AC 4349 PAD 37 Metropolitan Borough of Paddington REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1937. 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 1937. BY GEOFFREY EUGENE OATES, M.D., B.S. (London). M.R.C.P. (London); D.P.H. (Cambridge); Barrister-at-Law. Medical Officer of Health. Vail & Co., Ltd., Printers, 170, Farringdon Road, E.C.1 3 TO HIS WORSHIP THE MAYOR, THE ALDERMEN AND COUNCILLORS OF THE METROPOLITAN BOROUGH OF PADDINGTON. Mb. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1937 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good, although the death-rate showed a slight increase. This increase may not be a real one since the estimated resident population of the Borough, as furnished by the Registrar-General, is possibly inaccurate. There was also an increase in the number of deaths from tuberculosis, but this would appear to have been due to the prevalence of influenza in the early part of the year, and has no serious significance. It is a great pleasure for me to record that the infantile mortality for the year was only 66 per 1,000 births, the lowest figure on record in the Borough. During the year the staff of the Public Health Department was strengthened by the appointment of Dr. E. R. Emslie, who took up her duties as Assistant Medical Officer for Maternity and Child Welfare, and Public Vaccinator. The granting of extra nourishment is now regarded as an important means of promoting the welfare of mothers and young children, and tuberculous patients. During the year the schemes for grants of nourishment were revised and extended. I have again to express my appreciation of the loyal help of the staff of the Public Health Department of the Council and to thank the members of the Public Health, Maternity and Child Welfare, and Special Housing Committees for the support and kind consideration which they have extended to me during the past year. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, M.D., M.R.C.P., D.P.H., Medical Officer of Health. Town Hall, Paddington Green, W.2. June 9th, 1938. 4 PUBLIC HEALTH OFFICERS (on December 31st, 1937). (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 Officer for Maternity and Child Welfare, W.T. Ethel R. Emslie, M.D., Ch.B., D.P.H. Assistant Medical Officers of Health, P.T. (For purposes of the Public Health (Tuberculosis) Regulations.) R. S. Walker, M.R.C.P., L.R.C.S.Ed., L.R.F.P.S.Glas., D.P.H., Tuberculosis Officer, Paddington Tuberculosis Dispensary. A. B. Porteous, M.D., D.P.H., Tuberculosis Officer, St. Mary's Hospital Tuberculosis Dispensary. Medical Officers of Welfare Centres, P.T. S. Denovan Adam, M.R.C.S., L.R.C.P. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., R. Cove-Smith, M.A., M.B., B.Ch., M.R.C.P. L.R.C.P. E. Dorothy Fenwick, M.R.C.S., L.R.C.P. C. T. Potter, M.D., M.R.C.P. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.I.C. Public Vaccinators, Ethel R. Emslie, M.D., Ch.B., D.P.H. (For Borough, excluding Paddington Hospital.) W.T. W. J. Gill, M.D., M.B., Ch.B., F.R.C.S.(Ed.) (For Paddington Hospital.) P.T. Deputy Public Vaccinators, P.T. E. Dorothy Fenwick, M.R.C.S., L.R.C.P. (For Borough, excluding Paddington Hospital.) 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). S. W. Wordingham (Class 4). H. Ewings (Class 1). I. D. Clarke (Class 5). A. J. O. Sheppard (Class 1). R. H. Clark (Class 5). R. I. Fisher (Class 1). R. W. Carpenter (Class 5). C. T. Wyatt (Class 3). T. E. Rainger (Class 1, P.T., and Vaccination Officer, R. H. Davis (Class 4). P.T.) C. H. F. Drake (Class 4). I. C. Webb (Miss) (Welfare Centre). H. J. Parker (Class 4). Two Temporary Housing (Enquiry) Assistants. Two Temporary Clerks. Sanitary Inspectors, W.T. (In order of seniority.) C. G. Heron (2), (3), (11). 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), (4). E. Marshall (2), (3), (4), (5). W. H. G. Atkins (2), (5). Five Temporary Inspectors. 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), (8), (9). Miss P. E. Blake (7), (8), (9). Miss D. K. Newington (7), (8), (9). Miss G. E. Stephens (6), (7), (8), (9). Miss F. Fox (7), (8), (9). Miss A. M. A. Johnston (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). Seven Probationers. (Also Handyman-Porter, Cook, Housemaid, etc.) Mortuary Keeper. Assistant Mortuary Keeper. J. T. Lawson. L. W. J. Spears. Disinfectors. G. Cox and F. Webber. (1) Sanitary Inspector's Certificate, Royal Sanitary Institute. (2) „ „ „ Sanitary Inspectors' Examination Board, or Royal Sanitary Institute and Sanitary Inspectors' Examination Joint Board. (3) Meat and other Foods Certificate, Royal Sanitary Institute. (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. (11) 1st Class Instructor's Certificate, Civilian Anti-gas School, Falfield. 5 CLINICS, TREATMENT CENTRES, ETC. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres 232, Harrow Road Paddington School for Mothers. St. Simon's Hall, Macroom Road „ „ „ St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Infant Consultation Centres *232, Harrow Road Paddington School for Mothers. *St. David's Church Hall, St. Mary's Terrace „ „ „ *Congregational Institute, Third Avenue „ „ „ *St. Simon's Hall, Macroom Road „ „ „ Christ Church Parochial Church House, Queensborough Passage „ „ „ " Toddlers" Centre 232, Harrow Road „ „ „ Consultative and Physical Treatment Centre *232, Harrow Road * Two sessions weekly. „ „ „ Day Nurseries "Westbourne," St. John's House, Great Western Road Borough Council. " Paddington," 21, Howley Place Voluntary Association. "Queen's Park," 66, Lancefield Street Voluntary Association. Borough Maternity Wards St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Diphtheria Immunisation. Clinics † 232, Harrow Road Borough Council. †St. Mary's Hospital, Cambridge Place † One session weekly. St. Mary's Hospital. Tuberculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensary St. Mary's Hospital, Cambridge Place Venereal Diseases. St. Mary's Hospital. Clinic St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. 6 SUMMARY OF VITAL STATISTICS. 1937. 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 1937 138,300 Density of population per acre 102 Number of inhabited houses (end of 1937) according to Rate Books 21,592 Marriages 1,918 Total. Males. Females. Live Births Legitimate 1,602 792 810 Birth-rate per 1,000 of the estimated resident population 13.65 Illegitimate 286 157 129 Stillbirths 70 36 34 Stillbirth-rate per 1,000 total (live and still) births 36 Deaths 1,806 900 906 Death-rate per 1,000 of the estimated resident population 13.05 Percentage of total deaths occurring in public institutions 60.8 Deaths from Puerperal Causes. Rate per 1,000 total (live and still) births. Puerperal Sepsis 2 1.02 Other Puerperal Causes 6 3.06 Total 8 4.08 Deaths of infants under 1 year of age 125 Death Rates of Infants under 1 year of age— All infants per 1,000 live births 66 Legitimate infants per 1,000 legitimate live births 62 Illegitimate infants per 1,000 illegitimate live births 87 Deaths from Cancer (all ages) 273 „ Measles (all ages) 1 „ Whooping Cough (all ages) 6 „ Diarrhoea (under 2 years of age) 24 „ Pulmonary Tuberculosis (all ages) 92 „ all forms of Tuberculosis (all ages) 109 Death-rate from Pulmonary Tuberculosis, per 1,000 of the estimated resident population 0.66 Tuberculosis death-rate (all forms) 0.78 Rateable Value £1,831,423 Product of a Penny Rate £7,022 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. Estimated Population.* Births. Deaths at All Ages. Deaths under One Year. Registered Locally. Transfers. Nett. Registered Locally. Gross Mortality. Transfers. Nett. Registered Locally. Nett. Out. In. Totals. Rates. Out. In. Totals. Mortality. Number. Mortality Totals. Mortality 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 2,073 402 464 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 1937 138,300 1,978 599 509 1,888 13.65 1,887 13.64 643 562 1,806 13.05 149 75 125 66 * Registrar-General's estimates of resident population. POPULATION. Estimated Population.-—The resident population of the Borough at the middle of 1937 was estimated by the Registrar-General to be 138,300 persons, 900 less 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 1937 quoted in this report are based on these figures. The Borough 138,300 Wards— Queen's Park 12,999 Harrow Road 24,309 North Paddington 66,398 Maida Vale 22,212 Town 6,878 Westbourne 24,097 Church 16,537 Lancaster Gate, West 9,444 South Paddington 71,902 Lancaster Gate, East 9,468 Hyde Park 12,356 UNEMPLOYMENT. The Ministry of Health desire that information should be published in the Annual Report showing the extent of unemployment in the Borough. The Divisional Controller, Ministry of Labour Divisional Office for Employment and Insurance, 59-62, Queen's Gardens, W.2, has very kindly furnished the following particulars for the year 1937:— Month. Insured residents (aged 16 to 64 years) recorded as unemployed. Males. Females. Total. January 3,147 1,014 4,161 April 2,339 925 3,264 July 2,457 776 3,233 October 2,945 957 3,902 December (estimate) 3,255 989 4,244 No evidence is available to indicate the effect which unemployment may have on the health or physique of the population, and no conditions of occupation have come to light which would appear to have had a prejudicial effect on health. 8 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,918 marriages were solemnized in the Borough during 1937, being a rate of 27.7 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1937 was 1,978. From this total it is necessary to deduct 599 births which occurred to residents of other localities, and to add 509 births which occurred to Paddington residents outside the Borough. The corrected total of 1,888 births thus obtained is equal to a rate of 13.65 per 1,000 of the population. Of the 1,888 births, 949 were those of males and 939 those of females, and of these 157 males and 129 females were illegitimate. 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:— 1937. Birth-rates. No. of Births. Birthrates. 1936 1935 1934 1933 1932 England and Wales 610,557 14.9 14.8 14.7 14.8 14.4 15.3 London 55,011 13.3 13.6 13.3 13.2 13.2 14.3 Paddington 1,888 13.65 13.80 14.17 13.70 13.41 13.76 Wards— Queen's Park 130 10.00 9.70 10.36 11.94 10.94 10.67 Harrow Road 493 20.28 16.88 18.76 17.01 17.44 14.89 Maida Vale 260 11.70 14.13 13.20 12.91 12.15 12.87 Town 129 18.75 19.50 19.00 17.98 17.28 18.20 Westbourne 396 16.43 17.93 18.22 16.09 15.73 16.70 Church 261 15.78 16.76 17.44 16.57 18.39 21.55 Lancaster Gate, West 43 4.55 7.15 5.70 6.91 5.61 6.32 Lancaster Gate, East 55 5.80 5.56 4.43 5.12 4.94 4.17 Hyde Park 121 9.79 7.64 9.85 10.81 9.38 10.83 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 1937 13.65 Illegitimate Births.—These were 286 in number, or 15.14 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 5.38 Harrow Road 6.28 Maida Vale 15.00 Town 16.28 Westbourne 19.19 Church 20.30 Lancaster Gate, West 27.90 Lancaster Gate, East 21.81 Hyde Park 28.92 Stillbirths,—During 1937, 73 stillbirths were registered in the Borough in accordance with the provisions of the Births and Deaths Registration Act, 1926. Of these, 22 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 70, a figure equivalent to 3.7 per cent, of the total births recorded. Of the 70 stillbirths, males numbered 36 and females 34, 6 of the males and 10 of the females being illegitimate. 9 Births in Institutions. Local Institutions. Legitimate. Illegitimate. Total. Residents. Non-residents. Residents. Non-residents. Residents. Non-residents. Paddington Hospital 386 76 108 23 494 99 St. Mary's Hospital 287 311 3 5 290 316 Lock Hospital 5 17 3 32 8 49 Outlying Institutions (Paddington Residents). Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 92 9 101 Other Hospitals and Maternity Homes 131 45 176 Public Assistance Committees' Institutions 59 52 111 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 2,002 live births were notified to the Medical Officer of Health. There were also 70 stillbirths notified. Of the 2,072 living and stillbirths notified, 68.7 per cent, were notified by medical practitioners, 23.6 per cent, by midwives, 0.2 per cent, by parents, and 7.5 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 99.0 per cent, of the live births and 98.9 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 cautionary letters were sent to the persons 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 1,887. Of these 643 were of persons whose residence was not in Paddington, 577 dying in Paddington institutions and 66 in other places in the Borough. There were also reported to the Registrar-General 562 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the net number of deaths for Paddington as 1,806, making an annual death-rate of 13.05. 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 13.05 per 1,000 persons for the year 1937, gives an adjusted death rate of 12.91 per 1,000 persons. 1937. Selected Causes of Death Arranged in Four-Weekly Periods. Period ended. Measles. Scarlet Fever. Whooping Cough. Diphtheria. Phthisis. Cancer. Influenza. Bronchitis. Pneumonia. Diarrhoea and Enteritis (under 2 years). January 30th — — 1 1 9 26 48 16 34 — February 27th — — 1 — 9 23 5 4 17 1 March 27th — — — — 7 22 1 7 9 1 April 24th — — — 1 9 18 2 5 11 — May 22nd — — — — 4 22 2 2 15 4 June 19th — — 1 1 5 18 — 3 12 4 July 17th — — 1 — 9 19 — i 7 1 August 14th — — 1 — 6 23 — — 5 4 September 11th — — 1 — 5 16 1 1 6 — October 9th 1 — — 1 4 20 1 2 3 1 November 6th — — — — 8 25 — — 6 1 December 4th — — — 1 10 19 1 9 9 1 December 31st — — — — 7 13 1 7 11 5 Totals 1 — 6 5 92 264 62 57 • 145 23 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 1937. 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 900 906 1806 78 47 6 8 7 5 10 5 24 25 36 44 42 42 93 60 185 146 216 229 203 295 Typhoid and Paratyphoid Fevers — 1 1 — — — — — — — — — — — — — — — — — — — — — 1 Measles 1 — — — — 1 — — — — — — — — — — — — — — — — — — — Scarlet Fever — — — — — — — — — — — — — — — — — — — — — — — — — Whooping Cough 2 4 6 2 2 — 1 — — — 1 — — — — — — — — — — — — — — Diphtheria 1 4 5 — — — — 1 2 — — — 1 — 1 — — — — — — — — — — Influenza 23 37 60 — — — — — — — — — — 1 1 2 4 7 3 6 7 3 10 4 12 Encephalitis Lethargica 1 1 — — — — — — — — 1 — — — — — — — — — — — — — Cerebro-spinal Fever — 3 3 — 2 — — — — — — — — — — — — — — — — — — — — Tuberculosis of Respiratory System 63 29 92 — — — — 1 1 — — 10 7 9 10 13 4 10 3 15 4 4 — 1 — Other Tuberculous Diseases 9 8 17 2 — — — 1 — 1 — 3 5 1 2 — — — — 1 — — 1 — — Syphilis 6 3 9 — 1 — — — — — — — 1 — — — — 2 1 2 — 2 — — — General Paralysis of the Insane, Tabes Dorsalis 9 2 11 — — — — — — — — — — — — 1 — 1 — 5 2 2 — — — Cancer, Malignant Disease 142 131 273 — — — — — — — — 1 — 1 2 3 6 16 19 49 42 44 35 28 27 Diabetes 6 12 18 — — — — — — — — — — 1 — — 1 — — 1 2 2 5 2 4 Cerebral Haemorrhage, etc. 19 28 47 — — — — — — — — — — — — 1 1 2 — 4 6 5 10 7 11 Heart Disease 218 226 444 — — — — — — 1 1 — 2 3 5 5 9 16 5 34 24 73 78 86 102 Aneurysm 9 7 16 — — — — — — — — — — 1 1 2 — 1 1 1 2 4 3 — — Other Circulatory Diseases 45 75 120 — — — — — — — — — — 1 — — — 1 3 12 9 11 28 20 35 Bronchitis 34 28 62 4 3 — — — — — — — — 1 3 — — 5 1 8 1 9 6 7 14 Pneumonia (all forms) 82 68 150 14 7 3 2 1 — — — 1 2 2 2 4 5 6 4 18 11 20 15 13 20 Other Respiratory Diseases 9 14 23 — — — — — — — — — — — — — — 2 3 4 3 2 2 1 6 Peptic Ulcer 14 6 20 — — — — — — — — — — — — 2 1 3 — 3 — 4 1 2 4 Diarrhoea, etc. 18 10 28 15 6 1 2 — — — — — — 1 — — 1 — — — — 1 — — 1 Appendicitis 4 6 10 — — — — — 1 1 — — — 1 1 — — — — 1 3 — 1 i — Cirrhosis of Liver 1 7 8 — — — — — — — — — — — — — 1 — 1 — 2 1 1 — 2 Other Diseases of Liver, etc. 2 8 10 — — — — — — — — — — 1 — — 1 — 1 — 2 — 2 1 2 Other Digestive Diseases 18 22 40 2 1 — — — — 1 1 1 1 — 3 3 — 2 1 6 4 1 5 2 6 Acute and Chronic Nephritis 18 24 42 — — — — — — — — — 1 2 — 1 — 4 3 2 5 4 8 5 7 Puerperal Sepsis — 2 2 — — — — — — — — — 1 — 1 — — — — — — — — — — Other Puerperal Causes — 6 6 — — — — — — — — — 1 — 4 — 1 — — — — — — — — Congenital debility, Premature Birth, Malformations, etc. 33 21 54 31 21 1 — — 1 — — — — — — — — — — — — — — — Senility 3 16 19 — — — — — — — — — — — — — — — — — — 1 1 2 15 Suicide 14 13 27 — — — — — — — — 2 1 — 1 2 3 3 2 4 6 2 1 1 — Other Violence 28 31 59 3 2 — 3 1 1 2 1 3 1 7 1 2 1 4 2 1 3 1 4 4 12 Other defined diseases 68 54 122 5 2 — — 2 — 3 1 2 1 3 5 I 3 8 7 8 9 20 12 16 14 Causes ill-defined or unknown — — — — — — — — — — — — — — — — — — — — — — — — — 11 The following table shows the death-rate during each of the last six years in England and Wales m London, in Paddington, and in each of the wards of the Borough:— 1937. Death-rates. No. of Deaths. Deathrates. 1936 1935 1934 1933 1932 England and Wales 509,574 12.4 12.1 11.7 11.8 12.3 12.0 London 52,277 12.3 12.3 11.4 11.9 12.5 12 3 Paddington 1,806 13.05 12.81 12.08 12.47 13.36 13.26 Wards— Queen's Park 197 15.15 15.74 11.89 12.40 13.34 13.93 Harrow Road 318 13.08 12.34 12.97 13.10 14.11 13.82 Maida Vale 293 13.19 12.03 11.81 12.24 12.50 13.22 Town 88 12.79 14.58 13.63 12.65 16.01 14.28 Westbourne 327 13.57 13.77 13.25 13.14 13.99 13.90 Church 208 12.57 12.55 11.76 14.06 14.44 16.65 Lancaster Gate, West 116 12.28 13.04 10.88 10.06 13.52 10.40 Lancaster Gate, East 125 13.20 11.12 10.12 9.61 10.70 9.86 Hyde Park 134 10.84 10.61 10.74 12.17 11.28 9.90 There were, during the year, 73 deaths in the Borough of persons who had no fixed domicile. For the purpose of the above table, these have been distributed among the wards in proportion to the ward populations recorded at the Census of 1931. 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 1937 13.05 Deaths in Institutions, 1937. Local. Total. Nonresidents. Paddington Hospital 744 200 St. Mary's Hospital 247 183 Paddington Green Children's Hospital 36 28 Hospital for Women and Children (Lock Hospital) 3 2 St. Luke's Hospital 174 164 1,204 577 Deduct Non-residents 577 627 Outlying. Paddington Residents. Isolation Hospitals of London County Council 21 Municipal General Hospitals and Public Assistance Committees' Institutions 261 Mental Hospitals 56 Voluntary Hospitals (General) 101 Hospitals (Special, including Sanatoria) 31 470 Total deaths in institutions of Paddington residents 1,097 12 INFANTILE MORTALITY. During the year 1937 there were 1,888 births, and 125 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 66. The following table gives the births and the infantile deaths and death-rates for the year 1937 in England and Wales, in London, in the Borough and in the various wards of the Borough. The infantile mortality rates for 1932 to 1936 are given for comparison. 1937. Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1936 1935 1934 1933 1932 England and Wales 610,557 35,175 58 59 57 59 64 64 London 55,011 2,309 60 66 58 67 60 66 Paddington 1,888 125 66 72 71 95 85 107 Wards— Queen's Park 130 9 69 79 37 31 96 125 Harrow Road 493 27 55 53 74 79 48 80 Maida Vale 260 18 69 69 71 93 94 84 Town 129 13 101 103 107 72 123 161 Westbourne 396 18 45 71 73 109 87 107 Church 261 27 103 107 83 169 112 138 Lancaster Gate, West 43 3 69 29 18 91 127 113 Lancaster Gate, East 55 5 91 75 48 — 62 97 Hyde Park 121 5 41 42 57 96 67 79 Infantile Mortality Rates, 1896-1937. 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 1937 58 60 66 13 Infantile Mortality in Paddington—1937. Causes of Death. Under 1 week. 1 to 2 weeks. 2 to 3 weeks. 3 to 4 weeks. Total under 4 weeks. 4 weeks and under 3 months. 3 months and under 6 months. 6 months and under 9 months. 