AC 4349 PAD 46 Metropolitan Borough of Paddington REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1946 A. B. STEWART, M.D., D.P.H. VAIL & Co.. Ltd., Printers to the Council,170, Farringdon Road. E.C.I 2 CONTENTS. page Bacteriological Examinations :— Infectious Disease 10 Milk 18 Bakehouses 15 Births 7 Canal Boats 17 Child Life Protection 25 Clinics, Ante- and Post-Natal 23 „ Child Guidance 24 „ Dental 24 „ Foot 23 „ Physiotherapeutic 23 Common Lodging Houses 17 Consultation Centres, M and C.W. 20-21 Contraceptive Advice 26 Convalescence 25 Daily Guardians 25 Day Nurseries 26 Deaths:- Numbers and Rates 6 Classification 9 Infantile 7 Maternal 6 Tuberculosis 12 Dental Treatment:— M. and C.W. 24 Tuberculosis 13 Diabetes 13 Diphtheria Immunisation 10 Disinfection 14 Drainage Reconstruction Plans 16 Emergency Obstetric Service 24 Extra Nourishment:— M. and C.W. 26 Tuberculosis 13 Factories Act, 1937 14 Food Supervision 18 Fumigation Service 14 page Home Helps 25 Home Visiting, M. and C.W. 20 Housing 18-19 Ice Cream 18 Illegitimate Children, Care of 26 Infant Consultations 22 Infantile Mortality 7 Infectious Disease 9 Legal Proceedings 16 Marriages 10 Mass Radiography 13 Maternity and Child Welfare Work 19 Maternity Beds 24 Medicinal Baths 14 Milk (Special Designations) Regulations 18 Mortuary 14 Neo-natal deaths 8 Obstetric Consultant 24 Perambulator Hire Scheme 26 Pharmacy and Poisons Act, 1933 15 Population 7 Premature Infants, Care of 26 Rodent Control 17 Rent and Mortgage Interest (Restrictions) Acts 14 Sampling of Food 18 Sanitary Inspectors, Work of 15-17 Scabies, Treatment of 14 Shops Acts 15 Staff 5 Stillbirths 6 Tuberculosis 11-13 Unsound Food 18 Vaccination 11 Venereal Diseases 10 Verminous Rooms 14 Vital Statistics, Summary 6 Water Supply 10 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 1946. In submitting this report on the Public Health of the Borough I would point out that I commenced duty in Paddington on November 1st, 1946 and in consequence my knowledge of many of the matters contained in the report is not first hand. It is interesting to note that in his Annual Reports at the end of the 1914-1918 war the late Dr. Dudfield commented on the uncertainty attached to deductions drawn from the Vital Statistics and it was not until the 1921 Census figures were available that he attached full importance to the Statistics. The same is true to-day; the return of men and women from the forces, the return of families from evacuation, the redistribution of the population after war damage to property, the changing character of different districts in the Borough, all influence the figures before us. Interpretation of the figures is difficult when so many factors are operating simultaneously. Of interest in the Vital Statistics is the birth-rate figure showing a substantial rise from 17.16 per 1,000 to 20.28, and also the infant mortality figure of 47 deaths per 1,000 live births, the lowest figure yet recorded in Paddington. A more disquieting figure is the increase in the number of notified cases of tuberculosis as well as the increased number of deaths from this disease. Why this increase has happened is not clear but it is well to remember that, other things being equal, nutrition and housing are regarded as major factors in the incidence and spread of this disease. It is appropriate at this point to speak of Nutrition and Housing, both of such importance to the Public Health. Much has been said about Nutrition in the recent past and if these few remarks persuade the reader to discount the majority of the opinions which have been expressed they will have achieved a useful purpose. Apart from the study of special groups, e.g. expectant mothers, babies and schoolchildren, there is no true scientific base line from which to work in a comparison between 1939 and the present day. The figures available for the special groups mentioned show an improvement but these groups are privileged classes of the community in the eyes of the Ministry of Food, and rightly so. Opinions expressed about any other group or groups of the community are purely speculative and probably largely of a subjective and even political nature. It is of little account that distinguished nutrition experts and hygienists say that they do or do not feel the same as they did in 1939; how can they ? They are all seven or eight years older for one thing. In the face of a world food shortage we cannot expect the position to improve for some time. That the alternative foods to relieve the monotony of our diet are exotic, scarce and therefore expensive is unfortunate but unavoidable. Apart from the expectant mothers, babies, and schoolchildren who qualify for supplementary food there is one class of the community deserving every consideration. The old people are at a disadvantage, particularly those living alone, with a ration for a single person; perhaps pensioners unable to afford restaurant meals, and perhaps unfit to go shopping or queue for unrationed food. Welfare provision for the old is a service yet to be developed and this question of the feeding of the aged is as yet unanswered. The problem of housing confronting the Council is a many-sided one of considerable magnitude. Apart from the provision of new building and conversion work by the Engineer's Department, the maintenance and repair of existing dwellings presented a task beyond the resources of the Public Health Department staff as it existed at the end of the War. The Council took immediate steps to increase the staff available to deal with the inspection of property and the full result of this action should be evident in the report for 1947. Six years of war, with the cessation of repair and maintenance work, the effects of bomb-damage, and the fact that much of the property in the borough is 100 years old and that much of it has become property let in lodgings has resulted in a large accumulation of arrears in repairs to property. Shortage of labour and materials has made it necessary to limit repairs to those essential to conform to statutory sanitary notices. 4 On the one hand there is a body of property owners eager to keep their property in good repair and willing to spend as much as they are allowed in order to do so; on the other hand there are several speculative landlords in the borough bent on extracting as much rent as possible before selling again, who have little or no regard to the state of repair of the premises purchased. Some of these houses change hands two or three times within a few months, during which time it may be impossible to have repairs carried out owing to the difficulty in ascertaining the owner. In cases of excessive delay in executing essential repairs, and where no adequate and reasonable excuse was forthcoming, it has been necessary for the Council to institute legal proceedings. The details are set out in the body of the report. In my opening paragraph mention was made that much of my knowledge of this report was not first hand, but I wish to place on record that this has been but a small handicap as I was fortunate in having the collaboration of the Acting Medical Officer of Health for some time after taking up my duties. To take over the work from so distinguished and energetic a colleague as Dr. Charles Porter was in itself a pleasurable education and a privilege few have shared. Dr. Porter referred in his 1945 Report to Dr. Oates' retirement, for health reasons, after 20 years of valuable service, and also to Dr. Bulman's interim period of office. I wish to place on record my indebtedness and thanks to the Council, particularly the chairmen and members of the Public Health, Maternity and Child Welfare, and Housing Committees for their encouragement and kindness. Similarly, heads of departments and other officers of the Council have assisted me and shown me every consideration for which I express my gratitude. The Health and Welfare staffs have given me their fullest support in the difficult transition to peace time conditions. I have the honour to be- Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Medical Officer of Health. Public Health Department, 15, Park Place Villas, Paddington Green, W.2. 