AC 4349 PAD 48 Metropolitan Borough of Paddington REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1948 A. B. STEWART, M.D., D.P.H. VAIL & Co., Ltd., Printers to the Council, 170, Farringdon Road, E.C.I. 2 CONTENTS. PAGE Aged and Infirm Persons 11 Bacteriological Examinations :— Infectious Disease 8 Milk and Foods 17 Bakehouses 14 Births 5, 6 Bombed Sites 14 Burials 11 Canal Boats 14 Certificates of Disrepair 14 Child Life Protection 21 Clinics, Ante- and Post-Natal 20 „ Child Guidance 21 „ Dental 21 „ Foot 20 „ Physiotherapeutic 21 Common Lodging Houses 14 Compulsory Repairs 19 Convalescence 21 Daily Guardians 21 Deaths :— Numbers and Rates 5, 6, 7 Classification 7 Infantile 6 Maternal 6 Tuberculosis 6 Disinfection 11 Drainage Reconstruction Plans 14 Emergency Obstetric Service 21 Factories Act, 1937 12 Film Shows 18 Food Poisoning 17 Food Supervision 15-18 Fumigation 11, 20 Health Visiting 20 Holiday Homes for Elderly People 18, 19 Home Helps 21 Home Visiting, M. and C.W. 20 Houses Unfit for Human Habitation 19 Housing 19, 20 Ice Cream 17, 18 PAGE Illegitimate Children, Care of 22 Infant Consultations 20 Iniantile Mortality 7 Infectious Disease 8, 9 Legal Proceedings 14 Marriages 6 Maternal Mortality 6, 7 Maternity and Child Welfare Work 20-22 Maternity Beds 21 Medicinal Baths 11, 12 Milk (Special Designations) Regulations 17 Miniature Mass Radiography 10, 11 Mortuary 11 National Assistance Act, 1948 11 Obstetric Consultant , 21 Outworkers 13 Overcrowding 19 Penny Rate 6 Pharmacy and Poisons Act, 1933 14 Population 5 Premature Infants, Care of 22 Rateable Value 6 Rodent Control 14 Rent and Mortgage Interest (Restrictions) Acts 14 Sampling of Food 15, 16, 17 Sanitary Inspectors, Work of 13 Scabies, Treatment of 11 Smoke Nuisance 12 Shops Acts 15 Static Water Tanks 14 Staff 5 Stillbirths 5 Tuberculosis 9, 10 Unsound Food 17 Vacant Sites 14 Venereal Diseases 10 Verminous Rooms 11 Vital Statistics, Summary 5, 6 Water Supply 11 Work of District Inspectors 13 Work of Lady Sanitary Inspectors 8, 9 3 His Worship the Mayor, Aldermen and Councillors of the Metropolitan Borough of Paddington. Mr. Mayor, Ladies and Gentlemen, I have the honour to present the Annual Report of the Medical Officer of Health for the year 1948. During the year there have been many changes in the structure of the Health Services. The introduction of the National Health Service has radically altered the administration of the curative services and transferred the personal health services to the County Council. When the Public Health Act of 1848 was being passed, Macaulay had published in that year his " History of England." His confidence in the future was such that he wrote " It may well be in the twentieth century .... that sanitary police and medical discoveries may have added several more years to the average length of human life." Macaulay was proved correct in his prophecy, but at the time of writing there does not appear to be an equivalent contemporary historian willing to write in similar terms concerning our future. Many of the troubles which have followed the introduction of the National Health Service, and which have been widely publicised, are of a temporary nature and will disappear when supply and demand become adjusted. On the other hand, problems relating to staff and to new building are not to be easy to solve. In our health publicity we would do well to emphasise that the health services are worth paying for and that improvement and expansion cost money. Readers of the statistical tables will note that both the birth and death rates have been reduced. The reduction in the birth rate was expected as the immediate post-war higher birth rate was bound to fall. The marriage rate has also been reduced. It is gratifying, however, to be able to record once again that the infant death rate is the lowest yet recorded in Paddington. Although tuberculosis remains a great medical and social problem, it will be noted that the death rate has fallen almost to the 1938 level. The figures for the distribution of notified cases show a large increase in Hyde Park Ward, from 26 to 39. Although we have no ward population figures to guide us we think that there may be an increase in the population in the ward due to the increase of multi-occupation of premises, and probably also to an increase in the number of persons living in boarding houses in the area. An analysis of these cases shows that the increase has not occurred in Council requisitioned premises. Parents have come to accept diphtheria immunisation as an accepted item of routine in the care of their children i as a result diphtheria is no longer the most dangerous infectious disease in children. Only ten cases were notified during the year but after correction only three were proved to be suffering from diphtheria. This is in striking contrast to the incidence of the disease in the past, e.g. in 1928 there were 302 cases and in 1938, 229. The infectious diseases which proved most troublesome to children during the year were measles and whooping cough. Although deaths were few, many children develop troublesome complications which may cause ill-health in later life. The figures relating to environmental hygiene show signs that the war-time arrears of work are being overtaken, but the work of the sanitary inspectors remained heavy. In view of the smaller number of complaints received it was possible to pay greater attention to basements, and a survey of these premises, similar to the pre-war surveys, has been commenced. Another aspect of this work to which we were able to devote greater attention was the method of completing comprehensive repairs to premises which is possible under Section 9 of the Housing Act. This type of work is especially useful where there is danger of a general deterioration of property. It is work which benefits both tenant and owner, but during the year instances were met with of persons, owners of property in a small way, who found it exceedingly difficult to carry out the work owing to the high cost of repairs. It has been the experience of this department that the present cost of repairs bears little relationship to the value of many of the premises, or to the income from rent. In certain cases it is possible for the Council to carry out repair work and recover the cost from the rent. The supervision of food premises and food inspection work is carried out by this department in close collaboration with the local food office. The work of the food inspectors has resulted in considerable improvements to various food premises during the year. In particular, extensive alterations to ice-cream factories have been carried out. 4 In conclusion I have pleasure in recording my thanks to the Members of the Council for their support in Public Health matters, also to my colleagues of other departments and to all members of the Public Health Department staff. 