AC 4349 PAD 47 Metropolitan Borough of Paddington REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1947 A. B. STEWART, M.D., D.P.H. VAIL & Co., Ltd., Printers to the Council, 170, Farringdon Road, E.C.1. 2 CONTENTS. page Acute Polio-myelitis, etc. 10 Aged and Infirm Persons 20 Bacteriological Examinations:— Infectious Disease 10 Milk and Foods 19 Bakehouses 18 Births 6, 7, 8 Bombed Sites 15 Blood Transfusion 14 Canal Boats 18 Care Committee, Tuberculosis 13 Certificates of Disrepair 16 Child Life Protection 26 Clinics, Ante- and Post-Natal 22 „ Child Guidance 25 „ Dental 25 „ Foot 24 „ Physiotherapeutic 24 Common Lodging Houses 20 Compulsory Repairs 20 Consultation Centres, M and C.W. 21 Contraceptive Advice 26 Convalescence 26 Daily Guardians 26 Day Nurseries 27, 28 „ „ Administration 25 Deaths:— Numbers and Rates 6, 7 Classification 9 Infantile 6, 7 Maternal 6, 7 Tuberculosis 7 Dental Treatment:— M. and C.W. 25 Tuberculosis 13 Diabetes 14 Diphtheria Immunisation 11 Disinfection 14 Domestic Helps 25 Drainage Reconstruction Plans 17 Emergency Obstetric Service 25 Extra Nourishment:— M. and C.W. 26 Tuberculosis 14 Factories Act, 1937 15 Food Supervision 18, 19 Fumigation 14, 21 page Health Visiting 23 Home Helps 25 Home Visiting, M. and C.W. 23 Houses Unfit for Human Habitation 20 Housing 20, 21 Ice Cream 19 Illegitimate Children, Care of 27 Infant Consultations 23 Infantile Mortality 7 Infectious Disease 9 Legal Proceedings 17 Marriages 10 Maternity and Child Welfare Work 21, 28 Maternity Beds 23, 25 Medicinal Baths 14 Milk (Special Designations) Regulations 19 Mortuary 14 Neo-natal deaths 8 Obstetric Consultant 25 Outworkers 16 Overcrowding 21 Pharmacy and Poisons Act, 1933 18 Population 6 Premature Infants, Care of 27 Rag and Bone Dealer 15 Rodent Control 17 Rent and Mortgage Interest (Restrictions) Acts 16 Sampling of Food 18 Sanitary Inspectors, Work of 16, 17, 19 Scabies, Treatment of 14 Smoke Nuisance 15 Shops Acts 18 Spitting 14 Static Water Tanks 14 Staff 5, 6 Stillbirths 6 Town Planning 20 Tuberculosis 7, 12, 13, 14 Unsound Food 18 Vaccination 12 Venereal Diseases 10 Verminous Rooms 14 Vital Statistics, Summary 6, 7 Water Supply 10 Whooping Cough Inoculation 11 Work of District Inspectors 16, 17 Work of Lady Sanitary Inspectors 19 3 His Worship The Mayor, Aldermen and Councillors of the Metropolitan Borough of Padding ton. Mr. Mayor, Ladies and Gentlemen, I have the honour to present to you the Annual Report for the year 1947. This Report comes exactly one hundred years after the appointment of the first Medical Officer of Health by the City of Liverpool in 1847, and by the time this Report is printed the 100th anniversary of the passing of the first Public Health Act in 1848 will be celebrated. In some respects this period of 100 years of Public Health history will be regarded in the future as a period of continuous development, neatly rounded off by the passsing of the National Health Service Act, 1946, with the appointed day for its implementation on July 5th, 1948. This is perhaps a convenient time to look back over the accomplishments under the legislation of the past hundred years. The earliest complete record in the Health Department is that of the Sanitary Report of 1868, presented by Dr. William Hardwicke to the Vestry of that period. It is unfortunate that some of the problems of that period are still with us, but gratifying to notice progress in many directions. Dr. Hardwicke reports a death rate of 17.2 per 1,000 of the 1868 population—the death rate for the present year being 12.29. Although the infant mortality figures were not compiled in the same way it is possible to make a comparison. Dr. Hardwicke reports a rapidincrease in the population between 1861 and 1868—the population at that time rising from 75,807 to 100,587 . . . the population increasing at the rate of 3,511 per year. The mortality amongst children under the age of five years amounted to 650 children, compared with 121 deaths in children under five years in a population of 127,000 in 1947. The Medical Officer of Health in 1868 had considerable worries, supervising workshops and in controlling mews premises, where the keeping of large numbers of horses and vehicles appeared to be among the arduous problems being dealt with. Even at that time whole families were residing in mews premises and carrying on a large variety of businesses. It will be remembered that at that time large areas of the Borough, for example in the Maida Vale district, were not built-up areas, and the accommodating of 100,000 people in the existing premises of the period must have caused considerable overcrowding. It is interesting to note that many of the houses being built at that time, e.g. in Amberley Road and Netley Street, were subject to multi-occupation from the start, and it would appear that many houses designed for single occupation have never been so occupied. Coming to a later period in 1889, it is interesting to note that in Charles Booth's classic "Life and Labour of the People "comment is made on overcrowding and congestion in the Lock Bridge area—a point already mentioned by Dr. Hardwicke. The relevant maps in Charles Booth's work show little change from present occupation of premises in Paddington, except that many of the large houses in the southern part of the Borough are no longer in single occupation. At this point I feel that it is necessary to issue a warning to many property owners in the Borough. Much of the property is at present about 100 years old and it is unfortunate that from 1939 to 1945 it was not possible to carry out much maintenance work. The Sanitary Inspectors have been so busy since then dealing with urgent matters of repair that it has not been possible, in the time covered by this Report, to undertake house to house inspection of the Borough. Property owners who relied in the past on the Sanitary Inspectors calling their attention to early dilapidation of their property cannot rely on this service at the present time. It is only when tenants complain of defects that the Inspector can deal with the property. This means that much of the dilapidation in the Borough is being ignored by property owners because there have been no complaints. I would ask all property owners to ensure that property is in good repair. It is no uncommon thing for a property owner when faced with an extensive schedule of repairs to say that there have been no complaints for many years. It is obvious from the statment made that some property owners do not carry out routine inspections of their property, and I feel that if this were done and repairs effected at an early stage of dilapidation it would be possible to avoid large outlay of money, the use of considerable labour and materials, by early attention to defects. There is an erroneous impression abroad that it is not possible to have repair work carried out. Property owners will find that materials are available to remedy all sanitary nuisances, and the Licensing Committee deals sympathetically with applications made to have work carried out for the preservation of existing property. During 1947 the Sanitary Inspectors received 6,240 complaints and they made over 38,000 inspectoins of dwelling houses. It is because of the large amount of work which the Inspectors have to do in this connection that property owners cannot look to the inspectorial staff to draw their attention to defects in property, other than those which have been the subject of complaint. It is gratifying to note that there has been a further fall in the infant mortality rate, and the death rate among illegitimate children, usually higher than that amongst legitimate children, is this year surprisingly low. The reader will note that the number of deaths from tuberculosis has also fallen, although there has been some increase in the number of notifications of the disease. The position regarding sanatorium beds is still very far from satisfactory, and this is one of the most serious problems which the new Regional Hospital Boards must tackle in 1948. 