Metropolitan Borough of Paddington REPORT ON THE Public Health AND Vital Statistics OF THE BOROUGH OF PADDINGTON FOR THE YEAR 1938. 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 1938. 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. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you my Annual Report for the year 1938 as required by the Statutes and Orders applicable to my office. During the year the health of the Borough continued to be good, the death-rate being at a record low level. It is possible that the estimate of resident population furnished by the RegistrarGeneral is incorrect, and if this is the case the fall in the death-rate may not be a real one. The infantile mortality remained the same as for the previous year, namely 66, a record low figure, and the maternal mortality was also remarkably low. Attention is directed to the section of this Report dealing with overcrowding. From this it may be seen that during the last two or three years overcrowding has markedly diminished, not only by the removal of overcrowded families to London County Council estates but by the success of such families in obtaining additional accommodation in the same house or by removal to other premises. 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. August 15 th, 1939. 4 PUBLIC HEALTH OFFICERS (on December 31st, 1938). 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. Senior Visiting Medical Officer, Welfare Centre. (For Ante-and Post-Natal Consultations.) P.T. A. L. Gunn, Esq., F.R.C.S. (Edin ). Medical Officers of Welfare Centres, P.T. S. Denovan Adam, M.R.C.S., L.R.C.P. R. Cove-Smith, M.A., M.B., B.Ch., M.R.C.P. E. Dorothy Fenwick, M.R.C.S., L.R.C.P. Evelyn T. D. Maclagan, M.B., B.S., M.R.C.S., L.R.C.P. C. T. Potter, M.D., M.R.C.P. Visiting Dental Officer, Welfare Centre, P. T. P. A. Crow, L.D.S., R.C.S. (Eng ). Dental Anaesthetist, Welfare Centre, P.T. S. Denovan Adam, M.R.C.S., L.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). H. Ewings (Declassified). A. J. O. Sheppard (Class 1). R. I. Fisher (Class 1). C. T. Wyatt (Class 3). R. H. Davis (Class 3). C. H. F. Drake (Class 4). H. J. Parker (Class 4). S. W. Wordingham (Class 4). R. H. Clark (Class 5). R. W. Carpenter (Class 5). R. S. Welch (Class 5). T. E. Rainger (Class 1, P.T., and Vaccination Officer, P.T.) I. C. Webb (Miss) (Welfare Centre). Two Temporary Housing (Enquiry) Assistants. Three Temporary Clerks. 5 PUBLIC HEALTH OFFICERS (on December 31st, 1938)—continued. Sanitary Inspectors, W.T. (In order of seniority.) C. G. Heron (2), (3), (11). (Also Anti-gas Instructor.) V. L. Ronchetti (2), (3), (4), (5), (11). (Also Canal Boats, Child Protection and Antigas Instructor.) E. B. Wilde (2), (3), (4), (5), (10), (11). (Also Bakehouses, Common Lodging Houses, Child Protection and Anti-gas Instructor.) F. J. Pallet (2), (3). (Meat and Food.) E. Marshall (2), (3), (4), (5). A. J. Fisher (2). A. C. Harrison (2), (3). (Food and Shops.) F. L. Barker (2), (3), (12). J. S. Ackerman (2), (4). J. J. Atkinson (2), (3), (12). G. Duncan (2), (3), (4). A. J. Shelley (2), (3), (4). 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 E. M. Sells (9). Miss H. Waite (7), (8), (9). Miss E. C. Jackson (7), (8), (9). Miss P. E. Blake (7), (8), (9). Miss G. E. Stephens (6), (7), (8), (9). Miss N. M. Hill (7), (8), (9). (Also Maternity Wards Almoner.) Miss M. A. MacLean (7), (8), (9). (Also Child Protection Visitor.) Miss D. K. Newington (7), (8), (9). Miss M. M. M. Bathgate (7), (8), (9). Miss A. S. Anderson (7), (8), (9). Miss E. N. Candler (7), (8), (9). Miss J. Dowson (7), (8), (9). Masseuses, P.T. Miss M. Denney, C.S.M.M.G. Miss M. Kent, 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. J. T. Lawson. Assistant Mortuary Keeper. L. W. J. Spears. Disinfectors. F. Webber and R. Rigby. Caretaker, Welfare Centre. H. Hayes. (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. (12) Certificate of Sanitary Science, Royal Sanitary Institute. 6 CLINICS, TREATMENT CENTRES, ETC. Maternity and Child Welfare. Address. By whom provided. Ante-natal Consultation Centres *Welfare Centre, 283a, Harrow Road Borough Council. St. Simon's Hall, Macroom Road „ „ St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Infant Consultation Centres *Welfare Centre, 283a, Harrow Road Borough Council. *St. David's Church Hall, St. Mary's Terrace „ „ *Congregational Institute, Third Avenue „ „ *St. Simon's Hall, Macroom Road „ „ Christ Church Parochial Church Hall, Queensborough Passage „ „ "Toddlers" Centre Welfare Centre, 283a, Harrow Road „ „ Consultative and Physical Treatment Centre *Welfare Centre, 283a, 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 Ward St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Diphtheria Immunisation. Clinics Welfare Centre, 283a, Harrow Road Borough Council. St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Tuberculosis. Dispensaries 20, Talbot Road Paddington Tuberculosis Dispensary St. Mary's Hospital, Cambridge Place St. Mary's Hospital. Venereal Diseases. Clinic St. Mary's Hospital, Cambridge Place (Male and Female) London County Council. 7 SUMMARY OF VITAL STATISTICS. 1938. 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 1938 137,400 Density of population per acre 101 Number of inhabited houses (end of 1938) according to Rate Books 22,277 (approx.) Marriages 1,919 Total. Males. Females. Live Births Legitimate 1,620 849 771 Birth-rate per 1,000 of the estimated resident population 13.74 Illegitimate 268 144 124 Stillbirths 74 38 36 Stillbirth-rate per 1,000 total (live and still) births 37 Deaths 1,557 764 793 Death-rate per 1,000 of the estimated resident population 11.33 Percentage of total deaths occurring in public institutions 62.5 Deaths from Puerperal Causes. Rate per 1,000 total (live and still) births. Puerperal Sepsis 1 0.51 Other Puerperal Causes 2 1.02 Total 3 1.53 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 63 Illegitimate infants per 1,000 illegitimate live births 86 Deaths from Cancer (all ages) 269 „ Measles (all ages) 11 „ Whooping Cough (all ages) 3 „ Diarrhoea (under 2 years of age) 26 „ Pulmonary Tuberculosis (all ages) 70 „ other forms of Tuberculosis (all ages) 11 Death-rate from Pulmonary Tuberculosis, per 1,000 of the estimated resident population 0.51 Tuberculosis death-rate (all forms) 0.59 Rateable Value £1,863,396 Product of a Penny Rate £7,132 8 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 1927 142,700 2,064 322 474 2,216 15.53 2,006 14.05 489 419 1,936 13.56 188 91 176 79 1928 145,200 2,074 376 479 2,177 14.99 1,954 13.45 507 446 1,893 13.03 186 89 186 85 1929 142,800 2,058 447 518 2,129 14.90 2,344 16.41 550 417 2,211 15.48 230 111 215 101 1930 142,800 2,216 524 469 2,161 15.13 1,890 13.23 482 397 1,805 12.64 174 78 169 78 1931 140,300 2,073 462 464 2,075 14.79 2,000 14.25 589 420 1,831 13.05 228 110 182 87 1932 143,600 1,765 401 613 1,977 13.76 1,817 12.65 601 688 1,904 13.26 220 121 212 107 1933 141,900 1,855 460 508 1,903 13.41 1,864 13.13 567 599 1,896 13.36 171 92 163 85 1934 139,790 2,104 589 394 1,909 13.70 1,756 12.56 580 567 1,743 12.47 185 88 183 95 1935 138,600 2,038 547 473 1,964 14.17 1,623 11.71 543 595 1,675 12.08 154 75 140 71 1936 139,200 2,053 640 508 1,921 13.80 1,807 12.98 606 582 1,783 12.81 160 78 139 72 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 1938 137,400 2,069 660 479 1,888 13.74 1,758 12.79 663 462 1,557 11.33 142 68 125 66 * Registrar-General's estimates of resident population. POPULATION. Estimated Population.—The resident population of the Borough at the middle of 1938 was estimated by the Registrar-General to be 137,400 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 1938 quoted in this report are based on these figures. The Borough 137,400 Wards— Queen's Park 12,914 Harrow Road 24,151 Maida Vale 22,068 Town 6,833 Westbourne 23,941 Church 16,429 Lancaster Gate, West 9,383 Lancaster Gate, East 9,406 Hyde Park 12,275 North Paddington 65,966 South Paddington 71,434 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 1938:— Month. Insured residents (aged 16 to 64 years) recorded as unemployed. Males. Females. Total. January 3,575 1,181 4,756 April 3,372 1,209 4,581 July 3,240 1,151 4,391 October 4,029 1,382 5,411 December (estimate) 4,237 1,386 5,623 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. 9 MARRIAGES. According to provisional figures supplied by the Registrar-General 1,919 marriages were solemnized in the Borough during 1938, being a rate of 27.8 persons per 1,000 of the population. BIRTHS. The number of births registered in the Borough during 1938 was 2,069. From this total it is necessary to deduct 660 births which occurred to residents of other localities, and to add 479 births which occurred to Paddington residents outside the Borough. The corrected total of 1,888 births thus obtained is equal to a rate of 13.74 per 1,000 of the population. Of the 1,888 births, 993 were those of males and 895 those of females, and of these 144 males and 124 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:— 1938. Birth-rates. No. of Births. Birthrates. 1937 1936 1935 1934 1933 England and Wales 621,603 15.1 14.9 14.8 14.7 14.8 14.4 London 64,325 13.4 13.3 13.6 13.3 13.2 13.2 Paddington 1,888 13.74 13.65 13.80 14.17 13.70 13.41 Wards— Queen's Park 129 9.99 10.00 9.70 10.36 11.94 10.94 Harrow Road 454 18.79 20.28 16.88 18.76 17.01 17.44 Maida Vale 294 13.32 11.70 14.13 13.20 12.91 12.15 Town 107 15.66 18.75 19.50 19.00 17.98 17.28 Westbourne 458 14.95 16.43 17.93 18.22 16.09 15.73 Church 227 13.81 15.78 16.76 17.44 16.57 18.39 Lancaster Gate, West 54 5.75 4.55 7.15 5.70 6.91 5.61 Lancaster Gate. East 54 5.74 5.80 5.56 4.43 5.12 4.94 Hyde Park 111 9.04 9.79 7.64 9.85 10.81 9.38 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 1938 13.74 Illegitimate Births.—These were 268 in number, or 14.19 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 7.75 Harrow Road 8.59 Maida Vale 15.30 Town 17.76 Westbourne 15.72 Church 12.77 Lancaster Gate, West 22.22 Lancaster Gate, East 22.22 Hyde Park 25.22 Stillbirths.—During 1938, 74 stillbirths, assignable to the Borough, were registered in accordance with the provisions of the Births and Deaths Registration Act, 1926, equivalent to 3.7 per cent. of the total births recorded. Of the 74 stillbirths, males numbered 38 and females 36, five of the males and 7 of the females being illegitimate. 10 Births in Institutions. Local Institutions. Total. Legitimate. Illegitimate. Residents. Non-residents. Residents. Non-residents. Residents. Non-residents. Paddington Hospital 477 75 110 23 587 98 St. Mary's Hospital 246 362 5 9 251 371 Lock Hospital 2 17 8 33 10 50 Outlying Institutions (Paddington Residents). Legitimate. Illegitimate. Total. Queen Charlotte's Hospital 118 11 129 Other Hospitals and Maternity Homes 123 29 152 Public Assistance Committees' Institutions 50 33 83 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 2,034 live births were notified to the Medical Officer of Health. There were also 77 stillbirths notified. Of the 2,111 living and stillbirths notified, 71.5 per cent. were notified by medical practitioners, 21.2 per cent. by midwives, 0.2 per cent. by parents, and 7.1 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 99.4 per cent. of the live births and 97.3 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 1,758. Of these 663 were of persons whose residence was not in Paddington, 605 dying in Paddington institutions and 58 in other places in the Borough. There were also reported to the Registrar-General 462 deaths of Paddington persons whose deaths occurred outside the Borough. This correction gives the net number of deaths for Paddington as 1,557, making an annual death-rate of 11.33. The Registrar-General has calculated a comparability factor for each district, by the use of wh'ch 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 11.33 per 1,000 persons for the year 1938, gives an adjusted death rate of 11.21 per 1,000 persons. 1938. 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 29th 4 — 1 — 5 13 1 7 21 3 February 26th 1 — — — 8 25 3 5 10 5 March 26th 1 — — 3 9 18 — 6 12 3 April 23rd 2 — — — 7 19 1 1 17 4 May 21st 2 — — 1 2 16 2 3 6 1 June 18th 1 — — — 6 16 1 4 2 1 July 16th — — 1 — 6 27 1 — 3 3 August 13th — — — — 1 29 1 — 8 1 September 10th — — — — 8 29 — 1 2 1 October 8th — — — — — 16 1 1 1 2 November 5th — — 1 — 5 19 — — 5 1 December 3rd — — — 2 5 19 — 2 12 — December 31st — — — 2 8 19 — 3 11 1 Totals 11 — 3 8 70 265 11 33 110 26 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. 11 Deaths of Residents of the Borough 1938. 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 764 793 1557 76 49 13 8 4 9 6 5 19 16 27 36 37 31 81 59 165 123 170 172 166 285 Typhoid and Paratyphoid Fevers - - - - - - - - - - - - - - - - - - - - - - - - - Measles 4 7 11 1 1 2 4 1 2 - - - - - - - - - - - - - - - - Scarlet Fever - - - - - - - - - - - - - - - - - - - - - - - - - Whooping Cough 1 2 3 1 1 - - - 1 - - - - - - - - - - - - - - - - Diphtheria 4 4 8 - - - - - 2 4 2 - - - - - - - - - - - - - - Influenza 3 8 11 - - - - - - - - - - - 1 1 1 - 2 1 2 - 1 1 1 Encephalitis Lethargica - 1 1 - - - - - - - - - - - - - - - - - - - - - - Cerebro-spinal Fever - - - - - - - - - - - - - - - - - - - - - - - - - Tuberculosis of Respiratory System 42 28 70 - - - - - - - - 8 5 8 9 8 4 6 5 7 - 5 4 - 1 Other Tuberculous Diseases 4 7 11 - - - - - 1 - - 1 2 2 1 1 2 - - - - - - - 1 Syphilis 9 5 14 1 2 1 - - - - - - - - - 1 - 2 1 3 2 - - 1 - General Paralysis of the Insane, Tabes Dorsalis 9 3 12 - - - - - - - - - - - 3 2 - 3 - 1 - 2 - 1 - Cancer, Malignant Disease 121 118 269 — — 1 — — — — 1 1 — 2 2 4 7 17 18 41 42 37 32 18 46 Diabetes 10 14 24 - - - - - - - - - - - - - 1 - - 2 3 b 8 2 2 Cerebral Haemorrhage, etc. 16 30 46 - - - - - - - - - - - - - - 2 - 6 5 6 7 2 18 Heart Disease 203 221 424 - - - - - 1 — — 1 1 2 3 4 4 15 7 42 27 61 55 78 123 Aneurysm 2 4 6 - - - - - - - - - - - - - - - 1 1 1 - 1 1 1 Other Circulatory Diseases 48 42 90 - - - - - - - - - - - - - - - 1 13 4 17 16 18 21 Bronchitis 16 21 37 5 1 — — — — — — — — — 1 — — 2 1 1 5 4 6 4 7 Pneumonia (all forms) 68 43 111 21 8 6 3 2 1 — — 1 3 — 1 3 1 5 1 12 7 10 3 8 15 Other Respiratory Diseases 6 6 12 1 - - - - - - - - - - 2 1 1 1 — 1 2 2 — — 1 Peptic Ulcer 12 5 17 - - - - - - - - - - - - 2 1 4 — 2 1 2 2 2 1 Diarrhoea, etc. 14 12 26 12 12 2 - - - - - - - - - - - - - - - - - - - Appendicitis 5 3 8 — — — — 1 1 — — 1 — — 1 1 1 1 1 — Cirrhosis of Liver 4 2 6 — — — — — — — — — — — — — — 1 — 3 1 — 1 — — Other Diseases of Liver, etc. 1 3 4 - - - - - - - - - - - - - - - - - - - 3 1 - Other Digestive Diseases 17 27 44 1 3 - - - - - 1 1 1 1 4 2 — 3 5 4 2 2 6 3 5 Acute and Chronic Nephritis 15 18 33 — — — — — — — — 1 — 1 — 1 — 4 2 2 3 4 2 2 11 Puerperal Sepsis - 1 1 - - - - - - - - - - - 1 - - - - - - - - - - Other Puerperal Causes - 2 2 - - - - - - - - - - - - - - - - - - - - - - Congenital debility, Premature Birth, Malformations, etc. 30 19 49 30 19 - - - - - - - - - - - - - - - - - - - - Senility 5 10 15 - - - - - - - - - - - - - - - - - - - 1 5 9 Suicide 21 11 32 - - - - - - 1 - - 1 3 1 1 1 4 4 8 3 2 — 2 1 Other Violence 28 23 51 1 1 1 1 — — — — 1 1 5 2 3 — 8 3 3 3 2 3 4 9 Other defined diseases — 1 1 - - - - - - - - - - - - - - - - - - - - - 1 Causes ill-defined or unknown - - - - - - - - - - - - - - - - - - - - - - - - - 12 The following table shows the death-rate during each of the last six years in England and Wales, in London, in Paddington, and in each of the wards of the Borough:— 1938. Death-rates. No. of Deaths. Deathrates. 1937 1936 1935 1934 1933 England and Wales 478,927 11.6 12.4 12.1 11.7 11.8 12.3 London 45,545 11.4 12.3 12.3 11.4 11.9 12.5 Paddington 1,557 11.33 13.05 12.81 12.08 12.47 13.36 Wards— Queen's Park 184 14.25 15.15 15.74 11.89 12.40 13.34 Harrow Road 276 11.42 13.08 12.34 12.97 13.10 14.11 Maida Vale 282 12.77 13.19 12.03 11.81 12.24 12.50 Town 83 12.14 12.79 14.58 13.63 12.65 16.01 Westbourne 291 12.15 13.57 13.77 13.25 13.14 13.99 Church 162 9.86 12.57 12.55 11.76 14.06 14.44 Lancaster Gate, West 101 10.76 12.28 13.04 10.88 10.06 13.52 Lancaster Gate, East 77 8.18 13.20 11.12 10.12 9.61 10.70 Hyde Park 101 8.22 10.84 10.61 10.74 12.17 11.28 There were, during the year, 38 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 1938 11.33 Deaths in Institutions, 1938. Local. Total. Nonresidents. Paddington Hospital 703 178 St. Mary's Hospital 283 221 Paddington Green Children's Hospital 31 24 Hospital for Women and Children (Lock Hospital) 2 2 St. Luke's Hospital 190 180 1,209 605 Deduct Non-residents 605 604 Outlying. Paddington Residents Isolation Hospitals of London County Council 32 Municipal General Hospitals and Public Assistance Committees' Institutions 174 Mental Hospitals 66 Voluntary Hospitals (General) 55 Hospitals (Special, including Sanatoria) 43 370 Total deaths in institutions of Paddington residents 974 13 INFANTILE MORTALITY. During the year 1938 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 1938 in England and Wales, in London, in the Borough and in the various wards of the Borough. The infantile mortality rates for 1933 to 1937 are given for comparison. 1938. Infantile Mortality Rates. No. of Births. No. of Deaths of Children under 1 year. Infantile Mortality Rates. 1937 1936 1935 1934 1933 England and Wales 621,603 32,473 53 58 59 57 59 64 London 64,325 3,746 57 60 66 68 67 60 Paddington 1,888 125 66 66 72 71 95 85 Wards— Queen's Park 129 7 54 69 79 37 31 96 Harrow Road 454 35 77 55 53 74 79 48 Maida Vale 294 14 48 69 69 71 93 94 Town 107 5 47 101 103 107 72 123 Westbourne 458 35 76 45 71 73 109 87 Church 227 17 75 103 107 83 169 112 Lancaster Gate, West 54 3 56 69 29 18 91 127 Lancaster Gate, East 54 2 37 91 75 48 — 62 Hyde Park 111 7 63 41 42 57 96 67 Infantile Mortality Rates, 1896-1938. 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 1938 53 57 66 14 Infantile Mortality in Paddington—1938. 