9 months and under 12 months. Total Deaths under 1 year. Rate per 1,000 Births. All Causes 37 4 7 2 50 25 26 17 7 125 66 Common Infectious Diseases (6-10, 44) — — — — — — 2 — 2 4 2.12 Tuberculous Diseases (23-32) — — — — — — 1 — — 1 0.53 Diarrhoea and Enteritis (119) — — — — — 7 5 7 2 21 11.12 Developmental and Wasting Diseases (157, 158, 159, 161a) 28 2 2 1 33 10 5 3 51 27.01 Miscellaneous Diseases (Remainder) 9 2 5 1 17 8 13 7 3 48 25.42 Measles (7) — — — — — — — — — — — Whooping cough (9) — — — — — — 2 — 2 4 2.12 Diphtheria (10) Influenza (11) — — — 1 1 — — — — 1 0.53 Tuberculosis of nervous system (24) — — — — — — — — — — — Tuberculosis of intestines and peritoneum (25) — — — — — — — — — — — Other tuberculous diseases (23, 26-32) — — — — — — 1 — — 1 0.53 Syphilis (34) — — — — — — i — — 1 0.53 Meningitis (79) — — 1 — 1 — — — — 1 0.53 Convulsions (86) — — — — — — — — — — — Bronchitis (106) — — — — — 2 2 — — 4 2.12 Pneumonia (107-109) 2 1 1 — 4 4 5 4 3 20 10.59 Other respiratory diseases (105, 110-114) — — — — — — — — — — — Inflammation of the stomach (118) — — — — — — — — — — — Diarrhoea and Enteritis (119) — — — — — 7 5 7 2 21 11.12 Hernia, intestinal obstruction (122) — — — — — — — — — — — Congenital malformations (157) 4 1 — 1 6 2 2 1 — 11 5.82 Congenital debility and sclerema (158) 1 _— — — 1 8 1 2 — 12 6.35 Icterus (1616) — — — — — 1 — — — 1 0.53 Premature birth (159) 19 1 i — 21 — 1 — — 22 11.65 Injury at birth (160) 3 — 1 — 4 — — — — 4 2.12 Disease of umbilicus (161c : 1) — 1 — — 1 — — — — 1 0.53 Atelectasis (161a) 4 — i — 5 — 1 — — 6 3.18 Suffocation—in bed or not stated how (182 part) — — — — — — — 1 — 1 0.53 Other causes 4 — 2 — 6 1 5 2 — 14 7.41 Nett Births in the Year Legitimate 1,602. Illegitimate 286. Nett Deaths in the Year Legitimate Infants 100. Illegitimate Infants 25. 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. 1937. Infantile Mortality Rates. Births. Deaths. 1937 1936 1935 1934 1933 1932 Church Ward— North Wharf 16 1 62 111 57 77 135 105 Clarendon Street 90 12 133 89 82 177 121 142 Rest of Ward 155 14 90 119 90 181 98 140 Westbourne Ward— Alfred Road 79 4 51 101 72 114 69 123 Rest of Ward 317 14 44 65 73 108 92 104 Maida Vale Ward— Amberley Road 25 3 120 100 27 151 166 190 Rest of Ward 235 18 76 66 78 85 81 67 Totals for 4 Areas 210 20 95 97 68 145 114 140 Rest of Borough 1,678 105 62 69 72 88 80 100 14 MATERNAL MORTALITY. During the year 8 deaths, attributable to childbirth, occurred among the residents of the Borough. Of these, 2 were due to puerperal sepsis and 6 to other puerperal causes. Six of the deaths occurred in institutions. The 8 deaths were equivalent to a mortality rate of 4.08 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 five previous years are also given. England and Wales. London. Paddington. 1937 3.11 2.22 4.08 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:— 1937. London and Cities and Boroughs Estimated Resident Population. Live Births (Rate), Death Rate. Infantile Mortality per 1,000 Births. Crude. Adjusted. London 4,094.500 13.3 12.3 - 60 West Districts. Paddington 138,300 13.65 13.05 12.91 66 Kensington 175,600 12.1 13.3 12.4 83 Hammersmith 126,500 15.1 12.6 13.0 68 Fulham 138,900 13.9 13.08 13.2 56 Chelsea 56,510 10.8 14.1 12.0 59 Westminster 124,300 8.2 11.5 11.8 58.7 North Districts. St. Marylebone 92,110 9.36 13.10 12.98 73 Hampstead 90,690 11.2 11.6 10.9 54 St. Pancras 181,900 13.0 12.7 13.0 62 Islington 295,400 15.25 12.9 13.02 66 Stoke Newington 50,250 14.9 12.5 12.0 37.5 Hackney 206,700 13.8 11.1 11.7 43.38 Central Districts. Holborn 34,600 8.09 11.85 12.68 79 Finsbury 58,700 13.8 14.6 15.9 71 City of London 8,980 6.1 11.2 12.4 36.3 East Districts. 13.72 Shoreditch 82,240 14.86 12.47 54 Bethnal Green 94,560 13.3 12.5 14.1 54 Stepney 203,100 13.5 12.2 14.2 60.5 Poplar 136,800 15.5 12.6 14.0 61 South Districts. 14.1 64 Southwark 147,400 14.7 13.6 Bermondsey 98,790 14.4 12.3 14.0 59 Lambeth 273,800 14.1 13.2 13.0 68 Battersea 143,500 14.94 12.89 12.76 70.43 Wandsworth 341,700 11.53 12.36 11.43 62 Camberwell 224,800 14.08 12.83 12.83 58 Deptford 96,580 15.1 11.8 12.3 45 Greenwich 95,990 13.88 12.03 12.27 50 Lewisham 226,000 13.9 10.8 10.9 46 Woolwich 149,400 14.2 11.1 11.7 40 INQUESTS. During 1937, 114 inquests were held on residents of the Borough, and 91 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 Suspected Food Poisoning. The following table shows the number of cases (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 — — — „ Influenzal Pneumonia 67 30 11 „ Primary Pneumonia 116 73 19 „ Polio-encephalitis 1 1 — „ Polio-myelitis 4 3 — „ Rheumatism 24 15 1 Anthrax — —. — Cerebro-spinal Fever 5 5 2 Chicken-pox 239 20 — Continued Fever 1 1 — Diphtheria 214 211 5 Dysentery 56 21 — Erysipelas 56 36 2 Food Poisoning or Suspected Food Poisoning 30 4 — Infective Enteritis or Summer Diarrhoea 56 32 6 Malaria 3 2 — Membranous Croup — — — Ophthalmia Neonatorum 16 13 — Puerperal Fever 23 22 2 Puerperal Pyrexia 40 37 1 Scarlet Fever 233 216 — Smallpox — — — Typhoid or Enteric Fever 11 7 1 The following table summarises the cases of all notifiable diseases notified in the years 1927 1937 Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis.) 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 Acute Encephalitis Lethargica 4 1 5 1 — — — — — — — „ Influenzal Pneumonia 107 59 135 40 97 66 102 35 33 29 67 „ Primary Pneumonia 183 202 247 168 243 184 157 155 99 92 116 „ Polio-encephalitis 1 1 1 — 1 1 — — — — 1 „ Polio-myelitis 4 3 1 1 2 2 3 6 2 1 4 „ Rheumatism (a) 34 76 52 43 37 21 37 41 18 29 24 Anthrax 1 — — — 1 — — — — — — Cerebro-spinal Fever 3 4 6 3 5 9 6 3 7 3 5 Chicken-pox 461 567 382 515 555 291 364 333 365 285 239 Continued Fever 2 10 3 2 4 — 1 1 1 1 1 Diphtheria 367 302 311 366 254 194 277 245 203 215 214 Dysentery — — — — 2 5 1 1 11 8 56 Erysipelas 90 90 69 74 67 60 66 66 50 50 56 Food Poisoning or Suspected Food Poisoning — — — — — (a) 11 17 45 63 44 30 German Measles 78 109 1163 86 58 77 (6) 11 67 — — — — Infective Enteritis or Summer Diarrhoea (a) 6 20 63 30 40 103 70 81 71 56 Malaria 2 3 — 1 — 1 1 1 3 5 3 Measles 154 2862 210 1790 541 1414 (6)103 — — — — Membranous Croup 2 4 6 7 6 6 — 1 2 — — Ophthalmia Neonatorum 15 24 9 15 18 22 21 19 11 14 16 Puerperal Fever 7 5 4 5 8 7 12 12 14 13 23 Pyrexia 34 32 42 37 32 31 53 36 27 42 40 Scarlet Fever 320 519 323 356 379 286 396 437 267 261 233 Smallpox — 5 3 3 — 2 1 — — — — Tuberculosis—Total 381 321 335 284 311 289 270 284 242 217 262 Pulmonary 212 196 242 196 218 213 203 199 186 163 220 Other Forms 169 125 93 88 93 76 67 85 56 54 42 Typhoid or Enteric Fever 16 25 19 10 9 4 6 9 7 7 11 (а) First Year of Notification. (b) Not notifiable after 19th March, 1933. 16 The appended tables furnish an analysis of (A) the notified cases of infectious disease according to age and sex, and (B) certain 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 — 4 — 1 1 — — — — — — — — — — — 6 12 6 5 11 14 2 5 „ Primary Pneumonia 1 3 5 6 5 6 4 1 1 5 4 4 2 2 5 — 9 9 6 6 20 6 3 3 „ Polio-encephalitis — — — — — — — 1 — — — — — — — — — — — — — — — — „ Polio-myelitis — — — — — — — 1 — — 1 — — — — 1 — 1 — — — — — — „ Rheumatism — — — — — — 1 — — — 6 6 2 8 — 1 — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal Fever — 1 — — 1 — — — — — — — — — — — — 2 — 1 — — — — Chicken-pox 1 5 6 7 5 11 5 9 10 5 59 52 23 12 5 5 8 7 3 1 — — — — Continued Fever — — — — — — — — — — — — — — — — 1 — — — — — — — Diphtheria 3 1 7 7 8 9 7 10 10 5 38 40 14 14 1 6 7 22 1 1 3 — — — Dysentery 2 1 1 4 4 — 1 4 2 2 4 12 I 2 1 1 5 4 — 1 — 2 2 — Erysipelas 1 — — — — — — — 1 — — — 1 1 — 2 2 8 4 4 12 7 5 8 Food Poisoning or Suspected Food Poisoning — — — — 1 — — — — — — — 2 1 — — 4 12 — 3 — 5 1 — 1 — Infective Enteritis or Summer Diarrhoea 16 11 8 6 4 3 2 3 2 1 — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — — — — — 1 — Membranous Croup — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 8 8 — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever — — — — — — — — — — — — — — — 1 — 20 — 2 — — — — „ Pyrexia — — — — — — — — — — — — — — — 3 — 34 — 3 — — — — Scarlet Fever — — 6 5 7 5 11 12 11 10 36 57 17 9 2 4 10 22 — 5 1 3 — — Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Typhoid or Enteric Fever — — — — — — — — — — 1 2 1 — 1 1 2 1 — — I — — 1 B.—Ward Distribution. Borough. 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 14 12 24 23 10 11 5 4 14 28 24 27 2 3 4 2 2 5 Typhoid and Continued Fever — — 1 2 1 1 — — 3 1 1 — — 1 1 — — — Erysipelas 2 1 1 12 1 4 3 — 6 1 7 7 1 2 2 2 3 1 Ophthalmia Neonatorum 2 — 3 1 2 — — 2 — 1 1 3 — — — 1 — — Pneumonia—Acute Influenzal 3 3 8 6 3 9 2 2 1 3 3 12 1 1 3 3 2 2 „ Acute Primary 3 3 10 9 5 4 5 6 14 13 22 10 2 4 2 — 2 2 Puerperal Fever — — — 7 — 7 — 1 — 3 — 1 — 2 — 1 — 1 „ Pyrexia — 3 — 10 — 6 — 2 — 5 — 9 — 1 — 4 — — Scarlet Fever 15 16 29 29 17 14 5 2 10 20 15 30 2 4 2 4 6 13 Hospital Accommodation.—Owing to the difficulty experienced in obtaining nurses in sufficient numbers to make full use of the accommodation provided for cases of infectious diseases, the London County Council found it necessary, from the 13th December, to restrict the admission of cases of scarlet fever, measles, whooping cough and dysentery to those instances in which, in the opinion of the Borough Medical Officer of Health, hospital treatment was required owing to the severity of the case or the home conditions. The restrictions were still in force at the end of the year. A supply of anti-streptococcal (scarlet fever) serum is now provided by the Council for the use of patients suffering from Scarlet Fever who are unable to obtain it through the National Health Insurance Scheme or through other sources, and are not in a position to pay for it. SCARLET FEVER. During 1937 there were 233 cases of scarlet fever notified. The sex-age distribution of these cases is shown in Table A above. Of the 233 cases, 216 were removed to Isolation Hospitals. The remaining cases were treated at home, proper facilities being available for isolation and treatment. No death from this disease occurred during the year. Seasonal Prevalence.—The following table shows the number of cases notified in each fourweekly period during 1937. 17 Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 8. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 631 705 696 721 613 588 740 507 472 716 773 749 638 8,549 Paddington 19 27 34 22 21 14 25 9 14 14 12 10 12 233 Wards— Queen's Park 3 5 11 5 1 1 — 1 2 1 — — 1 31 Harrow Road 5 13 10 3 4 2 4 4 4 1 4 2 2 58 Maida Vale 4 3 3 3 3 5 3 — — 1 1 4 1 31 Town 1 2 — — — — 1 1 — 1 1 — — 7 Church 2 1 3 1 3 3 11 1 1 — 2 1 30 Westbourne I — 2 5 6 3 5 2 7 6 5 1 2 45 Lancaster Gate, West — 1 — 2 — — — — — 1 — 1 1 6 Lancaster Gate, East — — 2 1 2 1 6 Hyde Park 3 2 3 2 2 — 1 — — 2 1 — 3 19 DIPHTHERIA. (Including Membranous Croup.) During 1937 there were 214 cases of diphtheria notified, and none of membranous croup. The sex-age distribution of these cases is shown in Table A on page 16. ♦ Two hundred and eleven 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 1937, 3 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1927 11 deaths. 1928 7 „ 1929 9 „ 1930 12 „ 1931 9 „ 1932 13 „ 1933 19 „ 1934 13 „ 1935 13 „ 1936 5 „ 1937 5 „ Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1937:— Notifications of Diphtheria and Membranous Croup. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Perrid No. 11. Period No. 12. Period No. 13. Totals. London 568 650 532 443 507 496 498 376 509 724 875 967 757 7,902 Paddington 7 18 21 13 13 7 16 16 8 19 14 30 32 214 Wards— Queen's Park 1 5 — 2 3 1 1 2 — 3 2 4 2 26 Harrow Road — 5 4 2 — 3 5 2 1 5 5 9 6 47 Maida Vale — 1 5 3 — 1 1 1 1 3 — 1 4 21 Town — — 1 2 1 1 — — 1 — — — 3 9 Church 4 2 4 — 3 — 4 5 1 5 3 8 3 42 Westbourne 1 4 3 4 4 — 3 6 3 3 3 5 12 51 Lancaster Gate, West — — 3 — — — — — — — — 1 1 5 Lancaster Gate, East — — 1 — 2 1 1 — 1 — — — — 6 Hyde Park 1 1 — — — — 1 — — — 1 2 1 7 18 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to which 4 cases were referred by the Public Health Department during the past year. Anti-Diphtheritic Serum.—This is stocked at the Town Hall and supplied to medical practitioners on request for the use of patients resident in the Borough who are too poor to obtain such serum privately. During the year 12 phials of 8,000 units, 14 phials of 4,000 units, 11 phials of 1,000 units, and 14 phials of 500 units, were distributed. Diphtheria Immunisation.—A Clinic was inaugurated at the Welfare Centre, 232, Harrow Road, in 1933, for the immunisation of children against diphtheria, and is at present in the charge of the Assistant Medical Officer for Maternity and Child Welfare (Dr. Emslie). 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 preimmunisation 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 Public Health Committee reported as follows to the Council on the 29th May, 1937:— "We have had under consideration the steps to be taken to give greater publicity to immunisation against diphtheria, together with the action taken herein by the other Metropolitan Boroughs. Anti-diphtheria immunisation was inaugurated by the Council in June, 1933, and at the end of 1934 the Scheme was extended by the enlistment of the services of private doctors. The yearly record of individuals who were fully protected is as follows :—1933—at clinics —54 ; 1934—at clinics—225 ; 1935—-at clinics—130, by private doctors—276 ; 1936—at clinics—73, and by private doctors—129. There exists a great deal of apathy and even antipathy to this kind of immunisation. It has been found in other areas that intensive propaganda work can break down a certain amount of this resistance ; but it has to be continued, and, even then, there will remain a large proportion of the population which cannot be induced to submit to the necessary testings and inoculations. Up to the present, most of the propaganda has been personal, and directed to parents, by health visitors, welfare centre doctors and private doctors. Publicity has also been obtained by the exhibition of posters at the Welfare Centres, and by the distribution of leaflets in the schools and by private doctors to their own patients. Recently, posters have been exhibited at the Council's Establishments (Libraries, Baths, Recreation Ground, etc.) and on the street orderly bins. We propose to continue this form of publicity and to issue birthday cards as in some other Boroughs. These take the form of a Greeting posted to each child in the Borough on its attaining one year of age, the message incorporating information for the parents as to the advantages of immunisation." The sending of birthday cards commenced on the 1st November. The following report has been received from Dr. Emslie on the work carried out at the Clinic during the year:— " The figures for the Diphtheria Immunisation Clinic are to be found below. The Clinic has been in existence since 1933, but the response of parents has been disappointing. Up to the end of 1937 1,068 cases have been inoculated and rendered Schick negative, and 284 cases have been found on testing to be naturally immune. While this is of great benefit to the individuals concerned, the numbers are far too small to have any effect on the community as a whole. It has been estimated that at least 35% to 50% of the population under 10 years, evenly distributed, must be immunised if diphtheria is to be eliminated from the community." 19 Cases fully inoculated since the commencement of the Diphtheria Immunisation Scheme. Year. Under 5 years of age. Over 5 years of age. Total. 1933 16 18 34 1934 77 148 225 1935 161 (*95) 245 (*181) 406 (*276) 1936 96 (*57) 106 (*72) 202 (*129) 1937 145 (*51) 56 (*29) 201 (*80) 495 (*203) 573 (*282) 1,068 (*485) * Private medical practitioners' cases, included in totals. 1937. Number of Schick Tests. Positive. Negative. PseudoPositive. PseudoNegative. Unknown result. Total. Fully Inoculated. Partly Inoculated. No. of Inocs. given. Ordinary Clinic 14 9 — — — 23 121 60 450 Private Practitioners 6 4 — — 1 11 80 59 358 Totals 20 13 — — 1 34 201 119 808 Number of Schick Re-tests. Positive. Negative. Pseudo-Positive. Pseudo-Negative. Unknown Result. Total. After First He-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 5 — 117 3 1 — — — 6 132 Private Practitioners 6 — 71 3 — — — — 7 87 Totals 11 — 188 6 1 — — — 13 219 The numbers "Fully Inoculated" come under the following age groups:— Ordinary Clinic. Private Practitioners.[/### 6 to 12 months 6 121 —" 80 1 year to 5 years 88 51 5 years to 10 years 20 24 10 years to 15 years 2 5 15 years and upwards 5 —. Ten children received immunisation treatment at the Orphanage of Mercy, Randolph Gardens, during the year. 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 eight children received treatment during the year 1937. 20 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. E. R. Emslie, and the Deputy Public Vaccinator, Dr. E. D. Fenwick. 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 1936. This shows that 56.0 per cent, of the children whose births were registered during that year were successfully vaccinated, and that 18.08 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 26.92 per cent. During the year 1937, no vaccinations were performed in the Paddington Hospital. In the rest of the Borough, 728 infants under one year of age, and 42 persons over that age were successfully vaccinated by the Public Vaccinator, by whom also 14 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 1,284 ; and the total number of statutory declarations of conscientious objection received from Paddington and other districts was 406. No legal proceedings were taken during the year 1937 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 1937, 239 certificates were received from medical practitioners. In addition 381 cases were reported from other sources, making a total of 620 for the year. Chicken-pox is not usually nursed in an institution, but 20 cases received institutional treatment for various reasons. TYPHOID FEVER AND CONTINUED FEVER. Eleven cases of typhoid fever and one case of continued fever were notified in 1937. In cases where the diagnosis of typhoid fever cannot be made with certainty but there is a strong likelihood of the disease being present, local doctors are encouraged to obtain early hospital treatment for the patients by notifying them as having continued fever. Eight of the cases received hospital treatment. One death from typhoid fever occurred during the year. MEASLES. This disease is not now 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 232 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. 21 1937. 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 1 3 5 3 12 5 9 6 22 23 33 106 232 Wards— Queen's Park 1 — 1 — — 1 — — — 3 2 3 13 24 Harrow Road 1 — — 1 — — 2 — — 11 8 13 54 90 Maida Vale 1 — — 2 — i — — — 1 1 4 20 30 Town — — 1 1 — — — 1 — — — — — 3 Church — — 1 — 1 3 2 7 3 1 7 1 2 28 Westbourne — — — — 1 6 1 1 3 4 4 5 16 41 Lancaster Gate, West — — — — — 1 — — — — — 1 — 2 Lancaster Gate, East — — — — — — — — — — — 3 1 4 Hyde Park 1 1 — 1 1 — — — — 2 1 3 — 10 One death 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 7 under 5 years of age and 3 over 5 years of age. The number of visits paid by the nurses was 78 and 23 to each group respectively. Eighty-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 30 cases came to the knowledge of the Department through various sources of information. Ten 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. Sixteen notifications relating to cases of purulent eye-discharge of the new-born were received during 1937. 