4 I wish to place on record at this point the retirement of Miss E. A. S. Davies, Superintendent of the Welfare Clinics. Miss Davies was a pioneer in infant welfare work and was engaged in this work before health visitors were officially recognised. It must be gratifying to Miss Davies to know of the great inprovement in the child health which has occurred during her time of office. Miss Davies was a well-loved figure in the Maternity and Child Welfare Service and gave 25 years distinguished service to the mothers and children of Paddington. It is to be hoped that Miss Davies' health will improve during her retirement, which was brought about by her poor health. During the year we experienced in this country the most widespread outbreak of polio-myelitis so far experienced. Paddington was fortunate in that only 25 cases of polio-myelitis and polio-encephalitis were recorded with one death. Compared with other Boroughs in the London region Paddington was favourably placed. There are many other interesting items to be found in the index, and these are mentioned in some detail in the body of the Report. About the time of the presentation of this Report the Maternity and Child Welfare Services will, under the terms of the National Health Service Act, 1946, be transferred to the control of the County Council. The transfer of this personal health service to the larger authority has been the subject of much debate. On the one hand there are certain advantages to be obtained by operation through a large authority. On the other hand there is the danger that such a personal service might be damaged by reason of the size of the new organisation. It is gratifying to note that the County Council proposes to de-centralise the running of the personal health service. Paddington Borough Council will be represented on the Divisional Health Committee, dealing with the transferred functions, which include not only Maternity and Child Welfare but other personal health services, and it is gratifying to note that the staff responsible for the operation of these services will continue to work in the Paddington district. The proposals made ensure that the happy relationship between staff and public which has existed in the past will continue under the new arrangements. The Tuberculosis service will pass partly to the Regional Hospital Board and partly tothe County Council, and provision has been made for the continuation of the Voluntary Care Committee. No one had ever found it possible to defend the splitting up of the Public Health services in London under the previous legislation, and although a considerable effort has been made to remedy obvious defects this has only been achieved by creating others. The environmental health work which was previously attached to Maternity and Child Welfare and Tuberculosis work through the Borough Health Service is now left in isolation, almost completely divorced from the other branches of Public Health. Environmental hygiene has always been a most important part, and indeed part of the basis of the work of a Public Health Department. One can only hope that at some early date means will be found whereby this unnatural severance of environmental hygiene from the rest of the Health service can be remedied. Finally, I can assure the Council that the members of the staff, individually and collectively, by the spirit in which they work, will ensure the successful operation of the Health services whatever authority they may be working for, either Borough Council, the Regional Hospital Board, or the County Council. I would like to place on record my personal thanks to the Council, and particularly the Chairman and members of the Committees concerned with Public Health matters, for their spirit and encouragement. I am happy to record that the Chief Officers and members of all Departments of the Borough Council have given me, and members of my Department, every assistance during the year, and I have much pleasure in expressing thanks on behalf of this Department. 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. 22nd May, 1948. 5 PUBLIC HEALTH OFFICERS (on December 31st, 1947).—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. Senior Maternity and Child Welfare Officer, W.T. A. Mower White, M.R.C.S., L.R.C.P., 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. E. T. Maclagan, M.B., B.S., M.R.C.S., L.R.C.P. R. Bischoff, M.D., L.M.C.C., L.M.S. (Canada) C. T. Potter, M.D., M.R.C.P. R. Woolf, M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. C. Himsworth, M.B., B.S., M.R.C.S., L.R.C.P., H.Hodge, M.B., Ch.B. J. Marshall, M.B., Ch.B., D.C.H. 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. Ewings. A. J. O. Sheppard. R. I. Fisher. R. H. Davis. C. T. Wyatt. C. H. F. Drake. H. J. Parker. S. W. Wordingham. A. G. L. E. Houghton. R. S. Welch. P. F. Purser. J. T. G. Warby. L. Allchin. E. J. Cleaver. E. Craddock. Miss D. Smeaton. Miss M. J. Gair. Mrs. B. M. Riley. Miss F. M. Crook. Miss L. J. Brett. Miss J. Bailey Miss O. Rapson Mrs. G. Cutler. Miss J. Kirby. Miss S. Crook. Mrs. A. Malby. Mrs. E. Mascall. Mrs. M. J. P. Miller. Miss E. Low. Sanitary Inspectors—W.T. C. G. Heron (Senior Sanitary Inspector). V. L. Ronchetti. E. B. Wilde. F. J. Pallet (Food and Sampling). E. Marshall. A. C. Harrison (Food). J. J. Atkinson. G. Duncan. W. H. G. Atkins. F. Nau. J. Watson. J. Mains. W. G. Thurgood. G. A. Fraser. R. E. Haines. V. A. Vickers. D. T. Hopkins. C. Chesterman. Mortuary Superintendent—W.T. L. W. J. Spears. Assistant Mortuary Keeper—W.T. C. C. Lewis. 6 Rodent Officer.—W.T. W. A. Dunkley. and 17 Disinfecting, Fumigation, Rodent Control and Porter Staff. Lady Sanitary Inspectors—W.T. Miss D. M. Newhall. Miss E. Z. Amor. Health Visitors—W.T. Miss E. Donovan (Superintendent Health Visitor). Mrs. M. Vaughan. Mrs. M. Stevenson. Miss G. A. Ireson. Mrs. J. Slater. Miss A. Tamlyn Mrs. A. Thornthwaite Miss A. Ponting. Miss B. Broughton. Miss G. Gourley. Miss A. V. I. Rojas. Miss A. Wiglesworth. Miss A. M. C. Beausoleil. Miss M. O. Thomas. Clinic Nurse, Welfare Centre.—W.T. Miss J. P. Dempster. Physiotherapist, Welfare Centre,—W.T. Miss E. M. Suffling. Chiropodist, Welfare Centre.—P.T. Miss Akker Day Nursery Service. Nursery Liaison Officer. Miss E. C. Tackson. 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. Mrs. F. Lewis. Miss B. Preston. Miss W. Field. Miss T. Butterick. VITAL STATISTICS 1947—SUMMARY (For purposes of comparison numbers and rates for 1946 are given in brackets). Area of Borough: 1,356.1 acres, including waterways 20.0 acres. Population: Registrar-General's estimate of Civilian Population—127,450 (117,670). Number of inhabited houses (end of year) according to Rate Books—21,148 (21,294). Live Births: Total Males Females Birth Rate per 1,000 estimated) civilian population 19.77 (20.28) Legitimate 2,174 (2,007) 1,080 (1,017) 1,094 (990) Illegitimate 346 (379) 173 (190) 173 (189) Totals 2,520 (2,386) 1,253 (1,207) 1,267 (1,179) Stillbirths 57 (59) 30 (36) 27 (23) Still-birth Rate per 1,000 (live and still) births 22 (24) Deaths (all ages) 1,567 (1,525) 813 (780) 754 (745) Death Rate per 1,000 estimated civilian population 12.29 (12.96) Deaths from Puerperal Causes : Puerperal Sepsis (2) Rate per 1,000 (live and still) births 0.00 (0.81) Other Puerperal Causes 1 (2) „ 0.39 (0.81) Total 1 (4) „ 0.39 (1.63) Deaths of Infants under 1 year of age 109 (113) Death Rates of infants under 1 year of age:— All infants per 1,000 live births 43 (47) Legitimate infants per 1,000 legitimate live births 45 (43) Illegitimate infants per 1,000 illegitimate live births 35 (71) 7 Deaths from Tuberculosis : Pulmonary (all ages) 71 (95) Other forms (all ages) 12 (5) Death Rate from Pulmonary Tuberculosis per 1,000 of the estimated civilian population 0.56 (0.80) Tuberculosis Death Rate (all forms) 0.65 (0.85) Rateable Value £1,748,335 (£1,742,988) Product of a Penny Rate £6,684 (£6,122) General Summary of Vital Statistics. Year. Reg. General's Estimate of Population. Live Births Deaths Deaths under One Year Maternal Deaths Tuberculosis Deaths (All forms) Number. * Rate. Number. * Rate. Number. * Rate. Number. * Rate. Number * Rate. 1901 143,976 3359 23.29 2163 15.00 455 135 9 2.1 223 1.53 1911 142,541 2977 20.88 1885 13.22 388 129 10 3.3 212 1.48 1921 145,600 2859 19.63 1758 12.06 265 92 13 4.54 125 0.86 1931 140,300 2075 14.79 1831 13.05 182 87 10 4.63 138 0.98 1938 137,400 1888 13.74 1557 11.33 125 66 3 1.53 81 0.59 1939 135,300 1812 13.39 1608 12.74 106 60 8 4.38 95 0.75 1940 97,860 1556 15.90 1766 18.04 88 59 4 2.61 86 0.88 1941 77,640 1217 15.67 1418 18.26 64 60 4 3.62 97 1.25 1942 83,640 1397 16.70 1268 15.16 78 56 4 2.77 87 1.04 1943 90,580 1569 17.32 1390 15.32 107 68 2 1.86 79 0.87 1944 93,030 1639 17.62 1388 14.92 100 61 2 1.18 84 0.90 1945 99,790 1712 17.16 1367 13.69 104 61 7 3.97 68 0.68 1946 117,670 2386 20.28 1525 12.96 113 47 4 1.63 100 0.85 1947 127,450 2520 19.77 1567 12.29 109 43 1 0.39 83 0.65 * Corrected figures after allowing for inward and outward transfers. BIRTHS Total Live Births