AC 439(1) HARR 26 BOROUGH OF HARROW Annual Report OF THE MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 CARYL THOMAS M.D., B.Sc., D.PH. BARRISTER-AT-LAW BOROUGH OF HARROW Annual Report OF THF MEDICAL OFFICER OF HEALTH FOR THE YEAR 1959 CARYL THOMAS M.D., B.Sc., D.PH. barrister-at-law TABLE OF CONTENTS page General Statistics 8 Deaths from Accidents 13 Cancer of the Lung 5 General Health Services Hospitals 17 Nursing Homes 18 Establishments for Massage and Special Treatment 19 Nursing, etc., in the Home 19 Day Nurseries 20 Clinics and Treatment Centres 20 Provision for Special Classes of Person 23 The Aged 31 Laboratory Facilities 31 Ambulances 31 Legislation 32 Sanitary Circumstances 33 Water 33 Fluoridation 34 Drainage 34 Public Cleansing 36 Public Conveniences 38 Disposal of the Dead 38 Sanitary Inspection 40 Housing 43 Factories 49 Shops Act 53 Atmospheric Pollution 53 Hazards of Radiation 55 Inspection and Supervision of Food 60 Hygiene of Food 74 Health Education 75 Infectious and Other Diseases Prevention and Control 77 Poliomyelitis 84 Tuberculosis 87 B.C.G 90 5 ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH To His Worship the Mayor, Aldermen and Councillors of the Borough of Harrow. Mr. Mayor, Ladies and Gentlemen, I beg to submit the Annual Report on the Health and Sanitary Circumstances of the District for the year 1959. As judged by the usual vital statistics, 1959 was another healthy year for this district; the death rate was only 9.7 against a national figure of 11.6. The infant mortality rate only 15.0 as compared with 22.0, while this is the first year it is possible to record that there were no deaths due to or associated with pregnancy. The position as to the usual infections was satisfactory, there being no heavy incidence of scarlet fever or whooping cough, while for yet another year, the ninth in succession, the district was free from any case of diphtheria. Measles was prevalent in the earlier part of the year, but was not very damaging. The steadily improving position of tuberculosis which has been a feature of recent years continued, there being a further reduction in the number of new cases and a fall in the number of deaths of which last year there were only six. Of the two less predictable infections, this district had its share of the wave of influenza which attacked the country in the earlier part of the year and resulted in there being a sharp increase in the number of deaths. As regards the other—acute poliomyelitis—the position nationally and locally was most satisfactory. 1958 had been a year of low incidence; but it was also a year with a cold and wet summer so was one in which the incidence might be expected to be low. 1959 though was a year of a quite exceptional summer, one in which it might have been expected that poliomyelitis would have been very prevalent; that the incidence in spite of conditions which are felt to favour its prevalence was so low must be ascribed very largely to the efficacy of the inoculations which so much of the population have had. The routine pattern of the complaints which come in and which are the basis of much of the work of the Public Health Inspectors was interrupted more particularly this last year. At one phase there were many complaints about Wealdstone Brook, the results of the inadequacy of a sewer which the Council had already decided to supplement. There was, too, the number of complaints about a slaughter house which for a time was being used for the slaughter of a much greater number of animals than usual. 1959 was, too, a year in which wasps were very common and easily the greatest number of complaints ever received for the eradication of nests came in. The number was so large in fact that it was not possible to deal with them all. It is hoped that two decisions reached during the year will lead to a diminution in unsatisfactory states which have been the cause of many complaints. The one was the decision of the Highways and Cleansing ommittee to agree to the removal free of charge, of household waste 6 materials which are not of the type ordinarily removed in the domestic refuse bin and which being deposited lead to accumulations in different parts of the district. The other was the agreement arrived at with the Thames Conservators under which it will be possible to arrange for the flow of the River Pinn to be unobstructed and so reduce the number of complaints, particularly in spells of dry weather. The Council's Slum Clearance Programme has made disappointingly slow progress. Although it is years since the Northolt Road Area was represented and even three years since the Ministry enquiry, none of these houses has been dealt with. The Slum Clearance Programme hinges on the availability of new houses in which to decant those living in the properties on this site and representations about the remaining houses included in the Council's Slum Clearance Programme have had to be held-up except for some of the more especially urgent cases. In the meantime though the owners and particularly the owner-occupiers of a number of houses included in the original programme have decided to carry out a substantial volume of work to some of the houses which results in their being removed, at least for some time, from the list for demolition. The Council during the year decided to widen the range of interests of the sub-committee set-up in the first instance to deal with the Clean Food Campaign, feeling that what was learned about the approach to the public in regard to clean food could usefully be applied to the Clean Air Campaign and to such matters as accidents in the home. The new subcommittee then became the Health Advisory Council. The development of the arrangements for general health education in this district came about largely because for some years one of the Public Health Inspectors devoted virtually the whole of his time to it. Unfortunately, during the year, he resigned and it is becoming apparent that it is going to prove difficult to find someone to fill his place. Progress was made in the initial stages of delineating an area which was to become the first Smoke Control Area in this district. This area was chosen not because it was one about which information could easily be obtained and so enable a Smoke Control Area to be declared with the minimum of difficulties; on the contrary, it is representative of the residential part of the district and was selected as being the area from which progress to other parts could easily be made. Collecting the information of this relatively small area entails an enormous amount of work which has to be undertaken by Mr. King and the Public Health Inspectors without causing too much disruption to their ordinary labours. Many householders do not realise the importance of the domestic chimney in polluting the atmosphere. Over one million tons of smoke are emitted each year from domestic fires, compared with figures of half a million tons from industry and 100,000 tons from the railways. On the other hand, the domestic chimney contributes only 100,000 out of the tota of 900,000 tons of grit and dust emitted. Of the sulphur dioxide gas which is given off when any solid fuels or fuel oils are burned, the domestic fires contribute about one out of the 5½ million tons. It is incongruous at a time when the Government urges progress in the establishmen of smoke control areas that the Coal Utilisation Council, by advertisement, encourages householders to burn coal in domestic grates. Fortunately the trend is the other way; and even without the declaration of smoke control areas a growing proportion of householders are turning away from the consumption of coal in this way. It would probably speed-up progress if the expenditure people incurred in providing appliances to consume smokeless fuels and for which they would qualify for financial contribution if the change was made after the locality in which they live has been declared a smoke control area, could qualify for this contribution even when they make this change before the order comes into force. In default of some such arrangements being arrived at, it can be expected that some of those living in the localities which in time are to become smoke control areas might postpone such changes until such time as they would qualify for this financial benefit. The Council, although making substantial contributions towards the expenses incurred by the Harrow Old People's Welfare Committee and the various voluntary organisations who do so much of the work to help elderly people, has been only loosely in contact with the work of the parent Committee. In future, they will be kept much more closely in touch because the Council's representation on the Committee has been increased, and also because reports of the Executive Committee of the parent Committee will be presented to some of the Committees of the Council. The Old People's Welfare Committee accepted the suggestion of the Council that they should engage a whole-time Welfare Organiser. In March, the Royal Commission on Local Government in Greater London started to take oral evidence from local authorities, local authorities' associations and Government departments. The evidence of the Council was heard in July. I have the honour to be Your obedient servant, CARYL THOMAS, Medical Officer of Health. Council Offices, Kynaston Court, Harrow Weald. 20th July, 1960. 8 STATISTICAL AND SOCIAL CONDITIONS OF THE AREA Area (in acres) 12,555 Registrar-General's estimate of resident population, midyear 1959 213,700 Rateable Value (1st April, 1959) £3,767,150 Sum represented by a penny rate (1st April 1959) £15,545 Total number of occupied houses and flats 64,284 Extracts from Vital Statistics for the Year Live Births:— Male Female Total Legitimate 1,391 1,412 2,803 Illegitimate 68 60 128 Total 1,459 1,472 2,931 Live birth rate per 1,000 population 13.7 Illegitimate live births per cent of total live births 4.3 Stillbirths:— Male Female Total Legitimate 23 18 41 Illegitimate 1 1 2 Total 24 19 43 14.4 Stillbirth rate per 1,000 live and stillbirths Total live and stillbirths 2,974 Deaths:— 2,078 Number Death rate per 1,000 population 9.7 Deaths of infants under one year of age 44 Infant mortality rate per 1,000 live births 15.0 Legitimate I.M. rate per 1,000 legit, live births 14.3 Illegitimate I.M. rate per 1,000 illegit. live births 35.7 Neonatal mortality rate per 1,000 live births 11.6 Early neonatal mortality rate (deaths under 1 week) 10.8 Perinatal mortality rate 25.2 Maternal deaths (including abortions) — Maternal mortality rate per 1,000 live and stillbirths — Death from Cancer 444 Measles 1 Whooping Cough - Tuberculosis 0 Population The mid-year population of the district was estimated to be 213,700. This includes members of the armed forces stationed in the district. In each of the post-war years the population of the district increased to reach the highest figure of 220,300 in 1950. From that time there has been a slight fall each year in the estimated population, the midyear 1959 figure being 213,700, a fall of 600 on that of the previous year. This fall took place in spite of the natural increase in population which 9 is the excess of births over deaths and which last year was 853. Some at least of the fall is to be explained by the movement of some families out of the district to New and to Expanded Towns. Quite apart from these transfers though there is a steady movement of population in and out of such districts as this. Births The total number of live births registered during the year was 2,931 (1,459 male and 1,472 female). Of these 128 were illegitimate, being a percentage of total births of 4.3. The numbers of live births registered in the five years from 1955 onwards were: 2,747, 2,755, 2,791, 2,783 and 2,830. 819 births occurred in the district (815 live, 4 stillbirths). Of this number 32 were to residents of other districts. 2,171 (2,130 live and 41 still) birth notifications were transferred from other districts, being mostly of births occurring to Harrow mothers in hospitals in Middlesex or in London. The birth rate was 13.7. The local comparability factor for births is 1.02. The corrected birth rate was therefore 14.1; that for the country as a whole was 16.5, the highest rate since 1949. Deaths The Registrar-General arranges that the information about those who have died outside the district in which they normally reside is transferred to the Health Offices of those districts. These numbers are added to the deaths of those districts, corresponding deductions being made from the deaths allocated to any district in respect of those who died in those districts, but who normally resided elsewhere. While certain types of institutions are not regarded in ordinary circumstances as the usual residence of those living there, there are many institutions which are so regarded. 1,283 persons died in this district in 1959. This figure includes those members of the armed forces stationed here. Of these, 166 were of persons who were not resident in the area. 176 deaths took place in the various hospitals, eighty-four in Roxbourne, twenty-five in Oxhey Grove and forty-six persons died in non-transferable institutions. Of the 958 deaths of the local residents which occurred outside the district, most took place in institutions, 380 being at the Edgware General Hospital. 235 deaths took place in hospitals just outside the district, including twenty-one in nearby isolation hospitals, and 241 in various London hospitals. Four deaths were of infants born in hospitals outside the district. The total number of deaths was 2,078. The figure for 1958 was 1,992 and for 1957 was 1,937. The 2,094 of 1951 was the largest number of deaths recorded for this district. 10 The death rate was 9.7 per thousand population. The rates for the last five years were 8.8, 8.2, 8.8, 8.9 and 9.2. The rate for the country as a whole was 11.6. Liability to death varies at different ages. Any changes in the agedistribution of a population then affect the death rate; similarly, the death rates of the sexes are not the same. To offset the effects of these variations and so produce a rate which can be compared with that of other districts, or that of the same district at other times, the Registrar-General calculates a comparative mortality index based on the 1951 census population. When the death rate figure is multiplied by this, a figure is obtained which would have been the death rate for the district had the age and sex distribution of the population been that of the country as a whole in 1951. The index figure is 1.18; the adjusted rate is 11.5. The following is the Registrar-General's abridged list of causes of death in this district:— Male Female Male Female Resp. tuberculosis 5 1 Hypertension 21 34 Other tuberculosis — — Other heart disease 77 140 Syphilitic disease 3 2 Other circulatory disease 47 71 Diphtheria — — Influenza 19 1 Whooping Cough — — Pneumonia 59 62 Meningococcal Infections — — Bronchitis 75 31 Acute poliomyelitis — — Other respiratory disease 14 6 Measles — 1 Peptic Ulcer 14 9 Other infective diseases 3 4 Gastritis, enteritis 3 4 Cancer of stomach 25 21 Nephritis 6 5 Cancer of lung 91 13 Hyperplasia of prostate 17 — Cancer of breast — 55 Pregnancy, etc. — — Cancer of uterus — 10 Congenital malformation 7 10 Cancer of other sites 115 114 Other diseases 62 71 Leukaemia 5 6 Motor vehicle accidents 20 16 Diabetes 7 5 Other accidents 16 17 Vascular diseases of ous system 94 160 Suicide 10 22 1,057 1,021 Coronary disease 242 137 1,437 deaths were due to diseases of the circulatory system, vascular diseases of the central nervous system and to cancer, a percentage of seventy of the total deaths. The following are the numbers of persons who were of different ages at the time of death: under one year, 44; over one but under five years 9; five to fourteen years 14; fifteen to twenty-four years, 12; twenty-five to forty-four years, 62; forty-five to sixty-four years, 576, sixty-five to seventy-four years, 507; seventy-five years and over, 852. Of these local deaths, 60 per cent of those of males were persons of sixty-five or over, 30 per cent of seventy-five and over, and eighty-five and over 9 per cent. The corresponding figures for females were 72, 50 an 11. Of the local residents who died last year, 41 per cent had reached the age of 75, and 14 per cent had reached the age of 85. Infant Mortality The infant mortality rate is the ratio of the number of infant deaths under one year per thousand born in the year. Although higher rates are still found where environmental conditions are not satisfactory, this rate is not these days the index it used to be of the general healthiness of the district. Most of the infant deaths which now occur take place within the first days or even the first hours of birth, and are now more related to conditions operating at birth. The local rates have constantly been below the national rates; with the rapid fall in the rates for the country as a whole, this gap is narrowing. Last year, 44 infants living in the district or born to mothers ordinarily resident here died under one year of age. In the same year, 2,931 infants were born. The infant mortality rate therefore was 15.0. The rate for the country as a whole was 22 0. Of these 44 deaths, 34 occurred in infants under one month of age. The neonatal rate therefore was 11.6, comprising 77 per cent of the infant mortality rate. Of the 18 infants who failed to survive twenty-four hours, 5 had been born at home. Two were very premature, one died from want of attention at birth and two suffered from congenital developmental abnormalities. Of those born to mothers delivered in hospitals or nursing homes, in six the infant was prematurely born, and three died from congenital abnormalities. Fourteen infants survived twenty-four hours but failed to live one week Only two of these infants had been bom at home. The death of one was due to atelectasis, the other to congenital defects. Seven of these infants whose mothers were confined in hospitals were born prematurely. Two had birth injuries and two had developmental abnormalities. Only two infants who survived one week failed to reach one month. The mothers of both had been delivered in hospital; one infant had birth injuries, the other congenital abnormalities. Of the ten who attained one month but failed to reach the age of one year, two died at two months of age, two between three and six months, four between six and nine months and two between nine and twelve months. Five of the deaths were due to respiratory complaints, one to enteritis and three were the result of congenital defects. Stillbirths Forty-three stillbirths were registered last year. This was a rate per thousand population of 0.20, and a rate per thousand live and stillbirths 14.4. The rate per thousand births for the country as a whole was 20.9. Of the forty stillbirths about which particulars are known, all but four were to mothers confined in hospital. Of those where the mother was confined in an institution, many were premature. In six there was no apparent cause for the early onset of labour. 12 In five there was premature separation of the placenta with haemorrhage. Maternal toxaemia was present in two instances. Two suffered from developmental abnormalities. A number of stillbirths were of infants who were born full-time and who were alive just before the onset of labour. In four of these there was no obvious reason for the death. In another ten the labour was difficult, in two of these labour being overdue. Maternal toxaemia caused death before delivery in three instances. Peri-Natal Mortality Very much the same conditions are responsible for many of the stillbirths and for the deaths of infants in their first week, the early neonatal period. So much is this the case that it is almost a matter of chance as to whether the loss has to be recorded to one or the other group. For some years now these losses have been classed under the term of perinatal mortality, a rate which is calculated as the number of stillbirths and deaths under one week combined per thousand total live and stillbirths. The rate for this district for last year was 25.2, comprised of 10.8 the early neo-natal rate and 14.4 due to stillbirths. So many of these losses are bound-up with the obstetrical care of the mother that it has been suggested that they should become the yardstick of such care rather than the crude maternal mortality rate. The rate in this country has fallen with the increasing proportion of deliveries which take place in institutions. This need not point necessarily to the desirability that all confinements should take place in institutions, but does stress the necessity of facilities being available for dealing with emergencies. Many of these losses occur in the premature; much even yet has to be learned as to the reason for the premature onset of labour. Many of the losses too are the result of developmental abnormalities; something is being learned about the reasons for some of these. Death of Infants 1 to 5 years of age A child who survives the first year of life enters a period when the probability of dying is very small. Some survive their first birthday in spite of suffering from congenital abnormalities which later become responsible for, or contribute to death. Weaker children, especially in the earlier years, might succumb to infections which older children can throw off. Nine survived their first but did not reach their fifth birthdays. Of these, five were in their second, two in their third and two in their fourth years. Seven of the deaths were due to congenital abnormalities, and two to disease. No deaths were due to accidents. Maternal Mortality In the earlier years of the life of this Council, maternal deaths were all too common. The average number for the 1930's was 11.5. The average for the next six years, mostly war years, was 5.0 and in the succeeding 13 six years 3.5. From 1953 onwards the figure has been either one or two. 1959 is the first year in which it has been possible to record that there were no deaths due to or associated with pregnancy or childbirth. Deaths from Accidents The three main causes of deaths from accidents are those which occur on the road in which a motor vehicle is mostly involved, a variety of deaths occurring in the home, and falls. Apart from those falling into one of these three categories, accidents caused six deaths; two were the result of drowning, one of a railway accident. Deaths from Falls. Of the fourteen deaths from falls, all but four were the result of falls of elderly persons occurring in their homes or institutions in which they were living, including one which resulted from a fall downstairs. Road Accidents. The local figures of road accidents over the last few years have ranged from 10 to 23; this last year it was 26. Of these, fifteen, all of males, occurred outside the district. Of the eleven deaths which occurred in the district, five were of pedestrians of over seventy years of age who were knocked down by a motor vehicle. The local figures of road accidents for last year were much the same as those of the previous year. The monthly average of accidents was 39.3 (main roads 30.5, other roads 8.8). Of the monthly average of 51.4 of the injured, 43.3 were slight (34 on main roads, 9.3 on others) and 81 serious (5.8 on main roads, 2.3 on others). There were in all eight fatalities, six on the main and two on other roads. Accidents in the Home. The local deaths from accidents in the home this last year included seven of persons who died as the result of a fall when in their homes or institutions where they were living; all were over eighty years of age. Three persons died as the result of falls elsewhere; all were over seventy years of age. Two persons died from consuming poisons and five from coal gas poisoning. Burns caused the deaths of three adults and one small child. Falls. "Sixty per cent of all fatal home accidents are falls. Over five thousand people die every year in Great Britain from this cause, the chief victims are the elderly." The Council took part in the campaign sponsored by the Royal Society for the Prevention of Accidents which was an extension of the Annual Home Safety Week run by the London County Council. The object of the campaign was to draw attention to the risk of falls in the home and to encourage practical action to make the homes of elderly people safe from the risk of falls. Burns and Scalds. Each year, more than 6,000 persons die in England and Wales as the result of accidents in the home. Of these, 700 are due to burns and scalds. It is estimated that every year 50,000 persons need hospital treatment for burns or scalds caused by domestic accidents. 14 "There can be little doubt that the majority of the burning and scalding accidents could be avoided if adequate care were given to the construction, location and handling of the causative agents." 