio-myelitis 3 4 3 1 1 2 2 3 6 2 1 ,, Rheu-matism (a)34 76 52 43 37 21 37 41 18 29 Anthrax 1 1 - - 1 - - - - - Cerebro-spinal Fever 5 3 4 6 3 5 9 6 3 7 3 Chioken-pox 599 461 567 382 515 555 291 364 333 365 285 Continued Fever 2 10 3 2 4 1 1 1 1 Diphtheria .. .. .. 463 367 302 311 366 254 194 277 245 203 215 Dysentery 2 5 1 1 11 8 Erysipelas 76 90 90 69 74 67 60 66 66 50 50 Food Poisoning or Suspeoted Food Poisoning .. .. (а)ll 17 45 63 44 German Measles 124 78 109 1163 86 58 77 (b)11 - - - Infective Enteritis or Summer Diarrhoea (а) 6 20 63 30 40 103 67 70 81 71 Malaria 1 2 3 - 1 - 1 1 1 3 5 Measles 1738 154 2862 210 1790 541 1414 (b)103 - - - Membranous Croup 1 2 4 6 7 6 6 1 2 Ophthalmia Neonatorum.. 16 15 24 9 15 18 22 21 19 11 14 Puerperal Fever .. ;. 14 7 5 4 5 8 7 12 12 14 13 ,, Pyrexia Scarlet Fever Smallpox .. (а) 17 34 32 42 37 32 31 53 36 27 42 199 320 519 5 323 3 356 3 379 286 o 396 1 437 267 261 Tuberculosis—Total 356 381 321 335 284 311 289 270 284 242 217 Pulmonary .. .. .. , 218 212 196 242 196 218 213 203 199 186 163 Other Forms 138 169 125 93 88 93 76 67 85 56 54 Typhoid or Enteric Fever 12 16 25 19 10 9 4 6 9 7 7 (а) First Year of Notification. (b) Not notifiable after 16th Maroh, 1933. 16 The appended tables furnish an analysis of (A) the notified cases of infectious disease according to age and sex, and (B) a few selected infectious diseases according to sex and ward of the Borough. NOTIFICATIONS. A.—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 Acute Encephalitis Lethargica — — — — — — — - - - - - ,, Influenzal Pneumonia 1 — — __ 1 1 1 - 5 2 2 2 5 6 2 1 ,, Primary Pneumonia .. 5 5 5 4 4 3 — 4 5 3 1 1 5 1 6 11 3 2 11 5 1 7 ,, Polio-encephalitis — — — — — — — — - - - - „ Polio-myelitis — — — — 1 — — — - - - - - — — — — — — — — 1 8 9 4 5 2 — — — — — — — — Anthrax — — — — — — — — — — — — — — — Cerebro-spinal Fever 1 — — 1 — — — — — 1 — — — Chicken-pox 7 6 5 12 9 1 8 6 15 15 78 65 13 17 4 7 7 8 1 — 1 — — — Continued Fever — — — — — — — — 1 — — 1 — Diphtheria 4 2 6 5 9 8 10 12 11 10 37 40 10 11 5 4 3 19 3 3 2 1 — _ Dysentery 1 1 1 — — 1 — — 1 — 2 1 — — — — — — Erysipelas — 1 2 1 — — — — — — — — — 1 2 5 5 1 9 14 2 7 Food Poisoning or Suspected Food Poisoning — — 1 — 3 — — — 2 — — 1 — — 4 — 5 11 4 — 4 5 1 3 Infective Enteritis or Summer Diarrhoea 22 15 10 9 5 4 3 1 1 1 — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — 1 — 2 2 — — Membranous Croup — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 4 10 — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever — — — — — — — — — — — — — — — — — 11 — 2 — ,, Pyrexia — — — — — — — — — — — — — — — 3 — 38 1 — Scarlet Fever 2 — 7 9 7 9 12 12 11 11 49 50 10 17 3 7 14 23 2 2 — 4 Smallpox — — — — — — — — — — — — — — — — — — — — — Typhoid or Enteric Fever 1 1 — — — — — — — — — — — — — — 2 2 — — 1 — — - B.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne . Lancaster Gate. Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 13 15 17 19 9 17 6 2 23 24 19 16 1 2 6 6 6 14 Typhoid and Continued Fever — — — — 2 1 1 — — — — 2 1 — — 1 - Erysipelas 2 1 2 8 — 6 1 — 6 3 6 9 1 1 2 3 1 - Ophthalmia Neonatorum — 1 1 3 — 3 1 — — 1 2 2 - - - - - - Pneumonia—Acute Influenzal 2 — 1 4 2 2 2 1 4 1 3 2 1 2 1 1 ,, Acute Primary 3 1 6 7 5 7 2 2 14 7 13 16 1 3 1 1 1 2 Puerperal Fever — 1 — 4 — 3 — — — 2 — 1 — — — 1 1 ,, Pyrexia — 3 — 11 — 10 — 1 — 4 — 7 — — — 2 4 Scarlet Fever 15 10 30 27 16 22 1 2 23 33 21 38 4 5 2 3 5 4 SCARLET FEVER. During 1936 there were 261 cases of scarlet fever notified. Of the cases notified, 2 were under the age of one year, 78 were between the ages of 1 and 5 years, 126 between the ages of 5 and 15 years, 47 between the ages of 15 and 35 years, and 8 over the age of 35 years. Of the 261 cases, 239 were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. One death from this disease occurred during the year. Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1936. 17 DIPHTHERIA. (Including Membranous Croup.) During 1936 there were 215 cases of diptheria notified, and none of membranous croup. Of the 215 cases, 6 were under the age of 1 year, 71 between the ages of 1 and 5 years, 98 between the ages of 5 and 15 years, 31 between the ages of 15 and 35 years, and 9 aged 35 years and upwards. Two hundred and seven patients were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. Five deaths from this disease occurred during 1936, 3 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1926 21 deaths. 1927 11 „ 1928 7 „ 1929 9 „ 1930 12 „ 1931 9 „ 1932 13 „ 1933 19 ,, 1934 13 ,, 1936 13 „ 1936 5 ,, 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 875 748 835 842 846 905 851 730 611 799 930 918 937 10,827 Paddinqton 21 17 12 19 21 22 24 19 20 22 21 21 22 261 Wards— Queen's Park 2 — — 2 3 1 3 1 3 4 1 5 25 Harrow Road 2 1 2 6 6 6 6 7 6 2 2 4 7 57 Maida Vale 3 2 1 2 7 3 4 2 1 5 3 2 3 38 Town — — — — — 1 1 1 3 Church 4 5 2 3 1 4 7 1 5 5 8 8 3 56 Westbourne 5 7 5 3 3 7 5 3 7 4 o 6 2 59 Lancaster Gate, West 2 — 2 2 — 1 1 1 ___ 9 Lancaster Gate, East — 2 — — — 1 — 1 — 1 5 Hyde Park 3 - - 1 1 - 1 1 - - 1 — 1 9 18 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to which 9 cases were referred by the Public Health Department during the past year. Anti-Diphtheritic Serum.—This is stocked at the Town Hall and supplied to medical practitioners on request for the use of patients resident in the Borough who are too poor to obtain such serum privately. During the year 51 phials of 4,000 units and 37 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 the first Medical Officer. Dr. C. T. Potter undertook the duties as from the 6th November, 1935. 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. Two sessions weekly were continued until the week ended 16th February, 1935, when an additional session was foutad to be necessary. In the week ended 3rd August, two sessions were reverted to, and in the week ended 9 th November one session only was found to be sufficient. 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 following report has been received from Dr. Potter on the work carried out at the Clinic during the year :— During the year 1936, 261 cases have been inoculated against diphtheria under the Borough scheme. Of these, 202 had been fully immunised at the end of the year, and the remaining 59 will be dealt with during 1937. As in previous years the majority of these were in the age period in which they are most liable to infection. Following immunisation 219 cases were Schick-tested; of these 194 were found to be successfully immunised, 6 required further injections, and in 19 the result was unknown, the children having failed to return to the clinic. Only one of those tested during the year and found to be Schick-negative contracted diphtheria. He had been immunised in the previous year. Up to the present time we have not heard of a single case of those fully immunised during 1936 having contracted the disease. In view of these most encouraging results, it is to be regretted that more have not availed themselves of the facilities for protection against Diphtheria as provided by the Council. In October, 1936, a Diphtheria Immunisation Clinic was opened at St. Mary's Hospital. Dr. A. B. Porteous, the Medical Officer in charge of the Clinic reports that, up to the end of the year, eight children were treated, their ages varying from 10 to 4 years. In all cases the primary Schick test was positive, and the second, carried out two months later, completely negative. Twenty children received immunisation treatment at the Orphanage of Mercy, Randolph Gardens, during the year. 1936. Number of Schick Tests. Positive. Negative. PseudoPositive. PseudoNegative. Unknown result. Total. Fully Inoculated. Partly Inoculated. No. of Inocs. given. Ordinary Clinic 84 16 — — 3 103 73 42 106 Private Practitioners 28 9 — — — 37 129 17 427 Totals 112 25 - - 3 140 202 59 533 19 Number of Schick Re-tests. Positive. Negative. Pseudo-Positive. Pseudo -Negative. Unknown Resu It. 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. Ordinary Clinic 4 1 65 5 — — — — 4 79 Private Practitioners 2 — 129 — — — — — 15 146 Totals .. 6 1 194 5 — — — — 19 225 The number "Fully Inoculated" come under the following age groups:— Ordinary Clinic. Private Practitioners. 6 to 12 months 2 37 23 73 8 3 57 59 129 13 - 1 year to 5 years 5 years to 10 years 10 years to 15 years 15 years and upwards 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. J. Gill, acts as Public Vaccinator, and Dr. F. A. Bryning as Deputy 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 1935. Thisshows that 56.66 per cent, of the children whose births were registered during that year were successfully vaccinated, and that 17.83 per cent, were exempted on production of statutory declarations of conscientious objection. Insusceptibility, removals, deaths, postponement by medical certificate and not traced, account for the remaining 24.86 per cent. During the year 1936, no primary vaccinations were performed in the Paddington Hospital. In the rest of the Borough 742 infants under one year of age, and 42 persons over that age were successfully vaccinated by the Public Vaccinator, by whom also 36 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 1,451; and the total number of statutory declarations of consoientious objection received from Paddington and other districts was 390. No legal proceedings were taken during the year 1936 for non-compliance with the provisions of the Vaccination Acts. CHICKEN-POX. Chicken-pox has been notifiable in Paddington since November 28th, 1922, but the sections of the Public Health (London) Act, 1936, dealing with disinfection, exposure to infection, etc., are not in force as regards this disease. During 1936, 285 certificates were received from medical practitioners. In addition 190 cases were reported from other sources, making a total of 475 for the year. Chicken-pox is not usually nursed in an institution, but 42 cases received institutional treatment for various reasons. 20 TYPHOID FEVER AND CONTINUED FEVER. Seven cases of typhoid fever and one case of continued fever were notified in 1936. 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. All the cases received hospital treatment. Two deaths from typhoid fever occurred dur ing 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 1,135 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. 1936. 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 4 187 242 270 214 118 61 13 9 14 1 1 1 1,135 Wards— Queen's Park — 32 27 25 63 20 1 1 - - - - - 169 Harrow Road 1 106 60 50 43 11 16 5 4 2 — — — 304 Maida Vale 43 63 18 11 8 7 1 1 1 1 154 Town 1 3 11 16 37 14 2 - - - - - 84 Church 1 32 72 26 15 4 150 Westbourne 2 2 31 63 33 20 14 4 11 1 181 Lancaster Gate, West - 1 13 7 5 1 3 1 31 Lanoaster Gate, East 2 6 4 7 1 1 1 - - - - - 22 Hyde Park — — 1 20 10 5 1 3 — — — — — 40 Nine deaths from measles occurred during the year. 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 95 under 5 years of age and 26 over 5 years of age. The number of visits paid by the nurses was 1,058 and 357 to each group respectively. Three-hundred and five 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 20 cases came to the knowledge of the Department through various sources of information. Eight patients received treatment in hospital. OPHTHALMIA NEONATORUM. This disease is notifiable in London under Section 192 of the Public Health (London) Act, 1936, the London County Council having by resolution made this section applicable to the disease. Fourteen notifications relating to cases of purulent eye-discharge of the new-born were received during 1936. All 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 1936, 2 cases were referred to the District Nursing Association, 71 visits being paid. Ten cases of ophthalmia of the new-born were treated in hospitals as in-patients. 21 PUERPERAL FEVER. There were 13 cases of puerperal fever notified during 1936, 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. Five 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 42 cases of puerperal pyrexia were notified, 39 of which occurred within or were removed to institutions. In January, 1936, Mr. Douglas H. MacLeod, F.R.C.S., succeeded Mr. Aleck W. Bourne, F.R.C.S. (England), as consultant for cases of puerperal fever and puerperal pyrexia. One request for his assistance was made to the Council during the year. ERYSIPELAS. Fifty cases were notified, 34 of which occurred within or were removed to hospitals. ACUTE POLIO-MYELITIS. One case of this disease, otherwise known as Infantile Paralysis, was notified, and received treatment in hospital. Owing to the serious after-effects, such as deformities, which result from this disease, much care is taken to keep in touch with all cases previously notified. Recent experience tends to show that most of the cases notified by doctors receive all the necessary remedial treatment. It is evident that the possibility of preventing the onset of serious deformities is now realised by parents and doctors more than formerly. ACUTE POLIO-ENCEPHALITIS. No case of this disease, somewhat similar in its nature to the last-mentioned, was notified. ACUTE ENCEPHALITIS LETHARGICA. No case of this disease was notified, but three deaths were recorded during the year. CEREBRO-SPINAL FEVER. Three cases of this disease were notified in 1936, and were treated in hospital. All the cases proved fatal. MALARIA. Five cases of this disease were notified, all being treated in hospital. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. Ninety-two cases of acute primary pneumonia were notified in 1936, as compared with 99 in 1935. Of the ninety-two cases, 55 were nursed in institutions. Twenty-nine cases of acute influenzal pneumonia were notified, as compared with 33 in 1935. Of the 29 cases, 11 were nursed in institutions. Seventy-seven cases of pneumonia of all kinds received nursing attention at home under the auspices of the Council's scheme for district nursing, 1,211 visits being paid. ANTHRAX. No case of this disease was notified during the year. 22 ACUTE RHEUMATISM. This widely prevalent disease was made notifiable as from the 1st March, 1927, by virtue of the Paddington (Acute Rheumatism) Regulations, 1927. Paddington was the first area in Great Britain to make acute rheumatism notifiable. The above Regulations remained in force for a year and were extended to 31st March, 1930, from which date the disease, under further Regulations, became permanently notifiable in the Borough. During 1936, 29 cases of acute rheumatism were notified. This figure compares with 18 cases in 1935, 41 cases in 1934, 37 cases in 1933, 21 cases in 1932, 37 cases in 1931, and 43 cases in 1930. 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 1936, 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 1936 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge. As foreshadowed in last year's report, juvenile rheumatism was more prevalent in Paddington in 1936 than in 1935, 29 cases being notified as against 18 in the previous year. The Centre held 45 sessions at which 72 Paddington children made 128 attendances. During the year 12 new cases attended the Centre. Of these, 1 was referred by a sanitary inspector; 2 were sent by the School Medical Service; 7 were transferred from the In-patient and Out-patient departments of the Hospital; and 2 were brought up spontaneously by their mothers. Ten cases were discharged during the year. On the whole the type of juvenile rheumatism during the year was mild. No child attending the Centre suffered from a relapse serious enough to require in-patient treatment, and no case died. Even the new cases admitted to the wards of the hospital showed for the most part only transient heart disease, although there was one sad exception of serious heart disease when seen for the first time. Tonsillectomy was performed in a small number of cases in the hope of warding off further rheumatism. Mothers were instructed in the dangers of relapses and their possible prevention. Medical outpatient treatment was provided where necessary, and arrangements for suitable convalescence and holidays were made for some cases. The women sanitary inspectors paid 430 visits in connection with rheumatic children and reported faulty conditions of housing, where found. The year's work gives the impression that so long as juvenile rheumatism keeps to its present mild form, the disease is well in hand in Paddington. I acknowledge most gratefully the work so well undertaken by the women sanitary inspectors; and I am again indebted to Dr. Mary Davies for her help throughout the year. 23 CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. Eight cases of dysentery were notified during 1936, 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. It is doubtful whether notification would 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 of dealing with the disease. In 1936, 3 persons died of whooping-cough, 2 being children under the age of 5 years and 1 over 5 years of age. The number of deaths in 1935 and 1934 were 5 and 11 respectively. FOOD POISONING. Section 182 of the Public Health (London) Act, 1936, requires medical practitioners to notify cases of food poisoning or suspected food poisoning. During 1936, 44 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 idiosyncrasy or to the results of some dietetic indiscretion. CANCER. Cancer is now one of the commonest causes of death. 