Illegitimate Live Births Illegitimate Birth Rates* Paddington 2,520 (2,386) 346 (379) 13.7 (15.9) Wards: Queens Park 188 (182) 7 (16) 3.7 ( 8.8) Harrow Road 512 (558) 47 (59) 9.2 (10.6) Maida Vale 450 (450) 64 (64) 14.2 (14.2) Westbourne 529 (454) 87 (79) 16.5 (17.4) Town 273 (255) 46 (43) 16.8 (16.8) Church 74 (98) 11 (25) 14.9 (25.5) Lancaster Gate West 132 (125) 20 (17) 15.2 (13.6) Lancaster Gate East 129 (106)) 26 (36) 20.2 (34.0) Hyde Park 233 (158) 38 (40) 16.3 (25.3) *per 100 total live births INFANTILE MORTALITY Total Live Births Total Deaths under 1 year Rates* Paddington 2,520 (2,386) 109 (113) 43.3 (47.4) Wards: Queens Park 188 (182) 7 (6) 37.2 (33.0) Harrow Road 512 (558) 25 (30) 48.8 (53.8) Maida Vale 450 (450) 20 (13) 44.4 (28.9) Westbourne 529 (454) 16 (22) 30.2 (48.5) Town 273 (255) 11 (12) 40.3 (47.1) Church 74 (98) 4 (6) 54.1 (61.2) Lancaster Gate West 132 (125) 5 (6) 37.9 (48.0) Lancaster Gate East 129 (106) 8 (7) 62.0 (66.0) Hyde Park 233 (158) 13 (11) 55.8 (69.6) *Per 1,000 total live births. Deaths under 1 month Legitimate Rates* Deaths under 1 month Illegitimate Ratesf Paddington 49 (53) 22-5 (26 4) 9 (23) 26-0 (60 7) Wards : Queen's Park 5 (4) 27-6 (24-1) - (2) — (1250) Harrow Road 13 (13) 28-0 (26*0) 1 (4) 21-3 (67-8) Maida Vale 9 (7) 23 3 (181) 3 (2) 46-9 (31*2) Westbourne 7 (12) 15-8 (32-0) - (4) — (50-6) Town 5 (4) 22-0 (18-9) - (2) — (46-5) Church 2 (5) 31'7 (68 5) 1 (1) 909 (40-0) Lancaster Gate West 2 (1) 17-8 (9-3) 1 (3) 50-0 (176-4) Lancaster Gate East 3 (1) 29'1 (143) 2 (3) 76-9 (83-3) Hvde Park 3 (6) 15-4 (50-8) 1 (2) 26-3 (500) *Per 1,000 live births (legitimate) tPer 1,000 live births (illegitimate). 9 DEATHS.— Cause of Death. All Ages. Under One Year of Age. M F Total M F Total All Causes. 813 754 1567 54 55 109 Typhoid and paratyphoid fevers — — — — — — Cerebro-spinal fever — 2 2 — — — Scarlet fever — — — — — — Whooping cough 2 2 4 — 2 2 Diphtheria — — — — — — Pulmonary tuberculosis 41 30 71 — 1 1 Other tuberculous diseases 8 4 12 1 1 2 Syphilitic diseases 14 3 17 — — — Influenza 2 4 6 — — — Measles — — — — — — Acute polio-myelitis and polio-encephalitis — 1 1 — — — Acute infectious encephalitis 1 2 3 — — — Cancer of buccal cavity and oesophagus (males) 10 — 10 — — — Cancer of uterus — 13 13 — — — Cancer of stomach and duodenum 15 16 31 — — — Cancer of breast — 26 26 — — — Cancer of all other sites 87 62 149 — — — Diabetes 6 2 8 — — — Intra-cranial vascular lesions 49 87 136 — — — Heart disease 198 187 385 — — — Other circulatory diseases 40 51 91 — — — Bronchitis 73 40 113 2 4 6 Pneumonia 56 57 113 9 9 18 Other respiratory diseases 17 6 23 — — — Ulcer of stomach or duodenum 20 5 25 — — — Diarrhœa (under 2 years) 11 8 19 11 8 19 Appendicitis 3 3 6 — — — Other digestive diseases 16 19 35 1 — 1 Nephritis 15 9 24 — — — Puerperal sepsis — — — — — — Other maternal causes — 1 1 — — — Premature birth 10 12 22 10 12 22 Congenital malformation, birth injury, infantile disease 19 23 42 16 17 33 Suicide 10 6 16 — — — Road traffic accidents 15 6 21 — — — Other violent causes 20 21 41 1 1 2 All other causes 55 46 101 3 — 3 INFECTIOUS DISEASE.— Notifications. Disease. 1940 1941 1942 1943 1944 1945 1946 1947 Acute Encephalitis lethargica 1 1 — — — — — — „ Influenzal pneumonia 22 8 11 29 11 9 20 18 „ Primary pneumonia 80 68 96 53 47 88 100 67 „ Polio-encephalitis — — — — — — — 4 „ Polio-myelitis 1 3 1 1 2 1 2 21 „ Rheumatism 9 6 2 5 6 9 6 Cerebro-spinal fever 24 19 11 9 7 9 4 6 Continued fever 3 1 — — — — — — Diphtheria 42 58 38 54 50 51 37 20 Dysentery 3 12 35 94 38 86 34 8 Erysipelas 43 29 28 29 33 31 23 27 Food poisoning or suspected food poisoning 6 4 6 10 3 4 11 17 Infective enteritis or summer diarrhoea 24 13 27 84 107 154 143 128 Malaria 4 — 3 — 5 2 9 2 Measles 253 301 707 592 174 1,046 690 960 Membranous Croup — — — — 1 — — — Ophthalmia neonatorum 20 6 6 8 13 11 5 4 Puerperal fever 23 6 5 3 8 25 10 3 Puerperal pyrexia 17 25 38 23 24 37 24 16 Scabies (notifiable from 1st August, 1943) — — — 246 644 804 726 344 Scarlet fever 56 61 110 312 137 126 228 129 Smallpox — — — — 1 — — — Typhoid or enteric fever 5 9 1 3 — 2 — 3 Whooping cough 24 170 235 142 156 54 155 227 10 Bacteriological Examinations.—The number of examinations made in connection with infectious disease was 371, classified as follows:— Disease Examinations Positive Results Diphtheria 141 2 Typhoid Fever — — Scarlet Fever 5 — Dysentery 4 — Tuberculosis 221 33 371 35 Acute Polio-Myelitis and Encephalitis (Infantile Paralysis). As already reported in the introductory letter, this country experienced its largest outbreak of Acute Polio-myelitis and Polio-encephalitis during the year. Paddington was fortunate in escaping with a relatively small number of cases. Every effort was made to tackle this difficult problem, but in view of our limited knowledge regarding the spread of this disease we cannot be sure that the efforts made had any great contributory effect on the course of the epidemic. Considerable attention was paid to the suppression of flies. It was found to be quite unnecessary to give any consideration to the use of swimming baths, as the public appeared to take necessary action and avoid the swimming baths during the period of the outbreak. The consideration of the clinical aspects of the disease are perhaps out of place in a report of this nature, but it was evident from the number of consultations which I had with local practitioners that they were all fully alive to the possibility of this disease occurring in the Borough. There was no lack of publicity regarding this outbreak, as was evident from several cases which on investigation proved to be hysterical attacks. The epidemiologist and the clinician have been gaining considerable experience during the year, and we can look for improvements in control and treatment as a result of this experience. MARRIAGES.—The number of marriages solemnised in the Borough was 1,948, being a rate of 30.6 persons per 1,000 of the population. This is an increase of 262 marriages over the number solemnised in 1946, when the rate of 28.6. WATER SUPPLY.—No complaints were received during the year as to the quality of the water supplied by the Metropolitan Water Board. The Board reported 6 cases of water being cut off owing to wastage or non-payment of rates, this being a legal requirement. In all cases the supplies were reinstated without undue delay following appropriate action by the Public Health Department. On the 26th October the Minister of Health made an Order under Section 14 of the Water Act, 1945. The Order is called The Metropolitan Northern Area (Conservation of Water) Order, 1947, and defines an area which includes the Borough of Paddington. Briefly, the effect of the Order is that in this area a person must obtain a licence from the Ministry before constructing a well or extending an existing well, and makes it an offence for water to be extracted in excess of reasonable requirements, or to run water to waste. The Medical Officer of Health and the Sanitary Inspectors have been authorised by the Council to act for the purposes of the Order. In a report to the Ministry of Health, the Council stressed the desirability of existing wells in the London area being licenced, and envisaged the unsatisfactory position that could develop where a large number of existing wells were used without adequate supervision. A survey of Paddington shows that there are nine wells or bore-holes, of which 8 have become disused and sealed off. The remaining one is in constant use for trade purposes. Analyses of the water gives consistently good results, and there is no wastage. VENEREAL DISEASES.—The Borough Council is not concerned with the treatment of venereal diseases, but we assist the Ministry of Health and the London County Council in the dissemination of information to the public by means of posters and leaflets. 11 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, 1947. No. of children who completed a full course of primary immunisation during the year 1947 No. of children given a secondary or reinforcing injection during the year 1947 Under 5 years 5 to 14 years Total 1,289 240 1,529 109 Number of children who had completed a full course of immunisation at any time up to 31st December, 1947. Age at 31.12.47 Under 1 year 1 2 3 4 5-9 10-14 Total under 15 Number immunised 61 835 818 883 743 3,369 1,805 8,514 Estimated mid-year population, 1947. 