80% of the deaths resulting from extensive burns are due to ignition of clothing. Most of these are due to the clothing coming into contact with a heating element or frame of an unguarded or inadequately guarded fire. The type of fire was open in 66% of cases, electric in 24 and gas in 5. The chief preventive measure is guarding the fire. (a) There are certain statutory provisions, the Heating Appliances (Fireguards) Act, 1952 and the Regulations of 1953. The Public Health Inspectors visit premises retailing heating appliances, carrying out tests to ensure that fireguards fitted to gas fires, electric radiators and oil heaters are efficient. They are finding that goods now in production comply with the requirements, though some of the older types of electric and of gas fire do not. The unsatisfactory ones are cither destroyed or efficient guards are fitted. (b) The guarding of fires is a subject which is constantly in the minds of those such as health visitors and public health inspectors who visit homes, especially those in which there are children. At the clinics, too, publicity is given to this subject, and it is one of the subjects included in talks given to school children, to those attending the clinics, to women's organisations, etc. At times, a special drive is directed to this. A second line of defence is the choice of safer garments for women and children. It had up to this been thought that some fabrics were dangerously flammable while others were relatively safe. It seems, however, that this is not so, as virtually all fabrics in common use for clothing are flammable within fairly narrow limits. This makes it important to choose sensible garments. Nightdresses account for a substantial proportion of accidents and pyjamas are much safer, particularly for children. Full-skirted party dresses and loose flimsy garments require special caution. Industry and science are co-operating in research on processes which impregnate fabrics to render them flame resistant. They cost more than the untreated material, but increased demand might reduce this. In some cases too they alter the texture of the material. Recent legislation helps on these lines. Regulations made under the Fabrics (Misdescription) Act, 1913 which came into force on May 11th, make it an offence to offer for sale textile fabrics claimed to be flame proof or to have any degree of flame resistance unless they can pass tests laid down in the appropriate standard. The important relevant standard is that for low inflammability fabrics. To earn their label of low-inflammability, fabrics must have a flame resistance rating of 150, which means that it must take at least 150 seconds for flame to travel up a 100" strip of material. This rating provides a good level of safety if clothing catches fire; the wearer can quickly put out the flame or take off the garment. Some materials such as nylon are naturally flame resistant, others can obtain flame resistance througn chemical treatment. This flame resistance though can be seriously reducei 15 by washing. To qualify for the label of low flammability. samples must first undergo a washing test. The material is submitted to washing in a washing machine for half an hour in a strong solution of chemicals and detergents. After rinsing and drying it has to go through the whole treatment a further eleven times. At the end of all this it must still retain the flame resistant rating of 150. While labelling of a fabric "flameproof" or "flame resistant" will be an offence unless it complies with the rating, offering for sale highly inflammable fabrics without any label can still be done without any offence being committed. Deaths from Suicide About twenty persons living in this district commit suicide each year. This last year the figure was 32, ten men and twenty-two women. Coal gas poisoning was again far and away the most common method used, being chosen by nine men and fifteen women. Poisoning came next, being the method chosen by five women. There is no set pattern about the distribution of these occurrences throughout the year. The greatest number in any one month was five in December, though there were four in each of the months February, April and July. Although two of each sex were in their twenties and another two in their thirties, the age distribution in the sexes differed; whereas all the remaining men were over sixty, four of the remaining women were in their forties, six in their fifties and six in their sixties. Deaths from Cancer Of the 2,078 deaths of residents in this district, 444 were due to cancer, this causing 22 per cent of the deaths of males and 21 per cent of the deaths of females. Of the 231 deaths from this cause amongst males, in 91 the site was the lung, in 25 the stomach. Of the 213 deaths amongst females, the breast was the site in 55, the stomach in 21, lungs in 13 and the uterus in 10. The 444 deaths from cancer this year were a sharp rise on the number °f 414 in 1958 and the 415 of 1957. Twenty-two of this increase was due to the greater number of deaths of cancer of the lung: in men, a figure of 91 as against 71 in the previous year; in women it was 13 as against 11. Cancer of the Lung. In 1931 some 13,000 people in this country died of cancer of the lung. Each year since then there has been an increase °i nearly one thousand in that figure. It is anticipated that in time it will reach 25,000. There has been nothing to controvert the conclusion of the Medical Research Council about the relationship of cancer of the lung and cigarette smoking. "In the opinion of the Council, a most reasonable interpretation of this evidence is that the relationship is one of direct cause and effect." 18 The local figures for the years since 1951 are:— 1951 1952 1953 1954 1955 1956 1957 1958 1959 Males 69 71 63 71 79 65 80 71 91 Females 12 20 12 12 17 16 17 11 13 81 91 75 83 96 81 97 82 104 These figures do not point to any definite trend; but no comfort can be gained from them as they are certainly not diminishing. The Health Advisory Council were asked by the Public Health Committee to consider what might be done to bring to the attention of the public the information which points to the increase in the incidence of this complaint being related to the extent to which cigarettes are being smoked. They recommended "That the Public Health Committee be recommended to ask the Public Relations Committee to give the fullest publicity on the Council's noticeboards and in the Civic Bulletin and Civic News-sheet, to that part of the Medical Officer of Health's Annual Report for 1958, dealing with smoking and cancer of the lung, and that such information be also publicised at Clinics in the Borough, and also conveyed to the local Press, and to youth organisations and schoolchildren through the Borough Education Officer". The Public Health Committee, when they had previosuly discussed this subject, decided not to do anything about approaching youths or children at school as it was understood that the County Council were concentrating on this side of the problem. The County Council in 1956 had arranged for a letter to be addressed to all youth leaders in Middlesex referring to the fact, and suggesting that it was as well to postpone starting to smoke until after school years. The County Council felt that the answer to the whole problem would be found only by a long-term project directed towards children at school, aiming at getting them to put back the date on which they first start to smoke, with a hope too that some might not start at all. It was felt that little was known as to what was the most effective line of approach to these pupils. To find the answer to this, the County Health Education Officer undertook research in schools throughout the county, not merely to find out about the smoking habits ol children, but to find out how best to present the subject to them in a way which would influence their views about smoking. Deaths from Infectious Diseases These were six from tuberculosis, twenty from influenza and one from measles. 17 HEALTH SERVICES OF THE AREA HOSPITALS Particulars of the Hospital services for the Area were set out in the Annual Report of 1954. General Hospital Services. The provision of hospital accommodation for the district never kept up with the demand which resulted from the occupation of the large numbers of houses built in the 1930's. When the County Council were the hospital authority, the intention was that the needs of this Area should be met partly by the erection of a new hospital to the south east of the district. When in due course, hospital provision became the responsibility of the Ministry of Health, these proposals went by the board, and instead new provision was to be by the erection at Northwick Park of the new Charing Cross Hospital. As recently as the end of 1958 part of this project figured in the Ministry's hospital programme for 1960/61. Because of the difficulties arising from the fact that Charing Cross Hospital is a teaching school, this project in turn was abandoned. Instead, the North West Metropolitan Regional Hospital Board became responsible for meeting the needs of this district. It is still intended that there shall be a new hospital at Northwick Park. In the meantime, the Harrow Hospital has been included in the Harefield and Northwood Group of Hospitals. Isolation Hospital. Infectious cases are admitted to the Hendon Isolation Hospital (112 beds) in Goldhawk Avenue, Hendon. With the lessening demand for hospital beds for the infectious sick, 20 of these beds are now used for general medical patients, and another 20 for those with gynaecological conditions. Maternity Hospitals. Most of the mothers who wish to be confined in hospital are admitted to the maternity ward of the Edgware General Hospital (60 beds), or to the Bushey Maternity Hospital (36 lying-in and 14 ante-natal beds) which lies just outside the northern boundary of the district and which is an annexe to the Edgware General Hospital. Just over the boundary in another direction in Wembley is the Kingsbury Maternity Hospital (56 beds) associated with the Charing Cross Group of Hospitals. Perhaps because of housing difficulties, possibly for reasons of finance, and perhaps to have a greater sense of security or safety, a growing proportion of mothers elect to be confined in hospital rather than at home. In London and round about, this is causing difficulties. Mothers have to book very early if they wish to secure a bed for their confinement in hospital. Difficulties arise when for some reason or another it is necessary for a mother to be confined in hospital at which she has not reserved a bed. This could be because she has moved with her family from one district to another; it could be because of the development of some circumstances which make a home confinement undesirable. Whatever the reason, some of these women are placed in the most unfortunate 18 position of knowing that they should not have their confinements at home, of knowing too that they will probably be admitted somewhere at the last moment, but not knowing where to, and not having the absolute assurance that they will in fact, be accepted. All that they can be told is that they must wait until they go into labour, then summon their doctor who will approach the Emergency Bed Service with a view to finding a bed at some hospital, all a most distressing experience for a woman in labour. Accommodation for the Aged. There are 38 beds for geriatric patients at the Edgware General Hospital; 52 at Roxbourne Hospital, 32 at Oxhey Grove Hospital, 14 at Stanmore Cottage Hospital, 23 at Orme Lodge, 24 at Glebe House and 26 at St. Elizabeth's Hospital which is administered by the Barnet Group Hospital Management Committee. Contractual arrangements exist for 15 beds at Springbok House which is provided by the National Corporation for the Elderly, 9 at Grosvenor Nursing Home and 4 at the Avenue Nursing Home. In 1958 contractual arrangements were made for 30 beds at St. Andrews Hospital, Dollis Hill. This arrangement not only increased the number of available beds, but provided a third hospital to which patients can be admitted direct from their homes, the other two being Edgware General Hospital and Roxbourne Hospital. To meet the needs of the area then there are now 267 beds scattered over a wide area in eleven different establishments. Dr. Binks, the Geriatric Officer, is of the opinion that the district is 100 beds below the regional average which itself is one of the lowest in the country, and 330 below the national average. Of the 697 persons admitted to these beds, 300 or 43 per cent were discharged to their own homes; 70 or 10 per cent were discharged to voluntary homes and private nursing homes, and 26 or 4 per cent to local authorities homes. Mental and Mental Deficiency Hospitals. Sufferers from mental illness from this area are admitted mostly to Shenley Hospital. In the main, mental defectives from Middlesex go to Harperbury Hospital near St. Albans; to a lesser extent to Leavesden Hospital, Abbots Langley. There are three "designated" (observation) wards in general hospitals (North Middlesex, Central Middlesex and West Middlesex hospitals) to which patients may be admitted for a short period for observation whilst the general question of and the necessary formalities for their admission to a mental hospital can be dealt with. NURSING HOMES These are private establishments which provide accommodation for varying types of patients. Section 187 of the Public Health Act, 1930, requires that these homes shall be registered with the local health authorityThe responsibility for registering and supervising them rests with tne Health Committee of the County Council. Applications for registration should be made to the Clerk of the County Council. At the beginning of the year, there were 13 homes registered for 174 beds, of which 5 were for maternity cases. No homes were closed, 19 and no new ones opened, though Bowden House was registered for 22 instead of 19 patients, and Glenleigh for 16 instead of 14. At the end of the year, then, the 13 registered homes had 179 beds, of which 5 were for maternity cases. ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT Section 355 of the Middlesex County Council Act, 1944, prohibits any person carrying on in this district an establishment for massage and special treatment without a licence from the District Council authorising him to do so. There is a saving clause for registered members of the Chartered Society of Physiotherapists and for members of the medical profession. At the beginning of the year 31 establishments were licensed. One was licensed for the first time during the year; two were discontinued so the number at the end of the year was 30. In addition, certificates were lodged by three members of the Chartered Society of Physiotherapists. NURSING, MIDWIFERY, ETC., IN THE HOME General Nursing The National Health Service Act made local health authorities responsible for providing a home nursing service, either engaging their own staff or using the services of existing district nursing associations who had up to this done this work. At the end of the year, there were some 20 whole-time nurses and 7 part-time nurses who worked mostly in the mornings, an equivalent of 25 whole-time staff. During the year they paid in all 56,960 visits. The service is essentially a day-time one. The general medical practitioners get into touch with the nurses either directly or through the office. The administration of the home nursing service is one of the functions for which the local Area Committee is responsible. The superintendent of the home nurses is Mrs. R. Bromley, who works at the Area Health Office at "Kynaston Court". Nursing Equipment. The County Council in exercising its powers to make available nursing equipment on loan to patients being nursed at home have used the services of the Middlesex Branch of the British Red Cross Society. The Red Cross depot in this area is at 39 Sheepcote Road. Midwifery and Maternity Nursing The local midwifery service provided by the Harrow Council under the Midwives Act, 1936, passed in 1948 into the hands of the Middlesex County Council. This is one of the services administered locally by the local Area Committee. 20 Most of the midwives live in their own homes and the districts which they cover are as far as possible based on those points as centres. The work of the midwives is co-ordinated by the non-medical supervisor of midwives, Mrs. R. Bromley of 213 Exeter Road, South Harrow (Telephone No. Pinner 5723). The establishment of midwives was in April raised to 11½ Last year the midwives attended the confinements of 736 women in their homes, being present in 612 instances as midwives and in 124 as maternity nurses. Of these mothers confined in their own homes, 462 had the advantage of gas and air analgesia, 261 of pethidine and 276 of trilene. Home Helps This service is intended essentially as an emergency service by which help is sent in to a household faced with some emergency, often enough the result of the mother herself succumbing to some illness. In practice though it has gradually become one of providing help to the aged and those suffering from some long-standing illness. The help which can be given to these people is of the greatest assistance, as even moderate help enables some of them to continue to live at home who, without that help, could not have managed, and would have had to have been admitted to an institution, either Part III welfare accommodation or even a hospital. Although at no time has it been possible to recruit sufficient home helps to meet the full demands, and particularly to give more help at such times as epidemic illness, the staff engaged are able to meet promptly most of the requests. Additional staff would enable more help to be given in certain cases where the present limitation of numbers permits giving only of a minimum service. The average number of home helps was one full-time and 60 parttime, being an equivalent of 37 full-time home helps. They gave assistance in 1,125 households. In 292 of these the patient helped was a maternity case, in 14 was one suffering from tuberculosis, in 223 was one suffering from an acute condition and in 596 was a long term case. DAY NURSERIES The same two day nurseries provided for the admission of children whose mothers needed to go out to work, Headstone Drive Nursery with its 50 places and the Walton Avenue, South Harrow, Nursery with its 60. CLINICS AND TREATMENT CENTRES The following is a list of the clinics and treatment centres in, or serving the district:— Infant Welfare Centres The Clinic, Alexandra Avenue, South Harrow Mon. and Fri. p.m. Broadway Clinic, The Broadway, Wealdstone Wed. a.m. and p.m. The Pavilion, Chandos Rec. Ground, Edgware Thur. and Fri. p.m. 21 Elmwood Clinic, Elmwood Avenue, Kenton Mon. and Wed. p.m. Elstree Clinic, "Schopwick", Elstree 1st and 3rd Mon. p.m. Greenwood Hall, Rickmansworth Road, Pinner Wed. p.m. Memorial Hall, High Road, Harrow Weald Thu. p.m. The Clinic, Honeypot Lane, Stanmore Mon. and Wed. p.m. The Clinic, Kenmore Road, Kenton Wed. a.m. and p.m. Methodist Church Hall, Love Lane, Pinner Fri. p.m. Methodist Ch. Hall, Walton Ave., S. Harrow Thu. p.m. St. Alban's Church Hall, North Harrow Thu. a.m. St. Anselm's Hall, Hatch End Thu. p.m. St. George's Hall, Pinner View, Harrow Tue and Fri. p.m. St. Hilda's Hall, Northolt Road, South Harrow Tue. and Thu. p.m. Spiritualist Ch. Hall, Vaughan Rd., Harrow Wed. p.m. Stanmore Park (R.A.F.) Station Thu. p.m. The Clinic, Whittlesea Road, Harrow Weald Wed. p.m. Ante-Natal Clinics The Clinic, Alexandra Avenue, South Harrow Wed. p.m. Broadway Clinic, The Broadway, Wealdstonc Tue. a.m. and Thu. p.m. The Pavilion, Chandos Rec. Ground, Edgware Fri. a.m. Elmwood Clinic, Elmwood Avenue, Kenton Tue. p.m. Elstree Clinic, "Schopwick", Elstree 1st and 3rd Mon. p.m. Memorial Hall, High Road, Harrow Weald Tue. p.m. The Clinic, Honeypot Lane, Stanmore Tue. p.m. The Clinic, Kenmore Road, Kenton Fri. p.m. 76 Marlborough Hill, Wealdstone 2nd and 4th Mon. p.m. Methodist Church Hall, Love Lane, Pinner Mon. p.m. Methodist Ch. Hall, Walton Ave., S. Harrow Thu. a.m. St. Alban's Church Hall, North Harrow Tue. a.m. St. Hilda's Hall, Northolt Road, South Harrow Tue. a.m. St. Anselm's Hall, Hatch End Alternate Thu. a.m. Spiritualist Ch. Hall, Vaughan Rd., Harrow Wed. a.m. The Clinic, Whittlesea Road, Harrow Weald Fri. p.m. Toddlers' Clinics The Clinic, Alexandra Road, South Harrow Mon. a.m. The Pavilion, Chandos Rec. Ground, Edgware Thu. a.m. Elmwood Clinic, Elmwood Avenue, Kenton Fri. a.m. St George's Hall, Pinner View, Harrow 1st & 2nd Tue. a.m. The Clinic, Honeypot Lane, Stanmore Mon. a.m. Methodist Church Hall, Love Lane, Pinner Mon. a.m. The Clinic, Kenmore Road, Kenton Thu. a.m. spiritualist Ch. Hall, Vaughan Road, Harrow 1st Mon. a.m. The Clinic, Whittlesea Road, Harrow Weald Wed. a.m. These clinics are to enable children who are too old to be brought regularly to the infant welfare sessions to be kept under medical supervision and, as contrasted with the infant welfare clinics, only those who have been given an appointment can be seen. 22 Family Planning and Marriage Guidance Sessions of the Family Planning Association clinic are held at the Elmwood Avenue Clinic on Monday evenings and on Thursday afternoons. The Marriage Guidance Council have their offices at 7 Lyon Road, Harrow (HAR. 8694). School Minor Ailment Clinics Sessions are held at a number of premises in the district:— The Clinic, Alexandra Avenue, South Harrow Mon. Fri. and Sat. a.m. Broadway Clinic, The Broadway, Wealdstone Mon.,Thu. & Sat. a.m. The Pavilion, Chandos Rec. Ground. Edgware Thu. a.m. Elmwood Clinic, Elmwood Avenue, Kenton Fri. a.m. The Clinic, Honeypot Lane, Stanmore Mon. and Sat. a.m. Methodist Church Hall, Love Lane, Pinner Mon. a.m. The Clinic, Kenmore Road, Kenton Thu. a.m. The Clinic, Whittlesea Road, Harrow Weald Wed. a.m. Children attend at the request of the parents or of the teachers, or they are referred by school medical officers. Not only are those who need treatment for minor ailments seen at the clinics, but children are kept under observation for such conditions as cervical glands, cardiac murmurs, etc. Any children needing special examination, especially if these are likely to be prolonged, are referred to these clinics. Ophthalmic Clinics Sessions are held at the Honeypot Lane clinic on Tuesday mornings, Marlborough Hill clinic on Thursday afternoons and Friday mornings, and at the Alexandra Avenue clinic on Thursday mornings. The presscription is taken to an optician who provides the spectacles. Arrangements are made to keep those children provided with spectacles under observation. The ophthalmic surgeons at the clinics are now on the staff of the Regional Hospital Board. The deflection of a squinting eye can sometimes be straightened by exercises. An orthoptist treats children in this way at the Marlborough Hill clinic. Child Guidance Centre At the County Council's Child Guidance Centre at 82 Gayton Harrow, the full-time psychiatrist, Dr. Margaret Saul, is helped by psychologists and psychiatric social workers. Speech Clinic A speech clinic is held at the Marlborough Hill clinic where two whole-time speech therapists are engaged. Those attending are mainly pupils of maintained schools who have been referred for treatment either by the school medical officers or by the teachers. Sessions are now being held at some of the peripheral clinics. 23 Dental Treatment Dental treatment, apart from that provided under the National Health Service Act, is available for school children, children under five and expectant and nursing mothers. The service is under the administration of the area dental officer, Mr. A. G. Brown. There are dental surgeries at six premises: 76 Marlborough Hill, Elmwood Avenue clinic, Alexandra Avenue clinic, Roxeth clinic, Honeypot Lane clinic and Whittlesea Road clinic. Apart from the sessions when the dental officers are examining children in the schools, treatment sessions are held every week-day morning and afternoon. The school children treated there are those found, at the routine dental inspection of children at the schools, to need treatment. Only those who attend by appointment can be seen, except those referred by the head teachers of the schools for urgent or emergency treatment. Children under five, expectant and nursing mothers are referred by the medical officers at the clinics which they attend. Expectant mothers are also referred by their own doctors. An orthodontic surgeon works at the Marlborough Hill clinic. Care of the Feet A limited chiropody service is provided by the local health authority for children attending maintained schools, for nursing and expectant mothers, and for children under school age. Appointments are made at sessions held at the various permanent clinic buildings in the district. Chest Clinic The Chest Clinic serving most of the district is that at 199 Station Road, Harrow (Tel. No. Harrow 1075). The physician in charge is Dr. Grenville Mathers. Serving part of the district on the eastern side is the Chest Clinic at the Edgware General Hospital (Tel. No. Edgware 4467). The physician in charge is Dr. Trenchard. PROVISION FOR SPECIAL CLASSES OF PERSON The Deprived Child The County Council as the local authority under the Children's Act has a duty to take into care children under the age of seventeen who are without parents or have been lost, or abandoned by, or are living away from their parents or when their parents are unable to take care of them, and the intervention of the authority is necessary in the interests of the welfare of the child. These children are placed in residential homes or are boarded out. In certain circumstances the authority may assume parental rights of a child. It may also act as a fit person under the Children and Young Persons Act, 1953, when the Court commits a child to their care. It has a further responsibility for the supervision of children who are maintained apart from their parents for reward. 24 The Children's Officer of the Middlesex County Council is Miss J. Rowell, of 10 Great George Street, S.W.I (Tel. No. Trafalgar 7799). In this area the work is carried out by the Area Children's Officer, Miss Susan Boag, at Kynaston Court. The Mentally III and the Mentally Defective The mental health services are integrated with the other health services established under the National Health Service Act. The duties of the local health authority include responsibility for the initial care and conveyance to hospital of patients who need to be dealt with under the Lunacy and Mental Treatment Acts, and for the ascertainment and community care of mental defectives. The Health Committee of the County Council is responsible for the mental health functions of the Authority. Harrow is part of the central division of the County which is served by Shenley Hospital. The Mental Welfare Officer, Mr. W. J. Pedel, and other officers, work at Balnacraig Avenue, Neasden, N.W.10 (Gladstone 8624). Attached to this office are two psychiatric social workers who advise and help people suffering from mental illness aggravated by social conditions. The services of a Mental Welfare Officer needed out of office hours can be obtained by telephoning County Fire Control (Wembley 1121) asking for County Control who will arrange for the message to be passed on to the Mental Welfare Officer who is on call. A consulting clinic is attended on the mornings of the fourth Wednesday in each month at the clinic, Elmwood Avenue, Kenton, by Dr. Bennett or by Dr. Fidler of the Mental Health Section of the Health Service of the County Council. This is particularly useful for helping parents who have only just learnt that their baby is mentally abnormal in some way. Children who are mentally retarded but are nevertheless educable are admitted to the Shaftesbury School for the educationally subnormal. Those more retarded and who are considered ineducable might be helped by attending the Special Training School at Rayners Lane, at which in the earlier stages emphasis is placed on habit training in order to teach the children to become socially adapted. The Harrow Society for Mentally Handicapped Children which is affiliated to the National Society, works to promote the better appreciation and the welfare of all mentally handicapped children in the district. The Mental Health Act 1959, which repeals the Lunacy and Mental Treatment Acts 1890-1930 and the Mental Deficiency Acts 1912-1938, is a substitution for the many Acts concerned with mental disease. It makes provision with respect to the treatment and care of mentally disordred persons, and with respect to their property and affairs. It places the administrative care of patients in the hands of the Ministry of Health and it provides safeguards for the patient who is compulsorily admitted to hospital. 