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 36 4 1 2 43 19 27 21 15 125 66 Common Infectious Diseases (6-10, 44) — — — — — 1 1 1 1 4 2.12 Tuberculous Diseases (23-32) — — — — — — — — — — — Diarrhoea and Enteritis (119) — — — — — 2 10 9 5 26 13.77 Developmental and Wasting Diseases (157, 158, 159, 161a) 30 3 — 1 34 4 3 1 1 43 22.77 Miscellaneous Diseases (Remainder) 6 1 1 1 9 12 13 10 8 52 27.54 Measles (7) — — — — — — — 1 1 2 1.06 Whooping cough (9) — — — — — 1 1 — — 2 1.06 Diphtheria (10) — — — — — — — — — — — Influenza (11) — — — — — — — — — — — Tuberculosis of nervous system (24) — — — — — — — — — — — Tuberculosis of intestines and peritoneum (25) — — — — — — — — — — — Other tuberculous diseases (23, 26-32) — — — — — — — — — — — Syphilis (34) — — — — — 2 — 1 — 3 1.58 Meningitis (79) — — — — — — — — — — — Convulsions (86) — — — — — — — — — — — Bronchitis (106) — 1 — — 1 3 — 1 2 7 3.71 Pneumonia (107-109) 1 — — — 1 5 7 2 4 19 10.00 Other respiratory diseases (105, 110-114) — — — — — — — — 1 1 0.53 Inflammation of the stomach (118) — — — — — — — 1 — 1 0.53 Diarrhoea and Enteritis (119) — — — — — 2 10 10 5 27 14.30 Hernia, intestinal obstruction (122) 1 — — — 1 — 1 1 — 3 1.58 Congenital malformations (157) 1 1 — 1 3 1 1 — — 5 2.65 Congenital debility and sclerema (158) — 1 — — 1 1 1 — 1 4 2.12 Icterus (1616) 1 — — — 1 — — — — 1 0.53 Premature birth (159) 27 1 — — 28 2 1 — — 31 16.42 Injury at birth (160) — — 1 1 2 — — — — 2 1.06 Disease of umbilicus (161c: 1) 1 — — — 1 — — — — 1 0.53 Atelectasis (161a) 2 — — — 2 — — 1 — 3 1.58 Suffocation—in bed or not stated how (182 part) — — — — — — — — — — — Other causes 2 — — — 2 2 5 3 1 13 6.88 Nett Births in the Year Legitimate 1,620. Illegitimate 268. Nett Deaths in the Year Legitimate Infants 102. Illegitimate Infants 23. 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. 1938. Infantile Mortality Rates. Births. Deaths. 1938 1937 1936 1935 1934 1933 Church Ward— North Wharf 24 — — 62 111 57 77 135 Clarendon Crescent 82 10 122 133 89 82 177 121 Rest of Ward 120 6 50 90 109 90 181 98 Westbourne Ward— Alfred Road 61 7 114 51 101 72 114 69 Rest of Ward 396 27 68 44 65 73 108 92 Maida Vale Ward— Amberley Road 25 1 40 120 100 27 151 166 Rest of Ward 268 12 45 76 66 78 85 81 Totals for 4 Areas 192 18 94 95 97 68 145 114 Rest of Borough 1,696 107 63 62 69 72 88 80 15 MATERNAL MORTALITY. During the year 3 deaths, attributable to childbirth, occurred among the residents of the Borough. Of these, 1 was due to puerperal sepsis and 2 were due to other puerperal causes. All the deaths occurred in institutions. The 3 deaths were equivalent to a mortality rate of 1.53 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. 1933 4.32 3.55 5.00 1934 4.41 2.70 4.57 1935 3.93 2.50 3.95 1936 3.65 1.91 5.00 1937 3.11 2.22 4.08 1938 2.97 1.83 1.53 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:— 1938. London and Cities and Boroughs Estimated Resident Population. Live Births (Rate), Death Rate. Infantile Mortality per 1,000 Births. Crude. Adjusted. London 4,062,800 13.4 11.4 — 57 West Districts. Paddington 137,400 13.74 11.33 11.21 66 Kensington 174,100 12.8 11.7 10.9 78 Hammersmith 125,100 15.5 11.3 11.6 61 Fulham 137,700 14.2 11.6 11.7 51 Chelsea 56,050 10.2 13.5 11.5 80 Westminster 124,400 8.3 10.4 10.7 54.9 North Districts. St. Marylebone 90,680 8.84 11.12 11.00 60 Hampstead 90,480 11.7 11.4 10.7 57 St. Pancras 179,400 13.5 11.5 11.7 64 Islington 292,300 15.32 11.90 12.02 65 Stoke Newington 50,480 13.8 11.0 10.5 43.2 Hackney 205,200 13.4 10.7 11.2 56.46 Central Districts. Holborn 34,350 7.28 10.51 11.25 84 Finsbury 56,960 13.0 12.9 14.1 73 City of London 8,780 6.6 10.7 11.8 51.8 East Districts. Shoreditch 80,360 14.7 11.4 12.5 64 Bethnal Green 92,910 14.2 11.3 12.8 59.3 Stepney 200,500 13.06 11.05 12.92 60.7 Poplar 134,400 14.9 11.4 12.7 60 South Districts. Southwark 145,300 14.0 12.5 13.4 57 Bermondsey 97,420 14.8 11.0 12.54 45 Lambeth 272,800 14.09 11.9 11.7 51 Battersea 141,700 14.92 11.82 11.70 53.45 Wandsworth 340,100 11.92 11.17 10.38 46 Camberwell 222,400 13.97 12.27 12.27 61 Deptford 95,460 14.4 11.8 — 54 Greenwich 95,770 13.64 10.89 11.1 42 Lewisham 229,000 13.9 10.49 10.5 47 Woolwich 150,900 13.6 10.4 11.0 50 INQUESTS. During 1938, 104 inquests were held on residents of the Borough, and 74 deaths were registered after the issue of certificates by the Coroner under powers conferred by the Coroners (Amendment) Act, 1926. 16 THE PREVALENCE OF DISEASE. The following diseases are compulsorily notifiable under certain conditions in Paddington:— Acute Encephalitis Lethargica. Acute Influenzal Pneumonia. Acute Polio-encephalitis. Acute Polio-myelitis. Acute Primary Pneumonia. Acute Rheumatism. Anthrax. Cerebro-spinal Fever. Chicken-pox. Cholera. Continued Fever. Diphtheria or Membranous Croup. Dysentery. Erysipelas. Food Poisoning or Suspected Food Poisoning. Glanders. Hydrophobia. Infective Enteritis or Summer Diarrhoea. Malaria. Measles Ophthalmia Neonatorum. Plague. Puerperal Fever. Puerperal Pyrexia. Relapsing Fever. Scarlatina or Scarlet Fever. Smallpox. Tuberculosis. Typhoid or Enteric Fever. Typhus Fever. Whooping Cough. 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 — — 1 „ Influenzal Pneumonia 19 7 2 „ Primary Pneumonia 110 85 10 „ Polio-encephalitis 1 1 — „ Polio-myelitis 1 1 — Rheumatism 25 16 — Anthrax — — — Cerebro-spinal Fever 7 7 — Chicken-pox 294 25 — Continued Fever 1 1 — Diphtheria 229 228 8 Dysentery 32 20 — Erysipelas 54 38 2 Food Poisoning or Suspected Food Poisoning 31 — — Infective Enteritis or Summer Diarrhoea 42 37 5 Malaria 2 1 — *Measles 6 1 11 Membranous Crou — — — Ophthalmia Neonatorum 13 12 — Puerperal Fever 21 20 — Puerperal Pyrexia 44 40 — Scarlet Fever 195 167 — Smallpox — — — Typhoid or Enteric Fever 5 3 — *Whooping Cough 104 23 3 *Notifiable as from 1st October, 1938. The following table summarises the cases of all notifiable diseases notified in the years 1928 to 1938:— Analysis of Notification Certificates. (Uncorrected for Errors in Diagnosis.) 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 Acute Encephalitis Lethargica 5 1 — — — — — — — — „ Influenzal Pneumonia 135 40 97 66 102 35 33 29 67 19 „ Primary Pneumonia 247 168 243 184 157 155 99 92 116 110 „ Polio-encephalitis 1 — 1 1 — — — — 1 1 „ Polio-myelitis 1 1 2 2 3 6 2 1 4 1 „ Rheumatism 52 43 37 21 37 41 18 29 24 25 Anthrax — — 1 — — — — — — — Cerebro-spinal Fever 6 3 5 9 6 3 7 3 5 7 Chicken-pox 382 515 555 291 364 333 365 285 239 294 Continued Fever 3 2 4 — 1 1 1 1 1 1 Diphtheria 311 366 254 194 277 245 203 215 214 229 Dysentery — — 2 5 1 1 11 8 56 32 Erysipelas 69 74 67 60 66 66 50 50 56 54 Food Poisoning or Suspected Food Poisoning — — — (a) 11 17 45 63 44 30 31 Infective Enteritis or Summer Diarrhoea 63 30 40 103 67 70 81 71 56 42 Malaria — 1 — 1 1 1 3 6 3 2 Measles (6) 210 1790 541 1414 103 — — — — 6 Membranous Croup 6 7 6 6 — 1 2 — — — Ophthalmia Neonatorum 9 15 18 22 21 19 11 14 16 13 Puerperal Fever 4 5 8 7 12 12 14 13 23 21 Pyrexia 42 37 32 31 53 36 27 42 40 44 Scarlet Fever 323 356 379 286 396 437 267 261 233 195 Smallpox 3 3 — 2 1 — — — — — Tuberculosis—Total 335 284 311 289 270 284 242 217 262 247 Pulmonary 242 196 218 213 203 199 186 163 220 205 Other Forms 93 88 93 76 67 85 56 54 42 42 Typhoid or Enteric Fever 19 10 9 4 6 9 7 7 11 5 Whooping Cough — — — — — — — — — (c) 104 (а) First Year of Notification. (b) Not notifiable between 19th March, 1933 and 1st October, 1938. (c) Notifiable as from 1st October, 1938. 17 The appended tables furnish analyses 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. 0— 1— 2— 3— 4— 5— 10— 15— 20— 35- 45— 65— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Acute Encephalitis Lethargica — — — — — — — — — — — — — — — — — — — — — — — — ,, Influenzal Pneumonia — — 1 — — — — 1 — — — — — — — 1 6 — 1 2 2 2 1 2 ,, Primary Pneumonia 1 2 6 4 2 1 1 2 — 2 8 5 1 — 3 1 10 13 5 5 21 9 3 5 ,, Polio-encephalitis — — — — — — — — — — — — — — — — — — — — — — — — ,, Polio-myelitis — — — — — — — — — — — — — — — — — — — — — — — — ,, Rheumatism — — — — — — — — 1 1 5 5 9 2 1 1 — — — — — — — — Anthrax — — — — — — — — — — — — — — — — — — — — — — — — Cerebro-spinal Fever — — — — 1 — — — 1 — — — — 1 1 — 3 — — — — — — — Chicken-pox 3 4 12 7 10 17 11 6 14 19 74 67 12 20 5 4 2 6 — — — — 1 — Continued Fever — — — — — — — — — — — — — — — — — — — — — 1 — — Diphtheria 5 1 8 4 13 10 10 13 16 18 40 38 14 6 3 6 3 17 1 2 — 1 — — Dysentery 1 2 — — — 6 — — 2 I 3 3 2 — — 2 2 5 — 2 1 — — — Erysipelas — — 1 1 — — — — — — — — — — — 1 9 5 2 8 10 8 2 7 Food Poisoning or Suspected Food Poisoning — — — — — — — — 2 — — 1 — — — — 3 4 7 4 6 1 — 3 Infective Enteritis or Summer Diarrhoea 11 11 5 6 3 4 1 — — — — — — — — — — — — — — — — — Malaria — — — — — — — — — — — — — — — — — — 1 — 1 — — — *Measles 1 — 1 — — 1 1 1 — 1 — — — — — — — — — — — — — — Membranous Croup — — — — — — — — — — — — — — — — — — — — — — — — Ophthalmia Neonatorum 7 6 — — — — — — — — — — — — — — — — — — — — — — Puerperal Fever — — — — — — — — — — — — — — — 1 — 18 — 2 — — — — Pyrexia — — — — — — — — — — — — — — — 4 — 35 — 5 — — — — Scarlet Fever 2 — 2 1 8 7 6 10 8 10 34 43 11 6 — 11 12 11 4 4 3 2 — — Smallpox — — — — — — — — — — — — — — — — — — — — — — — — Typhoid or Enteric Fever — — — — — — — — — — — — — — — — — — — — — — — — *Whooping Cough 8 9 6 9 8 4 9 12 3 8 9 19 — — — — — — — — — — — — * Notifiable as from 1st October, 1938. B.—Ward Distribution. Queen's Park. Harrow Road. Maida Vale. Town. Church. Westbourne. Lancaster Gate. Hyde Park. West. East. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Diphtheria and Memb. Croup 6 12 28 25 20 18 7 10 27 28 21 18 — 2 1 1 3 2 Typhoid and Continued Fever — — — — 1 — — — — — — 3 — 1 — — 1 — Erysipelas 4 1 4 8 1 8 3 2 4 6 3 2 2 1 1 1 2 1 Ophthalmia Neonatorum — — 1 — 2 3 1 2 — — 2 — — — — — 1 1 Pneumonia—Acute Influenzal 1 — 1 — 1 2 2 2 2 1 3 2 — — — 1 1 — „ Acute Primary 3 4 15 15 7 10 6 1 12 9 11 8 3 1 2 — 2 1 Puerperal Fever — 1 — 6 — 2 — 4 — — 7 — 1 — — — „ Pyrexia — 2 — 8 — 6 — 5 — 5 — 10 — 3 — — — 5 Scarlet Fever 6 16 26 34 16 11 2 2 13 7 16 25 5 3 2 5 4 2 Hospital Accommodation.—The restriction, which was in force at the beginning of the year, on the admission of cases of scarlet fever, measles and dysentery to the infectious diseases hospitals of the London County Council was removed on the 16th May, 1938. 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. During the year 2 phials of serum, each of 10 c.c., were supplied. SCARLET FEVER. During 1938 there were 195 cases of scarlet fever notified. The sex-age distribution of these cases is shown in Table A above. Of the 195 cases, 167 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 1938. 18 Notifications of Scarlet Fever. Four-Weekly Periods. Period No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Peiiod No. 11. Period No. 12. Period No. 13. Totals. London 605 703 767 719 732 709 646 537 382 625 703 680 513 8.321 Paddington 11 11 12 21 20 33 16 11 8 18 9 12 13 195 Wards— Queen's Park 2 — — — 1 3 1 2 3 3 2 2 3 22 Harrow Road 2 2 3 8 12 12 8 2 1 2 — 4 4 60 Maida Vale 3 1 2 3 2 2 3 3 — 4 — 2 2 27 Town 1 — — — 1 — 1 — — 1 — — — 4 Church 1 2 1 1 1 4 — 2 — 2 2 3 1 2n Westbourne — 4 4 5 2 11 2 — 1 6 4 — 2 41 Lancaster Gate, West 1 — — 2 1 1 — 1 1 — 1 — — a Lancaster Gate, East 1 1 2 1 — — — — 1 — — 1 — 7 Hyde Park — 1 — 1 — — 1 1 1 — — — 1 6 DIPHTHERIA. (Including Membranous Croup.) During 1938 there were 229 cases of diphtheria notified, and none of membranous croup. The sex-age distribution of these cases is shown in Table A on page 17. Two hundred and twenty-eight patients were removed to Isolation Hospitals; the remaining case was treated at home, proper facilities being available for isolation and treatment. Eight deaths from this disease occurred during 1938, 2 of the deaths being those of children under the age of 5 years. Comparison with previous years is as follows:— 1929 9 deaths. 1930 12 „ 1931 9 „ 1932 13 „ 1933 19 „ 1934 13 „ 1935 13 „ 1936 5 „ 1937 5 „ 1938 8 „ Seasonal Prevalence.—The following table shows the number of cases notified in each four-weekly period during 1938:— Notifications of Diphtheria. Four-Weekly Periods. Peiiod No. 1. Period No. 2. Period No. 3. Period No. 4. Period No. 5. Period No. 6. Period No. 7. Period No. 8. Period No. 9. Period No. 10. Period No. 11. Period No. 12. Period No. 13. Totals. London 705 736 655 591 539 492 566 534 528 562 607 638 581 7,734 Paddington 31 31 30 14 21 13 10 14 6 10 9 24 16 229 Wards— Queen's Park 2 2 — 3 — — 2 1 — 2 3 2 1 18 Harrow Road 5 7 11 3 3 — 1 2 3 2 1 8 7 53 Maida Vale 5 6 8 2 4 3 1 — — 1 — 6 2 38 Town 2 2 2 1 2 2 — — — — 2 2 2 17 Church 10 9 4 3 5 1 2 6 2 4 3 5 1 55 Westbourne 6 5 4 1 6 4 4 4 1 1 — 1 2 39 Lancaster Gate, West — — — 1 — 1 — — — — — — — 2 Lancaster Gate, East 1 — 1 — — — — — — — — — — 2 Hyde Park — — — — 1 2 — 1 — — — — 1 5 19 Diphtheria Carriers.—There is a clinic for diphtheria carriers held at St. Mary's Hospital, to •which 8 cases were referred by the Public Health Department during the year. Anti-Diphtheritic Serum.—This is 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 18 phials of 8,000 units, 1 phial of 500 units, and 16 phials of 100 units were distributed. Diphtheria Immunisation.—A clinic was inaugurated in 1933 for the immunisation of children against diphtheria, and is at present held at the Welfare Centre, 283a, Harrow Road, in 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 payment to a practitioner 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 a child is susceptible to diphtheria is done by the Medical Officer of the Council's diphtheria immunisation clinic at the Welfare Centre, 283a, Harrow Road. During the year the scheme was amended to provide for the payment to a medical practitioner of a fee of 2s. 6d. for each injection given and for the provision of the necessary material free of charge. In the case of a child sent to the clinic for a pre-immunisation test, the result of which is negative, a fee of 2s. 6d. only is payable. The practitioner is responsible for any subsequent medical attention that may be necessary. The sending of a birthday card to each child in the Borough on its attaining the age of one year, incorporating information for the parents as to the advantages of immunisation, has been continued, together with the distribution of leaflets through the schools and the exhibition of posters at the Council's establishments and on the street orderly bins. The co-operation of the majority of the local chemists was also secured in the distribution of leaflets to selected customers. Dr. Emslie's report on the work carried out at the Clinic during the year is as follows:— "The numbers for 1938 show a slight increase, but it is disappointing that such a small proportion of parents seek protection for their children. None of the children have had serious indisposition after the injections and the results have been satisfactory." 20 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) 1938 171 (*63) 76 (*46) 247 (*109) 666 (*266) 649 (*328) 1,315 (*594) * Private medical practitioners' cases, included in totals. 1938. Number of Schick Tests. Positive. Negative. PseudoPositive. PseudoNegative. Unknown result. Total. Fully Inoculated. Partly Inoculated. No. of 1 nocs. given. Ordinary Clinic 39 35 — — 6 80 138 129 622 Private Practitioners 8 1 — — 1 10 109 123 591 Totals 47 36 — — 7 90 247 252 1,213 Number of Schick Re-tests. Positive. Negative. Pseudo-Positive. Pseudo-Negative. Unknown Result. Total. After First Re-test. After Further Re-test. After First Re-test. After Further Re-test. After First Re-test. After Further Re-test. After First Re-test. After Further Re-test. Ordinary Clinic 8 — 134 4 — — — — 8 157 Private Practitioners 8 — 105 4 — — — — 7 124 Totals 16 — 239 8 — — — — 15 281 The numbers "Fully Inoculated" come under the following age groups:— Ordinary Clinic. Private Practitioners. 6 to 12 months 3 138 — 109 1 year to 5 years 105 63 5 years to 10 years 19 34 10 years to 15 years 7 12 15 years and upwards 4 —. 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 three children and one adult received treatment during the year 1938. 21 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 1937. This shows that 54.24 per cent. of the children whose births were registered during that year were successfully vaccinated, and that 19.76 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 25.98 per cent. During the year 1938, no vaccinations were performed in the Paddington Hospital. In the rest of the Borough, 726 infants under one year of age, and 31 persons over that age were successfully vaccinated by the Public Vaccinator, by whom also 17 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 1,407 ; and the total number of statutory declarations of conscientious objection received from Paddington and other districts was 396. No legal proceedings were taken during the year 1938 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 1938, 294 certificates were received from medical practitioners. In addition 193 cases were reported from other sources, making a total of 487 for the year. Chicken-pox is not usually nursed in an institution, but 25 cases received institutional treatment for various reasons. TYPHOID FEVER AND CONTINUED FEVER. Five cases of typhoid fever and one case of continued fever were notified in 1938. 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. Four of the cases received hospital treatment. No death from typhoid fever occurred during the year. MEASLES. By virtue of The County of London (Measles and Whooping Cough) Regulations, 1938, measles became notifiable as from the 1st Octooer, 1938, except in the following circumstances:— (а) where to the knowledge of the medical practitioner a case of measles has occurred in the house and has been notified within the two months immediately preceding the date on which he first became aware of the disease in the case he is attending; (b) where the case is being treated in a hospital for infectious diseases; or (c) in the case of a person suffering from measles admitted as a patient into a hospital belonging to the County Council, if at the time of his admission a copy of a certificate to that effect has been sent by a district medical officer of health to the County Council. The order enables local authorities to "take such steps as are necessary or desirable for investigating the source of infection, for preventing the spread of infection, and for the removing of conditions favourable to infection." From the 1st October until the end of the year 6 cases of measles were notified in pursuance of these Regulations. There were, during the year under review, 1,118 cases brought to the knowledge of the Department by means of reports from schools, parents, etc. In the following table these cases, together with the notified cases, are distributed among the various wards of the Borough in four-weekly periods. 22 1938. 