C4349 pad 50 Metropolitan Borough of Paddington REPORT OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1950 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 10 Bakehouses 13 Basement Rooms 17 Births 4 Burials 10 Canal Boats 13 Chest Clinic 10 Clean Food Campaign 16 Closing Orders 17 Common Lodging Houses 13 Compulsory Repairs 17 Deaths:— Classification 6 Numbers and Rates 5 Infantile 5 Maternal 5 Tuberculosis 5, 9 Disinfection 11 Drainage Reconstruction Plans 13 Factories 11 Food Supervision Bacteriological Examinations 14 Food Poisoning 15 Food Premises 15 Milk Licences 16 Sampling 13 Unsound Food 14 Fumigation 11, 18 Holiday Home 17 Houses Unfit for Human Habitation 17 Housing:— Accommodation 18 Basement rooms 17 Closed Premises 17 Compulsory Repairs 17 Overcrowding 18 Unfit Houses Ice-Cream—see "Food." page Infantile Deaths 5 Infectious Disease:— Bacteriological Examinations 8 Notifications 7 Visiting 8 Legal Proceedings 13 Lice 11 Marriages 5 Maternal Deaths 5 Medicinal Baths 11 Milk—see " Food." Mortuary 10 National Assistance Act, 1948 10 Outworkers 12 Overcrowding 18 Pharmacy and Poisons Act, 1933 13 Population 4 Rateable Value 4 Removal of Persons needing Care and Attention 10 Rent and Mortgage Interest (Restrictions) Acts 13 Rheumatism 7 Rodent Control 13 Sampling of Food 13 Sanitary Inspectors, Summary of Work 12 Scabies 11 Shops Acts 16 Smoke Nuisance 11 Staff 4 Stillbirths 5 Tuberculosis:— Deaths 5, 9 Numbers and Rates 8, 9 Work of Chest Clinic 10 Unsound Food 14 Venereal Disease 10 Verminous Rooms 11 Vital Statistics 4, 5 Water Supply 10, 13 Except where otherwise indicated, the figures in brackets throughout this Report are the figures for 1949, and are shown for comparison. 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 my Annual Report for the year 1950. In contrast to the 1949 report with its record of smallpox in the borough the report for this year records no event of a startling nature. There is, however, steady progress to report in a number of fields. For the past four years it has been a satisfying duty to report that there have been no deaths from diphtheria. During 1950, although four cases of diphtheria were notified, further investigation showed that the patients were suffering from some other disease, so that this year, for the first time in the recorded reports, it is possible to say that no case of diphtheria occurred in the borough. In the 1920-1930 period the average number of cases of diphtheria was about 300 per year. By the 1940s this figure had fallen to about 40. Although we have reached the goal at which we aimed it would be idle to congratulate ourselves and dismiss the problem from our minds. If we are to maintain the present satisfactory position it will be necessary to ensure that a high degree of immunity exists in the borough. We cannot afford to relax our efforts to encourage mothers to have their children immunised. It is an interesting comment on our attitude to health and disease that the medical staff carrying out this preventative work is remunerated on a lower scale than the staff in hospitals. Throughout the year there has been widespread publicity to maintain clean food in this country. The Public Health Department has been glad of the impetus this has given to the public awareness of the importance of clean food. The active interest of the public in this matter is perhaps the most important single factor contributing to a higher standard. During the year advice and tuition were given to food handlers by members of this department. A more detailed account of this will be found in the appropriate section of the report. From time to time comment has been made regarding the difficulty of investigating food poisoning outbreaks owing to the late reception of information as to its occurrence. An example of this difficulty was the outbreak of gastro intestinal disturbance among at least forty prominent local citizens who were members of a luncheon club. All became ill within twelve hours of the luncheon, and all had recovered within a day or so. No common article of food or drink was consumed by all the victims, and some members of the club escaped illness altogether. All the food and even the cleaning materials for the china and cutlery were examined in a search for the cause, but none was found. The important point in this example which has been given is that not a single one of these cases was notified as food poisoning, and the information reached the department in a casual manner. The difficulty in maintaining the older type of property used for housing in the borough continues. Comment was made On this last year, and since then there has been no reduction in the cost of repairs and the position becomes more difficult each year. Tenants moved from worn out property to the new housing estates find that they are faced with a considerable increase in the rent in spite of the substantial subsidy which the new flats receive. Frequently it is families with a very small rent who require re-housing and who are unprepared for the bigger rent. Since 1914 the proportion of family income spent on rent has been declining, and families have become gradually accustomed to this. The solution to this problem is not one to be dealt with locally, but from the point of view of health the experience of McGonigle in Stockton-on-Tees cannot be forgotten. Without wishing to over simplify we must not ignore the importance of nutrition when deciding what proportion of the family income is to be available for food or for rent. I am grateful for continued help and support from members of the Council, and in particular the members of the Public Health Committee ; also for help and support from my colleagues in other departments ; and for the loyal assistance of the members of the Public Health Department staff. I have the honour to be, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, Public Health Department, 15, Park Place Villas, Paddington Green, W.2. 3rd July, 1951. Medical Officer of Health. 4 public health officers (on December 31st, I960).