271 deaths occurred among Paddington residents during the year. The numbers of deaths for previous years are shown in the list following:— Numbers of Deaths of Paddington Residents. 1906 164 1916 205 1917 201 1918 164 1919 170 1920 194 1921 226 1922 191 1923 200 1924 234 1925 230 1926 239 1927 247 1928 260 1929 284 1930 278 1931 220 1932 254 1933 231 1934 222 1935 235 1936 271 The following table furnishes an analysis of the sites affected in the fatal cases of cancer during the year. 1936. 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 — — — — — — — — 1 — 5 — 4 1 — 1 10 2 Digestive organs and peritoneum — 1 — — _ 3 3 9 12 18 9 17 23 11 23 58 71 Respiratory organs — — — — 1 — 3 1 5 — 9 4 6 3 1 1 25 9 Uterus — — — — — 2 — 1 — 6 — 4 — 3 — 3 — 18 Other female genital organs — — — 1 — 2 — 2 — 4 — 3 — 6 — — — 18 Breast — — — — — — — 1 — 8 — 5 — 8 — 8 — 30 Male genito-urinary organs — — — — — — — — — — 2 — 11 — 3 — 16 — Skin — — — — — — — — — — — — — — — — — 1 Other or unspecified organs — — — — 2 — — 1 1 — — 4 1 2 1 1 5 8 — 1 — 1 3 4 6 9 16 30 34 29 39 46 16 37 114 157 24 INFECTIVE ENTERITIS. This disease is notifiable in some eight other metropolitan boroughs. On May 2nd, 1927, the Council made the disease known as "Infective Enteritis" or "Summer 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-one cases of disease were notified during the year. The number of deaths under the age of 5 years was 31, as compared with 22 in 1935, 44 in 1934, 33 in 1933, 103 in 1932, 29 in 1931 and 29 in 1930. Forty-six 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 1936 are set out in the tables appended hereto. Owing to the fact that a case of tuberculosis may be notified in several boroughs or districts, the number of notification certificates received is only a very imperfect guide to the amount of tuberculosis in the Borough. There is also the consideration that notification is more strictly enforced in some districts than in others. However, alterations in procedure which have taken place 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 66 deaths in 1936, and from other tuberculous diseases there were 10 deaths. The number of deaths from tuberculosis of all kinds was 97 in 1934, 88 in 1935 and 76 in 1936, the latter figure creating a new low record. In recent years the numbers of deaths were as follows:— 1919 133 1928 116 1920 146 1929 128 1921 125 1930 114 1922 143 1931 138 1923 127 1932 122 1924 149 1933 104 1925 119 1934 97 1926 125 1935 88 1927 118 1936 76 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1936. Tuberculosis of the Lungs. Other Tuberculosis. Male. Female. Total. Male. Female. Total. Primary Notifications— 0— 1 year — — — — — — 1— 5 years 1 — 1 7 2 9 5—10 „ 2 2 4 14 2 16 10—15 " 1 1 2 — 3 3 15—20 " 7 12 19 2 2 4 20—25 " 13 20 33 5 4 9 25—35 " 25 24 49 4 3 7 35—45 " 9 10 19 1 3 4 45—55 " 12 10 22 1 1 2 55—65 9 3 12 — — — 65 years and over 2 — 2 — — — Total 81 82 163 34 20 54 Cases re-notified 75 48 123 6 8 14 Total Notifications on Form A 156 130 286 40 28 68 Cases removed from Register:— By reason of— Death 65 Removal 194 Recovery of patient or variation of diagnosis 66 Total 325 25 Of the patients who removed from the Borough during 1936, the new addresses were obtainable in 83 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1936, 7 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 1936 was 952 as compared with 1,033 at the close of the year 1935. Visits Paid to Homes op Tuberculous Patients. By Council's Women Inspectors 844 By Tuberoulosis Officers 494 By Dispensary Nurses— 20, Talbot Road 3,150 St. Mary's Hospital 2,018 6,506 Tuberculosis. New Cases and Mortality During 1936. Age Periods. New Cases. Deaths. Pulmonary. Non-Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. f. m. f. 0— - - - - - - 1 - 1— 1 - 7 2 - - - - 5— 2 2 14 2 - - - - 10- 1 1 - 3 - - 1 — 15— 7 12 2 2 - 20— 13 20 5 4 5 6 2 1 25— 27 25 4 4 10 6 1 - 35— 9 10 1 3 6 4 - 1 45— 14 10 1 1 8 3 — 1 55— 9 3 - — 5 4 - — 65 years and upwards 2 — — — 7 2 1 1 Totals 85 83 34 21 44 25 6 4 Eighteen persons dying from tuberculosis during the year were not formally notified, this number being equal to 23.7 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 connecton 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. Eight sets were so supplied during 1936 and seven sets were returned following the removal 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. No shelters were lent during the year, but one, lent in a previous year was still in use at the end of 1936. 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 1936, 20 patients received 171 refills, the total cost amounting to £89 15s. 6d. Ultra Violet Light Treatment. No applications were received during the year for the Council to bear financial responsibility for this form of treatment. 26 Dental Treatment.—Dental treatment for tuberculous persons attending either of the Tuberculosis Dispensaries is provided at 20, Talbot Road, by the Committee of the Paddington Tuberculosis Dispensary, in return for a payment by the Council of the sum of £90 per annum. A Dental Surgeon is in attendance one half-day weekly. Arrangements have also been made for the supply of dentures by the Dispensary Committee. In connection therewith 5 patients were provided with full dentures, 3 with partial dentures, and in 1 case repairs to dentures were carried out. The total cost was £35 5s. Od. Grants amounting to £30 4s. Od. were made by the Council, the balance being contributed by the patients, approved societies, or other agencies. When patients are able to contribute towards the cost of their dentures, arrangements are usually made for payment to be accepted by instalments. Particulars of the dental work done during the year are shown in the subjoined table. Summary of Dental Treatment for the Year 1936. 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. Boot. Without Anaesthetic. Local Administration. Gas Administration. Number of teeth extracted. Upper. Lower. Re-models. Repairs. Women 160 48 - 8 - 5 15 78 10 10 - - 1 32 66 14 Children 106 50 3 2 - 6 20 66 - - - - 4 36 - 16 Men 44 4 - 4 - 1 8 29 3 1 - - - 12 15 9 Total 310 102 3 14 - 12 43 173 13 11 - - 5 80 81 39 Number of Sessions held=46. Extra Nourishment.—In March the Council decided to exercise their statutory powers to provide extra nourishment to necessitous tuberculous persons who are not in receipt of Public Assistance. The following Scheme was adopted and the approval of the Ministry of Health obtained thereto:— Scheme for the Provision of Extra Nourishment by the Borough Council. 1. The types of cases most suitable to be dealt with are:— (a) Ex-Sanatorium cases, where the medical condition is such that a grant of extra nourishment is necessary to enable the patients to recover or maintain full working capacity. (b) Patients, with prospects of ultimate arrest of the disease, who are awaiting admission to sanatorium. 2. No fixed scale of income to qualify for grant. Where a grant of extra nourishment is made, it should be a condition that the patient is not receiving public assistance and is not reasonably able to provide the cost of extra nourishment. 3. The quantity and type of the extra nourishment to be left to the discretion of the Tuberculosis Officers and Consultant Medical Officers. 4. Where the Tuberculosis Officers and Consultant Medical Officers consider that an immediate grant of extra nourishment is necessary, they will transmit a certificate to the Public Health Department, when an emergency order will be issued for a period sufficient to include the interval which will elapse before the next meeting of the Tuberculosis Care Committee. Extra nourishment supplied under this order to be used only by the person to whom it has been granted. The Medical Officer of Health will be informed if there be (a) any change in income or address of any member of the family; (b) any assistance received from the Relieving Officer, Unemployment Assistance Board, or any other source. 27 5. The financial circumstances of all new cases will be considered by the Tuberculosis Care Committee together with all expiring cases requiring renewal. No grant to be made for a longer period than three months, without renewal of the recommendation by the Tuberculosis Officer or Consultant Medical Officer and reconsideration by the Tuberculosis Care Committee. Extra nourishment usually consists of milk, eggs and butter, a typical grant being 1 pint of "Pasteurised" milk and 1 new laid egg daily, and £lb. of butter weekly for the period recommended. From May, when the scheme was put into operation, until the end of the year, 28 patients received grants, the cost to the Council being approximately £60. 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 £1,600. During the year a definite forward step was taken with regard to the transfer of the Dispensary service to a larger and more convenient building, approval of the London County Council and Paddington Borough Council having been obtained to the site in Newton Road and the draft plans for the building. There is uow every reason to hope that the building will be commenced in the near future. The artificial sunlight department has worked to full capacity during the winter months, 23 delicate children attending for this special treatment. 488 exposures were given. X-ray examinations made at the Dispensary numbered 220. The value of such examinations in connection with early diagnosis and consequent prevention of Tuberculosis is now universally accepted. A number of patients continued to attend for artificial pneumothorax refills. We find by experience that patients who are working prefer to attend the Dispensary for this treatment, as regular visits at short intervals are usually entailed, and the Dispensary, being a small establishment, can treat such people at times which do not interfere with their hours of employment. It is, of course, impossible for large hospitals to make special arrangements for each patient. Visits to the Dispensary of parties of students from the London School of Hygiene and Tropical Medicine have now become an established custom, two such parties being received each year. These parties which usually comprise about 40 students from all parts of the world, spend an afternoon here when lectures are given by Dr. Harley Williams, Medical Commissioner to the National Association for the Prevention of Tuberculosis, and Dr. R. S. Walker, the Tuberculosis Officer. A number of trained nurses, studying for the Public Health Certificate at the College of Nursing and Battersea Polytechnic, attended the Dispensary for short courses of practical experience in connection with Tuberculosis work. We also received for a similar course, a Canadian nurse who was studying English Public Health Methods through the Florence Nightingale International Foundation. This Dispensary was selected to provide Nurse Jayes with an intensive course of practical experience before she went to Cyprus to join the staff of Dr. Noel Bardswell, who is organising an anti-tuberculosis scheme there for the National Association for the Prevention of Tuberculosis. The Glove Class continues satisfactorily and there is no doubt that the work taught provides a number of women patients with a definite interest as well as a little pocket money. 28 Return Showing the Work of the Dispensary During the Year 1936. 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 36 35 — 3 2 3 14 4 38 38 14 7 (6) Diagnosis not completed — — — — — — — — 3 2 1 2 723 (c) Non-tuberculous.. - - - - - - - - 85 218 145 170 B.—Contacts examined during the year:— (a) Definitely tuberculous - 2 - - - — 2 — — 2 2 — (6) Diagnosis not completed - — — — — — — — — — — — 175 32 51 43 45 C.—Cases written off the Dispensary Register as (a) Recovered 1 3 — — 1 6 5 4 2 9 5 4 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 117 269 192 221 819 D.—Number of Persons on Dispensary Register on 31st December:— (a) Definitely tuberculous .. 177 143 2 5 85 79 98 46 262 222 100 51 643 (6) Diagnosis not completed 3 2 1 2 1. Number of cases on Dispensary Register 2. Number of cases transferred from other on January 1st 648 areas and cases returned after charge under Head 3 in previous years 18 3. Number of cases transferred to other areas, cases not desiring further assistance under 4. Cases written off during the year as Dead the scheme, and cases "lost sight of" 71 (all causes) 31 5. Number of attendances at the Dispensary 6. Number of Insured Persons under (including Contacts) 5,062 Domiciliary Treatment on the 3lst December 132 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers (a) Personal to homes (including personal consul(b) Other 202 tations) 387 9. Number of visits by Nurses or Health 10. Number of Visitors to Homes for Dispensary pur- (a) Specimens of sputum, etc., examined 292 poses 3,150 (6) X-ray examinations made in connection with Dispensary work 220 11. Number of "Recovered" cases restored to Dispensary Register and included in 12. Number of "T.B. plus" cases on A (a) and A (6) above pensary Register on December 31st 176 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary, and was subsidised by a grant of £1,110 from the Paddington Borough Council during the year 1936. 29 Return Showing the Work of the Dispensary During the Year 1936. 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 16 16 2 1 1 2 3 2 17 18 5 3 (6) Diagnosis not completed - - - - - - - - - 1 1 1 102 - - - - - - - - 17 24 9 6 B.—Contacts examined during the year:— (a) Definitely tuberculous - - - - - - - - - - - - (b) Diagnosis not completed - - - - - - - - - - - - 34 (c) Non-tuberculous 5 12 7 10 C.—Cases written off the Dispensary Register as (a) Recovered 3 — — 1 — — 2 1 3 — 2 2 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous - - - - - - - - 22 36 16 16 97 D.—Number or Persons on Dispensary Register on December 31st:— (a) Definitely tuberculous 61 62 7 6 14 29 20 18 75 91 27 24 220 (b) Diagnosis not completed 1 1 1 1. Number of cases on Dispensary Register 2. Number of cases transferred from other on January 1st 233 areas and eases returned after charge under Head 3 in previous years 6 3. Number of casos transferred to other areas, cases not desiring further assistance under 4. Cases written off during the year as Dead the schemo, and cases "lost sight of 46 (all causes) 12 5. Number of attendances at the Dispensary 6. Number of Insured Persons under (including Contacts) 2,183 Domiciliary Treatment on the 31st December 10 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers (a) Personal 4 to homes (including personal consul(b) Other 60 tations) 107 9. Number of visits by Nurses or Health 10. Number of Visitors to Homes for Dispensary pur- (a) Specimens of sputum, etc., examined 94 poses 2,018 (b) X-ray examinations made in tion with Dispensary work 113 11. Number of "Recovered" cases restored to Dispensary Register and included in 12. Number of "T.B. plus" cases on A (a) and A (6) above pensary Register on December 31st 79 The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1936 was as follows:— Representing. Paddington Borough Council Councillor E. G. Lee. " " Councillor T. Turner. " " Councillor Mrs. J. E. Wright. " " 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 P. Simey. Insurance Committee Miss L. A. Parsell. Invalid Children's Aid Association Mies L. C. Streatfoild. London County Council Dr. R. H. Simpson (Divisional Medical Officer). " " Miss H. Bell (District Organiser of School Care Committees). Paddington Tuberculosis Dispensary Dr. R. S. Walker (Tuberculosis Officer). " " " Nurse C. Griffin. " " Nurse A. B. Munro. " " Misa C. Milner. " " The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1936 was as follows:— Representing. Paddington Borough Council Councillor E. G, Lee. " " " Councillor T. Turner. " " " Councillor Mrs. J. E. Wright. " " " 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 P. Simey. Insurance Committee Miss L. A. Parsell. Invalid Children's Aid Association Miss L. C. Streatfeild. London County Council Dr. R. H. Simpson (Divisional Medical Officer). " " " Miss H. Bell (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, 30 Paddington and St. Marylebone War Pensions Committee Mr. S. G. Last, J.P. (Chairman). Kensal House School Care Committoe ,, ,, Mrs. R. M. Drury, J. P. ,, ,, ,, Miss E. M. Kerr. Paddington and St. Marylebone District Nursing Association Miss A. M. Bennett. Public Assistance Committee Area VI Mrs. C. Taylor. Panel Committee Dr. S. Crown. St. Mary's Hospital Dr. A. B. Porteous (Tuberculosis Officer). ,, ,, Sister E. M. Phillips. Red Cross Emergency Fund Mrs. M. R. Cordon. Local Social Worker Mr. J. E. Bennison. ,, ,, ,, Miss H. C. Davidson. Paddington and St. Marylebone Employment Committee Mr. A. E. Goss. The Medical Officer of Health continued to act as Honorary Secretary to the Committee. 