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 126 160 163 252 175 85 29 15 4 2 3 7 3 1024 Wards— Queen's Park 11 28 17 23 15 8 4 — — 1 1 108 Harrow Road 37 34 29 47 71 29 5 2 — 1 3 1 259 Maida Vale 31 47 22 23 5 9 2 2 — 1 - — 1 143 Town 2 14 4 22 6 6 5 5 2 — - 1 67 Church 15 16 42 58 26 17 ' 2 1 — — 2 2 181 Westbourne 24 10 38 66 39 15 9 2 1 1 - - 205 Lancaster Gate, West 2 1 6 7 7 - 1 - - - - - 24 Lancaster Gate, East 2 1 3 2 2 - - - 1 — — - - 11 Hyde Park 2 9 2 4 4 1 1 3 — — — — - 26 Eleven deaths from measles occurred during the year. The Women Sanitary Inspectors visit cases of measles with few exceptions and arrange, where necessary, for the attendance of the District Nurses. The cases requiring nursing assistance during the year numbered 25 under 5 years of age and 13 over 5 years of age. The number of visits paid by the nurses was 288 and 143 to each group respectively. Seventy-four cases received treatment in hospital. GERMAN MEASLES. This disease is not notifiable in Paddington, but in the course of the year 201 cases came to the knowledge of the Department through various sources of information. Nineteen 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. Thirteen notifications relating to cases of purulent eye-discharge of the new-born were received during 1938. 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 case was referred to the District Nursing Association during the year. Twelve cases of ophthalmia of the new-born were treated in hospitals as in-patients. PUERPERAL FEVER. There were 21 cases of puerperal fever notified during 1938, 20 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. No death from the disease was recorded during the year. 23 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 44 cases of puerperal pyrexia were notified, 40 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-four cases were notified, 38 of which occurred within or were removed to hospitals. Two deaths from the disease were recorded during the year. ACUTE POLIO-MYELITIS. One case of this disease, otherwise known as Infantile Paralysis, was notified, and received treatment in hospital. Owing to the serious after-effects, such as deformities, which result from this disease, much care is taken to keep in touch with all cases previously notified. Recent experience tends to show that most of the cases notified by doctors receive all the necessary remedial treatment. It is evident that the possibility of preventing the onset of serious deformities is now realised by parents and doctors more than formerly. ACUTE POLIO-ENCEPHALITIS. 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. Seven cases of this disease were notified, and treated in hospital. There were no deaths from this disease. MALARIA. Two cases of this disease were notified, one being treated in hospital. ACUTE PRIMARY PNEUMONIA, ACUTE INFLUENZAL PNEUMONIA. One hundred and ten cases of acute primary pneumonia were notified in 1938, as compared with 116 in 1937. Of the 110 cases, 85 were nursed in institutions. Nineteen cases of acute influenzal pneumonia were notified, as compared with 67 in 1937. Of the 19 cases, 7 were nursed in institutions. Fifty-eight cases of pneumonia of both kinds received nursing attention at home under the auspices of the Council's scheme for district nursing, 1,933 visits being paid. ANTHRAX. No case of this disease was notified during the year. 24 ACUTE RHEUMATISM. This 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 1938, 25 cases of acute rheumatism were notified. This figure compares with 24 cases in 1937, 29 cases in 1936, 18 cases in 1935, 41 cases in 1934, 37 cases in 1933, 21 cases in 1932, and 37 cases in 1931. 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 were 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. In May, 1938, the Secretary of the Hospital gave notice to the Council that the Rheumatism Supervisory Centre would be closed at the end of the year, as the number of children who attended did not justify the cost of the establishment. Facilities, however, exist in the out-patient department of the hospital, and elsewhere, for the necessary supervision of children requiring to be examined. Paddington Green Children's Hospital Rheumatism Supervisoby Centre. Report for the Year 1938 by Reginald Miller, M.D., F.R.C.P., Physician-in-Charge. During the year 1938 the Centre held 45 sessions. New cases from the Borough numbered only 4, although 25 cases of acute (juvenile) rheumatism were notified during the year. The total number of attendances by Paddington children amounted to 94. The Women Sanitary Inspectors paid 254 visits and reported faulty housing conditions when found. With the small number of Paddington cases now being admitted to the Centre it was decided to close the Centre to new cases on 31st December, 1938. The supervision of old cases is being maintained and earlier cases are being followed up as far as possible. The diminution in the number of Paddington cases is partly due to the fact that cases of juvenile rheumatism notified in the Borough have not of recent years attended the Centre. A more welcome cause for the falling-off in the number of cases is, it is hoped, the diminution in frequency and severity of juvenile rheumatism in the Borough. Attention has been called to this in my reports for the last few years, and if the Centre has contributed to this improvement all the work undertaken in connection with it since it was first opened in October, 1926, has been well worth while. I am greatly indebted to Dr. Mary Davies, who has assisted me in the work of the Centre for the last eleven years. 20 CHOLERA, DYSENTERY, GLANDERS, HYDROPHOBIA, PLAGUE, RELAPSING FEVER, TYPHUS FEVER. Thirty-two cases of dysentery were notified during 1938; but there were no cases of the other diseases included in the heading. WHOOPING-COUGH. This disease became notifiable on the 1st October, 1938, under the same Regulations and conditions applicable to measles, as described on page 21 of this Report. The number of notifications received up to the end of the year was 104, and 23 of the cases received hospital treatment. In 1938, 3 children died of whooping-cough, all being under the age of 5 years. The numbers of deaths in 1937 and 1936 were 6 and 3 respectively. No cases were referred to the District Nursing Association during the year. 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 1938, 31 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 sixty-nine deaths occurred among Paddington residents during the year. The numbers of deaths for previous years are showTn in the list following:— Numbers of Deaths of Paddington Residents. 1906 164 1916 205 1926 239 1936 271 1937 273 1938 269 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 11. Site of Disease. Ages. All Ages. 0— 15— 25— 35— 45— 55— 65— 75— M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Buccal cavity and pharynx — — — — — — — — — — 4 — 1 — 1 — 6 — Digestive organs and peritoneum — — 1 — — — 2 3 8 5 14 17 25 21 13 25 63 71 Respiratory organs — — — — — 1 2 — 3 — 11 3 4 1 1 1 21 6 Uterus — — — — — 1 — — — 2 — 8 — 4 — 2 — 17 Other female genital organs — — — — — — — — — 6 — 5 — 3 — 4 — 18 Breast — — — — — — — 4 — 4 — 4 — 3 — 11 — 26 Male genito-urinary organs — — — — — — — — 3 — 10 — 6 — 3 — 22 — Skin — — — — — — — — — — — — — — — — — 1 Other or unspecified organs — 1 — — 2 — — — — 2 2 4 — 1 — 2 4 10 — 1 1 — 2 2 4 7 14 19 41 42 36 33 18 45 116 149 26 INFECTIVE ENTERITIS. This disease is notifiable in eight other metropolitan boroughs. On May 2nd, 1927, the Council made the disease known as "Infective Enteritis" or "Summer Diarrhoea," notifiable for a period of two years. This Order was made by virtue of the Public Health (London) Act, 1891, and is only applicable to children under the age of five years. It was extended in 1929 for a further period of three years. In 1932 the disease was made permanently notifiable. Forty-two cases of the disease were notified during the year. The number of deaths under the age of 5 years was 26, as compared with 24 in 1937, 31 in 1936, 22 in 1935, 44 in 1934, 33 in 1933, and 103 in 1932. Thirty-seven 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 1938 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 1938 there were 70 deaths from pulmonary tuberculosis, and 11 deaths from other tuberculous diseases, making a total of 81 deaths from all forms of tuberculosis. Mortality during 1938. Age periods. 0— 1— 2— 5— 15— 25— 35— 45— 55— 65— Total. Pulmonary, Males — — — — 8 8 8 6 7 5 42 „ Females — — — — 5 9 4 5 — 5 28 Non-Pulmonary, Males — — — — 1 2 1 — — — 4 „ Females — — 1 — 2 1 2 — — 1 7 Ten persons dying from tuberculosis during the year were not formally notified, this number being equal to 12.3 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 follow 1919 133 1929 128 1930 114 1931 138 1932 122 1933 104 1934 97 1935 88 1936 76 1937 109 1938 81 Public Health (Tuberculosis) Regulations, 1930. Summary of Notifications on Form A received during the year 1938. 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 — 2 1 1 8 19 25 17 14 12 6 105 203 „ Females 1 — 2 2 11 19 36 15 8 2 4 100 183 Non-pulmonary, Males — 3 — 2 3 1 4 — — — — 16 16 „ Females — 2 8 1 1 2 3 1 3 2 3 26 33 27 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 2 1 3 7 „ Females - - - - - - 1 2 1 - - 5 Non-pulmonary, Males - - - 1 - - 1 - - - - 2 „ Females - - - - - - 1 - - - - 1 The sources from which information as to the above-mentioned cases were obtained is stated below:— Source of Information. No. of Cases. Pulmonary. NonPulmonary. Death Returns From local Registrars 6 2 Transferable deaths from Registrar-General 1 - Posthumous notifications 1 - "Transfers" from other areas (other than transferable deaths) 4 1 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, 1938, on the Register of Notifications 288 264 552 196 142 338 890 Number of cases removed from the Register during the year by reason of:— 1. Withdrawal of notification 8 - 8 - - - 8 2. Recovery from the disease 3 9 12 13 16 29 41 3. Death (all causes) 37 28 65 2 7 9 74 4. Otherwise ("Transferred," "Lost sight of," etc.) 61 67 128 30 26 56 184 Of the patients who removed from the Borough during 1938, the new addresses were obtainable in 100 instances, and particulars of the cases were transmitted to the medical officers of health of the respective districts. In 1938, 8 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 1938 was 890 as compared with 923 at the close of the year 1937. Visits paid to Homes of Tuberculous Patients. By Council's Women Inspectors 827 By Tuberculosis Officers 490 By Dispensary Nurses— 20, Talbot Road 3,087 St. Mary's Hospital 1,769 6,173 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 1938, 15 patients were attended under this arrangement, the number of visits being 352. 28 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. Eleven sets were so supplied during 1938, and three sets were returned following the death or 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 1938. 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 1938, 34 patients received 341 refills, the total cost amounting to £179 0s. 6d. 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. Gold Treatment.—The Council undertook financial responsibility for this form of treatment in one case, 14 injections being given at a cost of 3s. per injection. 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 7 patients were provided with full dentures, and 3 with partial dentures. The total cost was £48 15s. 0d. Grants amounting to £41 12s. 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 arc usually made for payment to be accepted by instalments. Particulars of the'dental work done during the year are shown in the subjoined table. Summary of Dental Treatment for the Year 1938. Particulars of Patients. Number of Fillings. . Number of Scalings. Extraction Cases. Dentures. Number of Dressings. Number for Advice. Denture Visits. Number of New Patients. Number of Attendances. Simple. Root. Without Anaesthetic. Local Administration. Gas Administration. Number of teeth extracted. Upper Lower. Re-models. Repairs. Women 138 22 1 9 - 6 24 103 10 9 - - 2 27 54 14 Children 71 28 1 2 - 3 13 30 — — - - 5 23 - 5 Men 34 - - 2 - 3 8 40 3 3 - - - 8 14 4 Total 243 50 2 13 - 12 45 173 13 12 - - 7 58 68 23 Number of Sessions held—45. 29 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 foe the Provision of Extra Nourishment by the Borough Council. 1. The types of cases most suitable to be dealt with are:— (a) Ex-Sanatorium cases, where the medical condition is such that a grant of extra nourishment is necessary to enable the patients to recover or maintain full working capacity. (b) Patients, with prospects of ultimate arrest of the disease, who are awaiting admission to sanatorium. 2. No fixed scale of income to qualify for grant. Where a grant of extra nourishment is made, it should be a condition that the patient is not receiving public assistance and is not reasonably able to provide the cost of extra nourishment. 3. The quantity and type of the extra nourishment to be left to the discretion of the Tuberculosis Officers and Consultant Medical Officers. 4. Where the Tuberculosis Officers and Consultant Medical Officers consider that an immediate grant of extra nourishment is necessary, they will transmit a certificate to the Public Health Department, when an emergency order will be issued for a period sufficient to include the interval which will elapse before the next meeting of the Tuberculosis Care Committee. Extra nourishment supplied under this order to be used only by the person to whom it has been granted. The Medical Officer of Health will be informed if there be (a) any change in income or address of any member of the family; (b) any assistance received from the Relieving Officer, Unemployment Assistance Board, or any other source. 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 1938 the cost to the Council of grants made under the Scheme was approximately £211. The Borough Tuberculosis Care Committee. The constitution of the Tuberculosis Care Committee for the year 1938 was as follows:— Representing. Paddington Borough Council Councillor Mrs. E. Settle „ „ 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 A. Kenrick. 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. K. Urquhart. 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. Carden. Local Social Worker Mrs. F. Turner. 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. 30 The Committee met on 12 occasions during the year and two hundred and twenty-eight individual cases were considered. Residential treatment was granted by the London County Council to 246 patients, 22 of whom were children under the age of 16 years, and 23 children were boarded out under the Tuberculosis Contact Scheme. No funds are available in the hands of the Committee for the assistance of patients, but in several instances help was obtained from voluntary agencies. DISPENSARY TREATMENT OF TUBERCULOSIS. For administrative purposes the Borough is divided into two dispensary areas, the line of division passing down Inverness Terrace, Porchester Road, Lord Hill's Road, Formosa Street to its junction with Shirland Road, and Shirland Road to its junction with Kilburn Park Road. The portion of the Borough to the east of this line is served by the St. Mary's Hospital Dispensary, and the portion to the west of the line by the Paddington Tuberculosis Dispensary. Paddington Tuberculosis Dispensary, 20, Talbot Road. This is a voluntary agency supported by voluntary subscriptions, and a grant from the Paddington Borough Council which for the financial year 1938/9 mounted to £1,600. Dr. R. S. Walker, Tuberculosis Officer, reports as follows:— The X-ray department of the Dispensary again worked to full capacity, 405 examinations being made. No difficulty is experienced in persuading people attending the Dispensary to submit to this examination, and its importance in aiding early diagnosis is universally acknowledged. The artificial sunlight department was again open during the winter months, and the results of this form of treatment on delicate children continued to be most encouraging. Students from the London School of Hygiene and Tropical Medicine attending the Dispensary for lectures and demonstrations numbered sixty-five, and seven students from the College of Nursing, Battersea Polytechnic and Bedford College attended for training in Tuberculosis work. The late Lady Philip transferred to the Dispensary Trustees a piece of land in Newton Road as a site for a new Dispensary, and early in the New Year work commenced on the erection of the building. It is hoped that this will be ready for occupation before the publication of the next Annual Report. Return Showing the Work of the Dispensary during the Year 1938. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 44 38 1 1 2 5 2 3 46 43 3 4 585 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 85 166 108 130 B.—Contacts examined during the year:— (a) Definitely tuberculous 2 1 1 1 - 1 1 2 2 2 2 3 172 (b) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 34 54 40 35 C.—Cases written off the Dispensary Register as:— (a) Recovered 6 10 - - 8 10 18 8 14 20 18 8 719 (b) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 120 222 152 165 D.—Number of Persons on Dispensary Register on 31st December: (a) Definitely tuberculous 178 151 3 6 66 56 59 27 244 207 62 33 546 (6) Diagnosis not completed - - - - - - - - - - - - 31 Returning Showing the Work of the Dispensary during the year 1938 (continued). 1. Number of cases on Dispensary Register on January 1st 628 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 23 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 114 4. Cases written off during the year as Dead (all causes) 29 5. Number of attendances at the Dispensary (including Contacts) 4,486 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 118 7. Number of consultations with medical practitioners:— 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 379 (a) Personal 93 (b) Other 232 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 3,087 10. Number of (a) Specimens of sputum, etc., examined 290 (b) X-ray examinations made in connection with Dispensary work 405 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 184 32 St. Mary's Hospital Tuberculosis Dispensary. This dispensary is voluntary, and was subsidised by a grant of £1,120 from the Paddington Borough Council during the financial year 1938/9. Return Showing the Work of the Dispensary during the Year 1938. Diagnosis. Pulmonary. Non-Pulmonary. Total. Grand Total. Adults. Children. Adults. Children. Adults. Children. M. F. M. F. M. ' F. M. F. M. F. M. F. A.—New Cases examined during the year (excluding contacts):— (a) Definitely tuberculous 27 25 1 1 1 4 2 3 28 29 3 4 137 (6) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 24 37 9 3 B.