25 All forms of mental disorder are embraced. Mental disorder means mental illness, arrested or incomplete development of the mind, psychopathic disorder and any other mental disability. Psychopathic disorder is defined as a personality disorder which results in abnormally aggressive or seriously irresponsible conduct on the part of the patient. The Board of Control is dissolved, and its officials become officers of the Ministry of Health. In each Regional Hospital Board area there is to be a Mental Health Review Tribunal to deal with applications by patients. These changes will bring the management of mental disorder into line with that of other forms of illness. The provisions come into operation on such date as the Minister of Health may appoint. The first Order repealed certain words of the Lunacy Act 1890 and so enables mental hospitals to admit patients without using the procedure of the Lunacy and Mental Treatment Acts. In regard to compulsory admis ion, a magistrate will no longer take part in certification. The application is made by two doctors, one of whom must have had psychiatric experience. The criteria for admission are that the patient's disorder renders him suitable for admission and that it is in his interests or for the protection of others that he should be so detained. The application is made by the next-of-kin or by a mental welfare officer, supported by the two medical applications (one in emergency). Compulsory admission may be for observation, valid for 28 days, or for treatment for one year. In urgent cases emergency application may be made for detention up to three days. No application for compulsory admission is to be made without consultation with a near relative if reasonably available. Persons in Need of Care and Attention The powers of the County Council to provide welfare services include those under Sections 29 and 30 of the National Assistance Act. Under Section 29, "a local authority shall have power to make arrangements for promoting the welfare of persons to whom this section applies, i.e. persons who are blind, deaf or dumb or other persons who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed by the Minister". By Section 30 a local authority may employ as their agent for the purposes of that section, any voluntary organisation for the time being registered in accordance with this Act, being an organisation having for the sole or principal object or among its principal objects, the promotion of the welfare of persons to whom this section applies. The arrangements that may be made include those (a) for informing persons to whom the arrangements relate of the available services, (b) giving such persons instruction in their own home or elsewhere in methods of overcoming the effects of their disabilities, (c) for providing workshops and hostels, (d) for providing the persons with work in their own 26 homes or elsewhere, (e) for helping them to dispose of the produce of their work, (f) for providing them with recreational facilities in their own homes or elsewhere, (g) for compiling and maintaining classified registers of such persons. The County Council in the administration of the service for the blind and the partially sighted have continued to draw on the help of the voluntary associations who pro\ided these services before 1948. In regard to the schemes for the handicapped persons other than the blind and the partially sighted, the first step is for the handicapped person (who must be substantially handicapped) to register. This he does by communicating with the Chief Welfare Officer at 1 Queen Anne's Gate Buildings, Dartmouth Street, S.W. 1. The following are some of the services available for handicapped persons:— 1. Adaptations to premises to allow easy entrance and mobility of indoor chairs and housing of invalid carriages. 2. Adaptations for day to day living (installation of downstairs lavatories, handrails, etc.). 3. Home tuition in reading, writing, etc., to homebound adults. 4. Social activities at clubs, choral and dancing classes. 5. Special aids to enable handicapped persons to carry out normal activities in house and elsewhere and to assist those caring for them. 6. Work centres and home work. 7. Advice on domestic problems. 8. Handicraft classes. 9. Visitors to the homebound disabled. 10. Clothing supplied through voluntary organisations. 11. Reference to other statutory and voluntary bodies where necessary (National Assistance Board, Ministry of Labour, etc.). For the administration of the Welfare Service the County is divided into the same ten areas as for the County Council's functions under Part III of the National Health Service Act. Acting under the supervision of the Chief Welfare Officer for the County there is in each Area a welfare Officer. The one for this district is Mr. H. G. Plummer, "Kynaston Court", Boxtree Road, Harrow Weald. The County Council now has some 2,600 beds, most of them in about fifty old people's homes, in and around the County; the only one of these homes in this district is that at 79 Bessborough Road. In addition the County Council pays for about 1,100 beds in homes run by voluntary organisations. Although the Health Department of the District Council is often approached by those concerned that people apparently not fit to be living alone are not being helped, a District Council as such has no direct power or responsibilities in the matter unless circumstances are sufficiently bad to warrant action under Section 47 of the National Assistance Act, 1948, to obtain the removal of the person to a welfare home or hospital. This section can be invoked for the compulsory removal of persons who (a) are suffering from grave chronic disease or, being aged, infirm or physical y incapacitated, are living in insanitary conditions and (b) are unable o devote to themselves and are not receiving from others proper care an attention. 27 The Aged In 1950 the Minister of Health sent a circular letter to local authorities containing suggestions for developing better collaboration between local authorities and local voluntary organisations in promoting the welfare of old people. On this, a conference of representatives of appropriate organisations was convened; and at this it was decided to set up an Old People's Welfare Committee. This Committee appointed two main subcommittees. One was the Home Visiting sub-committee which arranged for lonely old people to be visited in their homes; the other was a Meals Services sub-committee which was responsible for running the luncheon clubs at the Belmont and the North Harrow Assembly Halls where old people can obtain a mid-day meal at low cost, and also provided the meals distributed by the W.V.S. 'Meals on Wheels' Service. The Council made grants for these services; and also made a grant of £100 to the British Red Cross Society to extend their chiropody service. The Council's direct statutory powers in regard to the aged are very limited, and are not restricted to the aged as such. There is the power under Section 47 of the National Assistance Act, 1948 under which a Court Order can be applied for to ensure the compulsory removal to hospital or a welfare home of a person, not necessarily elderly, where this is considered necessary. There is the power under Section 84 of the Public Health Act, 1936 to arrange in special circumstances for the laundering of articles. There is the authority under Section 50 of the National Assistance Act 1948 to arrange for the burial or cremation of a body when no other provision is made. Indirectly the Council by using the provisions of two Acts, S.4 of the Physical Training and Recreation Act 1937 and S.31 of the National Assistance Act 1948 can help by making grants to such voluntary organisations as the Harrow Old People's Welfare Committee. Although the Council is not directly responsible for the administration of the services provided by the Old People's Welfare Committee, there is a link in two ways. The one is by some of the members of the Council being members of that Committee; the other is by reports of the activities of the Old People's Welfare Committee being presented to the General Purposes Committee. No Committee of the Council though, either General Purposes Committee or Public Health Committee, has any direct powers for helping them. Because of the nature of the difficulties of some of the aged, their problems and the solution of them are closely related to other matters about which the Public Health Committee have responsibilities, and an indication of the growing closeness of that Committee's relationship was that when a conference on the Elderly in the Community was arranged in January by the Central Council for Health Education, the Chairman of the Public Health Committee and the Medical Officer of Health were invited to attend. As this was apparently to become a growing problem, the Public Health Committee at one of their meetings suggested a conference should held between representatives of the Council and the Harrow Old People's Welfare Committee. The General Purposes Committee appointed 28 representatives to meet representatives of the Harrow Old People's Welfare Committee to discuss (1) possible arrangements for increasing and extending the present services for old people in the Borough, (2) a suggestion of increasing the Council's representation on the Harrow Old People's Welfare Committee, and (3) a suggestion that reports of the Harrow Old People's Welfare Committee and of its sub-committees should be submitted to the General Purposes Committee and the Public Health Committee. This meeting was held on the 12th March. The various suggestions as to the future arrangements made at this meeting were referred to the Old People's Welfare Committee. When this Committee met on June 9th, it was resolved that consideration be given at the annual meeting of the Old People's Welfare Committee to (1) the formation of an Executive Committee to control and receive reports from the Home Visiting and Meals Services sub-committees, and (2) a possible extension of the membership of the Harrow Old People's Welfare Committee. The Council indicated to the Harrow Old People's Welfare Committee that they would sympathetically consider increasing their annual grant to the Committee to permit of the suggested extended services for old people in the borough, including the possible appointment of a wholetime Welfare Organiser. At their annual meeting in July, the Harrow Old People's Welfare Committee approved in principle the appointment of a full-time Welfare Organiser. The duties of such officer were to be (1) arranging for home visiting, (2) advising on all services available to the aged, including liaison with the various existing statutory and voluntary organisations and (3) promoting a holiday scheme and assisting with any shows, functions or services provided by the Old People's Welfare Committee. The Borough Council accepted this suggestion, and resolved that the Middlesex County Council be asked to bear the cost of the new appointment of Welfare Organiser for old people's services in the borough, in addition to the cost of the part-time Co-ordinating Officer for the home visiting of old people. The work of the Old People's Welfare Committee is being brought closer to that of the Borough Council by the Council's representation on the Committee being increased by that of the Chairman of the General Purposes Committee and the Chairman of the Public Health Committee. It is also agreed that reports of the quarterly meeting of the Executive Committee would be sent to the Council's General Purposes Committee. There have, in the course of the year, been certain decisions which will improve the lot of the aged in the district. Housing. Safety. The Housing Committee decided to provide fireguards in their dwellings for old people and to instal safety rails to baths. Removal Expenses. At their meeting in February, the Housing Committee decided to make enquiries about the powers of the Counci to re-imburse removal expenses incurred by old people in approved cases when granted tenancies of municipal dwellings. 29 Rent. The Old People's Rent Scheme provides that each tenant qualifying shall pay a net weekly rent of 10 per cent of the weekly gross income or the minimum rent for the property as calculated under the Council's Main Rents Scheme, whichever is the smaller sum, exclusive of general and water rates. To qualify, the tenant must have reached normal retirement age; a sole tenancy must exist, though joint tenancies between husband and wife or between two persons of companionable age shall be admitted; no occupant other than the tenant and/or spouse to be resident; the total gross income of the occupants must not exceed £7 per week and no rent allowance is being received from the National Assistance Board. Luncheon Clubs. The General Purposes Committee, at their meeting in November, agreed in principle to the provision of an old people's meals centre in the Queensbury area. The suggestion is to erect a prefabricated building on part of the land in Roch Avenue acquired by the Council for permanent allotments, the building to be erected for use as an assembly hall for letting to the Harrow Old People's Welfare Committee for an old people's luncheon club, and for general lettings at other times. The two luncheon clubs continued as on previous lines and at their June meeting the General Purposes Committee recommended the Council to authorise the making of a contribution at the rate of £1,150 per annum for the financial year ending 31st March, 1960, in respect of the operation by the Harrow Old People's Welfare Committee of a kitchen and restaurant for old people's meals at each of the North Harrow and the Belmont assembly halls, including the provision of meals for serving to infirm old people through the W.V.S. Meals on Wheels Service, it being understood that £400 of the grant is to cover £260 per annum to be made for the use of the North Harrow and Belmont assembly halls and the estimated cost of gas and electric power. Meals on Wheels. The number of people who can be helped by the Meals on Wheels Service was increased by the gift of a mobile canteen by the Greater Harrow District Nursing Association Trust. The Council made a grant of £230 towards the running costs of the vehicle. Chiropody. For the last two years, the Council contributed £100 per annum to the expenses of the Harrow Old People's Welfare Committee in providing in co-operation with the Harrow and Northwood Division of the British Red Cross Society, a chiropody service for needy old folk in the Borough. The Council at their meeting in June authorised the payment of a like amount during the financial year ending 31st March, 1960, While most of the treatment is given to persons who can visit the clinics, arrangements are made for treatment in their homes of those who are homebound. In spite of grants from the Harrow Council and the Middlesex County Council, and one from the National Corporation for the Care of Old People, the British Red Cross Society runs this service at a financial loss. For many years now organisations interested in the welfare of old People have pressed that arrangments be made by which they could 30 receive what treatment they needed for their feet. Some favoured a scheme as part of the National Health Services, others one provided by local authorities. The resistance to the introduction of such arrangements was apparently based partly on the cost of running a service, partly on the shortage of chiropodists, especially in certains parts of the country. During the year, however, the Government authorised local health authorities making such arrangements, concentrating in the early stages on certain priority classes which include the elderly. Laundry. For some years the Harrow Council has used its very restr eted powers under Section 84 of the Public Health Act which enables authorities to arrange for articles to be cleansed in certain circumstances. The Hendon Group Hospital Management Committee agreed to arrange for the actual work of treating the articles of clothing and bedding to be done if the District Council would meet the cost. When the scheme was first started, the Hospital Management Committee charged 4½d. an article. In view of the increase in wages and the cost of materials, the charge was raised as from 1st April, 1959, to 5¾d. per article. At the beginning of last year, nine persons were being helped. During the year there were requests to help a further 16 cases. Because of death or removal from the district, the number provided with help at the end of the year was eleven. A number of local launderettes operate a special service to old age pensioners at reduced charges. In addition to the Belmont and Harrow Weald launderettes which previously helped in this way, assistance can now be given to those in the Honeypot Lane, Hatch End and Pinner areas. Many of the problems of the elderly occur because they have lost touch with others. It is in providing this companionship that the luncheon clubs, the Evergreen Clubs, the Darby and Joan clubs and the Oversixty Clubs are of such inestimable benefit. Even though each of these has a large membership, in all they can reach only a small proportion of the elderly of the district and perhaps only a very small proportion of the lonely elderly. The home visiting scheme provided by the Old Peoples Welfare Committe reaches others, and is particularly helpful to those who are largely or perhaps wholly housebound. The home visitors, too, might establish contact with those who will not for one reason or another become members of any of the clubs. Of course, very many of the people who are getting on continue in touch with the various organisations of which they had all along been members. In the same way the members ot these organisations themselves in turn keep in touch with those who previously were members but who no longer attend the meetings. However energetic these various bodies are and with however many they are in touch, there are still many of these elderly people who are in touch with no one and are really not known to anybody, and who become known to the authority only when some disaster has overtaken them and urgent measures have to be taken. It is this type of person with whom it is necessary to get in touch before this stage has been reached in the hope 31 of preventing the developments or occurrences. This could be one of the most important aspects of the work of the officer to be appointed to the staff of the Old People's Welfare Committee. LABORATORY SERVICE The examination of clinical material of public health significance is carried out free of cost to the patient and to the doctor at the Central Public Health Laboratory, Colindale Avenue, London, N.W.9. (Tel. No. Colindale 6041 and 4081). The clinical material is collected each day by a van from the Laboratory, calling about mid-day at the Harrow Hospital, "Kynaston Court and the Central Fire Station, Pinner. The following is a summary of the examinations of material from this district carried out during the year: nose and throat swabs 106; faeces 98; sputum 5 and miscellaneous 2. AMBULANCE SERVICE Although the County Council decided that the Fire and Ambulance Service should be run as one combined service, the combination of the two services was limited to organisation and administration. Fire appliances are manned by firemen especially enrolled and trained for that purpose, and ambulances are manned by ambulance driver/attendants and attendants. At their meeting in October, 1958, the County Council decided on the separation of the Fire and Ambulance Services and the transfer of the control of the Ambulance Service to the Health Committee with the County Medical Officer as the responsible officer, with effect from April 1st, 1959. In February, however, they decided the Fire Service should continue to operate the accident and emergency branch for a further twelve months from 1st October, 1959. The administrative headquarters of the County's Ambulance Service is the Ambulance Headquarters, The Mall, Kenton (Tel. Wordsworth Ambulances specially equipped to deal with accidents and similar emergencies are kept at twenty eight fire stations throughout the county. These ambulances and their crews who are trained in first aid, are ready to respond to accident emergency calls made by dialing 999. The sick removal branch deals with the conveyance of patients to and from out-patient clinics and non-urgent admissions to and discharges from hospitals, etc. The ambulances are based at the ten sick removal repots in the county. No. 6 is at Imperial Drive, North Harrow (Tel. "pinner 8900). Requests for transport are made to the local depot. 32 The hospital car service operated jointly by the British Red Cross Society, the St. John's Ambulance Brigade and the Women's Voluntary Services, provides cars and drivers who give their services voluntarily, and by arrangement with the County Council takes many patients to and from hospitals and clinics. One of the rules on the use of local ambulances issued by the Ministry of Health reads: "The obligation which rests on the Ambulance Service is not to make arrangements for the conveyance of all persons suffering from illness but only of those for whom special transport such as the Service provides, is necessary. This applies just as much to transport for sitting cases such as by means of cars in the hospital car service, as to transport of stretcher cases". LEGISLATION Slaughter of Animals Act, 1958 This Act, which came into operation on the 18th January, 1959, consolidated the Slaughter of Animals Act, 1933, the Slaughter of Animals (Pigs) Act, 1953, the Slaughter of Animals (Amendment) Act, 1954 and the Slaughterhouses Act, 1958 Section 8 and second schedule. Housing (Underground Rooms) Act, 1959 The powers of an authority to close unhealthy underground rooms under Section 12(2) of the Housing Act, 1936, were lost by the effect of the Housing Repairs and Rents Act, 1954. This Act restores the earlier position. House Purchase and Housing Act, 1959 Amended legislation about improvement grants, providing in future for discretionary and standard grants. 33 SANITARY CIRCUMSTANCES OF THE AREA WATER Supply Almost the whole of the area obtains its water from the Colne Valley Water Company, coming from wells supplied by gathering grounds in the Chilterns. Full particulars of the places at which the water is collected and details of the purification processes carried out were set out in the Annual Report for 1954. Safety Responsibility for the wholesomeness of the water supply rests with the Water Company. In addition, district councils have under Section 111 of the Public Health Act, 1936, a responsibility for ascertaining the wholesomeness of the water supplies of their district. To this end samples are submitted periodically for full chemical and bacteriological analysis. In addition, samples are submitted for analysis of water collected from houses in which there are persons suffering from complaints which might have been contracted by consuming water. Particulars of these cases are passed by the Public Health Department to the Water Company. The following is the conclusion of the investigator on the results of the chemical analysis of a sample of water submitted for analysis in April: This sample is reasonably clear and bright in appearance, just on the alkaline side of neutrality and free from metals, apart from a negligible trace of iron. The water is hard in character but not unduly so. Contains no excess of mineral constituents and it is of satisfactory organic quality. From the aspect of the chemical analysis, these results are indicative of a pure and wholesome water suitable for drinking and domestic purposes. The following, which is a summary of a bacteriological examination of a sample submitted for analysis in June, is typical of other reports: No coliform bacilli present in 100 ml in MacConkey incubated for two days at 37°; no faecal coli per 100 ml. It is only occasionally that complaints are received about water supplied to this district. One was received from those at a school in the district of a stale sour taste. From information obtained from the Chief Chemist of the Colne Valley Water Company, it seems likely that the complaint was the result of the water leaving the Company's service reservoir at Bushey Heath having a slightly earthy taste and smell, the water coming from the Hillfield Park storage reservoir. The analysis of a sample of water submitted for full chemical examination gave normal findings. 34 Fluoridation. It is unlikely that any progress will be made in regard to introducing fluoridation of water supplies in this country until the results of the Ministry's trials are available. The tests which are being carried out in Watford, Anglesey and Kilmarnock end in 1961. DRAINAGE AND SEWAGE DISPOSAL The soil sewage from this district flows to the West Middlesex Drainage Works at Mogden. Surface water finds its way out of the district by the various water courses. The Annual Report for 1954 set out the arrangements for the disposal and treatment of the sewage of the district and the drainage. Soil Drainage. When the proposals for the construction of a new relief soil sewer in Pinner were considered, it was anticipated that at least two contributory relief sewers would be needed. The continued development of the area of Pinner Wood Park Estate and in Hatch End is causing surcharging of the existing sewers with resultant flooding. The first of these contributory sewers then is one from a point near the junction of Uxbridge Road with Paines Lane, being laid under Woodhall Avenue and Barrow Point Avenue, to discharge into the new relief sewer at the junction of Barrow Point Lane and Avenue Road. Flooding. There are certain parts of the district which are liable to flooding when the rainfall has been especially heavy. In extreme cases, because of the interference with the flow in the sewers, soiling occurs not only with surface water but with sewage. Following the storm of the night July 10th/11th complaints were received from the residents of houses in the following roads that their premises were flooded:—Elliot Drive; Station Road, Wealdstone; Sweetmans Avenue; Waverley Road; Yeading Avenue; Greystoke Avenue; Carlyon Avenue and Corfe Avenue. In some instances there was fouling by sewage. Towards the end of March, complaints were coming in from the occupants of houses in Brook Drive and Headstone Gardens about flooding of their gardens. The trouble arose through the drains not emptying because the sewers with which they communicated were running full. The ultimate remedy is the construction of the new relief soil sewer in Wealdstone, a proposal mooted for some years. As a temporary measure to afford relief, the North Harrow sewer was connected with the Wealdstone foul main drainage system. This measure brought relief to the immediate and urgent problem facing the householders in that locality, though it is a relief which might be bought at the expense of more general flooding in times of heavy rain. At the same time, those industries whose effluents are taken by the sewers, on being approached by the Borough Engineer, took steps in the interest of water economy, to reduce the flow rereaching the foul sewers. These measures were sufficiently successful that no further flooding took place at these houses. In June, an Inspector of the Ministry of Housing and Local Government held an enquiry into the Council's proposal for the construction of the relief foul sewer in 35 Wealdstone. In July, the Minister of Housing and Local Government approved, in principle, the scheme for this relief soil sewer in Wealdstone. One of the parts which suffers from flooding in times of heavy rain is The Chase and nearby roads. The remedy here is the reconstruction of the Gordon Avenue relief soil sewer. In March, the Highways and Cleansing Committee accepted the tender for the construction of about 540 yards of 12-inch diameter soil sewer in Gordon Avenue. The work was almost completed by the end of the year. Hatch End was again affected by flooding on the night of July 10th,/ 11th. The trouble here is that the open water course which flows through private property in Hillview Road becomes obstructed by debris or because of inadequate waterway and so floods on to the carriageway of Hillview Road, then on to Grimsdyke Road and on to Hatch End Broadway. The Highways & Cleansing Committee at their meeting in September, agreed to the construction of a relief culvert in Hillview Road and Hillview Close. River Pinn. Over the years, trouble has been experienced because of obstructions to the flow of the River Pinn. The powers of the responsible authorities, the Thames Conservancy and the County Council, are to prevent pollution, to keep free from obstruction, to maintain in a state of efficiency, and to improve and straighten. In each case the powers are permissive so that each authority can decide over what lengths of watercourse it will exercise jurisdiction. The Council had decided before making further representations, to wait until the new Pinner relief soil sewer could be completed; this was early in 1958. Last year's dry summer brought in a much greater than usual number of complaints about the River Pinn, many about the offensive smells which were noticeable in the village. At their June meeting the Public Health Committee appointed representatives to meet members of the Thames Conservancy; the Highways & Cleansing Committee accepted an invitation to attend. The real source of the trouble is the obstruction which is caused by the rubbish being thrown in. The outcome of the representations was that the Thames Conservancy agreed to pay £200 annually towards the cost if the Council would undertake such clearance as they considered necessary. In that at long last there is machinery for the removal of the obstructions which cause the nuisance, there ought now to be a great improvement and less cause for complaint. The ditch at the back of some houses in Cavendish Avenue, Sudbury Hill, which receives surface water from the surrounding roads, houses and shops, has for long given rise to a nuisance. It is on land owned by the British Transport Commission. The Highways and Cleansing Committee had agreed to the necessary work being done to improve matters it the Transport Commission as riparian owners and the owner of Hill ouse each agreed to contribute one-third of the estimated cost of £100. t their meeting in November the Highways & Cleansing Committee Agreed, subject to contributions of £33 each from the British Transport Commission and the owner of Hill House, to carry out the drainage although the revised estimated cost was £300. 