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, 4 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. No cases were referred to the District Nursing Association during the year. Thirteen cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 23 cases of puerperal fever notified during 1937, 22 of which were removed to or nursed in a hospital. There is no difficulty in obtaining institutional treatment for women suffering from this disease. Cases of puerperal fever referred to the London County Council are usually sent to the North-Western Hospital, Hampstead, where a special ward is set aside for these cases and special medical and nursing staffs are provided. Excellent accommodation is also available at Queen Charlotte's Isolation Hospital, Hammersmith. Two deaths from the disease were recorded during the year. 22 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 40 cases of puerperal pyrexia were notified, 37 of which occurred within or were removed to institutions. In January, 1936, Mr. Douglas H. MacLeod, F.R.C.S., was appointed consultant for cases of puerperal fever and puerperal pyrexia. No request for his assistance was made to the Council during the year. ERYSIPELAS. Fifty-six cases were notified, 36 of which occurred within or were removed to hospitals. Two deaths from the disease were recorded during the year. ACUTE POLIO-MYELITIS. Four cases of this disease, otherwise known as Infantile Paralysis, were notified, three of which received treatment in hospital. Owing to the serious after-effects, such as deformities, which result from this disease, much care is taken to keep in touch with all cases previously notified. Recent experience tends to show that most of the cases notified by doctors receive all the necessary remedial treatment. It is evident that the possibility of preventing the onset of serious deformities is now realised by parents and doctors more than formerly. ACUTE POLIO-ENCEPHALITIS. One case of this disease, somewhat similar in its nature to the last-mentioned, was notified, and received hospital treatment. ACUTE ENCEPHALITIS LETHARGICA. No case of this disease was notified, but one death was recorded during the year. CEREBRO-SPINAL FEVER. Five cases of this disease were notified, and treated in hospital. Two of the cases proved fatal. MALARIA. Three cases of this disease were notified, 2 being treated in hospital. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and sixteen cases of acute primary pneumonia were notified in 1937, as compared with 92 in 1936. Of the 116 cases, 73 were nursed in institutions. Sixty-seven cases of acute influenzal pneumonia were notified, as compared with 29 in 1936. Of the 67 cases, 30 were nursed in institutions. Eighty cases of pneumonia of both kinds received nursing attention at home under the auspices of the Council's scheme for district nursing, 1,284 visits being paid. ANTHRAX. No case of this disease was notified during the year. 23 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 1937, 24 cases of acute rheumatism were notified. This figure compares with 29 cases in 1936, 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. 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. Owing to the fact that the number of attendances of Paddington children had decreased considerably, the Council in June, 1937, decided to make, as from the 1st October, 1937, a quarterly grant to the Hospital on the basis of £50 per annum, instead of £100, as formerly. Paddington Green Children's Hospital Rheumatism Supervisory Centre. Report for the Year 1937 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge. During the year 1937, 24 cases of acute (juvenile) rheumatism were notified in Paddington. The Centre held 45 sessions, at which 56 Paddington children made 145 attendances. There were 9 new cases, of which 3 were transferred to the Centre by other departments of the Hospital, 3 were referred by the Sanitary Inspectors, 1 by the School Medical Service, 1 by a private doctor, and 1 was brought direct by its mother. Twelve cases were discharged from further attendance. The type of acute rheumatism was, as in previous years, mild. Evidence of active infection, either primary or in the form of recrudescences, was dealt with by appropriate in- or out-patient treatment. Tonsillectomy was performed in suitable cases in the hope of diminishing the dangers of relapses. In addition the mothers were given instruction on the points requiring special care in rheumatic children. Arrangements were made for attendance at the special schools for physically defective children or for convalescence where desirable. The women Sanitary Inspectors paid 355 domiciliary visits in connection with rheumatic children, and reported faulty housing conditions where found. The year's work again gives the impression that, as long as the disease keeps its present mild form, it is well in hand in the Borough. I acknowledge gratefully the work undertaken in connection with the Centre by the Sanitary Inspectors, and am again indebted to Dr. Mary Davies for her help throughout the year. 24 CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. Fifty-six cases of dysentery were notified during 1937; 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. In 1937, 6 persons died of whooping-cough, 5 being children under the age of 5 years and 1 over 5 years of age. The number of deaths in 1936 and 1935 were 3 and 5 respectively. Five children under 5 years of age received nursing assistance, the number of visits paid by the nurses being 34. 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 1937, 30 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. Two hundred and seventy-three deaths occurred among Paddington residents during the year. ihe numbers of deaths for previous years are shown m the hst following :— Numbers of Deaths of Paddington Residents. 1906 164 1916 205 1917 201 1918 164 1919 170 1920 194 1921 226 1922 191 1923 206 1924 234 1925 230 1926 239 1927 247 1928 260 1929 284 1930 278 1931 226 1932 254 1933 231 1934 222 1935 235 1936 271 1937 273 The following table furnishes an analysis of the sites affected in the fatal cases of cancer during the year. The total number differs slightly from the number in the table supplied by the RegistrarGeneral, appearing on page 10. 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 1 3 — 6 — 2 — 12 1 Digestive organs and toneum — — — — — 1 — 1 8 6 28 18 22 17 21 17 79 60 Respiratory organs — — — — 3 — 4 1 8 3 9 1 — — 24 5 Uterus — — — — — 1 — 4 — 7 — 3 — 1 — 16 Other female genital organs — — — — — — — — — — — — — — — 5 Breast — — — — — — — 3 —. 6 — 7 — 6 — 5 — 27 Male genito-urinary organs — — — — 1 — — — 1 — 6 — 3 — 3 — 14 — Skin ... — — — — — — — — — — — — — — 1 — 1 Other or unspecified organs — — 1 — — 1 — — 2 — 2 2 1 7 2 2 8 12 — — 1 — 1 2 3 5 16 19 47 41 41 34 28 26 137 127 25 INFECTIVE ENTERITIS. This disease is notifiable in some nine 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. Fifty-six cases of the disease were notified during the year. The number of deaths under the age of 5 years was 24, as compared with 31 in 1936, 22 in 1935, 44 in 1934, 33 in 1933, 103 in 1932, and 29 in 1931. Thirty-two 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 1937 are set out below. The number of certificates received, and the number of cases on the register serve only imperfectly to show the amount of tuberculosis in the Borough. It is possible for a case to be notified in more than one Borough or District, and many of the cases that are taken off the register as "lost sight of" have probably not removed out of the Borough. Several of these cases are, in fact, subsequently traced and restored to the register. The annual number of deaths, therefore, would appear to be the most reliable guide at the present time as to the prevalence of tuberculosis. In 1937 there were 92 deaths from pulmonary tuberculosis, and 17 deaths from other tuberculous diseases, making a total of 109 deaths from all forms of tuberculosis. Mortality during 1937. Age periods. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— Total. Pulmonary, Males — — 1 — 10 9 13 10 15 5 63 „ Females — — 1 — 7 10 4 3 4 — 29 Non-Pulmonary, Males 2 — 1 1 3 1 — _ 1 — 9 „ Females — — - 1 — 5 2 — - — 1 8 Thirteen persons dying from tuberculosis during the year were not formally notified, this number being equal to 11.9 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. The numbers of deaths from all forms of tuberculosis during recent years 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 1937 109 There was, in 1937, an increase of 25 deaths of males, and 8 deaths of females from tuberculosis over the year 1936 (which year showed the lowest death rate ever recorded in the Borough). The greater number of the deaths for 1937 occurred during the first half of the year, and covered the period of influenza prevalence, and this largely accounted for the increase in the number of deaths. Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1937. Age periods. Formal Notifications. Total Notifications. Number of Primary Notifications of new cases of tuberculosis. 0— 1— 5— 10— 15— 20— 25— 35— 45— 55- 65— Total (all ages). Pulmonary, Males — 3 1 2 7 17 30 23 17 9 6 115 186 „ Females — 3 i 1 14 23 36 12 7 6 2 105 167 Non-pulmonary, Males — 1 6 2 2 3 7 3 1 — — 24 35 „ Females — 3 1 2 1 3 6 2 — — — 18 29 26 New Cases of Tuberculosis coming to knowledge otherwise than by Formal Notification. Age periods. 0— 1— 5— 10- 15— 20— 25— 35— 45— 55— 65— Total. Pulmonary, Males - — - - 1 1 1 2 — 1 1 7 „ Females — — — — — 2 4 1 — 1 - 8 Non-pulmonary, Males 1 — — 1 — — 1 — 1 1 — 5 „ Females - — — — — 1 — 1 — — — 2 The sources from which information as to the above-mentioned cases was obtained is stated below:— Source of Information. No. of Cases. Pulmonary. Pulmonary. Death Returns From local Registrars . 3 2 Transferable deaths from Registrar-General 5 1 Posthumous notifications — 2 "Transfers" from other areas (other than transferable deaths) 7 2 The number of cases remaining on the Register at the end of the year, and the number of cases removed from the Register, are shown in the following table :— Notification Register. Pulmonary. Non-pulmonary. Total cases. Males. Females. Total. Males. Females. Total. Number of cases of Tuberculosis remaining, at the 31st December, 1937, on the Register of Notifications 287 253 540 221 162 383 923 Number of cases removed from the Register 1. Withdrawal of notification 4 3 7 1 1 2 9 2. Recovery from the disease 7 3 10 10 6 16 26 3. Death (all causes) 62 35 97 8 7 15 112 4. Otherwise (" Transferred," " Lost sight of," etc.) 47 69 116 31 29 60 176 Of the patients who removed from the Borough during 1937, the new addresses were obtainable in 97 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1937, 9 cases of patients who had removed into the Borough from other districts were added to the register. The number of cases remaining on the Tuberculosis Register at the close of 1937 was 923 as compared with 952 at the close of the year 1936. Visits paid to Homes of Tuberculous Patients. By Council's Women Inspectors 1,103 By Tuberculous Officers 511 By Dispensary Nurses— 20, Talbot Road 3,216 St. Mary's Hospital 1,921 6,751 In order to cover the cost of nursing cases of tuberculosis, the Council in May, 1937, increased the amount of their grant to the Paddington and St. Marylebone District Nursing Association from £25 to £40. During 1937, 18 patients were attended under this arrangement, the number of visits being 684. 27 Public Health (Prevention of Tuberculosis) Regulations, 1925.—By virtue of these regulations persons who are aware that they are suffering from tuberculosis of the respiratory tract may not enter upon any employment or occupation in connection with a dairy which would involve the milking of cows, the treatment of milk or the handling of vessels used for containing milk. Furthermore, if a local authority are satisfied that a person residing in their district who is engaged in any such occupation mentioned above is suffering from tuberculosis of the respiratory tract and is in an infectious state, they may by notice in writing require such person to discontinue his employment or occupation. It has not been necessary, so far, to make use 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. Seven sets were so supplied during 1937, and seven sets were returned following the removal of the patients. Shelters— The Council possess 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 1937. 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 1937, 24 patients received 280 refills, the total cost amounting to £147. In two cases in which the financial circumstances of the patients warranted it, the Council paid the fares to hospital for the purpose of receiving artificial pneumothorax treatment. Ultra Violet Light Treatment.—No applications were received during the year for the Council to bear financial responsibility for this form of treatment. 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, 2 with partial dentures, and in 1 case repairs to dentures were carried out. The total cost was £35 5s. Od. Grants amounting to £24 2s. 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 FOB THE YEAK 1937. Particulars of Patients. Number of Fillings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. Number of New Patients. Number of Attendances. Simple. Hoot. Number of Scalings. Without Anaesthetic. Local Administration. Gas Administration. Number of teeth extracted. Upper Lower. Re-models. Repairs. Women 138 40 2 7 - 4 19 53 3 3 — 3 9 21 40 14 Children 50 9 , 1 — 4 12 34 - — - — 3 18 — 10 Men 44 7 — 1 - 1 9 37 2 1 — — — 15 12 7 Total 232 56 3 9 - 9 40 124 5 4 — 3 12 54 52 31 Number of Sessions held—44. 28 Extra Nourishment.—In March, 1936, 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 fob the Provision of Extra Nourishment by the Borough Council. 1. The types of cases most suitable to be dealt with are:— (а) 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. (б) 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. 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. During the year 1937 the cost to the Council of grants made under the Scheme was approximately £180. The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1937 was as follows:— Representing. Paddington Borough Council Councillor E. g. Lee. . Councillor T. Turner. Councillor Mrs. R. M. Drury, j.P. 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 N. Hugh Smith. 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 M. St. Hill. Paddington Tuberculosis Dispensary Dr. R. S. Walker (Tuberculosis Officer). Nurse C. Griffin. Nurse A. B. Munro. Miss C. Milner. Paddington and St. Marylebone War Pensions Committee Mr. S. G. Last, j.P. (Chairman). Kensal House School Care Committee » » Miss 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. j. Green. St. Mary's Hospital Dr. A. B. Porteous (Tuberculosis Officer). Sister E. M. Phillips. Red Cross Emergency Fund Mrs. M. R. Corden. Local Social Worker 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. 29 The Committee met on 12 occasions during the year and two hundred and seventy-three individual cases were considered. Residential treatment was granted by the London County Council to 153 patients, 26 of whom were children under the age of 16 years, and 3 children were boarded out under the Tuberculosis Contact Scheme. No funds are available in the hands of the Committee for (lie assistance of patients, but in several instances help was obtained from voluntary agencies. DISPENSARY TREATMENT OE 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 Tubekculosis Dispensary, 20, Talbot Road. This is a voluntary agency supported by voluntary subscriptions, and a grant from the Paddington Borough Council which for the year 1937 mounted to £1,600. Dr. R. S. Walker, Tuberculosis Officer, reports as follows:— The X-ray department of the Dispensary worked to full capacity during the year, 325 examinations being made. The importance of X-ray work in connection with prevention, early diagnosis and artificial pneumothorax treatment of tuberculosis, cannot be over emphasised. The artificial sunlight department continues to fulfil a useful function, and the results of this form of treatment for delicate children are encouraging. Two parties of students from the London School of Hygiene and Tropical Medicine attended the Dispensary for lectures and demonstrations during the year. These lectures were given by Dr. Harley Williams, Medical Commissioner of the National Association for the Prevention of Tuberculosis, Lt.-Colonel E. D. Caddell, M.B., Secretary-General of the Association, and myself. Eight trained nurses, studying for the Health Visitor's Certificate at the College of Nursing and Battersea Polytechnic attended here for short courses of practical experience in connection with Tuberculosis work during 1937, and many nurses from all parts of the world paid us visits whilst they were in London attending the International Council of Nurses. Return tShoivmg the Work o] the Dispensary during the Year 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 vear (excluding contacts):— (a Definitely tuberculous 40 35 3 1 6 3 4 1 46 38 7 2 654 (6 Diagnosis not completed — — — — 1 2 4 — (c) N on-tuberculous - - - - - - - - 70 194 116 174 b.—Contacts examined during the vear:— (a Definitely tuberculous 2 5 — — — — 1 1 2 5 1 1 159 (b) Diagnosis not completed — — — — — — — — — — — — Non-tuberculous 31 54 28 37 C.—Cases written off the Dispensary Register as:— (a Recovered 3 3 — — 9 9 5 — 12 12 5 — 741 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 104 250 145 213 D.—Number of Persons on Dispensary Register on 31st December: Definitely tuberculous 185 153 3 4 82 70 82 42 267 223 85 46 628 (b Diagnosis not completed — — - - — — 1 2 4 - 30 Returning Showing the Work of the Dispensary during the year 1937 (continued). 1. Number of cases on Dispensary Register on January 1st 643 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 29 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 74 4. Cases written off during the year as Dead (all causes) 42 5. Number of attendances at the Dispensary (including Contacts) 4,884 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 124 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 401 (a) Personal 92 (6) Other 254 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,216 10. Number of (а) Specimens of sputum, etc., examined (б) X-ray examinations made in connection with Dispensary work 299 325 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above — 12. Number of " T.B. plus " cases on Dispensary Register on December 31st 183 31 PULMONARY TUBERCULOSIS. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1927 1927 1928 1929 1930 1931 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus co 3 g 6 Class T.B. plus Class T.B. minus Class T.B. plus a 3 0 O 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) 1 Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on DispensaryRegister on 31st December. Disease Arrested Adults M. 14 7 4 — 11 — — 2 — 2 - - — — — 2 1 1 - 2 3 2 1 — 3 4 3 2 — 5 F. 20 4 2 - 6 4 — 1 - 1 — 1 — — 1 2 — — — — 1 — — — — 1 — — — — Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Disease not Arrested Adults M. 3 2 3 3 8 - 1 - 2 3 — - 3 - 3 1 1 — - 1 — 1 1 - 2 3 1 2 - 3 F. 2 — 5 — 5 1 — - - — — 1 - - 1 — 1 — 1 — — — — — — — — — — Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Condition not ascertained during the year - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Total on Dispensary Register at 31st December 39 13 14 3 30 5 1 3 2 6 — 2 3 — 5 5 2 2 — 4 4 3 2 - 5 8 4 4 — 8 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 18 2 1 - 3 1 1 - - - - 1 - - 1 - - - - - - - - - - - - - - - F. 49 2 — - 2 3 - - - - - - - - - - - - - - - - - - - - - - - - Children - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Lost sight of, or otherwise removed from Dispensary Register 95 48 30 4 82 24 14 16 1 31 23 11 8 3 22 26 15 14 — 29 18 3 10 4 17 17 7 13 2 22 Dead Adults M. 11 22 25 46 93 4 1 — 14 15 4 2 3 14 19 2 3 9 12 24 4 2 9 17 28 3 2 10 11 23 F. 25 17 14 28 59 6 — 4 11 15 3 — 5 6 11 3 — 5 18 23 5 - 8 10 18 3 1 4 13 18 Children — 3 — — 3 - — - — - — — — 1 1 - - - - - - - - - - - - - - - Total written off Dispensary Register 199 94 70 78 242 38 16 20 26 62 33 14 16 24 54 31 18 28 30 76 31 5 27 31 63 23 10 27 26 63 Grand Totals 238 107 84 81 272 43 17 23 28 68 33 16 19 24 59 36 20 30 30 80 35 8 29 31 68 31 14 31 26 71 32 PULMONARY TUBERCULOSIS—continued. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis and their classification at that time. Condition at the time of the last record made during the year to which the return relates 1932 1933 1934 1935 1936 1937 Class T.B. minus Class T B. Plus Class T.B. minus Class T.B. Plus Class T.B. minus Class T.B. Plus Class T.B. minus Class T.B. Plus Class T.B. minus Class T.B. Plus Class T.B. minus Class T.B. Plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 4 2 — — 2 5 — 1 — 1 4 1 2 — 3 3 — — — — — — — — — — — — — — F. 2 1 — — 1 3 — 1 — 1 2 2 1 — 3 — 1 — — 1 — — — — — — — — — — Children — — — — — —- — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. 2 1 — 3 2 1 4 1 6 — 2 4 2 8 4 — 9 — 9 6 5 7 — 12 14 10 9 2 21 F. 1 1 3 — 4 2 1 2 — 3 — — 7 — 7 3 1 10 — 11 14 5 7 — 12 19 9 4 2 15 Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Condition not ascertained during the year — — — — — 1 — — — — — — 1 — 1 1 — 1 — 1 — — — — — — — — — — Total on Dispensary Register at 31st December 7 6 4 — 10 13 2 8 1 11 9 5 15 2 22 12 2 20 — 22 23 10 14 — 24 37 19 13 4 36 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 20 15 11 1 27 16 1 19 1 21 17 2 19 1 22 16 1 13 4 18 11 1 6 2 9 2 2 — 2 Dead Adults M. 1 2 3 11 16 3 — 8 15 23 — — 5 11 16 1 1 5 5 11 2 — 2 7 9 — — — 5 5 F. 4 5 1 9 15 — — 3 10 13 1 — 4 5 9 — — 3 3 6 1 — 1 3 4 1 — — 3 3 Children — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 25 22 15 22 59 19 1 30 26 57 18 2 28 17 47 17 2 21 12 35 14 1 9 12 22 3 - 2 8 10 Grand Totals 32 28 19 22 69 32 3 38 27 68 27 7 43 19 69 29 4 41 12 57 37 11 23 12 46 40 19 15 12 46 33 NON-PULMONARY TUBERCULOSIS. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register and (b) the reasons for the removal of all cases written off the Register. [####]Condition at the time of the last record made during the year to which the return relates Previous to 1927 1927 1928 1929 1930 1931 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — 3 — 12 15 — — — — — — — — — — — 1 2 3 — — — 2 2 1 — — 1 2 F. — 2 — 20 22 — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 4 — 22 27 — 1 — 11 12 — 1 — 19 20 — 2 — 7 9 1 — — 12 13 2 — — 11 13 Disease not Arrested Adults M. 1 1 — — 2 — — — — — — — — — — — — — — — — — — — — 2 — — — 2 F. 1 — — 1 2 — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — 1 — — — 2 2 — — — — — — — — — — — — — 2 2 — — — 5 5 Condition not ascertained during the year — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 4 11 — 55 70 — 1 — 13 14 — 1 — 19 20 — 3 — 9 12 1 — — 16 17 5 — — 17 22 Transferred to Pulmonary — — — 1 1 — — — — — — — — — — — — — — — — — — — — — — — — — (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 1 11 — 29 41 — — — 1 1 — — — — — — — — — — — — 1 — 1 — — — — F. 4 3 — 23 30 — — — 4 4 — — — _ — — — 1 1 2 1 — 3 1 — — 1 Children 1 7 — 78 86 — 3 — 20 23 — — — 6 6 1 2 — 7 10 — — — 1 1 — 1 — 3 4 Lost sight of, or otherwise removed from Dispensary Register 9 37 5 121 172 1 4 — 50 55 3 2 1 41 47 6 9 1 13 29 7 3 1 19 30 2 5 — 23 30 Dead Adults M. 1 1 1 — — — 1 — — — — F. 1 — — 1 2 1 1 1 1 Children — 1 — 3 4 — — — — — — — — 1 1 — — 1 1 2 — — — — — — 1 — — 1 Total written off Dispensary Register 16 69 5 255 335 1 7 — 75 83 3 2 1 49 55 7 11 2 23 43 10 4 2 20 36 3 8 — 26 37 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 20 70 5 310 405 1 8 — 88 97 3 3 1 68 75 7 14 2 32 55 11 4 2 36 53 8 8 — 43 59 34 NON-PULMONARY TUBERCULOSIS—continued. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register; and (b) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates 1932 1933 1934 1935 1936 1937 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — 3 3 — — — — — — — — — — — — — 2 2 — — — — — — — — — — Children 1 — — 8 9 — 1 — 1 2 — 3 1 1 5 — — — — — — — — — — — — — — — Disease not Arrested Adults M. — — — — — — — 2 2 1 — — — 1 2 — 1 1 4 — — — 1 1 1 2 2 — 5 F. — — 1 — 1 — 1 — 1 2 — 1 — 1 2 1 1 1 2 5 2 — — — 2 1 — — 2 3 Children — — — 4 4 1 1 — 11 13 — 1 — 10 11 2 — — 16 18 1 — — 16 17 1 1 — 5 7 Condition not ascertained during the year — — — — — — — — — — — 1 — — 1 — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 1 1 1 15 18 1 3 — 15 19 1 6 1 12 20 5 1 2 21 29 3 — — 17 20 3 3 2 7 15 Transferred to Pulmonary — — — — — — — — — — — — — 1 1 — — — — — — — — — — — — — — — (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. 1 Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 3 — — 26 29 4 2 1 9 16 3 5 — — 27 3 — 1 4 8 — — — 3 3 — — — — — Dead Adults M. — — — — — — — — — — — 1 — — — — — — — — — — — — — 1 — — — 1 F. 1 — — — 1 — — — — — — — — — — — — — — — 1 — — — — —- — — — — Children — — — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — Total written oS Dispensary Register 5 — — 26 31 5 2 2 9 18 3 6 — 19 28 3 — 1 4 8 1 — — 4 5 1 — — 1 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 6 1 1 41 49 6 5 2 24 37 4 12 1 31 48 8 1 3 25 37 4 — — 21 25 4 3 2 7 16 35 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 1937. Return Shouting the Work of the Dispensary during the Year 1937. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. 1 F. M. M F F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 15 10 1 — 3 3 — — 18 13 1 — 106 (b) Diagnosis not completed — — — — — — — — — 9 — — (c) Non-tuberculous — — - — — — — 28 28 6 3 B.—Contacts examined during the year:— (a) Definitely tuberculous — — — — — — — — — — — — 33 (b) Diagnosis not completed — — — — — — — — — — — — (e) Non-tuberculous — — — — — — — — 6 12 6 9 c.—Cases written off the Dispensary (a) Recovered — — — 1 1 — 3 1 1 — 3 2 116 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) — — — — — — — 35 46 12 17 D.—Numeer of Persons on Dispensarv Register on 31st December (a) Definitely tuberculous 53 59 6 4 12 26 17 12 56 85 23 16 189 (6) Diagnosis not completed — — - - — — — — — — — 1. Number of cases on Dispensary Register on January 1st 220 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 9 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases " lost sight of " 47 4. Cases written off during the year as Dead (all causes) 16 5. Number of attendances at the Dispensary (including Contacts) 1,850 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 10 7. Number of cosultations with medical practitioners:- 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 110 (a) Personal 6 (b) Other 75 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,921 10. Number of (a) Specimens of sputum, etc., examined 97 (6) X-ray examinations made in connection with Dispensary work 118 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (b) above — 12. Number of "T.B. plus "cases on Dispensary Register on December 31st 77 36 PULMONARY TUBERCULOSIS. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates Previous to 1927 1927 1928 1929 1930 1931 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 5 — 2 1 3 — — — — — — — — — — — — — — — 1 — — — — 1 1 1 — 2 F. 3 1 1 — 2 — — — — — — — — — — — 1 — 1 1 — — 1 1 3 1 — — 1 Children — — — — — 1 — — — — 1 — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. — — — — — — — 1 — 1 — — — — — — — — 1 1 — — 2 — 2 — — — — — F. — — — — — 1 — — — — — — — — — — — — — — — — — — — — — 1 1 2 Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 8 1 3 1 5 2 — 1 — 1 1 — — — — — 1 1 1 3 3 — 2 1 3 4 2 2 1 5 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 4 — — — — — — — — — — — — — — — — 2 — 2 — — — — — — — — — — F. 2 1 — — 1 — — — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — — 1 — — — — — — — — — — — — — — 1 — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 44 8 34 8 50 20 1 20 4 25 6 3 6 3 12 13 3 11 2 16 23 1 14 1 16 15 — 12 1 13 Dead Adults M. 3 1 5 29 35 1 — 3 5 8 — 1 7 4 12 2 — 4 5 9 — 1 2 3 6 1 — — 6 6 F. — — 2 14 16 — — 1 6 7 1 — — 4 4 6 — 2 4 6 — — 3 2 5 4 — 1 1 2 Children — — 1 — 1 — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 54 10 42 51 103 22 1 24 15 40 7 4 13 11 28 21 3 19 11 33 24 2 19 6 27 20 — 13 8 21 Grand Totals 62 11 45 52 108 24 1 25 15 41 8 4 13 11 28 21 4 20 12 36 27 2 21 7 30 24 2 15 9 26 37 PULMONARY TUBERCULOSIS—continued. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register ; and (b) the reasons for the removal of all cases written off the Register. The Table is arranged according to the years in which the patients were first entered on the Dispensary Register as definite cases of pulmonary tuberculosis, and their classification at that time. Condition at the time of the last record made during the year to which the return relates 1932 1933 1934 1935 1936 1937 Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. plus Class T.B. minus Class T.B. pius Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B. plus) Group 1 Group 2 Group 3 Total (Class T.B plus) —(a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — 1 — — — — — — — — — — — — — — — — — — — — — — — — F. 2 — 3 — 3 1 — — — — — — — — — — — — — — — — — — — — — — — Children 1 — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Disease not Arrested Adults M. — 1 — — 1 — — 2 — 2 3 2 1 — 3 3 — 2 — 2 1 5 3 — 8 — 8 3 1 12 F. — — — — — — 1 — 1 2 — 4 2 — 6 3 5 — — 5 5 4 2 — 6 3 5 1 1 7 Children — — — — — — — — — — 1 1 — 1 1 1 — — 1 2 — — — — — 1 — — 1 Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 3 1 3 — 4 2 1 2 1 4 4 7 3 — 10 7 6 2 — 8 8 9 5 — 14 3 14 4 2 20 (6) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 9 1 18 2 21 15 14 9 2 25 11 11 6 — 17 9 4 6 1 11 2 6 4 — 10 — — 1 — 1 Dead Adults M. — — 2 3 5 1 1 1 5 7 — — 4 4 8 2 3 3 8 1 2 — — 2 — — 2 2 F. 1 1 7 2 10 — 2 4 3 9 — 1 1 2 — 1 2 2 5 — 1 — — 1 — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total written off Dispensary Register 10 2 27 7 36 16 17 14 10 41 11 11 11 5 27 9 7 11 6 24 3 9 4 — 13 — — 3 — 3 Grand Totals 13 3 30 7 40 18 18 16 11 45 15 18 14 5 37 16 13 13 6 32 11 18 9 — 27 3 14 7 2 23 38 NON-PULMONARY TUBERCULOSIS. Supplementary Return showing in summary form (a) tbe condition at the end of 1937 of all patients remaining on the Dispensary Register; and (6) the reasons for the removal of all cases written ofi the Register. Condition at the time of the last record made during the year to which the return relates Previous to 1927 1927 1928 1929 1930 1931 Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total —(a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. 2 — i 1 4 2 — — — 2 — — — — — 1 — — — 1 — — — — — — — — — — F. 3 1 i 3 8 1 — — 1 2 1 — — — 1 — — — — — — — — — — — — — — — Children 1 — 8 9 1 — — 4 5 — — — 1 1 — — — — — — — — — — — — — — — Disease not Arrested Adults M. — — — — — — — — — — 1 — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — 1 — — — 1 1 — — — 1 — — — — — Children — — 1 — 1 — — — — — — — 1 — 1 1 — — — — — — — — — — — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Total on Dispensary Register at 31st December 6 1 3 12 22 4 — — 5 9 2 — 1 1 4 3 — — — 3 1 — — — 1 — — — — — Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — —(b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. 1 — 1 2 4 1 — 1 — 2 1 — 1 2 1 — — — 1 — — — — — — — — — F. 1 1 2 4 — — — — — — — — — — — — — — — — — — — — — — — — — Children 4 1 1 25 31 — — — 2 2 — — — 1 1 — — — — — — — — 1 1 — — — — Lost sight of, or otherwise removed from Dispensary Register 38 9 14 65 126 6 2 2 6 16 5 3 1 7 16 12 — 1 6 19 5 — 2 3 10 4 1 3 3 11 Dead Adults M. — 1 — 1 2 — — — — — — — — — — — — — — — — — — — — — — — — — F. — — 1 2 3 — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — 1 1 — — — — — Total written ofi Dispensary Register 44 11 18 97 170 7 2 3 8 20 7 3 1 9 20 14 — 1 6 21 5 — 2 5 12 4 1 3 3 11 . Grand Totals of (a) and (6) (excluding those transferred to Pulmonary). 50 12 21 109 192 11 2 3 13 29 9 3 2 10 24 17 — 1 6 24 6 — 2 5 13 4 1 3 3 11 39 NON-PULMONARY TUBERCULOSIS—continued. Supplementary Return showing in summary form (a) the condition at the end of 1937 of all patients remaining on the Dispensary Register; and (6) the reasons for the removal of all cases written off the Register. Condition at the time of the last record made during the year to which the return relates 1932 1933 1934 1935 1936 1937 Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and J oints Abdominal Other Organs Peripheral Glands Total Bones and Joints Abdominal Other Organs Peripheral Glands Total (a) Remaining on Dispensary Register on 31st December. Disease Arrested Adults M. — — — — — — — — — — 1 — — — 1 — — — — — —- — — — — — — — — — F. — — — — — — — — — — — — — 3 3 — — — — — — — — — — — — — — — Children 1 — — 1 2 — — — 1 1 — — 1 1 — — — — — — — — — — — — — — — Disease not Arrested Adults M. 1 — — — 1 — — — — — — — — 1 1 — — — — — — — — — — — — 1 — 1 F. — — — 1 1 — — — 1 1 — — 1 — 1 1 — — 1 2 1 — — 1 2 — — — 3 3 Children — — — — — — — — — — — — — — — — — — 2 3 1 1 — 2 4 — — — — — Condition not ascertained during the year — — — — — — — — — — — — — — — — — — — — — — — — — — — —- — — Total on Dispensary Register at 31st December 2 2 4 — — — 2 2 1 1 5 7 1 1 — 3 5 2 1 3 6 — i 3 4 Transferred to Pulmonary — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — (b) Not now on Dispensary Register and reasons for removal therefrom. Discharged as Recovered Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Children — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — Lost sight of, or otherwise removed from Dispensary Register 4 3 4 11 2 — — 5 7 6 2 4 12 1 — 1 3 5 2 — — 1 3 — 2 — — 2 Dead Adults M. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — F. — — — — — — — — — — 1 — — — 1 1 — — — 1 — — — — — — — — — — Children — — — — — — — — — — 1 2 — — 3 — — 1 — 1 — — — — — — — — — Total written off Dispensary Register 4 3 4 11 2 — — 5 7 8 2 2 4 16 2 — 2 3 7 2 — — 1 3 — 2 — — 2 Grand Totals of (a) and (b) (excluding those transferred to Pulmonary). 6 — 3 6 15 2 — — 7 9 9 2 3 9 23 3 1 2 6 12 4 1 — 4 9 — 2 1 3 6 40 MATERNITY AND CHILD WELFARE. The staff engaged in maternity and child welfare work consists of an Assistant Medical Officer for Maternity and Child Welfare, a Superintendent Health Visitor, 12 whole-time Health Visitors, one of whom a'so acts as Child Protection Visitor and one as Maternity Almoner, 5 part-time Visiting Medical Officers, 3 part-time Masseuses, and 1 full-time and 1 part-time Clerical Assistant. Health Visitors . The duties of these officers are :— (1) To visit the homes of children from birth up to the age of 5 years where considered necessary. (2) To make enquiries concerning stillbirths and deaths of infants and young children. (3) To visit and give advice to parents in cases of ophthalmia of the new-born, infective enteritis and other important diseases. (4) To investigate all cases of puerperal fever and puerperal pyrexia. (5) To attend the maternity and infant consultations at the Centres provided by the Paddington School for Mothers. The home visiting work performed by the Health Visitors during the year is summarised in the appended table :— Health Visiting. First Visits to children under 1 year of age 1,516 Revisits „ „ „ 6,282 7,798 Visits to children between the ages of 1 and 5 years 0,048 First visits to expectant mothers 1,224 Revisits „ „ 618 1,842 Other Visits— Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 292 Miscellaneous (including 4,158 ineffective calls) 11,812 12,104 The total number of children on the Health Visitors' lists at the close of the year was 4,681 Maternity and Child Welfare Centbes. 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 staff and work, having been in 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. The erection of the new Centre on the site of No. 283a, Harrow Road was commenced, and the ceremony of laying the foundation stone was performed by the Mayoress (Mrs. J. B. P. Karslake) on the 24th November. It is anticipated that the building will be ready for occupation towards the middle of 1938. The existing Centres are provided by the Paddington School for Mothers, which is a voluntary society financed by voluntary contributions and by grant from the Paddington Borough Council. To meet the extra expenditure occasioned by increased staff, additional consultations, and a decrease in income from the Sunday Cinema contribution, the annual grant by the Council was increased from £500 to £600. The following is a brief account of the activities of the Paddington School for Mothers :— Centres (as in December, 1937). 232, Harrow Road, W.2.—Ten rooms and Health Visitors' rest room, all warmed by gas fires. Two Infant Consultations weekly.—Tuesday and Thursday, 2.15 p.m. Medical Officer, Dr. E. R. Emslie. Area served :—Parts of Church, Harrow Road, Westbourne and Maida Vale Wards. 41 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. Two Consultative and Physical Treatment Consultations weekly. Tuesday and Thursday, 10 a.m. Medical Officer, Dr. R. Cove-Smith. Artificial Sunlight Treatment and Massage are given at these consultations by Miss Denny, C.S.M.M.G., Miss M. Kent, C.S.M.M.G., and Miss Suffling, C.S.M.M.G. Schick Testing and Diphtheria Immunisation Treatment weekly—Friday, 10 a.m. Medical Officer, Dr. E. R. Emslie. " Toddlers " Clinic, weekly.—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. E. R. Emslie., Friday 2 p.m. Medical Officer, Dr. Evelyn Maclagan. Area served :—Church. Town and Hyde Park Wards. Christ Church Parish Rooms, Queensborough Passage, Porchester Terrace, W. 2—Two large rooms, doctor's room and sales room warmed by electricity and coal fires. One Infant Consultation weekly.—Monday, 2 p.m. Medical Officer, Dr. E. R. Emslie. Area served :—Lancaster Gate East and West Wards and part of Westbourne Ward. Congregational Institute, Third Avenue, Harrow Road, W. 10.—Large room, doctor's room and sales room warmed by gas radiators and hot pipes. Large outer room for perambulators, etc. Two Infant Consultations weekly.—Tuesday, 2 p.m. Medical Officer, Dr. E. Dorothy Fenwick. Friday, 2 p.m. Medical Officer, Dr. E. R. Emslie. 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. C. T. Potter. Thursday, 2 p.m. Medical Officer, Dr. S. D. Adam. Area served :—Maida Vale Ward and part of Harrow Road Ward. One Maternity (Ante- and Post-natal) Consultation weekly.—Thursday, 10 a.m. Medical Officer, Dr. E. Dorothy Fenwick. Instruction in Maternal Hygiene (Ante- and Post-Natal), and in cutting out and making babies' clothes. 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 School for Mothers is given in many cases. Dental Treatment can also be obtained, for mothers and children attending 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 Health Visitors are received at No. 232, Harrow Road, W.2, for distribution. Convalescent and Holiday Homes.—Mothers and children are sent to Convalescent and Holiday Homes on the recommendation of the Medical Officers of the Centres. Financial assistance is given in many cases by the Borough Council for nursing mothers and their babies (see also p. 46).. In some other cases assistance is obtained from private sources. 