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. June 11th, 1949. 5 public health officers (on December 31st, 1948).—W.T. = Whole-time appointments. P.T. = Part-time appointments. Medical Officer of Health, P.T. A. B. Stewart, M.D., D.P.H. Public Analyst., P.T. Alan W. Stewart, D.Sc., A.I.C. Clerical Staff—W.T. S. W. Ruffey (Chief Clerk). A. J. O. Sheppard. R. I. Fisher. H. J. Parker. S. W. Wordingham. A. G. L. E. Houghton. J. T. G. Warby. L. Allchin. E. J. Cleaver. D. J. Myers. A. H. Lawrence. B. W. Godden. E. Craddock. Miss D. Smeaton. Miss P. Wheeler. 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). G. Duncan. W. H. G. Atkins. J. Mains. G. A. Fraser. V. A. Vickers. C. Chesterman. D. B. Hooper. F. H. Free. B. W. James. R. Fowler. N. E. Broom. J. B. Jones. Lady Sanitary Inspectors—W. T. Miss D. M. Newhall. Mortuary Superintendent—W. T. L. W. J. Spears. Rodent Officer—W.T. W. A. Dunklev. Miss E. Z. Amor. Mortuary Assistant—W.T. C. C. Lewis. and 10 Disinfecting, Fumigation, Rodent Control and Porter Staff. summary of vital statistics—1948. Throughout this Report figures shown in brackets relate to the year 1947, and are given for comparison. Area of Borough : 1,356.1 acres, including waterways 20.0 acres. Population : Registrar-General's estimate of Civilian Population at middle of year : 128,100 (127,450). Inhabited Houses (end of year) according to Rate Books—22,041 (21,148). Live Births : Males Females Totals Legitimate 1,050 (1,080) 997 (1,094) 2,047 (2,174) Illegitimate 167 (173) 139 (173) 306 (346) Totals 1,217 (1,253) 1,136 (1,267) 2,353 (2,520) Birth Rate per 1,000 estimated civilian population 18-37 (19-77) Stillbirths : Males Females Totals Legitimate 18 (23) 21 (24) 9 (47) Illegitimate 5 (7)6 (3) 11 (10) Totals 23 (30) 27 (27) 50 (57) Stillbirth Rate per 1,000 (live and still) births 20.1 (22.12) Males Females Totals Deaths (all ages) 704 (813) 677 (754) 1,381(1,567) Death Rate per 1,000 estimated civilian population 10.78 (12.29) 6 Deaths from Pueperal Causes: Puerperal Sepsis 2 (-) Rate per 1,000 (live and still) births 0.83 (0.00) Other Puerperal Causes 1 (1) Rate per 1,000 (live and still) births 0.42 (0.39) Total 3 (1) Rate per 1,000 (live and still) births 1. 24 (0.39) Deaths of Infants Under One Year of Age : Males Females Totals Legitimate 41 (47) 29 (50) 70 (97) Illegitimate 12 (7) 3 (5) 15 (12) Totals 53 (54) 32 (55) 85 (109) Death Rates of Infants Under One Year of Age :— All infants per 1,000 live births 36(43) Legitimate infants per 1,000 legitimate live births 34 (45) Illegitimate infants per 1,000 illegitimate live births 49 (35) Deaths from Tuberculosis : Pulmonary (all ages) 69 (71) Other forms (all ages) 12 (12) Death Rate from Pulmonary Tuberculosis per 1,000 estimated civilian population 0.54 (0.56) Death Rate from all forms of Tuberculosis per 1,000 estimated civilian population 0.63 (0.65) Rateable Value £1,750,252 (£1,748,335) Product of a Penny Rate £6,762 (£6,684) 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 1948 128,100 2353 18.37 1381 10.78 85 36 3 1.24 81 0.63 * Corrected figures after allowing for inward and outward transfers. births.—It is not now possible for detailed ward.analyses of births to be made, as we no longer receive particulars of individual births from the Registrars. The high birth.rate of 1946 (20.28 per 1,000 civilian population) has not been maintained. The rate fell to 19.77 in 1947 and a further drop to 18.37 for 1948 is revealed. The birth-rate for the Administrative County of London for 1948 was 20.1, and for England and Wales 17.9. The latter rate is, however, based on total population, and not civilian only. marriages.—The number of marriages solemnised in the Borough represented a rate of 28.2 per 1,000 of the population. This is a decrease of 143 marriages compared with 1947, when the rate was 30 . 6. deaths.—The death-rate of 10.78 is the lowest so far recorded in Paddington, and compares well with the rate of 11 .6 for the whole of London. The rate for England and Wales was 10.8, but this, again, is based on total population. 7 As will be seen from the classified table below, heart disease (332 deaths) and cancer (241 deaths) account between them for just over 41 per cent, of the total number of deaths recorded. Heart disease is largely a disease of old age, and 258 of the deaths from this cause are in the age-group 65 years and upwards. Analysis of the deaths from cancer, however, shows that nearly 50 per cent, were in lower age groups, viz. :— Age Group No. of Deaths 1-5 years 1 15-45 „ 19 45-65 „ 98 Over 65 „ 123 241 Deaths of Residents of the Borough, 1948. Sex-Age Distribution. Cause of Death. All Ages Deaths at Ages 0— 1— 5— 15— 45— 65— M. F. P. M. F. M. F. M. F. M. F. M. F. M. F. Typhoid and paratyphoid fevers — — — — — — — — — — — — — — — Cerebro-spinal fever 1 — 1 — — — — — — 1 — — — — — Scarletfever ... — — — — — — — — — — — — — — Whooping cough — 2 2 — 2 Diphtheria — — — — — — — —1 — — — — — — — Pulmonary tuberculosis 38 31 69 — — — — — — 14 22 22 7 2 2 Other tuberculous diseases 8 4 12 — 1 — 1 2 — 6 1 — 1 — Syphilitic diseases 7 7 14 — — — — — — — 2 3 2 4 3 Influenza 2 1 3 — — — — — — 1 — — — 1 1 Measles 2 — 2 — — 2 — — — — V — — — — Acute polie-rayelitis and encephalitis — — — — — — — — — — — — — — — Acute infectious encephalitis — 1 1 — — — — — — — 1 — — — — Cancer of buccal cavity and gus (males) 10 — 10 — — — — — — — — 4 — 6 — Cancer of uterus — 16 16 — — — — — — — — — 11 — 5 Cancer of stomach and duodenum 12 18 30 — — — — — — 1 1 4 1 7 16 Cancer of breast — 25 25 — — — — — — — 3 — 12 — 10 Cancer of all other sites 94 66 160 — — 1 — — — 8 6 42 24 43 