—Contacts examined during the year:— (a) Definitely tuberculous - - - 2 - - - - - - - 2 48 (6) Diagnosis not completed - - - - - - - - - - - - (c) Non-tuberculous - - - - - - - - 3 16 13 14 C.—Cases written off the Dispensary Register as:— (a) Recovered 1 1 - 1 - - 1 3 1 1 1 4 126 (6) Non-tuberculous (including any such cases previously diagnosed and entered on the Dispensary Register as tuberculous) - - - - - - - - 27 53 22 17 D.—Number of Persons on Dispensary Register on 31st December:- (a) Definitely tuberculous 66 60 6 6 12 28 10 13 78 88 16 19 201 (b) Diagnosis not completed - - - - - - - - - - - - 1. Number of cases on Dispensary Register on January 1st 189 2. Number of cases transferred from other areas and cases returned after discharge under Head 3 in previous years 14 3. Number of cases transferred to other areas, cases not desiring further assistance under the scheme, and cases "lost sight of" 52 4. Cases written off during the year as Dead (all causes) 9 5. Number of attendances at the Dispensary (including Contacts) 2,153 6. Number of Insured Persons under Domiciliary Treatment on the 31st December 14 7. Number of consultations with medical practitioners:— (а) Personal 8 (b) Other 84 8. Number of visits by Tuberculosis Officers to homes (including personal consultations) 111 9. Number of visits by Nurses or Health Visitors to Homes for Dispensary purposes 1,769 10. Number of (а) Specimens of sputum, etc., examined 93 (b) X-ray examinations made in connection with Dispensary work 144 11. Number of "Recovered" cases restored to Dispensary Register and included in A (a) and A (6) above - 12. Number of "T.B. plus" cases on Dispensary Register on December 31st 81 33 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, 6 part-time Visiting Medical Officers (one of whom acts as Dental Anaesthetist), 1 Visiting Dental Officer, 3 part-time Masseuses, 1 Clerk/Almoner, and 2 full-time and 1 part-time Clerical Assistants. 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 various Centres. 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 1,538 Revisits „ „ „ 7,273 8,811 Visits to children between the ages of 1 and 5 years 9,513 First visits to expectant mothers 1,308 Revisits „ „ 965 2,273 Other Visits— Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 192 Miscellaneous (including ineffective calls) 13,580 13,772 The total number of children on the Health Visitors' lists at the close of the year was 4,767, Maternity and Child Welfare Centres. The arrangement by which the Paddington School for Mothers provided accommodation for the various consultations with the aid of voluntary contributions and an annual grant from the Council was terminated on the 25th June, 1938, from which date the new Welfare Centre at No. 283a, Harrow Road was brought into use as headquarters and the old premises at No. 232, Harrow Road given up. The arrangements for the use of the branch centres were continued. The formal opening of the new centre took place on the 8th December, 1938, when the chair was taken by His Worship the Mayor (Alderman H. H. Dawes, O.B.E., T.D., J.P.), accompanied by the Mayoress. The opening ceremony was performed by Lord Dawson of Perm, accompanied by Viscountess Dawson. The following is a brief description of the Centres as at present:— Main Welfare Centre, 283a, Harrow Road. Ground Floor.—Waiting hall, 2 doctors' rooms, dental surgery and recovery room, light treatment room, massage room, weighing room and ante-natal waiting room. First Floor.—Office accommodation for health visiting and clerical staff, and caretaker's quarters. The building is centrally heated throughout. Two Infant Consultations weekly.—Tuesday and Thursday, 2.0 p.m. Medical Officer, Dr. E. R. Emslie. Area served:—Parts of Church, Harrow Road, Westbourne and Maida Vale Wards. 84 Two Maternity (Ante- and Post-Natal) Consultations weekly.—Wednesday, 2 p.m. Medical Officers. Mr. A. Gunn, F.R.C.S., and 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 M. Denney, C.S.M.M.G., Miss M. Kent, C.S.M.M.G., and Miss E. M. 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.—Tuesday, 2 p.m. Medical Officer, Dr. C. T. Potter. Dental Clinic, weekly.—Monday, 10 a.m. Mr. P. A. Crow, L.D.S., R.C.S. 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, IF. 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. 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 the Welfare Centre, No. 283a, Harrow Road, W.9, 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. 40). In some other cases assistance is obtained from private sources. 35 Consultation Centres : Summary of Work for the Year 1938. Infant Consultations 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 50 51 50 51 50 52 51 48 454 Number of Attendances 3,313 2,780 3,753 2,563 5,034 3,613 3,346 2,921 3,532 30,855 Average Attendance 65.0 55.6 73.6 51.3 98.7 72.3 64.3 57.3 73.6 67.9 Seen by Doctor 1,432 1,350 1,331 1,018 1,360 977 1,208 969 1,085 10,730 Average number seen by Doctor at each Session 28.1 27.0 26.1 20.4 26.7 19.5 23.2 19.0 22.6 23.6 The total number of children attending the consultations was 3,496, 1295 being under 1 year of age and 2,201 between the ages of 1 and 5 years. Ante-Natal and Post-Natal Clinics. Harrow Road. *(2 sessions weekly) Macroom Road. (1 session weekly) Number of Sessions 89 51 Number of Attendances 1181 510 Number of Expectant or Recently Confined Mothers who Attended 515 193 Average Attendance per Session 13.3 10.0 Number of Cases Referred by Midwives in Private Practice *from 5th April, 1938 Having regard to the increased number of women attending the ante- and post-natal maternity sessions it became necessary to hold an additional session from the 5th April, 1938, making three per week. It was also decided to engage a Senior Visiting Medical Officer for these consultations, and Mr. A. L. Gunn, F.R.C.S., was appointed and commenced duty on the 27th July. Mr. Gunn's report is as follows:— Since the ante-natal work was transferred to the new centre in Harrow Road, Dr. Fenwick and I have re-organised the ante-natal supervision with certain definite guiding principles in mind. The early recognition and quick investigation of abnormalities is of primary importance. Obstetric abnormalities which cannot be corrected at once are referred without delay to the hospital which will have charge of the woman's confinement. The dental department has been freely used. Other departments of the Council's health department have assisted in the care of women suffering from concurrent conditions. Nutrition has demanded a good deal of attention and we have concentrated on this aspect of the subject. Malnutrition and anaemia have been very common. In the many cases in which we have been able to advise on dietetic matters, and to help by providing nourishment in necessitous cases, the improvement in the condition of the expectant mother has been remarkable. This is a valuable method of reducing maternal mortality and morbidity, and one for which the facilities of the Borough Council are particularly suited. The work of the clinics has increased partly because of the need for adequate ante-natal care and partly as a result of happy co-operation with the medical staff of Paddington Hospital. Consultative and Physical Treatment Centre. Number of Sessions 103 Number of Attendances 4,054 Number of Cases 220 (of which 157 were new). Average Attendance per Session 39.36 Classification of Cases— Artificial Sunlight only 67 Artificial Sunlight and Massage 78 Massage only 59 Dietetic only 16 Treatments given— Artificial Sunlight 2,520 Massage 2,387 36 The following report has been received from Dr. R. Cove-Smith on the work carried out at the Centre:— By far the most significant episode of the year's work was the move made to the new premises of the Borough Health Centre at 283a, Harrow Road in June. Here, through the generosity of the Council new equipment has been installed with a Centrosol lamp capable of giving UltraViolet Light treatment to a dozen cases at a time instead of merely in twos and threes as heretofore, while a Duo-Therapy lamp is also available whereby individual treatments of Ultraviolet Light, Radiant Heat and Infra Red Therapy can be given. The more powerful lamp with its increased output and greater adaptability has already increased the scope of the work and there is every reason to suppose that this will grow as the possibilities of the treatment become more widely known. One hundred and three sessions have been held, with an average attendance of 39 patients, and 220 cases have been treated (of which 157 were new). These cases have had the following types of treatment:— Ultra-Violet Light Treatment 67 Ultra-Violet Light and Massage Treatment 78 Massage Treatment 59 Dietetic advice 16 and the total number of treatments given were:— Ultra-Violet Light 2,520 Massage 2,387 Toddlers' Clinic. Numberof Sessions 51 Number of Cases 354 (of which 233 were new). Number of Attendances 1,327 Average Attendance per Session 26 Dr. C. T. Potter's report for the year is as follows:— "At the Toddlers' Clinic provision is made for the medical examination of children of preschool age. Any abnormalities are noted and if treatment is necessary the cases are referred to their doctor or to hospital, or other departments of the Centre. The abnormalities requiring attention included malnutrition, dyspepsia, anaemia, septic tonsils and adenoids, cervical adenitis, naso-pharyngeal catarrh, bronchitis, squint, errors of refraction, carious teeth, stomatitis, enuresis, catarrhal jaundice, nervous exhaustion and tics, knock-knee, flat-foot. Many of these children were referred to other departments for massage and sunlight treatment, and convalescence arranged when necessary." Denial Clinic.—Following upon the decision of the Council to institute a dental clinic in connection with the new welfare centre, Mr. P. A. Crow, L.D.S., R.C.S.(Eng.), was appointed Visiting Dental Officer, and the first session was held on the 8th August. Dr. S. Denovan Adam acts as anaesthetist. Details as to the work of the Clinic up to the end of the year are given below:— Nursing and Expectant Mothers. Children. Totals. Patients examined 77 49 126 Number of teeth extracted 280 30 310 Administration of general anaesthetics 65 15 80 Number of fillings in temporary teeth - 17 17 Number of fillings in permanent teeth 25 - 25 The following report has been received from Mr. Crow:— "Statistics make dull reading, but it will be appreciated that after a longer period it should be possible to deduce interesting information from them. Suffice at present to note that of the number of patients presenting themselves for examination, not one adult was free from the need for treatment, and only three or four of the very youngest children had not developed caries or other dental ailment. Owing to practical difficulties, not the least of which is the moving population of the Borough, it will always be difficult to assess improvement in the Dental Health of those residents enjoying the amenities of the Health Services. It is hoped, however, that after a few years the benefits of prophylactic treatment and advice will be felt, and that there will be relatively less 'destructivecum-reparative' dentistry, and a greater proportion of more truly conservative work. At present the extensive extractions and replacements so often required in an expectant mother are cited to her as an example of what can be avoided in her child; and as often as possible she is advised on matters of diet, retention of deciduous teeth, and so on. It is hoped to extend the scope of this preventive aspect of the work. It is a pleasure to report the helpful co-operation of all concerned with the Dental Clinic, from Borough Administrators to the immediate assistants in the surgery. To the latter, Dr. Adam, Miss Newington, Miss Candler, and Miss Bathgate especial thanks are due, for being so much more than just efficient: for creating that atmosphere of kindness, quickly sensed by the patients, which will banish the traditional 'horror of dentistry' from this Dental Clinic." 37 Queen Charlotte's Maternity Hospital.—During the year 1938, 24 infants of mothers resident in Paddington attended the Infant Consultation Centre. The average number of attendances per infant was 31. During 1938 there were received into the Hospital for confinement 135 women from Paddington, and 239 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 1,518 by 181 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 55 and presumably all of these received examination and advice there. Maternity Nursing.—The arrangements whereby the Paddington and St. Marylebone District Nursing Association provided 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 was terminated on the 31st March, 1938, when the domiciliary midwifery service provided by the London County Council under the Midwives Act, 1936, came into operation. The number of confinements attended by the nursing staff up to the 31st March was 16, the number of visits being 357. The figures for 1937 were 63 and 1,260 respectively. Maternity Wards.—The agreement with the Board of Management of St. Mary's Hospital by which a suite of wards containing 14 beds was available for patients accepted for admission by the Borough Council expired on the 31st March, 1938. In view of the increased facilities for expectant mothers then existing in other institutions, and of the fact that on an average only two-thirds of the beds had latterly been occupied, it was decided to enter into a new agreement from the 1st April, 1938, for the reservation of a ward of six beds on the same terms as previously, viz., 9s. per day for each bed, whether occupied or not, for a further period of four years, subject to the whole matter being again considered at the end of the third year. Any additional beds which may be needed are available at the same rate. The following scale has been adopted by the Council for the assessment of cases for admission to the maternity ward, 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, 191 women were delivered in the wards. Three cases of puerperal pyrexia were notified. There were 7 stillbirths, and 2 deaths within 10 days of birth. Midwifery Service.—The arrangements with the Paddington and St. Marylebone District Nursing Association were terminated on the 31st March, 1938, on the coming into operation of the London County Council domiciliary midwifery service. Up to that date the Association's midwifery staff attended 15 cases. 38 Maternity Consultations.—Mr. Douglas H. MacLeod. F.R.C.S., continued to act as obstetric consultant. Five requests for his services were 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. Home Helps.—During the year Home Helps were provided in 64 cases, 46 being attended by Casual Home Helps selected from the Council's panel and the remaining 18 by the Council's Full Time Home Help who commenced duty on the 14th February. The services of an additional Full Time Home Help were found to be advisable and she began work on the 28th December. In addition, provision was made in three cases for carrying out the domestic washing of expectant or recently confined mothers. In every instance financial assistance was given towards the cost, each case being assessed on its merits. 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 42 necessitous women were referred to the Centre, but only 28 attended. Councillors Lady Bonham Carter and Mrs. Pain were 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. 9 examinations were made during the year, 4 being of expectant mothers and 5 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. There was no request for assistance during the year. 39 Care of Children.—Arrangements are made, where necessary, for the care of children whilst their mothers are in hospital for confinement, etc. During the year 7 children were accommodated in Beauchamp Lodge Emergency Home and 9 were temporarily placed in the charge of foster mothers, free or at a reduced charge according to circumstances. The cost to the Council was £15 13s. Od. PROVISION OF EXTRA NOURISHMENT FOR NECESSITOUS MOTHERS AND CHILDREN. During the year consideration was given to cases of children for whom grants of extra nourishment were authorised who did not continue in regular attendance at the Welfare Centre, and in order to secure that such children should receive proper medical supervision it was decided to amend the scheme by the inclusion of a requirement that any child in receipt of a grant should attend one of the Council's welfare centres at least once a month or that a report from a private doctor be submitted. The term "nursing mother" is construed as "a mother who has given birth to a living or stillborn child within a year." A copy of the present 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; (b) Nursing mothers; or (c) Children under the age of five years, not being educated in schools recognised by the Board of of Education; and it shall be a condition of the issue of a supply of nourishment for a child at less than cost price that the child shall attend one of the Council's Welfare Centres not less often than once a month, or that a report on the child from a private doctor be submitted, or that these conditions be specially waived by the "Grants" Committee. 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. 40 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 52/- 60/- 11 56/- 65/- 12 60/- 70/- Particulars of Extra Nourishment Grants During 1938. (1937 figures in brackets.) The total number of cases considered by the "Grants" Sub-Committee during the year was 6,578 (3,883), of which 1,393 (987) represented new applications. These latter were dealt with as follows:— Number of New Applications. Granted. Refused, withdrawn or referred to Public Assistance Committee. 1,393 (987) 1,215 (854) 178 (133) 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 £3,648 10s. 6d. (£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. Seven hundred and fifty-two families hitherto unknown to the Department applied for grants during the year, as compared with four hundred and twenty-two in 1937. 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, which was increased to £90 per annum from the 1st April, 1938. Eighteen mothers with their babies were sent for convalescence during the year. The home was closed at the end of the year, the National Association of Maternity and Child Welfare Centres having found it impossible to continue on a satisfactory financial basis. In addition, fifteen mothers with their babies, and two children without their mothers, were referred to other homes at a nett cost to the Council of £33 9s. 6d., the payments by patients totalling £4 8s. 6d. In 41 instances the Council made grants towards the cost of children convalesced by the Invalid Children's Aid Association. 