42 42 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 the Year 1937. Harrow Road. Third Avenue. Macroom Road. St. Mary's Terrace. Queens- boro' Passage. Totals. Tues. Thurs. Tues. Fri. Wed. Thurs. Wed. Fri. Mon. Number of Sessions 51 51 51 50 50 50 51 50 48 452 Number of Attendances 2,494 2,285 4,232 3,058 3.615 3,527 3,224 2,492 3,464 28,391 Average Attendance 49.0 44.8 83.0 61.1 72.3 70.5 63.2 49.8 72.1 62.8 Seen by Doctor 1.193 1,178 1,332 1,002 1,183 978 1,152 922 1,117 10,057 Average number seen by Doctor at each Session 23.4 23.0 25.7 20.0 23.6 19.5 22.6 18.4 23.2 22.2 The total number of children attending the consultations was 2,761, 978 being under 1 year of age and 1,783 between the ages of 1 and 5 years. Ante-Natal and Post-Natal Clinics. Harrow Road. Macroom Road. Number of Sessions 50 51 Number of Attendances 681 560 Number of Expectant or Recently Confined Mothers who Attended 317 223 Average Attendance per Session 13.6 11.0 Number of Cases Referred by Midwives in Private Practice Consultative and Physical Treatment Centre. Number of Attendances 3,171 Number of Cases 230 (of which 167 were new) Classification of Cases— Artificial Sunlight only 64 Artificial Sunlight and Massage 66 Massage only 70 Dietetic only 30 Treatments given— Artificial Sunlight 1,538 Massage 2,165 The following report has been received from Dr. R. Cove-Smith on the work carried out at the Centre :— "The total number of attendances duringl937 was 3,171. During the year 230 cases attended for treatment. Thirty of these were attending for dietetic advice alone, but the other two hundred were having physical treatment as well, 64 having Ultra-Violet Light, 70 having Massage and 66 having both Ultra-Violet Light and Massage. Of these 230 cases 21 were under one year and the remaining 209 between one and five years of age. Definite advances in medical knowledge have been made recently along dietetic lines and these advances must be followed up and consolidated if improvement .in child health is to be still further accelerated. It is difficult to make standards of comparison as we have no real " normal " by which to work and the " average " is so woefully below the optimum. Yet at the same time gradual change in habits, a greater availability and variation in foods and a better knowledge of food values is gradually being disseminated so that severe cases of deficiency diseases are becoming rarer. Several cases of erythroedema (pink disease) have been diagnosed, one of which was exceptionally severe, while three cases of congenital anal stenosis attended for treatment. 43 The Government campaign for physical fitness with the extra emphasis that is thereby implied on the nutritional side has not yet completely percolated through the community but a greater spirit of enquiry and increased receptiveness is gradually becoming noticeable amongst Paddington mothers. All this has an ultimate bearing on the health of succeeding generations." Queen Charlotte's Maternity Hospital.—During the year 1937, 25 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 8. During 1937 there were received into the Hospital for confinement 109 women from Paddington, and 223 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 1,665 by 289 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 65 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. During the year 1937, 63 confinements were attended by the nursing staff, the number of visits being 1,260. The figures for 1936 were 92 and 1,568 respectively. 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. 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 any special circumstances :—■ Number in family. Net Weekly Income after deducting rent, furniture and fares, not exceeding :— s. d. s. d. s. d. s. d. s. d. s. d. s. d. 20 0 25 0 30 0 35 0 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 0 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 necessary. The duties of Maternity Wards Almoner are carried out by Miss Hill, one of the Council's Health Visiting staff. During the year, 312 women were delivered in the wards. One case of puerperal fever and 3 of puerperal pyrexia were notified. There were 6 stillbirths, and 5 deaths within 10 days of birth. The payments made by patients admitted, or accepted for admission, to the wards amounted to £639 6s. 3d. 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 was one emergency case during 1937. 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 1937, 51 cases were attended, the patients' contributions collected to the end of the year amounting to £31 3s. Od. 44 Maternity Consultations.—Mr. Douglas H. MacLeod, F.R.C.S., continued to act as obstetric consultant, but no request for his services was received 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 £8 6s. 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. Twenty-two Helps were allocated during the year, and the grants made by the Council towards their remuneration totalled £21 14s. Od. The duties of Home Helps are as follow :— 1. To act under the direct supervision of the Superintendent Health Visitor or her 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 everything 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. 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 care 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 Health. 8. On the day following the confinement, the Home Help must notify the Medical Officer of Health 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 being removed from the list of Home Helps, and render her liable to forfeit the payment due to her. Contraceptive Advice.—In 1934, the Council made arrangements 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 grants of the cost of the advice (10s.) are made. During the year 17 necessitous women were referred to the Centre, but only 8 attended. Councillors Lady Bonham Carter and Mrs. Paterson were re-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. 4 examinations were made during the year, 2 being of expectant mothers and 2 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. Three cases were assisted during the year by grants amounting to £5 5s. Od. Baby Hospital, Ladbroke Square.—The agreement by which two beds for ailing children were reserved at this hospital was allowed to lapse on its expiration in March, there being now ample accommodation in local and other institutions. 45 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 no instance was it found necessary to make use of these facilities during the year. PROVISION OF EXTRA NOURISHMENT FOR NECESSITOUS MOTHERS AND CHILDREN. Following the receipt of Circular No. 1519 of the Minister of Health, the Council reconsidered the scheme for the supply of extra nourishment to necessitous mothers and children, with the result that grants to expectant mothers have now been made available after the third month of pregnancy and to all children under the age of five years not attending school. The requirement as to a medical certificate has been dispensed with, the Committee being guided by the report of the Health Visitor, it being deemed that the nourishment recommended is necessary for the maintenance of health. The term " nursing mother " is construed as " a mother who has given birth to a living or stillborn child within a year." The extra nourishment may take the form of butter and eggs in addition to or in substitution for milk where considered necessary, the normal grant being a half-pound of butter weekly and one egg daily. To ensure uniformity National Mark " Standard " eggs are specified. A copy of the revised scheme is given below. Scheme fob Grants of Nourishment. 1. The supply of nourishment at less than cost price shall be limited to necessitous applicants being :— (а) Expectant mothers after the third month of pregnancy ; (б) Nursing mothers ; or (c) Children under the age of five years, not being educated in schools recognised by the Board of of Education. 2. On the receipt of an application for the supply of nourishment at less than cost price, a visit shall be made to the home of the applicant by one of the Council's Health Visitors and a periodical report on the home conditions, health of children, etc., shall be made for the information of the Committee when considering renewal. 3. Where deemed necessary the income of the applicant's family shall be verified by the Investigation Officer. 4. The " Grants " Committee—being a Sub-Committee of the Maternity and Child Welfare Committee —shall meet as frequently as circumstances warrant but not less than once a month. All applications for supply of nourishment at less than cost price shall be reserved for consideration by the " Grants " Committee, and, except as hereafter provided, no supply shall be granted until the application has been considered by the " Grants " Committee. 5. In considering an application for a supply of nourishment at less than cost price the "Grants" Committee shall adhere to the scale of incomes set out in the Schedule appended to this Scheme, but where the " Grants " Committee are of opinion that strict adherence to the scale would deprive any mother or child of a supply of nourishment really necessary on grounds of health, the Committee may take into consideration any other facts of the case, and make their decision accordingly. 6. The Medical Officer of Health may authorise the issue of an Emergency Order for the requisite supply for a period sufficient to include the interval which will elapse before the next meeting of the " Grants " Committee. 7. Orders for the supply of nourishment shall be in the prescribed form and no payment for any such supply shall be made except upon production of the receipt of supply signed by the recipient. 8. The name of any purveyor of milk who has been convicted of any breach of the Milk and Dairies Order, 1926, or of an offence against the law as regards adulteration, etc., shall be reported to the Maternity and Child Welfare Committee, who will decide whether further orders shall be placed with such purveyor of milk. Samples shall be taken periodically of the milk supplied under any order issued under this Scheme. 9. Stock books showing orders for the disposal of all forms of dried milk and of other preparations of milk shall be kept by the Public Health Department, and stock shall be taken monthly at each Welfare Centre which acts as a distributing centre. 10. No grants shall be made to families in receipt of Public Assistance. 11. " Pasteurised " milk shall be supplied to recipients of ordinary milk grants, provided that the medical officers engaged at the welfare centres shall be authorised, in special cases, to recommend the supply of " Tuberculin Tested " milk. 12. Where the medical officer of a welfare centre considers that any mother or child attending is in urgent need of cod liver oil, vitamin preparation or other ancillary food and the family is already on grant from the Council, a free grant may be made. Further, if the family be not at the time in receipt of a grant but their economic circumstances appear to be such that in the opinion of the Superintendent of the Centre the food cannot be afforded, a grant may be made free of cost. In the latter cases, however, records of such emergency free grants shall be submitted to the Maternity and Child Welfare (Grants) Sub-Committee for •approval. 46 SCALE. Number in family. FREE. If total income (less rent) is under HALF-PRICE. If total income (less rent) is under 1 15/- 18/- 2 20/- 24/- 3 25/6 27/- 4 30/- 34/- 5 32/6 37/6 6 36/- 42/- 7 40/- 47/6 8 44/- 51/6 9 48/- 55/6 10 62/- 60/- 11 56/- 65/- 12 60/- 70/- Particulars of Extra Nourishment Grants During 1937. (1936 figures in brackets.) The total number of cases considered by the " Grants " Sub-Committee during the year was 3,883, of which 987 represented new applications. These latter were dealt with as follows :— Number of Refused, withdrawn or referred New Applications. Granted. to Public Assistance Committee. 987 (751) 854 (661) 133 (90) The expenditure incurred during the year in connection with the issue of grants of fresh and dried milks, butter, eggs, ancillary foods, medicines, etc., amounted to £1,697 17s. 8d. 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 seventy-two families hitherto unknown to the Department applied for grants during the year. CONVALESCENCE. On the 26th November, 1936, the Council approved the reservation of a bed at Mayfield (Sussex) Convalescent Home at a cost of £80 per annum, and the bed became available from the 8th April, 1937. Seventeen mothers with their babies were sent for convalescence during the year, their contributions towards the cost amounting to £8 6s. 6d. In addition, nine mothers with their babies were referred to other homes at a nett cost to the Council of £16 10s., the payments by patients totalling £6 16s. 6d. In 56 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 £237 0s. 8d. A grant of £15 in aid of the funds of the local branch of the Invalid Children's Aid Association was made. MATERNAL MORTALITY. During the year eight maternal deaths were enquired into by Dr. E. R. Emslie, Assistant Medical Officer for Maternity and Child Welfare, and reports thereon forwarded to the Ministry of Health. CHILD LIFE PROTECTION. Miss M. A. MacLean continues to act in 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, the Assistant Medical Officer (M.C.W.) and two of the Male Sanitary Inspectors are also authorised to exercise the powers and duties of Child Protection Visitors for special purposes. 47 During the year 1937, 1,048 visits and inspections were made, 37 new registrations of fostermothers were recorded, 71 new children were received and 4 children were removed—2 to hospital and 2 elsewhere. No deaths were reported. At the close of the year, the Register contained the names of 94 persons who were receiving children for reward. These persons had charge of 108 children. DAY NURSERIES. There are three Day Nurseries in the Borough, viz. :— The Queen's Park Day Nursery, 66, Lancefield Street ; The Paddington Day Nursery, 21, Howley Place ; and The Westbourne Day Nursery, St. John's House, Great Western Road. The two former provide accommodation for 25 and 45 children, respectively, and are managed by voluntary bodies. 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 Queen's Park Day Nursery £252, and to the Paddington Day Nursery £377. Supplemental contributions of £25 and £140 respectively, were made in respect of the year 1937. The premises of the Queen's Park Day Nursery at 66, Lancefield Street are owned by the Council. The Westbourne Day Nursery is under the control of the Council and provides accommodation for 70 children. The charges for admission per child are 8d. per whole day ; 5d. per half-day, including Saturday ; 6d. per day or 4d. per half-day for two or more in same family. Statistical Summary. " Westbourne." " Queen's Park." " Paddington." Days open Attendances Average attendance New Children Full Saturdays. days. Full Saturdays. days. Full days. Saturdays. 250 51 11,513 1,461 46 29 250 51 5,530 497 22 10 256 9,872 38 50 1,311 26 103 25 15 Cases of Infectious Disease. Diphtheria 1 — 1 Scarlet Fever — 2 Measles 22 1 — Whooping Cough 5 — — Sonne Dysentery 4 — — Summer Diarrhoea 1 — — Mumps — 12 2 There were no Closures during the year on account of infectious disease. Dr. Emslie reports as follows :— we6tboubne Day Nukseky. All children are medically examined on admission to the Nursery and thereafter once a month. The Assistant Medical Officer for Maternity and Child Welfare attends daily and sees any children requiring special attention. The health of the children has been on the whole very good throughout the year. The children are well cared for and in most cases there is a noticeable improvement in general physique after attendance at the Nursery for some time. There were several cases of whooping cough in July, but the rest of the children were inoculated against it and none of those who took it were seriously ill. There were several cases of measles in September and several cases of diarrhoea in November, two of whom were found on bacteriological examination to have sonne dysentery. As all the 70 children are admitted through one room great care has to be exercised to avoid the spread of infection, but we have not suffered unduly in this respect. All the children whose parents permit, are inoculated against Diphtheria, and this includes almost all the children. Matron's report for the year is as follows :— 1937 has been a year of extensions at the Westbourne Day Nursery and we can now take 70 children daily. Some 54 of these are under 3 years of age as we find the demand much greater for young children due to the L.C.C. Schools in this neighbourhood taking children from the age of 3 years. 48 We still continue to bathe all children under 3 years daily and the bigger children twice a week, but we are finding it difficult, as the bathroom, which was just big enough for our numbers in 1936, is hardly large enough to deal adequately with the increased number of children coming now. Although we had an epidemic of measles and some whooping cough, the health of the children on the whole has been good. Many of our regular attenders have been coming since we opened in May, 1936, and they can easily be detected by their happy, sturdy appearance. The children are a happy crowd and it is a very bad day indeed when the bigger ones are not out in the garden for some part of the day. We are, unfortunately, not able to get babies and tweenies out so much : in Summer we lift cots downstairs into the garden and they spend all fine days outside, but in winter it is a problem to get enough fresh air for them. The probationers are very satisfactory and three have now their Elementary Certificates and are waiting to take their Advanced examinations. Christmas was a happy time for both Staff and Children, the latter had a Christmas Tree and a Party, Dr. Christie very kindly acting as Father Christmas. On the evening of the same day the mothers came back at 7.30 after leaving their children with " Father " or " Granny " and we played games and danced. The nurses gave an amusing Sketch which we all enjoyed ; Mrs. Christie very kindly sent cakes and sausage rolls which were much appreciated and the mothers voted it " the best Christmas Party we have had for years." On December 18th, the nurses had a small Party, the enjoyment of which was greatly helped by the loan of a radiogram from the father of one of the children—-an electrician. We take this opportunity of thanking the following for gifts received during the year. The Mayor's Fund £3 for Christmas toys. Mrs. Christie Cakes, etc., for Parties. Lady Kenyon, Dr. Emslie, Mrs. Beaton, Mrs. Gregory, Mrs. Kinnear, Mrs. Lascelles, Mrs. Rennor, Mrs. Tweedy Toys. Dr. Fen wick Nursery posters. ADMINISTRATION. STAFF OF THE DEPARTMENT. A complete list of the Staff of the Department appears on page 4. The following changes and additions occurred during the year. Assistant Medical Officer for Maternity and Child Welfare and Public Vaccinator.—Miss Ethel R. Emslie, M.D., Ch.B., D.P.H., commenced duty on the 4th January, 1937. The appointment of an Assistant Medical Officer for Maternity and Child Welfare was a new one in conformity with the decision of the Council on the 30th April, 1936. The Public Vaccinator's duties were taken over from Dr. S. Denovan Adam, whose appointment ceased on the 3rd January, 1937. Visiting Medical Officers.—Consequent on the appointment of an Assistant Medical Officer for Maternity and Child Welfare it became necessary to re-arrange the staffing of the Welfare Centres. The term of engagement of all the Visiting Medical Officers expired at the end of 1936, and the following were appointed to act at the Sessions not attended by Dr. Emslie, as from the 1st January, 1937, viz. : Drs. S. Denovan Adam, R. Cove-Smith, E. Dorothy Fenwick, Evelyn T. D. Maclagan, and C. T. Potter. Clerks.—Mr. R. H. Clark and Mr. R. W. Carpenter commenced duties as Class 5 Clerks on the 29th January and 1st April respectively. Sanitary Inspectors.—Mr. H. D. Bailey resigned his appointment on the 30th June, and Mr. W. H. G. Atkins, then a temporary Inspector, was appointed on the 22nd July to fill the vacancy. On the 24th June the Council decided to appoint two additional temporary Sanitary Inspectors in connection with the Housing work, making the total temporary Inspectorial Staff five. Health Visitors.