36 Diabetes 4 3 7 — — — — — — 2 — 1 1 1 2 Intra cranial vascular lesions 46 79 125 — — — — — — — 1 10 11 36 67 Heart disease 165 167 332 — — — — — — 9 4 46 15 110 148 Other circulatory diseases 42 47 89 — — — — — — 1 1 12 7 29 39 Bronchitis 53 34 87 4 1 1 1 — — 3 — 5 5 40 27 Pneumonia 39 42 81 4 7 1 1 — — 1 3 5 4 28 Other respiratory diseases 9 8 17 — 1 — — — — 3 1 — 3 6 3 Ulcer of stomach or duodenum 14 8 22 — — — — — — 1 1 10 2 3 5 Diarrhoea (under 2 years) 6 2 8 5 2 1 — — — — — — — — — Appendicitis 1 3 4 — — — — — — — — — 3 1 — Other digestive diseases 15 15 30 — — — 1 — — — — 7 7 8 7 Nephritis 13 11 24 — — — — 1 — 2 1 1 1 9 9 Puerperal sepsis — 2 2 — — — — — — — 2 — — — — Other maternal causes — 1 1 — — — — — —` —` 1 — — — — Premature birth 11 7 18 11 7 — — — — — — — — — — Congenital malformation, birth jury, infantile disease 23 8 31 22 7 — — — — — — 1 — — 1 Suicide 14 15 29 — — — — — — 9 4 3 8 2 3 Road traffic accidents 5 3 8 — — — — 1 — 1 — 2 3 1 — Other violent causes 25 20 45 4 4 — — — 1 5 4 4 2 12 9 All other causes 45 31 76 3 — 1 — 1 — 6 7 4 7 30 17 All Causes (Totals) 704 677 1,381 53 32 7 4 5 1 74 66 186 137 379 437 infantile mortality.—The rate for infant deaths is falling year by year, and last year the low record of 36 was achieved in Paddington. At the same time it is still a little higher than the rate for the Administrative County of London, which records an infantile mortality rate of 31, the rate for England and Wales being 34. maternal mortality.—The low rate of 039 per 1,000 live and still births recorded in 1947 would have been repeated in 1948 but for the fact that two of the three deaths recorded under this heading were due to illegally induced abortion. 8 Infectious disease.—The year may be regarded as a satisfactory one so far as the incidence of infectious disease was concerned, although measles and whooping cough remained at a fairly high level. The consistent decline in the incidence of diphtheria is indisputable evidence of the benefit of immunisation, and for the second year in succession there has been no death from this disease. The number of cases of infective enteritis dropped by nearly 50 per cent., but, although a welcome improvement, the position cannot yet be regarded as satisfactory. Only six cases of infantile paralysis (acute polio-encephalitis or polio-myelitis) were notified, none of which was fatal. Notifications.—Following is a table showing the numbers of cases of infectious disease notified in each year from 1940 to 1948 :— Disease. 1940 1941 1942 1943 1944 1945 | 1946 1947 1948 Acute Encephalitis lethargica 1 1 - - - - - - - (-) „ Influenzal pneumonia 22 8 11 29 11 9 20 18 8 (8) „ Primary pneumonia 80 68 96 53 47 88 100 67 59 (59) „ Polio-encephalitis — — — — — — — 4 — (-) „ Polio-myelitis 1 3 1 1 2 1 2 21 6 (5) Rheumatism 9 6 2 5 6 — 9 6 4 (4) Cerebro-spinal fever 24 19 11 9 7 9 4 6 4 (2) Continued fever 3 1 — — — — — — — (-) Diphtheria 42 58 38 54 50 51 37 20 10 (3) Dysentery 3 12 35 94 38 86 34 8 13 (") Erysipelas 43 29 28 29 33 31 23 27 29 (27) Food poisoning or suspected food poisoning 6 4 6 10 3 4 11 17 16 (16) Infective enteritis or summer diarrhoea 24 13 27 84 107 154 143 128 68 (57) Malaria 4 — 3 — 5 2 9 2 3 (3) Measles 253 301 707 592 174 1,046 690 960 1,027 (1,023) Membranous Croup — — — — 1 — — — — (-) Ophthalmia neonatorum 20 6 6 8 13 11 5 4 9 (9) Puerperal fever 23 6 5 3 8 25 10 3 1 (1) Puerperal pyrexia 17 25 38 23 24 37 24 16 20 (20) Scabies (notifiable from 1st August, 1943) — — — 246 644 804 726 344 196 (196) Scarlet fever 56 61 110 312 137 126 228 129 147 (134) Smallpox — — — — 1 — — — — (-) Typhoid or enteric fever 5 9 1 3 — 2 — 3 2 (2) Whooping cough 24 170 235 142 156 54 155 227 254 (250) The number of notifications received is not always indicative of the incidence of infectious disease, as in many cases diagnoses are subsequently varied. The actual number of cases, after such correction, is shown in brackets. It is interesting to note that the total number of cases of diphtheria notified during the year was thereby reduced from ten to three, which is even less than the weekly average in pre-immunisation days. Bacteriological Examinations.—The number of examinations made in connection with infectious disease was 377, classified as follows :— Disease Examinations Positive Results Diphtheria 126 (141) — (2) Typhoid Fever 6 (-) 3 (-) Scarlet Fever 31 (5) 13 (-) Dysentery 9 (4) 2 (-) Tuberculosis 205 (221) 32 (33) 377 (371) 50 (35) Visiting.—The Lady Sanitary Inspectors visit cases of infectious disease, with the exceptions given below, and following is a summary of their work in this connection. 9 Disease. No. of Vinti. Acute Rheumatism 13 (63) Cerebrospinal Fever 8 (9) Chickenpox 297 (232) Diphtheria 40 (57) Dysentery 29 (22) Erysipelas 35 (36) Lice 516 (473) Malaria 3 (—) Measles 1,449(1,432) Pneumonia 69 (97) Scabies 833 (1,263) Scarlet Fever 234 (272) Typhoid and Paratyphoid Fever 13 (9) Whooping Cough 380 (405) Visits to Schools 68 (80) Miscellaneous 1,168 (1,266) Typhus and smallpox cases are visited by the male Sanitary Inspectors, food poisoning or suspected food poisoning by the Food Inspectors, puerperal fever, ophthalmia neonatorum and infective enteritis by the London County Council's Health Visitors, and tuberculosis by the Nurses at the Chest Clinic. tuberculosis. Notification Register.—Three hundred and six new cases of pulmonary tuberculosis and 23 of non-pulmonary tuberculosis were notified, beine an increase of 33 Dulmonarv cases and 1 non-nulmonarv case comnared with the previous year. The numbers of cases notified in previous years are shown in the following table : Year Population Pulmonary Non-Pulmonary Total Cases Incidence Rate (all forms) per 1,000 C. Pop. 1911 142,541 397 No record 397 pul. 2-8 1921 145,600 244 91 335 2-3 1931 140,300 213 87 300 2-1 1939 135,300 189 32 221 1-6 1940 97,860 168 37 205 2-1 1941 77,640 184 26 210 2-7 1942 83,640 195 40 235 2-8 1943 90,580 229 28 257 2-8 1944 93,030 233 26 259 2-8 1945 99,790 224 21 245 2-5 1946 117,670 261 24 285 2-4 1947 127,450 273 22 295 2-3 1948 128,100 305 23 329 2-6 The ward distribution of the cases notified during 1948 is as follows :— Ward Pulmonary Non-Pulmonary Total Males Females Males Females Queens Park 11 (8) 9 (6) - (-) 1 (2) 21 (16) Harrow Road 27 (23) 22 (17) 2 (2) 3 (1) 54 (43) Maida Vale 28 (28) 29 (31) - (2) 2 (2) 59 (63) Westbourne 28 (34) 30 (26) 2 (2) 6 (5) 66 (67) Church 18 (13) 12 (18) - (-) 1 (1) 31 (32) Town 5 (3) 3 (3) - (-) - (-) 8 (6) Lancaster Gate, W. 15 (14) 12 (D - (2) 1 (2) 28 (25) Lancaster Gate, E. 13 (8) 8 (8) - (1) 2 (-) 23 (17) Hyde Park 24 (19) 12 (?) 