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 12 occasions during the year, and two hundred and forty-nine individual cases were considered. Residential treatment was granted by the London County Council to 197 patients, 33 of whom were children under the age of 16 years. No funds are available in tihe hands of the Committee for the assistance of patients, but in several instances help was sought from voluntary agencies for the patient or dependents. MATERNITY AND CHILD WELFARE. The staff engaged in maternity and ohild welfare work consists of a Superintendent Health Visitor, 10 whole-time Health Visitors, one of whom also acts as Child Protection Visitor and one as Maternity Almoner, 10 (latterly 9) part-time Visiting Medical Officers, 3 part-time Masseuses, and 1 full-time Clerical Assistant. Health Visitors. The duties of these officers are:— (1) To visit the homes of children from birth up to the age of 5 years where considered necessary. (2) To make enquiries concerning stillbirths and deaths of infants and young children. (3) To visit and give advicc 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 1,577 Revisits ,, ,, ,, 6,874 8,451 Visits to children between the ages of 1 and 5 years 8,732 First visits to expectant mothers 1,113 Revisits ,, ,, 611 1,724 Other Visits— Sickness (including Puerperal Fovor, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea)241 Miscellaneous (including 4,071 ineffective calls) 11,355 11,596 The total number of children on the Health Visitors' lists at the close of the year was 4.563, 31 Maternity and Child Welfare Centres. For many years the need of a more suitable headquarters for the carrying out of the maternity and child welfare work of the Borough has been apparent, emphasis on the necessity being referred to by the Minister of Health as a result of his investigations into the services during 1934. The present premises, 232, Harrow Road, have proved unsuitable and insufficient to cope with the growth of the staS and work, having been ih use since 1910, when the then Paddington Health Society was divided into two distinct bodies, one to deal with tuberculosis and the other infant welfare. The latter was the Paddington School for Mothers. In June, 1934, the Council decided to proceed with a scheme for the provision of a well equipped Centre of modern type, but owing to the difficulty experienced in finding a suitable site, and to the prolonged negotiations in securing the Parsonage site near Lock Bridge (which was the one eventually decided upon), and, subsequently, to delay in securing approval of the plans, etc., final sanction had not been received by the end of the year. The existing Centres are provided by the Paddington School for Mothers, which is a voluntary society financed by voluntary contributions and by grants froan 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 ia a brief account of the activities of the Paddington School for Mothers:— Centres (as in December, 1936). 232, Harrow Road, W.2.—Ten rooms and Health Visitors' rest room, all warmed by gas fires. 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. 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. Area served:—South Paddington. Consultative and Physical Treatment Consultation weekly. Tuesday and Thursday, 10 a.m. Medical Officer, Dr. R. Cove-Smith. Schick Testing and Diphtheria Immunisation Treatment weekly—Wednesday, 2 p.m. Medical Officer, Dr. C. T. Potter. Artificial Sunlight Treatment and Massage are given twice weekly, Tuesday and Thursday, 10 a.m., by Miss Denny, C.S.M.M.G., Miss P. Smiddy, C.S.M.M.G., and Miss Suffling, C.S.M.M.G., in conjunction with the Consultative and Physical Treatment Consultation under Dr. R. Cove-Smith "Toddlers" Clinic, twice monthly.—First and third Friday, 10 a.m. Medical Officer, Dr. C. T. Potter. 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 p.m. Medical Officer, Dr. Alexander S. Hall, subsequently Dr. E. D. Fenwick. Friday, 2 p.m. Medical Officer, Dr. Evelyn Maclagan. Special arrangements for toddlers once in three months. Friday, 2 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 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Special arrangements for toddlers once in three months. Monday, 2 p.m. Instruction in Invalid Cookery, Knitting, etc., is given by a qualified Voluntary Worker. Monday, 2 p.m. Area served:—Lancaster Gate East and West Wards and part of Westbourne Wafd, 32 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 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Friday, 2 p.m. Medical Officer, Dr. S. Denovan Adam. Special arrangements for toddlers once in three months. Tuesday, 2 p.m. Area served:—Queen's Park Ward and part of Harrow Road and Westbourne Wards. 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 p.m. Medical Officer, Dr. J. McKail. Thursday, 2 p.m. Medical Officer, Dr. Hubert Hodge. Area servedMaida 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. 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. Area served:—North Paddington. At each Infant Consultation Centre there is a stall for the sale of babies' woollies, etc. Dental Arrangements.—Mr. F. H. Brinkley Tofts, L.D.S., R.C.S., 281, Harrow Road, treats mothers who attend Centres, on special terms. Financial assistance from private funds of the SYhool for Mothers is given in many cases. Dental Treatment can also be obtained for mothers and children from the Paddington Welfare Centres, at the local Hospitals, and at the Eastman Dental Clinic, Royal Free Hospital, Gray's Inn Road. Lectures on Health Topics are provided weekly at each Centre by the Health Visitors. Co-operation with Personal Service League.—Grants of clothes for cases recommended by Healtli 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 the recommendation of Medical Officers at Centres. Financial assistance is given in many cases by the Borough Council for nursing mothers and their babies. In some other cases assistance is obtained from private sources. 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., already referred to. Consultation Centres. Summary of Work for thk Year 1936. 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 53 51 53 50 52 51 53 51 50 464 Number of Attendances 2,156 1,839 3,648 2,737 2,580 2,292 2,583 2,526 3,711 24,072 Average Attendence 40.7 36.0 68.8 54.7 49.6 44.9 48.7 49.5 74.2 51.8 Seen by Doctor 1,031 746 1,330 965 838 978 1,090 1,072 1,592 9,792 Average number seen by Doctor At each Session 20.4 14.6 25.0 19.3 16.1 19.0 20.5 20.2 31.8 21.1 The total number of children attending the consultations was 2,571, 1,107 being under 1 year of age and 1,464 between the ages of 1 and 5 years. 33 Ante-Natal and Post-Natal Clinics. Harrow Road. Macroom Road Number of Sessions 49 50 Number of Attendances 686 561 Number of Expectant or Recently Confined Mothers who Attended 344 210 Averago Attendance per Session 14-0 11-2 Number of Cases Referred by Midwivoa in Private Practice 4 1 Consultative and Physical Treatment Centre. Number of Attendances 3,293 Number of Cases 212 (of whioh 203 were new) Classification of Cases- Artificial Sunlight only 60 Artificial Sunlight and Massage 58 Massage only 69 Dietetic only 26 Treatments given- Artificial Sunlight 1,483 Massage 2,100 The following report has been received from Dr. R. Cove-Smith on the work carried out at the Centre:— The total number of cases remaining on the register at the end of 1936 was 212 as against 168 left on last year. This figure does not of course represent the true number of cases actually seen as many casual cases come up for information and advice, whose condition does not warrant admission to the Special Clinic. Such cases may only attend once and are then referred back to their own local Welfare Centre or provision made for the Health Visitor or District Nurse to supervise them. Actually only 25 cases were admitted simply for Dietetic supervision although at least three times that number were seen. Sixty cases are receiving Sunlight treatment, sixty-nine Massage and fifty-eight both Sunlight and Massage. There were 223 new cases admitted and fewer than 200 discharged which accounts for the figure being about 50 higher than last year. Twenty-two of the cases were under one year of age and in four of these the trouble was due to a mild degree of congenital anal stenosis, but nevertheless sufficient to cause considerable distress and digestive upset. All these cases soon settled down as a result of manipulative treatment and have continued to make good progress. Queen Charlotte's Maternity Hospital.—During the year 1936, 55 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 14. During 1936 there were received into the Hospital for confinement 189 women from Paddington, and 216 Paddington women were delivered in their own homes by midwives from the Hospital. The average attendance of these patients at the Ante-natal Clinic was approximately 8. St. Mary's Hospital.—There is no Infant Consultation Centre at this Hospital but in addition to the ordinary ante-natal consultations one is specially held each week for women who have booked beds in the Borough Council's Maternity Wards at the Hospital. The number of attendances at that Clinic during the year was 1,585 by 256 women. No definite figures are available as to the number of Paddington women who attended the ordinary ante-natal consultations but the number of confinements attended by the Hospital extern staff in the Borough was 146 and presumably all of these received examination and advice there. 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 1936, 92 confinements were attended by the nursing staff, the number of visits being 1,568. These figures compare with similar ones of 97 and 2,024 in the year 1935. The annual grant in aid of this work is £175. Maternity Wards.—Under an agreement made with the Board of Management of St. Mary's Hospital, a suite of wards containing 14 beds became available in the Hospital on the 1st April, 1933, for patients accepted for admission by the Borough Council. The agreement is for a period of five years and provides for payment to be made to the Board at the rate of 9s. per day for each bed, whether occupied or not, the annual amount being approximately £2,300. 34 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:— Scale for Assessment of Patients. Net Weekly Income after deducting rent, furniture and fares, not exceeding:— Number in family. 1 a. d. 8. d. 8. d. 8. d. 8. d. 8. d. 8. d. 20 0 25 0 30 0 35 o 40 0 45 0 50 0 2 25 0 27 6 30 0 35 0 50 0 60 0 70 0 3 22 6 25 0 27 6 30 0 35 0 50 0 60 0 4 20 0 22 6 25 0 27 6 30 0 35 0 50 0 5 20 0 20 o 22 6 25 0 27 6 30 0 35 0 6 20 0 20 0 20 0 22 6 25 0 27 6 30 0 7 20 0 20 0 20 0 20 0 22 6 25 0 27 6 Note. — Assessments are made in accordance with the above where only one maternity benefit is expected. Where there is no maternity benefit a reduction will be made, but where two are payable an increase of the scale is made where deemed nectssary. The duties of Maternity Wards Almoner are carried out by Miss Hill, one of the Council's Health Visiting staff. During the year, 289 women were delivered in the wards. One case of puerperal fever and 3 of puerperal pyrexia were notified. There were 12 stillbirths, and 6 deaths within 10 days of birth. The payments made by patients admitted, or accepted for admission, to the wards amounted to £620 16s. Od. for the year. Midwifery Service.—In March, 1932, the Council authorised arrangements for the provision of a qualified midwife by the Paddington and St. Marylebone District Nursing Association to attend emergency maternity cases at a fee of 30s. per case. There were no emergency cases during 1936. 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 1936, 44 cases were attended, tihe patients' contributions collected to the end of the year amounting to £38 12s. Od. Maternity Consultations.—Mr. Douglas H. MacLeod, F.R.C.S., succeeded Mr. Aleck W. Bourne, F.R.C.S., as obstetric consultant in February, 1936, and he was called into consultation on one occasion during the year. Maternity Outfits.—Supplies of Maternity Outfits have been made available for confinement at home of necessitous women. In some instances the total cost (4s. (6d.) 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 £10 l1s. Od. Home Helps.—In 1935 the Council approved a Scheme for the provision of Home Helps for parturient women, and of grants in aid thereof, the assessment of such grants being based on the income of the patient's family, the balance necessary to complete the Home Help's remuneration being paid by the patient. Six Helps were allocated during the year, and the grants made by the Council towards their remuneration totalled £6 10s. Od. The duties of Home Helps are as follow:— 1. To act under the direct supervision of the Superintendent Health Visitor or iher Deputy. 2. To be at hand at the time of labour and confinement and at the onset of labour to immediately summon the Doctor or Midwife; to see that the patient's room is clean and every thing in readiness for the arrival of the Doctor or Midwife. The Home Help is not responsible for the confinement itself, nor must she interfere in any way with the instructions of the Doctor or Midwife. 3. After the confinement, to remove all soiled linen from the patient's room, and to care for her generally, especially as regards cleanliness and food. 36 4. To see that the infant is properly fed and cared for. and, if possible, put to sleep in a separate cot. 5. To wash and dry the labour clothes as soon as possible, and to keep the ordinary clothes washed in the usual way; to get meals and tidy the house as the patient would, were she not for the time laid aside. 6. To oare for any other children there may be, and see that school children attend punctually, and are clean and tidy. 7. Should the Home Help in any way come into contact with a case of infectious disease, either in her own home, the home of the patient, or elsewhere, she must at once report the matter to the Medical Officer of Healtih. 8. On the day following the confinement, the Home Help must notify the Medical Officer of Health (Town Hall, Paddington, W.2) that she has commenced her duties. 9. Any conduct on the part of the Home Help which is contrary to the interests of the person she is helping, may lead to her name bing removed from the list of Home Helps, and render her liable to forfeit the payment due to her. 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.) are made. During the year 34 necessitous women were referred to the Centre for advice, the cost in each case being payable by the Council. Councillors Lady Bonham Carter and Mrs. Paterson have been elected as the Council's representatives on the Committee of the North Kensington Women's Welfare Centre. X-Ray Examinations.—Arrangements are in force with the Paddington Tuberculosis Dispensary for the use of their facilities for X-ray examinations of expectant mothers and of children attending the Ante-natal and Welfare Centres. 13 examinations were made during the year, 7 being of expectant mothers and 6 of children, the fee for the former cases being 15s. and for the latter 7s. 6d. per patient. Unmarried Mothers and Their Children.—With a view to securing closer supervision of unmarried mothers in the early days of motherhood and, where desirable, affording facilities for breast feeding of their infants, the co-operation of the Paddington and St. Marylebone Ladies' Association for Rescue and Preventive Work has been enlisted and the Council make grants to the Association towards the cost of detaining in their Homes for varying periods such unmarried mothers and their babies. Six cases were assisted during the year by grants amounting to £44 15s. Od. 