8,440 11,000 19,440 Estimated percentage of child population immunised 39 6 470 43.8 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 50. The material is supplied free by the Council and a fee of 3s. 6d. per injection (usually two) is paid to the doctor. Owing to a greatly increased demand for immunisation, and in order that residents of the southern part of the Borough should be better served, an additional clinic was opened in November at St. David's Hall, St. Mary's Terrace, and is held on Wednesday afternoons. Publicity continued on the lines of last year, and the Health Visitors did much good work in bringing to the notice of parents the undoubted benefits of immunisation. An additional form of publicity was the showing of a suitable film during the Paddington Civic Week. WHOOPING COUGH.—It was decided to re-introduce facilities for the immunisation of children against whooping cough, and inoculations commenced in July. By the end of the year 1,111 children had received combined whooping cough/diphtheria immunisation, and 310 who had previously been immunised against diphtheria only were inoculated against whooping cough. The material used is Alum Precipitated Whooping Cough Vaccine containing 20,000 m organisms per c.c., and this is combined with a Diphtheria Prophylactic for dual inoculation. We have no proof that Whooping Cough vaccine is as efficacious as the Diphtheria Prophylactic which is used, but available data suggests that protection is afforded against Whooping Cough. A large scale controlled experiment is being carried out elsewhere, the result of which is not yet available, but it was felt that even if the protection was only slight, such protection ought to be afforded to the children in the Borough. VACCINATION.—The latest return available is for the year 1946. This shows that of the 3,523 children whose births were registered during that year 59.8% were successfully vaccinated, and 8.9% were exempted on production of statutory declarations. Insusceptibility, removals, not traced, etc., account for the remaining 31.3%. 12 Next year, after July 5th, vaccination will no longer be compulsory. It is interesting to note that by voluntary methods an enlightened populace has been persuaded to have diphtheria immunisation to a greater extent than they could be persuaded to have vaccination as a compulsory requirement. So far there has been no indication of the Ministry of Health's policy after the appointed day, but vaccination is to be made available to all free of charge. TUBERCULOSIS. Notification Register.—Two hundred and seventy-three new cases of pulmonary tuberculosis and 22 of non-pulmonary tuberculosis were notified, being an increase of 12 pulmonary cases and a decrease of 2 non-pulmonary cases compared with the previous year. The numbers of cases notified in previous years are shown in the following table: Year Population Pulmonary N on-Pulmonary Total Cases 1911 142,541 397 No record 397 pul. 1921 145,600 244 91 335 1931 140,300 213 87 300 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 1947 127,450 273 22 295 The ward distribution of the cases notified during 1947 is as follows:— Ward Pulmonary Non-Pulmonary Total Males Females Males Females Queens Park 8 6 — 2 16 Harrow Road 23 17 2 1 43 Maida Vale 28 31 2 2 63 Westbourne 34 26 2 5 67 Church 13 18 — 1 32 Town 3 3 — — 6 Lancaster Gate, W. 14 7 2 2 25 Lancaster Gate, E. 8 8 1 — 17 Hyde Park 19 7 — — 26 Borough 150 123 9 13 295 The following table shows the age distribution of the 295 cases:— 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total All ages Pulmonary-Male — 1 7 8 4 15 48 20 25 15 7 150 Pulmonary-Female — 6 2 1 8 23 48 19 10 3 3 123 Non-Pulmonary-Male — 1 2 1 — 1 1 2 1 — — 9 Non-Pulmonary-Female 1 2 2 — — — 3 3 1 1 — 13 Total 1 10 13 10 12 39 100 44 37 19 10 295 The number of cases on the Notification Register at the end of the year was 1,058, against 973 at the end of 1946. 13 Deaths.—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 Deaths Death-Rate Per 1,000 Pop. Pulmonary Tuberculosis Non-Pulmonary Tuberculosis 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 1947 71 12 83 0.56 0.65 Dispensary Treatment.—Following are particulars of the work carried out at the Paddington Tuberculosis Dispensary, Newton Road:— No. of patients examined for first time (excluding contacts) 1,037 No. of above found tuberculous 251 No. of contacts examined 293 No. of contacts found tuberculous ... 3 No. of attendances at Dispensary 7,965 No. of visits by Tuberculosis Officers 128 No. of visits by Tuberculosis Nurses 2,015 No. of cases on Dispensary Register at end of year 1,039 No. of artificial pneumothorax refills given 2,074 No. of X-Ray examinations made 3,114 No. of specimens of sputum examined 685 The Paddington Tuberculosis Dispensary service will, next year, after July 5th, become part of both the Regional Hospital Board Service and the London County Council Service. Broadly speaking, the clinical side of the work will be the concern of the Hospital Board, and the Social and Care side of the work will be the concern of the County Council as the local Health Authority. Tuberculosis Care Committee.—This Committee met on several occasions during the year, and gave assistance to patients in suitable cases, and referred others to appropriate organisations. When the National Health Service Act comes into force, this Committee will function as a Committee of the London County Council. Maintenance Allowance.—Although a great step in the right direction, the Scheme has undoubted faults in that it restricts benefit to pulmonary cases only, and those only so long as they are not "chronic" cases. With the coming into force of the National Insurance Act next year, however, maintenance allowances for the tuberculous will be superseded by benefits payable under that Act. Beds and Bedding.—8 sets were supplied on the recommendation of the Tuberculosis Officers in cases where it was desirable for separate sleeping arrangements to be made. Special Treatment.—138 artificial pneumothorax refills were supplied to patients at various hospitals at the expense of the Council. The Council also made itself responsible for light treatment in one case, and for a thorocoplastic belt in another. Dental Treatment.—Seventy attendances were made at the monthly session held at the Dispensary, and the Council made grants towards the cost of dentures required by two necessitous patients. 14 Extra Nourishment.—There has been no improvement to report in the standard of extra nourishment for the tuberculous, whose rations remain the same as those of the rest of the population, apart from milk granted on a medical certificate. In 219 cases the Council paid for extra milk where the patients themselves could not afford it. In-patient accommodation.—The insufficiency of in-patient accommodation for the tuberculous continued to be of serious concern, and the Council's representatives on the Metropolitan Boroughs' Standing Joint Committee were asked to raise this matter once again with a view to the Minister of Health being urged to accelerate and intensify the campaign for recruitment of adequate nursing staff. DIABETES.—The Council paid for the insulin required by 13 necessitous persons. SPITTING.—The Bye-laws of the London County Council for the Good Rule and Government of the County make it an offence to spit "on the floor, side or wall of any public carriage, or of any public hall, public waiting-room, or place of public entertainment, whether admission thereto be obtained upon payment or not." It would be almost an impossibility to enforce a Bye-law prohibiting spitting in public thoroughfares, and the only way to approach this matter is by appealing to the co-operation and goodwill of the public through the medium of posters. The Central Council for Health Education publish a poster which is calculated to draw attention to the need for refraining from this reprehensible habit, and a supply of these was obtained and exhibited in the Borough with the kind co-operation of the Paddington Chamber of Commerce. BLOOD TRANSFUSION.—In April the Council authorised arrangements being made with the Medical Research Council for the establishment of a blood transfusion service at the Welfare Centre. Members of the Council, the Staff, and the public were invited to volunteer, and the response was very gratifying. It was not until early in December, however, that the Research Council were able to send a unit to Paddington, but at the session then held a good proportion of the volunteers were called upon. MORTUARY.