1 (-) 2 (-) 39 (26) Borough 169 (150) 137 (123) 5 (9) 18 (13) 329 (295) 10 The following table shows the age distribution of the 329 cases :— 0- 1- 5- 10- 15- 20- 25- 35- 45- 55- 65- Total All ages Pulmonary-Male - (-) 2 (1) 4 (7) 1 (8) 4 (4) 23 (15) 55 (48) 37 (20) 25 (25) 14 (15) 4 (7) 169 (150) Pulmonary-Female - (-) - (6) 8 (2) - (1) 15 (8) 32 (23) 45 (48) 25 (19) 3(10) 7 (3) 2 (3) 137 (123) N on-Pulmonary-Male - (-) 2 (1) - (2) - (1) - (-) - (1) 2 (1) 1 (2) - (1) - (-) - (-) 5 (9) Non-Pulmonary-Female - (1) 2 (2) - (2) 4 (-) 2 (-) - (-) 5 (3) 3 (3) - (1) 2 (1) - (-) 18 (13) Total - (1) 6(10) 12 (13) 5(10) 21 (12) 55 (39) 107 (100) 66 (44) 28 (37) 23 (19) 6(10) 329 (295) The number of cases on the Notification Register at the end of the year was 1,075, against 1,058 at the end of 1947. 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 1948 69 12 81 0.54 0.63 Work Carried out at the Chest Clinic.—The following particulars relating to Paddington patients have been supplied by the Chest Clinic :— No. of patients examined for first time (excluding contacts) 1,360 (1,037) No. of above found tuberculous 247 (251) No. of contacts examined 270 (293) No. of contacts found tuberculous 2 (3) No. of attendances at Chest Clinic 7,477 (7,965) No. of visits by Tuberculosis Officers 131 (128) No. of visits by Tuberculosis Nurses 1,685 (2,015) venereal diseases.—The Borough Council is not concerned with the treatment of venereal diseases, but we call attention to the dangers of the disease by the display of posters and distribution of leaflets. The Council also makes a contribution to the funds of The National Society for the Prevention of Venereal Disease. miniature mass radiography.—Arrangements were made by the London County Council for an X-ray Unit to be available to people working in the Borough, and also to residents, for a period of a fortnight during May. The Unit was installed at premises in Kensington, there being at the time no suitable place available in Paddington. 11 Employers were invited to allow their staffs to make use of the facilities, and consent was readily given, with the result that attendance from this source reached the satisfactory figure of 2,000. The attention of private residents was called to the opportunity for X-ray by means of posters, advertisements in local papers, and distribution of leaflets from various Council establishments. The result was, however, disappointing, only about 100 residents attending. In the past certain general statistical data of the results has been furnished by the London County Council, but it is not anticipated that any information will be available in respect of this session, and with the coming into force of the National Health Service Act, control of Miniature Mass Radiography has been transferred to the Hospital Regional Board. national assistance act, 1948.—The Council is responsible for the administration of two sections of this Act the greater part of which came into force on the 5th July, 1948. Section 47—Removal to suitable premises of persons in need of care and attention.— This Section takes the place of Section 224 of the Public Health (London) Act, 1936, and embodies the main provisions of that Section, there being only one or two alterations in administrative procedure. No orders of the Court were applied for under either Act during the year. All the cases brought to the notice of the Department were dealt with informally, admission to hospital or institution being achieved by persuasion in some instances, the remaining cases being found on investigation not to come within the definition laid down, viz. :— " Persons suffering from grave chronic disease or, being aged, infirm, or physically incapacitated, are living in insanitary conditions, and are unable to devote to themselves, and are not receiving from other persons, proper care and attention." The duties of visiting are assigned to the Lady Sanitary Inspectors, who made 411 calls during the year. It may be mentioned that all cases coming to our knowledge, whether or not coming within the scope of the Act, are periodically visited in case a change of circumstances should occur. Section 50—Burial or cremation of the dead.—This Section places upon Sanitary Authorities the duty of arranging the burial or cremation of any person who has died or been found dead where it appears that no suitable arrangements for the disposal of the body have been or are being made otherwise than by the local authority. From the 5th July until the end of the year 66 burials had been arranged, there being no cremations. mortuary.—382 bodies were taken to the Mortuary, a decrease of 34 over the number for 1947. Inquests were held in 169 cases, and Coroner's Certificates were issued in 197. The remaining 16 bodies were taken to the Mortuary to await burial. 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 9 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. The Medical Officer of Health and the several Sanitary Inspectors have been authorised, by resolution of the Council, to act for the purposes of Section 14 of the Water Act, 1945. This empowers the specified officers to enter any premises for the purpose of inspection to see that there is no waste of water, and generally to see that the provisions of Section 14 are being carried out. fumigation service and cleansing of verminous rooms.—Very good use continues to be made of the Fumigation Service, 740 rooms being fumigated and 729 sprayed at the request of owners. The use of the service is invariably offered informally before serving notice under Section 123 of the Public Health (London) Act, 1936. The effect of this procedure is that the number of notices requiring to be served has been reduced to negligible proportions. disinfecting station and medicinal baths.—Approximately 14 tons of bedding etc. were dealt with in the steam disinfector, and 312 rooms were disinfected with formalin after the occurrence of infectious disease. 