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. On the 1st April, 1935, the number of beds was reduced to 2, and the grant therefor to £200 per annum. Six children were admitted during the year, one being subsequently re-admitted on two occasions, the periods of treatment ranging from 22 weeks to 2½ weeks. Special attention is paid by the Medical Officers of Centres, and the Health Visitors, etc., to children after their discharge. Beauchamp Lodge Emergency Home for Children.—Arrangements can be made for the admission of children to this home whilst the mothers are in hospital. The charge therefor is 12s. 6d. per week per child. In two instanoes it was found necessary to make use of these facilities, and the three children concerned were admitted at a cost of £5 15s. Od. 36 DAY NURSERIES. At the end of the year 1936, there were three Day Nurseries in Paddington (see page 5). Statistical Summary. "Queen's "Westbourne." Park." "Paddington." Full Satur- Full Satur- Full Saturdays. days. days. days. days. days. Days open 200 33 269 51 257 50 Attendances 5,802 773 4,726 640 8,975 1,152 Average attendance 29 23 17 12 34 23 New Children 124 31 27 Cases of Infectious Disease. Scarlet Fever 2 — — Measles 13 10 7 Impetigo — — — Whooping Cough — 7 — Mumps — — 8 Chickenpox — — 2 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 £25 was made by the Council to the Queen's Park Day Nursery in respect of the year 1936. Until this year the only Day Nursery facilities available in the Borough were those provided by the Paddington Day Nursery, 21, Howley Place, and the Queen's Park Day Nursery, 66, Lancefield Street, both managed by voluntary bodies. With a view to meeting the obvious need for further accommodation, the Council, as mentioned in last year's Report, decided to found the Westbourne Day Nursery at St. John's House, Great Western Road. The Nursery was actually available for the reception of children on the 4th May. The official opening ceremony, however, took place on the 25th May, and was performed by His Worship the Mayor, Alderman H. V. Kenyon, M.B.E., L.C.C., J.P. Miss Doris Knott, S.R.N., S.C.M., was appointed Matron, and Miss Evelyn Johnson, Staff Nurse. In addition, a Cook, Housemaid, Handyman-Porter and part-time Cleaning Staff were engaged. Four Probationer Nurses were authorised to be appointed, a premium of fifteen guineas being payable by each for a two-years' course of training, plus board, residence and laundry. In July the additional appointment of a Junior Staff Nurse was authorised, and was filled by Miss M. Kemp from the 24th July to the 22nd August, and by Miss G. Johnson from the 1st September onwards. One additional Probationer was authorised in November. The charges for admission are as follow:—8d. per whole day per child; 5d. per half-day, including Saturday, per child; 6d. per day or 4d. per half-day per child, for two or more in same family. Matron reports as follows:— The Nursery has now been open eight months and already we are convinced that it is very necessary in the neighbourhood. Except for an epidemic of measles, the health of the children has been good and great improvement has been noticed in many who were under weight. 37 The Nursery is divided into two sections, one for babies under one and a half years, and the other for children over that age; an improvement for working purposes might be effected with a separate nursery for children between one and two years. The Nurseries are most attractive. The Baby Nursery is furnished in pink, and each baby has his or her own cot with a play-pen and buffer chairs for the sitting-up babies. The bigger children, our "grown-ups," have their Nursery furnished with chairs and tables of primrose yellow, and delight in climbing their "Abbatt Frame" and dancing to the piano kindly presented by Councillor Mrs. Christie, the Chairman of the Maternity and Child Welfare Committee. Children of all ages up to five years are taken and our youngest was fourteen days old. All children up to three years are bathed immediately on reception and changed into nursery clothes. Children over three years are bathed alternate days, boys one day, girls the next, and wear nursery overalls and knickers. The children have three meals:— (i) Breakfast, consisting of porridge and fried bread in winter, or bread, butter and marmite, or bread and dripping. (ii) Dinner is varied, but stewed fruit or vegetables are given every day. We find that the simplest dinners are the most liked and very quickly the children settle into habits of good appetite and clean plates. (iii) Tea. The children have brown bread and butter with svrup, jam or honey, and fresh fruit every day. Milk is given to drink. Pure Cod Liver Oil is given during the winter and extras, such as Malt and Iron Tonics, where ordered by the Medical Officer. The children are examined by the Medical Officer on entry, and as a routine measure every month afterwards, unless they appear to need medical attention in the interim. The garden planted with bulbs and other plants by Councillor Mrs. Christie is also a great delight—the only drawback being the distance from the bathroom, which necessitates the small children having to be carried upstairs every time they require attention. The mothers are working-women and seem to greatly appreciate the care given to the children. We frequently hear remarks about the brightness of the surroundings and the happy faces of the Staff and children. Matron and the Staff would like to say how much they appreciate the wireless set so kindly given by Councillor Mrs. Lewis-Barned and the many gifts of toys made from time to time by the generosity of various people. PROVISION OF MILK FOR NECESSITOUS MOTHERS AND CHILDREN. The Scheme hitherto in force in connection with Grants of extra nourishment for necessitous mothers and children was under revision at the end of the year. Particulars of Milk Grants Doting 1936. (1935 figures in brackets.) The total number of grants considered by the "Grants" Sub-Committee during the year was 3,855 of which 751 represented new applications. These latter were divided up as follows:— Number of Refused, withdrawn or referred New Applications. Granted. to Public Assistance Committee. Fresh Milk 653 (673) 563 (582) 90 (91) Dried Milk 96 (87) 96 (87) — (-) Dinners 2 (7) 2 (7) — (—) 751 (767) 661 (676) 90 (91) 38 Details relating to expenditure incurred are given below :— £ s. d. £ s. d. Cost of Milk at Full Price 911 9 0 (828 6 2) Cost of Milk at Half Price 14 3 6 (15 4 11) Cost of Dried Milk at Full Price 179 0 10 (154 3 9) Cost of Dried Milk at Half Price 11 0 0 (18 8) Cost of Dinners 6 18 3 (27 18 9) £1,122 12 1 (£1,026 12 3) Supply of Dried Milk, Etc., at Consultation Centres. £ s. d. Purchases of Dried Milks, Drugs, etc. 1,670 18 7 Sales 1,285 19 1 Grants from Borough Council 404 2 8 The reception into the Borough of a large number of migratory necessitous families, referred to in previous Reports, would appear to persist. Four hundred and fifteen families hitherto unknown to the Department applied for grants during the 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. Seventeen cases of nursing mothers with babi es were referred for convalescence at a cost to the Council, after deducting contributions by patients, and from other sources, of £22 17s. Od. In 44 instances the Council made grants towards the cost of children convalesced by the Invalid Children's Aid Association. The amount paid by the Council to the Association during the year for the convalescing of children was £141 19s. 2d. MATERNAL MORTALITY. During the year five maternal deaths were enquired into by Dr. E. Dorothy Fenwick, the Council's medical investigator, and reports thereon forwarded to the Ministry of Health. CHILD LIFE PROTECTION. In pursuance of the Transfer of Powers (London) Order, 1933, the duties of the London County Council in connection with child life protection were transferred to the Borough Council as from the 1st April, 1933. These duties are now laid down in Part XIII of the Public Health (London) Act, 1936, and relate to:— (a) Reception of notices given by persons who undertake for reward the nursing and maintenance in a dwelling of children; (b) Inspection of premises by Child Protection Visitors, or other persons appointed by the Council for that purpose; (c) Fixing the number of children to be kept in a dwelling in which any child is received for reward. (d) Application to a Court of Justice for an Order direeting the removal of a child to a place of safety. In July, 1935, Miss M. A. MacLean was appointed to the dual office of Health Visitor and Child Protection Visitor, her duties in the latter respect occupying three-fourths of her time. In addition, other Health Visitors act as occasion requires and the Medical Officer of Health and two of the Sanitary Inspectors are also authorised to exercise the powers and duties of Child Protection Visitors for special purposes. During the year 1936, 1,217 visits and inspections were made, 31 new registrations of fostermothers were recorded, 47 new children were received and 32 children were removed—6 to hospital and 26 elsewhere. One death was reported. At the close of the year, the Register contained the names of 102 persons who were receiving children for reward. These persons had charge of 139 children. 39 ADMINISTRATION Staff of the Department.—A complete list of the Staff of the Department appears on page 4. The following changes occurred during the year. Visiting Medical Officers. Dr. A. S. Hall resigned his appointment as Visiting Medical Officer in April, and his Session at St. David's Church Hall was carried on until the end of the year by Dr. E. D. Fenwick. Clerks. Mr. I. D. Clarke was appointed Junior (Class 5) Clerk on the 25th February, and he took up his duties on the 16th March. Sanitary Inspectors. The appointments of Messrs. J. J. Atkinson, G. Duncan and A. J. Shelley on the 25th June brought the number of permanent Inspectors to 13. Two of these appointments were to replace temporary Inspectors, and one as an additional Food, etc., Inspector. There are still three temporary Inspectors engaged. Health Visitors. There were no alterations in or additions to the Health Visiting Staff during the year. The Council, on the 29th October, however, decided to appoint two additional Health Visitors to enable a more intensive visitation of children of pre-School age to be carried out in conformity with suggestions contained in the Circular 1550 of the Ministry of Health, dated 26th May, 1936. These new officers will take up duty as from the 1st April, 1937. Westbourne Day Nursery. Miss Doris Knott was appointed Matron on the 4th February, 1936, and Miss Evelyn Johnson Staff Nurse on the 24th March. The former took up non-resident duties on the 4th Marah and assisted in the preliminary details necessary to establish the Nursery. Miss Johnson commenced on the 1st May, when the residential arrangements were complete. Prevention of infectious Disease.—Visits of enquiry after notification of infectious disease numbered 1,766. 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 745. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 203 patients (comprising 121 cases of measles, 77 of pneumonia, 2 of ophthalmia neonatorum and 3 of whooping cough) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 2,727. Disinfection.—The rooms disinfected after infectious disease numbered 770. The weight of bedding, etc., removed for disinfection at the Wood Lane Disinfecting Station, under the agreement with the Kensington Borough Coucil, amounted to approximately 19 tons. Three hundred and fifty-eight library books were disinfected. Schools.—A total of 2,247 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 1,713 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, 323 reports were sent to the medical officers of health of other boroughs in connection with cases attending outlying schools. Bacteriological Work.—The Council have an arrangement with the Royal Institute of Public Health, 23, Queen Square, W.C.I, for the bacteriological examination, at the expense of the Council, of specimens sent by medical practitioners 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. 40 The examinations made during 1936 were as follows:— Number of Number of Disease suspected. Examinations. Positive Results. Diphtheria 546 85 Tuberculosis 329 28 Typhoid Fever 6 2 House Drainage.—During the year 23 existing drains were tested and found water-tight, and 93 defective drains were wholly or partly reconstructed. Reconstruction Plans.—Four hundred and twenty-four plans were Submitted for drainage! works in existing buildings. In connection therewith 814 letters were despatched. Four summonses were issued for failure to supply plans. Combined Drainage.—Orders were made under Section 74 Qf the Metropolis Management Act, 1855, or Section 38 of the Public Health (London) Act, 1936, with respect to new drainage systems to which the following groups of houses were to be connected:— Westbourne Park Road, Nos. 36 and 38. Devonport Mews, Nos. 12 and 13, and Nos. 14 and 15. New business premises or building on sites of Nos. 29—37 (odd inclusive), Hereford Road and boiler house premises at rear. New block of residential flats or building, situate on the north side of Bayswater Road and on sites of Nos. 3 to 8 Hyde Park Terrace and Nos. 10, 11, 12, 13 and 14, Albion Mews East. New shops and offices or building situate on north side of Harrow Road on sites of Nos. 480 and 482, Harrow Road. New block of flats or building situate on west side of St. Petersburgh Place and on the sites of Nos. 13 and 15, St. Petersburgh Place. Five residential houses or buildings situate on the east side of Porchester Terrace and on the site of No. 19, Porchester Terrace. New block of flats and shops or buildings situate on the north east corner of the junction between Edgware Road and Seymour Street, and on the sites of Nos. 13, 15, 17 and part of 19, Edgware Road, and Nos. 70, 72, and part of 74, Seymour Street. Blomfield Street, Nos. 26—42. No. 222 and Nos. 224—238 (even), Harrow Road; Nos. 2—10, Westbourne Park Crescent; Nos. 1—11, Westbury Road; and Nos. 1, 2 and 3, Westbourne Park Crescent Mews. Edgware Road, Nos. 349 and 351. Kensington Gardens Square, Nos. 1 and 2; Nos. 78 and 79. Twelve residential houses on the west side of Connaught Square Mews. Norfolk Crescent, Nos. 28 and 29. Porchester Place, Nos. 24 and 24a. Spring Street, Nos. 17 and 18. Talbot Road, Nos. 72, 74 and 76. Sussex Gardens, Nos. 63 and 65. Cambridge Street, Nos. 14 and 15. Lancaster Gate, Nos. 81, 82 and 83. Amberley Wharves, Nos. 9 and 10. New houses situate on the south side of Southwick Crescent on the sites of Nos. 1 and 2, Southwick Crescent, Nos. 28 and 30, Hyde Park Street, and a portion of Southwick Yard at its northern end at the rear of No. 28, Hyde Park Street. Xew houses situate on the north-east side of Sussex Place, on the sites of Nos. 1—8 (inclusive), Gloucester Square. New houses on west side of Radnor Place on sites of Nos. 32-37 (inclusive), Gloucester Square. 41 New block of flats, etc., situate on west side of Porchester Terrace on site of No. 48, Porchester Terrace. New block of flats, etc., situate on south-west side of Sussex Place on sites of Nos. 2-9 (inclusive), Sussex Place, and Nos. 1-8 (inclusive), Sussex Mews East. New blook of flats, etc., situate on south-west side of Maida Vale on sites of Nos. 203-225 (odd, inclusive), Maida Vale, and the whole of the properties at rear in Andover Place, and part of No. 227, Maida Vale, Nos. 1-5, Portsdown Place, and No. 26, Andover Place. New block of flats, etc., situate on east side of Queen's Road on the sites of Nos. 158-168 (inclusive) and part of No. 170, Queen's Road. New block of flats, etc., situate on west side of Edgware Road on sites of Nos. 353, 355 and 357, Edgware Road. New block of flats, etc., situate on north side of Bayswater Road on sites of Nos. 93 and 94, Lancaster Gate. New block of flats, etc., situate on north side of Bayswater Road on sites of Nos. 1 and 2, Hyde Park Terrace. Block of residential flats, shops and garage or buildings situate on south-west side of Edgware Road and on sites of Nos. 85-119, Edgware Road, 1-15, Cambridge Street, 8-11, Burwood Place, the whole of Torrington Mews, Sovereign Mews and Polygon Mews save No. 14 and part of No. 15, Polygon Mews. Garage and business premises or building situate on north side of South Wharf Road and on sites of Nos. 11 and 12, South Wharves, South Wharf Road, Paddington Basin. Three new residential houses or buildings situate on the north-west side of Stanhope Street on sites of Noe. 1, 2 and 3, Stanhope Street. New laundry or business premises, or building, situate on south-west side of Beethoven Street on sites of No. 21 and 23. Shrewsbury Road, Nos. 2 and 4; Nos. 6 and 8. Blomfield Road, No. 23, and Warwick Avenue, No. 18. Westbourne Terrace, Nos. 70 and 72. Westbourne Grove, Nos. 13, 15 and 17. Hyde Park Gardens Mews, Nos. 24 and 25. One combined system was reconstructed by the Council during the year. Sewer Connections.