30th May, 1947. 5 public health officers (on December 31st, 1946).—W.T. = Whole-time appointments. P.T. = Part-time appointments. Medical Officer of Health and Administrative Tuberculosis Officer, W.T. A. B. Stewart, M.D., 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. A. B. Porteous, M.D., D.P.H. Visiting Medical Officers, Welfare Centre, P.T. E. D. Fenwick, M.R.C.S., L.R.C.P. C. T. Potter, M.D., M.R.C.P. E. T. Maclagan, M.B., B.S., M.R.C.S., L.R.C.P. R. Frank, M.D. Psychiatrist, Welfare Centre, P.T. H. Gillespie, M.R.C.S., L.R.C.P. Medical Officer i/c Diphtheria Immunisation Clinic, Welfare Centre, P.T. H. W. Swann, M.B., B.S. Visiting Dental Officer, Welfare Centre, P.T. Miss A. H. Halperin, L.D.S. Dental Anaesthetist, Welfare Centre, P.T. H. R. Alban, M.R.C.S., L.R.C.P. Public Analyst, P.T. Alan W. Stewart, D.Sc., A.I.C. Public Vaccinator, P.T. E. D. Fenwick, M.R.C.S., L.R.C.P. Deputy Public Vaccinator, P.T. M. Hellier, M.B., Ch.B. Clerical Staff—W.T. S. W. Ruffey (Chief Clerk and Vaccination Officer). H. J. Parker. H. Ewings. S. W. Wordingham. A. J. O. Sheppard. A. G. L. E. Houghton. R. I. Fisher. R. S. Welch. R. H. Davis. P. F. Purser. C. T. Wyatt. Miss D. Smeaton. C. H. F. Drake. and 16 temporary clerks. Sanitary Inspectors—W.T. C. G. Heron (Senior Sanitary Inspector). W. H. G. Atkins. V. L. Ronchetti. F. Nau. E. B. Wilde. J. Watson. F. J. Pallet (Food and Sampling). J. Mains. E. Marshall. W. G. Thurgood. A. C. Harrison (Food). G. A. Fraser. J. J. Atkinson. R. E. Haines. G. Duncan. Mortuary Keeper.—W.T. L. W. J. Spears. Rodent Officer.—W.T. W. A. Dunkley. and 14 Disinfecting, Fumigation, Rodent Control and Porter Staff. Lady Sanitary Inspectors—W.T. Miss D. M. Newhall. Miss E. Z. Amor. 6 vital statistics—summary. Area of Borough : 1,356.1 acres, including waterways 20 0 acres. Population : Registrar-General's estimate of Civilian Population—117,670. Number of inhabited houses (end of 1946) according to Rate Books—21,294. Live Births : Total Males Females Birth Rate per 1,000 estimated civilian population 20.28 Legitimate 2007 1017 990 Illegitimate 379 190 189 Totals 2386 1207 1179 Stillbirths 59 36 23 Still-birth Rate per 1,000 (live and still) births 24 Deaths (all ages) 1525 780 745 Death Rate per 1,000 estimated civilian population 12.96 Deaths from Puerperal Causes: Rate per 1,000 (live and still) births 0.81 Puerperal Sepsis 2 Other Puerperal Causes 2 0.81 Total 4 1.63 Deaths of Infants under 1 year of age 113 Death Rates of infants under 1 year of age:— All infants per 1,000 live births 47 Legitimate infants per 1,000 legitimate live births 43 Illegitimate infants per 1,000 illegitimate live births 71 Deaths from Tuberculosis: Pulmonary (all ages) 95 Other forms (all ages) 5 Death Rate from Pulmonary Tuberculosis per 1,000 of the estimated civilian population 0.80 Tuberculosis Death Rate (all forms) 0.85 Rateable Value £1,742,988 Product of a Penny Rate £6,122 Health Visitors—W.T. Miss E. A. S. Davies (Superintendent of the Welfare Centre and Clinics). Miss E. Donovan (Superintendent Health Visitor). Miss M. S. Sells. Miss E. C. Jackson (Nursery Liaison Officer). Miss A. S. Anderson. Mrs. M. Vaughan. Mrs. M. Stevenson. Miss V. M. Goddard. Mrs. N. E. Sellen. Miss M. M. Barnes. Miss J. F. Foster. Miss G. A. Ireson. Clinic Nurse, Welfare Centre.—W.T. Miss J. P. Dempster. Chiropodist, Welfare Centre.—P.T. Mrs. R. Howell. Physiotherapist, Welfare Centre,—W.T. Miss E. M. Suffling. Day Nursery Service. Day Nursery. Maida Vale. Marylands Road. Peach Street. Queen's Park. St. Jude's. Westbourne. Matron,—W.T. Miss A. W. Purdon. Miss J. Handley-Jones. Mrs. E. Hill. Miss A. Fairbrother. Mrs. P. Pashley. Miss M. O'Dwyer. Deputy Matron.—W.T. Miss C. D. Hammonds. Miss A. Matthews. Miss E. Balmforth. Miss K. Evans. Miss W. Field. Miss T. Butterick. 7 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. *  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 1946 117,670 2386 20.28 1525 12.96 113 47 4 1.63 * Corrected figures after allowing for inward and outward transfers. BIRTHS Total Live Births Illegitimate Live Births Illegitimate Birth Rates* Paddington 2,386 379 15.9 Wards: Queens Park 182 16 8.8 Harrow Road 558 59 10.6 Maida Vale 450 64 14.2 Westbourne 454 79 17.4 Town 255 43 16.8 Church 98 25 25.5 Lancaster Gate West 125 17 13.6 Lancaster Gate East 106 36 34.0 Hvde Park 158 40 25.3 *per 100 total live births. INFANTILE MORTALITY Total Live Births Total Deaths under 1 year Rates* Paddington 2,386 113 47.4 Wards: Queens Park 182 6 33.0 Harrow 558 30 53.8 Maida Vale 450 13 28.9 Westbourne 454 22 48.5 Town 255 12 47.1 Church 98 6 61.2 Lancaster Gate West 125 6 48.0 Lancaster Gate East 106 7 66.0 Hyde Park 158 11 69.6 *Per 1,000 total live births. Deaths under 1 year Legitimate Rates* Deaths under 1 year Illegitimate Rates† Paddington 86 42.9 27 712 Wards: Queens Park 4 24.1 2 125.0 Harrow Road 26 52.0 4 67.8 Maida Vale 10 25.9 3 46.9 Westbourne 17 45.3 5 63.3 Town 10 47.2 2 46.5 Church 5 68.5 1 40.0 Lancaster Gate West 2 18.5 4 235.3 Lancaster Gate East 3 42.9 4 111.1 Hyde Park 9 76.3 2 50.0 * Per 1,000 live births (legitimate) † Per 1,000 live births (illegitimate) 8 neo-natal deaths Total Live Births Total Deaths under 1 month Rates* Paddington 2,386 76 31.9 Wards: Queens Park 182 6 33.0 Harrow Road 558 17 30.5 Maida Vale 450 9 20.0 Westbourne 454 16 35.2 Town 255 6 23.5 Church 98 6 61.2 Lancaster Gate West 125 4 32.0 Lancaster Gate East 106 4 37.7 Hyde Park 158 8 50.6 *Per 1,000 total live births. Deaths under 1 month Legitimate Rates* Deaths under 1 month Illegitimate Rates† Paddington 53 264 23 60.7 Wards: Queens Park 4 24.1 2 125.0 Harrow Road 13 26.0 4 67.8 Maida Vale 7 18.1 2 31.2 Westbourne 12 32.0 4 50.6 Town 4 18.9 2 46.5 Church 5 68.5 1 40.0 Lancaster Gate West 1 9.3 3 176.4 Lancaster Gate East 1 14.3 3 83.3 Hyde Park 6 50.8 2 50.0 *Per 1,000 live births (legitimate) †Per 1,000 live births (illegitimate). notification of births.—Notifications were received relating to 3,663 births occurring in Paddington, 3,555 being live births and 108 stillbirths. Medical practitioners sent 763 notifications, midwives 2,812, maternity assistants 119, and other persons 12. Further analysis shows that 2,167 notifications were sent by Paddington Hospital, 732 by St. Mary's Hospital, and 64 by Nursing Homes. A comparison of the Notification Register with the Returns supplied by the Registrars shows that of the 3,697 births registered during the year, only four were not notified. 9 deaths- cause of Death. All Ages. Under One Year of Age. M F Total M F Total All Causes. 780 745 1525 65 48 113 Typhoid and paratyphoid fevers — — — — — — Cerebro-spinal fever 1 1 2 1 — 1 Scarlet fever — — — — — — Whooping cough — — — — — — Diphtheria — 2 2 — — — Pulmonary tuberculosis 59 36 95 — — — Other tuberculous diseases 2 3 5 — — — Syphilitic diseases 15 6 21 1 — 1 Influenza 4 6 10 — — — Measles — 1 1 — — — Acute polio-myelitis and polio-encephalitis — — — — — — Acute infectious encephalitis — — — — — — Cancer of buccal cavity and oesophagus (males) 17 — 17 — — — Cancer of uterus — 10 10 — — — Cancer of stomach and duodenum 21 20 41 — — — Cancer of breast — 27 27 — — — Cancer of all other sites 85 72 157 — — — Diabetes 2 6 8 — — — Intra-cranial vascular lesions 40 74 114 — — — Heart disease 170 181 351 — — — Other circulatory diseases 33 30 63 — — — Bronchitis 66 35 101 — — — Pneumonia 59 62 121 10 9 19 Other respiratory diseases 7 7 14 — 1 1 Ulcer of stomach or duodenum 19 8 27 — — — Diarrhoea (under 2 years) 9 4 13 9 4 13 Appendicitis 3 4 7 — — — Other digestive diseases 17 15 32 1 2 3 Nephritis 17 15 32 — — — Puerperal sepsis — 2 2 — — Other maternal causes — 2 2 — — — Premature birth 24 10 34 24 10 34 Congenital malformation, birth injury, infantile disease 15 18 33 13 15 28 Suicide 20 5 25 — — — Road traffic accidents 9 2 11 — — — Other violent causes 19 25 44 4 4 8 All other causes 47 56 103 2 3 5 notification of infectious disease.