36 In July, complaints were received from the occupants of some houses of Handel Way, Edgware, about foul water out-cropping by the rear boundary fence of Nos. 63 and 65, which runs parallel to the bank of the Edgware brook. PUBLIC CLEANSING Much the same arrangements for the collection of refuse, its disposal and for street cleansing were continued last year as were described in the Annual Report for 1954. Refuse Disposal. For the last few years house refuse from the district has been taken to a tip at Harefield. The present agreement with the Uxbridge Corporation runs to the 31st March, 1964. Because the life of the available tips is limited, the Uxbridge Corporation are considering future arrangements for the disposal of the refuse of their district. This may involve finding some other site or some other arrangements for disposal. The Uxbridge Corporation then invited Harrow and Ruislip/ Northwood to consider the possibility of setting-up a joint committee to explore the question of providing a refuse destructor to serve the three areas. Collection of Refuse. The number of bins collected has now reached over 81,000. The contents are deposited in vehicles which travel an average distance of twelve miles to the tip at Harefield. The refuse from business and shop premises is collected on this normal weekly refuse collection round. A charge is made for the emptying of any bins more than the one for each property. In addition, special collections are made at a charge from those premises where there is more than can be dealt with by the normal services. In addition to the waste paper collected on the normal weekly refuse collection, a free waste paper and cardboard collection service is provided by the fortnightly collection made to 3,339 shops and business premises. For the removal of trade refuse a charge has to be made. From the public health point of view there would be fewer problems arising from accumulations at the back of shops which might harbour rats, and fewer complaints of smoke, the result of the shopkeeper getting rid of some of the containers by burning, if the refuse could be removed without charge. Since the time that all refuse has had to be taken to the tip at Harefield. facilities which previously could be taken advantage of are no longer available; for instance, waste matter could be accepted at the destructor without charge if private arrangements were made for it to be delivered there. As the law stands though, a charge must be made for the collection of trade refuse. The position is rather different in regard to house refuse. The Public Health Committee has at different times over the years asked the Highways & Cleansing Committee if they could extend the construction of the term "house refuse" beyond that matter which ordinarily finds its way into the household bin and is removed each week The special interest of the Public Health Committee in the subject has 37 been their wish to see an end to the dumping of waste matter which occurs at different sites in the district. These accumulations start probably because of the difficulty the householder has in getting rid of something such as a disused bedstead or perambulator. These articles have not been accepted for removal by the ordinary round for collecting house refuse, though they could be collected at a charge; but this the householder often enough is not prepared to pay. These articles then are dumped at some convenient site, and that might be the beginning of what becomes a large accumulation comprising such articles as old stoves, empty containers and garden rubbish, and in time builders rubbish as well. Apart from these accumulations being an eye-sore, they are a matter of concern to the Public Health Committee for more than one reason. They provide a harbourage for rats and in time foodstuffs for these rats finds its way there as well. Another reason is that often putrescible material is added and the deposit might become a public health nuisance. When there is such a nuisance, it can be dealt with at a charge to the Public Health Committee; but not until it has reached this stage. The Public Health Committee has up to this not been able to prevail on the Highways & Cleansing Committee to find a solution to the problem, in spite of their representations that that Committee might find itself able to extend the construction of the term "house refuse" beyond that matter which finds its way into the household dustbin. More recently, though, the Highways & Cleansing Committee have had their own reasons for wishing to see this material being dealt with because of the trouble experienced by flooding which has followed on the interference to the flow of a water course which has been brought about by such deposits placed in the water course. At their June meeting the Highways & Cleansing Committee agreed (a) that arrangements be made for the collection free of charge, of household refuse comprising typical domestic articles such as old mattresses, linoleum and carpets, old fenders, domestic cooking utensils, etc., and (b) to continue for the present the existing practice of making a nominal charge for the special collection of such items as old water tanks, rubble, garden rubbish, etc. It is confidently expected that this service will help materially to tidy-up the district and reduce the problems of those in the Public Health Department which arise from accumulations and deposits. Fouling of Footpaths by Dogs. This nuisance continues, partly because of the ignorance of the owners of dogs of the bye-law which aims at controlling it. The Public Relations Committee were asked to consider a suggestion that publicity should be given to the bye-law by the issue of a small notice about it with the rate demand notice. SWIMMING BATHS There are two open-air swimming baths in the district, one at Charles Crescent, Honeybun Estate, Harrow, and the other at Christchurch Avenue, Wealdstone. The former, constructed in 1923, measures 165 feet by 75 feet, with a depth of 7 feet to 3 feet 6 inches. The water, after being filtered, is treated by chlorination. Dressing accommodation, shower and 38 foot baths and sanitary conveniences are provided. The Wealdstone bath, constructed in 1934, measures 165 feet by 75 feet, with a depth of 8 feet 6 inches to 2 feet 6 inches; in addition, there is a shallow semicircular beginners' pool. Suitable dressing accommodation, with shower and foot baths, and sanitary conveniences, are provided. The water is treated by passing through filters and is then chlorinated by the breakpoint method. The duration of the turn-over period varies according to the amount the baths are used, but it is at least once a day, and at busy times is every eight hours. Daily tests are carried out for the presence of free chlorine and to determine the pH value. PUBLIC CONVENIENCES The district as a whole is not well supplied with public conveniences. Of the various localities Pinner and Kenton have been felt to be in greatest need of this provision. Of these, Pinner has at long last obtained its convenience at Chapel Lane. Progress is being made in regard to some other proposals. Towards the end of the year, tenders were received for the erection of a convenience at Rayners Lane near the station and at Belmont Circle. A convenience is to be built at Queensbury Circle in the grounds of the old Honeypot Lane Isolation Hospital, another at Woodridings, Hatch End and the prospects of one at Kenton were more hopeful towards the end of the year. DISPOSAL OF THE DEAD Burial Drounds There were no changes during the year in the provisions for the burial of the dead, particulars of which were set out in the Annual Report for 1954. Cremation A steadily increasing proportion of disposals are by cremation rather than by burial. The increasing demand is being met by the erection throughout the country of new crematoria. The following facilities are provided by neighbouring local authorities: East Finchley; Garston Manor, Watford; Hanworth; Golders Green; Kensal Green; Mortlake and Breakspear Crematorium, Ruislip. Part of the area covered by these crematoria is not adequately served. The need for this part would be met by some provision in this district. The Council has for years accepted that there should be a crematorium serving this district, and preferably in the district itself. Because of the objection to the use of the Old Vicarage site on which to erect a crematorium, the Council considered four other possible sites One of these was at the Warren House Estate, two were in the northem part of Pinner Park Farm, the other in the southern part of the same farm 39 Of these, the Crematorium Sub-Committee favoured land forming part of Pear Wood, Wood Lane, Stanmore. The Middlesex County Council Planning Committee, however, refused the Council's application for planning permission for the erection of a crematorium on any one of these four sites. Other proposals considered were the erection of a crematorium on burial land at Carpenders Park, the erection of a crematorium on the former Northwick Park golf course and the sharing of the Ruislip/Northwood and Uxbridge Breakspear Crematorium, Ruislip. At their September meeting the Crematorium Sub-Committee recommended that the question of sharing these facilities at Breakspear Crematorium be looked into; that the County Council be asked to consider making available part of the Northwick Park open space for the erection of a crematorium, and that in the meantime, further consideration of the four sites in the district be deferred. Burial Under Section 50 of the National Assistance Act, 1948, the Council can arrange for the burial or cremation of any person who has died or has been found dead in their area if no other suitable arrangements are being made. Each year there has been a small number of requests for these arrangements for burial to be made. In this last year there was only one. Mortuary The district is served by the one mortuary at Peel Road which is under the care of a full-time mortuary attendant, Mr. C. Russell, of 30 Lome Road, Wealdstone. The arrangement by which bodies from the Wembley area were received in the Corporation mortuary at a charge of £2 each continued until the new mortuary in Wembley was ready. During the year 379 bodies were received in the mortuary, 102 of these being from Wembley. Post-mortem examinations were carried out on all but six of the bodies admitted. Inquests were held on seventy-one. 40 SANITARY INSPECTION OF THE DISTRICT AND THE INSPECTION AND SUPERVISION OF FOOD The activities of the public health inspectors may be divided into four main categories, viz., housing inspection; inspection and supervision of other premises; the inspection and supervision of food; and measures to control certain infections. The following tables summarise the visits paid and the action taken: STATISTICAL SUMMARY PART I Inspections Made and Conditions Found HOUSING Visits 0) On complaint of dampness or other housing defects 956 (ii) On complaint of other nuisances 497 (iii) Routine inspections 1,238 (iv) Revisits arising from defects found 3,518 (v) Surveys under S. 157 Housing Act, 1936 122 Conditions Found (i) Number of dwellings or other premises where defects were found 1,338 (ii) Number of cases of overcrowding revealed 12 PUBLIC HEALTH Visits (i) On complaint or request 207 (ii) Routine inspections of premises 963 (iii) Revisits arising from defects found 1,351 (iv) Surveys arising from Rat and Mice complaints 1,690 (v) Inspection of Factories 242 (vi) Inspection of Workplaces 105 (vii) Inspection of Outworkers' Premises 170 Vlll) Inspection of Cinemas and Places of Entertainment 66 (ix) Inspection of Licensed Premises 125 (x) Visits under Shops Act 1370 (xi) Evening observations under Shops Acts 22 (xii) Sunday observations—Shops Acts 13 'xlll) Observations made for Smoke Nuisances 52 41 Conditions Found (i) Premises visited as a result of (i) and (ii) where defects or unsatisfactory conditions were found .. 921 (ii) Number of premises where action was taken by Rodent Operatives to deal with rats or mice .. 1,586 (iii) Number of Factories, Workplaces and/or Outworkers' Premises where defects or contraventions were found.. 71 (iv) Number of Cinemas and/or Licensed Premises where defects were found 36 (v) Contraventions of Shops Acts— (a) Failure to observe closing hours 3 (b) Other contraventions (failure to exhibit notices, etc.) 391 FOOD HYGIENE Visits (i) Slaughterhouses. 621 (ii) Butchers' Shops 316 (iii) Cowsheds12 (iv) Dairies30 (v) Fish Shops 86 (vi) Bakehouses 66 (yii) Cafes and Restaurants 308 (viii) Ice Cream Premises 194 (ix) Provision Merchants 421 (x) Greengrocers 266 (xi) Other Food Premises 176 COMPLAINTS RECEIVED Summary Accumulations of Refuse 89 Animals causing a nuisance 23 Dampness and Housing defects 296 Drains and sewers—choked 64 —defective 71 Dustbins defective 25 Flooding—Gardens 17 Vermin 32 Insect infestations 142 Overcrowding, alleged 22 Smoke nuisances 27 Watercourses 24 Other complaints (wasps' nests, defective fences) 955 rood unfit (excluding requests received from shops to visit and inspect food 49 42 NOTICES SERVED Under Housing Act, 1957 Statutory Notices served under S.9 requiring execution of repair work - Dwellings reported under SS. 16/17, as beingunfit for human habitation 13 Dwellings reported under S.18 (closing orders) 5 Informal notices served under S.9 4 Under Public Health Act, 1936 Statutory Notices under— (i) S.24—work to a public sewer 129 (ii) S.39—repair or renewal of drains 6 (iii) S.45—repair or renewal of defective water closets (iv) S.56—Undrained or badly drained yard area (v) S.75—renewal of a dustbin (vi) S.93—abatement of a nuisance 19 (vii) Informal notices served 1,323 ACTION TAKEN Following Housing Act Notices (i) S.9 Housing Act, 1957—dwelling rendered fit— (a) By owners — (b) By local authority in default of owners (ii) S. 16/17 Housing Act, 1957, Demolition Order made .. 13 (iii) S.18 Housing Act, 1957, Closing Order made .. (iv) Dwellings rendered fit by owners after receipt of informal notice 5 (v) S.28 Housing Act. Closing Order converted to DemolitionOrder 3 Following Public Health Act Notices (i) S.24—Public sewers repaired 110 (ii) S.39- (a) By owners 2 (b) By local authority in default of owners 2 (iii) S.45— (a) By owners - (b) By local authority in default of owners - (iv) S.56— (a) By owners - (b) By local authority in default of owners - (v) S.75— (a) By owners (b) By local authority in default of owners 1 (c) By occupier 1 (vi) S.93—Nuisances abated (vii) Nuisances abated and/or other work carried out by owners on receipt of informal notice 1283 43 HOUSING Inspection of Houses Although the Housing Act required local authorities to carry out systematic inspection of houses, this routine work has not been started since the war. Most inspections are carried out on receipt of a complaint and to obtain the carrying out of the necessary work, reliance is placed more on the provisions of the Public Health Acts than on those of the Housing Acts. Repair of Houses Improvement Grants. The Housing Act, 1949, authorised local authorities to give assistance in respect of (a) the provision of dwellings by means of the conversion of houses or other buildings (b) the improvement of dwellings. Later legislation amended these provisions. The most recent of these is the House Purchase and Housing Act, 1959, which came into operation on the 14th June. There are now two grants, the discretionary and the standard. The revised conditions attaching to the discretionary grants are that the minimum unexpired term which a lessee must be able to show is reduced from 30 to 15 years; the period during which the conditions of the grant have to be observed is reduced from 20 to 10 years; the owner may repay part of the grant; and an owner-occupier is allowed to sell to another owner-occupier without having to repay at all, provided the vendor or a member of his family has lived in the house for three years after receiving the grant. The standard grant, an innovation, applies to dwellings erected before 1944. They apply only to specific items and are subject to the same conditions as discretionary grants. The amount of the standard grant which an authority has a duty to make covers half the cost of whatever is paid up to a maximum expenditure of £310 if the house has none of the standard amenities. A grant for a bathroom is £25; hot water system £75; a food store £10; wash basin £5 and water closet £40. During the year, 42 applications were received for grants to improve or convert houses. Thirty-six were recommended in principle, six being disallowed. Fifteen applications were granted during the year, all to owner-occupiers. Slum Clearance Programme The Council's proposals submitted to the Minister in August, 1955, tor dealing with unfit houses in the district referred to 577 properties. It was expected that the clearing and replacement of these houses would be carried out in five years. At the time the survey was completed in April, 1955, the 577 houses included twenty-nine which were already the subject of confirmed Clearance Orders, thirty-nine the subject of confirmed Demolition Orders and 115 about which action had already been started. This 115 included the ninetyone houses in the Northolt Road area, four in Pinner Hill Road, ten in 44 Palmerston Road, four in Crown Street and six at Little Common. In April, 1955, then 183 of the 577 houses were the subject of some action. By the end of 1959, the position was this: Of the 29 houses in Clearance Orders confirmed by 1955, 23 had been demolished. One of the other six was vacant. Of the 39 houses the subject of Demolition or Closing Orders by 1955, 34 had been demolished. Of the 115 other houses in regard to which action had already been started by 1955, all being included in Clearance Orders, 22 had been demolished. At the time the Council's programme was sent to the Ministry, 193 of the 577 houses were the subject of some action. Of the other 394, 27 have been demolished, and in regard to 125 action has been or is being taken. Of the 577 properties referred to in the return, 106 have been demolished ; one other house not included in the return has also been demolished under the provisions of the Housing Act. Twenty-one have been reconditioned. It is expected that a substantial proportion of those not yet dealt with will be reconditioned, and so be removed at least for the time being from the original list. There are prospects that large numbers of these 577 houses will be demolished in the near future as 34 are vacant, 11 have been acquired by the Council and 115 have been represented or are the subject of confirmed Orders. Demolition of Houses There were, at the end of the year, many houses which, although they had been the subject of orders condemning them as unfit for human habitation, were still occupied. Very gradually those houses the subject of confirmed Clearance Orders which were made before the war, have been vacated and demolished. The rehousing of the remaining tenants in the houses Nos. 2-40 Headstone Drive during the year resulted in the position at the end of the year being that the only houses the subject of pre-war Clearance Orders which were still occupied are the five Nos. 1-5 Brewery Cottages. Some of the following groups of properties which had been officially represented since the war were still occupied at the end of the year. In all cases the Council decided to acquire: 46 Address Date of Official Representation No. still occupied 31, 33, 35, 37 Crown Street 1954 1 1 Albert Cottages and 8-9 Albert Place 1956 3 15, 17, 19 Crown Street 1946 2 34-42 Palmerston Road 1959 5 Northolt Road No. 1 Area 8 „ „ No. 2 Area 9 „ „ No. 3 Area 20 „ „ No. 4 Area 12 The following properties while suitable to be the subject of Clearance Orders were not officially represented but negotiations were entered into with a view to their being acquired by the Council by agreement: 101-109 Bessborough Road, occupied by five families—purchased January, 1959. 44-60 Greenford Road, occupied by eight families—purchased August, 1958. There are 20 houses in which are still living 23 families which are the subject of Demolition or Closing Orders and which are occupied. These are:— 1955: 13 Shelley Road, 12 Wordsworth Road. 1957: 1, 3, 9 Crown Street, 108 Cecil Road, 110 and 110a Cecil Road, 3 Marsh Cottages, Marsh Road, 23 Shelley Road. 1958: 56 Francis Road. 1959: 32 West End Lane, 14 Camden Row, Cuckoo Hill, 5 West Street, 1-4 Kirby Cottages, 6 Kirby Cottages, 76 Roxeth Hill, 31 Byron Hill Road. There are also 34 houses still standing but not occupied, which are the subject of Demolition or Closing Orders. Proposals for the reconditioning of two are under consideration. New Demolition or Closing Orders. During the year, Demolition or Closing Orders were made in respect of the following properties:— 129 High Street, Edgware (first floor flat); 32 West End Lane: 14 Camden Row, Cuckoo Hill; 5 West Street; 1-6 Kirby Cottages: 76 Roxeth Hill; 31 Byron Hill Road; part of 111 Headstone Drive; 32 Wolselev Road; Golf Cottage, Pinner Hill; 49 Byron Road; 23 Marlborough Road (first floor flat). Demolition. The following 42 properties were demolished during the year: 30-40 (even) Headstone Drive; 29-34 Little Common; 13A and 13B Alma Road; 2-12 Palmerston Road; 277, 279, 281 Pinner Road; 1.3, 5,7,9 St. Anns Road; 34-46 (even) Marlborough Road; 27, 29, 31 High Street, Stanmore. 46 Reconditioning of Houses. Some houses which have been made the subject of Closing Orders are later satisfactorily reconditioned and the Closing Order is revoked. 17 West Street was reconditioned during the year. Proposals in regard to the following have been received:— 1 and 2 Spring Villas; 8, 10, 12 Roxeth Hill; 7 Frognal Avenue; 129 High Street, Edgware, and 82 Stanmore Hill. Certificates of Disrepair The following is a summary of the applications received for the issue of certificates of Disrepair under the Rent Act: Number of Certificates granted 55 Number of applications not granted 2 Number of Undertakings accepted from owners 24 Number of Certificates cancelled upon application 21 Number of applications for a Certificate as to the remedying of defects 58 Number of applications by owners for Cancellation of Certificates not granted 14 Overcrowding The annual review of the state of overcrowding in the district shows that once more there is an improvement. As compared with the 55 cases known on January 1st, 1959, the number on December 31st was 49. The reduction which has taken place in recent years has become less each year. The figure of six for this year is a sharp fall of that of 17 in 1958. The net reduction of six is the difference between the 18 cases in which overcrowding was abated and the 12 new cases. The corresponding figures for 1958 were 17, 37 and 23. In 11 instances the abatement in the overcrowding was brought about by the families being rehoused in Council houses. Of the 12 new cases the overcrowding was caused in four by the increase in the size of the family, or by the ageing of the children and in three by the marriage of one of the children. Three houses were let so as to cause overcrowding, while in two the crowding was caused by the marriage of a child of the tenants. Of the 49 cases which were overcrowded at the end of the year, 16 were overcrowded by a half unit and 23 by 1 unit. Two families were living in premises overcrowded by l½ units, six in premises overcrowded by 2 units, and two in accommodation overcrowded by 2\ units or more. The greatest hardship is suffered not necessarily by those living in premises where there is the greatest degree of overcrowding, as indicated by the difference between the permitted number for the accommodation and the equivalent number of occupants; it might be felt most by those who have very limited accommodation which is overcrowded at all. Of two families each living in one room with a permitted number of 1½, one had an equivalent number of occupants of 2½, the other 3½. There were six families 47 who had only two rooms each. In the four where the permitted number was 2 units, there were two families with the equivalent of 2½ units and two of 3 units. In one two-roomed flat with a permitted number of 2½ units there was a family equivalent of 4 units; in another a family with an equivalent number of 5 units. New Housing The total number of new dwellings provided in this district from the end of the war up to the 31st December, 1959, was 5,963. Of these, 2,717 were new permanent council dwellings and 200 were new temporary dwellings. 2,426 permanent dwellings have been provided by private enterprise. 