—In 1936, 67 were reconstructed, either partially or wholly, 4 after Orders under Section 85 of the Metropolis Management Act, 1855, or Section 40 of the Public Health (London) Act, 1936, and 63 on the application of the owners of the properties concerned. Water Supply.—Fifteen certificates under Section 48 of the Public Health (London) Act, 1891, or Section 95 of the Public Health (London) Act,1936, were issued. The Metropolitan Water Board reported 18 cases of discontinuance of water supply for nonpayment of rates. Seven of the premises were unoccupied. In the remaining cases the water supply vras restored after various intervals, ranging from one day to ten days. Mortuary.—Five hundred and fifty-two bodies were deposited at the Mortuary, inquests being held on 404 of that number. Bodies deposited pending burial (all non-infectious) numbered 6. Three hundred and sixty post-mortem examinations were made. Trade Nuisances.—Forty-five complaints were received during the year, those relating to manure numbering 12. Removal of Manure.—Section 94 (2) of the Public Health (London) Act, 1936, 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 of 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, 1936, there were 15 rag and bone dealers in the Borough. Smoke Control.—During 1936, 7 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 19 occasions, occupying 10J hours. Smoke of all descriptions was noted during hours, no "black" smoke being observed. Five complaints relating to the emission of smoke were received during the year. 42 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 stafi Active assistance is given by the police, the Home Secretary having intimated in June, 1928 as a result of representations from the Council, that the police had been instructed to report to the Council such offences against the bye-law as come to their notice in the course of their ordinary duties During 1936, 5 prosecutions were instituted, fines being imposed in four cases, ranging from 5s to 10s, and in 1 case the summons was dismissed 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 CANAL BOATS ACTS, 1877 and 1884 By virtue of the Local Government Board Regulations of Nth 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 V L Ronchetti acted as Canal Boats Inspector during the year The following report for the year 1936 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 Ninety-five canal boats were inspected during the year, the following infringements of the Acts and Regulations being discovered:— Boats leaky 2 Cabins leaky 2 Woodwork of cabins defective 1 Cabin floors defective 1 Bulkheads defective - Bulkheads required — Stoves defective 1 Absence of water storage vessel — Boats without certificates 2 Painting of cabins required 1 Numbering wrong or illegible 2 Boats overcrowded — Four notices were served and on no occasion was admission to a boat refused Legal proceedings were instituted in one instanoe The case was heard at the Marylebone Police Court on the 21st April, 1936, when the defendants were fined ten shillings, with ten shillings costs, for failing to furnish the boat with a suitable and sufficient stove, and ten shillings, with ten shillings costs, for failing to remedy the leaky condition of the boat and the cabin thereof. No case of infectious disease was reported but one death was recorded as occurring among the canal boat population. Fifteen children of school age were found to be living on the boats inspected. 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. 43 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. The annual cleansing at Paddington Basin was carried out during the week-end 24th-26th April. About 750 tons of mud were removed from the bed of the Basin, in addition to 557 tons which were dredged previously, a total of 1,307 tons, being some 9 tons less than that removed in 1D35. HOUSING. Overcrowding Survey. The Housing Act, 1935, required the Council to make a survey of the Borough to ascertain the extent of overcrowding and the places where it existed and to report to the London County Council thereon. The survey commenced on 30th October, 1935, and was completed by the end of January, 1936. It comprised three phases:— (1) the preliminary enumeration, involving a visit to every working class dwelling in the Borough and the recording on the prescribed form of the number of rooms and the number of occupants, under and over ten years of age. (2) the survey, involving the measuring and recording of the rooms of every dwelling where at the preliminary visit it was not possible to verify the existence of overcrowding without measuring up rooms, but such was likely to be present. (3) the preparation of summaries for each ward, showing the number of families of various sizes and the number of rooms occupied, and indicating the number which were overcrowded and those which were not overcrowded. The survey was intended to apply only to "premises used as a separate dwelling by members of the working classes or of a type suitable for such use," but in order that none should be overlooked, the number of houses actually visited was approximately 12,100. In the course of the inquiry, however, it was ascertained that many of these were used for business purposes only or could not definitely be placed in the category laid down and consequently particulars of them were not included in the final summaries. As a result of the first stage or enumeration, 1,435 dwellings were found to be overcrowded within the meaning of the Act. A further 4,584 dwellings were found to be possibly overcrowded and the 3,042 houses containing these doubtfully overcrowded dwellings were the subject of the second stage, or survey. 2,500 houses were completely measured up and 542 only partly, this latter deficiency being accounted for by inability to gain admission to certain rooms and the restricted period allowed for the whole work. In the 3,042 "doubtfully overcrowded" houses there were found 563 definitely overcrowded dwellings. See '• Distribution " Table on page 64. As will be seen from the summary table below the number of occupied working class dwellings was 27,212. The number of overcrowded dwellings was 1,998, a percentage of 7.3. It was also ascertained that 2,024 empty rooms, contained in 641 houses of working class type, existed in the Borough. The final summaries were:— Borough Wards. Totals of families. Percentage overcrowded. Overcrowded. Not overcrowded. Total. Queen's Park 91 3,556 3,647 2.4 Harrow Road 365 7,625 7,990 4.5 Maida Vale 270 3,065 3,335 8.1 Westbourne (incl. Brindley House) 434 4,929 5,363 8.1 Church 525 2,597 3,122 16.8 Town 213 1,565 1,778 11.9 Lancaster Gate West 7 325 332 2.1 Lancaster Gate East 15 354 369 4.1 Hyde Park 78 1,198 1,276 6.1 Total 1,998 25,214 27,212 7.3 Borough Council Dwellings, Brindley House 4 4 8 50.0 44 Estimate of the Number of New Houses required for the Abatement of Overcrowding, Prepared in Accordance with Official Suggestions. Additional dwellings required on the standard of Table I in the First Schedule of the 1935 Act. Additional dwellings required on the standard of 1£ persons a room. Size. Number. 3 rooms. 4 ! rooms. 5 rooms. 6 rooms. 7 rooms. 8 rooms. 9 rooms. 10 rooms. Total. 3 rooms 573 458 86 29 — — — — — 573 4 rooms 225 — 90 124 11 — — — — 225 5 rooms 42 — — 9 15 16 2 — — 42 6 rooms 1 — — — — — 1 — — 1 7 rooms — — — — — — — — — — Totals 841 458 176 162 26 16 3 — — 841 Minimum Standard op Accommodation. The standard of accommodation laid down by the Act for determining overcrowding consists of two parts. The first aims at securing proper separation of the sexes; the second restricts the number of persons who may occupy a dwelling-house. The two requirements are distinct from each other and both must be complied with: they are more fully explained as follows:— (а) A dwelling-house is deemed to be overcrowded if the accommodation is such that any two persons, being ten years old or more, of opposite sexes and not being persons living together as husband and wife, are obliged to sleep in the same room. (б) The maximum number of persons, irrespective of sex, who may be permitted to sleep in a dwelling-house at one time is fixed in relation to the number and sizes of the rooms in the house. The maximum permitted number is ascertained by reference to the two following tables, and is the number obtained by the application of Table I or Table II, whichever is the less. Table I. No. of Rooms. Permitted No. of persons. 1 2 2 3 3 5 4 7 1/2 5 10 And two persons extra for each additional room. Table II. Size of Rooms. Permitted No. of persons. Under 50 sq. ft. Nil 50 or more, but less than 70 1/2 70 or more, but less than 90 1 90 or more, but less than 110 l 1/2 110 or more 2 For the purposes of these tables:— (i) A child under one year of age is not counted and a child between the ages of one and ten years counts as half a person. (ii) Only rooms normally used in the locality for sleeping or living purposes are counted as rooms. (iii) No room under 50 square feet is counted. (iv) Rooms occupied by a sub-tenant must be regarded as a separate dwelling-house. (v) In measuring the rooms, the floor area is measured at the level of the floor, and includes bay window extensions and space taken up by cupboards and projecting chimney-breasts; but where the height of the ceiling above the floor does not exceed five feet, then the floor area below that part of the ceiling is excluded. 45 The Sanitary Officers (London) Regulations, 1935, dated November 7th, 1935, require the Medical Officer of Health to furnish to the Minister of Health a yearly report for his district relating to overcrowding within the meaning of the Housing Act, 1935. The following statement is in respect of the year 1936:— Number of dwellings overcrowded and the number of persons dwelling therein 2,015 (8,951 units) Number of new cases of overcrowding reported 35 (156 1/2 units) Number of cases of overcrowding relieved and the number of persons concerned 18 (84 1/2 units) Particulars of any cases in which dwelling-houses in respect of which the local authority have taken steps for abatement of overcrowding have again become overcrowded Nil Clearance Areas. Titchborne Row.—This area, comprising 12 houses, occupied by 48 persons, was declared to be a clearance area on the 25th February, 1936. A Public Inquiry was held on the 1st December, 1936, and the Minister of Health subsequently confirmed a Clearance Order, subject to a payment being made under Section 42 of the Housing Act, 1936, in respect of certain well-maintained houses included in the Order. The size of the area is 0.11 of an acre, and the cleared site will be left with the owners to develop. Burlington Mews West.—This area comprises two terraces, each of twelve buildings of the news type, separated by a public thoroughfare. The premises are generally inhabited on the first floors, the ground floors being used for business purposes and occupied either apart from or in conjunction with the first floors. The area was declared by the Borough Council on the 23rd July. 1936, and a Compulsory Purchase Order made for the acquisition of the lands in the Area. At the end of the year this Order had not been confirmed. The complete site is 0.4] of an acre and the number of persons to be displaced is 82. It is proposed to utilise the cleared site for the purpose of an open space similar to that existing in Cirencester Street, the accommodation consisting of an open shelter, brick-built lavatories for each sex, a drinking fountain and an attendant's box. Seats would be placed in suitable positions for elderly people. Burlington Mews East.—This area comprises two terraces, each of six buildings of the mews type, separated by a public thoroughfare. The premises are generally inhabited similarly to those in Burlington Mews West. The area was declared a clearance area by the Borough Council on the 1st October, 1936, and a Compulsory Purchase Order was made for the acquisition of the lands in the area. At the end of the year this order had not been confirmed. The extent of the area is 0.25 of an acre and it is proposed to rehouse the 36 persons to be displaced on London County Council Estates. The proposals for utilising the cleared site are the same as for Burlington Mews West. Richmond Mews, Nos. 1-14 (consecutive).—This area, comprising 14 buildings of the mews type, occupied by 29 persons, was declared by the Borough Council to be a clearance area on the 17th December, 1936. The size of the area is 0.17 of an acre. Official representations were made during the year in respect of the following clearance areas which were declared by the Council on the 28th January, 1937. Richmond Mews West.—The area comprises Nos. 1-19 (consecutive), Richmond Mews West and Nos. 69b, 71 and 73, Richmond Road. The Council propose to secure the clearance of the area by purchasing the lands comprised in the area and themselves undertaking, or otherwise securing, the demolition of the buildings thereon. It is proposed that the cleared site (0.42 of an acre) should be used for some purpose of public recreation. 62 persons will be displaced and it is anticipated that re-housing accommodation can be found for these persons on London County Council Estates. Carlton Mews.—The area, Nos. 1-11 (consecutive), Carlton Mews and No. 46a, Woodfield Road, comprises a terrace of twelve buildings of the ordinary mews type. It is proposed to make a Compulsory Purchase Order to acquire the lands in the area. The site (0.12 of an acre) does not lend itself to immediate development, but possession of it would facilitate the widening of Great Western Road at some future time. The Order will displace 18 persons. Chippenham and Rodborough Mews.—This area comprises Nos. 1-12 (consecutive), Rodborough Mews, Nos. 54-78 (even), Nos. 63-67 (odd), Nos. 77-87 (odd), and No. 79a, Chippenham Mews, and 134 persons are in occupation. In order to secure the satisfactory development or user of the site, the Council propose to purchase it, together with certain adjoining lands, namely, No. 52, Chippenham 46 Mews, and Nos. 3-19 (odd), Woodfield Crescent; the highway of Rodborough Mews to be closed and that of Chippenham Mews diverted. The combined site, with an area of approximately 0.92 of an acre, is suitable for the erection of working class flats to the extent of 0.73 of an acre, leaving an area of about 0.19 of an acre to be developed in other ways. Upon the housing site it is proposed to erect a block of flats, containing 46 tenements and housing some 223 persons. The accommodation would comprise 12 tenements with living room, three bedrooms, kitchenette, bath and W.C.; 22 tenements with living room, two bedrooms, kitchenette, bath and W.C.; 8 tenements with living room, one bedroom, kitchenette, bath and W.C.; 4 tenements with living room, having bed-recess, kitchenette and bath/W.C. It is estimated that there are 226 persons at present living on the whole site and the provision outlined above allows for 223 persons being re-housed. Jonson Mews (Nos. 1 to 21 (odd numbers), Alfred Road; Nos. 1 to 7 (odd numbers), Paignton Street; and Nos. 2 to 28 (even numbers), Waverley Road).—Jonson Mews contains some thirteen buildings and forms a cul-de-sac entered from Waverley Road. The buildings are either of the mews type, inhabited on the first storey and used for business purposes on the ground floor, or used for business purposes only. The sites of Nos. 1 and 2, Jonson Mews are bare. The surrounding properties are, with a few exceptions, three-storey tenement houses, with one or two-storey back additions and semi-basements. The most satisfactory method of dealing with the unwholesome conditions existing in this area is by securing the clearance of all the buildings in it. The area is suitable for incorporation in a larger area for redevelopment with flats for workingclass occupation, and it is proposed that the Council should purchase it, together with the sites of Nos. 1 and 2, Jonson Mews. The gross superficial area, i.e., the area of all the lands to be purchased up to, and including, half the width of the surrounding roads, amounts to some 5,400 square yards (1.12 aores), while the net superficial area, within the actual boundaries of the properties and including the highway of Jonson Mews, after allowing right of way to the rear of properties in Harrow Road, aggregates some 3,980 square yards (0.82 of an acre). The area contains 298 persons. Oliver Mews (Nos. 1 and 3 and 2-18 (even)).