— Medical Officer of Health:—- A. B. Stewart, M.D., D.P.H. Public A nalyst:— C. H. Wordsworth, B.Sc., F.R.I.C. Clerical Staff:— S. W. Ruffey (Chief Clerk) L. Allchin. A. J. O. Sheppard A. H. Lawrence R. I. Fisher B. W. Godden H. J. Parker. E. Craddock S. W. Wordingham. T. New. A. G. L. E. Houghton. Miss D. Smeaton. E. J. Cleaver. Mrs. L. Walters. D. J. Myers. Miss P. Goldenberg. J. T. G. Warby. Sanitary Inspectors:— C. G. Heron (Senior Sanitary Inspector) G. A. Fraser V. L. Ronchetti V. A. Vickers E. B. Wilde. C. Chesterman. F. J. Pallet (Chief Food Inspector). D. B. Hooper. E. Marshall. B. W. James. A. C. Harrison (Food). R. Fowler. G. Duncan. . B. Jones. W. H. G. Atkins. H. Lawson. J. Mains. D. B. Mills. J. M. A. Fabel. Lady Sanitary Inspector— Miss E. Z. Amor. Health Visitor— Miss K. Brennand. Mortuary Superintendent— C. C. Lewis. Mortuary Assistant— S. King. Rodent Officer— W. A. Dunkley. There are also fifteen Disinfecting, Fumigation, Rodent Control and Porter Staff. Bexhill Holiday Home. Mrs. G. Hoskings (Manageress) and three whole-time and one part-time Domestic Staff. summary of vital statistics—1950. Area of Borough: 1,356.1 acres including 200 acres of waterways. Population : Registrar-General's estimate of population at middle of year is 130,600 (130,640). Inhabited houses: At the end of the year according to the Rate Books—22,819 (22,663). Rateable value: £1,772,008 (£1,760,851) ; the product of a penny rate being £6,996 (£6,967). Live Births: Males Females Totals Legitimate 945 (1,027) 941 (924) 1,886 (1,951) Illegitimate 146 (170) 124 (122) 270 (292) Totals 1,091 (1,197) 1,065 (1,046) 2,156 (2,243) Birth Rate per 1,000 estimated population 16.51 (17.17) 5 Stillbirths: Males Females Totals Legitimate 19 (21) 16 (21) 35 (42) Illegitimate 2 (4) 4 (1) 6 (5) Totals 21 (25) 20 (22) 41 (47) Stillbirth Rate per 1,000 (live and still) births 18.66 (20.52) Males Females Totals Deaths (all ages) 704 (754) 693(735) 1,397(1,489) Death Rate per 1,000 estimated population 10.70 (11.39) Maternal Deaths: All causes -(2) Rate per 1,000 (live and still)births — (0.87) Deaths of Infants Under One Year of Age: Males Females Totals Legitimate 30 (29) 20 (13) 50 (42) Illegitimate 9 (7) 3 (9) 12 (16) Totals 39 (36) 23 (22) 62 (58) Death Kates ot Intants Under One Year of Age:— All infants per 1,000 live births 29 (26) Legitimate infants per 1,000 legitimate live births 27 (21) Illegitimate infants per 1,000 illegitimate live births 44 (55) Deaths from Tuberculosis: Pulmonary (all ages) 53 (79) Other forms (all ages) 2 (6) Death Rate from Pulmonary Tuberculosis per 1,000 estimated population 0.41 (0.60) Death Rate from all forms of Tuberculosis per 1,000 estimated population 0.42 (0.65) 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 143,970 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 1305 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 1949 130,640 2243 17.17 1489 11.39 58 26 2 0.87 85 0.65 1950 130,600 2156 16.51 1897 10.70 62 29 — 0.00 55 0.42 * Corrected figures after allowing for inward and outward transfers. births and deaths.—The Borough birth rate (16.51) is slightly lower than that for the county (17.8) but higher than for England and Wales (15.8). The death rate (10.70) is slightly below that for both London (11.8) and England and Wales (11.6). marriages.—The number of marriages solemnised in the Borough was 1,608. The number was 1,581 for 1949 and in 1948 and 1947 it was 1,805 and 1,948 respectively. deaths.—In the following Table the deaths are classified according to the Abridged List of the International Manual of Causes of Death, and the sex.age distribution is also shown. 6 Deaths, 1950.—Abridged List of Causes of Death, and Sex-Age Distribution. Cause of Death All Ages Deaths at Ages 0— 1— 5— 15— 25— 45— 65— 75— M. F. Total M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. Pulmonary tuberculosis 35 18 53 1 — — — — — 3 1 5 7 16 8 8 0 2 — Other tuberculous diseases 2 — 2 — — 1 — — — — — 1 — — — — — — — Syphilitic diseases 8 6 14 — — — — — — — — 1 — 4 4 2 2 1 — Diphtheria — — — — — — — — — — — — — — — — — — — Whooping cough — — — — — — — — — — — — — — — — — Meningococcal infections — — — — — — — — — — — — — — — — — — — Acute poliomyelitis 1 — 1 — — — — — — — — — — — — — — — — Measles — — — — — — — — — — — — — — — — — — — Other infective and parasitic diseases 2 2 4 — — 1 — — — — — — 1 — 1 — — 1 — Malignant neoplasm of the stomach 24 15 39 — — — — — — — — 1 2 10 4 9 4 4 — Malignant neoplasm of the lung and bronchus 36 12 48 — — — — — — — — 3 1 18 — 13 3 0 2 Malignant neoplasm of the breast — 32 32 — — — — — — — — — 3 — 12 — 7 — 10 Malignant neoplasm of the uterus — 11 11 — — — — — — — — — 1 — 5 — 2 — 3 Other malignant and lymphatic neoplasms 71 66 137 — — — — — — — 1 6 6 23 22 22 21 20 16 Leukaemia and aleukaemia 4 — 4 — — — — — — — — 1 — 1 — 2 — — — Diabetes 3 4 7 — — — — — — — — 1 1 1 2 1 — 1 Vascular lesions of nervous system 49 88 137 — — — — — — — — — 2 10 18 17 28 22 40 Coronary disease, angina 102 66 168 — — — — — — — — 2 1 46 10 29 24 25 31 Hypertension with heart disease 35 32 67 — — — — — — — — — — 10 7 12 9 13 16 Other heart diseases 72 118 190 — — — — — — 1 — 6 6 10 8 18 20 37 84 Other circulatory diseases 22 36 58 — — — — — — — — 1 — 5 7 5 10 11 19 Influenza 1 3 4 — — 1 — — — — — — — — 1 — — — 2 Pneumonia 35 28 63 3 1 4 1 — — — — 1 — 7 2 11 5 9 19 Bronchitis 54 26 80 1 1 — 1 — — — — 1 17 7 18 3 17 14 Other diseases of the respiratory system 6 3 9 — — — — — — — — 1 — 2 1 2 — 1 2 Ulcer of stomach and duodenum 12 8 20 — — — — — — — — 1 — 3 4 5 2 3 9 Gastritis, enteritis and diarrhoea 9 4 13 7 2 — — — — — — — — 1 1 — — 1 1 Nephritis and nephrosis 4 11 15 — — — — — — — — — 1 3 1 — 6 1 2 Hyperplasia of the prostate 9 — 9 — — — — — — — — — — — — 4 — 5 — Pregnaney, childbirth and abortion — — — — — — — — — — — — — — — — — — — Congenital malformations 6 8 14 9 2 1 1 — — 1 — 2 1 3 — — 1 — Other diseases 59 76 135 22 16 2 2 — — — 3 6 14 20 12 18 6 14 Motor vehicle accidents 5 6 11 — — — 1 1 — — — — — 1 1 2 1 1 3 Other accidents 17 7 24 3 1 — — 2 — 2 — 3 2 4 1 — — 3 3 Suicide 19 7 26 — — — — — — 1 — 8 — 5 6 3 1 2 — Homicide and operations of war 2 — 2 — — — — — — — — 1 — — — 1 — — — All Causes (Totals) 704 693 1,397 39 23 10 6 3 1 8 2 47 42 212 161 197 169 188 289 7 infectious disease.— Notifications.