— Disease. 1940 1941 1942 1943 1944 1945 1946 Acute Encephalitis lethargica ... 1 1 20 ,, Influenzal pneumonia 22 8 11 29 11 9 ,, Primary pneumonia 80 68 96 53 47 88 100 „ Polio-encephalitis — — — — — — Polio-myelitis 1 3 1 1 2 1 2 ,, Rheumatism 9 6 2 5 6 — 9 Cerebro-spinal fever 24 19 11 9 7 9 4 Continued fever ... 3 1 — — — — Diphtheria 42 58 38 54 50 51 37 Dysentery 3 12 35 94 38 86 34 Erysipelas... 43 29 28 29 33 31 23 11 Food poisoning or suspected food poisoning ... 6 4 6 10 3 4 Infective enteritis or summer diarrhoea 24 13 27 84 107 154 143 Malaria 4 — 3 — 5 2 9 Measles 253 301 707 592 174 1,046 690 Membranous Croup — — — — 1 — — Ophthalmia neonatorum 20 6 6 8 13 11 5 Puerperal fever ... 23 6 5 3 8 25 10 Puerperal pyrexia 17 25 38 23 24 37 24 Scabies (notifiable from 1st August, 1943) — — — 246 644 8)1 726 Scarlet fever 56 61 110 312 137 126 228 Smallpox ... — — — — • 1 — — Typhoid or enteric fever 5 9 1 3 — 2 Whooping cough 24 170 235 142 156 54 155 10 marriages.—The number of marriages solemnized in the Borough was 1,686, being a rate of 28 6 persons per 1,000 of the population. This is an increase of 129 marriages over the number solemnized in 1945, when the rate was 31.2. This seeming paradox is accounted for by the fact that the population for 1946 shows an increase of nearly 18,000 over that for 1945. bacteriological examinations.—At the beginning of the yeaf the Public Health Committee decided that pathological specimens (other than tuberculosis) and food samples should be sent to the Laboratory at St. Mary's Hospital for bacteriological examination, instead of the Royal Institute of Public Health as formerly, and it was agreed that the examinations should be carried out for a fixed annual sum of £220. Examinations of sputa for tubercle bacilli are still done at the Paddington Tuberculosis Dispensary. The number of examinations made in connection with infectious disease was 510, classified as follows:— Disease Examinations Positive Results Diphtheria 244 3 Typhoid Fever 4 — Scarlet Fever 36 8 Dysentery 6 2 Tuberculosis 210 28 510 41 water supply.—This has been satisfactory throughout the year. Samples of the water in all stages of purification are analysed daily at the Laboratories of the Metropolitan Water Board. All new and repaired mains are chlorinated before being put into use and samples of water from them are tested bacteriologically. The closest watch is kept by the Board for any form of contamination, and immediate action is taken if the results of analyses are not up to standard. During the year the M.W.B. reported five cases of water being cut off for non-payment of rates, and in all cases the supply was reinstated following appropriate action by this Department. venereal diseases.—The publicity campaign was continued, a further 1,000 bills being posted throughout the Borough during the year. The metal plates affixed in the many conveniences were also examined and replaced as necessary. diphtheria immunisation.—The following tables give information as to the numbers of children immunised during the year by private practitioners, London County Council school medical officers or at the Council's clinic; and the estimated numbers and percentages of the child population who had completed a full course of immunisation at any time up to the 31st December, 1946. No. of children who completed a full course of primary immunisation No. of children given a secondary or during the year 1946 reinforcing injection during the year 1946 Under 5 years 5 to 14 years Total 1,034 189 1,223 30 11 Number of children who had completed a full course of immunisation at any time up to 31st December, 1946. Age at 31.12.46 Under 1 year 1 2 3 4 5-9 10-14 Total under 15 Number immunised 3 588 766 770 643 3,006 3,104 8,880 Estimated mid-year population, 1946. 7,210 9,930 17,140 Estimated percentage of child population immunised 38.4 61.5 51.8 The scheme whereby immunisation is carried out by private practitioners at the homes of patients continued in operation. The number of children immunised under this scheme was 78. The material is supplied free by the Council and a fee of 3s. per injection (usually two) is paid to the doctor. In support of the Government's publicity scheme the following action was taken by the Council. Advertisements were inserted on four occasions during the month of May in four local weekly papers ; a letter was addressed to all doctors practising in the Borough asking for their support of the scheme ; posters were exhibited at the Council's premises and on their notice boards, and leaflets were made available at the Council's offices, etc. Efforts are made by the Health Visitors during the course of home visiting and at the various infant consultations to obtain parental consent to immunisation as children reach the age of 1 year. Cases in which such consent is not immediately forthcoming are specially followed up and the parents urged to take advantage of the protection afforded by treatment. vaccination.—The latest return available is for the year 1945. This shows that of the 2,700 children whose births were registered during that year 57.2% were successfully vaccinated, and 9.9% were exempted on production of statutory declarations. Insusceptibility, removals, not traced, etc., account for the remaining 32.9%. tuberculosis. Notification Register.—Two hundred and sixty one new cases of pulmonary tuberculosis and 24 of non-pulmonary tuberculosis were notified, being an increase of 37 pulmonary and 3 non-pulmonary cases over those notified in the previous year. The annual numbers of cases notified since 1939 are shown in the following table: Year Population Pulmonary Non-Pulmonary Cases 1939 135,300 189 32 221 1940 97,860 168 37 205 1941 77,640 184 26 210 1942 83,640 195 40 235 1943 90,580 229 28 257 1944 93,030 233 26 259 1945 99,790 224 21 245 1946 117,670 261 24 285 12 The ward distribution of the cases notified during 1946 is as follows:— Ward Pulmonary N on-pulmonary Total Males Females Males Females Queens Park 10 10 2 1 23 Harrow Road 19 19 2 2 42 Maida Vale 39 22 2 1 64 Westbourne 29 14 3 6 52 Church 13 13 — 1 27 Town 6 1 1 — 8 Lancaster Gate, W. 14 9 — — 23 Lancaster Gate, E. 9 10 — 1 20 Hyde Park 16 8 — 2 26 Borough 155 106 10 14 285 The following table shows the age distribution of the 285 cases:— 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total All ages Pulmonary-Male — 5 6 2 4 15 40 35 22 21 5 155 Pulmonary-Female — 1 4 3 9 26 37 8 11 7 — 106 Non-Pulmonary-Male — 1 — — 1 1 3 3 1 — — 10 Non-Pulmonary-Female — 1 1 3 1 — 5 2 1 — — 14 Total — 8 11 8 15 42 85 48 35 28 5 285 The number of cases on the Notification Register at the end of the year was 973, against 910 at the end of 1945. Deaths.—Unhappily, the low mortality from tuberculosis recorded in 1945 was not maintained in 1946. The numbers of deaths, and the death rates for each year from 1939 are set out in the following table:— Year No. of Deaths From Total Death-Rate Per 1,000 Pop. Pulmonary Tuberculosis N on-Pulmonary Tuberculosis Deaths Pulmonary Tuberculosis All Forms of Tuberculosis 1939 83 12 95 0.66 0.75 1940 72 14 86 0.73 0.88 1941 85 12 97 1.09 1.25 1942 70 17 87 0.83 1.04 1943 74 5 79 0.82 0.87 1944 76 8 84 0.82 0.90 1945 59 9 68 0.59 0.68 1946 95 5 100 0.80 0.85 13 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) 1,009 No. of above found tuberculous 202 No. of contacts examined 216 No. of contacts found tuberculous 3 No. of attendances at Dispensary 7,134 No. of visits by Tuberculosis Officers 164 No. of visits by Tuberculosis Nurses 2,102 No. of cases on Dispensary Register at end of year 946 No. of artificial pneumothorax refills given 2,101 No. of X-Ray examinations made 2,761 No. of specimens of sputum examined 676 Tuberculosis Care Committee.