—Miss F. Fox and Miss A. M. A. Johnston were appointed Health Visitors on the 25th February, consequent on the decision of the Council in October, 1936, to augment the Visiting Staff. They commenced duty on the 1st and 5th April respectively. Westbourne Day Nursery.—The increase in the number of children attending the Nursery necessitated slight additions to the Staff. Two additional Probationer Nurses were authorised and obtained in May, making the approved total seven. 49 PREVENTION OF INFECTIOUS DISEASE. Visiting.—Visits of enquiry after notification of infectious disease numbered 2,127. 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 749. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 95 patients (comprising 10 cases of measles, 80 of pneumonia, and 5 of whooping cough) were visited in their homes by the nurses of the Association. The visits paid to such patients numbered 1,419. Disinfection.—The rooms disinfected after infectious disease numbered 627. The weight of bedding, etc., removed for disinfection at the Wood Lane Disinfection Station, under the agreement with the Kensington Borough Council, amounted to approximately 19 tons. Two hundred and forty-six library books were disinfected. Schools.—A total of 1,095 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 585 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, 206 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 infectious disease. 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 practitioners concerned. Examinations of sputa from patients suspected to be suffering from tuberculosis of the lungs are undertaken by the Paddington Tuberculosis Dispensary, 20, Talbot Road. The examinations made during 1937 were as follows :— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 1,019 66 Tuberculosis 433 33 Typhoid Fever 12 1 Scarlet Fever 7 4 Dysentery 33 15 Food Poisoning 1 — HOUSE DRAINAGE. During the year 23 existing drains were tested and found water-tight, and 105 defective drains were wholly or partly reconstructed. RECONSTRUCTION PLANS. Three hundred and seventy-one plans were submitted for drainage works in existing buildings. In connection therewith 701 letters were despatched. Six summonses were issued for failure to supply plans. COMBINED DRAINAGE. Orders were made under Section 38 of the Public Health (London) Act, 11)36, with respect to new drainage systems to which the following groups of buildings were to be connected:— Princes Square, Nos. 64 and 65. Bathurst Mews, Nos. 24 and 25; Nos. 18, 19 and 20. Westbourne Street, Nos. 13, 14 and 15. Sussex Square , No. 5, and Sussex Mews East, No. 14. Inverness Terrace, Nos. 2 and 4 ; and Nos. 8 and 10. Edgware Road, Nos. 405, 407 and 407a, and Wards Flats, Crompton Street. Kensington Gardens Square, Nos. 86, 87, 88, 89 and 90. Warrington Crescent, Nos. 37 and 39. Eight new residential houses on the sites now numbered and known as Nos. 5, 6, 7, 8, 9, 10 and 12, Southwick Place, and No. 6, Hyde Park Crescent, and the 15 garages at the rear thereof. 50 Sis shops with maisonettes over on the sites of premises formerly numbered and known as Nos. 3-13 and 13a, Kilburn High Road, and a portion of the existing garage premises at the rear. New garage premises on sites of premises formerly numbered and known as Nos. 1-10 (inclusive, save No. 6), Conduit Mews and the remaining premises at the rear of Nos. 4-18 (inclusive, save No. 12), Spring Street. Four new residential houses and garages on the sites of premises formerly numbered and known as Nos. 29, 30 and 31, Gloucester Square, Nos. 10, 12 and 14, Radnor Place, and No. 41, Devonport Mews. Two new residential houses and garages on the sites of premises formerly numbered and known as Nos. 1 and 3, Hyde Park Street, No. 13, Clarendon Mews, and No. 7, Chester Mews. New warehouse premises on the sites of premises formerly numbered and known as Nos. 8, 9 and ]lj, Paddington Green. Four new residential houses on the sites of premises formerly numbered and known as Nos. 15, 16 and 17, Hyde Park Crescent, and Nos. 9 and 10, Somers Place. Block No. 19 (Flats 73 to 82), Block No. 21 (Flats 83 to 92), and Block No. 23 (Flats 93 to 102), Delaware Mansions; Block No. 29 (Flats 123 to 132), Block No. 31 (Flats 133 to 142), Block No. 33 (Flats 143 to 152), Block No. 35 (Flats 153 to 162) and Block No. 37 (Flats 163 to 167), Delaware Mansions. New Cinema and car park on the sites of premises formerly numbered and known as Nos. 319 and 32), Edgware Road; Nos. 131 to 145 (odd, inclusive), Church Street; and private yard and properties at the rear of Nos. 311 to 327 (odd, inclusive), Edgware Road. New block of residential flats, shops and garage on sites of premises formerly numbered and known as Nos. 147, 149 and 151, Maida Vale, and Nos. 34 to 40b (even, inclusive), Canterbury Terrace. New block of residential flats on the sites of premises formerly numbered and known as Nos. 11 and 12, Hyde Park Terrace. New block of residential flats and garage on the sites of premises formerly numbered and known as Nos. 3 to 8 (inclusive), Porchester Gate. New block of residential flats and garages on the site formerly occupied by a Church School, and situate between No. 112, Shirland Road and the flank of No. 128, Elgin Avenue. New block of residential flats on the sites of premises formerly numbered and known as Nos. 69, 69a, 71 and 71a, Artesian Road. New block of shops, residential flats, cinema, petrol filling station and garage, on the sites of premises formerly numbered and known as Nos. 51 to 79 (inclusive), Edgware Road; Nos. 57 to 61 (inclusive), Cambridge Street; No. 16, Connaught Square; Nos. 1 to 13 (inclusive), and 23, Portsea Place. New block of residential flats on the sites of premises formerly numbered and known as Nos. 415-421 (inclusive), Edgware Road. New block of working class flats on the sites of premises formerly numbered and known as Nos. 27 (part) to 48 (inclusive), North Wharf Road; and Nos. 1 to 29 (inclusive), Dudley Street. Somers Mews, Nos. 14 and 15. No combined systems were reconstructed by the Council during the year. SEWER CONNECTIONS. In 1937, 27 sewer connections were reconstructed, either partially or wholly, on the application of the owners of the properties concerned. No Orders were made under Section 40 of the Public Health (London) Act, 1936. WATER SUPPLY. Twenty-one certificates under 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. Five of the premises were unoccupied. In the remaining cases the water supply was restored after various intervals, ranging from one day to 29 days. MORTUARY. Five hundred and fifty-six bodies were deposited at the Mortuary, inquests being held on 410 of that number. Bodies deposited pending burial (all non-infectious) numbered 16. Three hundred and forty-five post-mortem examinations were made. TRADE NUISANCES. Ten complaints were received during the year, those relating to manure numbering 7. REMOVAL OF MA NITRE. 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. 51 RAG AND BONE DEALERS. In December, 1937, there were 19 rag and bone dealers in the Borough. SMOKE CONTROL. During 1937, 7 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 26 occasions, occupying 13 hours. Smoke of all descriptions was noted during 3J hours, "black" smoke being observed for one minute. Eight complaints relating to the emission of smoke were received during the year. CANAL BOATS. Part X (Sections 249-258) of the Public Health Act, 1936, relates to Canal Boats, the Canal Boats Acts, 1877 and 1884, having been repealed. By virtue of the Local Government Board Regulations of 17th May, 1878, the Paddington Borough Council is one of the Registration Authorities for the Regents and Grand Junction Canals, now the Grand Union Canal. The Medical Officer of Health is the Examining Officer for the purposes of the Regulations. Mr. V. L. Ronchetti acted as Canal Boats Inspector during the year. The following report for the year 1937 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. Ninety visits of inspection were made, the following infringements of the Act and Regulations being discovered:— Cabins leaky 2 Stove flue pipe defective 1 Boats without Certificates 3 One notice was served. On no occasion was admission to a boat refused, and it was not found necessary to institute legal proceedings. No case of infectious disease was reported. One death was recorded. Six children of school age were found to be living on the boats inspected. The registration of one boat was cancelled, it having been re-registered by another authority. 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. The annual cleansing at Paddington Basin was carried out during the week-end 22nd-24th April. About 775 tons of mud were removed from the bed of the Basin, in addition to 595 tons which were dredged previously, a total of 1,370 tons, being some 63 tons more than that removed in 1936. TENEMENT HOUSES. The number of houses on the register at the close of the year was 2,031. Inspections totalled 8,025, and legal proceedings were instituted with respect to nuisances or contraventions of the Bye-laws in 6 instances. Particulars of the defects, etc., discovered and remedied during the year are shown below:— Defects, Nuisances and Contraventions of Bye-laws (other than items of Dilapidation) Discovered and Remedied. Drain defective 41 „ choked 10 Soil pipe or soil vent pipe defective 25 Fresh-air inlet valve defective or missing 38 Manhole cover defective 10 Gully grating missing 21 Gully choked 16 Rain-water pipe defective 48 „ „ choked 4 Gutters defective 17 Waste-pipe defective 70 choked 20 „ untrapped 38 „ missing - Sink defective 47 52 Absence of means for carrying away waste water from taps 13 Houses with insufficient water supply 70 Additional draw-ofi taps provided 27 Water-closet roof defective 26 „ walls out of repair 50 „ flooring defective 9 „ flushing apparatus defective 81 „ pan defective 23 „ pan foul 13 „ seat defective 56 „ choked 22 „ door missing, off hinges, defective, or fastenings out of order 33 „ lighting or ventilation inadequate 2 „ accommodation insufficient 60 Drinking water cistern defective 3 „ „ „ dirty 3 „ „ „ uncovered or cover defective 4 Rooms damp 276 Rooms, staircases, wash-houses, water-closets, yards, areas, etc., dirty 3,193 Rooms verminous 122 Rooms, floor, bedding or contents dirty 8 Roof leaky 249 Mixing of sexes - Chimney smoky 10 Food cupboard not provided 86 Cooking accommodation not provided or defective - Staircase not provided with artificial light - „ without handrail - Window cords or fastenings out of repair 508 Common staircase out of repair 96 Animals improperly kept 1 Premises where water supply was cut off 1 Wash-house paving defective 45 Yard or area paving defective 123 Dustbin defective 101 „ accommodation insufficient 13 Premises without ashpit accommodation - Accumulation of refuse 27 Notices Issued. Written Intimations 473 Statutory Notices:— Verminous rooms 89 Additional taps 279 Other matters 307 Bye-law Notices 1,011 Items of Dilapidation for which Letters were sent to the Owners (Section 9 of the Housing Act, 1936). Wall-plaster broken, bulging, or defective 208 Matchboarding defective 3 Wall-paper loose 15 Skirting defective 10 Doors defective or missing 44 Locks defective 35 Ceiling plaster defective 132 Ceiling paper loose 11 Floors broken or badly worn 132 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 126 Stove settings defective 27 Flues defective 33 Hearths defective 8 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) ... 30 Cupboard doors defective or missing and shelves missing 23 Cupboard shelves missing 1 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 191 Window-frames loose or defective (including oak sills worn or rotten) 94 Window-glass broken 197 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 49 Steps to front entrance or area defective 35 Railing to area or area steps defective 9 Guard rails to addition roofs defective, broken or rotten 6 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 23 Vault doors missing or defective 15 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— 53 (a) Water-cJoset 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 33 premises. In addition, 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. Annual Cleansing.—1,101 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 two common lodging houses in Kilburn Lane and one (Cecil House) in Harrow Road. The number of beds for which each is licensed is as follows:— 268 and 720, 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 124 inspections (including 32 night inspections) were made by the two Sanitary Inspectors responsible for the supervision of these houses. Two cases of notifiable illness and one death occurred among the occupants. RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-1933. Five applications for certificates were made, all of which were granted. In several instances the attention of owners was called to the fact that rent books did not contain the particulars required by the Acts, and in 4 cases legal proceedings were instituted, the results of which are shown on page 68. FACTORIES, WORKSHOPS AND WORKPLACES... Defects.—The defects found and remedied during the year in Factories, Workshops and Workplaces are shown in the subjoined table:— 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 57 61 — — Want of ventilation — — — — Overcrowding — — — — Want of drainage of floors — — — — Other nuisances 6 2 — — Sanitary accommodation insufficient 2 1 — — unsuitable or defective 4 7 — — not separate for sexes — — — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (s. 101) 1 1 — — Other offences (Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921.) — — — — Total 70 72 — — * Including those specified in Sections 2, 3, 7 and 8 of the Factory and Workshop Act, 1901, as remediable under the Public Health Acts. 54 At the end of 1936 there were 898 premises on the Register. During 1937, 103 premises were removed from the Register and 66 added, making the total at the end of the year 861. The Department reported to the Home Office 1 case in which the prescribed abstract of the Factory and Workshop Act, 1901, was not displayed, and received from that Office notice of 5 workshops, 4 of which were already known to the Department. Homework (Outworkers).—Local employers of outworkers sent in 14 lists in February and 13 in August. These lists contained 234 names and addresses of which 206 were forwarded to other districts. From other districts 227 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 678 inspections, comprising 241 of factories, 416 of workshops and 21 of workplaces. There were 70 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 3 complaints, which comprised:— Sanitary conveniences not separate for sexes 1 Other offences 2 Bakehouses.—During the year 1 level bakehouse was opened, the total number on the Register at the end of the year being 70, of which 51 were factory bakehouses. The number of level bakehouses was 31 (15 being factories), and of underground 39 (36 being factories). The bakehouses were inspected on 375 occasions during the year. Rag Flock.—Little, if any, rag flock is used in the Borough, and no samples were taken during the year. SHOPS ACTS, 1934 and 1937. The Shops Act, 1934, enacts that in every part of a shop in which persons are employed about the business of the shop:— (а) Suitable and sufficient means of ventilation shall be provided and suitable and sufficient ventilation shall be maintained ; (б) 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, apd 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. The Shops Act, 1937, which came into operation on the 1st January, 1937, extended, for the purposes of the Shops Acts, 1912 and 1934, the expression "retail trade or business" so as to include the business of lending books or periodicals when carried on for purposes of gain. 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. 55 The inspection of shop premises in the Borough is carried out by Mr. A. C. Harrison, one of the Meat and Food Inspectors. The following particulars relate to work carried out under the Shops Acts during the year:— First inspections 340 Re-inspections 1,674 Exemption certificates as regards sanitary conveniences applied for 50 „ „ granted 50 The following contraventions of the Acts were discovered during the year:— Insufficient sanitary conveniences 10 Sanitary conveniences unventilated 17 „ „ improperly sealed from lobbies 17 Absence of lobbies to sanitary conveniences 20 Water-closets improperly screened 8 Water-closet walls and ceilings defective or dirty 52 „ roofs defective 2 „ pans defective or dirty 32 windows defective 9 doors defective 9 „ fittings defective 59 Absence of indicators to water-closet doors 61 ,, lighting to water-closets 94 Reasonable temperature not maintained 58 Insufficient ventilation 10 In the course of his inspections, the Inspector also discovered the following defects:— Premises dilapidated or dirty 93 Drains choked 9 Fresh air inlet connections to drains defective 4 Inspection chamber covers defective 7 Internal gully traps uncovered 2 Flues defective 2 Waste-pipes of sinks untrapped 39 ,, ,, defective 9 Yard pavings defective 5 Dustbins defective 37 Accumulations of rubbish 19 No legal proceedings were necessary during the year. HOUSING. Abatement of Overcrowding. In this Borough the Minister of Health fixed the appointed dayfor the purposes of sections 3, 4, 8 and 68 of the Housing Act, 1935, as the 1st January, 1938, and for the purposes of section 6 of the Act as the 1st July, 1937. Section 6 (1) (now section 62 (1) of the Housing Act, 1936) provides that as from the expiration of six months from the appointed day, every rent book or similar document used in relation to a dwelling-house must contain the following summary of the provisions of the Act relating to overcrowding, including a statement of the number of persons permitted to sleep in the house:— After the 1st day of January, 1938, an occupier who causes or permits his dwelling to be overcrowded is liable to prosecution for an offence under the Housing Act, 1936, and, if convicted, to a fine not exceeding five pounds. Any part of a house which is occupied by a separate family is a " dwelling." A dwelling is overcrowded if the number of persons sleeping in it is more than the " permitted number," or is such that two or more of those persons, being ten years old or over, of opposite sexes (not being persons living together as husband and wife) must sleep in the same room. The "permitted number" for the dwelling to which this (Rent Book) ( ) relates is persons. In counting the number of persons each child under ten years of age counts as half a person, and a child of less than one year is not counted at all. The Act contains special provisions relating to overcrowding already existing on the abovementioned date or which is due to a child attaining the age of either one or ten years after that date, or which is due to exceptional circumstances. Full information about these special provisions as to overcrowding can be obtained free on application to the Medical Officer of Health, whose address is Town Hall, Paddington Green, W.2. Under section 6 (2) of the Act it is the duty of the local authority, upon the application of the landlord, or of the occupier, of a dwelling-house, to inform the applicant in writing of the number of persons constituting the permitted number in relation to the house, and a statement inserted in a rent book or similar document under the foregoing subsection shall be deemed to be a sufficient and correct statement if it agrees with information given under this subsection. 