—Following is a table showing the numbers of cases of infectious disease notified in each year from 1945 to 1950. Commencing with 1948 the actual number of cases after allowing for corrections of diagnoses is shown in brackets. Disease 1945 1946 1947 1948 1949 1950 Acute encephalitis† — — — — (-) (-) (-) 1 (1) Acute pneumonia (primary and influenzal) 97 120 85 67 (67) 87 (86) 52 (52) Acute poliomyelitis 1 2 21 6 (5) 35 (32) 13 (13) Acute rheumatism — 9 6 4 (4) 2 (2) 2 (2) Diphtheria 51 37 20 10 (3) 13 (7) 4 (-) Dysentery 86 34 8 13 (11) 14 (10) 22 (22) Erysipelas 31 23 27 29 (27) 13 (12) 18 (18) Food poisoning or suspected food poisoning 4 11 17 16 (16) 24 (23) 41 (38) Infective enteritis or summer diarrhoea 154 143 128 68 (57) 64 (58) 37 (36) Malaria 2 9 2 3 (3) 2 (2) 1 (1) Measles 1,046 690 960 1,027 (1,023) 568 (567) 944 (940) Meningococcal infection f — — — — (-) — (-) 3 (2) Ophthalmia neonatorum 11 5 4 9 (9) 8 (8) 1 (1) Puerperal fever* 25 10 3 1 (1) — (-) — (-) Puerperal pyrexia 37 24 16 20 (20) 18 (18) 9 (9) Scabies 804 726 344 196 (196) 84 (83) 51 (51) Scarlet fever 126 228 129 147 (134) 127 (123) 165 (157) Smallpox — — — — (-) 2 (2) — (-) Typhoid or enteric fever 2 — 3 2 (2) 4 (1) 3 (3) Whooping cough 54 155 227 254 (250) 131 (130) 254 (253) * Ceased to be notifiable on 30.7.48. † Notifiable from 1.1.50. Notification of Rheumatism.—The Public Health Committee considered the position regarding the notification of Acute Rheumatism during the year. The history of the notification of Acute Rheumatism in Paddington is of some interest. On the 1st March, 1927, by virtue of the "Paddington (Acute Rheumatism) Regulations, 1927" Acute Rheumatism became notifiable in this borough. It may be appropriate here to summarize the regulations. Acute Rheumatism was defined as: (i) rheumatic pains or arthritis, if accompanied by a rise of temperature; (ii) rheumatic chorea; (iii) rheumatic carditis, occurring separately or together in a child under the age of 16 years. The regulations enjoined the medical officer of health to make the necessary enquiries and to take steps to investigate the source of the disease, for removing conditions harmful to the patient, and arranging for the treatment of the patient. These enquiries and necessary action were delegated to the Rheumatism Supervisory Centre which was opened at Paddington Green Children's Hospital on October 9th, 1926. The Director of this centre was the late Dr. Reginald Miller. The Borough Council made a financial contribution to Paddington Green Children's Hospital to assist in the work. Notifications of the disease varied between 30 and 70 per year between 1927 and 1939. The work had already begun to decline and in 1937 the Borough Council grant was reduced from £100 per annum to £50 per annum. In May, 1938, the supervisory centre was closed as the number of children attending did not justify the cost of the establishment and the facilities were transferred to the Out-patients' Department of the hospital. With the outbreak of war the notification machinery became of little value, and since 1940 the notifications have varied from a minimum of 2 in 1942 to a maximum of 9 in 1945. The paediatric consultants in the Borough were consulted, and they remarked on the reduced number of Acute Rheumatism cases. Many of the younger practitioners in the district appeared to be unaware of the notification regulations, and in the neighbouring borough of Kensington the notification regulations for rheumatism expired on the 30th November, 1948. The Minister of Health took the view that the regulations should not be renewed as the responsibility for rheumatism service now rested with the hospital boards and the local health authorities. The Committee took the view that the existing regulations had outlived their usefulness and the Committee was satisfied that the care of the rheumatic patient is well covered in other directions and that the limited powers of the Public Health Department meant that there was very little action which could be taken to supplement the existing facilities. The Committee realised that notification in such circumstances was of little value and that unless it was used in connection with a comprehensive study of the disease, backed by the service of a complete medical and social team, that there was little point in accepting a few notifications each year. 8 The Committee decided to recommend to the Minister that the Paddington (Acute Rheumatism) Regulations, 1930, be revoked. This was done in the Acute Rheumatism Regulations, 1950, and as from the 1st October, 1950, the Paddington regulations were revoked. In these same regulations, however, the disease was made notifiable in certain parts of the country where special study of the disease is being made. This closes an interesting chapter in the Public Health work of Paddington. The borough was without doubt the pioneer borough in tackling this problem, but the change in the circumstances brought about by the National Health Service Act has so altered the position that the responsibility for this work now rests elsewhere. The Public Health Department will, of course, always follow this work with interest and make its contribution in dealing with environmental factors. Bacteriological Examinations.—The number of examinations made in connection with infectious disease was 239, including 33 examinations for tuberculosis. 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. In addition to the 2,885 visits listed they made 1,477 unclassified calls. Disease Visits Disease Visits Acute rheumatism 10 Meningococcal infections 3 Chickenpox 191 Pneumonia 55 Diphtheria 16 Poliomyelitis 51 Dysentery 33 Scabies 251 Erysipelas 16 Scarlet fever 246 Lice 435 Typhoid fevers 17 Malaria 1 Whooping cough 272 Measles 1,288 Typhus and smallpox cases are visited by the male Sanitary Inspectors, food poisoning or suspected food poisoning by the Food Inspectors, puerperal pyrexia, ophthalmia neonatorum and infective enteritis by the London County Council's Health Visitors, and tuberculosis by the Nurses at the Chest Clinic. Visits to cases of infectious disease paid by the male Sanitary Inspectors numbered 85, nearly all of which were to smallpox contacts referred to us by Port Authorities or under the Aircraft Regulations. tuberculosis. Notifications.—Two hundred and forty-six new cases of pulmonary tuberculosis and 23 of non-pulmonary tuberculosis were notified, being a decrease of 59 pulmonary cases and a decrease of 5 non-pulmonary cases compared with the previous year. The number of cases on the Notification Register at the end of the year was 1,213 against 1,180 at the end of 1949. 