—This Committee, whose work is ancillary to that of the Paddington Tuberculosis Dispensary, met on several occasions during the year, Twenty-two patients or their families were given practical assistance from the limited funds at the disposal of the Committee, and many other cases were dealt with by reference to appropriate organisations. Maintenance Allowances.—Eighty-five new applications were dealt with, making a total of 446 since the inception of the scheme. Beds and Bedding.—The Public Health (Tuberculosis) Regulations, 1930, empower a local authority to "supply all such medical or other assistance and all such facilities and articles as may be required for . . . preventing the spread of infection." One of the ways in which this power is employed is to supply beds and bedding in suitable cases to encourage separate sleeping. Three patients were so assisted during the year. Shelters.—Under the same Regulations the Council may also provide open air shelters. There is not much call for this service, but provision is made in the Annual Estimates for the purchase of shelters should they be required. Artificial Pneumothorax Refills.—189 refills were given to 9 patients at outlying hospitals at a cost to the Council of 10s. 6d. each. For particulars of the refills given at the Paddington Tuberculosis Dispensary see above. Light Treatment.—One patient received this form of treatment at a London hospital, the Council guaranteeing to defray the cost. In-patient Accommodation.—At the request of the Council the Metropolitan Boroughs' Standing Joint Committee approached the Ministry of Health on the serious shortage of in-patient accommodation for tuberculous persons, resulting in patients having to remain on the waiting list for as long as three months. In his reply the Minister of Health stated that the problem was one of staffing rather than of actual shortage of accommodation, and that both the Minister of Health and the Minister of Labour and National Service were taking all possible steps to solve the matter. Dental Treatment.—Sixty-three attendances were made at the 12 sessions held at the dental clinic. The Council made a grant towards the cost of the dentures required by one necessitous patient . Extra Nourishment.—One hundred and fifty-seven grants were made under the Council's scheme during the year, but owing to the restrictions imposed by rationing, milk was still the only food which could be supplied. During the year the Council asked the Metropolitan Boroughs' Standing Joint Committee to take up with the Ministry of Food the desirability of increasing and improving supplies of extra nourishment to tuberculous patients generally. The outcome of this was that the Minister of Food gave an assurance that, whilst no improvement could be promised during the present world shortage of food, the scheme of de-rationing that had been prepared placed tuberculous persons high in the order of priority. The Minister stated however, that the Food Rationing (Special Diets) Advisory Committee of the Medical Research Council were satisfied that the present allowances were adequate for the maintenance of a satisfactory diet. mass radiography.—The London County Council's X-Ray Unit was not available for Paddington residents and employees during the year. It is, however, interesting to record that of the 90,379 persons examined in the County of London from October 1943 to July 1945, 744 were found to have pulmonary lesions of probably tuberculous origin, which gives a percentage of 0.82. This is the latest information at the time of going to press. diabetes.—Use continued to be made of the powers given to local authorities by the Minister of Health to supply insulin free of charge to necessitous persons who did not come within the scope of the Insurance or Poor Law Acts. Nine patients were assisted in this manner by the Council during 1946. 14 mortuary.—Three hundred and five bodies were deposited. Inquests were held in 168 cases, 124 were for Coroner's enquiries without Inquests, the remaining 13 being taken to the Mortuary to await burial. fumigation service and cleansing of verminous rooms.—During the year 45 notices were served under Section 123 of the Public Health (London) Act, 1936. In 2 cases it was necessary to institute legal proceedings, fines being imposed, but most of the owners were glad to take advantage of the facilities offered by the Council's Fumigation Service. Altogether, 615 rooms were fumigated and 106 sprayed. The total number of rooms dealt with was considerably fewer than the number dealt with in the previous year, when 1061 rooms were fumigated and 75 sprayed. This drop is in a great measure due to the efficacy of the treatment, for whereas the same rooms were formerly dealt with year after year, the percentage of recurrent cases now cropping up is less than one-half per cent (i.e., 1 in 200 cases dealt with). disinfecting station and medicinal baths.—About 20 tons of bedding etc. passed through the steam disinfector ; 245 library books were dealt with, and 376 rooms were disinfected with formalin after the occurrence of infectious disease. There was a drop in the number of scabies cases reported during the year, and a corresponding decrease in the number of cases dealt with at the Medicinal Baths, i.e., 955 as against 1,188 for 1945. The verminous cases dealt with numbered 370. The Disinfecting Station and Medicinal Baths are at present situated at the Kensal Road Baths, but it has been evident for some time that the output of work renders a more commodious establishment highly desirable. The Public Health Committee therefore decided that the Council's premises at 186, Kensal Road (which were being vacated by Kensington Borough Council) could well be adapted for the purpose. The position at the end of 1946 was that the Borough Engineer & Surveyor had been instructed to prepare a suitable scheme for early submission to the Committee and the provisional sum of £5,700 was approved for inclusion in the Capital Estimates for 1947/1948. rent and mortgage interest (restrictions) acts.—Residents of Paddington are becomingly increasingly aware of their rights under these Acts as the result of the posters and leaflets issued by the Council. During the year 25 applications were received for certificates of disrepair and in only two instances did the condition of the dwellinghouses not warrant certificates. Upon payment of a fee of 1s., an owner is entitled to apply for a. certificate that the dwelling house has been put into a reasonable state of repair, and, if granted, cancels the certificate issued to the tenant by which the tenant was enabled to make certain deductions from the rent whilst his dwelling was not reasonably fit. Only 4 such certificates were applied for and issued to landlords during the year. factories act, 1937.—For the purposes of the Factories Act, 1937, factories are divided into two categories, i.e those using mechanical power and those not using mechanical power. Where mechanical power is not employed the Borough Council is responsible for the sections of the Act relating to cleanliness, overcrowding, temperature, ventilation, drainage of floors and sanitary conveniences, but where mechanical power is employed the Council deals with sanitary conveniences only, and H.M. Inspector of Factories with the other beforementioned general health provisions. The London County Council is the responsible Authority in London for enforcing the provisions of the Act relating to "means of escape in case of fire" in both categories of factories. The following is a record of action taken by the Department during the year:— Power Factories Non-Power Factories Complaints received 17 10 Visits in connection with above 17 19 Routine inspections 59 12 Re-inspections 39 23 Infringements found and dealt with:— Sanitary conveniences 11 9 Overcrowding — — Temperature — — Inadequate ventilation — 1 Inefficient drainage of floors — — Other offences — 3 15 At the end of the year the Register contained particulars of 422 "Power" and 88 "Non-Power" factories, and with the anticipated additions to the inspectorial staff, it should be possible to keep these factories under regular supervision. The Council is also responsible for the visiting of "Outworkers" engaged in certain occupations. The Outworkers Register at present contains the names of 86 persons, and 35 of these had been visited by the end of the year by one of the lady Sanitary Inspectors. shops acts.