—This area contains eleven buildings of the ordinary mews type, generally inhabited in the upper parts, the lower parts being used for business purposes and occupied either apart from or in conjunction with the upper parts. It would appear that the most satisfactory method of dealing with the unwholesome conditions existing in this area is by securing the clearance of all the buildings in it. The site (0.14 of an acre) is apparently suitable for large-scale redevelopment in conjunction with surrounding sites, as working-class dwellings, and it is proposed that the site should be purchased by the Council. The properties in the area are occupied by 26 persons. An official representation was also made during the year in respect of the following olearance area, which was declared by the Council on the 24th April, 1937:— Foscote Mews.—This area comprises No. 74a, Amberley Road and Nos. 2-9 (consecutive), Foscote Mews. The area comprises a publio thoroughfare running north-west to south-east from Sutherland Avenue to Amberley Road, and is on the average 26 feet in width; No. 74a, Amberley Road is a dwelling-house, but part of the ground floor is constructed for use as a shop and is soused. Nos. 2, 3, 4, 5, 6, 7, 8 and 9, Foscote Mews are all of the mews type. The upper parts are inhabited and the lower parts used for business or garage purposes. It is considered that the most satisfactory method of dealing with the unhealthy conditions existing in the area is by securing the olearance of all the buildings therein, and that the best use of the site will be secured by its purchase by the Council. It is proposed that the site (0.15 of an acre) should be utilised for a purpose similar to the Cirencester Street open space, the accommodation consisting of an open shelter with brick-built lavatories at either end for each sex, and a drinking fountain in close proximity. 31 persons will be displaced from the area. Artesian Road Clearance Area.—On the 29th September, 1936, the London County Council gave "town planning" consent to the proposed erection by the Borough Council of a block of flats on this site. Mews Areas.—The method of dealing with a number of mews areas is still under discussion between the Borough Council and the County Council. Whereas the Borough Council are of opinion that the most satisfactory method of alleviating the unwholesome conditions which may exist in the areas is generally by closing order proceedings directed to the upper parts of the mews buildings, the County Council hold the view that certain of the areas are more suitable for clearance. Individual Mews Dwellings.—The upper habitable parts of 25 mews buildings which could not be made fit at a reasonable cost were closed for human habitation. The number so dealt with should be considerably increased during the next year as a result of the general survey of mews areas. 47 Summary of Clearance and Housing Operations of the Metropolitan Borough Councils up to 31st March, 1937—Prepared by the London County Council. Metropolitan Borough. Clearance areas declared under the Housing Acts, 1930 and 1936. Action taken under Part II of Housing Acts, 1930 and 1936. Dwellings provided since 1919. Number of areas or groups of areas. Premises. Size of areas. Persons displaced or to be displaced. Houses demolished Houses or parts of houses closed. Completed. In course of erection. Plans in preparation. (1) (2) (3) (4) (6) (6) (7) (8) (9) (10) acres. Battersea 2 15 0.33 87 15 14 600 - 220 Bermondsey 49 2,124 44.57 12,542 57 10 2,169 685 1,588 Bethnsl Green 6 113 2.78 714 6 — 486 35 65 Camberwell 41 408 8.35 1,672 8 17 442 - 66 Chelsea 1 59 1.60 218 17 1 70 80 - Deptford — 216 0.20 64 9 55 246 — - Finsbury 2 168 4.42 882 5 — 448 — - Fulbam 10 292 6.23 2,221 3 49 454 271 266 Greenwich 14 314 9.25 1,376 15 5 1,280 174 60 Hackney 42 876 18.63 4,066 10 66 883 457 258 Hammersmith 13 205 4.67 702 14 11 796 269 82 Hampstead 3 23 0.48 97 — 61 430 — 43 Holborn 1 13 0.54 224 20 40 92 94 Islington 17 195 2.65 1,051 7 447 1,177 140 431 Kensington 14 181 4.14 1,116 7 333 518 — 210 Lambeth 2 227 5.83 1,540 62 83 884 49 62 Lewisham 11 144 3.72 488 2 32 769 - - PADDINGTON 11 224 4.23 1,026 — 505 18 — 104 Poplar 27 205 5.55 1,272 5 18 996 66 38 St. Marylebone †- — — — 2 92 130 — — St. Pancras 14 173 4.20 767 17 273 634 77 347 Shoreditch 7 65 0.84 317 — 35 273 - 10 Southwark 20 450 9.50 2,140 60 120 343 70 - Stepney 16 314 3.53 1,963 15 46 890 212 295 Stoke Newington 7 110 2.01 446 - 2 214 - 80 Wandsworth 23 572 20.06 2,467 15 31 2,027 601 90 Westminster 12 199 4.00 812 4 352 1,174 - - Woolwich 31 315 12.88 1,241 58 3 3,972 278 176 † in this Borough all the work of slum clearance is being undertaken by the London County Council, and the Borough Council is contributing towards the expenses thereof. Houses Unfit for Human Habitation.—The following figures show the extent of the Council's operations during 1936:— Number of basement rooms closed for human habitation 27 Number of basement rooms closed for sleeping purposes only 112 Number of dwelling-houses or parts of dwelling-houses closed for human habitation (other than basement rooms) 26 Number of persons displaced or who will be displaced as a result of the Council's operations 344 Number of displaced persons re housed on London County Council Housing Estates.. 144 A number of displaced persons have found accommodation through their own efforts, while others are awaiting suitable vacancies on London County Council Estates. In lieu of making closing oideis the Council, in 42 instances, after consultation with owners, accepted undertakings from them as empowered by Section 19 (2) of the Housing Act, 1930. Such undertakings possess the advcntage cf 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. Subsequently, three of the owners submitted proposals for making the premises fit for human habitation. In each instance the proposals were approved, the work carried out to the satisfaction of the Council, and the undertakings cancelled. During the year 776 inspections and 1,868 re-inspections of basement premises were made. Underground Rooms.—The use of this term in this paragraph is restricted to rooms dealt with under Section 132 of the Public Health (London) Act, 1936. Particulars of basement rooms in icgaid to which action was taken under the Housing Act, 1930, will be found in the preceding paisgiaphs. Dmirg the year special attention was given to the inspection of underground rooms which did net appear to possess the requisites specified in the above-mentioned section and therefore 48 could not lawfully be occupied separately as dwellings. As a result of the inspections made, a number of 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 the majority of the rooms above referred to was either terminated or prevented. Further action will, if necessary, be taken during the current year with regard to any room which is found on re-inspection to be separately occupied. Compulsory Repairs.—The number of notices served from the 1st January to the 31st December, 1936, under Section 17 of the Housing Act, 1930, was one. At the end of the year the Notice had not been complied with. Six hundred communications were also sent to owners drawing attention to defects liable to be dealt with under this Section. In 559 instances these communications resulted in the defects being remedied. Housing on the London County Council Estates. During the year 351 applications were accepted for housing accommodation on London County Council Estates. Of this number, 273 were sent forward to the County Council with a request that the applications be given preferential consideration in the allocation of accommodation on grounds of overcrowding, unhealthy conditions, urgency and special hardship. The remainder of the applications, in view of the fact that the financial circumstances and place and hours of work of the applicants did not justify their removal to estates situated outside the London area, were placed on the list of applicants waiting to be nominated for suitable vacancies on local estates, such as the Wormholt Estate, Hammersmith, and the Old Oak Estate, East Acton. The number of Paddington families accommodated on London County Council Estates on applications submitted by the Borough Council was 66, whilst 75 other Paddington families were offered and accepted improved accommodation on applications submitted direct to the County Council. Since April, 1920, 973 Paddington families have secured accommodation on London County Council estates on applications submitted by the Borough Council, and since September, 1930, 405 other families have been rehoused as a result of direct application to the County Council. Disposition of Houses on London County Council Estates in Connection with which Nominations are made by the Borough Council under the Agreements in Force between the Two Councils. 1927-1928 Agreements. Wormholt Estate 150 1934 Agreement. Becontree, Essex 2 East Hill, Wandsworth 2 Honor Oak, Deptford 1 Kennington Park, Lambeth 1 Loraine Place, Islington 2 Old Oak, East Acton 40 Roehampton, Putney 1 St. Helier, Morden 3 Watling, Edgware 7 White Hart Lane, Tottenham 1 Wormholt, Hammersmith 58 Total 268 During the year 7 vacancies occurred in the 150 houses on the Wormholt Estate (1927-1928 Agreements), and 7 vacancies in the 118 houses provided under the 1934 Agreement. Altogether the Agreements entered into by the Borough Council have resulted in 336 families obtaining improved housing conditions. I 49 HOUSING. (Ministry of Health Table.) 1.—Inspection of Dwelling-houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health and Housing Acts) 4,431 (b) Number of inspections made for the purpose 29,551 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (6) Number of inspections made for the purpose — (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation — (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects 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 reoord 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 *600 (2) Number of dwelling-houses which were rendered fit after service of formal notice:— (а) by owners 559 (б) 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 1,933 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 1,967 (b) by Local Authority in default of owners — C. Proceedings under Sections 19 and 21 of the Housing Act, 1930— (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — D. Proceedings under Section 20 of the Housing Act, 1930— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 165 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 3 * Informal notioes. 4.—Housing Act, 1935—Overcrowding. (а) (1) Number of dwellings overcrowded at the end of the year 2,015 (2) Number of families dwelling therein 2,015 (3) Number of persons dwelling therein 8,951 units. (б) Number of new cases of overcrowding reported during the year 35 (156½ units). (c) (1) Number of cases of overcrowding relieved during the year 18 (2) Number of persons concerned in such cases 84J units. (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e) Any other particulars with respect to overcrowding conditions upon whioh the Medical Officer of Health may consider it desirable to report — 60 Tenement Houses.—The number of houses on the register at the close of the year was 1,751. Inspections totalled 10,170, and legal proceedings were instituted with respect to nuisances or contraventions of the Bye-laws in 19 instances. Particulars of the defects, etc., discovered and remedied will be found on page 51. 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 the washing of 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 the year steps continued to be 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, and special attention was devoted to certain areas. Notices were served with respect to 148 premises, the notices being complied with in 124 instances either by the provision of the necessary accommodation or by re-arrangement of the tenancies, and 24 cases were outstanding at the end of the year. 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 4 cases of overcrowding were discovered, and were abated either by the removal of the families or by the re-arrangement of the occupants of the rooms. Annual Cleansing.—1,460 registered tenement houses were inspected during the year and notices were served for the cleansing and other work found to be necessary. Common Lodging Houses.—There are 2 common lodging houses in Kilburn Lane and 1 (Cecil House) in Harrow Road. The number of beds for which each is licensed is as follows :— 268 and 270, Kilburn Lane, 60 beds for men. 272, 274 and 276, Kilburn Lane, 105 beds for men. Cecil House, 179, Harrow Road, 69 beds for women and children. During the year 83 inspections (including 17 night inspections) were made by the two Sanitary Inspectors responsible for the supervision of these houses. One case of notifiable illness and three deaths occurred among the occupants. Housing Act: Rent Books.—Two reports were received as to rent books not containing the required particulars. Cautionary letters were sent to the owners. Rent and Mortgage Interest (Restrictions) Acts, 1920-1933. Six applications for certificates were made, all of which were granted. 51 Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied in Registered Tenement Houses. 1936. Drain defective 74 ,, choked 37 Soil pipe or soil vent pipe defective 77 Fresh-air inlet valve defective or missing 103 Manhole cover defective 21 Gully grating missing 50 Gully choked 10 Rain-water pipe defective 78 ,, ,, choked 7 Gutters defective 44 Waste-pipe defective 104 ,, choked 21 ,, untrapped 26 ,, missing 2 Sink defective 107 Absence of means for carrying away waste water from taps 22 Houses with insufficient water supply 91 Additional draw-off taps provided 155 Water-closet roof defective 49 ,, walls out of repair 48 ,, flooring defective 18 ,, flushing apparatus defective 168 ,, pan defective 110 ,, pan foul 6 ,, seat defective 52 ,, choked 12 ,, door missing, off hinges, defective, or fastenings out of order 128 ,, lighting or ventilation inadequate 24 ,, accommodation insufficient 168 Drinking water cistern defective 7 ,, ,, ,, dirty 6 ,, ,, ,, uncovered or cover defective 8 Rooms damp 144 Rooms, staircases, wash-houses, water-closets, yards, areas, etc., dirty 3,835 Rooms verminous 784 Rooms, floor, bedding or contents dirty 16 Roof leaky 306 Mixing of sexes 6 Chimney smoky 19 Food cupboard not provided 197 Cooking accommodation not provided or defective 28 Staircase not provided with artificial light 18 ,, without handrail — Window cords or fastenings out of repair 766 Common staircase out of repair 161 Animals improperly kept 1 Premises where water supply was cut off 1 Wash-house paving defective 48 Yard or area paving defective 123 Dustbin defective 171 ,, accommodation insufficient 30 Premises without ashpit accommodation 2 Accumulation of refuse 34 Notices Issued. Written Intimations 901 Statutory Notices:— Verminous rooms 112 Additional taps 13 Other matters 404 Bye-law Notices 1,963 Item of Dilapidation for which Letters were sent to the Owners (Seotion 9 of the Housing Act, 1936). Wall-plaster broken, bulging, or defective 182 Matchboarding defective 7 Wall-paper loose 13 Skirting defective 11 Doors defective or missing 70 Locks defective 10' Ceiling plaster defective 163 Ceiling paper loose 2 Floors broken or badly worn 234 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 246 Stove Bettings defective 35 Flues defective 29 Hearths defective 32 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 31 Cupboard doors defective or missing and shelves missing 12 52 Cupboard shelves missing 3 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 347 Window-frames loose or defective (including oak sills worn or rotten) 103 Window-glass broken 410 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 130 Steps to front entrance or area defective 25 Bailing to area or area steps defective 12 Guard rails to addition roofs defective, broken or rotten 9 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 22 Vault doors missing or defective 30 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 101 97 — — Want of ventilation 8 8 — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 2 — — — Insufficient Sanitary accommodation unsuitable or defective not separate for sexes 3 1 2 1 - — — — - — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) - - - - Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) 2 1 - - Total 118 108 — — * 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 1935 there were 996 premises on the Register. During 1936, 141 premises were removed from the Register and 43 added, making the total at the end of the year 898. The Department reported to the Home Office 6 cases in which the prescribed abstract of the Factory and Workshop Act, 1901, was not displayed, and received from that Office notice of 8 workshops, 4 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 14 lists in February and 14 in August. These lists contained 222 names and addresses of which 191 were forwarded to other districts. From other districts 218 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 638 inspections, comprising 225 of factories, 389 of workshops and 24 of workplaces. There were 118 nuisances or defects found upon registered premises, nearly 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 9 complaints, which comprised:— Sanitary conveniences not separate for sexes 2 Other offences 7 Bakehouses.