328 library books were also disinfected. It is pleasing to record a consistent fall in the incidence of scabies since the end of the war. In 1945, the number of scabies cases attending the Medicinal Baths had reached 1,188 ; the number for 1948 was only 307, of which 72 were children. The Defence Regulation giving power to enforce compulsory treatment for scabies was revoked at the end of the year. 12 The annual number of cases attending for treatment for vermin also declined steadily, as is shown by the following figures :— 1945 337 1946 370 1947 196 1948 137 In my last Annual Report disappointment was expressed that no progress had been made with the proposed new Disinfecting Station and Medicinal Baths at 186, Kensal Road. Another year has passed without the necessary consents being given to this project, and it seems unlikely that action can be expected in the near future. smoke nuisance.—Two complaints were received under this heading, and advice was given by the Sanitary Inspector as to means to be adopted to reduce the quantity and density of smoke to a minimum. Much depends, of course, on the quality of the fuel used for firing, and it is not always of the best. An offence against the Byelaws is deemed to have been committed when " black " smoke is omitted from an industrial chimney for an aggregate of two minutes in any period of thirty minutes. 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 121 31 3 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority ... 556 293 17 — (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 2 — — — TOTAL 679 324 20 — Particulars of Defects Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Ref To H.M. Inspector irred By H.M. Inspector Want of cleanliness (S.l) 30 28 — 1 — Overcrowding (S.2) 2 — 2 — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) 5 5 — — — Ineffective drainage of floors (S.6) 1 1 — — — Sanitary Conveniences (S.7) (a) Insufficient 4 3 — 3 — (6) Unsuitable or defective 51 49 — 5 — (c) Not separate for sexes 2 2 — 2 — Other offences against the Act (not including offences relating to Outwork) — — — — — TOTAL 95 88 2 11 13 outworkers.— Section 110 Section 111 No. of out-workers in August list required by Sect. 110 (1) (c) 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 unwholesonje premises Notices served Prosecutions 77 — — — — work of the district inspectors.— Summary of Work Done During 1948. (Figures for 1947 in brackets). Complaints received 5,166 (6,240) Inspections and reinspections of dwelling houses 36,951 (38,750) Inspections of basements 147 (14) Inspections for purposes of Housing Act 57 (207) Visits in connection with re-housing applications 404 (452) Visits in connection with infectious disease 70 (163) Smoke observations 6 (2) Written Intimation Notices 3,570 (4,478) Statutory Notices 1,520 (1,735) Bye-law Notices 977 (786) Work Carried Out :— New dustbins provided 545 (1,089) Roofs repairs 1,509 (2,327) Dampness remedied 2,409 (3,018) Rooms cleansed 5,120 (5,158) Rooms treated for vermin 250 (663) Yard paving repaired 148 (104) Water-closets repaired 622 (1,124) Wall and ceiling plaster renewed 3,710 (5,267) Flooring repaired 746 (672) Accumulations of rubbish removed 244 (253) Sundry repairs 4,332 (4,739) Drainage :— Entire re-drainage 14 (9) Partial re-drainage 129 (109) Drains examined 364 (465) Drains tested 251 (239) Drains repaired 220 (217) Drains cleared 278 (322) Drainage conversions 20 (19) Soil and waste pipes repaired 460 (650) Soil and waste pipes renewed 86 (98) New water-closets provided 212 (251) New sinks provided 297 (335) Water Supply :— Supplies reinstated 108 (222) Cisterns cleansed 44 (29) Cisterns renewed 9 (12) 14 Legal Proceedings :— No. of cases referred for legal action .. .. 522 (620) No. of summonses heard .. .. 264 (331) Fines £358 18s. Od. (£248 10s. Od.) Costs £427 7s. Od. (£378 18s. 6d.) Abatement/Prohibition Orders .. .. 78 (74) Dismissed under Probation of Offenders Act .. .. 45 (85) Adjourned sine die .. .. 30 (27) RENT AND MORTGAGE INTEREST (RESTRICTIONS) ACTS.—Applications for disrepair certificates numbered 16, all of which were granted. Three clearance certificates were also applied for and issued to owners. DRAINAGE RECONSTRUCTION PLANS.—During the year 163 plans were submitted for drainage work to be executed in existing buildings. 48 contraventions of the London County Council's Drainage Byelaws came to light, but in three cases only was it necessary to institute legal proceedings ; in two instances a fine of £1 with £1 Is. Od. costs was imposed. In the remaining case the summons was withdrawn, the work having been made to conform with the Byelaws. VACANT SITES.—Bombed sites and the sites of static water tanks continue to be the source of many complaints. The creation of a byelaw making a punishable offence the dumping of rubbish on these sites may possibly act as a deterrent, but the only sure prevention of nuisance would appear to be the provision of adequate fencing. Meanwhile the Council arrange for the removal of offensive refuse, and spraying of the sites with insecticide to prevent breeding of flies or mosquitos. CANAL BOATS.—The Canal Boats Inspector visited the Paddington Basin on 107 occasions, and inspected 84 boats No serious defects or infringements were discovered, the minor matters requiring attention being disposed of without recourse to the service of notices. Four girls and seven boys 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. A large number of Canal Boats are now in the ownership of the Inland Waterways Executive. It is pleasant to record that any contraventions of the Canal Boat Regulations which have been informally brought to their notice, have been remedied without question. 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. BAKEHOUSES.—The number of bakehouses in the Borough remained at 40 (15 level and 25 underground). 91 visits were made. COMMON LODGING HOUSES.—43 visits were made by a Lady Sanitary Inspector to Cecil House, 179 Harrow Road. Periodical visits were also paid by a Male Sanitary Inspector to examine the boilers and fire escape arrangements. RODENT CONTROL.