338 dwellings destroyed by enemy action were rebuilt and 334 existing houses were converted. At the end of the previous year, the number of permanent council dwellings provided was 2,596 and the number of buildings provided by private enterprise 2,087. In addition, 954 family dwelling units were provided in requisitioned premises. By the end of the year, all but 44 of these had been released. The Minister of Housing and Local Government said in January that the council housing programme for the erection of 157 dwellings and 64 garages during 1959 could only be approved in respect of 72 dwellings (i.e. those contemplated up to the 30th September). They did suggest, though, depending on the overall housing problem later, that the remaining 78 dwellings scheduled for the Northolt Road clearance area in the last quarter of the year might be agreed. Further use was made during the year of the arrangements for the removal of Harrow families to the New or Expanded Towns, 259 Harrow families being housed during the year. By the end of the year, the total number of families who had been housed under these arrangements was 1,896, of which 655 were from the normal housing list. Most of these removals were to the New Towns of Hemel Hempstead, Stevenage and Harlow and the Expanded Towns of Bletchley and Swindon. Smaller numbers went to Welwyn, Hatfield, Basildon, Bracknell and Aylesbury. New Towns. In March, 1958, the Middlesex County Council convened a Conference to learn the views of the County District Councils in regard to the provision of a New Town to take the County's overspill population. The Conference favoured the County Council making enquiries of the Minister about using the provisions of the New Town Act. The reply was that it was not the Government's intention that these provisions should be used to create further New Towns in England and Wales, and that if a local authority felt a New Town was needed, it should consider building one with the help of the special subsidies available under Section 3 of the Housing Subsidies Act, 1956. To a further conference held in May, the County Planning Officer reported that most New Towns were likely to complete their schemes by 1967, and that he that at least one New Town of 50,003 population, coupled with smaller town development schemes for 10,000 people, were needed to maintain the rate of provision for Middlesex families for the next four 48 or five years, after which further supplemental schemes would be necessary. The Conference "having agreed that there is housing need in Middlesex asked the County Council to explore further the means of meeting that need, and to report back to a further conference of local authorities in Middlesex." On the question of whether or not the County Council should be given out-county housing powers, the Housing Committee favoured concerted action by the local authorities in Middlesex with the advisory support of the County Council, with a view to the setting up of a New Town or Towns. Allocation of New Houses Waiting List. In 1958, it was decided that an application should not normally be considered from a person whose income or the household income exceeded £1,000 per annum. This was amended during the year to: (1) normally no application be considered where the joint gross income of the husband or wife exceeds £1,000 per annum, (2) that a general and financial hardship as well as housing need shall be taken into account when assessing the degree of priority to be accorded to a particular case. When the Housing Management Sub-Committee on the 9th February undertook the customary annual review of the Council's housing situation, it was then anticipated the building programme was 474 dwellings. Of these, 147 would be available by March, 1960. There were 739 applicants under the Council's new housing policy. The existing demand, including commitments of 80 dwellings carried over from the previous year, comprised a need of the Civic Centre Sub-Committee for an additional allocation over the next two years of 59 dwellings for rehousing further families from the Poets Corner area, together with the earmarking of a further 26 later on, a priority need of some 90 families still occupying requisitioned accommodation which must be dealt with before 31st March, 1960, and the needs for larger houses of tenants occupying the two-bedroom Arcon temporary bungalows on the Rayners Lane Estate. In addition, some of the 217 applicants on the New Towns list will, in due course, qualify by length of residence, to be considered for inclusion on the general waiting list. The sub-committee felt that, in the circumstances, the allotting of houses must be kept on as flexible a basis as possible to meet the various needs within the Council's policy, and it should refrain from making the usual provisional allocation of new dwellings to the various classes. The Housing Committee, at their meeting on the 19th February, decided "that as a matter of policy and by way of departure from existing practice, the Council do not stipulate in advance any fixed provisional allocation of new council dwellings to meet particular needs during 1959 60 other than to preserve the present allocation of one-tenth of all such dwellings to tuberculous cases as in previous years, and that it be left to the Housing Committee to let all dwellings in accordance with the Council s current housing policy, which has regard to certain priorities and to applicant's individual housing needs or hardship." 49 The Council accepted the recommendation of the Housing Committee that applications for housing accommodation be accepted from Service men who have completed regular engagements of a minimum of six years, provided that in cases where the period is less than 12 years, the applicant shall show that he has lived continuously in the Borough for at least 5 years up to the date of his enlistment or in the case of his wife, that she has a like qualification up to the date of their marriage. All applicants accepted on the housing waiting list under this policy were to be informed that they are only likely to be offered the accommodation in a New or Expanded Town. SUPERVISION OF OTHER PREMISES Routine visits are paid by the public health inspectors to such premises as factories, licensed piemises, cinemas and other buildings. Factories There are 530 factories in the district. To these 428 visits were paid. Seventy-one contraventions were found. Of these 22 were due to want of cleanliness, 3 in respect of insufficient sanitary accommodation and 22 in respect of defective or unsuitable sanitary accommodation. The remaining offences were mostly in regard to non-compliance with the requirements about the exhibition of notices. Information about matters about which he is concerned are passed to the Inspector of Factories. He in his turn draws the attention of the department to those matters which he has discovered and which concern them. The building of different premises—blocks of offices, private houses, shops, etc., has necessitated special attention being given to the provision of sanitary conveniences for the use of the building employees. Fiftyhve visits were paid for this purpose. In some instances the use of an Elsan chemical closet was the only solution. Local authorities are required to keep a register of outworkers with a view to action being taken where work is being done in unwholesome Premises or where there is risk of spread of infection. At the end of the year, there were 147 outworkers on the register. 106 were engaged on making or altering wearing apparel, 30 in the making of Christmas crackers. 170 visits were paid. The premises in all cases were satisfactory. The Ministry require the inclusion of prescribed particulars about the administration of tne Factories Acts to be set out in a set form: 50 Prescribed Particulars on the Administration of the Factories Act 193??? Part I of the Act 1 .—Inspections for purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises Number on Register Number of Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 58 44 2 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 411 299 10 (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 61 95 16 - Total 530 438 28 — 2.—Cases in which Defects were found Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector Want of cleanliness (S.1) 22 17 — — — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — —- — — Inadequate ventilation (S.4) — — — — — Ineffective drainage of floors (S.6) — — — — — Sanitary Conv'cs. (S.7): (a) Insufficient 3 2 - - — (6) Unsuitable or defective 22 16 - 9 — (c) Not separate for sexes — — — — - Other offences against the Act (not including offences relating to outwork) 24 19 - - Total 71 54 - 9 — 51 Part VIII of the Act outwork (Sections 110 and 111) Nature of Work Section 110 Section 111 No. of out-workers in August list required by Section 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 (1) (2) (3) (4) (5) (6) (7) Wearing apparel: Making, etc 106 — — — — — Cleaning and Washing — — — — — — Umbrellas, etc. 2 — — — — — Artificial flowers 4 — — —• — — Making of boxes or other receptacles or parts thereof made wholly or partially of paper 1 - - - - - Brush making Carding, etc., of buttons, ctc. 2 — — — — — 1 — — — — — Stuffed toys Cosaques, 1 — — — — — mas stockings, etc. 30 — — — — — total 147 — — — — — 52 Shops There are 2,365 shops on the register, an increase of eight on the previous year. During the year 1,390 visits were made for the purpose of administering the Shops Act. The following is a summary of the contraventions noted:— Heating, insufficient or absence 27 Water closet, accommodation insufficient 1 Assistants employed on weekly half-holiday 6 Young person employed after the specified hours 3 Shops open on half-holiday without displaying prescribed notices 18 Shops open on half-holiday selling non-exempted articles 10 Sundays. Shops open for selling non-exempted articles 3 „ Failing to keep record of assistants employment „ Failing to allow compensatory holiday for Sunday employment or working excessive number of Sundays 6 „ Keeping shop open without prescribed notices 10 Shops failing to close at Closing Hour 1 396 warnings were sent in respect of these items. During normal inspections of shops the following defects were noted: washbasins defective 4; water heaters defective 9; redecoration necessary 26; W.C. compartments needing ledecoration 35; yards untidy 11. Two traders were prosecuted during the year—one for serving customers after closing hours was fined 20/- and 36/- costs, the other for selling cigarettes after closing time was fined 20/- and 21/- costs. Proceedings were authorised in a third case where a youth of under sixteen years of age was employed in a cafe up to 11 p.m. three nights a week. There were only two infringements of the Regulations made in 1953 under the Heating Appliances (Fireguards) Act, 1952, although many visits were paid especially to secondhand shops. The one was the display of a new electric fire without a guard, the other an old fashioned gas fire. In each case the retailer was warned. Places of Entertainment. At the end of the year there were 78 premises in the district licensed for public entertainment. These include 10 cinemas; 15 public houses, 16 church halls; 4 local authority assembly halls; 22 schools and 11 dance and other assembly halls, clubs, etc. To these 86 visits of inspection were made. The premises on the whole were found to be kept in a clean condition, but in five redecoration was necessary; on approach being made to the owners the work was put in hand. 53 Licensed Premises There are 58 licensed premises in the district. To these 125 visits were paid. Most are modern buildings with satisfactory sanitary conveniences. At a few, however, conditions are not so satisfactory and the owners were approached with a view to their being improved. Of the older houses which needed modernising, the Havelock was reconstructed; the Roxborough Hotel too has been modernised, but not yet the Iowa public house. A report about the state of these premises is sent to the Clerk of the Justices each year just before the Brewster Sessions. Keeping of Pet Animals The number of licensed pet shops in the district is 13. All were inspected during the year and were found to be satisfactory. Rag Flock The four premises in the district registered under this Act were visited during the year. They were found to be kept in a clean condition. In no case was any dirty filling material found on the premises. Marine Stores Three persons are registered with this Authority under the Old Metal Dealers Act, 1861, as they deal in old metal. No complaint of any nuisance at these premises was received during the year. Periodical visits were made; at no time was there a nuisance. Hairdressers' and Barbers' Premises These premises are subject to byelaws made under Section 282 of the Middlesex County Council Act, 1944 for the purpose of securing the cleanliness of any premises in their district used for the purpose of carrying on the business of a hairdresser or barber and of the instruments, towels, equipment and materials used in the premises. Every person using any such premises shall keep exhibited in a suitable place a copy of the byelaws. They are also subject to the provisions of the Shops Acts which ensure that there shall be a sufficient number of sanitary conveniences for the staff employed, and that the premises shall be properly heated and ventilated. The same Act regulates the early closing days, the assistants' half-holidays and the arrangements for the health and comfort of the assistants. There are in the district 130 such establishments. They are visited periodically to see that the requirements of the byelaws are being complied with; at most establishments a very high standard of cleanliness is maintained. CONTROL OF NUISANCES Atmospheric Pollution Legislation. The Smoke Control Areas (Exempted Fireplaces) Order, 1959, came into operation on the 17th July. This exempts certain c asses of fireplaces from the provisions of Section 11 (which relates to smoke control areas) as the Minister of Housing and Local Government 54 is satisfied that such fireplaces can be used for burning fuel other than authorised fuels without producing any smoke or a substantial quantity of smoke. Smoke Nuisances. 27 complaints were received about smoke nuisances from industrial premises. Most of these related to smuts from oil fired boilers. These problems are not easily resolved, and are receiving attention from the Department of Scientific and Industrial Research, The Management of the factories concerned were in all cases anxious to find a solution to this problem and co-operated wholeheartedly with the Department in the enquiries that are being made. Smoke Control Area. The Public Health Committee, at their meeting on the 17th February, considered a report on the factors to be taken into account in selecting an area to be designated as a smoke control area and the procedure to be followed. Consideration of the sites was referred to a meeting of an ad hoc sub-committee appointed to consider the question in all its aspects (including that of publicity) of designating part of the Borough as a smoke control area. The Committee at the same meeting considered Ministry of Housing and Local Government Circular 5/59 which asked Councils in "black areas", which include the Borough, to consider their domestic smoke problem as a whole and to decide on the smoke control orders that will be needed, in what order of priority they should be made and how many years it is likely to take to complete the task; on this information they should prepare a phased programme for establishing smoke control areas over the next five years. At their meeting on the 31st March the Public Health Committee declared the following section of the Borough a smoke control area— (1) 45 acres to the south of the London, Midland and West Railway line which includes some 400 dwellings, about half of which were Council properties and (2) a rectangular area of 180 acres bounded on the north by Eastcote Lane, by Alexandra Avenue on the east and by the boundaries with Ruislip-Northwood Urban District and the Borough of Ealing on the west and south respectively with some 1,900 premises. The area proposed, then, is 225 acres on which are some 2,300 premises. This is the first step towards the Council's ultimate objective of making the whole of the Borough smoke controlled by means of orders made from time to time in respect of different areas. The necessary particulars were forwarded to the Minister of Housing and Local Government who, after examining the information submitted by the Council with regard to their proposals for declaring an area in South Harrow as a smoke control area, in consultation with the Minister of Power, gave provisional approval to the proposal. Accordingly, a detailed survey of the area was started and was well under way by the end of the year. The date suggested for the coming into operation of the order is September, 1961. Expenses of Conversion. Section 12 of the Clean Air Act reads— If the owner or occupier of a private building which is in or will be in a smoke control area has to incur expenditure in adapting his heating arrangements, the local authority shall repay to him at least seven-tent s 55 of the sum. If it thinks fit, it may in any case pay the whole or any further part of the remainder. According to Section 13, in the case of privately owned houses, the exchequer contribution will be four-sevenths of the contribution made by the local authority. The effect of the various payments is that the owner or occupier of a house will pay three-tenths, the local authority three-tenths and the Central Government the remaining four-tenths. In any case, where a local authority pays more than fourtenths of the cost borne by a private owner or occupier, the Government contribution will not be proportionately larger. Section 14 says that the work must include only what is reasonably necessary to avoid contravention of a smoke control area order and any expense beyond this must be left out of account. Clean Air Act, 1956. Section 10. Another aspect of the campaign for clean air arises in industrial undertakings. Under Section 10 of the Act, the local authority are to be satisfied that the height of a chimney is such that the products of combustion will be adequately dispersed and will not give rise to a nuisance. Even when smokeless fuels are used their products of combustion which will include sulphur fumes, must be emitted at a sufficient height. Hazards of Radiation Local authorities have not been made responsible for any measures to protect the public against radiation risks. Nevertheless, they cannot help the public looking to them when for any reason they are particularly anxious. Following the Windscale accident, it is probable that many mothers approached their authorities as did some in this district, to be reassured about the safety of the milk they were giving their children. Any authority must be anxious if a container of isotopes falls off a vehicle which is passing through their district. The following is a copy of a report submitted to a meeting of the Public Health Committee, which is a summary of the position in regard to radiation hazards: 1. The sources of radiation to which we are exposed are outer space, the earth we live on, the food, water and air we take in, radio-active elements in our bodies, and man-made additions. These last include: 1. Fall-out from detonated bombs. This has added less than one per cent to the inescapable dose. 2. The earliest man-made sources were the machines for the production of X-rays. 3. They were closely followed by the extraction of naturally active nuclides, radium and thorium from uranium ores (they provide mainly gamma rays). 4. With the construction of reactors came not only isotopes (over 1,000 of them) but also organic compounds "tagged" with radio-active elements. 56 5. Incidental to the production of nuclear fuel came an accumulation of mixed fission products; and with them the problem of 'waste disposal'. Of these hazards, that of greatest potential is from the reactors. 2. Reactors and processing establishments produce large quantities of radio-active wastes which have to be disposed of. The methods include storage, deposit on ocean beds and land burial. All—solid, liquid or gas—call for rigid control of their transport and final resting place. Control of fluid effluents to rivers, estuaries and the sea off-shore is exercised jointly by the Ministry of Housing and Local Government and the Ministry of Agriculture, Fisheries and Food. Transport of active fuel products by road is controlled by the Authority and the police. Until recently, gaseous effluents have not given cause for anxiety. Stacks are monitored and the air entering and leaving the stack is filtered. The whole area of the site and the country for many miles round is regularly monitored. Samples of pasture, vegetable and animal life are regularly examined radiologically and chemically. 3. Up to about ten years ago, major sources of radiation were in the main confined to hospitals, physics departments of universities and some heavy industry establishments. Today, the situation is very different. There is widespread employment not only of closed sources but also of nuclides (naturally and artificially produced elements for distributive employment in solution). Open sources are a potential hazard by inhalation and ingestion. They call for elaborate methods of containment, shielding, remote handling and disposal. Ionising radiation absorbed in the body whether from external or internal sources is measured in the unit rem. The average person receives from the various natural sources a total dose to the gonads of about 1 rem in the course of ten years. Opinion favours the limitation of gonad exposure to a total of 6 rem in the first thirty years of life, this figure being additional to the unavoidable 3 rem in this period. The additional dose for each mass radiography examination is about 1/4000th rem, and for diagnostic radiography of sites in the region of the gonads 1 rem. Apart from the genetic effect there is no reason to suppose that any harm befalls an individual through exposure to radiation at average levels considerably higher than these. 4. The Agricultural Research Council accept responsibility for monitoring soil, herbage, farm animals and milk and other foodstuffs. Atomic Energy Research Establishments remain responsible for monitoring air and rain water, and for analysing the radio-activity present in samples of human bone. The Ministry of Housing and Local Government and the Ministry of Agriculture, Fisheries and Food jointly exercise control of fluid effluents to rivers, estuaries and the sea off-shore. 57 The Council had been in touch with the Association of Municipal Corporations. Early in the year they were informed that the Minister was opening discussions with Local Authority Associations and one matter to be discussed was the provision of information to local authorities necessary to enable them to carry out their functions. The Minister of Housing and Local Government stressed that the ultimate responsibility must rest on the Government because the major artificial additions to background radioactivity are from sources not susceptible to local control. The present position is: In regard to the medical and industrial use of radio-isotopes, X-ray equipment, etc., the Health Department of the Ministry of Housing and Local Government has appointed a committee under Lord Adrian to review present practice in the field of radiotherapy and radiology. As regards factories, the primary responsibility rests with the Ministry of Labour who have many factory inspectors specially trained for this purpose. New regulations will supplement the present provisions of the Factories Act to provide a complete industrial safety code. The Home Office have agreed with the manufacturers and users a safety code governing the use of shoe-fitting fiuoroscopes. Guidance has been issued to local education authorities about the use of X-ray equipment in technical colleges and schools. In regard to fall-out, the Government has a full programme for the measurement of fall-out in this country as a result of nuclear weapon tests. Some thousands of samples of milk, water, foodstuffs and human bones are being tested each year under arrangements supervised by the Agricultural and Medical Research Councils. The Atomic Energy Authority is, by the Atomic Energy Authority Act, 1954, barred from discharging radioactive waste except in accordance with authorisations given by the Minister of Agriculture and the Minister of Housing and Local Government. These arrangements are to be extended to other nuclear installations. The powers under the general body of public health legislation do not provide an adequate means of applying to other radio-isotope users corresponding controls. The position in regard to radioactive waste was made clearer towards the end of the year when the Radioactive Substances Bill was presented to Parliament, and a White Paper on the Control of Radioactive Waste was issued. The Bill provided that users of radioactive waste would need to be registered and that authorisation would be required for the disposal of radioactive wastes; also that the control should be exercised by the Central Government, provision being made for sending copies of the registrations and authorisation certificates to local authorities. For the control of the transport of radioactive materials by road, the Ministry of Transport expected regulations to be ready early in the New Year. Although it would seem that no direct responsibility will be imposed on local authoriries, the question of the training of public health staff being considered by a committee under the chairmanship of Sir Douglas 58 Some local authorities have set up their own monitoring service for radioactivity; others seem to be considering doing so. While agreeing that there is a special case in relation to drinking water, and perhaps a special responsibility falling on those local authorities who are water undertakers, the Minister of Housing and Local Government feels that in general any measurements local authorities might make only tend to duplicate the Government's own monitoring programme for fall-out, and that they could only expect to detect radioactivity which they could do little to control within the limits of their powers and areas. Particularly because of an incident which occurred in the Borough when a radioactive isotope fell from a lorry on its way through the district, the Council approached the Minister of Transport about what precautionary measures could be taken. They were informed that draft regulations were to be ready early in the New Year which would cover such things as the precautions to be taken by carriers, the labelling of containers and the standards of packing to be complied with. The object of these regulations would be to ensure that packages containing radioactive material can be transported without danger either to the public or to the crew of the vehicle. Rats and Mice The rodent operatives found rats or mice at 1,586 of the 1,690 premises they visited. Each of the infestations was small and localised. Most complaints were from private dwelling houses, 1,294 of these being in respect of rats, 82 of mice. Forty infestations of rats and four of mice were at Corporation properties, 121 and 45 at other premises. All these figures are larger than the corresponding ones for 1958. The number of visits made by the rodent operatives to these properties was 1,690, a marked rise of those in recent years. Vermin infestation is encouraged by the widespread practice of people feeding pets and wild birds in the back gardens of their houses without taking even elementary precautions against this encouraging rodents. The small number of sewers known to be infested with rats were treated twice during the year. The results of the treatment do not suggest any increase in the rat population. Periodical surveys of watercourses and land owned by the Corporation were made and treatments carried out where necessary. Wasps There are marked variations in the prevalence of wasps and in the requests for help to deal with their nests. In 1957 there were 345, in the next two years, 213 and 265. 1958 was a year of low infestation, only 111 nests being destroyed. By contrast, the number of 818 this last year was the largest number of requests ever received. Limitations of staff prevented them all being dealt with, and even these had to be attended to in rotation and a waiting list created. It proved possible to deal with only 672 of these requests. 