56 Pursuant to the resolution of the Council of the 18th March, 1937, steps were taken to measure the rooms in working class houses for the purpose of ascertaining the permitted number for each working-class dwelling and for the furnishing of this information to landlords for insertion in the prescribed form of notices in rent-books. Of the 9,180 houses forming the subject of this survey, 8,494 houses, comprising 22,207 dwellings, were completely measured. A further 336 houses were found to be owner-occupied or not to be in working-class occupation and were not measured, and admission to 350 houses could not be obtained. The total cost of the survey was £604, the London County Council contributing half of this sum. Housing Act, 1936. Part III. During the year clearance or compulsory purchase orders were confirmed by the Minister of Health as follows:— Titchborne Row (12 houses). Clearance Order confirmed, subject to a payment being made by the Council under Section 42 in respect of eight houses. Burlington Mews West (24 houses). Compulsory Purchase Order confirmed, subject to the modification that Ref. No. 11 will be excluded from the Clearance Area but will remain in the Order as lands adjoining the Area, to be purchased by the Council under Section 27 of the Act. The Minister also directed that a payment under Section 42 shall be made in respect of Ref. Nos. 4, 5 and 7. Burlington Mews East (12 houses). Compulsory Purchase Order confirmed without modification. Seven other clearance or compulsory purchase orders referred to in last year's annual report have not yet been confirmed by the Minister. Paddington Borough Council, Clarendon Street Redevelopment Area. On the 24th June, 1937, the Council declared an area bounded by the rear boundaries of the properties in Harrow Road, the Canal, the west side of Ranelagh Road and the north side of Bourne Terrace, to be a proposed redevelopment area. It is proposed to provide in the area housing accommodation for persons of the working classes. A redevelopment plan is being prepared and will be submitted to the Minister of Health in due course. Acreage of lands comprised in the area 14.4 acres Total population on 14th October, 1937 4,281 Total number of houses 423 Number of working-class houses 397 Number of persons of the working-classes occupying the houses 4,235 Number of non-working-class houses 16 Number of persons occupying these houses 40 Number of premises not in use for human habitation (stores, etc.) 10 Houses Unfit for Human Habitation. The following figures show the extent of the Council's operations during 1937 : Number of basement rooms closed for human habitation 52 Number of basement rooms closed for sleeping purposes only 126 Number of dwelling-houses or parts of dwelling-houses closed for human habitation (other than basement rooms) 73 Number of persons displaced or who will be displaced as a result of the Council's operations 551 Number of displaced persons re-housed on London County Council Housing Estates 249 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 orders the Council, in 68 instances, after consultation with owners, accepted undertakings from them as empowered by Section 11 (3) of the Housing Act, 1936. Such undertakings possess the advantage of expediting procedure, whilst securing the closure of the parts of the premises to which they refer as effectively as though closing orders had been made. 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. A number of other premises have been made fit for human habitation without recourse to formal, proceedings under the Housing Act. During the year 596 inspections and 1,537 re-inspections of basement premises were made. Compulsory Repairs. No notices were served during the year under Section 9 of the Housing Act, 1936. 57 Two hundred and twenty-six communications were, however, sent to owners, drawing attention to defects liable to be dealt with under this Section. At the end of the year these communications resulted in nearly all the defects being remedied. Housing on the London County Council Estates. During the year 369 applications for housing accommodation were sent forward to the County Council with a request that the apphcations be given preferential consideration in the allocation of accommodation on grounds of overcrowding, unhealthy conditions, medical and special hardship. Of this number 150 were offered, and accepted, suitable vacancies. A further 116 familieswere housed on apphcations submitted direct to the County Council. Since April, 1920, 1,123 Paddington families have secured accommodation on London County Council estates on apphcations submitted by the Borough Council, and since September, 1930, 521 other families have been re-housed as a result of direct application to the County Council. Borough Council Accommodation on London County Council Estates. Agreements are in force between the Borough Council and the County Council whereby houses and flats are provided on County Council Estates for the re-housing of Paddington families. Under these agreements the Borough Council has a right to nominate the ingoing tenants, and in the case of the 1934 Agreement should a house or flat become vacant on an outlying estate for which no tenant is available the nomination can be transferred to a local estate, such as Wormholt or Old Oak, Hammersmith, to suit the convenience of those applicants who desire to live near the Borough. Three hundred and sixteen houses and flats have been provided to date as set out below. This number, however, is being augmented from month to month as displacements from unfit basements and clearance areas occur. 1927-28 Agreements. (A contribution of £7 per annum is payable to the London County Council in respect of each dwelling.) Wormholt Estate, Hammersmith 150 1934 Agreement. (A contribution of £1 17s. 6d. per annum is payable to the London County Council in respect of each dwelling.) Wormholt Estate, Hammersmith 63 Old Oak Estate, East Acton (adjoining Wormholt) 61 Walter House, Ossulston Estate 1 Becontree 2 Somerset Buildings, Churchway Estate, St. Pancras 1 Hanwell 9 Honor Oak, Deptford 1 Kennington Park, Lambeth 1 Loraine Place, Islington 4 Roehampton, Putney 1 St. Helier, Morden 3 Watling, Edgware 11 White Hart Lane, Tottenham 1 Priestly House, St. Pancreas 1 Leonard Day House, St. Pancras 2 Berners House, Barnsbury Estate 1 Kenmore Park 3 Total 166 During the year 4 vacancies occurred in the 150 houses on the Wormholt Estate (1927-28 Agreements), and 12 vacancies in the 166 houses provided under the 1934 Agreement. Altogether the Agreements entered into by the Borough Council have resulted in 400 families obtaining improved housing conditions. Borough Council Accommodation within the Borough. Brindley House, Brindley Street 8 flats Artesian House, Artesian Road 8 flats 8, Warrington Crescent (non-working class) 6 flats 30, Westbourne Square (non-working class) 4 flats 58 Flats under Construction. North Wharf Road 50 flats This scheme will house some 232 persons, and will comprise:— 15 4-room flats (rent 17s.; rates and water 6s. 5d.) 25 3-room flats ( „ 12s. 6d;. ,, „ ,, 5s. 2d.) 10 2-room flats ( „ 7s. 6d.; „ ,, ,, 4s. Id.) Schemes under Consideration. Chippenham and Rodborough Mews, and Woodfield Crescent 54 flats This scheme will house some 229 persons, and will comprise:— 12 4-room flats (Approximate inclusive rent 23s. Id.) 22 3-room flats ( „ „ ,, 18s. 0d.) 8 2-room flats ( „ „ „ 12s. 2d.) 4 1 -room flats ( „ ,, ,, 7s. 2d.) Clarendon Street Redevelopment Area. It is proposed to erect a large number of working-class flats on this site, but the scheme is not sufficiently advanced for more detailed information to be given. Paddington Houses Association, Ltd. The Council have to date subscribed the sum of £7,500 in debentures of the Paddington Houses Association, Ltd., for the extension of the Association's scheme of purchasing and reconditioning houses in Paddington for occupation by persons of the working-classes. Disinfestation of Furniture, etc., with Hydrogen Cyanide. The Agreement entered into with the Kensington Borough Council for the disinfestation of verminous furniture, etc., by hydrocyanic acid gas and steam disinfection of bedding remains in operation. During the year it did not become necessary to put this Agremeent into force, but the facilities available will enable the Council to insist that the furniture and bedding of every family taking over the tenancy of a Council flat shall be treated for vermin. HOUSING. (Ministry of Health TableI) 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) 4,284 (6) Number of inspections made for the purpose 26,500 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 — (b) 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 record 3.—Action under Statutory Powers during the Year. A. Proceedings under Sections 9, 10 and 16 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which notices were served requiring repairs *226 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) by owners 226 (b) by Local Authority in default of owners — B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1,868 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) by owners 2,037 (b) by Local Authority in default of owners — C. Proceedings under Sections 11 and 13 of the Housing Act, 1936— (1) Number of dwelling-houses in respect of which Demolition Orders were made — (2) Number of dwelling-houses demolished in pursuance of Demolition Orders — 59 D. Proceedings under Section 12 of the Housing Act, 1936— (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made 251 (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 notices. 4.—Housing Act, 1936—Overcrowding. (а) (1) Number of dwellings overcrowded at the end of the year 2,008 (2) Number of families dwelling therein 2,008 (3) Number of persons dwelling therein 8,8861/2 units (b) Number of new cases of overcrowding reported during the year 76 (338 units) (c) (1) Number of cases of overcrowding relieved during the year 83 (2) Number of persons concerned in such cases 4021/2 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 which the Medical Officer of Health may consider it desirable to report — FOOD SUPERVISION. Slaughterhouses.—There is one slaughterhouse within the Borough, at 275, Edgware Road. Three hundred and twenty-two inspections were made during the year. The number of animals slaughtered was 2,450, comprising 200 bullocks and 2,250 sheep, a decrease of four bullocks and 578 sheep as compared with 1936. Caboases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed 200 — — 2,250 — Number inspected 200 — — 2,250 84 All diseases excepting Tuberculosis. Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 94 — — 828 — Percentage of the number inspected aSected with disease other than tuberculosis 47.0 — — 36.8 — Tuberculosis only Whole carcases condemned — — — — — Carcases of which some part or organ was condemned 7 — — — 5 Percentage of the number inspected affected with tuberculosis 3.5 — — — 5.9 The following Table shows the number of organs destroyed, and the disease with which they were affected:— Bullocks. Sheep. Heads. Tongues. Lungs. Livers. Mesenteries. Stomachs. Lungs. Livers. Hearts. Abscess — — 1 2 — — 3 3 3 Actinomycosis 3 3 — — — — — — — Blood aspiration — — — 1 — — — — — Cystercercus Tenui-collis — — — — — — 1 1 1 Distomum Hepaticum — — 3 96 — — — — — Parasitic Invasion — — 2 — — — 823 77 59 Pentastomum Denticulatum — — 1 — — — — — — Pleurisy — — 6 — — — — — — Pneumonia — — — — — — 1 1 1 Tuberculosis 5 5 5 2 1 1 — — — 8 8 18 101 1 1 828 82 64 Total weight, 2,267 lbs. Pieces of meat, weighing in all 149 lbs., were also destroyed for various reasons. In addition to the animals slaughtered in the licensed slaughterhouse, a number of pig carcases arrive in the Borough which have not been previously inspected. During 1937 the number of carcases was 84. On examination it was found necessary to destroy 5 heads and olfal weighing 70 lbs., all affected with tuberculosis. 60 Slaughter of Animals Act, 1933.—The purpose of this Act is to provide for the humane and painless slaughter of animals and for the licensing of slaughtermen. Licences are held by four slaughtermen who follow that occupation in the Borough. Public Health (Meat) Regulations, 1924.—It was not found necessary to take any legal proceedings under these Regulations during the year. Occasional defaults were dealt with by means of a caution. Unsound Food.—In one instance proceedings were taken under section 180 of the Public Health (London) Act, 1936, in respect of meat pies exposed for sale, which were "unsound and unfit for the food of man." A fine of £5 was imposed on the defendant, and the Council were awarded £5 costs. Food Purveyors.—At the end of the year there were some 1,009 purveyors of food in the Borough, classified as follows:—Butchers 64, Fishmongers 28, General 77, Grocers 151, Fried Fish 32, Refreshments 163, Confectioners 172, Greengrocers 97, Milk 139, Provision 86. In addition to the above, there were at the end of 1937, 63 licensed Street Traders selling food within the borough, namely:—Fruit and Vegetables 41, Ice Cream 8, Light Refreshments 8. These, with the storage premises of 25 Street Traders licensed by other boroughs, are under constant supervision. There were 6 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 4,661. 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 manu acture 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 99 premises. Ice Cream.—There were 198 shops at which ice cream was known to be sold, comprising the following kinds of businesses:—Bakers 9, General 22, Milk 22, Confectioners 81, Refreshment 53, Wholesale 3, Newsagents 6, Greengrocer 1, Fancy Goods 1. Three hundred and sixteen inspections of premises were made. Ice cream was sold from 35 barrows stored within the Borough and from some 40 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 1937, there were 188 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 6 tons, 1 cwt., 5 qtrs., 20 lbs., comprising the following varieties: Meat and offal, 2,486 lbs.; poultry, 110 lbs.; fruit, 31 lbs.; vegetables, 11,440 lbs.; pies, 13 lbs.; eggs, 35 lbs.; fish, 561 lbs.; and tinned meat, 44 lbs. Dairies and Milkshops.—At the end of the year 1936 there were 135 names on the Register. During the year 1937, 4 names were added, making a total of 139. There were 588 inspections made. In addition to the above-mentioned, there are 31 persons registered as purveyors of milk whose premises are situated in other districts but who come into the Borough to trade. Sterilised milk in bottles was found to be on sale at 115 premises. Milk (Special Designations) Order, 1936. The licences issued by the Council during the year numbered 91, viz.:— Principal licences to sell "Accredited" milk 2 Principal licences to sell "Pasteurised" milk 69 Supplementary licences to sell "Pasteurised " milk from addresses outside the Borough 7 Principal licences to sell "Tuberculin Tested" milk 20 Supplementary licences to sell "Tuberculin Tested" milk from addresses outside the Borough 3 91 One of the licences to sell "Pasteurised" milk was issued in consequence of a change of ownership, so that there were actually 58 principal licences in force with regard to this grade of milk. No licences were applied for with respect to the pasteurising process, or for the bottling of "Tuberculin Tested" milk. 61 The samples taken by the Council's Inspector numbered 38, comprising 29 of "Pasteurised" milk and 9 of "Tuberculin Tested" milk. The samples included 4 of "Pasteurised" milk taken at Paddington Hospital, and 13 of "Pasteurised" milk taken at Schools. With one exception all the samples were reported to comply with the appropriate bacteriological standards. In addition to these samples, 15 were submitted for animal inoculation for tubercle bacilli. All these samples gave negative results, except for one, in which, although tubercle bacilli were not demonstrated microscopically, it was considered that there was a slight element of suspicion. Milk and Dairies Order, 1926. No contraventions of the provisions of this Order were reported during the year. Food and Drugs (Adulteration) Act, 1928. Of the 600 samples taken during the year, 8 (1.33 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 2.0 per cent, in 1936 and 2.6 per cent, in 1935. Fifty-five of the samples were taken on Sundays and Bank Holidays. All were reported to be genuine. Twenty-six 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 (Hospitals, Nurseries, Orphanage, etc.) and 26 schools from which samples of milk are taken periodically. Thirty-one samples were taken during 1937, all of which were returned as genuine. Sampling of Milk from Automatic Machines.—Automatic machines for supplying milk are in use at eight premises in the Borough. From these, during 1937, 10 samples were taken for chemical analysis, and were reported to be genuine. Public Health (Preservatives, etc., in Food) Regulations, 1925 to 1927. With few exceptions all samples taken under the Food and Drugs (Adulteration) Act were examined for the presence of preservatives. One contravention of the Regulations was detected but no legal action was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year 5 samples of full cream sweetened, and 5 samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. Three samples of dried milk were taken during 1937 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 are 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 1937, samples of Sheep's Head, Soup made from Sheep's Head, Smoked Cod's Roe and Tinned Salmon were submitted for special examination, and one empty Salmon tin. No unusual features were 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 68. In connection with the analysis of milk samples, the Public Analyst furnishes the result of his analysis and the following table is of interest. 62 Genuine Milk Samples, 1937. Average Monthly Figure for Percentage. Fat Content. Non-Fatty Solids. January 3.62 8.60 February 3.46 8.50 March 3.44 8.72 April 3.56 8.62 May 3.40 8.78 June 3.41 8.87 July - - August 3.49 8.72 September 3.73 8.82 October 3.81 8.80 November 3.91 8.78 December 3.97 8.88 Average for Year. Samples taken at Paddington Station 4.10 8.93 ,, ,, elsewhere 3.59 8.77 Samples Submitted to Public Analyst, 1937. Number examined. Number Adulterated. Percentage Adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 4 — — — — Ammoniated Tincture of Quinine — 3 — — — — Baking Powder — z — — — — Blauds Pills. — 1 — — — — Boracic Ointment — 3 — — — — Bottled Prawns — 1 — — — — Brandy — 2 — — — — Bread 9 1 — — — — Bread and Butter — 4 — — — — Butter — 11 — — — — Cake — 2 — — — — Calomel Ointment — 2 — — — — Cheese — 6 — — — — Cheese and Tomato Paste — 1 — — — — Chocolate — 2 — — — — Coca Cola — 1 — — — — Cocoa — 4 — — — — Cod Liver Oil — 1 — — — — Coffee — 6 — — — — Coffee and Chicory — 2 — — — — Cookeen Fat — 1 — — — — Cream — 11 — — — — Crystallised Ginger — 1 — — — — Currants — 5 — — — — Custard Powder — 3 — — — — Dried Apricots — 2 — — — — Dripping — 2 — — — — Essence of Coffee and Chicory — 3 — — — — Fish Paste — 7 — — — — Flaked Rice — 1 — — — — Flour — 4 — — — — Full Cream Condensed Milk, Sweetened — 5 — — — — Full Cream Dried Milk — 2 — — — — Gin — 6 — — — — Golden Syrup — 1 — — — — Grey Powder — 2 — — — — Ground Almonds — 2 — — — — Ground Rice — 1 — — — — Half Cream Dried Milk — 1 — — — — Honey — 4 — — — — Horseradish Cream — 2 — — — — Hydrogen Peroxide — 2 — — — — Ice Cream — 9 — — — — Iodine Ointment — 1 — — — — Jam 1 11 — 2 — 18.18 Lard — 3 — — — — Lemonade — 1 — — — — Lemonade Powder — 2 — — — — Lime Juice and Soda — 1 — — — — Malted Milk — 1 — — — — 63 Samples submitted to Public Analyst, 1937.