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 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 128,100 306 23 329 2.6 1949 130,640 305 28 333 2.5 1950 130,600 246 23 269 2.1 Thirty-three cases of tuberculosis came to the knowledge of the Department during the year otherwise than by formal notification. These are classified as follows 9 Source of information Pulmonary Non-Pulmonary Males Females Males Females Death Returns from Local Registrars 6(8) 3(2) -(-) -(1) Death Returns from Registrar-General 5(3) 2(1) -(2) -(-) Posthumous notifications 2(3) -(1) -(1) -(-) Transfers from other areas (excluding transferable deaths) 11(9) -4(7) -(-) -(2) Totals 24(23) 9(11) -(3) -(3) The following table shows the age distribution of the 269 cases:— 0— 1— 2— 5— 10— 15— 20— 25— 35— 45— 55- 65— 75— Total All Ages Pulmonary-Male -(-) 2 (1) 1 (1) 5 (7) 3 (-) 8 (7) 12 (15) 38 (44) 29 (35) 21 (34) 10 (15) 5 (8) 1 (1) 135 (168) Pulmonary-Female - (1) 1 (1) 5 (1) - (1) - (7) 7 (10) 32 (27) 34 (49) 21 (17) 4 (18) 3 (5) 3 (—) 1 (-) 111 (137) Non-Pulmonary-Male 1 (-) 1 (1) 1(-) - (2) 1 (1) - (1) 2 (3) 1 (1) -(-) - (1) - (-) — (—) - (-) 7 (10) Non-Pulmonary-Female - (2) -(-) 1 (2) - (3) 1 (1) - (1) 4 (5) 4 (3) 2 (-) 2 (-) 1 (1) -(-) 1 (-) 16 (18) Total 1 (3) 4 (3) 8 (4) 5 (13) 5 (9) 15 (19) 50 (50) 77 (97) 52 (52) 27 (53) 14 (21) 8 (8) 3 (1) 269 (333) The ward distribution ot the cases notified during 1950 is as follows :— Ward Pulmonary Non-Pulmonary Total Males Females Males Females Queens Park 10 (10) 4 (3) 1 (-) 3 (-) 18 (13) Harrow Road 21 (16) 20 (24) 1 (1) 1 (2) 43 (43) Maida Vale 23 (42) 19 (32) 1 (2) 4 (3) 47 (79) Westbourne 29 (26) 20 (33) 1 (2) 3 (5) 53 (66) Church 8 (21) 12 (14) 2 (2) 2 (2) 24 (39) Town 2 (6) 8 (3) - (-) - (-) 10 (9) Lancaster Gate, W. 18 (15) 9 (10) - (-) 1 (-) 28 (25) Lancaster Gate, E. 11 (19) 13 (7) - (1) 1 (1) 25 (28) Hyde Park 13 (13) 6 (11) 1 (2) 1 (5) 21 (31) Borough 135 (168) 111 (137) 7 (10) 16 (18) 269 (333) Deaths.—The numbers of deaths from tuberculosis, and the death rates for each year from 1939 are set out in the following table:— 10 Year No. of Deaths From Total Deaths Death-Rate Per 1,000 Pop. Pulmonary T uberculosis 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 0.9 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 1949 79 6 85 0.60 0.65 1950 53 2 55 0.41 0.42 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) 1,622 (1,453 No. of above found tuberculous 248 (266) No. of contacts examined 442 (367) No. of contacts found tuberculous 11 (19) No. of attendances at Chest Clinic 7,571 (7,704) No. of visits by Chest Physicians 561 (199) No. of visits by Nurses 2,477 (1,670) venereal diseases.—The Borough Council is not concerned with the treatment of venereal diseases, but gives publicity to the dangers of the disease. During 1950 the permanent notices in the public conveniences were renewed and further notices affixed, with the consent of the landlords, in conveniences attached to public houses in the Borough. The Council also contributes to the funds of The National Society for the Prevention of Venereal Disease. national assistance act, 1948. Section 47—Removal to suitable premises of persons in need of care and attention.—One Court Order was applied for and granted during the year, the person concerned being detained in hospital for approximately three months. The Order was revoked upon an undertaking being given that daily help would be provided. All cases brought to our notice are visited by the Lady Sanitary Inspectors, who made 340 visits during the year in this connection. Section 50—Burial or cremation of the dead.—There was a sharp drop in the number of burials during the year— 35 compared with 81 in 1949. This was due to the Council not being called upon to deal with persons dying in hospitals. mortuary.—The number of bodies received at the Mortuary was 345 (376). Inquests were held in 94 (123) cases and Coroner's Certificates were issued in 243 (239). The remaining 8 bodies were taken to the Mortuary to await burial. water supply.—One water supply certificate under Section 95 of the Public Health (London) Act, 1936, was issued. The water supply was cut off in 8 cases on account of wastage or non-payment of rates and the Council notified in accordance with Section 98 of the Public Health (London), Act, 1936. Appropriate action was taken by the Department for the reinstatement of supplies. 11 In one instance the Department's attention was called to premises where linen was discoloured when washed. A bacteriological and chemical examination showed, however, that the water contained nothing detrimental to health. Investigation of other possible sources of discolouration failed to find the cause. fumigation service and cleansing of verminous rooms.—During the year 160 (395) rooms were fumigated and 1,414 (1,250) sprayed for vermin by the Council at the request of owners or occupiers. It was found necessary to serve only six notices under Section 123 of the Public Health (London) Act, 1936. disinfecting station and medicinal baths.—Approximately 21 tons of bedding passed through the steam disinfector (8 tons more than in 1949) and 375 rooms were sprayed with formalin after the occurrence of infectious disease ; 608 library books were also disinfected. The number of persons treated for scabies was 167, of whom 20 were children under the age of 5 years. In all 316 treatments were given. Treatment for verminous heads was given to 138 adults and 33 children under 5 years of age ; and for body vermin in 165 cases, including 4 children. smoke nuisance.—One complaint was received and four observations made. An informal approach by the Inspector resulted in the nuisance being remedied. 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 115 (103) 65 (29) 1 (-) - (-) (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 498 (508) 245 (324) 33 (17) - (—) (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 8 (11) - (-) - (-) -(—) TOTAL 621 (622) 310 (353) 40 (17) -(-) Particulars of Defects Number of cases in which defects were found Found Remedied Referred To H.M. Inspector By H.M. Inspector Number of cases in which prosecutions were instituted Want of cleanliness (S.l) 1 (19) 1 (16) - (—) 1 (2) - (—) Overcrowding (S.2) - (2) - (2) - (—) - (—) - (—) Unreasonable temperature (S.3) - (—) - (—) - (—) - (—) - (—) Inadequate ventilation (S.4) 1 (4) 1 (3) - (—) - (1) - (—) Ineffective drainage of floors (S.6) 1 (1) 1 (1) - (—) -(—) -(—) Sanitary Conveniences (S.7) (a) Insufficient 4 (1) 4 (1) - (—) 4 (—) - (—) (i>) Unsuitable or defective 41 (28) 37 (25) - (—) 7 (3) - (—) (c) Not separate for sexes - (4) - (4) - (—) - (2) - (—) Other offences against the Act (not including offences relating to Outwork) 10 (6) 7 (5) 1 (—) - (—) - (—) TOTAL 58 (65) 51 (57) 1 1 (—) 12 (8) - (—) 12 outworkers.