—The Ministry of Agriculture and Fisheries now make a consolidated grant of 50 per cent, of the approved net expenditure on the cost of rodent control upon certain conditions, chief of which are maintenance of an organisation adequate for effective rodent control, and complying with the Ministry's requirements on the methods to be employed. We have 4 Rodent Operatives, working under the control of a Rodent Officer, a senior Sanitary Inspector being generally in charge. The services of two Disinfectors are also utilised at times of pressure, and we have also found it necessary to borrow the services of two employees from the Paving Department at times, to assist in the block control schemes undertaken. The methods adopted, and which meet with the Ministry's approval, are (a) dealing with individual complaints ; (b) putting block systems in operation where several individual complaints suggest the possibility of a minor infestation ; (c) treatment of the sewers every six months in co-operation with the Sewers Department. (d) treatment of refuse dumps, and vacant sites where observations indicate likelihood of rats. Three hundred and ninety four complaints were received and dealt with ; the sewers were treated in January and July ; and several block schemes were carried out, mostly with satisfactory results. Admittedly there are one or two difficult areas in the Borough, but no effort is spared to keep the rat population down to a minimum. A word of thanks is due to the Rodent Officer and his men who have tackled their work with enthusiasm. 15 SHOPS ACTS.— Visits for the purposes of the Shops Acts are made by one of the Food Inspectors so far as " food " shops are concerned, and by one of the Lady Sanitary Inspectors as concerns all other shops in the Borough. This arrangement made possible the better supervision of shops, and 1,531 visits were made during the year, nearly a thousand more than in 1947. Section 10 of the Shops Act, 1934 deals with the arrangements for the health and comfort of shop workers, and places upon the Borough Council responsibility for ensuring (a) suitable and sufficient means of ventilation ; (J) suitable and sufficient means for maintaining a reasonable temperature ; (c) suitable and sufficient sanitary conveniences, unless a certificate of exemption is granted. This section of the Act makes the ensuring of the provision of suitable and sufficient lighting and washing facilities the responsibility of the London County Council, who are, of course, also responsible for applying the other parts of the Act relating to hours of employment, etc. A Home Office Committee has been investigating the whole question of shops and it is possible that the recommendations of this Committee may form the basis of future legislation relating to shops. At the present time the administration of the Shops Act is shared in London by the County Council and the Borough Council ; the Borough Council duties being those of a sanitary authority. FOOD SUPERVISION. Sampling.—600 samples were submitted to the Public Analyst, 31 being formal samples and 569 informal. 205 of the samples were of milk, which were all up to standard. The following table shows the complete list of samples taken :— Number Examined Number Adulterated Formal Informal Formal Informal Apple juice — 1 — — Aspirins — 3 — — Bacon — 8 — — Baking powder — 3 — — Bicarbonate of Soda — 1 — — Biscuits — 1 — — Bread and rolls — 8 — Bread crumbs — 1 — — Butter — 9 — — Cakes, buns, scones, etc. — 18 — — Cake, pudding, sponge, etc. mixtures — 18 — — Camphorated oil — 2 — — Caraway seeds — 2 — — Cereals, flaked — 3 — — Cheese — 8 — — Chocolates — 1 — — Chopped liver, tinned — 1 — — Cocoa — 1 — — Coffee — 5 — — Coffee and chicory essences — 9 — — Coffee extract, dried — 3 — — Cooking fat — 10 — 1 Cough and lung mixture — 3 — — Creamy sponge 1 — — Currant loaf 1 — — Dessert sauces and powders, etc. 2 — — Edible oils 7 — — Epsom salts 3 — — Essences, flavouring and colour 15 — — Fish cakes 5 — — Fish paste 14 — — Fish, tinned 9 — — Flour 6 — — Fruit, tinned 6 — — Gelatine and jelly powders 3 — — Gin 1 — — Glauber salts 1 — — 16 Number Examined Number Adulterated Formal Informal Formal Informal Glycerine, lemon and honey — 1 — — Grape fruit, tinned — 1 — — Herbs — 4 — — Honey and artificial honey — 2 — — Hydrogen peroxide — 1 — — Ices — 3 — — Iodine, tincture of — 2 — — Jam and marmalade — 6 — — Junket powder — 2 — — Lemonade crystals — 5 — — Macaroni — 3 — — Malt-cup — 1 — — Malto-bar — 1 — — Margarine — 8 — — Meats, etc., tinned — 4 — _ Meat extract — 2 — — Meat paste — 1 — — Meat pies — 14 — — Meats, pressed — 4 — — Meat and vegetable extract — 1 — — Milk 30 175 — — Milk, condensed, full cream — 1 — — Mustard — 2 — — Ointment, sulphur — 2 — — Ointment, zinc — 1 — — Olives, bottled — 2 — — Onions, bottled — 1 — — Onions, dried — 2 — — Orange, chocolate spread — 6 — — Peppers — 6 — — Pickles — 7 — — Puddings, tinned — 3 — — Rissoles — 1 — — Salad dressing — 2 — — Sandwich spread — 1 — — Sauces — 4 — — Sausages and sausage meat 1 11 1 1 Sausages, liver and luncheon 8 — — Sausages and spaghetti, tinned 1 — — Sausage rol's — 2 — — Senna pods — 1 — — Semolina — 8 — — Soft drinks — 7 — — Soup powder — 2 — — Soup, tinned — 5 — — Spaghetti — 5 — — Spices — 3 — — Stomach powder — 1 — — Sugar — 7 — — Sweets — 2 — — Tomato juice — 3 — — Tomato puree and ketchup — 4 — — Tea — 7 — — Vegetables, tinned — 2 — — Vinegar — 4 — " White and black puddings — 9 — — Yeast extract and tablets — 2 — 31 569 1 2 600 3 17 Of the 600 samples, only 3 (0.50 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 Sausages Informal 34% deficient in meat Formal sample.taken Sausages Formal 14% deficient in meat No proceedings taken in view of circumstances, but further samples to be taken periodically. Cooking fat Informal 100% soft paraffins in composition No action, as further investigation revealved that the fat was used only for greasing bread tins. Unsound Food.—Approximately 13 tons of diseased or unsound food were surrendered by tradesman for destruction, as against 28f tons surrendered in 1947. There were no " seizures " of unsound food. Food Poisoning.—12 cases of Food Poisoning or Suspected Food Poisoning were enquired into, but there was nothing of a serious nature calling for special report. Inspections.