—continued. Number examined. Number Adulterated. Per centage Adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Malt Vinegar — 1 — — — — Margarine — 12 — — — — Meat Paste — 11 — — — — Milk 276 24 6 — 2.17 — Vlincemeat — 5 — — — — Mustard — 2 — — — — Orange Crush — 1 — — — — Orange Quinine Wine — 1 — — — — Peel — 5 — — — — Pepper — 2 — — — — Pepsi Cola — 1 — — — — Pickles — 4 — — — — Port — 2 — — — — Raisins — 5 — — — — Rum — 3 — — — — Sago — 1 — — — — Sauce — 1 — — — — Sausages 16 — — — — — Semolina — 2 — — — — Sherry — 2 — — — — Shredded Suet with Flour — 3 — — — — Skimmed Condensed Milk, Sweetened — 5 — — — — Smoked Roe — 1 — — — — Soaked Peas — 1 — — — — Soda Water — 2 — — — — Sponge Cakes — 2 — — — — Steak and Kidney Patty — 1 — — — — Stout — 2 — — — — Sugar — 2 — — — — Sultanas — 5 — — — — Sweets — 1 — — — — Tapioca — 2 — — — — Tea — 2 — — — — Tincture of Iodine — 1 — — — — Tinned Asparagus — 1 — — — — Tinned Corned Beef — 1 — — — — Tinned Fish — 5 — — — — Tinned Fruit — 5 — — — — Tinned Peas — 3 — — — — Tinned Salmon — 1 — — — — Tinned Tomatoes — 3 — — — — Vinegar — 7 — — — — Whisky — 2 — — — — White Precipitate Ointment — 1 — — — — Zinc Ointment — 3 — — — — Zinc Ointment (Compound) — 1 — — — — 302 298 6 2 1.99 0.67 600 8 1.33 Bye-laws for the Protection of Food.—On the 1st January, 1937, the bye-laws made by the London County Council under Section 6 of the London County Council (General Powers) Act, 1932 (now Section 183 of the Public Health (London) Act, 1936) came into force. These Bye-laws provide for the cleanliness, ventilation and lighting of premises used for the sale of food, and prohibit the wrapping of food in paper or other material that is not clean and reasonably suitable for the purpose; for stalls to be kept clean and in good condition; and for the prevention of persons suffering from infectious disease from handling any article of food. A person who offends against the Bye-laws is liable, on summary conviction, to a fine not exceeding £5, and in the case of a continuing offence, to a further fine not exceeding 40s. for each day during which the offence continues after conviction. It was not necessary for any legal action to be taken during the year under these Bye-laws. 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, byway 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. 64 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.:—Currants 5, Sultanas 5, Honey 4, Butter 10, Apples 5, Tomatoes 5, Oat Product 1, Salmon 3. Artificial Cream Act, 1929. 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. At the end of 1936 there were 116 entries in the list. During 1937, 8 new entries were made and 3 entries were cancelled, there being 121 entries in the list at the end of the year. Rule 28 (4) of the Poisons Rules, 1935, renders it necessary for the Council's Welfare Centres, in which certain poisons are stored, to be inspected at regular intervals, not exceeding three months, by a pharmacist, or by some other person appointed by the Council. On the 25th February, 1937, the Medical Officer of Health was designated by the Council the person to make the inspections. EXAMINATION OF BATH WATER. Ten samples of bath water from the two bathing establishments of the Council were taken during the year (one each quarter from each swimming bath in use). The samples were examined at the Royal Institute of Public Health, and proved to be satisfactory. PUBLIC HEALTH (LONDON) ACT, 1936, SECTION 121. Seven complaints of nuisance caused by pigeons were received during the year, but no action was taken by the Council under this Section. RATS AND MICE (DESTRUCTION) ACT, 1919. Ninety-one complaints were received during the year. 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. Hat Week.—This was held from 1st to 6th November inclusive. The usual circular letter was sent out to the principal wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—-Ninety-five adults and fourteen children 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 123 of the Public Health (London), Act, 1936, were served with respect to 118 premises, the verminous rooms numbering 161. The owners of 35 premises accepted the Council's ofier with regard to the spraying of infested rooms with a special insecticidal solution, 57 rooms being so treated at a charge to the owners of 7s. 6d. per room. In cases where bedding, etc., was found to be infested, it was removed to the Kensington Borough Council's Disinfecting Station for steam treatment. Verminous Household Goods.—Arrangements are in force with the Council of the Royal Borough of Kensington for the disinfestation at their Station of furniture, of persons removing to Council houses, to ensure that their belongings are free from vermin. Hydro-cyanide gas is used, the charge per load being £3 7s. 6d. No cases were dealt with during the year. 65 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 cases where the verminous person does not consent to being removed to a cleansing station. No use was made of this Section during the year. COMPULSORY REMOVAL OF AGED, INFIRM OR DISEASED PERSONS. By virtue of Section 224 of the Public Health (London) Act, 1936, it is possible in London to remove to " a suitable hospital or other institution, or other suitable place," by compulsion under certain circumstances, aged, infirm, sick or physically incapacitated persons. The circumstances which may enable an order for removal to be obtained are somewhat involved. Unless the person concerned is suffering from disease it is necessary for the premises to be insanitary. It is in all cases necessary as well to prove that the person is not receiving proper attention and that removal is necessary in the interests of the affected person and of other persons. It was not necessary for application to be made to the Court for the removal of any person during the year. 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 14,200 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 £3 lis. Od. 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 is enforced by the Medical Officer of Health and his staff. Active assistance is given by the police, the Home Secretary having intimated in June, 1928, as a result of representations from the Council, that the police had been instructed to report to the Council such offences against the bye-law as come to their notice in the course of their ordinary duties. During 1937 there was one prosecution, a fine of 10s. being imposed. The publicity which has been given to the bye-law has had good effect in causing many dogowners to be more careful. One minor difficulty in enforcing the bye-law is that an offender cannot be compelled to divulge his identity, and cannot be given in charge as the police do not enforce the bye-law. Notices concerning the bye-law were frequently posted on shingle-bins throughout the Borough. LEGAL PROCEEDINGS, 1937. Premises. Offence. Result. Public Health (London) Act, 1936. Section 82. (Summonses for Order and Penalty in each case.) 16, Alfred Road Main roof defective Work done. £1 fine) £1 Is. costs. 17, Amberley Road Main roof defective Work done. Summonses dismissed. 14, Beethoven Street Walls and ceilings of general staircase, landings, passages and water-closets dirty ; walls of ground floor front room damp ; walls of ground floor back room damp and defective ; back addition roof and guttering defective ; waste-pipe of top floor sink defective and improperly discharging. Work done. £2 fine; £2 2s. costs. 23, Brindley Street Main roof defective Work done. Summons withdrawn. £2 2s. costs. " " Water service pipe in wash-house defective; absence of water supply to draw-off tap. Work done. Summons withdrawn. £2 2s. costs. " " Guttering to flat roof defective, insecure and choked Work done. £2 fine; £2 2s. costs. 66 Legal Proceedings, 1937.—continued. Premises. Offence. Result. Public Health (London) Act, 1936 Section 82. (Summonses for Order and Penalty in each case) 59, Brindley Street Main roof defective Order made. Is. fine; £3 3s. costs. " " Failing to comply with Magistrate's Order to make main roof watertight. £10 fine ; £5 costs. 11, Delamere Terrace Ceiling of first half-landing defective; ceiling of third floor front left-hand room dirty and defective. Work done. Summonses withdrawn. £2 2s. costs. " " Premises without a proper and sufficient water supply Work done. Summonses withdrawn. £2 2s. costs. 16, Delamere Terrace Pan of first half-landing water-closet defective Work done. Summons dismissed under Probation of Offenders Act. £1 Is. costs. 52, Formosa Street Walls of ground floor slip room damp Work done. 5s. fine; 16s. costs. 54, Formosa Street Waste-pipe of sink on second half-landing defective Work done. Summons dismissed. " " Main roof defective Work done. Summons dismissed. 27, Gloucester Gardens Premises without a proper and sufficient water supply Premises vacated. Summonses withdrawn. 39, Harrow Road Main roof defective Summonses dismissed. £1 Is. costs. " " Main roof defective Closing Order made. £1 fine ; £1 Is. costs. 264, Harrow Road Premises without a proper and sufficient water supply Work done. £2 fine; £1 Is. costs. " " Light and ventilation to top floor (south) rooms obstructed by hoarding ; windows fixed. Order made. " " Main roof defective Work done. £2 fine; £1 Is. costs. 91, Lancefield Street Drain defective Work done. £1 fine; £1 Is. costs. 299, Shirland Road Walls of first floor back room damp Work done. 5s. fine; £1 Is. costs. 93, Talbot Road Premises without a proper and sufficient water supply Water supply reinstated. £2 costs. 46, Torquay Street Guttering defective ; absence of means of carrying off rainwater from balcony roof. Order made. £2 fine; £1 Is. costs. 40, Warlock Road Walls and ceilings of wash-house, general staircase, landings and passages dirty ; wash-house paving defective ; front entrance steps defective. Summonses dismissed. 4, Woodchester Street Main roof defective Order made. Is. fine; 10s. 6d. costs. " " Premises without a proper and sufficient water supply Closing Order made. Public Health (London) Act, 1936. Section 40. 19, Hereford Road Drain between intercepting chamber and sewer defective Summons dismissed. Public Health (London) Act, 1936. Section 180. Ofience. Result. Exposing for sale meat pies which were unsound and unfit for the food of man £5 fine; £5 costs. 67 Legal Proceedings, 1937.—continued. Bye-laws pursuant to thb above and othek Acts. Premises. OSence. Result. 93, Cirencester Street Failing to keep the common staircase in a state of good repair Work done. £1 fine; £1 Is. costs. 3, Craven Hill Gardens Executing drainage work not in conformity with the bye-laws 10s. fine; £1 costs. " " Failing to deposit plans and other particulars with regard to drainage work. 10s. fine. " " Failing to give notice of intention to execute drainage work 10s. fine. 14, Craven Hill Gardens Failing to deposit plans and other particulars with regard to drainage work. £2 fine. £2 costs. 52, Formosa Street Failing to keep the window cords of the ground floor back room in good order and repair. Work done. Summons dismissed under Probation of Offenders Act. £1 Is. costs. 31, Gloucester Terrace Failing to maintain the dustbins in a proper condition of repair. Work done. Summons dismissed under Probation of Offenders Act. £1 Is. costs. 80, Ledbury Road Failing to maintain the dustbin in a proper condition of repair. Work done. Summons dismissed under Probation of Offenders Act. 2s. costs. 4, Leinster Gardens Failing to deposit plans and other particulars with regard to drainage work. £1 fine; £1 costs. " " Failing to give notice of intention to execute drainage work £1 fine; £1 costs. 241, Portnall Road Failing to keep the paving of rear yard in proper repair 5s. fine; 10s. 6d. costs. 18, Praed Street Failing to deposit plans and other particulars with regard to drainage work. £1 fine; £1 costs. 99, Praed Street Executing sanitary work in an improper manner Work amended. Summons, dismissed under Probation of Offenders Act. 23, St. Luke's Road Failing to deposit plans and other particulars with regard to drainage work. 10s. fine; 10s. costs. 1-13, St. John's Buildings Failing to cause the yard at rear to be properly paved Work done. £1 fine; £1 Is. costs. 299, Shirland Road Failing to cleanse the drinking water cistern Summons dismissed under Probation of Offenders Act. 10s. 6d. costs. " " Failing to provide a proper cover to the drinking water cistern. Summons dismissed under Probation of Offenders Act. 10s. 6d. costs. 79, Sutherland Avenue Executing sanitary work without notice and failing to deposit plans and other particulars. Summonses marked "Not Served." Defendant " Gone away." 21, Talbot Road Failing to deposit plans and other particulars with regard to drainage work. 10s. fine. 41, Waverley Road Failing to maintain the flushing cistern to basement watercloset in a proper state of repair. Work done. Summons dismissed under Probation of Offenders Act. 10s. costs. 46 Westbourne Grove Failing to give notice of intention to execute drainage work. 2s. fine; £1 costs. " " Executing drainage work in a manner contrary to the Byelaws. Summons dismissed under Probation of Offenders Act. £1 Is. costs. 68 Legal Proceedings, 1937—continued. Premises. Offence. Result. Food and Drugs (Adulteration) Act, 1928. Sample No. 75 Selling milk containing 1.41 per cent, of added water Summons dismissed under Probation of Offenders Act. £3 3s. costs. Sample No. 168 Selling milk 17.66 per cent, deficient in fat Summons dismissed under Probation of Offenders Act. £1 lis. 6d costs. Regulations made under Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. 62, Ashmore Road Failing to inscribe the required particulars in the rent book of the tenant of the first floor. £1 fine; £1 Is. costs. 61, Cirencester Street Failing to inscribe the required particulars in the rent book of the tenant of the basement. 10s. fine. 4, Elcom Street Failing to inscribe the required particulars in the rent book of the tenant of the ground floor. 10s. fine. 9, Elcom Street Failing to inscribe the required particulars in the rent book of the tenant of the ground floor. 10s. fine. 69 Report of the Work of the District Inspectors. Inspection of Dwelling Houses. Sanitary Works completed in Dwelling Houses. To Regulate Keeping of Animals. Drainage, etc. Water Supply. Dust Receptacles Miscellaneous. YEARS. Number of Complaints received. "House-to-House." On Complaint or after Illness. Re-Inspections of all kinds. Entire Reconstruction. Drains Relaid, Trapped or Ventilated. Drains Repaired and made Sound. Waste Pipes Disconnected. New Waste Pipes Provided. Rain-water Pipes Disconnected. W.C.'s, New Provided, Repaired, etc. Soil Pipes, New Provided. Soil Pipes Repaired. Soil Pipes Ventilated. Services Separated. Supplies Reinstated. Cisterns, New Provided. Cisterns, Cleansed, Repaired, etc. New Provided. Repaired, etc. Drains, Cleared, Flushed, etc. Houses or Rooms Cleansed, Whitewashed, etc. Cases of Overcrowding Abated. Yards and Areas Paved and Drained. Roofs Repaired. Manure Receptacles Reconstructed, etc. Accumulations Removed. Improperly kept, Removed. 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 - 1937 2,295 77 1,847 13,897 6 55 68 69 2756 22 680 74 11 153 2 7 - 14 312 - 51 436 1 11 107 1 - - 70 CONTENTS. PAGE Acute Encephalitis Lethargica 22 Acute Influenzal Pneumonia 22 Acute Polio-encephalitis 22 Acute Polio-myelitis 22 Acute Primary Pneumonia 22 Acute Rheumatism 23 Administrative Work 48 Aged, etc., Persons, Removal of 65 Agricultural Produce (Grading and Marking) Act, 1928 63 Annual Cleansing 53 Ante-natal Consultation Centres 5,40-42 Anthrax 22 Artificial Cream Act, 1929 64 Artificial Pneumothorax 27 Artificial Sunlight Treatment 5,41-42 Baby Hospital, Ladbroke Square 44 Bacteriological Work 49 Bakehouses 54 Basement Rooms 56 Bath Water Examinations 64 Beauchamp Lodge Emergency Home 45 Births 6, 8-9 Borough Council Accommodation within the Borough 57 Canals, Canal Boats 51 Cancer 24 Cerebro-spinal Fever 22 Chicken-pox 20 Child Life Protection 46, 47 Cholera 24 Clarendon Street Redevelopment Area 56 Clearance Areas 56 Clinics, Treatment Centres, etc. 5 Combined Drainage 49 Common Lodging Houses 53 Compulsory Purchase Orders 56 Compulsory Repairs 56 Compulsory Removal of Aged, etc., Persons 65 Condensed Milk Regulations 61 Consultation Centres 42-43 Continued Fever 20 Contraceptive Advice 44 Convalescent Homes 41, 46 Dairies and Milkshops 60 Day Nurseries 47,48 Deaths 6, 9,11 Dental Treatment: Maternity and Child Welfare 41 „ „ Tuberculosis 27 Diarrhoea 25 Diphtheria 17 „ Carrier Clinic 18 „ Immunisation 18-19 Diseased, etc.. Persons, Removal of 65 Disinfection 49 Disinfestation 58, 64 District Inspectors' Work 69 Dogs, Fouling of Footways by 65 Drainage, Combined 49 page Drainage, House 49 „ Reconstruction Plans 49 Dried Milk Regulations 61 Dysentery 24 Erysipelas 22 Extra Nourishment: Tuberculosis 28 ,, „ Maternity and Child Welfare 45 Factories and Workshops 53, 54 Food Adulteration 61 „ Bye-laws for the Protection of 63 Food, Chemical and Bacteriological Examination 61 „ Destroyed 60 „ Poisoning 24 „ Purveyors 60 „ Samples Analysed 61, 62 „ Supervision 59 „ Unsound 60 Footway fouling by Dogs 65 German Measles 21 Glanders 24 Grants for Necessitous Persons 28, 45 Health Visiting 40 Home Helps 44 Homework (Outworkers) 54 Houses Unfit for Human Habitation 56 Housing 55,59 Hydrophobia 24 IceCream 60 Infant Consultation Centres 42, 43 Infantile Mortality 6, 12-13 Infectious Diseases, Notification of 15, 16 „ „ Nursing of 26,49 „ „ Prevention of 49 Infective Enteritis 25 Infirm, etc., Persons, Removal of 65 Inquests 14 Insulin, Provision of 65 Invalid Children's Aid Association 46 L.C.C. Estates, Housing on 57 Legal Proceedings 65-68 Malaria 22 Manure, Removal of 50 Marriages 8 Massage Treatment 41,42 Maternal Mortality 6,14,46 Maternity and Child Welfare 40 „ Consultations 44 „ Nursing 43 „ Outfits 44 „ Wards 43 Measles 20-21 Meat Regulations 60 Medical Officers, Visiting 4, 48 Membranous Croup 17 Merchandise Marks Act, 1926 63 Mews Areas 56 Midwifery Service 43 Milk and Dairies Order, 1926 61. CONTENTS—continued. page Milk, etc., Grants (M. & C.W.) 45 „ ( „ (Tuberculosis) 28 Milk Sampling 61,62 Milk (Special Designations) Order, 1936 60 Milkshops and Dairies 60 Mortuary 50 Necessitous Mothers and Children, Grants for 45 Nursing of Cases of Infectious Illness 26, 49 Nutritional and Physio-Therapeutic Clinic 42 Obstetric Consultant 44 Ophthalmia Neonatorum 21 Outworkers (Homework) 54 Overcrowding, Abatement of 55 Paddington Houses Association, Ltd. 58 Pharmacy and Poisons Act. 64 Pigeons, Nuisance from 64 Plague 24 Plans, Drainage 49 Pneumonia 22 Population 7 Post-natal Consultation Centres 5, 40, 42 Preservatives, etc., in Food Regulations 61 Puerperal Fever 21 „ Pyrexia 22 Rag and Bone Dealers 51 Rag Flock 54 Rats and Mice Destruction 64 Relapsing Fever 24 Rent and Mortgage Interest (Restriction) Acts 53 Rent Books 53 Rheumatism (Acute) 23 page Rheumatism Centre 23 Sanitary Inspectors' Work 69 Scarlet Fever 16, 17 Schools 49 Sewer Connections 50 Shops Act, 1934 and 1937 54, 55 Slaughter of Animals Act 60 Slaughterhouses 59 Smallpox 20 Smoke Control 51 Staff 4, 48 Tenement Houses 51-53 "Toddlers" Clinic 41 Trade Nuisances 50 Treatment Centres, Clinics, etc. 5 Tuberculosis 25-39 „ Care Committee 28 „ Dispensaries 29-39 Typhoid Fever 20 Typhus Fever 24 Unemployment 7 Unfit Habitations 56 Unmarried Mothers and their Children 44 Unsound Food 60 Vaccination 20 Venereal Diseases Clinic 5 Verminous Conditions 64 Vital Statistics 6-14 Water Supply 50 Welfare Centres 5,40 Whooping Cough 24 Workshop Supervision 54 X-ray Examinations 44