- Section 110 Section 111 No. of outworkers 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 unwholesome premises Notices served Prosecutions 163 (179) -(-) - (-) - (-) - (-) -(-) The 163 Outworkers visited were engaged in the following occupations:— Wearing apparel (making, altering or repairing) 90 (114) Paper bags 50 (26) Wearing apparel (cleaning and washing) 2 (3) Buttons, carding of 2 (2) Household linen 2 (3) Toys, stuffed 4 (7) Furniture and upholstery 2 (1) Lampshades 6 (14) Artificial flowers 4 (9) Metalwork 1 (-) No cases of infectious disease were reported from outworkers premises, and the 176 visits paid by the Lady Sanitary Inspector engaged on this work showed that the premises were suitable for homework, although advice was necessary in a few cases as regards cleanliness and ventilation. work of the district inspectors.— Summary Complaints received 4,732 (5,680) Inspections and reinspections of dwelling houses 36,682 (38,319) Inspections of basements 445 (457) Inspections for purposes of Housing Act 115 (307) Visits in connection with re-housing applications 1,707 (2,055) Visits in connection with infectious disease 85 (356) Smoke observations 4 (21) Written Intimation Notices served 2,717 (3,342) Statutory Notices served 1,199 (1,157) Bye-law Notices served 647 (603) Work carried out:— New dustbins provided 387 (908) Roofs repaired 1,079 (1,251) Gutters and rain-water pipes renewed or repaired 344 (447) Dampness remedied 1,448 (1,776) Rooms, staircases and passages cleansed 2,838 (3,033) Yard paving repaired 64 (58) Water-closets repaired or renewed 466 (395) Wall and ceiling plaster renewed 1,978 (2,383) Flooring repaired 479 (548) Accumulations of rubbish removed 150 (184) Sundry repairs 2,564 (3,629) Staircase lighting provided 26 (46) Drainage:— Entire re-drainage 18 (18) Partial re-drainage 153 (175) Drains tested or examined 538 (532) Drains repaired 206 (217) Drains cleared 276 (289) Drainage conversions 60 (73) Soil and waste pipes repaired or renewed 181 (181) New sinks provided 270 (192) New baths or lavatory basins provided 473 (299) 13 Water Supply:— New supplies provided 71 (46) Supplies reinstated 31 (55) Cisterns cleansed 28 (19) Cisterns renewed 47 (14) Legal Proceedings:— No. of cases referred for legal action 258 (196) No. of summonses heard 153 (135) Fines £177 0s. 6d. (£121 5s. 0d.) Costs £128 0s. 6d. (£89 17s. 0d.) Abatement/Prohibition Orders 41 (27) Adjourned sine die 8 (8) No. of summonses withdrawn on payment of costs 67 (59) Amount of costs received £108 3s. 0d. (£93 9s. 0d.) rent and mortgage interest (restrictions) acts.—Applications for disrepair certificates numbered 15, 13 of which were granted. Two clearance certificates were also applied for and one was issued. drainage reconstruction plans.—During the year 231 plans were submitted for drainage work to be executed in existing buildings. In one case legal proceedings for the non-deposit of plans were taken and a fine of £3 with two guineas costs was imposed. canal boats.—The Canal Boats Inspector visited the Paddington Basin on 85 occasions, and inspected 53 boats. One notice was served and complied with; other defects found were remedied after an interview with the owner's representative. Two girls and five boys of school age were found to be living on boats coming into the Basin. On no occasion was admission to a boat refused. No cases of infectious disease among the canal boat population were reported during the year and no deaths were registered. pharmacy and poisons act, 1933.—At the end of the year the Register contained the names of 109 persons entitled to sell the poisons scheduled in Part II of the Poisons List. bakehouses.—There are now 18 bakehouses in the Borough treated as "level" and 8 "basement" bakehouses. Of these three have been largely reconstructed during the year and it is anticipated that two others will close in the near future. During the year 14 basement bakehouses have closed. The Inspectors made 257 visits. common lodging houses.—A Lady Sanitary Inspector made 18 visits to Cecil House, 179, Harrow Road, which provides beds for women and children. Periodical visits were also paid by a Male Sanitary Inspector to examine the boilers and fire escape arrangements. rodent control.—The Prevention of Damage by Pests Act, 1949, came into force on the 31st March, 1950, re-enacting, with modifications, the Rats and Mice (Destruction) Act, 1919. This Act imposes an obligation on the Council to keep their district free from rats and mice and empowers them to serve notices on owners and occupiers to this end. Two sewer treatments were undertaken, as were also a number of minor "block" schemes. In addition 631 individual complaints, of which 559 came from dwelling houses, were received and dealt with. When the Council's Mill Hill Piggeries were closed special action was taken to exterminate the rats there. food supervision. Sampling.—600 samples were submitted to the Public Analyst, 15 being formal samples (all milk) and 585 informal. All the samples were reported on as genuine. One sample of suet was described as rancid but no formal action was considered necessary. The "Tea time Tablets" were found to be wrongly labelled and this was taken up with the Ministry of Food who advised the firm concerned to amend the label. The following table shows a complete list of samples taken. 