—416 bodies were taken to the Mortuary, an increase of 111 over the number for 1946. Inquests were held in 176 cases, and Coroner's Certificates were issued in 219. The remaining 21 bodies were taken to the Mortuary to await burial. The London County Council have decided, after consultation with the Borough Council, not to rebuild the Coroner's Court attached to the Mortuary, which was destroyed by enemy action in 1941. The western area of London will continue to be served by the two Courts situated at Fulham Palace Road, Hammersmith, and Horseferry Road, Westminster. FUMIGATION SERVICE AND CLEANSING OF VERMINOUS ROOMS.—The exceptionally hot summer of 1947 accounted for a very big rise in the number of applications received for the use of the Council's Fumigation Service, 645 rooms being fumigated and 725 sprayed, as compared with 615 rooms fumigated and 106 sprayed in 1946. It was necessary to serve 54 notices under Section 123 of the Public Health (London) Act, 1936, and to take legal proceedings in 18 cases to secure compliance with the Notices. DISINFECTING STATION AND MEDICINAL BATHS.—Approximately 14 tons of bedding etc. were dealt with in the steam disinfector, and 386 rooms were disinfected with formalin after the occurrence of infectious disease. 260 library books were also disinfected. There was a further drop in the number of scabies cases requiring treatment at the Medicinal Baths; 500 persons attended, as against 955 in 1946. A similar improvement was revealed so far as verminous cases were concerned, only 196 needing treatment, approximately half the number dealt with in the previous year. It is very disappointing to record that no progress has been made with regard to the establishment of the Disinfecting Station and Medicinal Baths at 186, Kensal Road. At the time of writing (March, 1948) the Minister of Health had not indicated his approval of the scheme submitted to him some months previously, and it is probable that prior needs for housing may render necessary a curtailment of the scheme as originally proposed. STATIC WATER TANKS.—Many complaints were received during the year about the condition of emergency water tanks, and a number of them were accompanied by demands for immediate demolition of the tanks. It is difficult sometimes to convince complainants that the Council have no power in the matter of demolition, and that we can only ensure the removal of any rubbish which is, or is likely to become, a nuisance. The public, quite understandably, look upon the tanks as a public nuisance, and their removal a matter of public concern. It is indeed hoped that a Directive from higher quarters may soon be given in the matter of demolition. Meanwhile, the Department does whatever it can in the prevention of nuisance. All tanks are sprayed at regular periods during the summer months, and the Director of Public Cleansing is informed of any accumulations of rubbish requiring removal. 15 BOMBED SITES. The remarks about static water tanks apply equally to bombed sites, and it will be impossible to prevent occasional nuisances arising until adequate fencing is erected. Whilst tenants of nearby houses do undoubtedly use the sites at times as a dumping ground for household rubbish, old beds and such like, by far the greater nuisance is caused by itinerant vendors, who have come to regard the sites as a heaven sent means of disposing of their trade refuse free of charge. RAG AND BONE DEALERS.—An offence against the Bye-laws relating to the Business of a Rag and Bone Dealer was reported, and as it was a first offence, it was considered that the sending of a cautionary letter would sufficiently meet the case. SMOKE NUISANCE.—The Council are concerned only with "industrial" smoke, there being nothing on the Statute Book dealing with the emission of smoke from the chimneys of private houses. Any smoke nuisance from the latter can only be dealt with as a nuisance at common law. In Paddington we find the owners of industrial undertakings very co-operative and willing to act upon the advice of the Council's officers. No offences against the L.C.C. Bye-laws relating to the emission of "black" smoke were observed, and no complaints were received. FACTORIES.—Following is a table showing the work carried out during the year under the Factories Act, 1937. Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 108 52 16 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 455 307 44 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 3 — — — TOTAL 566 359 60 — Particulars of Defects Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.1) 19 19 3 — — Overcrowding (S.2) 1 1 — — — Unreasonable temperature (S 3) — — — — — Inadequate ventilation (S.4) 3 3 — — — Ineffective drainage of floors (S.6) 2 2 — — — Sanitary Conveniences (S.7) (a) insufficient 7 6 — — — (b) Unsuitable or defective 32 31 — 4 — (c) Not separate for sexes 3 2 — 1 — Other offences against the Act (not including offences relating to Outwork) — — 1 — — TOTAL 67 64 4 5 — 16 OUTWORKERS.— Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (e) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions 95 — — — — — RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS,—Applications for disrepair certificates numbered 23, of which 16 were granted. Of the remaining 7 cases, the premises were in 4 instances in a reasonable state of repair, and 3 premises were not subject to old control. Three clearance certificates were also applied for and issued to owners. On the subject of disrepair of houses generally, the Council decided to forward certain suggestions to the Metropolitan Boroughs' Standing Joint Committee for consideration by the Minister of Health when the contemplated revision of the Rent Restrictions Acts was undertaken. These suggestions were:— (i) that a reduced rent should be paid in cases where a house is not in a reasonable state of repair; (ii) that the reduction of rent should apply to " 1939 " Act premises, as well as those controlled under the principal Act; (iii) that the reduction should be made from the standard rent, and not on the recoverable rent. As the result of the representations made by the M.B.S.J.C. to the Minister of Health, the Minister stated that he would bear these recommendations in mind. Later, however, in reply to a question in the House of Commons, he stated that there was no prospect of any revision of the Rent Restrictions Acts at the present time. WORK OF THE DISTRICT INSPECTORS.—Additions to the Inspectorial Staff during the year brought the number of Inspectors available for district work up to 16, and, as will be seen from the appended summary, much additional work was accomplished. The year 1947 was a year of very hard work for the District Inspectors, and very considerable progress was made in clearing off arrears of work in the matter of disrepair and dilapidation. In the introductory letter the position regarding repairs has already been explained, and it is only necessary for me to point out that the Borough is now completely covered by the sixteen District Inspectors. In some of the districts it has been necessary to employ additional inspectors to attempt to deal with the more unsatisfactory areas. Summary of Work Done During 1947. (Figures for 1946 in brackets). Complaints received 6,240 (4,904) Inspections and reinspections of dwelling houses 38,750 (24,600) Inspections of basements (14) (41) Inspections for purposes of Housing Act 207 (16) Visits in connection with re-housing applications 452 (1,090) Visits in connection with infectious disease 163 (632) Smoke observations 2 (14) Written Intimation Notices 4,478 (5,050) Nuisance Notices (Sec. 82) 1,681 (1,191) Bye-law Notices 786 (840) Vermin Notices (Sec. 123) 54 (45) Other Notices 194 (134) 17 Work Carried Out:— New dustbins provided 1,089 (551) Roofs repaired 2,327 (1,170) Dampness remedied 3,018 (957) Rooms cleansed 5,158 (1,378) Rooms treated for vermin 663 (286) Yard paving repaired 104 (43) Water-closets repaired 1,124 (419) Wall and ceiling plaster renewed 5,267 (1,433) Flooring repaired 672 (331) Accumulations of rubbish removed 253 (120) Sundry repairs 4,739 (1,285) Drainage:— Entire re-drainage 9 (15) Partial re-drainage 109 (75) Drains examined 465 (97) Drains tested 239 (88) Drains repaired 217 (122) Drains cleared 322 (234) Drainage conversions 19 (22) Soil and waste pipes repaired 650 (236) Soil and waste pipes renewed 98 (86) New water-closets provided 251 (149) New sinks provided 335 ( 219) Water Supply:— Supplies reinstated 222 (85) Cisterns cleansed 29 (20) Cisterns renewed 12 (11) Legal Proceedings:— No. of cases referred for legal action 620 (314) No. of summonses heard 331 (138) Fines £248 10s. 0d. (£80 1s. 0d.) Costs £378 18s. 6d. (£171 16s. 6d.) Abatement/Prohibition Orders 74 (37) Dismissed under Probation of Offenders Act 85 (56) Adjourned sine die 27 (12) DRAINAGE RECONSTRUCTION PLANS.