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 four 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. 41 During the year 1938, 992 visits and inspections were made, 44 new registrations of fostermothers were recorded, 102 new children were received and 4 children were removed—3 to hospital apd 1 elsewhere. Two deaths were reported. At the close of the year, the Register contained the names of 92 persons who were receiving children for reward. These persons had charge of 128 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 £75 and £213 respectively, were made in respect of the financial year 1938/9. 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." Full days. Saturdays. Full days. Saturdays. Full days. Saturdays. Days open 252 50 246 48 254 51 Attendances 12,518 1,335 5,499 228 8,447 953 Average attendance 50 27 22 5 33 19 New Children 92 18 20 Cases of Infectious Disease. Measles 7 16 20 German Measles 22 1 - Whooping Cough - 3 3 Chicken Pox 26 - 3 Scarlet Fever 15 - - Queen's Park Day Nursery was closed from the 9th to the 25th April on account of Measles. Dr. Emslie reports as follows:— westbourne day nursery. "Apart from outbreaks of infectious disease the health of the children has been on the whole satisfactory, especially as it must be remembered that most of them come from the poorest homes. We had an outbreak of German Measles in February, and a simultaneous outbreak of Measles and Scarlet Fever in May and June. Two of the children were very seriously ill at this time, but recovered well. We had several cases of Chickenpox in August and September, and we had one or two cases of Acute Enteritis throughout the year, but no outbreak. The inoculation of the children against Diphtheria and Whooping Cough has been continued and the response has been very satisfactory. The demand for places in the Nursery continues to be far greater than the number of vacancies. The mothers are very appreciative on the whole, and the Nursery solves some serious economic problems as well as giving some delicate children a better chance than they would otherwise have." Matron's report for the year is as follows:— "1938 has been a quiet year at the Nursery. The Nursery is increasing in popularity and we have to send a number of applicants for vacancies away every week. There has been no change in the staff, but three of our probationers finished training during the year and are in private posts. 42 The examination results have been good; we have had no failures and several of the girls obtained good marks. On 6th January, 1939, we had our first practical examination ; two of the nurses took it and we had three visitors from the 'Eagles' Nest' to take it with them. The examiner was pleased with the standard of training, and both girls passed with credit. The large front nursery was painted in June and looks very pretty indeed with its white cots, pink furniture and bonny babies. We put the children into woolly suits for the winter, rose pink for the Tweenies and green for the Toddlers. These were all knitted by the Staff and have been a great success, as the children have been warm and tidy through all the cold days. Christmas was a happy time. The Children's Party, greatly helped by the gift of a Christmas Tree complete with toys from the Paddington Bowling and Sports Club, by gay bags of sweets from Mrs. Bromage and Dr. De Swiet as Father Christmas. The Mothers' Party was lively and most enjoyable. Mrs. Christie gave a marvellous supper and came to help entertain. The Nurses' Party on 18th December was a great success. We had no refusals to our invitations and one couple came from as far away as Coventry. We have several new friends this year, and especially I would like to thank 'Ann Towers,' of Weldon's publications, through whose interest we have had several parcels of toys and a steady supply of cotton reels, which are most valuable as teaching toys for the bigger children. Although we have had more toys given this year, we are still very short and would be most grateful for gifts of new or good second-hand toys for our large family. For those who wish to see the Nursery the best times to see the children are from 10.30 to 11.30 a.m. and 2.30 to 4 p.m." THE LONDON PUBLIC MEDICAL SERVICE. The London Public Medical Service provides for the dependants of insured persons and others of similar income, medical treatment and continuity of advice from their own family doctor. Those interested should apply for entrance forms to their own doctor, or to the Secretary of the London Public Medical Service, at 17, Russell Square, W.C.I. ADMINISTRATION. STAFF OF THE DEPARTMENT. A complete list of the Staff of the Department appears on pages 4 and 5. The following changes and additions occurred during the year. Senior Visiting Medical Officer, Welfare Centre.—Mr. A. L. Gunn, F.R.C.S.(Edin.), was appointed by the Council on the 30th June as Senior Visiting Medical Officer for ante-natal and post-natal consultations. Visiting Dental Officer, Welfare Centre.—Mr. P. A. Crow, L.D.S., R.C.S.(Eng.), was appointed by the Council on the 28th May. ♦ Dental Anaesthetist, Welfare Centre.—Dr. S. Denovan Adam was appointed by the Council on the 27th October, 1938. Health Visitors.—Miss F. E. Stammers resigned on the 20th September in consequence of having reached the age limit of 65 years, and Miss H. S. Beattie, Miss F. Fox, and Miss A. M. A. Johnston also resigned their appointments. Miss M. M. B. Bathgate, Miss A. S. Anderson, Miss E. M. Candler, and Miss J. Dowson were appointed to fill the vacancies thus created. Clerks.—Mr. I. D. Clarke, Junior Clerk (Class 5), resigned his appointment, and Mr. R. S. Welch was appointed by the Council on the 5th May to fill the vacancy. PREVENTION OF INFECTIOUS DISEASE. Visiting.—Visits of enquiry into cases of infectious disease numbered 3,935. 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 733. In connection with the arrangement between the Council and the Paddington and St. Marylebone District Nursing Association, 298 patients (comprising 250 under and 48 over 5 years of age) were visited in their homes by the nurses of the Association. The visits paid to each group were 2,460 and 681 respectively. 43 Disinfection.—The rooms disinfected after infectious disease numbered 757. 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 20 tons. Four hundred and fifty-three library books were disinfected. Schools.—A total of 2,070 notices relating to cases of infectious disease was despatched to the Head Teachers of the various schools attended by patients or their "contacts," 451 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, 235 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 1938 were as follows:— Disease suspected. Number of Examinations. Number of Positive Results. Diphtheria 966 69 Tuberculosis 395 28 Typhoid Fever 7 1 Scarlet Fever 102 56 Dysentery 8 - Food Poisoning 8 3 HOUSE DRAINAGE. During the year 28 existing drains were tested and found water-tight, and 110 defective drains were wholly or partly reconstructed. RECONSTRUCTION PLANS. Two hundred and fifty-eight plans were submitted for drainage works in existing buildings. In connection therewith 420 letters were despatched. No summonses were issued for failure to supply plans. COMBINED DRAINAGE. Orders were made under Section 38 of the Public Health (London) Act, 1936, with respect to new drainage systems to which the following groups of buildings were to be connected:— Bathurst Mews, Nos. 18; 19 and 20; Nos. 61 and 62. Westbourne Terrace, Nos. 79 and 81; Nos. 103 and 105. Chester Place, Nos. 1, 2 and 3. Burlington Mews West, Nos. 17 and 19. Hereford Mews, Nos. 7 and 8. Frederick Close, Nos. 1 and 1a. Sussex Gardens, Nos. 35, 37 and 39. Brook Mews North, Nos. 24 and 24a; Nos. 27 and 28. Sussex Gardens, No. 73; and Westbourne Street, No. 11. Craven Road, No. 31; and Brook Mews North, No. 18. Lancaster Street, Nos. 14 and 14a. Hyde Park Gardens Mews, Nos. 14 and 14a. Praed Street, Nos. 37 and 39. Westbourne Terrace, No. 42; and Gloucester Mews, No. 42. New cinema and car park or building situate on the south side of Harrow Road, on the sites of premises formerly numbered and known as Nos. 25 to 49 (odd, inclusive) Harrow Road, and certain properties at the rear in Irongate Wharf Road. New block of shops and residential flats over, or building, situate on the south-west side of Maida Vale, and on the sites previously numbered and known as Nos. 229 to 237 (odd, inclusive), Maida Vale. New block of shops with flats over, or building, situate on the south side of Harrow Road, and on the sites of premises formerly numbered and known as Nos. 53, 55, 57; and the Salvation Army Hall, Harrow Road; and Nos. 25-31 (odd, inclusive); and the petrol filling station. Irongate Wharf Road, Four new houses with garage, or building, situate on the south-west side of Sussex Square, on the sites of the premises formerly numbered and known as Nos. 23, 24 and 25, Sussex Square; No. 9, Bathurst Street; and Nos. 2 and 3, Sussex Mews West. 44 Block of residential flats and underground garage, or building, situate on the north side of Bayswater Road, and on the sites of premises formerly numbered and known as Nos. 100-103, Lancaster Gate. Porchester Place, Nos. 19 and 19a. Block of flats, two residential houses, garages with flats over, or building, situate on the north-west side of Gloucester Square, and on the sites of premises formerly numbered and known as Nos. 9, 10, 11 and 12, Gloucester Square, and Nos. 24 and 25, Radnor Mews. No combined systems were reconstructed by the Council during the year. SEWER CONNECTIONS. In 1938, 19 sewer connections were reconstructed, either partially or wholly, 18 on the application of the owners of the properties concerned and 1 following an Order made by the Council under Section 40 of the Public Health (London) Act, 1936. WATER SUPPLY. Eighteen certificates under Section 95 of the Public Health (London) Act, 1936, were issued. The Metropolitan Water Board reported 11 cases of discontinuance of water supply for nonpayment of rates. Three of the premises were unoccupied. In the remaining cases the water supply was subsequently restored. MORTUARY. Four hundred and seventy-six bodies were deposited at the Mortuary, inquests being held on 372 of that number. Three hundred post-mortem examinations were made. TRADE NUISANCES. Forty-two complaints were received during the year, those relating to manure numbering 6. REMOVAL OF MANURE. Section 94 (2) of the Public Health (London) Act, 1936, empowers the local authority to give notice requiring the periodical removal of manure from stables, etc. With a view to the prevention of an increase in flies as well as of other nuisances arising from accumulation of manure, it has been the practice of the Council for some years past to require stable refuse to be removed twice weekly during the months of May to September, public notice of such requirement being given by means of posters displayed in the various Mews in the Borough. Very little difficulty is experienced in securing compliance with the notice. RAG AND BONE DEALERS. In December, 1938, there were 19 rag and bone dealers in the Borough. SMOKE CONTROL. During 1938, 7 trade premises were kept under observation for the detection of smoke emitted so as to be a nuisance. These premises were watched on 18 occasions, occupying 9| hours. Smoke of all descriptions was noted during 3A hours, "black" smoke being observed for one minute. Six 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 1938 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. 45 Eighty-nine visits of inspection were made, the following infringements of the Act and Regulations being discovered:— Cabins leaky 4 Stove flue pipe defective 2 Boats without Certificates 4 Two notices were served. On no occasion was admission to a boat refused, and it was not found necessary to institute legal proceedings. Three cases of infectious disease were reported. No death was recorded. Nine children of school age were found to be living on the boats inspected. It is practically certain that a number of boats, registered many years ago, have changed ownership, been registered with another authority or been broken up. It is under the circumstances impossible to trace a number of registered boats or to know the exact number of " live " certificates of registration. The annual cleansing at Paddington Basin was carried out during the week-end 16th-18th April. About 398 tons of mud were removed from the bed of the Basin, in addition to 400 tons which were dredged previously, a total of 798 tons, being some 572 tons less than that removed in 1937. TENEMENT HOUSES. The number of houses on the register at the close of the year was 2,301. Inspections totalled 7,154, and legal proceedings were instituted with respect to nuisances or contraventions of the Bye-laws in 17 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 14 „ choked 13 Soil pipe or soil vent pipe defective 8 Fresh-air inlet valve defective or missing 51 Manhole cover defective 9 Gully grating missing 2 Gully choked 9 Rain-water pipe defective 32 „ „ choked 9 Gutters defective 18 Waste-pipe defective 36 „ choked 5 „ untrapped 12 „ missing - Sink defective 15 Absence of means for carrying away waste water from taps 11 Houses with insufficient water supply 57 Additional draw-off taps provided 35 Water-closet roof defective 21 „ walls out of repair 17 „ flooring defective g „ flushing apparatus defective 65 „ pan defective 35 „ pan foul 13 „ seat defective 34 „ choked 18 „ door missing, off hinges, defective, or fastenings out of order 41 „ lighting or ventilation inadequate 3 accommodation insufficient 3 Drinking water cistern defective 1 „ „ „ dirty 19 „ „ „ uncovered or cover defective 6 Rooms damp 197 Rooms, staircases, wash-houses, water-closets, yards, areas, etc., dirty 2,358 Rooms verminous 110 Rooms, floor, bedding or contents dirty 4 Roof leaky 275 Mixing of sexes — Chimney smoky 14 Food cupboard not provided 46 Cooking accommodation not provided or defective — Staircase not provided with artificial light 1 „ without handrail 8 Window cords or fastenings out of repair 1,049 Common staircase out of repair 143 Animals improperly kept — Premises where water supply was cut off — Wash-house paving defective 88 Yard or area paving defective 106 Dustbin defective 86 „ accommodation insufficient 8 Premises without ashpit accommodation 1 Accumulation of refuse 34 46 Notices Issued. Written Intimations 621 Statutory Notices:— Verminous rooms 57 Additional taps 35 Other matters 372 Bye-law Notices 1,216 Items of Dilapidation for which Letters were sent to the Owners (Section 9 of the Housing Act, 1936). Wall-plaster broken, bulging, or defective 308 Matchboarding defective 6 Wall-paper loose 23 Skirting defective 15 Doors defective or missing 38 Locks defective 54 Ceiling plaster defective 154 Ceiling paper loose 34 Floors broken or badly worn 216 Stoves defective (including fire tiles burnt away, bars broken or missing, oven plates burnt through, oven doors defective or missing, plates broken or missing) 162 Stove settings defective 6 Flues defective 22 Hearths defective 18 Chimney-pieces loose or defective (including jambs, frieze, or mantel broken, loose, or missing) 31 Cupboard doors defective or missing and shelves missing 3 Window-sashes defective (including sash or sash-bars broken, rotten or defective, beads missing or defective, putties defective) 305 Window-frames loose or defective (including oak sills worn or rotten) 115 Window-glass broken 242 Copper brickwork defective, furnace pan leaky, furnace door missing or defective, setting defective, flue smoky or defective 52 Steps to front entrance or area defective 28 Railing to area or area steps defective 6 Guard rails to addition roofs defective, broken or rotten 9 Rubbish or refuse in yard, washhouse, vault, area, under-basement, etc. 10 Vault doors missing or defective 11 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— (a) Water-closet accommodation; (b) Accommodation for the washing of clothes; (c) Accommodation for the storage of food in a reasonably cool position with proper ventilation from the external air wherever practicable, and with protection from dust and flies; (d) Accommodation for the preparation and cooking of food; and, where reasonably necessary, and so far as practicable, the owner shall provide separate accommodation as specified in (a), (b), (c) and (d) for each such family. For the present, however, this Bye-law is applicable only to a house which is decontrolled throughout. During the year steps continued to be taken to enforce the Bye-law in the case of every decontrolled tenement house which came under the notice of the sanitary inspectors in the ordinary course of their duties, and special attention was devoted to certain areas. Notices were served with respect to 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.—1,071 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 270, Kilburn Lane: 60 beds for men. 272, 274 and 276, Kilburn Lane: 105 beds for men. Cecil House, 179, Harrow Road: 65 beds for women and children. During the year 63 inspections (including 7 night inspections) were made by the two Sanitary Inspectors responsible for the supervision of these houses. 47 A census, taken at midnight on llth/12th February, showed the number of beds occupied at each common lodging house as follows:— 268 and 270, Kilbum Lane 23 272, 274 and 276, Kilbum Lane 40 Cecil House, 179, Harrow Road 37 Three deaths occurred among the occupants during the year. No cases of infectious disease were notified. RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS, 1920-1933. Seven applications for certificates were made, all of which were granted; in 1 instance a certificate that the necessary repairs had been carried out to the satisfaction of the Sanitary Authority was subsequently issued. 