14 Number Examined Number Adulterated Number Examined Number Adulterated Formal Informal Formal Informal Formal Informal Formal Informal Acid — 1 — — Margarine — 4 — Almonds, ground — 2 — — Meat paste — 4 — Apples — 1 — — Meatpie — 7 — Aspirin — 4 — — Meat roll — 1 — — Bacon — 2 — — Milk 15 263 — — Baking powder — 3 — — Milk, condensed — 4 — — Bouillon — 1 — — Milk pudding — 1 — — Brawn — 2 — — Milk whipping compound — 1 — — Bread — 3 — — Mincemeat — 1 — — Butter — 3 — — Mineral waters — 10 — — Cake decorations — 1 — — Mint sauce — 2 — — Cakes — 1 — — Muffins — 1 — — Camphorated oil — 3 — — Mussels, bottled — 1 — — Castor oil — 1 — — Mustard, prepared — 1 — — Cheese — 5 — — Olive oil — 3 — — Cherries, glace — 1 — — Onions, dried — 2 — — Chicken paste — 1 — — Oysters, canned — 1 — — Choc-ice — 4 — — Pastries — 10 — — Chocolate, drinking — 1 — — Pastry mixture — 3 — — Chocolate roll — 1 — — Peanut butter — 2 — — Chocolate spread — 1 — — Pearl barley — 1 — — Coconut, desiccated — 2 — — Peas, canned — 1 — Coffee — 4 — — Pease pudding — 1 — — Coffee essence — 2 — — Peel — 3 — — Coffee extract — 1 — — Pepper, cayenne — 1 — — Colouring — 1 — — Pepper compound — 3 — — Condiment, non-brewed — I — — Pickles — 1 — — Cooking fat — 3 — — Pork pie — 1 — — Cornflour — 1 — — Potato powder — 2 — — Cough mixture — 6 — — Pudding, canned — 1 — — Currant loaf — 1 — — Quinine — 1 — — Custard powder — 3 — — Rabbit, canned — 1 — — Dripping — 1 — — Raising powder — 1 — — Eels, canned — 1 — — Rennet essence — 1 — — Eggs, fresh — 1 — — Rice — 2 — — Epsom salts — 1 — — Roes, canned — 3 — — Faggots — I — — Sacchari n tablets — 1 — — Fish, canned — 4 — — Salad cream — 2 — — Fish cakes, canned — 1 — — Sandwich spread — 1 — — Fish paste — 10 . — — Sardines, canned — 2 — — Flavouring — 5 — — Sauce — 4 — — Flour — 2 — — Sausage rolls — 4 — — Fruit, canned — 5 — — Sausages — 1 — — Fruit, dried — 1 — — Semolina — 3 — — Fruit juice — 1 — — Senna pods — 1 — — Glauber salt — 1 — — Soup,canned — 6 — — Gravy salt — 1 — — Soup, powder — 1 — — Ham, canned — 1 — — Spaghetti — 2 — — Herbs, dried — 6 — — Spice — 6 — — Honey — 2 — — Sponge mixture — 1 — — Hydrogen peroxide — 1 — — Stewed steak — o — — Ice-cream — 17 — — Stout — 1 — — Ice lolly — 1 — — Suet — 2 — — Icing — 1 — — Sugar — 3 — — Iodine — 2 — — Sweets — 9 — — Indigestion tablets — 1 — — Tea — 5 — — Jam — 4 — — Tea-time tablets — 2 — — Jelly — 3 — — Tomatojuice — 1 — — Kreem pop — 1 — — Tomatosauce — 1 — — Lettuce — 1 — — Tomatoes, canned — 1 — — Liver sausage — 1 — — Vegetables, canned — 15 — — Luncheon meat — 9 — — Vinegar, malt — 2 — — Luncheon sausage — 1 — — Yoghourt — 4 — — Macaroni — 1 — — — — — — — Unsound Food.—Approximately 10 tons of diseased or unsound food were surrendered for destruction, less than half the amount surrendered in 1949. Bacteriological examination of milk and food.—Bacteriological examinations were made of 102 samples of milk, all of which complied with the tests prescribed in the Milk Regulations. 15 Samples of ice-cream (42) examined for bacterial content as prescribed in the Ice-Cream (Heat Treatment) Regulations gave the following results. Two ice " lollies " (not graded) were also examined. Grade 1 8 Grade 3 10 Grade 2 16 Grade 4 8 Nine other samples of various foods were submitted for examination in connection with food poisoning investigations. These were eggs, stewed steak (canned), trifle, steak and kidney pudding (canned), cream buns, chocolate eclairs, lettuce, cooked veal and mussels. A heavy growth of staphylococcus aureus was found in the trifle; no pathogenic organisms were found in the other samples. Food poisoning.—During the year 41 cases of Food Poisoning or Suspected Food Poisoning were notified and investigated. Among the notified cases of food poisoning during the year there was one which caused the greatest alarm in the Department, but fortunately it did not become the cause of a wide-spread infection. A five weeks' old child was admitted to hospital on the 28th August, passing blood per rectum. Clinically the child appeared fit, but cultures of the stools showed the presence of Salmonella Thompson. A course of Chloromycetin, extending over a period of ten days, failed to remove the organisms, although the child ceased to pass blood and appeared fairly normal. On the 15th September the child was discharged from hospital and Salmonella Thompson was still present; and on the 21st September a letter was received from the House Surgeon giving the above information. This letter seems to have been an afterthought, as the House Surgeon stated that it was on the instructions of the Pathologist that we were notified of the case. Our worry at having a known excreta of Salmonella Thompson at large for six days was increased when a visit was paid to the premises at which the child resided. The child lived in a house which had become a multi-occupied one, and there were in all some twenty-one persons—fifteen adults and six children—occupying this house. Technically there were two water-closets, but as one was situated in a yard and was not used there was in actual practice only one water-closet. Fortunately the mother of the child was scrupulously clean, and although she had been taking no special precautions in washing the napkins we did know her to be domestically clean. Of the fifteen adults seven were engaged in the food trade. There were five waiters, one kitchen hand and a porter in a butter store—the last being the father of the sick child. The child was immediately removed to an isolation hospital, and to our relief all other bacteriological tests in the house were negative. That no serious outbreak resulted from this one case can only be attributed to good fortune, and once again that great obstacle to adequate investigation of food poisoning was present, namely slowness of notification. Food premises and undertakings.—Following are details of the food premises and undertakings in the Borough at the end of the year :— Food " Shops ":— Bakers 34 Grocers 43 Cake shops 14 Provision stores 101 Butchers 60 Domestic stores 16 Horsemeat shops (human consumption) 3 Corn chandlers 2 Confectioners 109 Greengrocers 79 Chemists 48 General shops 46 Dairies 9 Public Houses 98 Fishmongers 24 Cider Houses 2 Fried fish shops 22 Off Licences 54 Cafes, restaurants, etc. 139 Note.—There are 103 shops registered for the sale of milk. 160 premises registered for the sale of ice-cream and 90 pubic house hold catering licnces from the Ministry of Food. Food Factories:— There are 11 food factories in the Borough including 3 ice-cream factories. Street Traders:— Coffee stalls 11 Greengrocers rounds 18 Greengrocers stalls 33 Ice-cream stalls 2 Animal Food Dealers:— There are two cats' meat shops and one cats' meat stall in the Borough. Catering Establishments:— The following establishments hold catering licences from the Ministry of Food. Private hotels 155 Staff canteens 59 Industrial canteens 24 Institutions 17 Note.—There are an unknown number of residential establishments (probably several hundreds) which provide meals to residents on their books, but which do not hold catering licences. 16 Milk Licences.—Licences in force at the end of the year are given in the table below. Dealers' Principal Licences Dealers' Supplementary Licences To sell— 1 '' Pasteurised " milk 59 16 " Sterilised " milk 100 17 " Tuberculin Tested " milk 52 16 " Accredited " milk - 1 Dealers' supplementary licences enable applicants to sell milk in the Borough from premises outside the Borough on condition that they hold principal licences from the authorities concerned. shops acts.