—During the year 109 plans were submitted for drainage work to be executed in existing buildings. In connection therewith 245 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, but one case was reported to the Committee, who directed the Town Clerk to send a cautionary letter. Plans were subsequently deposited, and the work altered to conform with the Bye-laws. RODENT CONTROL.—The number of complaints received of rats or mice was 350, 115 fewer than the number received in 1946. The Borough Engineer and Surveyor was asked to carry out examinations of sewer connections in 257 instances, and a number of minor defects found were made good. The Rat Extermination Service which was inaugurated in 1944, has fully justified its existence, and the old method of dealing with each complaint individually has given place to the much more efficient method of dealing with houses in the immediate neighbourhood at the same time, where conditions suggest that the rat infestation is not confined to a particular house. The official "Block Scheme" approved by the Ministry of Food came to an end on 30th September, and although it is not possible to furnish any estimate of the number of rats and mice killed, it is safe to say that the poison baits taken indicate that the rat population in the areas dealt with was considerably reduced. Charges for treatments at business premises are made in all cases; at private houses only where it is considered reasonable to expect payment. The Public Health Committee authorised free treatment in 102 instances during the year. 18 At the end of the year "ship" rats were found to have invaded a small area of business premises in the vicinity of the Canal Basin. All occupiers were warned by the Department of the unusual characteristics possessed by these rats, and our co-operation was offered to deal with the menace. Fortunately there is no indication that these rats are on the increase. The sewers received their usual treatments in January and July, and it is probable that over 5,000 rats were accounted for. CANAL BOATS.—The Canal Boats Inspector visited the Paddington Basin on 90 occasions, and inspected 71 boats. No serious defects or infringements were discovered, the minor matters requiring attention being disposed of without recourse to the service of notices. Eight girls and one boy of school age were found to be living on the boats coming into the Basin. There were no deaths or cases of infectious disease among the canal boat population. SHOPS ACTS.—590 visits were made under this heading ; no notices were served, any infringements of the Acts (mainly concerned with sanitary accommodation) being dealt with informally. PHARMACY AND POISONS ACT, 1933, etc.—At the end of the year the Register contained the names of 97 persons entitled to sell the poisons scheduled in Part II of the Poisons List, and 155 visits were made to ensure that the poisons were being stored and sold in accordance with the requirements of the Pharmacy and Poisons Rules. BAKEHOUSES.—The number of bakehouses in the Borough remained at 40 (15 level and 25 underground). 209 visits were made. FOOD SUPERVISION. Sampling.—600 samples were submitted to the Public Analyst, 22 being formal samples and 578 informal. 147 of the samples were of milk, on which there was no adverse report. Of the 600 samples, only 4 (0.66 per cent.) were "not genuine," and particulars of these, and the action taken are shown below:— Article Formal or Informal Nature of Adulteration or Irregularity Action Taken Rum Formal 38.13° under proof, equal to 4.82% excess of water Legal proceedings taken. Case dismissed with costs against the Council. Sulphur Ointment Informal 662/3 deficient in sulphur Cautionary letter. Tinned Herring Informal Tins blown; contents unsuitable for human consumption ,, Pineapple Jam Informal Jar contained pieces of glass ,, Unsound Food.—Approximately 28f tons of diseased or unsound food were surrendered by tradesman for destruction. Two cases were reported of bread being sold unfit for consumption. In one instance the bread contained a cockroach, and in the other, a nail. A tin of Irish Stewed Steak was found to contain a portion of a bandage, and the Ministry of Food was asked to communicate with the Eirean Authorities about this. Food Poisoning.—18 cases of Food Poisoning or Suspected Food Poisoning were enquired into, but there was nothing of a serious nature calling for special report. 19 Inspections.—The visits paid by the Food Inspectors to food premises and stalls were as under:— Bakers 77 (41) Butchers 737 (555) Confectioners 154 (150) Dairies 538 (583) Fish 312 (362) Fried Fish 84 (147) General 280 (292) Greengrocers 325 (347) Grocer 900 (869) Ice Cream 301 (190) Public Houses 56 (33) Provisions 735 (726) Restaurants 709 (929) Street Traders 68 (72) Milk (Special Designations) Regulations.—Licences were issued as follows:— Dealers' Principal Licences— To sell—"Pasteurised" Milk 38 "Tuberculin-Tested" Milk 20 Dealers' Supplementary Licences— To sell—"Pasteurised" Milk 3 "Tuberculin-Tested" Milk 3 Pasteuriser's Licence 1 61 samples were taken for bacteriological test, 4 of which did not comply with the prescribed conditions. The Express Dairy Co., Ltd., to whom the Pasteuriser's Licence was issued, ceased to use their premises at 163, Harrow Road in the latter part of the year for the heat treatment of milk. Ice Cream.—The Ice Cream (Heat Treatment etc.) Regulations came into operation on the 1st May, 1947. In brief, these require that the ingredients of ice cream shall be heat treated after being mixed, and that the mixture shall be cooled until the freezing process is begun. After freezing, the ice cream must not be sold unless it has been kept at a temperature of not more than 28°F.; but if its temperature has risen above 28°F. it must be heat treated again and then be kept at not more than 28°F. after having been frozen. This, however, does not apply to what is known as a "complete cold mix." Thermometers are required to be used for indicating and recording temperatures. It is not yet possible to enforce this requirement owing to the difficulty of obtaining the instruments. No bacteriological standard of cleanliness has been provided for in the Regulations, there being still no reliable test which would justify its use in law. A form of the methylene blue test has, however, been adapted for testing ice cream for bacterial cleanliness, and if, out of the four grades recommended, ice cream fails consistently to reach grades I and II, it is considered reasonable to presume defects of manufacture or handling calling for investigation. During 1947, 19 samples of ice cream and 4 of "choc-ice" were submitted to the methylene blue test, with the following results:— Grade I Grade II Grade III Grade IV Ice Cream 2 7 7 3 Choc-Ice — 2 2 — WORK OF THE LADY SANITARY INSPECTORS.— Infectious Disease.—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. 20 Disease. No. of Visits. Acute Rheumatism 63 (21) Cerebro-spinal Fever 9 (5) Chickenpox 232 (170) Diphtheria 57 (63) Dysentery 22 (34) Erysipelas 36 (27) Lice 473 (504) Measles 1,432 (942) Pneumonia 97 (121) Scabies 1,263 (2,225) Scarlet Fever 272 (347) Typhoid and Paratyphoid Fever 9 (2) Whooping Cough 405 (263) Visits to Schools 80 (70) Miscellaneous 1,266(1,276) Aged and Infirm Persons.—309 visits were paid to the cases brought to the knowledge of the Department. They were all dealt with informally, without recourse to the provisions of Section 224 of the Public Health (London( Act, 1936. The Old Persons Club inaugurated by the W.V.S. is playing an important part in looking after the social side for old people. Although the premises are commodious, it has not been found possible to accommodate all the old persons wishing to join, and early after the club was formed it was necessary to have a waiting list. It is to be hoped that when the building position improves, and it is possible to consider the building of community centres and similar establishments, adequate provision will be made for the aged persons. Common Lodging Houses.—62 inspections were made of the one common lodging house (Cecil House, 179 Harrow Road) there being nothing unsatisfactory to record. HOUSES UNFIT FOR HUMAN HABITATION.