—The Borough Council is concerned with the Shops Acts only as far as concerns ventilation and temperature of shops, and the provision and maintenance of sanitary conveniences. During the year some 700 visits were paid, the greater number of these being to the food shops in the Borough. pharmacy and poisons act, 1933, and pharmacy and medicines act, 1941.—Section 21 of the Pharmacy and Poisons Act requires sellers of the poisons included in Part II of the Poisons List to have their names entered in a Register kept by the local authority. A fee is payable for the original entry, and for each year in which the entry is retained in the Register. Retailers of "Part I" poisons must be registered pharmacists, and the Council is not concerned with these. It may be of interest to record the poisons at present scheduled as "Part II" poisons, and these are set out hereunder :— Ammonia. Arsenic sulphides. Arsenious oxide. Calcium arsenates and arsenites. Copper acetoarsenites, arsenates and arsenites. Lead arsenites. Potassium arsenites and fluoride. Sodium arsenates, arsenites and thioarsenates. Barium carbonate and silicofluoride. Formaldehyde. Hydrochloric acid (spirits of salt). Hydrofluoric acid. Sodium fluoride and silicofluoride. Mercuric chloride and iodide. Organic compounds of mercury. Metallic oxalates. Nicotine and its salts. Nitric acid. Nitrobenzine. Phenols (carbolic acid and its homologues). Phenylene and toluene diamines, and their salts (hair dyes). Potassium hydroxide (caustic potash). Sodium hydroxide (caustic soda). Sulphuric acid. At the end of 1947, 93 persons were registered as Part II sellers, and visits were paid to these as required. bakehouses.—At the end of the year there were 15 level and 25 basement bakehouses on the Register, Inspections numbered 292. work of the district inspectors.—Eight Sanitary Inspectors were engaged on District work at the beginning of the year, and, by the end, this number had increased to twelve, following the decision of the Council to augment the Inspectorial Staff in order that a thorough survey could be undertaken of the sanitary conditions of the Borough. With the prospect of further additions to the staff early in 1947 it is hoped that regular " house-to-house " inspection will be possible. The posters exhibited throughout the Borough by direction of the Council resulted in a very sharp rise in the number of complaints received—4,904 as compared with 2,964 in 1945, and 1,812 in 1944. Below is given a summary of the work of the District Inspectors for the year, so far as it is possible to tabulate the results. In addition, two Inspectors carried out surveys with a view to possible procedure under Section 9 of the Housing Act, 1936. On account, however, of the difficult circumstances prevailing, the Council has not yet found it practicable to take action. 16 Summary of Work Done During 1946. Complaints received 4,904 Inspections and reinspections of dwelling houses 24,600 Inspections of basements 41 Inspections for purposes of Housing Act 16 Visits in connection with re-housing applications 1,090 Visits in connection with infectious disease 632 Smoke observations 14 Written Intimation Notices 5,050 Nuisance Notices (Sec. 82) 1,191 Bye-law Notices 840 Vermin Notices (Sec. 123) 45 Other Notices 134 Work Carried Out:— New dustbins provided 551 Roofs repaired 1,170 Dampness remedied 957 Rooms cleansed 1,378 Rooms treated for vermin 286 Yard paving repaired 43 Water-closets repaired 419 Wall and ceiling plaster renewed 1,433 Flooring repaired 331 Accumulations of rubbish removed 120 Sundry repairs 1,285 Drainage:— Entire re-drainage 15 Partial re-drainage 75 Drains repaired 122 Drains cleared 234 Soil and waste pipes repaired 236 Soil and waste pipes renewed 86 Drainage conversions 22 New water-closets provided 149 New sinks provided 219 Drains examined 97 Drains tested 88 Water Supply:— Supplies reinstated 85 Cisterns cleansed 20 Cisterns renewed 11 Legal Proceedings:— No. of cases referred for legal action 314 No. of summonses: Taken out 153 Heard and decided 138 Fines £80 1s. 0d. Costs £171 16s. 6d. Abatement/Prohibition Orders 37 Dismissed under Probation Offenders Act 56 Adjourned sine die 12 drainage reconstruction plans.—During the year 113 plans were submitted for drainage work to be executed in existing buildings. In connection therewith 279 letters were despatched. No legal proceedings were taken on account of failure to deposit plans or for carrying out work in contravention of the drainage bye-laws. 17 work of the lady sanitary inspectors. —The two Lady 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 21 Cerebro-spinal Fever 5 Chickenpox 170 Diphtheria 63 Dysentery 34 Erysipelas 27 Lice 504 Measles 942 Pneumonia 121 Scabies 2,225 ScarletFever 347 Typhoid and Paratyphoid Fever 2 Whooping Cough 263 Visits to Schools 70 Miscellaneous 1.276 In addition 247 visits were paid to aged and infirm persons under Section 224 of the Public Health (London) Act. common lodging houses. —The one common lodging house in the Borough (Cecil House, 179, Harrow Road) was open throughout the year. It is licensed to take up to sixty-nine women or children, and applications for accommodation usually are in excess of the number of beds available. The institution is under regular supervision by a lady sanitary inspector, who paid 59 visits during the year. Visits are also paid by one of the male inspectors to ensure that the requirements of the Byelaws are being observed. canal boats.—The Canal Boats Inspector visited the Paddington Basin on 64 occasions and made 39 inspections of canal boats. All the minor defects and infringements found were dealt with informally, and it was not necessary to serve any notices. Admission to a boat was not refused at any time. Three children of school age, and 7 under school age were found to be living on the boats coming into the basin. No deaths, or cases of infectious disease, occurred among the boat population. The Grand Union Canal Company have not yet re-instituted the pre-war practice of emptying and cleaning the Canal Basin during the Easter Holiday period, dredging now being the method used to keep the Basin clear. rodent control.—During 1946, 465 complaints were received of nuisance from rats or mice. This is more than double the number (227), reported during the previous year, and was undoubtedly the result of the Council's publicity campaign. At the request of this Department, examinations of sewer connections were carried out by the Borough Engineer & Surveyor at 154 premises, a number of defects being found and made good. A rather troublesome infestation of rats occurred at the Refreshment Pavilion in the Paddington Recreation Ground, consequent on the closing down of the Council's Piggeries. Up to the end of the year the Pavilion had received ten treatments, and the infestation was being lessened, although somewhat slowly. Two other major rat infestations were discovered, in Shrewsbury Mews and Westmoreland Mews and although some improvement has been effected, these infestations have not yet been cleared. Only one other rat infestation was found, this being of a " minor secondary degree," and the few mice infestations which came to light were also of this character. The sewers were given two treatments for the elimination of rats, 473 entrances being dealt with on each occasion, resulting in an estimated kill of 4,000. The sewers have now received six treatments altogether, and it is computed that nearly 16,000 rats have been accounted for. The " Block Scheme " approved by the Ministry of Food under Circular N.S.12 was put into operation in August, and it is intended to deal with 41 " blocks " covering about 25 per cent, of the area of the Borough. Satisfactory progress was made, and by the end of the year 4 major rat infestations, 83 minor rat infestations and 114 minor mice infestations had been discovered and dealt with successfully, apart from three of the rat infestations which were still under treatment. Although the Block Scheme was approved only for the fiscal year ending 31st March 1947, it is hoped, and expected, that the Ministry of Food will consent to its being continued beyond that date. The satisfactory results achieved undoubtedly warrant such a course. 