59 Pigeons In 1958 the nuisance from pigeons, particularly in South Harrow, had become so great that the Council authorised the destruction of the birds at the Gas Works in Northolt Road and at the nearby Railway Arches. This treatment resulted in a marked diminution in the numbers. It was appreciated, though, that similar treatment would be necessary periodically so long as these places are unguarded and provide facilities for the pigeons roosting and brooding. The Council asked the Association of Municipal Corporations to press for the inclusion in the pending Public Health (Miscellaneous Provisions) Bill of a clause to extend to Authorities outside London the powers contained in clause 121 of the Public Health (London) Act, 1936, under which action can be taken to abate or mitigate any nuisance caused by the congregation of house doves or pigeons. The Association represented to the Minister of Housing and Local Government that such clause should be included. Caravan Site A proposal of the County Council to make a compulsory purchase order for the land at North Lodge, Edgware, used as a caravan site and which has for so long been a matter of concern to the Authority, prevented any progress being made. The Council could not take steps to enforce compliance with standards set out in the provisions of the Middlesex County Council Act, 1944, as, in view of this Order being sought, the land was so soon to cease to be used for this purpose. As part of their understanding with the County Council, the Borough Council rehoused five of the families. There was then much of an improvement as at no time since have there been more than fifteen caravans on the site. The basic faults though and the low standards of sanitation remain. 60 INSPECTION AND SUPERVISION OF FOOD (A) MILK Production Milk production ceased at one farm during the year and there are now only five farms producing milk in the district. Store cattle are kept at two farms. Two out of the five farms produce tuberculin tested milk; the milk from the other farm is sent to a Wholesaler for processing. Distribution and Licensing: Milk is pasteurised at two dairies in the district, the plants being licensed by the Middlesex County Council. The following are particulars of the numbers of various types of licences issued under the Milk (Special Designations) Regulations, 194954, to 38 persons or companies:— (1) The number of premises from which milk was sold 50 (2) The number of premises outside Harrow from which pasteurised milk was retailed in the district 22 (3) The number of premises from which T.T. milk was sold 44 (4) The number of premises outside Harrow from which T.T. milk was retailed in the district 22 (5) The number of premises from which sterilised milk was sold 46 (6) The number of premises outside Harrow from which sterilised milk was retailed in the district 20 Supervision During the year 37 visits were paid by Public Health Inspectors to dairies and cowsheds in the district. Sampling 38 samples of milk were taken and submitted to the Colindale Laboratory for analysis. All were satisfactory. This sampling is independent of that carried out by the County Council. Complaints During the year, 31 complaints were received about milk bottles; fourteen were about the dirty or damaged state of the bottles, the other 17 about the presence of foreign matter. Apart from one period when there was a run of complaints about splinters of glass in milk bottles, the vast majority of complaints about milk bottles is because of the dirtiness of the inside. While at times some solid matter is present, most often the complaints refer to some 61 caking on the inside wall of the bottle. This in most cases is the result not of any mis-use of the bottle but from the failure of the householder to rinse it. The following is a summary of an investigation into the hygienic conditions of milk bottles which had at one time been mis-used:— (1) Twelve experiments in six dairies in various parts of England have shown that, when foreign matter in a milk bottle is impervious, the normal washing process delivers the "dirty bottle" in an excellent hygienic condition, with a low colony count and absence of coli and milk-souring organisms. (2) When the foreign matter is pervious, a high colony count is often obtained. However, the absence of coli in these bottles suggests that even these are hardly likely to be a danger to public health. (3) All such types of dirty bottles arise from deliberate misuse by members of the public, or at least failure to return and consequent neglect. (4) In spite of all efforts by dairy firms a misused bottle occasionally escapes detection. It is probable that as long as glass bottles are used, the occasional dirty bottle will get through on rare occasions. (5) Present legislation bears harshly on dairies but ignores the real culprit. More positive measures should be adopted to prevent the misuse of milk bottles. The practice of stacking crates of empty milk bottles on the public highway is diminishing. Where it persists, it is largely due to the failure of householders, particularly on Sundays, to put out the empty bottles for collection so that the large number to be collected on Monday is more than can be dealt with on that day. Milk and Tuberculosis The virtual eradication of Bovine Tuberculosis in this country is a measure of public health importance which seems to have been brought about unnoticed by many. In the earlier decades of this century the incidence of tuberculosis in cattle was high, probably up to 20 per cent of all cattle and even 40 per cent of adult cattle. With an incidence of this magnitude, the problem was not only how to bring about a reduction, but how to do so without impairing the milk supply of the country. An early public health measure, the Tuberculosis Order, aimed at the slaughter of open cases. Although large numbers of cattle were slaughtered, some 23,000 in 1936, this measure had little effect on controlling the spread because so often infection had already spread to other animals before the case was detected. A different line of approach was introduced by the Milk Act, 1934, aiming at the building-up of attested herds. These were herds which were already free from tuberculosis or had been made free by the tuberculin-testing of the members of the herd and disposal of the reactors. The scheme was given an added incentive under the Agriculture Act of 1937 which authorised the declaration of eradication areas. In addition to the bonus for each gallon of milk produced under this scheme, a capitation bonus was available to herds other than those producing milk. Financial assistance was also given for the tuberculin testing of the herds. Progress was hampered during the war but in 1944 the Attested Herds Scheme was re-opened. It now became much more popular, and with the steady rise in the number of 62 attested herds there was a fall in the number of cattle dealt with under the Tuberculosis Order. In 1950, a plan for area eradication was introduced. Under this, areas were selected in which the percentage of attested cattle was highest, and notice was given that in two years time these areas would be declared eradication areas. After that date any herds not already subject to the rules of the Attested Herd Scheme would be compulsorily tested, with slaughter of the reactors and payment of compensation. When such areas had been tested twice, at an interval of not less than two months, and the reactors removed, the area would be declared an attested area. In the meantime, other areas were to be selected and to be treated similarly. The first attested areas were the Isles of Scilly, Shetland, Cumbrae and Arran. By the end of 1951, 31 per cent of all cattle in the country were in attested herds. The first eradication areas—in South and West Scotland and South Wales—were declared in October, 1952. These became attested areas in March 1953. Since that time a succession of new eradication areas have been declared, becoming attested six months later. By October, 1959, Scotland and Wales became attested areas. By the end of the year, 95 per cent of the ten million cattle were included in attested herds. In that year only 119 cattle were dealt with under the Tuberculosis Order. It is expected that by the end of 1960 the remaining parts of the country will be eradication areas, then becoming attested areas, so that the whole country will be one attested area. This satisfactory position, of course, does not mean that all tuberculous cattle have been eliminated; there is certain to be some residual infection. There is, too, the possibility of re-infection by animals including humans, so that regular tuberculin testing at intervals will be necessary to ensure that the disease will not become re-established. Non-pulmonary tuberculosis in humans, at one time so very common, especially in children, was in most cases the result of consuming milk infected with the tubercle bacillus. The virtual elimination of this condition reflects the increased safety of milk, not only as a result of the eradication of this infection in cattle, but also as a result of the practice of pasteurising milk. (B) MEAT Slaughterhouses Review oe position. The Slaughterhouses Act of 1958 provided for the first time for minimum standards for the construction and equipment of slaughterhouses. These standards applied immediately to all new slaughterhouses on the coming into effect in 1958 of the Act. Existing premises are to be brought up to these standards as soon as possible, but without reducing the facilities available in an area below the required minimum. Those premises which do not reach the minimum standard are to be dealt with in two stages. In the first phase, expected to be some two years, traders will be free to establish slaughterhouses where they like, subject to standards and to Town Planning requirements. In the next phase some measure of control will be exercised 63 over the granting of licences. In due course, each local authority will have to report to the Minister on the existing and probable future requirements of their districts of slaughterhouse facilities, and facilities which are, or are likely to become, available to meet these requirements. When reporting, each Council will recommend a date on which the Minister might apply to existing slaughterhouses the new standards of construction, for hygiene and for the prevention of cruelty to animals. It was ascertained that no new provision in nearby areas would meet the needs for slaughterhouse facilities in this district. The following is a copy of a report submitted to the Public Health Committee at their meeting in March about the facilities for slaughtering: Report to the Ministry. Section 3 (1) of the Slaughterhouses Act 1958, requires each local authority to review, and after consultation with such organisations as appear to the authority to represent the interests concerned, to report to the Minister on:— (1) The existing and probable future requirements of their district for slaughter-house facilities, having regard to the needs both of persons requiring the use of such facilities and of other persons; and (2) The slaughterhouse facilities which are or are likely to become available to meet those requirements. The Slaughterhouse Reports (Appointed Day) Order of the Ministry of Agriculture, Fisheries and Food appoints November 2nd, 1959, as the earliest date for submission of the report, and November 2nd, 1960 as the latest. Position Locally Pre-War. In 1934 there were 9 licensed slaughterhouses in the district. Just before the war there were 8, namely those at 9 Northolt Road, South Harrow; 46 High Street, Wealdstone; 94 High Street, Wealdstone; High Street, Pinner; Green Man, Honeypot Lane, Stanmore; Stanmore Hill; Stanmore Hall Farm and 63 High Street, Edgware. Only small amounts of killing took place at any of these, and during 1938 only 146 cattle excluding cows were killed, 59 cows, 314 calves, 1,601 sheep and lambs and 1,561 pigs. In 1935, when the then Council considered the matter, they decided that the limited amount of killing performed in this district did not warrant the establishment of a Municipal Abattoir. Position during the War. Shortly after the outbreak of the war most of the killing at private slaughterhouses ceased. The Livestock (Restriction on Slaughtering) Order of the Ministry of Food, which came into operation early in 1940, resulted in the work previously carried out in about 11,500 premises being concentrated at some 500 slaughterhouses. Very little use was made of any of the local slaughterhouses during the war, only the occasional pig or sheep belonging to an institution or private pig club being killed. 64 This was the position throughout the country, and it had been hoped that one of the benefits resulting from the war would be that never again would the large number of slaughterhouses used before the war be brought into use; but instead that killing would be concentrated in a small number of buildings designed for the purpose, and that all animals killed at these premises would be subjected to full post-mortem examination. A Circular in 1954 referred to the Government's intention to bring about concentration of slaughtering facilities throughout the country, though it was recognised that the long-term policy would take some years to apply. In the meantime the circular set out the principles to be taken into account by an authority considering the licensing and provision of slaughterhouses for the period immediately following the decontrol of meat and live-stock in July, 1954. "In the meantime it was the duty of local authorities to make use of their powers to secure that sufficient slaughtering accommodation would be available after decontrol. When dealing with applications for the grant or renewal of licences, local authorities were to consider whether having regard to the accessibility and capacity of public slaughtering accommodation in its own district or in the district of a neighbouring authority, the privately owned slaughterhouses were required." Licensing of Slaughterhouses locally. At their meeting on June 1st 1954, the Public Health Committee resolved that licences be granted to the slaughterhouses at 46 High Street, Wealdstone (L. Rance), Dracotts, Stanmore Hill, Stanmore (M. Dixey), and Stanmore Hall Farm, Dennis Lane, Stanmore (A. Keen); that the Committee would be prepared to grant a licence in respect of 7 Northolt Road (H. E. Wright) subject to satisfactory reconstruction; and that the application in respect of 720 Honeypot Lane, Stanmore (G. Massey), be deferred. Position under Slaughterhouses Act 1954. This Act repealed the previous provisions about licensing and registration. Licences could now be refused when the authority were not satisfied that the premises conform with the requirements of section 13 of the Food and Drugs Act, and of any regulations in force relating to hygiene. Authorities could licence for periods greater than the maximum of thirteen months allowed by the 1938 Act, provided the period did not go beyond 31st July, 1959. The licences granted or renewed after the 30th June, 1956, remained subject to the maximum period of thirteen months. No licences could be granted to premises not used or licensed or registered as a slaughterhouse at any time from 1st October, 1934, without the consent of the Minister of Food. Closure of Slaughterhouses. Section 61 of the 1938 Act enabled a local authority which had provided a public slaughterhouse to close some or all of the private slaughterhouses in the district. Section 4 of the 1954 Act extended this power so that it could be exercised by a local authority who had not provided a slaughterhouse, but which was of the opinion that there was adequate alternative slaughtering accommodation in a neighbouring district to meet the needs of the district. 65 Where a local authority was satisfied that there was sufficient slaughtering accommodation, private or public, available for their district, and that no additional facilities were required, they could by resolution determine that no further licences be granted or renewed in respect of any premises not licensed on the date the resolution takes effect. Claims for compensation could be made by any person having an interest in any licensed slaughterhouse which could no longer operate as a result of such a resolution. Government's Long term Policy. Based on the recommendations of the Inter-departmental Committee on Slaughtering, the White Paper Cmd. 9761 of May, 1956 set out the policy. This was that central planning of slaughterhouses was no longer advisable: instead, subject to normal town planning requirements, and to the premises reaching prescribed standards there should be a limited period during which meat traders could be free to provide their own slaughterhouses of the type and in the place that best suited their individual businesses. After that period, a measure of control would be re-imposed. The White Paper indicated that minimum standards would be prescribed for the construction, layout and equipment of slaughterhouses which would secure humane treatment of animals, hygienic conditions for the handling of meat and satisfactory welfare facilities for the staff employed. These would apply to new buildings as soon as the new regulations are made, but not to existing premises until dates are determined. The Slaughterhouses (Hygiene) Regulations 1958 and the Slaughter of Animals (Prevention of Cruelty) Regulations 1958 designed to secure the observance of sanitary and cleaner conditions in connection with the construction and operation of slaughterhouses and the handling of meat therein came into operation on 1st January, 1959, in relation to new slaughterhouses. Local Killing. The following gives an analysis of the extent of slaughtering in the district in different years: 1938 1955* 1956 1957 1958† Cattle (excluding cows) 146 794 1,565 1,931 1,807 Cows 59 — 221 236 150 Calves 314 581 757 741 460 Sheep and Lambs 1,601 2,065 3,367 3,933 3,526 Pigs 1,561 1,129 6,053 2,177 1,711 Total 3,681 4,569 11,963 9,018 7,654 *7 Northolt Road reconstructed † Dracotts extended in November. 66 The following is an analysis of the volume of work at the different slaughterhouses in 1958:— 46 High St., Wealdstone Dracotts Stanmore Hall Farm 7 Northolt Road Cattle (excluding cows) 857 189 85 676 Cows 146 1 1 2 Calves 425 21 12 2 Sheep and Lambs 2,741 262 382 141 Pigs 1,189 263 259 — Total 5,358 736 739 821 Much, though not all, of what was killed at the slaughterhouses in this district was for local consumption. Recently, first at 46 High Street, Wealdstone, and then towards the end of 1958 at Dracotts, there has been an increase in the slaughtering not for local consumption. The 1938 figures are representative of the killing at the greater numbers of slaughterhouses in the years before the war. The larger amount of killing in the post-war years, even in the reduced number of slaughterhouses used, was easily dealt with until the recent development at Dracotts, much of which was to produce meat not for local consumption. The figures then do not suggest that any additional slaughtering accommodation is needed to meet the needs of those living in this district. Factors influencing type of meat consumed. The demands for home killed meat in this country as a whole might change over long periods of time because of the different tastes of people, or could change for a short time because of trade difficulties or of circumstances in the countries sending meat from overseas. The following is an extract from an article on meat and meat products from the supplement to The Times on Britain's Food, of March 9th: "Of the total carcass meat and offal supplies (excluding bacon) in this country it is perhaps surprising to note that last year 65 per cent came from home fed cattle, as against one half in 1938, and the figure should increase still further this year. Thus the housewife who is out; for English meat should be increasingly satisfied. Proportions of the various kinds of meat, however, vary considerably, for while mutton and lamb supplies were less and beef and veal remained much the same, pork production rose by a sixth. Our roast beef is two-thirds Old England; and, of the rest, mainly chilled, the largest amount came from Argentina in 1958. But in view of the drastic reductions on Argentine beef exports, we may take more in 1959 from Australia and New Zealand, which were responsible tor a tenth of our supplies in 1958 in the form of frozen and boneless beef. Home production of veal is only about a fortieth of our beef production, but nevertheless we provide three-quarters of our supplies ourselves. Of the quarter imported, Holland, Australia and New Zea land make up the total about equally between them, with Australia having gained at the expense of New Zealand over the past lew years 67 Mutton and lamb, though shown together in official returns, are rxt in equal proportions, since we eat about five times as much lamb as mutton. Home supplies account for a little over one-third of our needs, while of the imported chilled or frozen mutton in 1958, fourfifths came from New Zealand and the rest from Australia—the latter almost doubling her share. Four-fifths of our chilled, and frozen lamb came from New Zealand, one-twelfth from Australia and one-twelfth from Argentina—supplies from the latter dropping in 1958 by over half. Iceland and Uruguay supplied us with small amounts. It is in pork meat (excluding bacon) that our home production is supreme. With an increase in home production of 15 per cent in 1958— and a decline in imports of 30 per cent—home sources accounted for about 96 per cent of our supplies, the bulk of the remainder coming from South Africa and Argentina, the leading supplier in 1957, whose supplies again declined by over one half. Pork also comes increasingly from Sweden, while amounts from New Zealand, the leading supplier in 1956, declined further. Bacon and ham tell a different story. There was more bacon available in 1958—and the United Kingdom provided about two-fifths of the nation's needs (including imported frozen carcases). Of the remainder, two-fifths came from Denmark, with substantial amounts from Poland, Eire, and Holland, and smaller quantities from Hungary, Sweden, and South Africa. Our home production of offal remained much the same in 1958 as 1957, as did imports—so that of the total offal eaten one-third is imported. Of those imports Argentina accounted for about a third, although Eire and Australia increased their share. The United States sends us a noticeable amount of beef offal as does Brazil, which otherwise does not export beef to this country. As might be expected, New Zealand is most important in exporting lamb offal, while Denmark is in sending offal from pigs." Consultation with representative organisations. The circular requires the authority to review and after consultation with such organisations as appear to the authority to represent the interests concerned, to report to the Minister. There are two distinct groups who are interested, namely, those who are concerned with slaughtering and those whose main interest is in the sale of meat. There are 137 butchers' shops in the district. Many of these are branches of large concerns, some dealing only with meat, others dealing with meat as one of their lines. 50 of the butchers' shops in the district are owned by such companies who probably are not interested in any facilities being made available for killing locally, though they might be interested in whatever storage facilites were provided. The other shops are managed by the individual butchers. Even though he is not one of those with his own s aughterhouse, a butcher might be interested in there being additional slaughtering facilities in the district, and even more interested in additional storage room. Most of these butchers are members of the Retail Meat Traders' Association. 68 It is suggested that some members of the committee might be nominated to meet to discuss with representatives of the Retail Meat Traders' Association and also of some of the larger firms who have butchers' shops in this district." Views of Town Planning Committee. The Planning Committee who had received a petition asking for the closure of a slaughterhouse on Stanmore Hill, asked that consideration be given to the provision of a public abattoir to serve the needs of the Borough. The Public Health Committee favoured the provision of a central slaughterhouse or abattoir in the Borough, suggesting a suitable site might be earmarked at the former Great Stanmore sewage farm. Renewal of Licences. When the applications for the renewal of licences of four slaughterhouses were considered by the Public Health Committee at their January meeting, they agreed to the renewal of that at 7 Northolt Road, South Harrow, but deferred consideration of the other three. At the March Meeting the licence of the slaughterhouse at High Street, Wealdstone, was renewed to the 30th June to give the owner an opportunity of carrying out the necessary work. At a later meeting licences were granted in respect of the slaughterhouses at Dennis Lane, Stanmore and at Stanmore Hill. Hygiene in Slaughterhouses. Under the Slaughterhouses (Hygiene) Regulations, 1958, which came into operation on January 1st, 1959, all new slaughterhouses in England and Wales will have to comply with requirements of construction and equipment, cleanliness, and personal hygiene of employees. Existing slaughterhouses will not have to comply with the Regulation about construction until dates to be agreed between the Ministry of Agriculture, Fisheries and Food and the Local Authority. Other matters covered under these Regulations are precautions to be taken with animals and meat that may be unfit, and the disposal of unpleasant by-products. Prevention of Cruelty. The Slaughter of Animals (Prevention of Cruelty) Regulations, 1958, which also came into operation on January 1st, 1959, are designed to reinforce the 1954 Regulations of the same name. The most important amendment is that all adult cattle must now be killed in a stunning pen. Existing slaughterhouses and knackers' yards in England and Wales have not yet to comply with those Regulations entailing construction. The responsibility for enforcing the Regulations rests with local authorities. Pigs slaughtered in England and Wales may be anaesthetized, in special installations, by carbon dioxide gas, under the Slaughter of Pigs (Anaesthesia) Regulations, 1958, which came into operation on 1st December. The installations work on the principle of conveying the pig into a chamber containing carbon dioxide, where it becomes insensible in a few moments. The dose is not lethal, but renders the pig unconscious until slaughtered. Some of the safeguards included in the Regulations are. the local authority must be satisfied before the installation may be used, 69 people concerned with operating installations must be instructed; the concentration of the gas—which must be neither too low nor too high— must be sufficient to render the pig insensible to pain until it is slaughtered; one of the recognised instruments for stunning animals must always be at hand in case of a fault in the gassing arrangements. Meat (Staining & Sterilization) Regulations, 1950. These Regulations made jointly by the Ministry of Agriculture, Fisheries and Food and the Ministry of Health provided for the staining of all meat which is unfit for human consumption and all meat from knackers' yards, and prohibited the sale by retail of any unfit meat unless it has been sterilized, exceptions being made only for sale from slaughterhouses and knackers' yards to zoos, menageries and milk farms. The Regulations were to have come into force on April 1st, 1959. They were revoked, however, by the Revocation Regulations which came into operation on the 26th March because the Ministers decided, in view of the many protests received, to have further consultations with the interests concerned. Complaint about slaughterhouse at Stanmore Hill. One of the four slaughterhouses in the district still used is that at the back of 87 Stanmore Hill. Over the years it had been used for quite limited killing so that, in spite of its shortcomings, no real nuisance had arisen. Towards the end of 1958, however, the situation changed in that the number of killings substantially increased and animals were being kept overnight. Alterations and additions to the slaughterhouse would have been necessary to bring the premises up to the required standard. The Public Health Committee at their meeting on the 6th January, being informed of the extent to which slaughtering was being carried out, deferred consideration of the renewal of the licence for 1959. The Planning Committee, at their meeting on the 10th February, refused the application in respect of the proposed alterations to the slaughterhouse on the grounds that the proposal would constitute an extension of a nonconforming use. A petition signed by a number of residents of Green Lane and Stanmore Hill, protesting against the use of the slaughterhouse and urging the closure of the premises, was submitted to the Public Health Committee at their meeting on the 17th February, who were also informed of the decision of the Planning Committee taken at their meeting on the 10th February. As the condition of the slaughterhouse was giving rise to contraventions of the Slaughterhouse (Hygiene) Regulations, 1958, and the Slaughtero Animals (Prevention of Cruelty) Regulations, 1958, the Committee resolved that the application for the renewal of the licence be not granted. The owner then indicated that he was prepared to use the slaughterhouse only in connection with his retail business, and undertook that, should the licence be renewed, the slaughterhouse would be used exclusively for the applicant's retail business (which would involve a return to the numdbers dealt with before November, 1958), that except in cases of emergency, no stock would be laired on the premises overnight and except in exceptional circumstances slaughtering operations would be restricted to one day a week. In addition, he proposed to rebuild 70 the lairing within the existing curtilage and to bring the slaughterhouse up to the standards of the new Regulations. The Public Health Committee, at their meeting on the 31st March, then granted a temporary licence until the 30th June, subject to the undertakings given by the applicant. Inspection of Meat The total number of animals slaughtered last year at the four slaughterhouses was 7,197, compared with 7,654 in 1958. The number of cattle killed dropped to 926 from 1957, a satisfactory feature, as these are the animals which the local slaughterhouses are least equipped to deal with in large numbers. The number of sheep killed increased to 4,434 from 3,526. Probably as a result of the Attested Herd Scheme and Area Eradication Plan, tuberculosis in cattle has declined, only five cases being diagnosed in the last six months of the year. The incidence (1958 figures in brackets) of tuberculosis in cattle other than cows was 3.51% (5.14%), in cows 18.6% (19.3%) and pigs 1.76% (2.34%). There was one case of generalised tuberculosis in a beast; all other cases were localised, the most common site of lesions being the respiratory and digestive systems in cattle, and the head in pigs. 15 cases of cysticercus bovis, a cause of tape worm in man, were diagnosed, a percentage of 1.62% (1.63%). All cases were localised, eight lesions being found in the head, seven in the heart and two in the diaphragm; four cases were degenerate and the carcases released. All the other carcases were submitted to treatment by refrigeration. The incidence of other diseases was 33.5% (27.9%) in cattle, 39.5% (35.3%) in cows, 17.8% (22.7%) in pigs and 10.9% (9.8%) in sheep. Parasitic infections were the most common trouble in cattle and sheep, and respiratory disorders in pigs. The total weight of meat condemned at slaughterhouses was 8,207 lbs. (15,405 lbs.). This was destroyed by incineration at the Wembley destructor. The following is a summary of the return of the post-mortem inspection of animals at slaughterhouses, and relates to carcases and offal inspected and condemned in whole or in part:— 71  Cattle Excluding Cows Cows Calves Sheep and Lambs Pigs Horses Number killed 883 43 356 4,434 1,481 — Number inspected 883 43 356 4,434 1,481 — All diseases except Tuberculosis and Cysticeri Whole carcases condemned - - - 1 2 - Carcases of which some part or organ was condemned.. 