AC 4349 PAD 45 Metropolitan Borough of Paddington REPORT OF THE ACTING MEDICAL OFFICER OF HEALTH FOR THE YEAR 1945 CHARLES PORTER, M.D., B Sc. Printed by Vail & Co., Ltd., 170, Farringdon Road, E.C.I 2 To His Worship the Mayor, the Aldermen and Councillors of the Metropolitan Borough of Paddington. Mr. Mayor, Ladies and Gentlemen, Though I did not take up duty as Acting Medical Officer of Health until 8th October, replacing Dr. Bulman, Medical Officer of Health of St. Marylebone, who had acted during the period of leave of absence on account of ill-health granted to Dr. Oates, I willingly accept the responsibility and welcome the opportunity of submitting the health report for the year 1945. Speaking generally, from the statistical point of view, despite a number of disturbing conditions and circumstances —domestic (the changes in Medical Officer of Health for example) and national, the Borough made a not unsatisfactory showing. There were considerable improvements in certain important directions indeed, the general death rate declining from 14.92 to 13.69 and the tuberculosis death rate from 0.90 to 0.68 per 1,000 of the population. In the -case of pulmonary tuberculosis there was a fall, pleasant to record, from 0.82 to 0.59. On the maternity and child welfare side the figures were less satisfactory, the maternal death rate showing a rise from 1-18 to 3.97 while the rate of infant mortality remained stationary at 61 per 1,000 births, which is 8 points higher than the 1945 rate (53) for London as a whole. In the latter part of the year efforts were made to replace the Maternity and Child Welfare Scheme on the pre-war foundation. Several additional ante-natal and infant clinics were opened, and massage, foot, dental and other special clinics established or re-commenced. Amongst the infectious diseases the only one to assume anything like epidemic proportions was measles, 1,046 cases being notified. Fuller details with regard to these and other matters will be found in the body of the report. I wish to thank the Council and, more particularly, the Chairman and members of the Public Health and Maternity and Child Welfare Committees, for the kindness and consideration consistently shown to me during the period of my service. I would express appreciation also of the help I have received from the heads of other departments. The Health and Welfare staffs have done admirable work in the face of difficult circumstances and have rendered the fullest possible assistance at all times. In addition to Dr. Oates who, for health reasons, resigned on 30th October after over 20 years of valuable work on behalf of the health of Paddington, Mr. Dunning, who had been Chief Clerk of the Department and one of its mainstays for many years left also, taking with him, as did Dr. Oates, the best wishes of all those who had known and worked with him. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Acting Medical Officer of Health. Public Health Department, 15, Park Place Villas, Paddington Green, W.2. 18th June, 1946. 3 Area of Borough : 1,356.1 acres, including waterways 20 0 acres. Population : Registrar-General's estimate of Civilian Population—99,790. Number of inhabited houses (end of 1945) according to Rate Books—21,302. Live Births : Total Males Females Birth Rate per 1,000 estimated civilian population 17.16 Legitimate 1328 663 665 Illegitimate 384 200 184 Totals 1712 863 849 Stillbirths 49 26 23 Still-birth Rate per 1,000 (live and still) births ... 28 Deaths (all ages) 1367 638 729 Death Rate per 1,000 estimated civilian population 13-69 Deaths from Puerperal Causes : Rate per 1,000 (live and still) births 2.27 Puerperal Sepsis 4 Other Puerperal Causes 3 „„ 1.70 Total 7 „„ 3.97 Deaths of Infants under 1 year of age 104 Death Rates of infants under 1 year of age :— All infants per 1,000 live births 61 Legitimate infants per 1,000 legitimate live births 55 Illegitimate infants per 1,000 illegitimate live births 80 Deaths from Tuberculosis : Pulmonary (all ages) 59 Other forms (all ages) 9 Death Rate from Pulmonary Tuberculosis per 1,000 of the estimated civilian population 0.59 Tuberculosis Death Rate (all forms) 0.68 Rateable Value £1,706,834 Product of a Penny Rate £5,639- General Summary of Vital Statistics. Year. Reg. General's Estimate of Population. Births Deaths Deaths under One Year Maternal Deaths Number. » Rate. Number. * Rate. Number. * Rate. Number. • Rate. 1938 137,400 1888 13.74 1557 11 .33 125 66 3 1 .53 1939 135,300 1812 13.39 1608 12.74 106 60 8 4.38 1940 97,860 1556 15.90 1766 18.04 88 59 4 2.61 1941 77,640 1217 15.67 1418 18.26 64 60 4 3.62 1942 83,640 1397 16.70 1268 15.16 78 56 4 2.77 1943 90,580 1569 17 .32 1390 15.32 107 68 2 1.86 1944 93,030 1639 17.62 1388 14.92 100 61 2 1.18 1945 99,790 1712 17 .16 1367 13.69 104 61 7 3.97 * Corrected figures after allowing for inward and outward transfers. 