18 The staff engaged on rodent control consists of four Rodent Operatives, who work under the supervision of a Rodent Officer, and a Sanitary Inspector is in general charge of this branch of the Department's activities. Two of the operatives attend to routine complaints, and two work on the Block Scheme. Two labourers have been seconded from the Borough Engineer & Surveyor's Department to assist the latter, and, in addition, the two Fumigation Assistants are utilised for rat work whenever possible. food supervision. Sampling.—Six hundred samples (including 214 of milk) were submitted to the Public Analyst, an increase of 100 over the previous year. All the samples were reported to be genuine. Unsound Food.—About 20 tons of diseased and unsound food were surrendered by tradesmen for destruction. Ice Cream.—Ice Cream received special attention during the year, following reports of illness in other parts of the country as the result of the eating of ice cream. Many samples were taken throughout the Borough for bacteriological examination, although this test is admittedly inconclusive owing to the irregular distribution of bacteria throughout the ice cream. As was to be expected, the results showed wide divergence on occasions, but there was at no time reason to suppose that the ice cream sold in Paddington was a potential carrier of disease, and no cases of illness suspected to have arisen from this source were reported. The Minister of Health has under consideration Regulations requiring the heat treatment of ice cream, and it is anticipated that these will become law early in 1947. Inspections.—The visits paid by the Food Inspectors to food premises and stalls were as under:— Bakers 41 Butchers 555 Confectioners 150 Dairies 583 Fish 362 Fried Fish 147 General 292 Greengrocers 347 Grocer 869 Ice Cream 190 Public Houses 33 Provisions 726 Restaurants 929 Street Traders 72 Milk (Special Designations) Regulations.—Licences were issued as follows:— Dealers Principal Licences— To sell—"Pasteurised" Milk 38 "Tuberculosis-Tested" Milk 19 Dealers Supplementary Licences— To sell—"Pasteurised" Milk 3 "Tuberculosis-Tested" Milk 3 Pasteuriser's Licence 1 All samples taken for bacteriological test complied with the prescribed conditions. Sale of Food and Drinks in Public Places.—The Council, at their July meeting, decided to exercise, as from the 1st October, their powers under Section 16(2) of the Food & Drugs Act, 1938, by which the vendors of any kind of food or drink (except milk and ice cream which are dealt with by separate Regulations) are required to display their names and addresses on their stalls, vehicles, etc. housing.—During the year a further 635 dwellings were provided in requisitioned properties and 72 other families were accommodated in temporary houses. The total number of families provided with accommodations is as follows:— In requisitioned properties 1,138 In temporary houses 85 19 Thirteen families recommended for preferential consideration in the allocation of accommodation on medical grounds were rehoused by the Borough Council, and one other family by the London County Council. Areas scheduled for the erection of new accommodation:— St Mary's Square (Housing) Scheme. The old buildings on the St. Mary's Square site are being demolished and the work of preparing the site for the erection of 48 self-contained flats is progressing. Paddington Borough Council (Fulham Place) Compulsory Purchase Order, 1945. The London County Council have given conditional approval to the plans for the redevelopment for housing purposes of the Fulham Place site. The first stage proposals include the erection of some 106 flats. Paddington Borough Council (Peach Street) Compulsory Purchase Order, 1946. Following the holding of a Public Inquiry into this Order, the Minister of Health has decided to confirm the Order without modification. It is proposed to provide 92 flats on the site. Paddington Borough Council (Bishop's Bridge Road) Compulsory Purchase Order, 1946. Objections having been received to this Order, the Minister of Health has ordered a Public Inquiry to be held early in the New Year. It is proposed to utilize the site for housing purposes. A number of other areas suitable for the erection of working-class flats are under consideration by the Council. Houses Unfit for Human Habitation. Five basement rooms were closed for human habitation, but no persons were displaced as a result of the Council's action. Three closing orders were determined or undertakings cancelled during the year and one other premises made fit for human habitation without recourse to formal proceedings under the Housing Act. Housing Act, 1936—Overcrowding. (a) (1) Number of dwellings overcrowded at the end of the year 339 (2) Number of families dwelling therein 339 (3) Number of persons dwelling therein 1,367½ units (b) Number of new cases of overcrowding reported during the year 268 (c) (1) Number of cases of overcrowding relieved during the year 77 (2) Number of persons concerned in such cases 389½ units (d) Particulars of any cases in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding — (e) Any other particulars with respect to overcrowding conditions upon which the Medical Officer of Health may consider it desirable to report — Of the cases of overcrowding relieved during the year— 39 were provided with accommodation by the Borough Council, 13 were rehoused by the London County Council, 6 secured accommodation privately, and 19 were relieved by a natural reduction in the size of the family or on obtaining additional accommodation. During the year Associated Fumigators, Limited, under an Agreement with the Council, removed and treated the furniture, etc. of forty-eight families with hydrogen cyanide gas. The cost of the work was £202 10s. 0d. maternity & child welfare.—Dr. E. R. Emslie, Assistant Medical Officer for Maternity & Child Welfare, resigned as from the 30th November, and the appointment of a Senior Maternity & Child Welfare Officer in her stead was under consideration at the end of the year. Miss M. M. Bathgate and Miss E. M. Candler, Health Visitors, who had been seconded to the Ministry of Health and the Housing Department, respectively, also resigned to take up other appointments. The administration of the day nursery service was reviewed following the assumption by the Council, as from the 1st April, of responsibility for the nurseries established under War-time arrangements, and as a consequence it was decided to appoint a Nursery Liaison Officer. For this purpose Miss E. C. Jackson was seconded from her Health Visiting duties. 20 The shortage of qualified Health Visitors gave rise to difficulty in filling vacancies which occurred during the year, and the resources of the Health Visiting staff were strained in coping with the additional work entailed by the increase in the birth rate and the consequent numbers of mothers and children attending the various centres. Home Visiting: First visits to children under 1 year 1,909 Revisits 9,749 11,658 Visits to children ages 1-5 years 7,805 First visits to expectant mothers 1,375 Revisits 873 2,248 Other Visits: Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 318 Miscellaneous (including ineffective calls) 9,758 10,076 The number of children on the Health Visitors' lists at the close of the year was 8,622. consultation centres.