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 10 cases legal proceedings were instituted, the results of which are shown on page 64. FACTORIES ACT, 1937. A record of the inspections made, and the defects found and remedied, are shown in the subjoined table:— Premises. Number of Inspections. Written Notices. Occupiers prosecuted. (1) (2) (3) (4) Factories with mechanical power 289 3 - Factories without mechanical power 367 3 - Other Premises under the Act (including works of building and engineering construction but not including outworkers' premises) 34 - - Total 690 6 - Defects Found. Particulars. Number of Defects. Number of defects in respect of which Prosecutions were instituted. Found. Remedied. Referred to h.m. Inspector. (1) (2) (3) (4) (5) Want of cleanliness (S. 1) 31 46 - - Overcrowding (S. 2) - - - - Unreasonable temperature (S. 3) - - - - Inadequate ventilation (S. 4) - - - - Ineffective drainage of floors (S. 6) 1 - 1 - Sanitary Conveniences (S. 7) insufficient 1 - - - unsuitable or defective 3 6 - - not separate for sexes 2 2 - - Other offences (Not including offences relating to Home Work or offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921, and re-enacted in the Third Schedule to the Factories Act, 1937.) - - - - Total 38 54 1 - 48 At the end of 1937 there were 861 premises on the Register. During 1938, 96 premises were removed from the Register and 62 added, making the total at the end of the year 765. The Department reported to the Home Office 2 cases in which the prescribed abstract of the Factory and Workshop Act, 1901, was not displayed, and received from that Office notice of 10 workshops, 3 of which were already known to the Department. Homework (Outivorkers).—Local employers of outworkers sent in 13 lists in February and 11 in August. These lists contained 233 names and addresses of which 208 were forwarded to other districts. From other districts 271 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 690 inspections, comprising 289 of factories, 367 of workshops and 34 of workplaces. There were 40 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 7 complaints, which comprised:— Sanitary conveniences not separate for sexes 1 Other offences 6 Bakehouses.—During the year 1 level bakehouse was closed, the total number on the Register at the end of the year being 69. The number of level bakehouses was 31 and of underground 39. The bakehouses were inspected on 333 occasions during the year. Rag Flock.—Little, if any, rag flock is used in the Borough, and no samples were taken during the year. The inspection of shop premises in the Borough is carried out by Mr. A. C. Harrison, one of the Meat and Food Inspectors. SHOPS ACTS. The following particulars relate to work carried out under the Shops Acts during the year:— First inspections 110 Re-inspections 1,939 Exemption certificates as regards sanitary conveniences applied for 8 granted 8 The following contraventions of the Acts were discovered during the year:— Insufficient sanitary conveniences 3 Sanitary conveniences unventilated 15 „ „ improperly sealed from lobbies 11 Absence of lobbies to sanitary conveniences 18 Water-closet walls and ceilings defective or dirty 32 „ pans defective or dirty 13 „ windows defective 5 „ doors defective 22 „ fittings defective 37 Absence of indicators to water-closet doors 31 ,, lighting to water-closets 50 Reasonable temperature not maintained 40 Insufficient ventilation 18 In the course of his inspections, the Inspector also discovered the following defects:— Premises dilapidated or dirty 128 Drains choked 13 Fresh air inlet connections to drains defective 3 Inspection chamber covers defective 2 Internal gully traps uncovered 4 Flues defective 1 Waste-pipes of sinks untrapped 10 ,, ,, defective 23 Yard pavings defective 2 Dustbins defective 42 Accumulations of rubbish 26 No legal proceedings were necessary during the year. 49 HOUSING. Housing Act, 1936. Clearance and Re-Development. During the year clearance or compulsory purchase orders were confirmed by the Minister of Health as follows:— Chippenham and Rodborough Mews (45 houses). Compulsory Purchase Order confirmed subject to the following modifications:— Reference Number 70 will be excluded from the Order and from the Clearance Area. If the Council desire to acquire the building, of which the property included under Reference Number 70 forms part, it will be open to them to consider its acquisition under Section 27 of the Act. Reference Numbers 12, 56, 58, 65 and 67 will remain in the Order as properties to which the proviso to Section 40 (2) of the Act applies. Foscote Mews (9 houses). Compulsory Purchase Order confirmed without modification. Jonson Mews (48 houses). Compulsory Purchase Order confirmed subject to the modification that Reference Numbers 12, 13 and 14, Jonson Mews will be excluded from the Order and from the Clearance Area, leaving it to the Council, if they desire to acquire the site of these properties, to proceed under Section 27 of the Act. The Minister also directed that a payment under Section 42 of the Act shall be made in respect of Reference Numbers 17, Alfred Road and 28, Waverley Road. Oliver Mews (11 houses.) Compulsory Purchase Order confirmed subject to the modification that Reference Numbers 4 and 8 will remain in the Order as properties to which the proviso to Section 40 (2) of the Act applies. Rainsford Street (23 houses). Clearance Order confirmed without modification. Randolph Mews (26 houses). Clearance Order confirmed subject to. the following modifications:— Reference Numbers 20 and 21 will be excluded from the Order but not from the Clearance Area as being properties demolished. The Minister also directed that a payment under Section 42 of the Act should be made in respect of Reference Numbers 1 and 5. Richmond Mews (14 houses). Clearance Order confirmed subject to the modification that Reference Numbers 1, 2, 3, 4, 5, 6, 7, 8 and 12 will be excluded from the Ordei and from the Clearance Area. The Minister stated that Reference Numbers 1, 2, 5, 6, 7 and 8 will be excluded in view of the Council's willingness to accept the owner's proposals for dealing with them. The Minister also directed that a payment under Section 42 of the Act be made in respect of Reference Numbers 9 and 10. Richmond Mews West (22 houses). Compulsory Purchase Order confirmed subject to the modifications that Reference Numbers 14 and 15 and the portion of Reference Number 19 shown coloured pink on the map referred to in the Order will remain in the Order as properties to which the proviso to Section 40 (2) of the Act applies. Clearance or compulsory purchase orders confirmed by the Minister previous to 1938:— Clearance Order. Artesian Road (4 houses). Titchborne Row (12 houses). Compulsory Purchase Orders. Burlington Mews West (24 houses). Burlington Mews East (12 houses). Area dealt with by arrangement with owners. Carlton Mews. Following the Council's declaration of a Compulsory Purchase Order in respect of Nos. 1 to 11 (cons.), Carlton Mews and No. 46a, Woodfield Road, a Public Inquiry was held at the Town Hall on the 18th October, 1937. With the consent of the Minister of Health's Inspector the Inquiry was adjourned sine die in order that the Council could examine proposals submitted by the owners. The Council subsequently passed the following resolutions:— (a) That, pursuant to Section 31 of the Housing Act, 1936, joint application be made by the Council in conjunction with the owners of Nos. 6, 7, 8, 9, 10 and 11, Carlton Mews for the substitution of a Clearance Order in place of the proposed Compulsory Purchase Order in respect of those premises. (b) That the Council do accept the offer of Mr. J. B. Harris to dedicate as part of the highway known as Great Western Road the land in advance of the front door steps and areas of Nos. 13 to 27 (odd), Great Western Road, without payment by the Council. (e) That no objection shall be raised by the Council to the stopping up of that part of Carlton Mews situate to the south-east of a line drawn from the boundary dividing Nos. 11 and 13, Great Western Road to the boundary dividing Nos. 5 and 6, Carlton Mews. (d) That the application to the Minister of Health for confirmation of the Compulsory Purchase Order in respect of Nos. 1, 2, 3, 4 and 5, Carlton Mews, and No. 46a, Woodfield Road, be withdrawn subject to closing orders being made in respect of the living accommodation at Nos. 1 to 5 (consecutive), Carlton Mews, and to an undertaking being given by the owner that when possession of the living accommodation at Nos. 1, 2, 3, 4 and 5, Carlton Mews has been obtained, he will forthwith demolish those parts of the building used for living accommodation. (e) That the Special Housing Committee be authorised to include in the Clearance Order relating to Nos. 6 to 11 (inclusive), Carlton Mews, such conditions as may be necessary to ensure the utilisation of the cleared site on a satisfactory basis; that the Common Seal be affixed to any necessary documents, and that the resolution of the Council of 28th January, 1937, be varied accordingly. 50 Clearance Area dealt with during the year. Falconer Mews. This area, comprising Nos. 1, 2, 3 and 4, Falconer Mews, together with a building in the rear of No. 165, Canterbury Road, was declared to be a clearance area on the 5th May, 1938. The buildings are of the ordinary mews type and partly surround a court, which is a cul-de-sac entered from the south side of Canterbury Road Eighteen person will be displaced from this area. Clarendon Street Re-development Area. In last year's report reference was made to an area bounded by the rear boundaries cf the properties in Harrow Road, the canal, the west side of Lord Hills Road and the north side of Bourne Terrace which the Council had declared to be a proposed Re-development Area. Section 35 of the Housing Act, 1936, provides that within six months after a local authority have passed such a resolution or within such extended period as the Minister of Health may allow, the authority shall prepare and submit to the Minister a re-development plan of the area. In view of negotiations which were proceeding with the Church authorities relative to St. Mary Magdalene's School premises it became necessary for application to be made to the Minister to extend the period in which the plan was to be submitted from six to twelve months. The plan was subsequently exhibited in the Council Chamber; notice published in the local Press that the plan had been prepared ; where the plan could be inspected; the manner in which objections thereto could be made; and a notice to the like effect was served on every owner, lessee and occupier of land in the defined area and on all statutory undertakers owning apparatus in the area. Houses Unfit fob Human Habitation. The following figures show the extent of the Council's operations during 1938:— Number of basement rooms closed for human habitation 228 Number of basement rooms closed for sleeping purposes only 25 Number of dwelling-houses or parts of dwelling-houses closed for human habitation (other than basement rooms) 158 Number of persons displaced or who will be displaced as a result of the Council's operations 930 Number of displaced persons re-housed on London County Council Housing Estates 328 Number of displaced persons re-housed on Paddington Borough Council Estates 200 A number ot displaced persons have found accommodation through their own ettorts, while others are awaiting suitable vacancies on London County Council Estates. In lieu of making closing orders the Council, in 30 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. Thirty-four closing orders were determined or undertakings cancelled during the year and 65 other premises made fit for human habitation without recourse to formal proceedings under the Housing Act. A summary of the major works executed in connection with these premises is given below:— Mews Dwellings. Baths fitted 9 Ceilings raised 25 Ceilings repaired 65 Chimney stacks pointed 9 Dampness remedied 19 Dormer windows provided 77 Drain fresh-air-inlets repaired 18 Dustbins provided 2 Firegrates repaired 15 Fire escapes provided 2 Floors repaired and strengthened 53 Food cupboards provided 40 Garages fireproofed 46 Gutters repaired 2 „ renewed 4 Landings and passages lighted and ventilated 12 Permanent ventilation to rooms provided 41 Rain-water-pipes repaired 1 Roofs repaired 14 Sashcords renewed 7 Sinks renewed 5 Skylights repaired 1 „ enlarged 1 Soil pipes repaired 1 Stables separated from habitable rooms 2 Staircases reconstructed 14 „ repaired 13 „ lighted and ventilated 22 handrails provided 28 Walls pointed 21 „ reconstructed or repaired (external) 13 „ repaired (interior) 63 „ plastered 18 Washing accommodation provided 16 Waste pipes repaired 2 Water-closets, solid partitions constructed 26 „ ventilated approach provided 5 „ ventilated 35 „ lighted 14 lobbies constructed 10 „ „ lighted 3 „ „ ventilated 3 51 Water supply from mains provided 4 Windows enlarged 43 „ provided 6 „ raised to required height 2 „ repaired 9 Basements. Additional water supplies provided 2 Areas enlarged, surfaces lowered 34 Area steps reconstructed 8 Areas and yards paved 20 Concrete laid over site 92 Damp-proof courses in walls provided 117 Drains, re-laid, trapped, ventilated 15 Floors lowered, new floors provided, floors reconstructed 106 Food cupboards provided 7 Means of sub-floor ventilation provided 30 New drains constructed 3 New water-closets provided 4 New walls constructed 27 Obstructive buildings demolished 6 Rooms cleansed, etc. 107 Sinks and baths provided 13 Walls rendered in waterproof materials 87 Windows enlarged, new windows provided 17 During the year over 841 inspections and 2,893 re-inspections of basement premises were made, also 263 inspections and 1,855 re-inspections of mews dwellings. Town Planning. A condition of the London County Council's consent to the conversion and altering of premises is that the Borough Council must be satisfied as to the proposed user of basement rooms. During the year the London County Council referred to the Borough Council for examination a large number of applications of this nature, and as a result of the Council's observations permission was refused for certain basement rooms to be used for human habitation where the rooms did not conform to the statutes and regulations in force in the Borough. Compulsory Repairs. No notices were served during the year under Section 9 of the Housing Act, 1936. Four hundred and twelve communications were however sent to owners drawing attention to defects liable to be dealt with under this Section. In three hundred and fifty-nine instances these communications resulted in the defects being remedied. Certificates as to the Condition of Houses. During the year eight certificates were issued under Section 51 of the Housing Act, 1936, in respect of the following houses:— Premises. Period of Certificate. 14, Elnathan Mews 10 years. 29, Elnathan Mews 10 „ 19, Elnathan Mews 10 „ 30, Hethpool Street 10 „ 8, Lanark Mews 10 „ 8, Oxford Mews 10 „ 3, Princes Mews 10 „ 17, Shirland Mews 10 „ Housing on London County Council Estates. During the year 541 applications for housing accommodation were sent forward to the Connty Council, with a request that the applications be given preferential consideration in the allocation of accommodation on grounds of overcrowding, unhealthy conditions, medical and special hardship. Of this number 111 were offered, and accepted, suitable vacancies. A further 12 families were housed on applications submitted direct to the County Council. Since April, 1920, 1,234 Paddington families have secured accommodation on London County Council estates on applications submitted by the Borough Council, and since September, 1930, 533 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 eighty-six 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. 52 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.) Dibdin House, Maida Vale 30 Wormholt Estate, Hammersmith 63 Old Oak Estate, East Acton (adjoining Wormholt) 75 Walter House, Ossulston Estate, St. Pancras 1 Somerset Buildings, Churchway Estate, St. Pancras 1 Priestley House, St. Pancras 1 Leonard Day House, St. Pancras 2 Levita House, Ossulston Estate, St. Pancras 1 Seymour Buildings, Churchway Estate, St. Pancras 1 Chalton House, Ossulston Estate, St. Pancras 1 Becontree, Essex 2 Hanwell 17 Honor Oak, Deptford 1 Kennington Park, Lambeth 1 Loraine Place, Islington 5 Roehampton, Putney 2 St. Helier, Morden 3 Watling, Edgware 20 White Hart Lane, Tottenham 1 Berners House, Barnsbury Estate 1 Kenmore Park, Kenton 4 Castelnau Estate, Barnes 2 Whitfield House, St. Marylebone Housing Association, Limited 1 Total 236 During the year two vacancies occurred in the 150 houses on the Wormholt Estate (1927-28 Agreements), and five vacancies in the 236 houses provided under the 1934 Agreement. Altogether the Agreements entered into by the Borough Council have resulted in 477 families obtaining improved housing conditions. On the 27th October, 1938, the Council agreed to continue the 1934 Agreement with the London County Council on a revised basis of contribution of £4 10s. Od. per dwelling a year, to take effect from the 1st January, 1939. Borough Council Accommodation within the Borough. Artesian House, Artesian Road 8 flats Brindley House, Brindley Road 8 flats Dudley House, North Wharf Road 50 flats 8, Warrington Crescent (non-working class) 6 flats 30, Westbourne Square (non-working class) 4 flats The flats at Dudley House were completed ready for occupation on the 1st September, 1938, and tenants selected from families displaced as a result of the Council's operations under the Housing Act, 1936, are being re-housed therein. The accommodation consists of fifteen four-roomed flats, twenty-five three-roomed flats, and ten two-roomed flats, and will provide accommodation for some 232 persons. Schemes under Consideration. Chippenham and Rodborough Mews, and Woodficld Crescent. It is proposed to erect fifty-four flats on this site. The accommodation will comprise sixteen four-roomed flats, twenty-one three-roomed flats, thirteen two-roomed flats, and four one-roomed fiats. The accommodation will house some 235 persons. Clarendon Street Redevelopment Area. A scheme to erect several hundred working-class flats on this site is at present under consideration. Accommodation Provided in the Borough by Private Enterprise. Dibdin House. A block of 160 flats at the Carlton Vale end of Maida Vale was completed for the Ecclesiastical Commissioners for England during the year. The entire scheme provides for 233 flats. The completed portion has been erected in accordance with the provisions of the Housing Acts, 1930-1936, under which subsidies from the Government and the London County Council are obtainable. The selected tenants were nominated by the London County Council and were drawn from persons displaced in Paddington and adjoining Boroughs in connection with operations under the Housing Act. Thirty displaced families from Paddington secured accommodation. 