—The two Shops Acts Inspectors made 1,591 visits. No notices were served, all contraventions being dealt with informally. The Shops Act, 1950, which came into operation on the 1st October, had the effect of consolidating into one Act all previous law relating to shops. The first Act was passed in 1912, but it was not until 1936 that sanitary authorities were given certain powers with regard to the health and comfort of shop workers. These powers concerned ventilation, temperature, and sanitary conveniences, and the same provisions are embodied in Section 38 of the Act of 1950. The County Council administer the rest of the Act, including that part of Section 38 which deals with lighting and washing facilities. clean food campaign.—The question of introducing, in common with other Councils, a Clean Food Campaign received the earnest consideration of the Committee at the commencement of the year. Many Councils have instigated such schemes and in certain boroughs a system of issuing Certificates to food shops where a certain hygienic standard is maintained, has been adopted. In my opinion, the acknowledgment of two standards of hygiene is fundamentally wrong, and moreover, because of the differing types of shop premises, and the severe restriction on the issue of licences for additional sanitary fitments necessary to achieve the ideal, is inequitable and in addition suggests that those without certificates are below standard. This, of course, cannot be admitted so far as Paddington is concerned, and I would go so far as to say that the setting up of independent organisations is quite wrong and an admission that existing arrangements have failed in any area where such a scheme has been found necessary. Whilst endorsing this view, the Committee considered that the following steps should be taken to bring home the vital importance of cleanliness to food handlers and the public :— (i) Introduction of free washing facilities for food handlers at all the public conveniences in the Borough. (ii) Films and lectures to be given to all the food handlers and the public with the co-operation of the Chamber of Commerce, and other organisations in the Borough. As a result of our representations to the Works Committee, free washing facilities have been established in all the public conveniences in the Borough, of which due publicity was given in the local press and by notices in the premises concerned. Films entitled "Another case of food poisoning " and " Fly about the house " and film strips entitled " What food infections are," "The food handlers' part " and " Hygiene in the kitchen " have been shown to a variety of audiences. In addition, suitable leaflets addressed to housewives have been circulated through the medium of the Public Relations Officer, Council's Offices, Libraries, etc., and a similar leaflet dealing with their particular aspect has been circulated to every food handler in the Borough. Further, at the request of the Clerk to the Justices, Paddington Division, a comprehensive survey was undertaken into the adequacy and conditions of the sanitary accommodation provided in all the licenced premises in the Borough. Of the one hundred licenced premises in the Borough, twelve premises were found to be without separate sanitary accommodation for female customers; four without separate sanitary accommodation for male customers and one was without any sanitary accommodation for customers at all, although there was a public convenience in close proximity; and in twelve cases the existing accommodation was found to be unsatisfactory and/or defective. No fault could be found in the sanitary accommodation of the remaining licenced premises. A full report was forwarded to the Clerk to the Justices, and many improvements were subsequently carried out by the brewers to the premises which fell short of the recognised sanitary standards. Owing to the restrictions on material and labour, however, certain of the more comprehensive plans submitted had to be modified for the time being in the hope that the remainder of the improvements can follow at a later date. I am satisfied that, with the continuance of the presentation of appropriate films as and when possible, combined with the ready co-operation of the traders themselves, and the various organisations who have shown such an active interest in this important subject, the campaign for clean food will continue energetically and without cessation, as hitherto. 17 Perhaps the greatest value of the Clean Food Campaign is the publicity it has received, which has drawn the attention of the ordinary citizen to the desirability of clean food. In the end it is the ordinary citizen who decides the level of efficiency achieved. He can obtain the degree of cleanliness he is prepared to demand and pay for, quite apart from the statutory efforts of the local authority. bexhill holiday home .—The year 1950 was the first complete year that this Holiday Home had been open, and its popularity among the elderly residents of the Borough showed no sign of abating. The house accommodates sixteen visitors weekly and, apart from a few odd vacancies, was fully occupied from the 6th February until the 20th November, and for ten days at Christmas. In order to assist in the filling of vacancies during the early part of the year it was decided that during the months of January, February and March applicants should be offered fortnightly holidays, many old people having said it was not worth going for a week at this time of the year. In addition a visit during these months did not count against any entitlement to go during the summer months. It was also decided, in order to ensure that summertime vacancies be allotted equitably, that no visitor who had a holiday during June, July or August in 1949 should visit the home during the same months of 1950. This has now been made a standard practice for any consecutive years. All other conditions for applicants remain as stated in my 1949 Report. During the year a wash basin was installed in each of the top floor bedrooms, thus bringing them into line with the first floor. Some items of equipment were renewed, and certain repair work to the house was carried out. The painting of the exterior