—The continued increase in the number of attendances at the various clinics rendered the provision of further facilities necessary, and additional maternity consultations were commenced on the 16th January and the 5th April. These, however, failed to satisfy the growing demand and towards the end of the year it was decided that the need existed for two maternity sessions in addition to the foregoing ; it was also considered necessary to arrange for an additional infant session. These will commence to function early in the new year. The Dental Clinic, which was suspended on the outbreak of War, was re-established at the Welfare Centre, 283a, Harrow Road, on the 6th February, and the war-time arrangement by which treatment was given by a local dentist was terminated. In order to deal adequately with psychological problems connected with children attending the centres the institution of a Child Guidance Clinic, under the direction of a specialist medical officer, was decided upon. The first session was held on the 8th March. 21 Particulars of the consultations in operation at the end of the year are given below:— Day and Hour Designation Where Held Monday. 10.0 a.m. Maternity Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Dibdin House, Maida Vale. Tuesday. 10.0 a.m. Maternity Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Congregational Hall, Third Avenue. Wednesday. 10.0 a.m. Dental Welfare Centre, 283a Harrow Road. 10.0 a.m. Maternity Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant St. Simon's Vicarage, Macroom Road. 2.0 p.m. Maternity Welfare Centre, 283a Harrow Road. Thursday. 10.0 a.m. Maternity Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant St. Simon's Vicarage, Macroom Road. 2.0 p.m. Foot Welfare Centre, 283a Harrow Road. Friday. 10.0 a.m. Child Guidance Welfare Centre, 283a Harrow Road. 10.0 a.m. Maternity Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant St. David's Hall, St. Mary's Terrace. Daily. 10.0 a.m. Physiotherapy Welfare Centre, 283a Harrow Road. *Temporarily transferred to St. Simon's Vicarage from 17th September. 22 summary for year. infant consultations. No. of Sessions Attendances Seen by Doctor Total Average Total Average Welfare Centre, 283a Harrow Road. Monday 49 2,599 53.0 785 16.0 Tuesday 52 3,977 76.5 1,005 19.3 Thursday 51 3,723 73.0 1,008 19.8 Friday 51 2,127 41.7 755 14.8 Dibdin House. Monday 49 2,974 60.7 776 15.8 Congregational Hall. Tuesday* 36 2,083 57.9 546 15.2 St. Simon's Vicarage. Tuesday* 16 743 46.4 243 15.2 Wednesday 51 2,369 46.5 643 12.6 Thursday 51 2,024 39.7 756 14.8 St. David's Hall. Friday 51 4,126 80.9 1,349 26.5 TOTALS 457 26,745 58.5 7,866 17.2 * Temporarily transferred to St. Simon's Vicarage from 17th September. Of the 2,059 children who attended the Centres for the first time during the year, 1,749 were under the age of one year and 310 between the ages of one and five years at the date of their first attendance. The total number of children attending the consultations was 3,992, of whom 1,610 were under the age of one year, and 2,382 between the ages of one and five years at the end of the year. 23 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 1,929 39.4 455 Tuesday 52 1,627 31.3 440 Wednesday (a.m.)* 49 1,292 26 4 460 (p.m.) 51 2,621 51.4 501 Thursday 51 1,365 26.8 411 Friday** 38 988 26.0 337 TOTALS 290 9,822 33.9 2???04 *Commenced 16th January. ** „ 5th April. 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 83 ante-natal and 87 post-natal cases made a total of 911 attendances. foot clinic. Adults. Children. No. of sessions 50 No. of cases 38 5 No. of attendances 198 19 physiotherapeutic clinic. Adults. Children. No. of sessions 283 No. of cases 187 126 No. of attendances 1,208 1,731 Classification of cases:— Light 4 101 Massage 41 62 Heat 46 — Exercises 152 14 Treatments given:— Light 38 1,326 Massage 495 841 Heat 490 — Exercises 691 490 24 dental clinic.* Nursing and Expectant Mothers. Children No. of sessions 43 Patients examined 156 42 Teeth extracted 542 42 Temporary fillings — — Permanent fillings 21 4 Partial dentures 5 — Full dentures 7 — *Commenced 6th February. child guidance clinic.* No. of Sessions 37 No. of Cases 33 No. of Attendances 105 *Commenced 8th March. Dr. H. Gillespie, the medical officer in charge, reports as follows:— A considerable proportion of the cases are relatively simple and can be dealt with in two or three interviews by suitable advice to the mothers. There are, however, a number of difficult and severe problems, not only in the children but in the mothers, some of which require much more intense and prolonged treatment. As regards the results of treatment, these have on the whole been gratifying, and confirm the view that when a child's problem is taken in hand early the prospects of solving it are much brighter than if it is allowed to drag on to an age at which children are customarily referred to a Child Guidance Clinic, i.e., school age. My experience at Paddington leaves me in no doubt as to the prophylactic value of this kind of treatment. Inasmuch as the treatment consists largely in education of the mothers regarding the normal development and needs of the child, and the best ways of management, its good effect is likely to be extended to any other children the mother may have. The following are the commoner reasons for reference to the Clinic:— Enuresis 14 Tempers 12 Feeding difficulties 9 Fears 7 Disturbances of sleep 6 Unhappiness 5 The main underlying causes appear to be maternal anxiety, which generally leads to over-protection; or on the other hand a tendency to reject the child, which may lead either to neglect or, paradoxically, again to overprotection. Another frequent causative factor is to be found in discord between the parents, which can, in some cases, be adjusted after discussion with the therapist. maternity beds.—Under an agreement with the Board of Management of St. Mary's Hospital four beds are reserved for patients accepted for admission by the Borough Council at a charge of 15s. Od. per day per bed, whether occupied or not. Any additional beds which may be needed are available at the same rate. Patients are assessed according to means. During the year 87 women were delivered in these beds. There was one stillbirth and no deaths within 10 days of birth. obstetric consultant.—Mr. Douglas H. MacLeod, M.S., F.R.C.S., continued to act as obstetric consultant, but no request for his services was received during the year. emergency obstetric service.—This service is provided by the London County Council. Its object is to deal with acute obstetric emergencies in connection with patients who cannot be moved to hospital without undue risk 25 and whose cases cannot adequately be dealt with by the Borough Obstetric Consultant. It is not intended to be used as an alternative to treatment in hospital, but solely in cases where the patient's condition is so grave that removal to hospital would be dangerous. The emergency unit has available the necessary apparatus for carrying out blood transfusion. The fee payable to the London Council is £5 5s. 0d. per patient. The facilities were not utilised during the year. home help service.—At the end of the year 19 women were employed full-time in connection with the Council's arrangements for the provision of help in the home during confinement or illness, supplemented by casual part-time women. Assistance was provided in 217 cases, comprising 150 maternity patients and 67 cases where domestic help was needed on account of illness. Patients are assessed for payment in accordance with the scale recommended by the Metropolitan Boroughs Standing Joint Committee. 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.