—The visits paid by the Food Inspectors to food premises and stalls were as under :— Bakers 46 (77) Butchers 757 (737) Confectioners 151 (154) Dairies 458 (538) Fish 347 (312) Fried Fish 163 (84) General 219 (280) Greengrocers 265 (325) Grocers 795 (900) Ice Cream 333 (301) Public Houses 109 (56) Provisions 643 (735) Restaurants 742 (709) Street Traders 17 (68) Milk (Special Designations) Regulations.—Licences were issued as follows :— Dealers' Principal Licences— To sell—" Pasteurised " Milk 44 " Tuberculin-Tested" Milk 19 Dealers' Supplementary Licences— To sell—" Pasteurised " Milk 3 " Tuberculin-Tested" Milk 3 Forty samples of " Pasteurised " milk were taken for bacteriological test, all of which complied with the prescribed conditions. Ice Cream.—One hundred and forty-six premises in the Borough are registered pursuant to Section 14 of the Food and Drugs Act, 1938, as follows :— Manufacture, sale and storage 16 Sale only 130 146 and 333 inspections were made. The vehicles of street vendors, on which have to appear the names and addresses of the vendors, were also kept under supervision. 18 Some of the premises registered manufacture or sell " Lollies " (water ices) only. On the whole, the standard ot ice-cream has been good, and whilst the methylene blue test produced some " Grade IV " results, this does not mean that the ice-cream was unwholesome or of poor quality. Following is a summary of the samples submitted to this test during the year :— Number Submitted Grade I Grade II Grade III Grade IV 19 6 7 2 4 The bacterial count ranged from 400,000 to 250 at 37° C. As long ago as 1898 an exhaustive investigation into the method of manufacture and quality of ice cream was carried out in Paddington, and a few of the results of analyses then made are produced here for comparison. They show, very forcibly, that the supervision now possible over the manufacture of ice-cream has resulted in a much higher standard of cleanliness :— Analyses of Ice-Cream Samples taken in 1898 General Description of Sample Estimated No. of Bacteria in 1 c.c. Bacillus Coli Communis " Foreign " material found in sediment Custard colour, frothy, faint putrifactive smell 7,400,000 Very numerous .. No obvious " added " dirt. Light custard colour, faint indefinite smell 4,354,000 Very numerous .. Large quantity of amorphous dirt, linen fibre, minute round worm. Light custard colour, faint indefinite smell 1,509,000 Numerous Human hair, linen fibre, coarse amorphous dirt. " Strawberry Ice" colour, distinct " sour milk " smell 1,214,000 Numerous Very little added dirt, a few animal epithelial cells, strawberry fruit debris. During 1948 movements were on foot to obtain still further supervision and control over the manufacture and sale of ice-cream by (a) the removal of the exemption from registration under Section 14 of the Food & Drugs Act, 1938, of clubs, hotels and restaurants, and (b) by amendment of the law so as to provide for registration of all street vendors of ice-cream in order that the Ice-Cream (Heat Treatment) Regulations, 1947 could be more effectively administered. There is still a shortage of cooling apparatus, and because of this the operative date of Regulation 3 (b) (iii) of the Regulations was altered from 1st May, 1948 to 1st May, 1949. FILM SHOWS.—To enable the public to obtain a more intimate knowledge of the public health functions of the Council than can be achieved by posters and leaflets, a programme of suitable films was arranged by the Public Health Committee. The first of the series was shown at the Reading Room, Porchester Road Libarry, on the 3rd November, 1948 ; and a monthly series commencing on the 12th November was also arranged to be shown alternately at the Town Hall and the Maternity and Child Welfare Centre, Harrow Road, to terminate on the 11th March, 1949. The attendance at the Porchester Road Library Reading Room was distinctly encouraging, but at the subsequent shows in November and December, however, the attendances dropped considerably. Whilst it is early yet to prophesy the reactions of the public to this new venture, nevertheless, it is hoped that future attendances will encourage the efforts of the Council in their endeavour to bring the local public health activities more closely to the attention of the people of Paddington. HOLIDAY HOME FOR ELDERLY PEOPLE.—The need for a holiday home for elderly people was considered by the members of the Public Health Committee, and it was eventually decided that such an establishment would be a suitable welfare service which the Council could render to elderly residents of the Borough. After exploring many properties situated both in the country and at the seaside, the selection fell on the suitable property of " Kincardine " Brassey Road, Bexhill-on-Sea, which, after allowing for a resident Manageress and Chambermaid/waitress, provided accommodation for 16 visitors. 19 It is a non-basement house of three floors, about 40-50 years old, facing east and within easy reach of the sea, the town's shopping centre and the railway station. The accommodation is well planned and consists of nine double bedrooms, one single bedroom, two bathrooms, lounge hall, three reception rooms, kitchen, etc. Negotiations are in progress to acquire this property either by agreement at an approved figure or compulsorily, and it is probable that the owner would be willing to sell the furniture, fittings, etc. In anticipation of its ultimate purchase, the following conditions have been approved by the Council :— 1. Women guests should be over 60 years ; men over 65 years (i.e. in general, of pensionable age). 2. A charge of 21s. per week should be made (to be reduced to 15s. for persons in receipt of supplementary pensions), the charge to be " spread over " as far as possible, but fully paid before the holiday commences. 3. For the first three or four months after the opening of the Home (probably early summer) each visitor should stay for one week. This arrangement would be reviewed before the expiration of this period. 