53 Siddons House. Following an agreement with the Council under which the Grand Junction Company, Limited, were to provide accommodation in the vicinity for persons displaced from the Rainsford Street Clearance Area, a block of workmen's flats was erected on the sites of Nos. 53, 55 and 57, Harrow Road, the Salvation Army Hall, Nos. 25, 27, 29 and 31, Irongate Wharf Road and other adjoining land. The flats were completed ready for occupation Dy the 31st December, 1938, and eighteen families displaced by the operation of the Clearance Order were rehoused therein early in the New Year. Abatement of Overcrowding. The overcrowding survey undertaken by the Council in 1935 revealed the existence of 1,998 cases of overcrowding in 27,212 occupied working-class dwellings, a percentage of 7.34 ; 231 cases of new overcrowding have since been brought to notice. At the end of 1938 the known overcrowding in the Borough had been reduced to 887 cases, giving a percentage for the 27,212 occupied workingclass dwellings of 3.25 per cent., or a reduction of 55 per cent, in the 1935 overcrowding figure. These figures, however, can only be considered as a means of showing the progress that is being made in abating overcrowding, as without a full survey of all the working-class dwellings in the Borough no information on the subject could be regarded as being strictly accurate. Of the abated overcrowding, 104 families were accommodated on London County Council estates, while others secured adequate accommodation of a private nature, either by obtaining additional rooms in the same house or by removing to other premises. In many cases the overcrowding was abated by natural causes, such as a member of the family leaving home, etc. It is hoped that the figure of 887 cases will be further considerably reduced during the next year when the flats now being erected at the White City, Hammersmith, become available for letting. These flats are conveniently situated for local workers, and it is understood that it is the intention of the County Council to allocate a considerable portion of the accommodation to Paddington. Three hundred applications from overcrowded families for accommodation on County Council estates have already been sent forward to the County Valuer, and it is anticipated that many of these families will be found suitable for accommodation at the White City. It is expected also that many other families who for economic reasons, etc., are unable to live outside of the Borough will become decrowded by overflowing into the accommodation left vacant Dy removals to County Council estates. Other factors which will have a strong bearing on the reduction of overcrowding in the Borough are:— The proposed redevelopment of the Clarendon Street Area—an area showing 50 per cent. of overcrowding in 1935 ; the clearance and redevelopment of certain mews areas the subject of Clearance or Compulsory Purchase Orders ; and the closure of unfit mews and basement dwellings. Table No. 1 below shows the distribution of overcrowding according to Wards ; and Table No. 2 the distribution of overcrowded families in relation to size of family and size of dwelling occupied. TABLE No. 1. Borough Wards. Totals of Families. Percentage Overcrowded. Overcrowded. Number of Workingclass Dwellings in 1935. Queen's Park 23 3,647 .63 Harrow Road 96 7,990 1.2 Maida Vale 87 3,335 2.6 Westbourne 168 5,363 3.13 Church 399 3,122 12.78 Town 75 1,778 4.21 Lancaster Gate West 4 332 1.2 Lancaster Gate East 8 369 2.16 Hyde Park 27 1,276 2.11 Total 887 27,212 3.25 54 TABLE No. 2. Size of family ("equivalent number" of persons). Size of dwelling occupied, in terms of the maximum "equivalent number" of persons permitted to occupy it without causing it to be overcrowded. Totals of families. 0* ½* 1 1½ 2 2½ 3 3½ 4 4½ 5 5½ 6 6½ 7 7½ 8 8½ 9 1 1 2 3 1½ - - - - 2 - - - 5 16† 21 2½ - - - 9 21 30 3 - - - 6 15 5 26 3½ - - - 3 5 24 110 142 4 - - - - 5 58 130 3 196 4½ - - - - 2 16 64 3 - 85 5 - - - - 1 13 60 - 6 6 86 5½ - - - - - 6 40 - 16 - 23 85 6 - - - - - 6 17 - 20 3 40 1 87 6½ - - - - - 3 6 1 9 7 8 1 - 35 7 - - - - - 1 7 - 5 1 5 4 1 - 24 7½ - - - - - 2 1 - 3 - 3 1 3 - 4 17 8 - - - - - - 2 - 4 1 6 - 8 1 1 1 24 8½ - - - - - 1 1 - - - 1 - 3 - - 1 - 7 9 - - - - - 2 - - - - 2 - 5 - 1 4 - 1 15 9½ - - - - - - - - - - - - - - - - - 1 1 2 10 - - - - - - - - 1 - - - 1 - - - - - - 2 Totals 1 2 - 23 65 137 438 7 64 18 88 7 21 1 6 6 - 2 1 887 * 0=a dwelling of 1 room under 50 square feet; ½=a dwelling of 1 room between 50 and 70 square feet. †amilies with insufficient accommodation to secure proper sex separation and for that reason overcrowded. 55 LEGAL PROCEEDINGS. Housing Act, 1936. Premises and Offence. Result of Proceedings. No. 91, Fernhead Road. (Failure to insert in the rent-book a statement of the permitted number of persons for the dwellinghouse to which the rent-book relates.) (Section 62.) Defendant pleaded guilty, but no penalty inflicted ; summons dismissed under the Probation of Offenders Act. Magistrate expressed the hope that the liabilities of Landlords in regard to this and similar matters would be circulated through the Press. No. 43, Lancefield Street. (Failure to insert statement, as No. 91, Fernhead Road.) Defendant pleaded guilty, with result as above. No. 190, Gloucester Terrace. (Failure to insert statement, as No. 91, Fernhead Road.) Defendant pleaded guilty, with result as above, but also ordered to pay costs amounting to 10s. Od. No. 41, Cornwall Road. (Causing or permitting the dwelling-house to become overcrowded.) (Section 59.) Summons withdrawn. HOUSING. (Ministry of Health Table) 1.—Inspection of Dwelling-houses during the Year. (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health and Housing Acts) 3,166 (6) Number of inspections made for the purpose 25,687 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 - (6) Number of inspections made for the purpose - (3) Numberof 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 *412 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) by owners 359 (6) by Local Authority in default of owners - B. Proceedings under Public Health Acts— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 1.94S (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) by owners ... 2,001 (6) 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 3 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders 3 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 411 (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined, the tenement or room having been rendered fit 34 * Informal notices. 4.—Housing Act, 1936—Overcrowding. (a) (1) Number of dwellings overcrowded at the end of the year 887 (2) Number of families dwelling therein ... 887 (3) Number of persons dwelling therein ... 4,229$ units (6) Number of new cases of overcrowding reported during the year 120 (c) (1) Number of cases of overcrowding relieved during the year 1,241 (2) Number of persons concerned in such cases 4,657 J units (id) Particulars of any cases in which dwelling-houses have again become overcrowde after the Local Authority have taken steps for the abatement of overcrowding ... i 3 (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report ... ... 56 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 2,868, comprising 200 bullocks and 2,668 sheep, an increase of 418 sheep as compared with 1937. Carcases Inspected and Condemned. Cattle, excluding Cows. Cows. Calves. Sheep and Lambs. Pigs. Number killed ... 200 — — 2,668 — Number inspected 200 — — 2,668 — All diseases excepting Tuberculosis. Whole carcases condemned 1 Carcases of which some part or organ was condemned 107 — — 2,162 — Percentage of the number inspected affected with disease other than tuberculosis 53.5 — — 81.0 — Tuberculosis only Whole carcases condemned — Carcases of which some part or organ was condemned 5 — — — — Percentage of the number inspected affected with tuberculosis 2.5 — — — 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.—No legal proceedings were taken under section 180 of the Public Health (London) Act, 1936, in respect of unsound food. Food Purveyors.—At the end of the year there were 999 purveyors of food in the Borough, classified as follows :—Butchers 66, Fishmongers 30, General 74, Grocers 149, Fried Fish 32, Refreshments 157, Confectioners 173, Greengrocers 96, Milk 133, Provision 89. In addition to the above, there were at the end of 1938, 56 licensed Street Traders selling food within the borough, namely :—Fruit and Vegetables 39, Ice Cream 7, Light Refreshments 9, Fish 1. These, with the storage premises of some 20 Street Traders licensed by other boroughs, are under constant supervision. There were 7 premises on which fish curing was performed, this business, as well as fish frying, being regulated by special bye-laws. The number of visits of inspection paid to premises occupied by food purveyors was 4,873. Section 187 of the Public Health (London) Act, 1936, provides that any premises (other than premises used as a club, hotel or restaurant) used or proposed to be used for the preparation, or manufacture of sausages, potted, pressed, pickled or preserved meat, fish or other food intended for sale shall be registered by the owner or occupier, or intending occupier thereof with the sanitary authority. At the close of the year the Register contained the addresses of 92 premises. Ice Cream.—There were 189 shops at which ice cream was known to be sold, comprising the following kinds of businesses :—Bakers 2, General 25, Milk 21, Confectioners 75, Refreshment 39, Wholesale 3, Newsagents 20, Greengrocers 2, Fancy Goods 2. Three hundred and twenty 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 1938, there were 163 entries in the Register. Food Destroyed.—The total weight of food surrendered by tradesmen and dealers for destruction by the Council was 2 tons, 6 cwt., 1 qtr., 24 lbs., comprising the following varieties : Meat and offal, 4,206 lbs. ; poultry, 256 lbs. ; vegetables, 18 lbs. ; fish, 718 lbs.; and tinned meat, 6 lbs. 57 Dairies and Milkshops.—At the end of the year 1937 there were 139 names on the Register. During the year 1938, 56 names were added and 3 businesses were closed, making a total of 192. There were 540 inspections made. In addition to the above-mentioned, there are 42 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 93, viz. :— Principal licences to sell " Pasteurised " milk... 61 Supplementary licences to sell " Pasteurised " milk from addresses outside the Borough 8 Principal licences to sell " Tuberculin Tested " milk 20 Supplementary licences to sell " Tuberculin Tested " milk from addresses outside the Borough ... ... 4 93 The samples taken by the Council's Inspector numbered 66, comprising 62 of " Pasteurised " milk and 4 of " Tuberculin Tested " milk. The samples included 19 of " Pasteurised " milk and 1 of " Tuberculin Tested " taken at Paddington Hospital, and 28 of " Pasteurised " milk taken at Schools. With 3 exceptions all the samples were reported to comply with the appropriate bacteriological standards. In addition to these samples, 17 were submitted for animal inoculation for tubercle bacilli. All these samples gave negative results, except for two. In these two cases all the animals inoculated died of inter-current infection. It was not possible therefore to report as to the presence of tubercle bacilli. 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, 7 (1.16 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 1.33 per cent, in 1937 and 2.0 per cent, in 1936. Fifty-seven of the samples were taken on Sundays and Bank Holidays. All were reported to be genuine except one, which was 28.66 per cent, deficient in fat. Seven 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. Fifty-three samples were taken during 1938, 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 1938, 17 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. Two contraventions of the Regulations were detected but no legal action was deemed necessary. Public Health (Condensed Milk) Regulations, 1923 and 1927. During the year 1 sample of full cream unsweetened, and 10 samples of skimmed sweetened condensed milk were taken. All were found to comply with the Regulations. Public Health (Dried Milk) Regulations, 1923 and 1927. Four samples of dried milk were taken during 1938 which complied with the Regulations. 58 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 1938, samples of Water, Greens, Pork, Tinned Peas and Salmon and Shrimp Paste were submitted for special examination. A coccus of a staphylococcus pyogenes aurens type was isolated from the Salmon and Shrimp Paste. In no other case was any unusual feature 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 64. In connection with the analysis of milk samples, the Public Analyst furnishes the result of his analysis and the following table is of interest. Genuine Milk Samples, 1938. Average Monthly Figure for Percentage. Fat Content. Non-Fattv Solids. January 3.77 8.95 February ... 3.63 8.84 March 3.49 8.82 April 3.39 8.69 May ... 3.34 8.77 June 3.37 8.73 July 3.13 8.66 August ... ... 3.43 8.71 September ... 3.67 8.72 October 3.77 8.80 November ... 3.79 8.81 December ... 3.83 8.77 Average for Year. Samples taken at Paddington Station ... 3.68 9.08 ,, ,, elsewhere 3.61 8.87 Samples Submitted to Public Analyst, 1938. Number examined. Number Adulterated. Percentage Adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Ale — 4 — — — — Ammoniated Tincture of Quinine ... — 2 — — — — Baking Powder — 1 — — — — Blaud's Pills ... — 1 — — — — Boracic Ointment — 2 — — — Blue Ointment — 1 — — — — Blue Pills — 1 — — — — Brandy... — 1 — — — — Bread ... ... ... 11 — — — — — Bread and Butter — 2 — — — — BreadCrumbs... — 1 — — — — Butter ... — 13 — — — — Cake — 1 — — — — Camphorated Oil — 2 — — — — Cheese ... .., — 9 — — — — Chocolate — 1 — — — — Chocolate Ginger — 1 — — — — Cocoa ... — 5 — — — — Coffee ... — 5 — — — — Coffee and Chicory Essence ... — 1 — — — — Cooked Peas ... — 1 — — — — Cooking Fat — 1 — — — — Cornflour — 2 — — — — Cough Tablets... — 1 — — 59 Samples submitted to Public Analyst, 1938.—continued. Number examined. Number Adulterated. Percentage Adulterated. Formal. Informal. Formal. Informal. Formal. Informal. Cream ... — 12 — — — Currants — 4 — — — — Custard Powder — 4 — — — — Dried Fruit Salad — 4 — — — — Dripping — 4 — — — — Fish Paste — 3 — — — — Flour ... — 4 — — — -— Frozome ... ... ... ... — 1 — — — — Full Cream Dried Milk — 3 — — — — Full Cream Condensed Milk, Unsweetened — 1 — — — — C.in 1 2 — 1 50.00 — Grey Powder ... ... — 2 — — — — Ground Almonds — 1 *— — — — Ground Ginger... — 1 — — — — Half Cream Dried Milk — 1 — — — — Honey — 5 — — — — Ice Cream — 2 — — — — Ice Cream Soda — 1 — — — — Iodine Ointment — 2 — — — — Iodoform Ointment ... — 1 — — — — Jam — 8 — 1 — 12.50 lam Tarts — 2 — — — — Kola Champagne — 1 — — — — Lard — 4 — — — — Lemonade — 1 — — — — Lemonade Powder — 4 — — , — — Liquid Coffee ... — 1 — — — — Margarine — 8 — — — — Meat Paste ... — 5 — — — — Meringue — 1 — — — — Milk 260 40 3 — 1.15 — Milk Pudding Powder — 1 — — — — Mincemeat — 4 — — — — Mint Sauce — 1 — — — — Mustard — 3 — — — — Peel — 4 — — — — Pepper — 3 — — — — Pickles ... — 5 — — — — Port — 1 — — — — Preserved Ginger — 1 — — — — Raisins ... — 4 — — — — Rice ... — 2 — — — — Rolls and Butter ... — 2 — — — — Rum 1 2 — 1 — 50.00 Sago — 2 — — — — Salad Dressing ... — 2 — — — — Sage and Onion Stuffing — 1 — — — — Sausages 12 — — — — — Semolina ... ... ... ... ... — 2 — — — — Shredded Suet with Flour — 2 — — — — Skimmed Condensed Milk, Sweetened — 10 — — — — Sponge Cakes — 2 — , — — — Suet (Chopped) — 4 — — — — Sugar ... — 2 — — — — Sulphur Ointment — 2 — — — — Sultanas 1 4 — 1 — 25.00 Sweets ... — 2 — — — — Tapioca — 2 — — — — Tea — 3 — — — — Tinned Fish — 6 — — — — Tinned Fruit ... — 4 — — — — Tinned Peas — 7 — — — — Tinned Tomatoes — 5 — — — — Tinned Steak and Kidney Pudding — 1 — — — — Tinned Lunch Tongue — 1 — — — — Tinned Soup ... — 1 — — — — Tinned Roes ... — 1 — — — — Tinned Beans ... — 1 — — — — Tinned Rice Pudding — 1 — — — . — Tinned Veal, Ham and Tongue Roll — 1 — — — — Tripe — 4 — — — — Table Jelly — 1 — — — — Vinegar — 6 — — — — Vinegar of Squills — 1 — — — — Whisky — 2 — — — — White Precipitate Ointment... — 2 — — 1 — — Yellow Mercury Oxide — 1 — — — — Zesto — 1 — — — — Zinc Ointment — 1 — — — — 286 314 3 4 1.04 1.27 V ¥ J 600 7 v "V ' 1.16 60 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. No legal action was taken during the year under these Bye-laws, but cautions were issued in two instances. Agricultural Produce (Grading and Marking) Act, 1928. 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. 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 5, Butter 10, Apples 5, Tomatoes 5. 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. At the end of 1938, there were 119 entries in the list, as compared with 121 at the end of 1937. 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. PIGEONS. No action was taken by the Council during the year under Section 121 of the Public Health (London) Act, 1936. 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. No notices were served under the Act in respect of rat-infested premises. Rat Week.—This was held from 7th to 12th November inclusive. The usual circular letter was sent out to the principal wharfingers, railway companies, tradesmen, etc. VERMINOUS CONDITIONS. Cleansing of Verminous Persons.—One hundred and eighty-three adults and 239 children received treatment during the year. Section 127 of the Public Health (London) Act, 1936, authorises the cleansing of verminous persons by the exercise of powers granted by a petty sessional court in 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. Cleansing of Verminous Rooms.—Notices under Section 123 of the Public Health (London Act, 1936, were served with respect to 63 premises, the verminous rooms numbering 87. The owners of 31 premises accepted the Council's offer with regard to the spraying of infested rooms with a special insecticidal solution, 46 rooms being so treated at a charge to the owners of 7s. 6d. per room. 61 In cases where bedding, etc., was found to be infested, it was removed to the Kensington Borough Council's Disinfecting Station for steam treatment. Disinfestation of Furniture, etc., with Hydrogen Cyanide.