4 CLASSIFICATION OF DEATHS. All Ages. Under One Year of Age. M F Total M F Total All Causes. 638 729 1367 49 55 104 Typhoid and paratyphoid fevers — — — — — — Cerebro-spinal fever 1 1 2 — — — Scarlet fever — — — — — — Whooping cough 1 — 1 1 — 1 Diphtheria — 2 2 — — — Pulmonary tuberculosis 36 23 59 — — — Other tuberculous diseases 6 3 9 — — — Syphilitic diseases 6 7 13 1 — 1 Influenza — 2 2 — — — Measles — 4 4 — — — Acute polio-myelitis and polio-encephalitis — — — — — — Acute infectious encephalitis — 1 1 — — — Cancer of buccal cavity and cesophagus (males) 9 — 9 — — — Cancer of uterus 1 16 16 — — — Cancer of stomach and duodenum 20 11 31 — — — Cancer of breast — 22 22 — — — Cancer of all other sites 71 54 125 — — — Diabetes — 4 4 — — — Intra-cranial vascular lesions 41 83 124 — — — Heart disease 115 169 284 — — — Other circulatory diseases 36 47 83 — — — Bronchitis 52 34 86 1 — 1 Pneumonia 49 46 95 8 7 15 Other respiratory diseases 10 9 19 1 — 1 Ulcer of stomach or duodenum 14 4 18 — — — Diarrhœa (under 2 years) 3 10 13 3 10 13 Appendicitis 4 — 4 — — — Other digestive diseases 14 13 27 — — — Nephritis 12 13 25 — — — Puerperal sepsis — 4 4 — — — Other maternal causes — 3 3 — — — Premature birth 12 23 35 12 23 35 Congenital malformation, birth injury, infantile disease 19 14 33 17 12 29 Suicide 7 13 20 — — — Road traffic accidents 12 6 18 — — — Other violent causes 28 30 58 3 3 6 All other causes 60 58 118 2 — 2 notification of infectious disease.— Disease. 1939 1940 1941 1942 1943 1944 1945 Acute Encephalitis lethargica 1 1 1 — — — — „ Influenzal pneumonia 34 22 8 11 29 11 9 ,, Primary pneumonia 106 80 68 96 53 47 88 ,, Polio-encephalitis — — — — — — — „ Polio-myelitis 3 1 3 1 1 2 1 „ Rheumatism 18 9 6 2 5 6 — Cerebro-spinal fever 11 24 19 11 9 7 9 Continued fever 1 3 1 — . — — — Diphtheria 86 42 58 38 54 50 51 Dysentry 5 3 12 35 94 38 86 Erysipelas 44 43 29 28 29 33 31 Food poisoning or suspected food poisoning 8 6 4 6 10 3 4 Infective enteritis or summer diarrhoea 47 24 13 27 84 107 154 Malaria — 4 — 3 — 5 2 Measles 28 253 301 707 592 174 1,046 Membranous Croup — — — — — 1 — Ophthalmia neonatorum 10 20 6 6 8 13 11 Puerperal fever 17 23 6 5 3 8 25 Puerperal pyrexia 37 17 25 38 23 24 37 Scabies (notifiable from 1st August, 1943) — — — — 246 644 804 Scarlet fever 130 56 61 110 312 137 126 Smallpox — — — — — 1 ~~ Typhoid or enteric fever 1 5 9 1 3 — 2 Whooping cough 239 24 170 235 142 156 54 5 notification of births.—Notifications were received relating to 2,762 births occurring in Paddington, 2,681 being live births, and 81 stillbirths. Medical practitioners sent 769 notifications, midwives 1,958, maternity assistants 27, other persons 6, and parents 2. Further analysis shows that 1,730 notifications were sent by Paddington Hospital, 724 by St. Mary's Hospital, and 37 by Nursing Homes. A comparison of the Notification Register with the Returns supplied by the Registrars shows that the of 2,642 births registered during 1945, only seven were not notified. marriages.—The number of marriages solemnized in the Borough was 1,557, being a rate of 31.2 persons per 1,000 of the population. This is an increase of 370 marriages over the number solemnised in 1944, when the rate was 24.6. bacteriological examinations.—The number of examinations made in connection with infectious disease was 400, classified as follows :— Disease. Examinations. Positive Results. Diphtheria 219 14 Typhoid Fever 1 — Scarlet Fever 10 7 Dysentery 11 2 Tuberculosis 159 15 400 38 water supply .—This has been satisfactory throughout the year, and there is nothing untoward to report. Six cases were reported by the Metropolitan Water Board of water supply being cut off owing to non-payment of water rates; these were dealt with by the Department, and the supplies were reinstated in all the cases without delay. venereal diseases.—In support of the Ministry of Health's publicity campaign, 915 bills were posted up throughout the Borongh under the supervision of the Sanitary Inspectors, and 142 metal plates were affixed in the Council's public conveniences and the conveniences attached to cinemas and public houses. Both the bills and plates are kept under observation, and replaced when necessary. diphtheria immunisation.