296 17 3 487 264 Percentage of the number inspected infected with disease other than tuberculosis and cysticerci 33.5 39.5 0.8 10.9 17.8 - Tuberculosis only Whole carcases condemned 1 - Carcases of which some part or organ was condemned 31 8 - 26 Percentage of the number inspected affected with tuberculosis 3.51 18.60 - - 1.76 Cysticercosis Carcases of which some part or organ was condemned 14 1 - - - - Carcases submitted to treatment by refrigeration 10 1 - Generalised and totally condemned — — - — — — 72 (C) OTHER FOODS Food Premises There were in the district at the end of the year, 233 Grocers' shops, 144 Fruiterers' and Greengrocers', 137 Butchers', 53 Fish shops. 50 Dairies and 152 Confectioners/Cafes. Food Condemned During the year 4,002 lbs. of food were found to be unfit and had to be destroyed. Fruit and vegetables accounted for 1,031 lbs. of this, meat and meat products for 2,820 lbs., fish for 254 lbs., and groceries the remaining 188 lbs. In addition, 345 fluid oz. of tinned fruit juice, 386 packets of frozen food and 81 pints of milk had to be destroyed. Complaints Thirty-three complaints were received about foreign matter in foodstuffs. Twenty-one of these related to bread, cakes and confectionery, three to meat pies, and nine to tinned or packed food. Ice Cream At the end of the year 411 premises were registered for the retailing of ice cream, an increase of 27 on the number on the register at the end of 1958. Of these, 8 were registered for the purpose of manufacture, but at only two was ice cream made. 69 samples were taken, 12 from the manufacturers in the district and 57 from retailers of prepacked or loose ice cream. Grades I and II are considered satisfactory; grades III and IV are not, and if repeated indicate faults in practice. Of the 12 samples from local manufacturers, only one was Grade IV, and therefore not satisfactory, the remainder being Grades I and II. Of the remaining 57, 14 samples of loose or prepacked ice cream were in Grades I and II, 43 in Grades III or IV. This high proportion is, of course, because of repeated examinations of an unsatisfactory product. 28 of the 29 samples of ice lollies examined were satisfactory. The 4 samples of fruit lollies were satisfactory. Composition. New regulations relating to ice cream based on the recommendations of the Food Standards Committee, came into operation in April. The main changes are that standards are to be fixed for dairy ice cream and for milk ice which are to contain milk fat and must not contain any other fat; that saccharin and other artificial sweeteners are not to be used in any ice cream or in milk ice and no minimum sugar content is laid down; that ice cream made with non-milk fat is not be labelled or advertised in a way which is suggestive of butter, cream or milk, but such ice cream may continue to be sold as ice cream. From November 30th, all pre-packed ice cream made from non-milk fat has had to be labelled as containing vegetable or non-milk fat if it is sold as ice cream. Ice cream must now contain not less than 5 per cent fat and not less than 7½ per cent of milk solids not fat. 73 Preserved and Pickled Foods The Food and Drugs Act, 1938, requires premises where sausages or preserved or pickled foods are prepared or manufactured to be registered by the Local Authority. The number of premises now registered is 128, an increase of 3 on the previous year. These premises are regularly inspected. Registration of Hawkers The Middlesex County Council Act, 1950, requires that any person not being a shopkeeper retailing any food from a cart, barrow, basket or any other receptacle, shall be registered with the Local Authority, and that the storage premises used by him shall also be registered. The number registered as trading in the district at the end of the year was 64, an increase of 3 during the year. Of these 24 were trading from storage premises in Harrow and 40 from premises outside the district. (D) ADULTERATION OF FOOD The sampling of foods and drugs is one of the activities of the staff of the Public Control Department of the County Council. Other work they do includes duties under the Weights and Measures Acts, the Merchandise Marks Act, and the Pharmacy and Poisons Act. This Department also deals with the licensing of agencies for the supply of nurses, the registration of theatrical employers and the licensing of employment agencies. In addition, it has responsibilities under the Road Traffic Acts for checking that on vehicles using County roads the weights transmitted by the road wheels do not exceed the prescribed weight, and the enforcement of the Motor Cycles (Protective Helmets) Regulations. The following particulars have been taken from the Annual Report of the Chief Officer of the Public Control Department for the year 1958/ 59, and which of course relates to the whole County and not merely to this district. Of the 1,497 samples examined by the Public Analyst, only 82 were found to be incorrect. This was a marked improvement on the position of the previous year, but even then only 140 out of 1,567 samples examined were incorrect. Only 14 of the 507 samples of milk were incorrect. There was virtually no adulterated or sub-standard milk. Of the 10 incorrect new milk samples, being milk as delivered by farmers, 9 were samples from individual churns from consignments which on average were satisfactory. The tenth incorrect sample of "new milk" was from a churn containing 6% added water, the churn being one of a consignment of ten of which the other nine were allright. This farmer was cautioned. The four unsatisfactory samples of other milk were all of bottles delivered to schools. One bottle contained a chip of glass, the other three were contaminated by dust or mould. The dairymen were cautioned. The tighter control of the use of the word 'cream' has almost eliminated the former trade practice by which the word cream was applied to cakes and pastries filled with imitation cream. 74 Though not as much as in past years, there was still a little trouble in respect of pre-packed Continental cheeses. This arises because of the different practice between Continental and British traders. On the Continent the fat content is declared as a percentage of the dry matter, not of the whole sample; also a lower standard for cream cheese is accepted on the Continent than here with its minimum fat content of 50% of the whole sample. There was little trouble with preservatives in food. Two traders were prosecuted for selling foods containing unpermitted preservatives. One trader was prosecuted for selling sausages containing undeclared preservatives, and six retailers were cautioned for failing to declare the presence of permitted preservatives in sausages. 774 samples were examined by officers of the Department. These examinations are to detect the passing-off of one type of food for another, or to detect foreign bodies or other visual causes of complaint. Of these, only 54 were incorrect. The passing-off complaints continue to decline. None of the 346 samples of milk tested for the presence of the tubercle bacillus was found to be infected. 269 routine inspections were paid to the 25 premises licensed for the pasteurisation of the milk and the three licensed for the sterilisation of milk. 1,185 samples were tested to determine the adequacy of the process. In only two instances was it necessary to caution the trader. In addition to inspecting the plant and sampling the milk, washed bottles were submitted for bacteriological examination. Very few, and those only minor faults, were found amongst the 336 samples. (E) HYGIENE OF FOOD When, some ten years ago, the Council embarked on its food hygiene campaign, it followed three lines of approach—the conditions of the premises, those working in these premises and the consumers. As regards the premises themselves, there is now in general little enough cause for complaint. Much work had been carried out improving them, full advantage being taken of the many new fittings, equipment and materials which play their part in making the hygienic handling of food easier to practice; but carelessness, ignorance or indifference on the part of those working in these surroundings can still result in unsatisfactory states of affairs. This emphasises the need for the continued education of those handling the foodstuffs. This is not an easy problem and is one which is aggravated by staffing difficulties. Not only is there a quick turnover in the staff at many of these establishments which means the loss of those who might have been educated in standards of hygiene, but it leads to the engagement of those who are not experienced in the work and have not the standards of hygienic practice so essential to those handling food. This means that in the kitchens and in the shops there are lapses. No amount of supervision by the Inspectors can lead to the detection and eradication of these. It is for the public itself to play its part, the purchasers drawing the attention of the management to any undesirable practices. 75 Health Education. 44 talks on different subjects about health education and the health services of the district were given to audiences in the district. Among the various exhibits arranged was the one at the Delegate Conference. Most of the others were shown at the clinics and at the libraries. Appointment of Health Advisory Council. As part of their campaign for clean food, the Council in 1949 set up the Harrow Food Hygiene Advisory Council, a body on which those engaged in food in any way were strongly represented. In the earlier stages when there were no statutory standards, various members of the Committee were extremely helpful in advising about the codes of practice which, while being sufficiently stringent to be really useful, would nevertheless be practicable and be acceptable to those who had to work them. The Advisory Council were responsible, too, for deciding whether an applicant should be granted a food hygiene certificate which he could exhibit on his premises, and also qualify for a plaque which could be displayed. It was hoped that in time those dealing with foodstuffs would apply for and qualify for the receipt of certificates and plaques, it being hoped that when a substantial proportion exhibited them the discriminating shopper would appreciate their significance. In point of fact only a small proportion applied even though many who did not apply undoubtedly qualified for them, and in all only about one-third obtained and exhibited their certificates so this side of the work of the Advisory Council virtually came to an end. At the same time, the introduction of the Food Hygiene Regulations gave added powers to authorities to bring about the desirable standards of hygiene at food premises. This resulted in the work becoming part of the routine work of the Public Health Inspectors. Concurrently with the diminution in the work to be done by the Food Hygiene Advisory Council there was a continued expansion in the field of health education, something which in this district had started with the educational side of the clean food campaign. It was becoming increasingly necessary to get into touch with various bodies and a matter growing in importance was that of learning the best way of approaching them. To its other duties the Public Health Committee had added certain responsibilities in regard to the campaign in favour of safety in the home, while at the same time it was apparent that under the Clean Air Act, particularly the work dealing with smoke control areas, the right approach to the problem and to the people concerned was to be a matter of the utmost importance. This education of the public and also study of the way to approach the public was something the Food Hygiene Advisory Council had had experience in, and it seemed that it would be helpful if their experience could be made available in these extended ventures on which the Public Health Committee was embarking, The position, then, was that, while the food hygiene activities of the Food Advisory Council were diminishing, the Public Health Committee needed the assistance that a body with the accumulated experience of this Advisory Council could give in its extended activities. At their meeting on the 17th February then, the Public Health Committee submitted the following resolution: "That the Council hereby approve the setting up of a Health Advisory Council 76 to replace the Food Hygiene Advisory Council, its terms of reference being to consider all matters relating to food hygiene, clean air, safety in the home, and such other matters as are referred to the Advisory Council from time to time by the Public Health Committee and to make recommendations thereon to that Committee." Dogs in Food Shops. The question of whether a bye-law could be made prohibiting dogs being brought into shops was first considered by the Food Hygiene Advisory Council in October, 1949, when the views of the traders were obtained on whether they would favour a bye-law prohibiting dogs from all shops in the district where food is prepared, stored, handled or distributed. In view of the favourable response an approach was made to the Minister. He replied that the phrasing of the bye-laws then in force made under Section 15 of the Food and Drugs Act, 1938, did not prohibit the admission of dogs into shops. Following consideration of the Ministry of Food's circular M.F. 20/51, the Committee distributed to those food traders throughout the district notices suggesting to customers that in the interests of hygiene, dogs should not be brought on to food premises. These notices were remodelled and replaced in September, 1957, and it is these which are now displayed throughout the Borough. In January, 1959, the Minister of Health was asked whether he would favourably consider making a bye-law aimed at prohibiting dogs from shops dealing in foods. It seems though he felt it doubtful if a prohibitive regulation or bye-law would prove successful, it being difficult to impose such a requirement, as an authorised officer of the local authority would be unlikely to witness an offence and the shopkeeper would probably be reluctant to bring a charge against a customer. PREVALENCE OF AND CONTROL OVER INFECTIOUS AND OTHER DISEASES PREVALENCE OF INFECTIOUS DISEASES (other than Tuberculosis) Disease Under 1 yr. 1-4 yrs. 5-9 yrs. 10-14 yrs. 15-19 yrs. 20-24 yrs. 25-34 yrs. 35-44 yrs. 45-54 yrs. 55-64 yrs. 65 + yrs. Unknown Total Scarlet Fever 1 37 124 31 4 1 - - - - 198 Pneumonia, Primary 2 2 8 5 3 1 4 4 9 3 7 2 49 Pneumonia, Influenzal — 2 3 1 1 3 4 4 9 17 10 1 55 Diphtheria — — — — — — — — — — — — — Dysentery — 1 1 1 1 1 2 7 Erysipelas — — 1 1 3 1 1 1 8 Meningococcal Infection — — — — — — — — — — — — 1 Puerperal Pyrexia 1 — 3 2 — — — 1 10 Ophthalmia Neonatorum 1 — — — — — — — — — — — 1 Poliomyelitis, Paralytic — — — — 1 — — 1 — — — — 2 Poliomyelitis, non-paralytic — 1 — — — — — 1 — — — — 2 Encephalitis, Infective — — — — — — — — — — — — — Measles 54 1,027 1,156 52 4 2 4 3 3 18 2.323 Whooping Cough 1 17 12 3 — — — — — — — — 33 Paratyphoid Fever — — — — — — — — — — — — — Typhoid Fever — — — — — — — — — — — — — Food Poisoning 1 5 6 2 4 2 4 2 2 2 1 31 Malaria — — — — — — — 1 — — — — — CONTROL OF INFECTIOUS DISEASES As contrasted with the position even as recently as just before the last war, the infections today are not a formidable public health problem. The incidence of some of the more lethal infections has diminished. In some cases such as diphtheria, this is largely the result of active immunisation of large sections of the population. Other infections which wrought such havoc, especially amongst children, are no longer a menace. This in some instances is not due to a reduction in the incidence of the infection but to a lowering in the severity of what attacks still occur. This presumably in many cases is due to a change in the toxity of the organism, though helped by therapeutic measures to ward-off the damaging effects of secondary invaders. In other infections such as whooping cough there would seem to be a dimunition in incidence, doubtless contributed to by the active immunisation of many children; and also a lessening of the severity of the illness in those still attacked. The fall in the numbers of hese infections emphasizes the occurrence of outbreaks of other infections. these, influenza is one which is always a possible menace, being amaging not only to the individuals attacked but to the very life of the nation. Up to this, nothing could be done to stem the march of an outreak through the country. It is too early yet to decide on the value of the vaccines which have been prepared to ward off the infection. Fortunately the country virtually escaped from influenza last year. The other outstanding infection is poliomyelitis. In spite of the country having 78 experienced one of the hottest and sunniest of summers for years, one in which in ordinary circumstances it could have been anticipated that there would have been many cases of poliomyelitis, in point of fact its prevalence was low. For this active immunisation must be given much of the credit. There was no change during the year in the arrangements made to control the spread of the various infections. During the year, authority was given for steps to be taken for the erection of the new disinfecting plant. DIPHTHERIA Incidence Although a number of patients were suspected to be suffering from diphtheria, in none was the diagnosis confirmed. The district has been free from this infection since 1950, a period of nine years. The last fatal case was in 1946. In this last year there have been outbreaks of diphtheria in different parts of the country with the result that the curve of incidence which had fallen each year since the practice of immunisation of children against diphtheria was accepted on a wide scale throughout the country in the early 1940's has not only continued to fall, but has risen sharply. What has happened in these different districts is a sharp reminder that diphtheria was controlled only by large scale immunisation, and can be held in check only by the same means. Immunisation An undue proportion of cases of paralytic poliomyelitis were found to occur in children who had recently been inoculated. Enquiries showed that the risk was greater following some inoculations than others, and that there was a variation in the risk of antigens used to protect against the one infection. There have been few cases of these, but because there was a different incidence after varying preparations, it was decided that the use of those which semed to carry the greater risk, even though this was quite slight, should be discontinued. For this reason the use of the combined preparation aimed at preventing diphtheria and whooping cough was discontinued. This meant the children who were to be protected against both these infections had to receive a greater number of inoculations. This is the probable explanation for the fall in the numbers of children being inoculated against diphtheria. In the Spring a conference of those specially concerned with the matter was held. It was hoped the outcome would be a firm recommendation about the practice ot immunisation against the various infections, so that the arrangements would virtually become standard throughout the country. It was, however, not possible to reach agreement as some were still much concerned about this risk of provocation poliomyelitis. Most have concluded that the risks were magnified, and in any case that what risk there was had to be set against the fact that the price of reducing this risk was that many more children, because they were not being immunised against diphtheria, 79 would be that much more subject to the risk of contracting this infection. It is hoped that the resumption of the use of the combined preparation will result in more children being protected against diphtheria. During the year, 2,307 children were treated for the first time, 1,415 by general practitioners and 892 at the infant welfare centres. The corresponding figures for 1958 were 1,934, 1,128 and 806; for 1957 2,135, 1,174 and 962, and in 1956, 2,336, 1,109 and 1,227. It will be noticed that the increase in the numbers treated is mostly amongst those treated by general practitioners. The reason is doubtless that many of the general practitioners continued to use the combined preparation at a time when its use was discontinued at the clinics. It was estimated that at the end of the year, 60 per cent of children under five years of age were protected and 97 per cent of those aged five to fifteen years. The difference in these two percentages comes about for two reasons. The one is that it is not the practice to immunise against diphtheria a very young child. At one time few babies would have completed their course of immunisation before they were one year old. At that time even if all were then done before they were five, the percentages of those under five immunised could not be more than eighty. The same position holds, though not to the same extent, now that immunisation against diphtheria is carried out at younger ages; in none of them is treatment started before the age of six months. The other reason for the difference is that those in the five to fifteen age group are the carry-over of those who were inoculated at a period when most infants were receiving this treatment. Booster doses were given to 792 children, 460 by general practitioners and 332 at the clinics. SCARLET FEVER For many years now scarlet fever has been a very mild infection, the change in the severity of the illness presumably being due to a change in the virulence of the organism. During this phase the incidence has been most variable. This again is presumably the result of changes in the invasiveness of the organism. In the last few years the incidence has been light. In 1955, 125 cases were notified; in the succeeding years, 129, 76 and 134. In this last year the number rose to 202. The rate per thousand population was 0.90. The corresponding rate for the country as a whole was 106. The weekly notification rates over the four quarters were 5, 4, 1 and 5. The type of infection remained mild. Scarlet fever today causes very tew deaths. The last case contracted in this district which proved fatal was in 1937. Very small numbers of patients suffering from scarlet fever are now removed to hospital. This last year the number was only five, and of those iee were transferred from other hospitals. 