—In spite of the great scarcity of housing accommodation it has been found necessary to deal with certain premises by demolition or closing orders. It is with reluctance that such premises are dealt with in such a manner, but this action is taken only in cases where further repair of the buildings appears to be impossible. No. of basement rooms dealt with by closing orders 6 No. of houses dealt with by demolition orders or in respect of which undertakings were accepted 4 Thirty-nine persons were displaced as a result of the Council's action, all of whom were rehoused in Paddington or on London County Council Estates. Five closing orders were determined or undertakings cancelled during the year and two other premises made fit for human habitation without recourse to formal proceedings under the Housing Act. COMPULSORY REPAIRS.—During the year the Council authorised the service of notices under Section 9 of the Housing Act, 1936, in regard to parts of two houses in the Borough. In each instance the necessary works were completed within the period of time specified in the notice. Several other houses were surveyed with a view to action under this section of the Act, but the cost of repairs rendered it inadvisable to take action. There is however the prospect of a continuation and perhaps expansion of this type of work in the New Year. TOWN PLANNING.—A condition of the London County Council's consent to the conversion and altering of premises is that the Borough Council must be satisfied as to the proposed user of basement rooms. During the year the London County Council referred to the Borough Council for examination a large number of applications of this nature, and as a result of the Council's observations permission was refused for certain basement rooms to be used for human habitation where the rooms did not conform to the statutes and regulations in force in the Borough. Similarly all applications received by the Borough Council for Civil Building Licences to restore basement rooms to the required public health standards are referred to the Medical Officer of Health for observation prior to consideration by the appropriate Committee. 21 HOUSING ACT, 1936—OVERCROWDING.— (a) (1) Number of dwellings overcrowded at the end of the year 504 (2) Number of families dwelling therein 535 (3) Number of persons dwelling therein 2,121 (Units). (b) Number of new cases of overcrowding reported during the year 270 (c) (1) Number of cases of overcrowding relieved during the year 105 (2) Number of persons concerned in such cases 470 (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 — 0 Any other particulars with respect to overcrowded conditions upon which the Medical Officer of Health may consider it desirable to report — Of the cases of overcrowding relieved during the year:— 59 were provided with accommodation by the Borough Council, 45 were rehoused by the London County Council, and 1 secured accommodation privately. HOUSING ACCOMMODATION : PREFERENTIAL TREATMENT.—Eleven families recommended for preferential consideration in the allocation of accommodation on medical grounds were rehoused by the Borough Council, and five by the London County Council. FUMIGATION.—During the year Associated Fumigators, Limited, under an Agreement with the Council, removed and treated the furniture, etc. of eight families with hydrogen cyanide gas. The cost of the work was £60. AREAS SCHEDULED FOR THE ERECTION OF NEW ACCOMMODATION.— St. Mary's Square (Housing) Scheme. The erection of self-contained flats on the St. Mary's Square site is progressing. Fulham Place (First Stage) Housing Scheme. The foundation works for this scheme are in hand. Peach Street Housing Scheme. The London County Council have now approved the final drawings for this housing scheme. Bishop's Bridge Road Housing Scheme. The Minister of Health has confirmed the Compulsory Purchase Order relating to Stages I and II of this housing area. A number of other areas suitable for the erection of working-class flats are under consideration by the Council. MATERNITY & CHILD WELFARE.—Dr. A. Mower White commenced duty as Senior Maternity and Child Welfare Officer on the 1st May in succession to Dr. E. R. Emslie, and Miss E. A. S. Davies, Superintendent of the Welfare Centre and Clinics, relinquished her appointment as from the 30th September on medical grounds. During the year consideration was given to the question of the adequacy of the health visiting staff and the filling of the vacancy created by the retirement of Miss Davies. The committee decided that by a rearrangement of the duties of the existing staff it was no longer necessary to continue the post vacated by Miss Davies but to appoint an additional District Health Visitor instead, and further that to deal effectively with the present day conditions prevailing in the Borough, the total establishment of District Health Visitors in addition to Miss Donovan (Superintendent Health Visitor) should be increased to 17. The continued shortage of qualified women, however, prevented the attainment of that standard, there being four vacancies at the end of the year. CONSULTATION CENTRES.—Three additional infant consultations were commenced during the year, viz., at St. David's Hall on the 14th January, at the Welfare Centre, 283a Harrow Road, on the 23rd September, and at St. John's Church Rooms, Hyde Park Crescent, on the 20th November. It was also found necessary to arrange for an additional Child Guidance Clinic each alternate week, the first of which was held on the 5th May. 22 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 St. Simon's Vicarage, Macroom Road. 10.0 a.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Welfare Centre, 283a Harrow Road. 2.0 p.m. Infant Congregational Hall, Third Avenue. 2.0 p.m. Infant St. David's Hall, St. Mary's Terrace. 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. 2.0 p.m. Infant St. John' Church Rooms, Hyde Park Crescent. Friday. 10.0 a.m. Child Guidance Welfare Centre, 283a Harrow Road. 2.0 p.m. (Alternate weeks) 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. 23 HEALTH VISITING.—Home visits paid by the Health Visitors are summarised in the appended table:— First visits to children under 1 year 2,374 (1,909) Revisits 17,584 (9,749) - 19,958 (11,658) Visits to children ages 1-5 years 15,223 (7,805) First visits to expectant mothers 1,767 (1,375) Revisits 1,662 (873) 3,429 (2,248) Visits re Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 291 (318) Miscellaneous (including ineffective calls) 8,901 (9,758) 9,192 (10,076) The number of children on the Health Visitors' lists at the close of the year was 8459. (8,622). INFANT CONSULTATIONS. No. of Sessions Attendances Seen by Doctor Total Average Total Average Welfare Centre, 283a Harrow Road. Monday 49 (49) 3,234 (2,599) 66.0 (53.0) 983 (785) 20.1 (16.0) Tuesday (a.m.)* 14 (—) 649 (—) 46.3 (—) 253 (—) 18.1 (—) ,, (p.m.) 52 (52) 4,628 (3,977) 89.0 (76.5) 1,219 (1,005) 23.4 (19.3) Thursday 51 (51) 4,100 (3,723) 80.4 (73.0) 1,179 (1,008) 23.1 (19.8) Friday 50 (51) 3,095 (2,127) 61.9 (41.7) 874 (755) 17.5 (14.8) Dibdin House. Monday 49 (49) 2,483 (2,974) 50 7 (60 7) 785 (776) 16.0 (15.8) Congregational Hall. Tuesday 52 (52) 2,999 (2,826) 57.7 (54.3) 865 (789) 16.6 (15.2) St. Simon's Vicarage. Wednesday 52 (51) 2,649 (2,369) 50.9 (46.5) 751 (643) 14.4 (12.6) Thursday 51 (51) 2,141 (2,024) 42.0 (39.7) 809 (756) 15.9 (14.8) St. David's Hall. Tuesday** 49 (—) 3,529 (—) 72.0 (—) 1,086 (—) 22.2 (—) Friday 50 (51) 3,602 (4,126) 72 .0 (80.9) 1,111 (1,349) 22.2 (26.5) St. John's Church Rooms. Thursday*** 6 (—) 283 (—) 47.2 (—) 109 (—) 18.2 (—) TOTALS 525 (457) 33,392 (26,745) 63.6 (58.5) 10,024 (7,866) 19.1 (17.2) * Commenced 23rd September. ** Commenced 14th January. *** Commenced 20th November. 24 Of the 2,398 (2,059) children who attended the Centres for the first time during the year, 2,102 (1,749) were under the age of one year and 296 (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 4,244 (3,992) of whom 1,801 (1,610) were under the age of one year, and 2,443 (2,382) between the ages of one and five years at the end of the year. 