—Nine hundred and seventy three children, including 146 school children, were fully inoculated, and 264 partly inoculated, during the year. Of the estimated child population of 6,180 under 5 years of age, 2,017 have been immunised (32.6%), and of the 8,540 children between the ages of 5 and 15 years, 6,034 have been immunised (70.7%). This gives a percentage of 54.7% of children immunised under the age of 15 years. whooping cough inoculation.—During 1945, 553 children were completely inoculated, and 102 cases were not fully completed at the close of the year. The number of injections given was 2,207. On the advice of Dr. Bulman, the then Acting Medical Officer of Health, it was decided towards the end of the year to discontinue inoculation of childrenag ainst whooping cough, except to complete the cases remaining outstanding. vaccination.—The latest return available is for the year 1944. This shows that of the 2,180 children whose births were registered during that year, 56.9% were successfully vaccinated, and 10.4% were exempted on production of statutory declarations. Insusceptibility, removals, not traced, etc., account for the remaining 32.7%. tuberculosis. Notification Register.—New cases comprised 224 of pulmonary tuberculosis and 21 of non-pulmonary tuberculosis. The number of cases on the register at the end of the year was 910, against 842 at the end of the previous year. The death rate for pulmonary tuberculosis showed a welcome decrease, being 0.59 as compared with 0.82 for the year 1944. The death rate for all forms of tuberculosis was 0.68 (0.90 for 1944). Dispensary Treatment.—following are particulars of the work carried out at the Paddington tuberculosis Dispensary, Newton Road :— No. of patients examined for 1st time (excluding contacts) 935 No. of above found tuberculous 212 No. of contacts examined 223 No. of contacts found tuberculous 6 No. of attendances at Dispensary 7085 No. of visits by Tuberculosis Officers 201 No. of visits by Tuberculosis Nurses 3538 No. of cases on Dispensary Register at end of year 887 No. of artificial pneumothorax refills given 1685 No. of X-Ray examinations made 2373 No. of specimens of sputum examined 742 Tuberculosis Care Committee.—The Committee met periodically during the year, and was able to provide assistance to 11 patients from the Samaritan Fund which it administers. 6 Maintenance Allowances.—Since this Scheme came into operation in July 1943, 361 patients resident in the Borough have applied for benefit, 204 new applications being received during 1945. Disabled Persons (Employment) Act, 1944.—This Act is designed to assist men and women handicapped by disablement (including inactive tuberculosis) to obtain a suitable form of employment, and provides for courses of vocational training and industrial rehabilitation for those who need to learn a new occupation, and for assistance in finding employment for those who already have an occupation. There is close co-ordination between the Tuberculosis Officer and the Disabled Rehabilitation Officer at the Employment Exchange, with the result that a number of Dispensary patients have been trained in new occupations and established in suitable positions. Dental Treatment.—Eleven sessions were held at the Dispensary, at which there were 63 attendances. In 3 cases the Council sanctioned grants towards the cost of dentures. Extra Nourishment.—One hundred and six grants were made under this Scheme on the recommendation of the Tuberculosis Officers. Beds and Bedding.—Six sets were supplied during the year to patients in cases where it was desirable for separate sleeping arrangements to be made. Artificial Pneumothorax Refills.—During the year 174 refills were given to 11 patients at outlying hospitals at a charge to the Council of 10s. 6d. each. For particulars of the refills given at the Paddington Tuberculosis Dispensary see page 5. Light Treatment.—The Council accepted financial responsibility for this form of treatment in one case. mass radiography.—The miniature mass radiography unit operated by the London County Council at St. Luke's Hospital, Chelsea, became available towards the end of the year and a total number of four hundred and twenty-one men and women were X-rayed, comprising contingents from the Staffs of the Paddington Borough Council, Metropolitan Electric Supply Company, Westbourne Park Building Society and Ushers Wiltshire Breweries. In 1943 when the Unit was first installed 933 persons attended from Paddington, making a total of 1,354 who have been X-rayed under the Scheme. diabetes.