—During the year 1 level bakehouse was opened, the total number on the Register at the end of the year being 69, of which 51 were factory bakehouses. The number of level bakehouses was 30 (15 being factories), and of underground 39 (36 being factories). The bakehouses were inspected on 324 occasions during the year. Rag Flock.—Little, if any, rag flock is used in the Borough, and no samples were taken during the year. 53 SHOPS ACT, 1934. The Shops Act, 1934, enacts that in every part of a shop in which persons are employed about the business of the shop :— (a) Suitable and sufficient means of ventilation shall be provided and suitable and sufficient ventilation shall be maintained; (b) suitable and sufficient means shall be provided to maintain a reasonable temperature and a reasonable temperature shall be maintained The Act also enacts that:— "In every shop, not being a shop which is exempted, there shall be provided and maintained suitable and sufficient sanitary conveniences available for the use of persons employed in or about the shop." A shop is exempted if there is in force a certificate exempting the shop, granted by the Council, and any such certificate remains in force until it is withdrawn by the authority. No such certificate may be granted unless the Council is satisfied that by reason of restricted accommodation or other special circumstances affecting the shop it is reasonable that such a certificate should be in force, and that suitable and sufficient sanitary conveniences are otherwise conveniently available. A certificate must be withdrawn if the Council is at any time not satisfied that it should remain in force. Up to the end of August, the inspection of the shop premises in the Borough was carried out by the District Inspectors; for the remaining part of the year the work was performed by Mr. A. C. Harrison, one of the Meat and Food Inspectors, On the 4th February, 1936, the Council adopted the following standards regarding sanitary accommodation :— In shops where members of both sexes are employed separate sanitary conveniences for each sex are to be provided if the number of assistants exceeds four; but if the number is four, or less, one sanitary convenience is to be regarded as suitable and sufficient, provided that the door of such convenience is fitted with a proper lock or fastener on the internal side and an automatic indicator showing on the external side of the door whether the apartment is engaged or vacant. With regard to the distance from a shop at which an outside convenience may be situate, generally speaking, no certificate of exemption is to be granted unless the sanitary convenience provided for a male assistant is less than 100 yards from the shop, and it may be a public or private convenience. As regards a female shop assistant, the maximum distance is to be 25 yards and the convenience must be a private one. The following particulars relate to work carried out under the Shops Act, 1934, during the year: — First inspections 284 Re-inspections 511 Exemption certificates as regards sanitary conveniences applied for 37 ,, ,, granted 35 The following contraventions of the Act were discovered during the year :— Insufficient sanitary conveniences 6 Sanitary conveniences unventilated 7 ,, ,, improperly sealed from lobbies 9 Absence of lobbies to sanitary conveniences 18 Water-closet walls and ceilings defective or dirty 37 ,, roofs defective 1 ,, pans defective or dirty 6 ,, windows defective 10 ,, doors defective 26 ,, fittings defective 18 Absence of indicators to water-closet doors 40 ,, lighting to water-closets 1 Reasonable temperature not maintained 9 Insufficient ventilation 3 54 In the course of his inspections, the Inspector also discovered the following defects:— Premises dilapidated or dirty 32 Waste pipes of sinks untrapped 23 ,, ,, ,, defective 3 Yard paving defective .... 1 Pavings of dairies defective 1 Dustbins defective 14 Accumulation of rubbish 2 No legal proceedings were necessary during the year. FOOD SUPERVISION. Slaughterhouses.—There was, at the end of the year 1936, one slaughterhouse within the Borough, at 275, Edgware Road. The slaughterhouse at 249, Maida Vale was closed during the latter part of the year. Three hundred and two inspections were made during the year. The number of animals slaughtered, so far as is known, was 3,032, comprising 204 bullocks and 2,828 sheep, a decrease of four bullocks and an increase of 354 sheep as compared with 1935. 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. Hearts. Lungs. Livers. Hearts. Tuberculosis 5 5 9 6 5 3 2 Actinomycosis 1 1 — — — — — — — Abscess — — — 3 — — — 12 12 12 Distomum Hepaticum — — — 58 — — — — — — Parasitic Invasion — — 5 — — — 531 72 72 Pentastomum Denticulatum 1 2 — — — — — Injury — 1 — — — — — — — — Pleurisy — — 4 — — — — 3 — — Cystercercus Tenui-collis — — — — — — — — — — Cavernous Angioma — — — 2 — — — — — — 6 7 19 69 7 3 2 546 84 84 Total weight, 2,560 lbs. Pieces of meat, weighing in all 56 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 1936 the number of carcases was 82. On examination it was found necessary to destroy 5 heads and offal weighing 69 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. Licenses previously granted to the three slaughtermen who follow that occupation in the Borough, continued in force during the year. 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, situated at 51, Shirland Road, was closed in November. Forty-five inspections were made and approximately 3,990 head of poultry were slaughtered. TJnsound Food.—No proceedings were necessary in regard to food unfit for human consumption. Food Purveyors.—At the end of the year there were some 836 purveyors of food in the Borough, classified as follows:—Butchers 74, Fishmongers 26, General 67, Grocers 106, Fried Fish 31, Refreshments 122, Confectioners 112, Greengrocers 102, Milk 135, Provision 61, 55 In addition to the above, there were at the end of 1936, 63 licensed Street Traders selling food within the borough, namely:—Fruit and Vegetables 45, Ice Cream 8, Light Refreshments 9, Sweets 1. These, with the storage premises of 26 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 2,802. Section 187 of the Public Health (London) Act, 1936, 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 137 premises. Ice Cream.—There were 183 shops at which ice cream was known to be sold, comprising the following kinds Qf businesses :—Bakers 9, General 26, Milk 12, Confectioners 82, Refreshment 48, Wholesale 2, Newsagents 2, Greengrocer 1, Fancy Goods 1. One hundred and fifty:nine inspections of premises were made. Ice cream was sold from 34 barrows stored within the Borough and from some 39 barrows stored outside the Borough. The above-quoted section of the Public Health (London) Act, 1936, 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 1936, there were 167 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 3 tons 17 cwts. 3 qrs. 25 lbs., comprising the following varieties :—Meat and Offal 2,685 lbs.; Poultry, 317 lbs.; Fruit, 392 lbs.; Vegetables 5,250 lbs. Pastries and Cakes, 84 lbs.; Brawn, 5 lbs. Dairies and Milkshops.—At the end of the year 1935 there were 130 names on the Register. During the year 1936, 5 names were added, making a total of 135. There were 311 inspections made. In addition to the above-mentioned, there are 33 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 110 premises. Milk (Special Designations) ORDER, 1936. This Order came into operation on the 1st June, 1936, superseding and replacing the orders of 1923 and 1934. It reduces the number of grades from four to three, namely "Tuberculin Tested," "Accredited" and "Pasteurised." "Tuberculin Tested" takes the place of "Certified" and "Grade A (Tuberculin Tested)," and "Accredited" takes the place of "Grade A." The special designation "Pasteurised" remains as heretofore. The licences issued by the Council during the year numbered 108, comprising 39 for "Tuberculin Tested " milk, 2 for " Accredited " milk, and 67 for "Pasteurised" milk. The licenses in respect of "Tuberculin Tested" milk included one for a bottling establishment, and those in respect of "Pasteurised" milk, 1 for a pasteurising establishment. The samples taken by the Council's Inspector numbered 34, comprising 23 of "Pasteurised" milk and 11 of "Tuberculin Tested" milk. The samples included 6 of " Pasteurised " milk taken at Paddington Hospital, and 13 of "Pasteurised" milk taken at Schools. All the samples were reported to comply with the appropriate bacteriological standards. Milk and Dairies Order, 192b. 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, 12 (2.0 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 2.6 per cent, in 1935 and 2.5 por cent, in 1934, 56 Sixty of the samples were taken on Sundays and Bank Holidays. All were reported to be genuine. Fifty-eight samples of milk were taken at Paddington Station on delivery by rail, all of which were reported to be genuine. No samples of milk were obtained at Paddington Station at the request of other Boroughs. Sampling of Milk Supplies to Public Institutions.—There are 11 institutions and 18 Schools from which samples of milk are taken periodically. Twenty-six samples were taken during 1936, which, with one exception, were returned as genuine. This sample, taken from a School, revealed a deficiency in fat to the extent of 21.66 per cent. Sampling of Milk from, Automatic Machines.-—Automatic machines for supplying milk are in use at eight premises in the Borough. From these, during 1936, 20 samples were taken for chemical analysis, and were reported to be genuine, except one, which showed a fat deficiency of 12.33 per cent. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined for the presence of preservatives. Two contraventions of the Regulations were detected but no legal action was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year 4 samples of full cream sweetened, and 9 samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. Four samples of dried milk were taken during 1936 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.I, where also bacteriological examinations are made of food suspected of being deleterious, and of samples of milk procured under the provisions of the Milk (Special Designations) Order, 1936. During 1936, samples of pickles, tinned salmon, smoked salmon, cooked and uncooked marrow, chocolate and jam were submitted for special examination, no unusual features being detected. The results of other samples analysed or bacteriologically examined are recorded elsewhere in this Report under the appropriate headings. Summaries of the results of analyses made by the Public Analyst during the year are given below. The results of legal proceedings taken are summarised on page 62. In connection with the analysis of milk samples, the Public Analyst furnishes the result of his analysis and the following table is of interest. Genuine Milk Samples, 1936. Average Monthly Figure for Percentage. Fat Content and Non-Fatty Solids. January February 3.57 8.60 March 3.44 8.55 April 3.43 8.66 May 3.60 8.67 June 3.34 8.68 July 3.61 8.61 August 3.79 8.69 September 3.56 8.61 Ocotober 3.79 8.74 November 3.74 8.63 December 3.87 8.63 Avebage for Year. Samples taken at Paddington Station 3.79 8.73 ,, ,, elsewhere 3.63 8.67 57 Samples Submitted to Public Analyst—1936. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 5 — — Ammoniated Tincture of Quinine 2 - Anchovies 1 - - Baking Powder - 4 - — — Blue Ointment - 1 - — — Borax - 1 - — — Brawn - 1 - Bread 5 - - - Bread and Butter (cut) - 2 - — Butter — 10 - — — — Cake — 4 - — — Calomel Ointment 1 - Camphorated Oil 2 Candied Peel — 2 - — Cheese — 6 - — - Chocolate 3 Chocolate Caramels 1 Chopped Suet 2 - Claret 1 - - Cocoa 4 - Coffee 6 - Coffee Extract 1 - - Corned Beef 2 - - Crab Paste 3 - - - Cream - 11 - - - - Crystalised Fruit Jellies 1 - - Crystalised Ginger 2 - Custard Powder - 4 Dried Fruit — 10 - Dripping — 4 - — — Essence of Coffee and Chicory — 5 - — — — Fish Paste — 1 - — Flour — 2 - Full Cream Condensed Milk, Sweetened — 4 - — Full Cream Dried Milk Food - 3 - - - - Gin — 5 - — Ginger Beer 2 - - - Grape Fruit Crush 1 - Ground Almonds 5 Half Cream Dried Milk Food — 1 - — Honey — 3 - — — Ice Cream 9 - - Iodine Ointment 2 - - - Jam 10 1 10.00 Jelly — 2 - — - Lard — 4 - — Lemonade Powder — 4 - — — Margarine — 11 - — Meat Paste 5 - Mercury Ointment 1 Milk 300 — 6 — 2.00 Mincemeat — 3 — — Mineral Water — 2 — — — — Mustard — 6 — — Pepper — 4 — — — — Pickled Walnuts 1 - - Pickles - 4 - - - - Port 3 - - Rice - 2 - - - - Rum 1 1 1 100.0 - Sago 2 Salad Cream 2 - Sauce 1 Sausages 14 — 1 — 7.14 Seidlitz Powder - 5 - - - - Self-Raising Flour 1 - - - Semolina — 2 — — — Shredded Suet — 1 — — — — Shredded Suet with Flour — 1 — 1 — 100.00 Skimmed Condensed Milk, Sweetened 9 - Smoked Salmon 1 Sponge Cakes — 2 — — — — Stout — 1 — — — — Sugar — 3 — — — - Sulphur Ointment — 1 — — — — Sweets 2 - Tapioca — 1 2 — — — — 58 Samples Submitted to Public Analyst—1936—continued. Number examined. Number adulterated. Percentage adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Tea 3 — — — Tincture of Iodine 1 _ - Tinned Beef Steak Pudding 1 - - - - Tinned Fish - 8 Tinned Fruit - 4 — — — — Tinned Peas - 2 - - - - Tinned Veal, Ham and Tongue __ 1 - - — - Tinned Tomatoes 4 Vegetable Marrow 2 Vinegar 1 5 1 1 100.0 20.00 Vinegar of Squills - 2 - - - - Whisky 1 3 - White Precipitate Ointment 1 Yellow Mercury Oxide Ointment — 2 - — — — Zinc Ointment - 1 - — — — 322 278 9 3 2.79 1.08 600 12 2.00 Agricultural Produce (Grading and Marking) Act, 1928. The Council is responsible for enforcing the provisions of this Act and the Medical Officer of Health and the male Sanitary Inspectors have been authorised to act as officers for this purpose. 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. All samples taken were found to comply with the regulations applicable. Merchandise Marks Act, 1926. The Council is responsible for executing the provisions of this Act, so far as relates to any goods being foodstuffs to which an Order in Council under the Act applies, and excepting any provisions relating to the importation of goods. The Medical Officer of Health and the Sampling Officer have been authorised to act as officers in this respect. The following purchases were made with a view to ascertaining whether the requirements of the Orders had been complied with, viz:—Honey 5, Butter 8, Apples 5, Tomatoes 5, Sultanas 5, Currants 5, Raisins 5, Oat products 5, Salmon 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. One establishment in the Borough has been registered under the Act for the manufacture or sale of Artificial Cream. Pharmacy and Poisons Act, 1933. This Act came into operation on 1st May, 1936. 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. During the year, 120 applications for entry on the list were received, and 116 names were placed on the list, the remaining 4 applications being withdrawn, as upon investigation it was found that entry was not necessary. 59 EXAMINATION OF BATH WATER. At the request of the Baths and Washhouses Committee (13th July, 1936), arrangements were made for the bacteriological examination of samples of bath water from the two bathing establishments of the Borough Council. Ten samples annually are to be taken by the Medical Officer of Health (one each quarter from each swimming bath in use). The examinations are made by the Royal Institute of Public Health, and the annual cost is fifteen guineas. The sample taken during 1936 proved to be satisfactory. PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 121. Nuisance Caused by Pigeons.