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 (49) 1,930 (1.929) 39.4 (39.4) 355 (455) Wednesday (a.m.) 52 (49) 1,270 (1,292) 24.4 (26.4) 525 (460) (p.m.) 52 (51) 3.081 (2,621) 59.2 (51.4) 186 (501) Thursday 51 (51) 1,253 (1,365) 24.6 (26.8) 401 (411) Friday 50 (38) 1,278 (988) 25.6 (26.0) 267 (337) St. Simon's Vicarage Tuesday* 52 (52) 1,118 (1,627) 215 (31.3) 252 (440) TOTALS 306 (290) 9,930 (9,822) 32 4 (33.9) 1,986 (2,604) * Transferred from 283a Harrow Road on 9th 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 99 (83) ante-natal and 101 (87) post-natal cases made a total of 846 (911) attendances. FOOT CLINIC. Adults. Children. No. of sessions 48 (50) No. of cases 41 (38) 7 (5) No. of attendances 191 (198) 30 (19) PHYSIOTHERAPEUTIC CLINIC. Adults. Children. No. of sessions 284 (283) No. of cases 236 (187) 160 (126) No. of attendances 721 (1,208) 1,934 (1,731) Classification of cases:— Light 7 (4) 126 (101) Massage 21 (41) 56 (62) Heat 19 (46) — (—) Exercises 209 (152) 40 (14) Treatments given:— Light 60 (38) 1,314 (1,326) Massage 162 (495) 679 (841) Heat 159 (490) — (—) Exercises 488 (691) 440 (490) 25 DENTAL CLINIC. Nursing and Expectant Mothers. Children. No. of sessions 48 (43) ) Patients examined 224 (156) 57 (42) Teeth extracted 423 (542) 86 (42) Temporary fillings — (—) — (—) Permanent fillings 12 (21) 23 (4) Partial dentures 1 (5) — (—) Full dentures 21 (7) — (—) CHILD GUIDANCE CLINIC. No. of Sessions 57 (37) No. of Cases 101 (33) No. of Attendances 185 (105) GRANTS AND ASSESSMENTS: NURSERY ADMINISTRATION.—Prior to the outbreak of War it was the practice for all assessments in respect of services provided by the Council free or at a reduced rate to be made by a "Grants" Sub-Committee whose decisions were submitted to the Maternity and Child Welfare Committee for approval. It was felt that the time had now arrived when this procedure might advantageously be resumed, and a sub-committee of five members was therefore appointed with the following terms of reference:—To consider and make recommendations (i) upon all matters relating to the administration of the day nurseries and (ii) in relation to applications received for those welfare services for which an assessment falls to be made in accordance with the scales approved by the Council from time to time. The first meeting of the Sub-Committee was held on the 31st December. 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. 0d. 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. The usual period of stay has hitherto been 14 days but having regard to the acute shortage of maternity accommodation generally, the Council agreed during the year to a request from the Board of Management for a modification of that arrangement in order to permit of normal cases being discharged, at the discretion of the Medical Officer of the hospital, after a period of 10 days. During the year 115 (87) women were delivered in these beds. There were 5 (1) stillbirths 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 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 utilised in 4 (—) instances. HOME HELP SERVICE.—At the end of the year 25 (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 300 (217) cases, comprising 126 (150) maternity patients and 174 (67) cases where domestic help was needed on account of illness. Patients are assessed for payment in accordance with the scales 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. 26 CONVALESCENCE.—Convalescence was arranged for 5 (4) children, assistance towards the cost being given in each case. In addition, 19 (13) 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 Maternity & Child Welfare Officer and all the male Sanitary Inspectors are authorised to exercise the powers and duties of Child Protection Visitors for special purposes. During the year 226 (275) visits and inspections were made, 11 (13) new registrations of foster mothers were recorded, 18 (23) new children were received and 15 (31) children were removed—1 (2) to hospital and 14 (29) elsewhere. No deaths were reported. No legal proceedings were necessary. At the close of the year the Register contained the names of 16 (16) persons who were receiving children for reward. These persons had charge of 21 (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 week's 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 mot her in emergency. During the year the Scheme was taken advantage of by 6 (9) foster mothers who had charge of 9 (9) children. DAILY GUARDIANS.—A scheme is in operation for providing 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. 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 18 (15) persons were registered for the care of 20 (15) children. At the end of the year the register contained the names of 7 (6) Guardians who had charge of 7 (6) children. 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. 0d.) being borne by the Council in appropriate cases. No use was made of this arrangement as compared with two cases during the previous 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 24 (20) such cases. 27 CARE OF ILLEGITIMATE CHILDREN.—The duties of Welfare Worker in this connection are carried out by the Superintendent Health Visitor. During the year 12 (13) applications were received from the Paddington and St. Marylebone Association for Moral Welfare Work for grants towards the cost of arrangments made by them for the maintenance in hostels of unmarried mothers, all of which were granted. The mothers, who are admitted to hospital for confinement are received into the hostel prior to the birth and subsequently return until suitable arrangements can be made for their future. 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 revised planning of the scheme for the establishment by the Council of a hostel for mothers and babies, necessitated by the requirements of the Ministry of Health, was found to result in a considerable increase in the cost of adapting the proposed premises. Mainly for this reason, but in the light of all the circumstances it was reluctantly decided not to proceed with the matter. The use of other suitable premises which are likely to be less costly to adapt is being kept in view. 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. Several have been referred to employment agencies and placed in posts where they have been allowed to have their babies with them. Difficulty is still expreienced 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 51/2 lbs. or less was 165 (123), of whom 33 (28) were born at home and 132 (95) in institutions. Of those born at home 31 (27) were nursed entirely at home, 2 (—) died during the first 24 hours and 28 (26) survived at the end of one month. Of those born in institutions 12 (9) died during the first twenty-four hours and 106 (67) survived at the end of one month. The special equipment provided in accordance with Ministry of Health Circular 20/44 was utilised in 7 (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.—During the year certain works of adaptation etc. were carried out at Westbourne Day Nursery to restore the accommodation to its pre-war figure of 70, the number of places in the six Day Nurseries provided by the Council being now 320, viz., 137 for children under the age of two years and 183 for those between the ages of two and five. In addition accommodation for 20 children is provided at the Peter Pan Day Nursery, 6, Delamere Terrace, under the auspices of the Save the Children Fund. The demand for nursery facilities shows no sign of diminution, the number of children on the waiting list at the close of the year being 569 as compared with 459 at the end of 1946. With the exception of Queen's Park all the Council's nurseries have been approved by the Minister of Health as Training Schools for Nursery Nurses. The much reduced number of children attending on Saturday mornings led to the experimental closing on that day of Queen's Park and Maida Vale Nurseries, the few children thus displaced being accommodated elsewhere. This was found to be satisfactory, and, taking into consideration the economies effected, it was decided to continue the arrangement indefinitely. 28 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. 25 45 70 255 48 14,211 777 55.7 16.2 61 (254) (48) (12,898) (917) (50.8) (19.1) (29) Maida Vale, 14, Blomfield Road. 25 27 52 255 40* 11,700 538 45.9 13.5 41 (254) (48) (12,204) (920) (48.0) (19.2) (41) St. Jude's, 88, Bravington Road. 27 18 45 255 48 10,642 806 41.7 16.8 27 (254) (48) (10,979) (1,075) (43.2) (22.4) (58) Peach Street 29. 33 62 255 48 14,936 939 58.7 19.6 46 (254) (48) (14,303) (998) (56.3) (20.8) (76) Marylands Road 31 34 65 255 48 17,029 1,142 66.8 23.9 44 (254) (48) (14,968) (1,183) (58.9) (24.5) (59) Queen's Park, 66, Lancefield Street. 26 26 255 40* 5,589 128 21.9 3.2 33 (254) (48) (5,574) (449) (21.9) (9.4) (33) * Closed on Saturdays from 1st November. There is one nursery school in the Borough, provided by the London County Council, viz., at Senior Street School.