—In 5 cases insulin was supplied free of charge under the terms of Ministry of Health Circular No. 2734. domestic helps.—By an Order in Council made at the end of 1944, local authorities are empowered to provide domestic help to sick or infirm persons who themselves are unable to obtain such help. The Scheme was adopted by the Council but owing to the difficulty of obtaining suitable women for the work, it was not possible to bring it into operation until May, 1945 when the first domestic help was engaged. By the end of the year five women had been taken on, and they were sent out to twenty-four cases. Persons making use of the service pay according to a scale of assessment recommended by the Metropolitan Boroughs' Standing Joint Committee and adopted by the Council. mortuary.—263 bodies were deposited during the year. medicinal baths.—The number of persons who received treatment for scabies was 1,188 (men 269 and women 919) to whom 2,254 treatments were given. The figures for the previous year were 997 persons and 2,142 treatments. 337 verminous cases were also dealt with during 1945. fumigation service and cleansing of verminous rooms.—This was the first full year during which this service had operated, 1,061 rooms being fumigated and 75 sprayed. There were very few instances of bug re-infestation after fumigation had been done and none has occurred since D.D.T. and Gammexane became available for use in conjunction with fumigation. During the year five notices were served under Section 123 of the Public Health (London) Act, 1936 and these were dealt with without recourse to legal proceedings. disinfecting station.—The approximate weight of bedding treated iu the Disinfector was 25 tons. Rooms disinfected after the occurrence of infections disease numbered 259, and 198 library books were dealt with. rent and mortgage interest (restrictions) acts.—Four applications for certificates of disrepair were received, and granted. factories act, 1937.—Inspections numbered 228. At the end of the year there were 426 factories on the Register, 336 of which were using mechanical power. In factories using mechanical power the Council enforce only the provisions of the Act relating to sanitary conveniences, but in factories not using mechanical power, the Council enforce in addition the provisions as to cleanliness, heating, lighting, ventilation, permitted numbers, etc. Visits were also paid to the 56 outworkers known to be working in the Borough. 7 bakehouses .—At the end of the year there were 15 level and 25 basement bakehouses on the Register. Inspections numbered 280. shops acts.—Inspections totalled 661. All matters requiring attention were remedied without recourse to legal proceedings. pharmacy and poisons act, 1933.—There were 82 entries in the Register at the close of the year. Inspections numbered 359, and no case was discovered where the provisions of the Act were not being observed. work of the district inspectors. —At the beginning of the year five Inspectors were engaged on district work, but this number was augmented midway through the year by the return of three Inspectors who had been seconded to Civil Defence work. The number of complaints dealt with numbered 2,964—an increase of 1,152 over the number for the previous year. Inspections totalled 17,885 and in thirty-five instances legal proceedings were instituted for offences under the Public Health (London) Act, 1936 or for contraventions of the Bye-laws. In addition to their ordinary visits, the District Inspectors visit contacts of typhus or smallpox cases, and also carry out duties under the Factories Act. Visits to contacts of these diseases numbered 169, and the figures for factory visits are recorded elsewhere in this report. During the year the District Inspectors made a survey of vacant properties in the Borough for re-housing purposes. work of the women sanitary inspectors.