—The number of complaints received arising from the above cause was 13. 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 95 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 houses 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 2nd to 7th November inclusive. The usual circular letter was sent out to principal wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—Seventy-four 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, and (after 1st October) Section 123 of the Public Health (London), Act, 1936, were served with respect to 168 premises, the verminous rooms numbering 253. The owners of 65 premises accepted the Council's offer with regard to the spraying of infested rooms with a special insecticidal solution, 102 rooms being so treated at a charge to the owners of 7s. 6d. per room. Verminous Household Goods.—Arrangements are in force with the Council of the Royal Borough of Kensington for the disinfestation at their Station of verminous furniture, bedding, etc. Hydro-cyanide gas is used for furniture and steam treatment for bedding, the charge per load being £3 for the former and 2s. 6d. the latter. No cases were dealt with during the year. Section 127 of the Public Health (London) Act, 1936, authorises the cleansing of verminous persons by the exercise of powers granted by a petty sessional court in oases 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 224 of the Public Health (London) Act, 1936, 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 circumstanoes 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 it was necessary to obtain an order of the Court for removal. One hundred and thirty-seven visits were paid to the cases to which the attention of the Department ha,d been called. SUPPLY OF MEDICINE AND MEDICAL ASSISTANCE. Section 227 of the Public Health (London) Act, 1936, empowers a sanitary authority, with the sanction of the Minister of Health, to provide a "temporary supply of medicine and medical assistance for the poor inhabitants of their district." Under the provisions of this Section 11,300 units of insulin were supplied to a resident of the Borough, through the Diabetic Clinic of the University College Hospital, at a cost to the Council of £2 15s. 6d. 60 LEGAL PROCEEDINGS, 1936. Premises. Offence. Fine. Costs. Public Health (London) cqt, 1891, Section 4. Public Health (London) Act, 1936, Section 82. £ s. d. 23, Brindley Street Ceiling of second floor front room defective Work done 1 1 0 45, Brindley Street Main roof and ceiling plaster of top landing defective Work done 1 1 0 45, Carlton Vale Premises without a proper and sufficient water supply Order made 1 0 0 40 Chippenham Road Premises without a proper and sufficient water supply Summonses dismissed — ,, ,, .. Drip sink in first half-landing sink closet and flooring of basement passage defective Summonses dismissed — 18, Clarendon Street Rear wall of back addition room damp; flooring of basement front room defective; back addition roof defective Order made 1 1 0 50, Clarendon Street Accumulation of refuse in basement front room £1 1 0 0 67, Clarendon Street and front area Walls of back area and walls and ceilings of staircase, wash-house, basement passage, water-closet, basement back room and second floor front room dirty Work done 1 1 0 18, Delamere Terrace Walls of top floor left-hand front room and walls and ceilings of top floor back room, ground floor slip room and water-closet, passage, staircase and landings dirty Order made 1 1 0 30, Delamere Terrace Water-closet on second half-landing choked and defective Work done 3 3 0 ,, ,, .. Back addition roof defective; leakage into second floor water-closet; ceilings of first floor kitchen and staircase defective; ground floor water-oloset choked Summons marked "Not Served'' - ,, ,, .. Ground floor water-closet continually choking Work done 1 1 0 ,, ,, .. Drain choked (a) Order made 1 1 0 ,, ,, .. Rain-water and waste-pipes at rear defective (b) ls 1 1 0 84, Fernhead Road Main roof defective Work done 2 2 0 11, Kildare Terrace Ceiling of bathroom on first half-landing defective, and bath overflow pipe and condensation pipe of geyser improperly connected to waste-pipe Work done 1 1 0 114, Ledbury Road Premises without a proper and sufficient water supply Work done 2 2 0 4, Paignton Street Walls and ceilings of staircase, wash-house, water-closet, ground floor back addition room and basement passage dirty; walls of front and back areas dirty Order made 1 1 0 10, St. Stephen's Square Main roof defective Work done 1 1 0 79, Sutherland Avenue Failing to comply with Magistrate's Order to remedy the dampness of the walls of the basement front room, amend the waste-pipe of sink in basement scullery, and cleanse the walls and ceiling of the basement front entrance. Adjourned sine die - 19, Warlock Road Main roof and flooring of basement passage defective ; walls of basement back room damp Order made 1 1 0 16, Warwick Avenue Main roof and skylight over basement bathroom defective; walls of basement left-hand living room damp Work done 1 1 0 12, Waverley Road Walls of back area and walls and ceiling of ground floor water-closet dirty Work done. Summons withdrawn - 89, Woodchester Street Walls of front and back areas dirty; walls and ceilings of staircase, wash-house, lower water-closet and ground floor addition room dirty Public Health (London) Act, 1891, Section 37. Work done 1 1 0 9, Portsdown Road Insufficient dustbin accommodation £1 1 1 0 45, Carlton Vale Insufficient dustbin accommodation Public Health (London) Act, 1891, Section 96. £1 ls - 45, Cirencester Street Letting the basement front room contrary to the above Section. £1 1 1 0 61 LEGAL PROCEEDINGS, 1936.—continued. Premises. Offence. Fine. Costs. Byb-laws pursuant to above and other Acts £ s. d. 19, Ashmore Road Failing to provide proper accommodation for the storage of food for the separate use of each family Work done. 10s. 1 1 0 160, Ashmore Road .. Failing to provide proper accommodation for the storage of food for the separate use of each family Work done. Summons dismissed 8, Brindley Street Executing sanitary work in a manner contrary to Bye-laws £1 — 16, Brindley Street .. Executing sanitary work in a manner contrary to Bye-laws £1 — 20, Brindley Street Executing sanitary work in a manner contrary to Bye-laws £1 — 45, Carlton Vale Failing to keep sash-cords of top half-landing £1 Is. — 1 1 II * * window in a proper condition of repair Failing to carry out Annual Cleansing £1 Is. II II • • Failing to maintain the dustbin in a proper state of repair £1 Is. — 40, Chippenham Road Failing to carry out Annual Cleansing Summons dismissed and £3 3s. costs awarded against Council M II Failing to maintain the dustbin in a proper state of repair Summons dismissed — II tt Failing to maintain the basement water-closet and the accessories thereof in a proper state of repair Summons dismissed tt tt Failing to keep the window cords, etc., of the ground floor front and back rooms and second floor front and back rooms in good order and repair Summons dismissed 61, Chippenham Road Failing to maintain the dustbins in a proper state of repair Notice complied with. Summons dismissed. — 37, Cirencester Street.. Failing to maintain the junction of sink wastepipe with waste stack in a proper condition of repair £2 2s. 1 1 0 66, Cirencester Street.. Failing to maintain the sink in wash-house in a proper condition of repair Work done. Summons marked ' 'Not Served'' — 80, Cirencester Street.. Executing sanitary work in a manner contrary to Bye-laws Work amended. 10s. — 11, Clarendon Street .. Constructing the ground floor water-closet in a manner contrary to Bye-laws £2 2 2 0 19, Clarendon Street .. Failing to maintain the flushing cistern of the ground floor water-closet in a proper state of repair £1 1 1 0 15, Delamere Crescent Failing to maintain the dustbin in a proper state of repair Notice complied with. Summons dismissed — 18 Delamere Terrace .. Failing to keep the sash-cords of windows of top front (left) room, top half-landing, second floor back room, second half-landing, ground floor slip room and ground floor back room in good order and repair 10s. 30, Delamere Terrace.. Failing to keep the window cords and fittings of first floor front and back rooms and second half-landing water-closet in good order and repair 10s. 0 10 6 66, Great Western Road Failing to give notice of intention to execute sanitary alterations Summons dismissed under Probation of Offenders Act 0 10 6 tt tt Executing sanitary work in a manner contrary to Bye-laws Ditto. 0 10 6 8, Harrow Road Executing sanitary work in a manner contrary to Bye-laws 10s. 1 1 0 242, Harrow Road Failing to provide water-closet accommodation for the separate use of each family £1 1 1 0 It It • • Failing to provide adequate means for the artificial lighting of every common staircase £1 — 244, Harrow Road Failing to provide water-closet accommodation for the separate use of each family £1 — II II • • Failing to provide adequate means for the artificial lighting of every common staircase £1 — 342, Harrow Road Failing to deposit plans and other particulars with regard to drainage work Plans produced prior to hearing 1 1 0 11, Hethpool Street .. Failing to provide water-closet accommodation and proper accommodation for the storage of food for the separate use of each family 5s. 1 1 0 80, 81 and 82, Kensington Gardens Square Failing to deposit plans and other particulars with regard to drainage work £1 62 LEGAL PROCEEDINGS, 1936.—continued. Premises. Offence. Fine. Costs. £ B. d. 114, Ledbury Boad .. Failing to provide water-closet accommodation and proper accommodation for the storage of food for the separate use of each family £1 1 0 0 25, Market Street Failing to provide water-closet accommodation, proper accommodation for the storage of food, and accommodation for the preparation and cooking of food, for the separate use of each family £1 2 2 0 51, Market Street Knowingly suffering overcrowding of the basement back room Summons dismissed under Probation of Offenders Act 1 1 0 63, Oxford Terrace Constructing a sink waste-pipe discharging into a hopper head 10s. 1 1 0 II 9 9 • • Constructing a sink waste-pipe of materials other than thoBe prescribed by the Bye-laws Summons dismissed — 14, Praed Street Failing to deposit plans and other particulars with regard to drainage work Summons marked "Not Served," Defendant "Gone Away" 9 9 9 9 • • Executing drainage work in a manner contrary to Bye-laws Ditto — 26, Randolph Mews .. Failing to keep the rain-water pipe in a good state of repair Summons dismissed under Probation of Offenders Act 0 10 6 131, Shirland Road .. Failing to deposit plans and other particulars with regard to drainage work 10s. 1 1 0 II II • • Executing drainage work in a manner contrary to Bye-laws Work amended. Summons dismissed with a caution - 12, Waverley Road .. Failing to maintain the dustbin in a proper state of repair Work done. Summons withdrawn — 23, Woodfield Road .. Failing to keep the common staircase in a state of good repair Work done. 10s. 1 1 0 41, Chippenham Road London County Council (General Powebs) Act, 1908. Using the bakehouse as a sleeping place in contravention of Section 8 £1 — 18, Delamere Terrace.. London County Council (General Powers) Act, 1922. Section 10. Ground floor back room verminous 10s. - 11, Hethpool Street .. First floor front room verminous Food and Drugs (Adulteration) Act, 1928. 5s. 1 1 0 Sample No. 2 .. Selling rum containing 11.13 per cent, excess water Summons dismissed under Probation of Offenders Act 5 6 0 Sample No. 144 Selling milk containing 5.06 per cent, of added water Summons dismissed under Probation of Offenders Act — Sample No. 328 Selling milk 12.33 per cent, deficient in fat 5s. 1 1 0 Sample No. 359 Selling vinegar 26.5 per cent, deficient in acetic acid Summons dismissed under Probation of Offenders Act 5 5 0 Sample No. 423 Selling milk 21.66 per cent, deficient in fat Summons not served — C. B. "Brothers" 9 9 9 9 • • Canal Boats Regulations, 1879, and Canal Boats Amendment Regulations, 1925. Stove defective and smoky Boat and cabin leaky 10s. 10s. 0 0 10 10 0 0 63 Report of the Work of the District Inspectors. Inspeotion 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. j Improperly kept. Removed. 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 1935 1,621 18 1,871 15,086 3 193 45 12 3415 7 945 65 16 168 4 7 12 16 546 10 58 1007 5 27 200 — 8 — 1936 1,636 39 2,156 14,542 7 57 46 18 2847 7 911 46 5 181 — 5 2 8 302 — 39 531 3 13 128 — 8 — 64 HOUSING ACT, 1935.—OVERCROWDING SURVEY. Distribution of working class families in relation to size of family and size of dwelling occupied. Metropolitan Borough of PADDINGTON. 65 CONTENTS. page page Acute Encephalitis Lethargica 21 Food, Chemical and Bacteriological Examina- Acute Influenzal Pneumonia 21 tion 56 Acute Polio-encephalitis 21 ,, Destroyed 55 Acute Polio-myelitis 21 ,, Poisoning 23 Acute Primary Pneumonia 21 ,, Purveyors 54 Acute Rheumatism 22 ,, Samples Analysed 56-58 Administrative Work 39 ,, Supervision 54 Aged, etc., Persons, Removal of 59 ,, Unsound 54, 55 Agricultural Produce (Grading and Marking) Footway fouling by Dogs 42 Act, 1928 58 German Measles 20 Annual Cleansing 50 Glanders 23 Ante-natal Consultation Centres 5, 31 Grants for Necessitous Persons 26, 37 Anthrax 21 Health Visiting 30 Artificial Cream Act, 1929 58 Home Helps 34 Artificial Pneumothorax 25 Homework (Outworkers) 52 Artificial Sunlight Treatment 5, 31, 33 Housing 43-50 Baby Hospital 35 Hydrophobia 23 Bacteriological Work 39 Ice Cream 55 Bakehouses 52 Infant Consultation Centres 5, 31 Bath Water Examinations 59 Infantile Mortality 12, 13 Beauchamp Lodge Emergency Home 35 Infectious Diseases, Notification of 15, 16 Births 6, 7-9 ,, ,, Nursing of 39 Canals, Canal Boats 42 ,, ,, Prevention of 39 Cancer 23 Infective Enteritis 24 Cerebro-spinal Fever 21 Infirm, etc., Persons, Removal of 59 Chicken-pox 19 Inquests 14 Child Life Protection 38 Insulin, Provision of 59 Cholera 23 Invalid Children's Aid Association 38 Clearance Areas 45-47 L.C.C. Estates, Housing on 48 Clinics, Treatment Centres, etc. 5, 31 Legal Proceedings 60-62 Combined Drainage 40 Malaria 21 Common Lodging Houses 50 Manure, Removal of 41 Compulsory Repairs 48 Marriages 6, 7 Compulsory Removal of Aged, etc., Persons 59 Massage Treatment 31,33 Condensed Milk Regulations 56 Maternal Mortality 14,38 Continued Fever 20 Maternity and Child Welfare 30 Contraceptive Advice 35 ,, Nursing 33 Convalescent Homes 32, 38 ,, Outfitg 34 Dairies and Milkshops 55 ,, Wards 5,33 Day Nurseries 5, 36, 39 Measles 20 Deaths 6, 9-11 Meat Regulations 54 Dental Treatment: Maternity and Child Wel- Medical Officers, Visiting 4, 39 fare 32 Membranous Croup 17 ,, ,, Tuberculosis 26 Merchandise Marks Act, 1926 58 Diarrhoea 24 Mews Areas 45, 46 Diphtheria 17 Midwifery Service 34 ,, Carrier Clinic 18 Milk and Dairies Order 55 ,, Immunisation 5, 18, 19 Milk, etc., Grants (M. & C.W.) 37 Diseased, etc., Persons, Removal of 59 ,, ,, (Tuberculosis) 26 Disinfection 39 Milk Sampling 55, 56 District Inspectors' Work 63 Milk (Special Designations) Order 55 Dogs, Fouling of Footways by 42 Milkshops and Dairies 55 Drainage, Combined 40 Mortuary 41 ,, House 40 Necessitous Mothers and Children, Grants for 37 ,, Reconstruction Plans 40 Nursing of Cases of Infectious Illness 39 Dried Milk Regulations 56 Nutritional and Physio-Therapeutic Clinic 5, 31, 33 Dysentery 23 Obstetric Consultant 34 Erysipelas 21 Ophthalmia Neonatorum 20 Factories and Workshops 52 Outworkers (Homework) 52 Food Adulteration 55 Overcrowding 50 66 CONTENTS—Con tinned. page page Overcrowding Survey 43, 64 Slaughterhouses 54 Pharmacy and Poisons Act 58 Smallpox 19 Pigeons, Nuisance from 59 Smoke Control 41 Plague 23 Staff 4, 39 Plans, Drainage 40 Tenement Houses 50-52 Pneumonia 21 ' 'Toddlers'' Clinic 5, 31 Population 6, 7 Trade Nuisances 41 Post-natal Consultation Centres 5, 33 Treatment Centres, Clinics, etc. 5 Poultry Slaughtering 54 Tuberculosis 24-30 Preservatives, etc., in Food Regulations 56 ,, Care Committee 29 Puerperal Fever 21 ,, Dispensaries; 5, 27 ,, Pyrexia 21 Typhoid Fever 20 Rag and Bone Dealers 41 Typhus Fever 23 Rag Flock 52 Underground Rooms 47 Rats and Mice Destruction 59 Unfit Habitations 47 Relapsing Fever 23 Unmarried Mothers and their Children 35 Rent and Mortgage Interest (Restrictions) Acts 50 Vaccination 19 Rent Books 50 Venereal Diseases Clinic 5 Rheumatism (Acute) 22 Verminous Conditions 59 Rheumatism Centre 22 Vital Statistics 6-14 Sanitary Inspectors' Work 63 Water Supply 41 Scarlet Fever 16, 17 Welfare Centres 5, 31 Sewer Connections 41 Whooping Cough 23 Shops Act, 1934 53 Workshop Supervision 52 Slaughter of Animals Act 54 X-Ray Examinations 35