was done, as this had been postponed when the house was purchased. There is no doubt that there is a great need for a service of this nature for the old people of the Borough, and it seems very likely that the difficulty in the future will be to accommodate all those who wish to spend a holiday at Bexhill. Therefore, to obtain applications in good time and in order that the scheme should embrace as many of the old age pensioners in the Borough as possible, notices, giving particulars of the Home, were made available in the local post offices asking intending visitors to apply for vacancies during the months of October and November. By the end of the year enough applications to fill the Home had already been received, as, apart from new applications arising from the post office publicity, practically every person who had visited the home wished to go again. housing. Houses unfit for human habitation— No. of basement rooms dealt with by closing orders 190 No. of houses dealt with by demolition orders or in respect of which undertakings were accepted 8 Thirty-eight persons were displaced as a result of the Council's operations, fourteen being rehoused by the Paddington Borough Council and three by the London County Council. Six secured accommodation through their own efforts and fifteen are awaiting suitable Council vacancies. Closing orders were determined or undertakings cancelled on five basements and the upper parts of six mews premises. Three houses were also wholly made fit following action under Section 11 of the Housing Act, 1936. Basement Room Survey. In accordance with the Council's desire to prevent the reoccupation of unfit basement rooms, the District Sanitary Inspectors continued to report to the Medical Officer of Health the existence of empty basement rooms on their districts. A number of basement rooms suitable for closure were brought to notice in this way many of which were subsequently closed for human habitation, whilst others were brought up to the required standard without recourse to formal proceedings. Closed Premises. A few cases of contravention of the closing orders in force on basements and the upper parts of mews premises were discovered following a survey carried out during the latter part of the year. Warning letters were sent to the persons concerned calling upon them to cause such unlawful occupation to cease within a reasonable time. Compulsory Repairs. Twelve 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 five other premises. In two further cases works are being undertaken by the Council in default, and at four other premises the works have not yet commenced. Thirteen Notices served prior to 1950 have also been complied with during the year, and in one other case the work was carried out by the Council in default. 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. 18 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 bv the appropriate Committee. Housing Act, 1936—Overcrowding. (a) (1) Number of dwellings overcrowded at the end of the year 633 (2) Number of families dwelling therein 661 (3) Number of persons dwelling therein 2,467 ½ (Units) (b)Number of new cases of overcrowding reported during the year 421 (c) (1) Number of cases of overcrowding relieved during the year 315 (2) Number of persons concerned in such cases 1,122 (Units) (d)Particulars of any case in which dwelling-houses have again become overcrowded after the Local Authority have taken steps for the abatement of overcrowding Nil (e)Any other particulars with respect to overcrowded conditions upon which the medical officer may consider it desirable to report Nil The number of overcrowded dwellings on the Register of Overcrowding at the end of 1950 (633) shows an increase on the figure for 1949 (527). Some 164 of these were basement dwellings. Of the cases of overcrowding relieved during the year— 39 were provided with accommodation by the Borough Council. 156 were rehoused by the London County Council. 89 secured accommodation privately, and 31 were relieved by a natural reduction in the size of the family or on obtaining additional accommodation. The practice of sending warning letters to owners and landlords against permitting the premises to again become overcrowded has been continued in all known cases where overcrowding has been abated. Housing Accommodation : Preferential Treatment. Five families recommended for preferential consideration in the allocation of accommodation on medical grounds were rehoused by the Borough Council, and nineteen by the London County Council. Rehousing I nquiries. Some 1,440 communications were received during the year from the Borough Director of Housing, the County Divisional Medical Officer, the County Director of Housing and Valuer, and from other authorities requesting information on the housing conditions of persons applying for re-housing on grounds of overcrowding, insanitary conditions, and ill-health. Such information enables the inquirer to assess the degree of priority to be given to the applicants concerned. In each case a visit was made by the Sanitary Inspector and a report furnished. New Accommodation. During the year 109 flats at John Aird Court and 84 flats at Queen's Park Court were completed, and families selected from the Council's waiting list were rehoused therein. Fumigation. Associated Fumigators, Ltd., under an agreement with the Council, removed and treated the furniture and effects of 153 families with hydrogen cyanide gas during the year. The cost ol the work was £680. Slum Clearance Survey. In 1949 the London County Council asked for a survey to be made which would show the extent of the slum clearance problem in the Borough, the degree of urgency for dealing with particular areas, and the need for " decanting " accommodation. For two months the Sanitary Inspectors devoted the greater part of their time to a re-inspection of many properties and in preparing reports. As a result of their efforts, a map was prepared showing (i) existing clearance areas ; (ii) premises suitable for slum clearance; (iii) border line premises ; and (iv) premises to be watched ; also a schedule was compiled detailing information as to the properties marked on the map, together with information as to the number of families (4,047) which would be displaced by clearance. The map and schedule were submitted to the Public Health Committee of the Council before being sent to the London County Council.