—The two Women Sanitary Inspectors visit cases of infectious disease other than typhus, smallpox, puerperal fever and pyrexia, infective enteritis, summer diarrhoea and tuberculosis, and one of them also acts in a supervisory capacity at the medicinal baths. The following table gives an indication of the nature of their work. Disease. No. of Visits. Acute Rheumatism 7 Cerebro Spinal Fever 1 Chickenpox 229 Diphtheria 95 Dysentery 67 Erysipilas 22 Lice 626 Measles 563 Pneumonia 66 Scabies 1,702 Scarlet Fever 191 Typhoid and Paratyphoid Fever 8 Whooping Cough 43 Visits to Schools 97 Miscellaneous 969 In addition 309 visits were paid to aged and infirm persons under Section 224 of the Public Health (London) Act. common lodging houses.—There is now only one common lodging house in the Borough—Cecil House, 179, Harrow Road, which is licenced to take a maximum number of sixty-nine women or children, and there are few nights when the accommodation is not filled to capacity. Periodical inspections are made by one of the Women Sanitary Inspectors, and these numbered 71 during 1945. canal boats.—Mr. V. L. Ronchetti, the Canal Boats Inspector, was seconded to Shelter Supercision and other Civil Defence duties until June, 1945 and was not, therefore, until then able to carry out routine inspections, but from the visits that he was able to make, it was apparent that there was a decrease in the canal boat population, most of the families having gone ashore. During the year the Inspector paid 79 visits to the Paddington Basin, and made 24 inspections of Canal Boats. A number of minor defects were found and were remedied without service of notices. On no occasion was admission to a boat refused. No deaths or cases of infectious disease were reported among the canal boat population, and only one child of school age and two children under five were found living on the boats coming into the Basin. Before the war the Basin was emptied and cleaned every year during the Easter Holiday period, but during the war only dredging has been done. 8 rats and mice.—Two hundred and twenty-seven complaints of rates or mice were made to the Department during the year, an increase of thirty-six over the number received during 1944. Where necessary the Borough Engineer and Surveyor was asked to arrange for examinations of the sewer connections of affected premises, and also of adjoining premises, and a number of defects were found and made good. Mr. A. C. Harrison, one of the Food Inspectors, carried out the duties of Rodent Officer until the 5th November, when Mr. W. A. Dunkley, who had been appointed as a full-time Rodent Officer, took over the duties, and at the same time two of the Fumigation Operatives were transferred to the Rat Extermination Service, and were designated Rat Catchers. Concurrently with these changes, the Council decided to make a charge for the Service, and this was fixed at 5s. per treatment for private premises, and 10s. for business premises. In the case of poorer persons, the Medical Officer of Health was authorised to waive these charges, subject to approval of the Public Health Committee in each case. At the end of 1944 a major infestation of rats was discovered at the Council's Piggeries in the Paddington Recreation Ground, and three treatments were given during 1945—in January, February and December—and it was computed that about one thousand rats were killed. Otherwise during the year only a minor secondary degree of rat infestation was found in the food and other premises in the Borough. This condition also applied to mice. Where infestations were found, the usual method of pre-baiting followed by poison bait was employed, but trapping was resorted to in some cases. During the year the sewers were given a further treatment for the elimination of rats, 427 entrances being dealt with, resulting in an estimated kill of 2,445. Altogether, four treatments have now been given to the sewers, and the total estimated kill is 11,800. food supervision. Sampling.—Five hundred samples (which included 157 of milk) were taken for analysis. These were all reported by the Public Analyst to be genuine samples. Unsound Food.—The weight of diseased and unsound food surrendered by tradesmen and dealers for destruction was approximately 16 tons. Inspections.—During the year 463 inspections were made of the premises from which milk is sold or distributed, and 4,609 inspections of other food premises. At the end of the year the register showed that there were in the Borough 59 Dairies, 57 Purveyors of Milk, and 870 other Food Premises. Milk (Special) Designations Orders.