—Convalescence was arranged in four instances, viz., three mothers and one child, assistance towards the cost being given in three of the cases. In addition, thirteen children were sent to Homes under the arrangement entered into with the Invalid Children's Aid Association. child life protection.—The duties of Child Protection Visitor are carried out by each Health Visitor in respect of her own district. In addition, the Medical Officer of Health, the Senior Medical Officer for Maternity & Child Welfare, and two of the male Sanitary Inspectors are authorised to exercise the powers and duties of Child Protection Visitors for special purposes. During the year 275 visits and inspections were made, 13 new registrations of foster mothers were recorded, 23 new children were received and 31 children were removed—2 to hospital and 29 elsewhere. No deaths were reported. No legal proceedings were necessary. At the close of the year the Register contained the names of 16 persons who were receiving children for reward. These persons had charge of 20 children. In 1943 the Council adopted a scheme in connection with foster mothers for children under five years of age designed to remove certain weaknesses which had hitherto existed, such as non-payment of fees with consequent financial loss to the foster mother and failure to secure the attendance of the children at a Welfare Centre. Under these arrangements the Council is responsible for the collection of the parents' contributions and the payments to the foster mothers. Details are given below:— Children Eligible. Children under five years of age who are not in receipt of public assistance. Procedure.—Parents may apply personally at the Welfare Centre or by letter. In necessitous cases help towards payment may be given. Foster mothers apply for registration on forms supplied at the Welfare Centre, and the homes are inspected before acceptance. Conditions. Foster mothers are required to retain the child for a specified preliminary period before being accepted on a permanent basis. A separate cot for each child must be provided and a fireguard always kept in use. Parents must give a weeks notice of intention to remove a child. Children must attend a Welfare Centre regularly. The mother must be allowed to visit the child weekly at a suitable time. The mother is required to pay necessary doctor's fees. The foster mother must not leave the child except with a responsible person. The Council retains the right to transfer the child to a suitable institution or to another foster mother in emergency. During the year the Scheme was taken advantage of in 9 instances, in 1 of which financial assistance was given. daily guardians.—Responsibility for these arrangements, which were inaugurated by the Ministry of Labour and National Service in 1942, was transferred to the Borough Council on the 1st April. They provide for financial assistance to working mothers towards the cost of caring for children under the age of five years during the day. The mother makes her own arrangement with the Guardian as to payment, which is supplemented by a grant of 4s. per week for a child cared for on four days or more, or 2s. per week for a child cared for on less than four days. 26 Prospective guardians are registered by the Council after interview as to their suitability, and visits are paid to ensure that home conditions are satisfactory. During the year 15 persons were registered for the care of 15 children. At the end of the year the register contained the names of 6 Guardians who had charge of 6 children. perambulator hire scheme.—The demand for the facilities provided under these arrangements fell off considerably during the year, and in view of this and the fact that, owing to depreciation and other causes, the number of perambulators available for issue was very much reduced, it was decided to terminate the scheme on the expiration of existing hiring agreements. The expenditure on this service from its inception in 1942 until the 30th June, 1946, was £383; income for the corresponding period was £438. There is no doubt that the scheme succeeded in its object of easing the position created by the scarcity and high price of perambulators during the war period. contraceptive advice.—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 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. Two such women were referred for advice during the year. extra nourishment.—The National Milk Scheme is supplemented, where necessary on medical grounds, by grants under the Council's scheme. Assistance was given in 20 such cases during the year. care of illegitimate children.—The duties of Welfare Worker in this connection are carried out by the Superintendent Health Visitor. During the year 13 women were admitted to the Main Memorial Home, Hampstead, prior to confinement. 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. A contribution of £176 was made towards the funds of voluntary organisations concerned with moral welfare work, in accordance with the scheme arranged by the Metropolitan Boroughs Standing Joint Committee. The arrangements in connection with the establishment of a hostel for mothers and babies proceeded during the year and plans of the proposed layout were submitted to the Ministry of Health. The nature of the Ministry's observations, however, were such as to necessitate complete re-planning, and amended proposals were under consideration at the end of the year. All unmarried mothers are interviewed during the ante-natal period and encouraged to make arrangements for keeping their babies ; they are also referred to the appropriate Moral Welfare Workers. Difficulty is experienced in obtaining suitable foster-mothers or places in residential nurseries when these are required. premature infants.—The number of Paddington babies whose weight at birth was 5½ lbs. or less was 123, of whom 28 were born at home and 95 in institutions. Of those born at home 27 were nursed entirely at home, none died during the first 24 hours and 26 survived at the end of one month. Of those born in institutions 9 died during the first twenty-four hours and 67 survived at the end of one month. The special equipment provided in accordance with Ministry of Health Circular 20/44 was utilised in 8 instances, and in no case was it necessary to obtain paediatric advice. All premature infants who survived the neo-natal period progressed satisfactorily during the year and were the subject of special attention by the Health Visitor. Notification is received of the discharge of all infants born in institutions in the Borough. day nurseries.—Responsibility for the nurseries established under war-time arrangements was transferred to the Council as from the 1st April. There are six day nurseries in the Borough, providing accommodation for 274 children, 132 under the age of two years and 142 between the ages of two and five. These, however, are insufficient to meet the continued demand for vacancies, the number of children on the waiting list at the end of the year being 459. Efforts are being made to discover premises suitable for conversion to day nursery purposes, and the use of vacant sites for the erection of hutted nurseries is being borne in mind. 27 With the exception of Queen's Park, all the existing nurseries have been approved by the Minister of Health as Training Schools for Nursery Nurses. Particulars of accommodation, attendances, etc., are set out below:— Nursery Accommodation Days Open Attendances New Children Total Average 0-2 2-5 Total Full days Sats. Full days Sats. Full days Sats. Westbourne, Great Western Road. 20 30 50 254 48 12,898 917 50.8 19.1 29 Maida Vale, 14, Blomfield Road. 25 27 52 254 48 12,204 920 48.0 19.2 41 St. Jude's, 88, Bravington Road. 27 18 45 254 48 10,979 1,075 43.2 22. 4 58 Peach Street 29 33 62 254 48 14,303 998 56. 3 20.8 76 Marylands Road 31 34 65 254 49 14,968 1,183 58.9 24.5 59 Queen's Park, 66, Lancefield Street. - 26 26 254 48 5,574 449 21 9 9.4 33 There is one nursery school in the Borough, provided by the London County Council, viz., at Senior Street School.