4. That the Home should be closed for about two weeks each year for redecoration, staff holidays, etc. The Council's powers for providing this desirable welfare service for the aged is contained in the Physical Training and Recreation Act, 1937, and in accordance with the provisions of this Act, this scheme will be administered in association with the Paddington Old People's Welfare Committee. The Public Health Committee have appointed a Sub-Committee to maintain that close liaison with the Old People's Welfare Committee which will be necessary for the smooth running of a scheme of this nature. It is intended to convey visitors to and from Bexhill by motor coach, and negotiations to that end are at present under way. Monday of each week is to be the " change over " date. This service is not commonly provided by Local Authorities, but as it is for a section of the community which received little attention in the past it is to be hoped that it may prove to be a prelude to a considerable expansion of welfare work for the aged by the local authority. HOUSES UNFIT FOR HUMAN HABITATION.— No. of basement rooms dealt with by closing orders 27 No. of upper parts of mews premises closed for human habitation 2 No. of houses dealt with by demolition orders or in respect of which undertakings were accepted 16 Ninety-seven persons were displaced as a result of the Council's operations, seventy-one being rehoused by the Paddington Borough Council and five by the London County Council. Fourteen secured accommodation through their own efforts and seven are awaiting suitable Council vacancies. Closing orders were determined or undertakings cancelled on four basements and the upper parts of three mews premises made fit for human habitation during the year. COMPULSORY REPAIRS.—Five Notices under Section 9 of the Housing Act, 1936, were served during the year. One Notice was complied with, and works were in progress at three other premises. A further notice served prior to 1948, in respect of a block of 13 flats, was also complied with. HOUSING ACT, 1936—OVERCROWDING.— (a) (1) Number of dwellings overcrowded at the end of the year 425 (2) Number of families dwelling therein 516 (3) Number of persons dwelling therein 1,695 (Units) (b) Number of new cases of overcrowding reported during the year 290 (c) (1) Number of cases of overcrowding relieved during the year 369 (2) Number of persons concerned in such cases 1,4851 (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 — («) Any other particulars with respect to overcrowded conditions upon which the Medical Officer may consider it desirable to report — 20 The number of overcrowded dwellings on the Register of Overcrowding at the end o. 1948 (425) shows a reduction on the figure for 1947 (504). This is due in the main to a survey undertaken during the year when it was ascerta ned that 220 families had secured alternative accommodation privately or that the overcrowding had been abated by other means. Of the cases of overcrowding relieved during the year :— 32 were provided with accommodation by the Borough Council, 117 were rehoused by the London County Council, 175 secured accommodation privately, and 45 were relieved by a natural reduction in the size of the family or on obtaining additional accommodation. HOUSING ACCOMMODATION : PREFERENTIAL TREATMENT.—Six families recommended for preferential consideration in the allocation of accommodation on medical grounds were rehoused by the Borough Council and fifteen 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 forty-nine families with hydrogen cyanide gas. The cost of the work was £210. NEW ACCOMMODATION.—-The forty-eight flats at Fleming Court were completed during the year, and families selected from the Council's waiting list were housed therein. MATERNITY AND CHILD WELFARE.—With the coming into operation of the National Health Service Act, 1946, the Maternity and Child Welfare functions of the Council passed to the London County Council on the 5th July, 1948, and the following summary relates to the period prior to that date. HEALTH VISITING.—Home visits paid by the Health Visitors :— First visits to children under 1 year 1,076 Revisits 6,891 7,967 Visits to children aged 1-5 years 7,922 First visits to expectant mothers 1,018 Revisits 942 1,960 Visits re Sickness (including Puerperal Fever, Puerperal Pyrexia, Ophthalmia Neonatorum and Infantile Diarrhoea) 205 Miscellaneous (including ineffective calls) 4,997 5,202 INFANT CONSULTATIONS. No. of children attending 2,214 No. of attendances 17,209 ANTE-AND POST-NATAL CLINICS. No. of expectant or recently confined mothers attending 943 No. of attendances 4,713 FOOT CLINIC. Adults Children. No. of patients attending 19 3 No. of attendances 92 13 21 PHYSIOTHERAPEUTIC CLINIC. Adults. Children. No. of cases 97 130 No. of attendances 286 1,401 Classification of cases :— Light 5 93 Massage 18 49 Heat19 — Exercises 80 35 Treatments given :— Light 4 1,090 Massage 137 465 Heat 138 — Exercises 164 316 Nursing and DENTAL CLINIC. Expectant Children. Mothers. Patients examined 99 39 Teeth extracted 420 4 Temporary fillings — — Permanent fillings 28 — Partial dentures — — Full dentures 5 — CHILD GUIDANCE CLINIC. No. of cases 33 No. of attendances 107 MATERNITY BEDS. No. of patients delivered in beds reserved by the Council at St. Mary's Hospital 71 OBSTETRIC CONSULTANT. There were no requests for this service EMERGENCY OBSTETRIC SERVICE. These facilities were utilised in two instances. HOME HELPS. No. of cases attended : Maternity 38 Other 160 CONVALESCENCE OF CHILDREN. No. of cases in which financial assistance was given :— Invalid Children's Aid Association 4 Other Nil. CHILD LIFE PROTECTION. No. of visits and inspections 126 No. of deaths Nil. No. of foster mothers under Council's scheme for guaranteed payments .. .. 1 DAILY GUARDIANS. No. of guardians on register at 4th July 10 No. of children cared for at 4th July 10 22 care of illegitimate children. No. of cases in which assistance was given to Moral Welfare Associations 1 premature infants. (a) No. of Paddington babies whose weight at birth was 5| lbs. or less 68 (b) No. of babies born prematurely in Paddington including non-residents 112 (i) No. born at home 13 (ii) No. born in institutions 99 (iii) Of those born at home :— No. nursed entirely at home 12 No. dying during first 24 hours Nil No. surviving at end of 1 month 12 (iv) Of those born in institutions :— No. dying during first 24 hours 7 No. surviving at end of 1 month 82