—Licences issued were as follows :— Principal licences. Supplementary licences. " Pasteurised " Milk 46 3 " Tuberculin Tested " Milk 16 3 62 6 Seven samples of " Pasteurised " milk were taken and these complied with the prescribed conditions with one exception. There are no Pasteurising plants in the Borough, neither is there any bottling of " Tuberculin Tested " milk. Bacteriological Examination of Food.—One sample of meat of the "spam" type examined showed no unusual features. housing.—Up to the 31st December, 1945, 474 dwellings in 173 requisitioned properties were provided for Paddington families, and a further 13 families were accommodated in temporary houses. During the year 11 Paddington families secured accommodation on London County Council Estates. At the end of the year the number of houses on which extended work was completed in conformity with the Minister of Health's standard for war damaged houses was 7,500. Schemes for the erection of 154 flats on two sites at Fulham Place and St. Mary's Square are in hand. Closing Orders on the upper parts of two mews premises were determined following the completion of approved works, and three persons living in premises the subject of clearance or closing orders made prior to the year under review secured accommodation of a private nature by their own efforts. 9 Of the 114 cases of overcrowding on the Register at the end of 1944 :— 11 were found to be abated by removal, and a further 5 by a natural reduction in the size of the family, or on obtaining additional accommodation ; 39 were found to be temporarily abated in consequence of members of the family serving with H.M. Forces, etc.; 49 were still overcrowded; and 10 could not be investigated as no one could be found to answer inquiries. 54 new cases of overcrowding were discovered during the year, of which four were abated by removal. Two overcrowded families were provided with accommodation by the Council, and two others secured accommodation privately. During the year Associated Fumigators, Limited, under an Agreement with the Council, removed and treated the furniture, etc. of four families with hydrogen cynaide gas. The cost of the work was £13. maternity & child welfare.—The question of improvements in the administrative arrangements in connection with the Maternity & Child Welfare Services was considered, and as a consequence it was decided to separate the supervision of the Clinic and District work and for this purpose to appoint a " Superintendent of the Welfare Centre & Clinics " in addition to the Superintendent Health Visitor. The duties of the first-mentioned were allotted to Miss E. Davies, the former Superintendent Health Visitor, and Miss E. L. Donovan was appointed Superintendent Health Visitor in her stead with effect from the 1st September. It was also thought desirable to provide suitable assistance for the doctors at the various clinics, and for this purpose a State Registered Nurse with C.M.B. qualifications was appointed. Dr. E. R. Emslie, the Assistant Medical Officer for Maternity & Child Welfare, relinquished her duties as Public Vaccinator and her whole time is now devoted to Maternity & Child Welfare. The Health Visiting staff at the end of the year comprised the Superintendents above-mentioned and 14 Health Visitors (including one seconded to the Ministry of Health and one employed with the Rehousing Department). Home Visiting : First visits to children under 1 year 1,744 Revisits 12,523 14,267 Visits to children ages 1-5 years 11,196 First visits to expectant mothers 1,092 Revisits 954 2,046 Other Visits : Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhœa) 441 Miscellaneous (including ineffective calls) 6,422 6,863 The number of children on the Health Visitors' lists at the close of the year was 5,892. consultation centres.—Following on the return home of evacuated mothers and children it became necessary to provide additional maternity and infant consultations and to resume certain other facilities which were suspended on the outbreak of war. 10 Particulars of the consultations in operation at the end of the year are given below :— Day and Hour Designation Where Held In Attendance Monday. 10 a.m Maternity Welfare Centre, 283a Harrow Road. Dr. E. R. Emslie 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. Dr. E. R. Emslie 2.0 p.m. Infant Dibdin House, Maida Vale. Dr. E. Maclagan Tuesday. 10.0 a.m Maternity Welfare Centre, 283a Harrow Road. Dr. R. Frank 2.0 p.m. Infant Welfare Centre, 283a, Harrow Road. Dr. E. R. Emslie 2.0 p.m. Infant Congregational Hall, Third Avenue. Dr. C. T. Potter Wednesday. 