—Following the completion of the Borough Council's flats at Dudley House it became necessary to arrange for the removal and disinfestation of the furniture and household effects of the ingoing tenants. The Medical Officer of Health of Kensington was asked if he would undertake the work under the Agreement in force between the two Councils, but replied that owing to the large number of removals in his own Borough at that time he was not in a position to offer us the necessary facilities only over a protracted period. As this would have meant a loss of rent to the Council an Agreement was entered into with the Associated Fumigators, Limited. The Agreement with the Company provides, inter alia, for the works specified as follows :— (a) Remove all the effects as directed by the Medical Officer, load into a suitably constructed gas tight van to be provided by the Company and convey the loaded van to the Council's Wharf specified. (b) Treat each load of effects with hydrogen cyanide gas of sufficiently high concentration to kill all bugs and other vermin and their ova, the treatment to extend over a period of not less than four hours. (c) After fumigation thoroughly ventilate the van and where applicable beat the effects and take all such steps as may be necessary to ensure that the effects are free from any dangerous concentration of hydrogen cyanide gas. (d) Carry out tests at the request and to the satisfaction of the Medical Officer for the presence of hydrogen cyanide gas after ventilating the treated effects. (e) Deliver all the effects when free from the said hydrogen cyanide gas to the dwelling houses as directed by the Medical Officer on the same day as removal and disinfestation takes place as aforesaid and on delivery to the said dwelling houses issue a certificate to the Medical Officer that at the-time of such delivery and thereafter all the effects are free from hydrogen cyanide gas. A charge is made by the Company of two pounds (£2) per household when two or more are dealt with in one day or two pounds fifteen shillings (£2 15s. Od.) when only one household is dealt with in one day, the work to be to the satisfaction of the Medical Officer. The steam disinfection of bedding, etc., is being carried out by Kensington under the present contract at no extra charge. During the year the Kensington Borough Council removed and treated the furniture, etc., of eight families and the Associated Fumigators, Limited, seventy-nine families. The cost of the work was £185. 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 three residents of the Borough were provided with insulin at a cost to the Council of £3 7s. 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. During 1938 there were eight prosecutions, fines ranging from 2s. 6d. to 10s being imposed. The publicity which has been given to the bye-law has had good effect in causing many dozowners 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 b\'e-law were frequently posted on shingle-bins throughout the Boroui'h. 62 LEGAL PROCEEDINGS* 1938. Offence. Offence. Result. Public Health (London) Act, 1936 Section 82. (Summonses for (a) Order and (6) Penalty in each case) 73, Amberley Road ... Waste pipe to sink on top floor half-landing defective and improperly fixed. (a) Work done (6) £2 fine ; £2 2s. Od. costs. 133, Ashmore Road ... Ground floor front room damp ... ... (a) Work done : £2 2s.Od. costs ; (6) £1 fine, costs included with (a). 160, Ashmore Road ... Ground floor front room damp ... (a) and (6) Summonses dismissed. 240, Ashmore Road ... Ground floor front room damp ... (a) Work done, £1 Is. Od. costs ; (6) 10s. fine ; £1 Is. Od. costs. 30, Brindley Street ... Main drain choked. (a) and (6) Summonses dismissed. 82, Fernhead Road ... First floor water-closet choked ; waste pipe of sink in top floor water-closet apartment choked. (a) and (6) Work done. Summonses dismissed under Probation of Offenders Act. 18, Hampden Crescent Main drain choked ... ... ... ...• ... ... (a) Work done; (b) £2 fine ; £2 costs. 25, Kennet Road Premises without a proper and sufficient water supply (a) Work done ; (6) Summons dismissed under Probation of Offenders Act. >» »# Walls of basement front and back rooms damp ; roof of first floor water-closet defective ; front entrance steps leaky ; gutter of back addition defective ; waste pipes on back addition improperly discharging. (a) Order made; (6) £1 fine. 21, Kensal Road Flat roof defective ... ... ... ... ... ... (a) and (6) Work done. Summonses withdrawn. £2 2s. Od. costs. 139, Lancefield Street Main and back addition roofs defective (a) Work done ; (6) 10s. fine ; 10s. costs. 15, Norfolk Place First floor water-closet defective (a) and (b) Summonses dismissed, £2 2s. Od. costs against the Council. 144, Porthall Road ... Ground floor back room damp ... (a) Work done, £1 Is. Od. costs (6) 2s. 6d. fine. 178, Shirland Road ... Walls of first floor back room and water-closet damp (a) Order made, £1 fine r £2 costs. 59, Sutherland Ave. ... Roof defective (a) Work done. Summons dismissed under Probation of Offenders Act, (6) £2 fine ; £2 2s. Od. costs to include both summonses. Section 105. (Insufficient ashpits.) 37, Cirencester Street Premises without a sufficient ashpit (dustbin) 10s. fine ; 10s. costs. 89, Lancefield Street... Premises without a sufficient ashpit (dustbin) Notice complied with. Summons dismissed under Probation of Offenders Act. 178, Shirland Road ... Premises without a sufficient ashpit (dustbin) Notice complied with. Summons dismissed under Probation of Offenders Act. 63 LEGAL PROCEEDINGS, 1938—continued. Premises. Offence. Result. Section 156. (Common Lodging Houses.) 6, Consort Street (late Albert Street). Keeping the premises as a Common Lodging House without a licence. Summons dismissed. £2 2s. Od. costs against the Council. „ Keeping the premises as a Common Lodging House without a licence. Summons dismissed. 11, Consort Street Keeping the premises as a Common Lodging House without a licence. Summons dismissed. 86, Harrow Road Keeping the premises as a Common Lodging House without a licence. Bye-laws Pursuant to the above and other Acts. Summons not served, defendant "gone away." 32, Amberley Road ... Failing to maintain water service pipe to yard water-closet in a proper state of repair; failing to keep fittings to windows of ground floor front room, first floor front room and second floor front room in good order and repair; failing to maintain ashpit (dustbins) in a proper condition of repair. Summonses dismissed under Probation of Offenders Act. 10s. costs. 56, Amberley Road ... Executing drainage work contrary to the provisions of the Bye-laws. Summons dismissed under Probation of Offenders Act. £2 2s. Od. costs. 14, Brindley Street ... Failing to carry out annual cleansing of ground floor passage, ground floor back and addition rooms, first floor back room, second floor front and back rooms, back area and washhouse. £2 fine ; £2 costs. .. Failing to keep the window cords of first floor front room in good order and repair. £2 fine ; £2 costs. Failing to keep the paving of back area in proper repair ... £2 fine ; £2 costs. 20, Brindley Street ... Failing to carry out annual cleansing of second floor back room. £1 fine ; £1 costs. 80, Cirencester Street Failing to maintain the flushing cistern to yard water-closet in a proper state of repair. £1 fine ; £1 costs. 19, Clarendon Crescent Failing to maintain flushing cistern of ground floor watercloset in a proper state of repair. Summons dismissed under Probation of Offenders Act. 18, Delamere Terrace Failing to keep the window cords of ground floor back room in good order and repair. £1 fine ; £1 costs. .. Failing to maintain adequate means of ventilation to the ground floor back room. £1 fine ; £1 costs. 25, Kennet Road Failing to carry out annual cleansing of top floor front and back rooms, first floor water-closet basement scullery and water-closet, general staircase, landings and passages. £1 fine; £1 10s. Od. costs. 104, Ledbury Road ... Executing drainage work contrary to the provisions of the Bye-laws. Summons dismissed under Probation of Offenders Act. £1 Is. Od. costs. 81, St. Stephens Gdns., (late 27, Burlington Road). Failing to provide water-closet accommodation and proper accommodation for the storage of food for the separate use of each family. £2 fine ; £4 4s. Od. costs. 21, Tavistock Crescent Failing to carry out annual cleansing of staircase, wash-house, top water-closet, first floor front room and upper addition room. £1 Is. Od. fine ; £2 2s. Od. costs. 39, Tavistock Crescent Failing to carry out annual cleansing of staircase, passages, cupboard on first half-landing, wash-house, water-closets and second floor back room. £1 fine; £2 2s. Od. costs. 41, Walterton Road ... Failing to provide water-closet accommodation and proper accommodation for the storage of food for the separate use of each family. Adjourned sine die. 61 LEGAL PROCEEDINGS, 1938—continued. Premises. Offence. Result. 67, Waverley Walk ... Failing to carry out annual cleansing of staircase, yard watercloset, ground floor passage, front and back areas and second floor front room. Adjourned sine die. " Failing to maintain the paving of front and back areas in proper repair. Adjourned sine die. Conveyance of offensive refuse in a manner contrary to the Bye-laws. £1 fine ; £1 costs. .. Conveyance of offensive refuse in a manner contrary to the Bye-laws. £1 fine ; £1 Is. Od. costs. Bye-laws made by the London County Council respecting the business of a Rag and Bone Dealer. 30. Lancefield Street... Failing to maintain the premises so as to ensure thorough cleanliness. Summonses adjourned sine die. Bye-laws made by the London County Council respecting the business of a Diesser of Fur Skins. 30, Lancefield Street... Failing to cause the floor of the premises to be kept clean ... Summonses adjourned sine die. Food & Drugs (Adulteration) Act, 1928. Offence. Result. Sample No. Ill Selling milk 35.33 per cent, deficient in fat Summons dismissed under Probation of Offenders Act. 10s. costs. Sample No. 113 Selling milk 11.66 per cent, deficient in fat Summons dismissed under Probation of Offenders Act. 10s. costs. Sample No. 150 Selling milk 28.66 per cent, deficient in fat Summons dismissed under Probation of Offenders Act. £3 3s. Od. costs. Regulations made under Rent and Mortgage Interest Restrictions (Amendment) Act, 1933. Premises. Offence. Result. 2, Amberley Road ... Failing to inscribe the required particulars in the rent book of the tenant of the basement. Summons dismissed under the Probation of Offenders Act. 9, Amberley Road ... Failing to inscribe the required particulars in the rent book of the tenant of the second floor. Summons withdrawn. 14, Brindley Street ... Failing to inscribe the required particulars in the rent books of the tenants of the first floor front room, first floor back room and second floor rooms. Summonses adjourned sine die. 37, Brindley Street ... Failing to inscribe the required particulars in the rent book of the tenant of the ground floor rooms and first floor back room. Summons adjourned sine die. 39, Clarendon Crescent Failing to inscribe the required particulars in the rent book of the tenant of the first floor. Summons dismissed under Probation of Offenders Act. 2, Delamere Crescent Failing to inscribe the required particulars in the rent book of the tenant of the basement. Summons dismissed under Probation of Offenders Act. 21, Senior Street Failing to inscribe the required particulars in the rent books of the tenants of the basement and second floor. Summonses adjourned sine die. 22, Tavistock Crescent Failing to inscribe the required particulars in the rent book of the tenant of the ground floor. Summons dismissed under Probation of Offenders Act. 43, Walterton Road ... Failing to inscribe the required particulars in the rent book of the tenant of the first floor. Summons withdrawn by direction of Magistrate. 9, Woodfield Place ... Failing to inscribe the required particulars in the rent books of the tenants of the ground, first and second floors. Summonses dismissed under Probation of Offenders Act. £1 costs. 65 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. 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 _ 1938 ... 2,179 — 1,677 14,539 13 72 71 40 1752 11 599 61 15 115 6 4 — 8 275 — 37 498 1 7 153 1 3 — 66 CONTENTS. page Acute Encephalitis Lethargica ... ... 23 Acute Influenzal Pneumonia ... ... 23 Acute Polio-encephalitis ... ... ... 23 Acute Polio-myelitis... ... ... ... 23 Acute Primary Pneumonia ... ... ... 23 Acute Rheumatism ... ... ... ... 24 Administrative Work ... ... ... 42 Aged, etc., Persons, Removal of ... ... 61 Agricultural Produce (Grading and Marking) Act, 1928 60 Annual Cleansing ... ... ... ... 46 Ante-natal Consultation Centres ... 6,35 Anthrax ... ... ... ... ... 23 Artificial Cream Act, 1929 ... ... ... 60 Artificial Pneumothorax ... ... ... 28 Artificial Sunlight Treatment ... 28. 35-36 Bacteriological Work ... ... ... 43 Bakehouses ... ... ... ... ... 48 Basement Rooms ... ... ... ... 51 Bath Water Examinations ... ... ... 60 Beauchamp Lodge Emergency Home ... 39 Births ... ... ... ... ... 7-10 Borough Council Accommodation within the Borough ... ... ... ... 52 Canals, Canal Boats ... ... ... 44-45 Cancer ... ... ... ... ... 25 Cerebro-spinal Fever ... ... ... 23 Certificates as to Condition of Houses ... 51 Chicken-pox ... ... ... ... ... 21 Child Life Protection ... ... 40-41 Cholera ... ... ... ... ... 25 Clarendon Street Redevelopment Area ... 50 Clearance Orders ... ... ... ... 49 Clinics, Treatment Centres, etc. ... ... 6 Combined Drainage ... ... ... 43-44 Common Lodging Houses ... ... 46-47 Compulsory Purchase Orders ... ... 49 Compulsory Repairs ... ... ... ... 51 Compulsory Removal of Aged, etc., Persons 61 Condensed Milk Regulations ... ... 57 Consultation Centres ... ... 6, 33, 36 Consultative and Physical Treatment Centre 35 Continued Fever ... ... ... ... 21 Contraceptive Advice ... ... ... 38 Convalescent Homes ... ... 34, 40 Dairies and Milkshops ... ... ... 57 Day Nurseries ... ... ... 41, 42 Deaths 7-8, 10-12 Dental Treatment : Maternity and Child Welfare ... ... 36 „ „ Tuberculosis ... ... 28 Diarrhoea ... ... ... ... ... 26 Diphtheria ... ... ... ... ... 18 „ Carrier Clinic ... ... ... 19 „ Immunisation ... ... 19-20 Disinfection ... ... ... ... ... 43 Disinfestation ... ... ... 60, 61 District Inspectors' Work ... ... ... 65 Dogs, Fouling of Footways by ... ... 61 Drainage, Combined ... ... ... 43-44 page Drainage, House ... ... ... ... 43 „ Reconstruction Plans ... ... 43 Dried Mills Regulations ... ... ... 57 Dysentery ... ... ... ... ... 25 Erysipelas ... ... ... ... ... 23 Extra Nourishment: Tuberculosis ... 29 ,, ,, Maternity and Child Welfare 39-40 Factories Act, 1937 ... ... ... 47-48 Food Adulteration ... ... ... ... 57 „ Bye-laws for the Protection of ... 60 ,, Chemical and Bacteriological Examination ... ... ... ... 58 „ Destroyed ... ... ... ... 56 „ Poisoning ... ... ... ... 25 „ Purveyors ... ... ... ... 56 „ Samples Analysed ... ... 58-59 „ Supervision ... ... ... 56-60 „ Unsound ... ... ... ... 56 Footway fouling by Dogs ... ... ... 61 German Measles ... ... ... ... 22 Glanders ... ... ... ... ... 25 Grants for Necessitous Persons ... 29,39-40 Health Visiting ... ... ... ... 33 Home Helps ... ... ... ... ... 38 Homework (Outworkers) ... ... ... 48 Houses Unfit for Human Habitation ... 50 Housing ... ... ... ... 49-55 Hydrophobia ... ... ... ... 25 Ice Cream ... ... ... ... ... 56 Infant Consultation Centres ... 6, 33-36 Infantile Mortality ... ... ... 13-14 Infectious Diseases, Notification of 16-17 „ „ Nursing of ... ... 42 „ „ Prevention of ... 42 Infective Enteritis ... ... ... ... 26 Inquests ... ... ... ... ... 15 Insulin, Provision of ... ... ... 61 Invalid Children's Aid Association ... 40 L.C.C. Estates, Housing on ... ... 51-52 Legal Proceedings ... ... ... 55,62-64 London Public Medical Service ... ... 42 Malaria ... ... ... ... ... 23 Manure, Removal of ... ... ... 44 Marriages ... ... ... ... ... 9 Massage Treatment ... ... ... 33-34 Maternal Mortality ... ... ... 7, 15, 40 Maternity and Child Welfare ... 33-42 „ Consultations ... ... ... 38 „ Nursing ... ... ... ... 37 „ Outfits ... ... ... ... 38 „ Wards ... ... ... ... 37 Measles ... ... ... ... 21-22 Meat Regulations ... ... ... ... 56 Medical Officers, Visiting ... ... 4, 33-34 Membranous Croup ... ... ... ... 18 Merchandise Marks Act, 1926 ... ... 60 Mews Dwellings ... ... ... ... 50 Midwifery Service ... ... ... ... 37 Milk and Dairies Order, 1926 ... ... 57 67 CONTENTS—continued. PAGE Milk, etc., Grants (M. & C.W.) ... 39-40 „ „ (Tuberculosis) ... ... 29 Milk Sampling ... ... ... 57-58 Milk (Special Designations) Order, 1936 ... 57 Mortuary 44 Necessitous Mothers and Children, Grants for ... ... ... ... 39-40 Nursing of Cases of Infectious Illness ... 42 Obstetric Consultant ... ... ... 38 Ophthalmia Neonatorum ... ... ... 22 Outworkers (Homework) 48 Overcrowding, Abatement of 53 Pharmacy and Poisons Act ... ... ... 60 Pigeons ... ... ... ... ... 60 Plague ... ... ... ... ... 25 Plans, Drainage ... ... ... ... 43 Pneumonia ... ... ... ... ... 23 Population ... ... ... ... ... 8 Post-natal Consultation Centres ... ... 35 Preservatives, etc., in Food Regulations ... 57 Puerperal Fever ... ... ... ... 22 „ Pyrexia ... ... ... ... 23 Rag and Bone Dealers ... ... ... 44 Rag Flock ... ... ... ... ... 48 Rats and Mice Destruction 60 Relapsing Fever ... ... ... ... 25 Rent and Mortgage Interest (Restriction) Acts ... ... ... ... ... 47 Rent Books ... ... ... ... ... 47 Rheumatism (Acute) ... ... ... 24 Rheumatism Centre ... ... ... ... 24 Sanitary Inspectors' Work 65 Scarlet Fever ... ... ... ... 17-18 page Schools ... ... ... ... ... 43 Sewer Connections ... ... ... ... 44 Shops Acts, 1934 and 1937 ... 48 Slaughter of Animals Act 56 Slaughterhouses ... ... ... ... 56 Smallpox ... ... ... ... ... 21 Smoke Control ... ... ... ... 44 Staff 4-5, 42 Supply of Medicine, etc. ... ... ... 61 Tenement Houses ... ... ... 45-46 " Toddlers " Clinic 36 Town Planning ... ... ... ... 51 Trade Nuisances ... ... ... ... 44 Treatment Centres, Clinics, etc. ... ... 6 Tuberculosis ... ... ... ... 26-30 „ Care Committee ... ... 29 „ Dispensaries ... ... 30-32 Typhoid Fever 21 Typhus Fever ... ... ... ... 25 Unemployment ... ... ... ... 8 Unfit Habitations ... ... ... ... 50 Unmarried Mothers and their Children ... 38 Unsound Food ... ... ... ... 56 Vaccination ... ... ... ... ... 21 Venereal Diseases Clinic ... ... ... 6 Verminous Conditions ... ... 60-61 Vital Statistics ... ... ... ...7-15 Water Supply ... ... ... ... 44 Welfare Centres ... ... ... 6,33-34 Whooping Cough ... ... ... ... 25 Workshop Supervision ... ... ... 48 X-ray Examinations ... ... 30, 38