2.0 p.m. Infant St. Simon's Vicarage, Macroom Road. Dr. C. T. Potter 2.0 p.m. Maternity Welfare Centre, 283a Harrow Road. Dr. E. R. Emslie Thursday. 10.0 a.m Maternity Welfare Centre, 283a Harrow Road. Dr. E. R. Emslie 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. D. E. R.Emslie 2.0 p.m. Infant St. Simon's Vicarage, Macroom Road. Dr. R. Frank 2.0 p.m. Foot Welfare Centre, 283a Harrow Road. Mrs. R. Howell Friday. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. Dr. E. R. Emslie 2.0 p.m. Infant St. David's Hall, St. Mary's Terrace. Dr.E. D. Fenwick Daily. 10.0 a.m Physio-Therapy Welfare Centre, 283a Harrow Road. Miss E. M. Suffling 11 SUMMARY FOR YEAR. INFANT CONSULTATIONS. No. of Sessions Attendances Seen by Doctor Total Average Total Average Welfare Centre, 283a, Harrow Road. Monday 48 3,295 68.7 968 20.2 Tuesday 51 3,445 67 .5 996 19.5 Thursday 52 4,078 78.4 1,118 21.5 Friday * 14 449 32.1 173 12.3 Dibdin House. Monday 48 2,460 51.3 702 14.6 Congregational Hall. Tuesday 50 2,814 56.3 798 16.0 St. Simon's Vicarage. Wednesday 52 2,877 55.3 946 18.2 Thursday ** 14 449 32.1 148 10.6 St. David's Hall. Friday 52 2,948 56.7 1,038 20.0 Total 381 22,815 59.9 6,887 18.1 * Commenced 28th September. ** " 27th Of the 1,732 children who attended the Centres for the first time during the year, 1,362 were under the age of one year and 370 between the ages of one and five years at the date of their first attendance. The total number of children attending the consultations was 3,029, of whom 1,140 were under the age of one year, and 1,889 between the ages of one and five years at the end of the year. 12 ANTE- AND POST-NATAL CLINICS. No. of Sessions Attendances No. of expectant or recently confined mothers who attended Total Average Welfare Centre, 283a, Harrow Road Monday 49 1,226 25.0 302 Tuesday ** 17 328 19.3 163 Wednesday 51 1,524 29.9 389 Thursday * 21 342 16.3 194 TOTALS 133 3,420 24.8 1,048 * Commenced 9th August. ** „ 4th September. In addition to the above, a weekly clinic is held at St. Mary's Hospital for women booked for confinement in the beds reserved by the Council at that institution. During the year 90 ante-natal and 105 post-natal cases made a total of 919 attendances. FOOT CLINIC. (Commenced 6th September.) Adults. Children. No. of sessions 14 No. of cases 17 2 No. of attendances 24 3 PHYSIO-THERAPEUTIC CLINIC. (Commenced 1st October.) Adults. Children. No. of sessions 75 No. of cases 91 92 No. of attendances 145 482 Classification of cases :– Light 8 74 Massage 15 38 Heat 17 — Exercises 70 14 Treatments given :— Light 12 429 Massage 37 233 Heat 33 — Exercises 108 114 13 Dental Treatment : 32 nursing or expectant mothers received treatment under arrangements made with Mr. F. H. Brinkley Tofts, L.D.S., R.C.S. (Eng.). Maternity Beds : 106 women were delivered in the beds reserved at St. Mary's Hospital. No case of puerperal infection was notified. There were three stillbirths and three deaths within 10 days of birth. Emergency Obstetric Service : This service is provided by the London County Council at a charge of £5 5s. Od. per patient. The facilities were utilised in one instance during the year. Home Helps : Six full-time maternity Home Helps are employed, supplemented by Casual Helps selected from the Council's panel. During the year assistance was provided in 90 cases, 82 of which were attended by Full-time Helps and 8 by Casual Helps. Provision is also made for carrying out the domestic washing of expectant or recently confined mothers, but use was not made of these facilities during the year. Convalescence : One mother was sent for convalescence, part of the cost being met by the Council. Five children were sent to Homes under the arrangement made with the Invalid Children's Aid Association. Child Life Protection : 294 visits and inspections were made. At the close of the year the Register contained the names of 23 persons, who had charge of 30 children. No legal proceedings were necessary. The Council's scheme of guaranteed payments to foster mothers was utilised in three instances. Daily Guardians : 28 persons were registered for the care of 13 children. At the end of the year the Register contained the names of 25 guardians who had charge of 13 children. Perambulator Scheme : Advantage continued to be taken of these facilities, the number of perambulators available for hire being 76 (including 3 twin perambulators). Contraceptive Advice, etc. : The Council have an arrangement with the North Kensington Women's Welfare Centre for the giving of contraceptive advice to married women who are already in attendance at a Maternity & Child Welfare Centre of the Council and whose health would be adversely affected by another pregnancy, the cost (10s. Od.) being borne by the Council in appropriate cases. Five such women were referred for advice during the year, four of whom attended. Extra Nourishment : The National Milk Scheme is supplemented, where necessary on medical grounds, by grants under the Council's scheme. 63 applications were dealt with during the year, all of which were granted. Care of Illegitimate Children : The duties of Welfare Worker in this connection are carried out by the Superintendent Health Visitor. . . During the year 10 women were admitted to Homes prior to confinement (nine to the Main Memorial Home, Hampstead, and one to St. Faith's Home, Loughton). After the birth, which in each case took place in hospital, mother and child were re-admitted to the Home pending satisfactory arrangements for the infant's care. Financial assistance was given in all cases. Following the decision of the Council to establish a Hostel, negotiations were in progress at the end of the year for the acquisition of suitable premises for the purpose. Premature Infants : The number of Paddington babies whose weight at birth was 5½ lbs. or less was 128, of whom 23 were born at home and 105 in institutions. Of those born at home 17 were nursed entirely at home, 3 died during the first 24 hours and 16 survived at the end of one month. Of those born in institutions 5 died during the first twenty-four hours and 79 survived at the end of one month. The special equipment provided in accordance with Ministry of Health Circular 20/44 was utilised in 5 instances, and in no case was it necessary to obtain paediatric advice. Notification is received of the discharge of all infants born in institutions in the Borough. 14 War-time Day Nurseries : Particulars of the nurseries in operation during the year are given below :— Accommodation. 0—2 years. 2—5 years. Total. Westbourne, Great Western Road 20 30 50 Maida Vale, 14, Blomfield Road 25 27 52 St. Jude's 88, Bravington Road 27 18 45 Peach Street 29 33 62 Marylands Road 49 16* 65 *2—3 years. Accommodation is also provided at the Queen's Park Day Nursery, 66, Lancefield Street, for 26 children between the ages of 2 and 5 years, although not formally approved by the Minister of Health as a War-time Day Nursery. Details of attendances are given in the following table :— Days open. Attendances. No. of places. Average attendance. New children. Westbourne Full days 251 10,987 50 43.8 29 Saturdays 50 1,066 21.3 Maida Vale Full days 251 11,089 52 44.2 41 Saturdays 50 1,019 23.8 St. Jude's Full days 251 10,325 45 41.1 40 Saturdays 50 1,088 21.8 Peach Street Full days 251 13,463 62 53.6 76 Saturdays 50 1,259 25.2 Marylands Road Full days 251 13,499 65 53.8 70 Saturdays 50 1,422 28.4 Queen's Park Full days 251 4,956 26 19.7 43 Saturdays 50 506 11.2 There is one nursery school in the Borough, provided by the London County Council, viz., at Senior Street School. 15 CONTENTS. PAGE Bacteriological Examinations :— Infectious Disease 5 Milk 8 Bakehouses 7 Births 5 Canal Boats 7 Child Life Protection 13 Cleansing of Verminous Rooms 6 Clinics, Ante- and Post-Natal 12 Common Lodging Houses 7 Contraceptive Advice 13 Convalescence 13 Daily Guardians 13 Dairies and Milk Purveyors 8 Day Nurseries 14 Deaths :— Numbers and Rates 3 Classification 4 Infantile 3 Maternal 3 Dental Treatment :— M. and C.W 13 Tuberculosis 6 Diabetes 6 Diphtheria Immunisation 5 Disinfection 6 Domestic Helps 6 Emergency Obstetric Service 13 Extra Nourishment :— M. and C.W. 13 Tuberculosis 6 Factories Act, 1937 6 Food Supervision 5 PAGE Fumigation Service 6 Home Helps 13 Home Visiting, M. and C.W. 9 Housing 8 Illegitimate Children, Care of 13 Infant Consultations 9,10,11 Infectious Disease 4 Marriages 5 Mass Radiography 6 Maternity and Child Welfare Work 9 Maternity Beds 13 Medicinal Baths 6 Milk (Special Designations) Orders 8 Mortuary 6 Perambulator Scheme 13 Pharmacy and Poisons Act, 1933 7 Population Premature Infants, Care of 13 Rats and Mice 8 Rent and Mortgage Interest (Restrictions) Acts 6 Sampling of Food 8 Sanitary Inspectors, Work of 7 Scabies, Treatment o‡ 6 Shops Acts 7 Stillbirths 3 Tuberculosis 5 Unsound Food 8 Vaccination 5 Venereal Diseases 5 Verminous Rooms 6 Vital Statistics, Summary 3 Water Supply 5 Whooping Cough Inoculation 5