80 Scarlet fever is still a communicable disease, and in nine households there was a secondary case. In four of these, removal to hospital of the first patient as soon as he was recognised to be suffering from this infection would not have avoided the infection being passed on to the other patient as this second patient had already been attacked by this time and in fact in two instances both patients were diagnosed together. In three cases removal of the primary case would probably have avoided the infection of the other patients in the house because in these instances the interval between the onset of the infections were longer than the usual incubation period, being ten, nine and fourteen days. In the remaining two households where there were secondary cases the intervals between the onsets of illnesses in the two sets of patients were forty-six and thirtytwo days. In neither instance was there any person who gave a history which might suggest that he was a missed case, and so provide a link in the two cases in the household. Occasionally a child succumbs to the infection some days after the return home of another child who had been removed to hospital suffering from scarlet fever. Where a second child falls ill within twenty-eight days of the return home this is classed as a returned case, the patient being presumed to have been infected by the returning child. There was one such case this year. The primary case had been admitted to a hospital for some other condition and there developed scarlet fever, so she was transfeired to an infectious diseases hospital. Ten days after her return home her mother succumbed to an attack of scarlet fever. It is quite exceptional these days to have an outbreak of scarlet fever amongst pupils at a school where it is accepted that the infection must have been contracted at the school. Nevertheless, groupings of cases do occur which suggest this possibility. This is the more marked where there are over a period a number of cases amongst pupils at a school quite out of proportion to the incidence of infection in the district as a whole. These groupings might be of one of two patterns. The one is the occurrence of a number of cases over a short space of time. The other is the occurrence of small numbers of cases, one or two each week, spread over a number of weeks. This disproportionate distribution of cases amongst pupils of a school is suggestive, but becomes much less so when the cases are broken down into the various classes the children attend. It is then so often found that there is no undue incidence amongst those attending any one class. There was last year one instance of the first type of grouping. This occurred at Priestmead School in the last three weeks of the summer term; in the Infants' department there were five cases, in the Junior, two. There were two instances of the drawn-out grouping, both occurring in the Autumn. Over a period of eight weeks there were five cases of scarlet fever amongst children in the Infants department of Pinner Park School and over the same period four amongst those in the Junior department. The other occurrence was at Vaughan Road school where, over a period of eight weeks, there were seven cases, two occurred in one week; there were no notifications at all in each of two weeks and one notification in each of the other weeks. 81 SMALLPOX There were three occasions on which contacts of persons suffering or suspected to be suffering from smallpox came into the district. The first was on the occurrence of a case of smallpox in Liverpool in March in which there was one secondary case. Later in the month a patient who was admitted to a hospital in this district had travelled on a 'plane from which had been removed a patient suffering from smallpox. In the third instance five passengers and three members of the crew of a boat on which there had been a suspected case of smallpox came into this district; the diagnosis, however, was not confirmed. In these cases the contacts are kept in touch with for a period something longer than the usual incubation period of the infection. Vaccination During the year, 2,374 persons living in the district were vaccinated against smallpox for the first time. Of these, 1,810 were under one year of age and 231 were over one but under two years of age. 722 persons were re-vaccinated. 2,931 babies were born daring the year. The number of vaccinations of those under one year of age was therefore 62 per cent of the births. Of those under one year of age who were vaccinated 865 were treated at the infant welfare centres. The present position, though far short of what is desirable, is a marked improvement on that of the country as a whole, and is better than the position before 1948 when, although it was obligatory on parents to have their children vaccinated, a very much smaller proportion were in fact treated because so many parents took advantage of the clause by which they could claim exemption. It is possible that more parents are having their babies vaccinated because of the scale on which protection against other infections is carried out and they are coming to accept vaccination against smallpox as just one of these procedures. ENTERIC FEVER Although it is many years now since any substantial number of cases of enteric fever occurred in any one year amongst those living in this district, it was up to recently usual to have a few notifications each year, most of these being of persons suffering from paratyphoid fever. 1959 followed 1958 as being a year in which no notifications were received, not even amongst those who had spent summer holidays abroad. DYSENTERY The number of notifications received of patients suffering from yhse,?tery varies greatly from year to year, depending very largely on aetha the infection has struck the pupils of one or more schools in e district. This year there were only seven notifications; nearly all of em were of adults. In a number of instances the diagnosis was arrived 82 at on clinical grounds, no bacteriological examinations being carried out, or if carried out the findings being negative. The organism of Shigella sonnei was recovered in three instances. The cases were distributed throughout the year with no incidence in any one period. There was only one instance of a secondary infection in the home; in this the illness of a child of one year of age was followed by a similar illness in her mother. FOOD POISONING The numbers of notifications of food poisoning received each year since 1954 were 37, 57, 77, 65 and 44. This last year the number was 31. Though this is a reflection of an actually lower incidence than has been the case in recent years, too much should not be read into it as the fall pointing to the problem being on the way to solution. The figures of notifications are too unreliable for that. There are still too many cases of sufferers not being notified for that to be accepted as the position. It is still common on enquiries being made at the household of a sufferer, to find that other members give a history of similar symptoms to the patient who has been notified, but who have not themselves been notified, possibly not even having had the attention of a doctor. Similarly, when enquiries are made about a person at risk in some of the large scale food poisoning occurrences outside the district, it is found that some sufferers had symptoms sufficiently mild and possibly so evanescent that they had not called in their doctors, but in whom these symptoms developed at the same time as in the more seriously ill persons. On the other hand, notifications of food poisoning are received in respect of some in whom the diagnosis is in doubt. This is more likely to be the case of single notifications. This occurred less often than usual this year, there being only one single case of a child being notified with no examination of the faeces, and one in which the examination failed to show the presence of food poisoning organisms. Most notifications related to persons who were involved in grouped occurrences, either familial or associated with a canteen, even though in many instances only one person was notified. Sometimes this would be because the foodstuff was consumed outside the district and the person notified was the only one living in the area and therefore the only one to be notified here. The first of these groupings was a family infection of five members falling ill simultaneously. The food suspected was scotch eggs. S. typhimurium was recovered from the patients. The next was a schoolI chi who had meals at the school canteen. All other members of the family remained well until some three weeks later when her sister fell ill. S. typhimurium was recovered from the faeces of both. In July, a girl of three had a birthday party. Eight of the eleven children and two of the nv adults present became ill. S. Heidelberg was recovered from the faeces. Many of the articles of food could have been the source of the orgams but nothing was proved. In September, an adult woman and her adult 83 son fell ill together; S. typhimurium was recovered from both. In December, many who attended a staff party in London fell ill. Only one of the five people in this district who had symptoms was notified. S. typhimurium was the cause of the trouble. There were three occurrences suggestive of food poisoning involving more than one person but where no food poisoning organisms were recovered on examination of the faeces of the patients. Two were members of a luncheon club outside the district; salmon was suspected, but no food poisoning organisms were recovered from it. An adult female fell ill with the same symptoms as a number of others at her place of work outside the district, at which there was a staff canteen; none of the members of her family at home was ill. A boy of seventeen was the only one of a family of three who was notified, though in fact all three had the same symptoms. There were four occurrences which suggested food poisoning though no bacteriological examinations were carried out. The first was a girl of fourteen who was one of some forty sufferers amongst the pupils at a school outside the district which had a school canteen. Two children aged four and two fell ill simultaneously, the other members of the family remaining well. A girl of twenty-five was one of some forty sufferers who had food from a canteen at some works outside the district. A mother and her boy of six fell ill while the father and another child remained well; the sufferers had eaten sausages which were not consumed by those who did not fall ill. There were ten single cases. From eight of these a food poisoning organism was recovered; in four this was S. typhimurium, in one S. Anatum and two salmonellae not specified. From the faeces of a boy of eight no food poisoning organisms were recovered; because his mother worked in a canteen, examination was carried out of the faeces and CI. welchii was recovered. Of the other two single cases, one was a baby from whom no food poisoning organism was recovered who was already ill when he was being brought into the district; and in the other case no tests were carried out. In the twelve grouped occurrences, S. typhimurium was responsible for five, S. Heidelberg for one. Of the ten single cases, salmonellae, of one sort or another, accounted for seven, CI. welchii probably for one. The first of the cases was notified in April. From then on the only month in which there were no notifications was August. Most occurrences were in July and September when there were five in each month. Nine of the cases occurred in the second quarter, 13 in the third and 9 in the last. Each year the Public Health Laboratory Service publishes a report about Food Poisoning in the country as a whole. That for 1958 recorded about in incidence of 3 per cent on the numbers for 1957. The report says; ''it becomes clearer each year that food poisoning in England and ales is largely a matter of salmonellosis. Recent studies have uncovered numerous hitherto unsuspected sources of infection. What is now needed is application of control measures to the known sources, and in particular to egg products. Until control is applied, no great change in the incidence of salmonellosis can be expected." 84 ERYSIPELAS Only eight people were notified last year as suffering from erysipelas, 4 men and 4 women. In five the face was the affected site. In two instances the condition followed injury. Three of the patients were removed to hospital. None of the cases was fatal. MENINGOCCOCAL INFECTION In only one of the thirteen patients removed to hospital suspected to be suffering from cerebro-spinal meningitis was the diagnosis confirmed. The sufferer was a girl of fifteen who fell ill in January. ACUTE ANTERIOR POLIOMYELITIS The incidence of poliomyelitis in the country as a whole for the first half of the year followed the pattern of the previous year, a year of very low incidence. Whereas though in 1958 the numbers of weekly notifications continued to rise as expected in the summer, in 1959 the rise was much less, so that by the period of heaviest incidence, the weekly notifications were only about half those of the corresponding weeks of the previous year. This was in spite of the country having experienced one of the warmest and sunniest summers for years, conditions in which in ordinary circumstances the incidence would have been expected to be high. From the beginning of the last quarter, when following the usual pattern, the incidence was falling, there was a steadily increasing disproportion between the figures for corresponding periods of the two years; the ratio of one to two became one to four and later even more. The figures of notifications for the last three weeks of 1959 were 7, 4 and 2. The figures for the corresponding weeks of 1958 were 47, 28 and 20. For this lowered incidence, immunisation of large numbers of the population must be given credit. By the end of the year 46 per cent of those in the 16-26 age group had registered and nearly all had had two doses. The acceptance rate of children reached 75 per cent. The lowest incidence of poliomyelitis is towards the end of March. With the very small numbers of cases occurring towards the end of 1958 there were hopes that by March the position would be reached when for some weeks there would be no cases at all. In point of fact that situation did not arise, so that what will happen when it does occur is still uncertain. It might happen that once a break occurred, the pattern of incidence of the infection in this country might revert to what it was before the first nation-wide attack in 1947, since when the country has never been free from the infection. Should there be this reversion to the pre-1947 pattern, the whole question of immunisation of the general population against poliomyelitis would come up for consideration. It was estimated that in 1958 the incidence rate was 4.3 per 100,000 in the vaccinated, and 21.4 per 100,000 in the unvaccinated. In the same year the fatality rate was over ten times in the non-immunised children as to those vaccinated. 85 The Soviet Union embarked on a mass vaccination programme in 1959, using a live-virus vaccine given by the mouth, the aim being to treat the entire population under the age of 20 by the end of 1960. Inoculation. This year was the first time the arrangements for inoculating sections of the population against poliomyelitis ran smoothly, there being sufficient material at all times except a short period in April. Towards the end of the year, by which time the large volume of additional work entailed by the decision to extend the course to three doses had been disposed of, inoculation against poliomyelitis was assuming the hoped-for pattern in that most of the work was that of giving babies their routine inoculations. The following is a summary of the work done during the year:— 20,957 persons received two injections. These comprised 8,875 children under 15 years of age, 10,369 in the 15 to 25 age group. 1,324 expectant mothers, 46 general medical practitioners and their families, 6 ambulance staff and 337 hospital staff. 30,607 persons received their third injections. 166 persons had received only the one injection by the end of the year. MEASLES The rise in the number of cases notified in the later weeks of 1958 continued into the earlier weeks of 1959. In January the average number of notifications each week was 140. In February it rose to 211, the month of greatest prevalence. In the week ending February 21st, 235 cases were notified, this being the greatest number of notifications ever received in the district in any one week. There was a sharp decline to a weekly average of 84 in March, and a further fall to 69 in April. Declines in the next two months led to the virtual freedom of the district from this infection. In all, 2,323 cases were notified. The average number of notifications each week in the first quarter was 143; in the second 36, in the third 4 and only 1.5 in the last quarter. In general, the clinical attack was mild, though there was one fatal case. Only 7 sufferers were admitted to hospital. In the early weeks of the year when the infections was especially prevalent, a number of schools were heavily attacked, these including the infant and junior departments of Aylward, Glebe, Kenmore, Longfield, Pinner Park, Priestmead and West Lodge. Those schools which had been attacked in the autumn term of the previous year escaped, most °f them almost completely. WHOOPING COUGH This district was very free from whooping cough throughout the year, only 33 cases being notified. Of these, half occurred in the last weeks of the year. No persons suffering from whooping cough were removed to ospital, and there were no fatalities from this infection. Inoculation. During the year, 2,272 children were inoculated against whooping cough, 1,309 by general practitioners and 963 at the clinics. 86 PUERPERAL PYREXIA Of the 10 women who were notified as suffering from puerperal pyrexia, six were confined at home. In three the raised temperature was due to engorged or inflamed breasts; in one the rise of temperature followed a miscarriage. Clinically the cases were mild and the fever short-lived. Four notifications related to women who had been confined in hospital but who had come home early. In only one case did it seem that the rise in temperature was due to a uterine infection. OPHTHALMIA NEONATORUM Only one infant was notified as suffering from ophthalmia neonatorum, this condition occurring in a baby whose mother had been confined at home. The condition was mild and recovery was rapid and complete. NON-NOTIFIABLE INFECTIONS Knowledge of the prevalence of some of the infections which are not notifiable in the district is obtained from intimations received from Head Teachers about the absence of children from school. Chicken Pox More than half of the 432 intimations that pupils in the various maintained schools were absent because of chicken pox came from Priestmead School where, in the summer term, the infants and then the junior departments were heavily attacked with in all 222 cases. At the same time, the junior department at Aylward School was affected with 77 cases and St. Bernadettes 35. Many of the other schools had anything up to ten cases, though many more remained quite free. Roxeth Manor and Stanburn School, two schools especially affected in 1958, were almost completely free. Mumps There were small numbers of cases of mumps amongst the pupils of a number of schools in the first two terms of the year, but it was not until the autumn term that substantial numbers at any school were attacked. Even at this time some schools escaped entirely and many had only small numbers. In all, 539 intimations were received. Of these, 105 related to Greenhill School, 55 to Pinner Wood, 46 to St. Bernadettes and West Lodge 43. Bridge Schools and Priestmead each had 39 pupils and Stag Lane 34. Although some pupils in the junior schools were attacked, most cases were amongst those in the infants' department. Although mumps in childhood is a trivial infection, in older children it can give rise to serious complications. A number of persons were removed to hospital suffering from mumps encephalitis. 87 German Measles While cases of german measles most commonly occur when the usual variety is prevalent, in this last year the 50 cases about which intimations were received bore no relation to the prevalence of measles in the earlier part of the year, the distribution of the cases being even throughout the three school terms, although there was little of the ordinary type of measles in the second and third terms. Influenza. This district was involved in the wave of influenza which attacked the country in the earlier part of the year. The first intimation of this district being affected was when almost half the pupils in the boys secondary modern school were absent with pharyngitis in the third week in January. By the middle of February outbreaks of an influenza-like illness were attacking those in residential schools, the day nurseries and service units throughout the country. While the rate of attack of those in these establishments was 40 - 60% there was at that time little evidence of any general involvement of the pupils. The next phase was the occurrence of localised outbreaks of a respiratory disease in many parts of the country, especially the North, the Midlands and the London region. In some of those, Virus A (Asian) was isolated, in others Virus B. The notifications of pneumonia increased, and then the deaths from pneumonia and bronchitis. The numbers of deaths from influenza then rose sharply, these being mostly people over 55. For instance of the 1,121 deaths in the week ending 21st February, 952 were of persons of 55 or over. At this stage the mortality level of the outbreak was less than half that of the peak of 1951 and was similar to the level of the outbreak of the winter of 1953 and of the autumn of 1957. Towards the end of February, the peak of the outbreak had passed and the yellow warning of the Emergency Bed Service, which had been introduced, was cancelled on the 10th March. In this district the wave was at its highest about the third and fourth weeks of February. Influenza as such is not notifiable but influenzal pneumonia is; as also is acute primary pneumonia. The notifications of influenzal pneumonia for each of the weeks from that starting week ending January 3rd were—0, 1, 6, 5, 5, 20, 6, 4, 1, 1, 1. The notifications of primary pneumonia in the corresponding weeks were—3, 3, 6, 3, 3, 2, 2, 0, 0, 1, 0. Of the 18 deaths from influenza during the year, most were of persons of over 55 years of age; 8 were over 75. TUBERCULOSIS Notification The improvement in the general situation inregard to tuberculos is in the country as a whole continues. The fall in the numbers of notifications each year nationally is seen also in this district. For each year since 1955 the numbers of primary notifications have fallen, the actual figures being 160, 141 and 118; for last year the figure was 102. The same improvement is seen in the figures that give the numbers of those notified here 88 for the first time during the year combined with those of people who came to the district already suffering from the disease. The figures from 1955 onwards were 287, 264, 214, and 199; for last year it was 181. The following table gives the age and sex distribution both of the persons resident in the district which were learned of for the first time to be suffering from tuberculosis, and of those who moved into the district already suffering from the disease.:— Primary Notification Brought to notice other than on Form "A" Pulmonary NonPulmonary Pulmonary NonPulmonary M F M F M F M F Under 1 1-4 1 — — — — — — — 5-9 — — — — — 1 — 10-14 — — — — — — 1 — 15-19 5 5 — — — — — — 20-24 4 8 — 1 3 13 — — 25-34 6 8 2 1 11 21 — — 35-44 12 5 — 3 6 11 — — 45-54 7 5 1 1 3 1 — — 55-64 7 6 — — 3 — — — 65 and over 8 4 1 1 2 3 — — Totals 50 41 4 7 28 50 1 — A history of close contact with someone suffering from pulmonary tuberculosis, usually a member of a household, was obtained in 27 per cent of the male cases notified for the first time during the year and twentyfive per cent of the women. There are some occupations on which those engaged are especially prone to contract the infection. There were five instances of this this last year. There was no history of any of those illnesses or other states which predispose to the onset of tuberculosis, except that two of the women notified were pregnant when the disease was first recognised. There were four instances of a relapse in those who had suffered some years before and who had apparently recovered. In the remaining cases, and these formed the majority, no reason could be found for the breakdown in resistance which allowed the organism to gain the upper hand. Register The tuberculosis register is a compilation of the names of those persons in the district who are suffering from the disease or have recently suffered from it. The names of those newly notified are added to it, and entries are made of those persons who have moved into the district suffering from tuberculosis. Names are deleted on the removal of persons 89 fiom the district or on death or recovery, an accepted standard of recovery being a lapse of five years in the pulmonary cases and three years in nonpulmonary cases from the date the disease was arrested. The following is a summary of the changes which have taken place in the register during the year:— Pulmonary Non-Pulmonary Mate Female Male Female No. on register, 1st January, 1959 1,306 1,019 129 144 No. of new cases added (primary notification) 50 41 4 7 No. of cases other than primary notifications 28 50 1 — No. of cases restored to Register 10 5 — — No. of cases removed 112 94 7 10 No. on register, 31st December, 1959 1,282 1,021 127 141 Of the 223 deductions, 105 (98 pulmonary) were of persons who had left the district, 21 (all pulmonary) were of persons who had died, 79 (69 pulmonary) were of persons who had recovered and 17 (all pulmonary) were of persons who had been lost sight of. One had been de-notified. The net decrease in the number of cases on the register is 27, there being 22 fewer pulmonary cases and 5 fewer non-pulmonary cases. This is the third year that it has been possible to record a fall in the numbers of those on the register. Deaths Only 6 persons (5 men and 1 woman) in this district died from tuberculosis last year, all from the pulmonary type. This is a continuation of the decline which started a few years ago. The set-back during the war to the improving position developing before the war has now been completely overcome, this figure of 6 being in sharp contrast to the 97 deaths from this complaint in 1944 and even of the 57 which occurred as recently as 1949. In this last year, the infection caused a death rate of only 0.03 per thousand population and was responsible for only 0.3 per cent of the total deaths. The corresponding figures in 1934 were 0.57 and 7.1 and in 1946 were 0.42 and 4.9. Preventive Measures A most important aspect of the work of those engaged at the Chest Clinic is the prevention of the spread of infection. Early diagnosis in the sufferer is a very important preventive measure because the patient might be saved from reaching the infective stage in which he passes the infection to others. The examination of the immediate contacts of those discovered to be offering from pulmonary tuberculosis is helpful in two ways. In the first place it might lead to the detection of the infection in one who had been the source of infection of the first patient; his discovery might avoid his passing on infection to others. The other way in which this practice is helpful is, of course, that the disease is recognised early in 90 those to whom infection has been passed on. The activities at the Chest Clinic are important in less direct ways. Persons attend the clinic even though not suffering from pulmonary tuberculosis and many, especially children, attend until the clearing up in their chests of conditions which would have developed some lung change which in turn would have rendered them more liable to succumb to tuberculous infection. The Mass X-Ray Unit which is run not as part of the Chest Clinic service but by the hospital service, plays its part in prevention in the same way by leading to the detection of disease at an earlier stage than otherwise would have been the case, and so saving many from reaching the infective stage in which they pass on trouble to others. About 20 per cent of new cases are discovered by these means. This Unit was last here in 1956. The local school medical and nursing staff, too, have some part to play in the control of infection in different ways: 1. At some schools the school medical officers carry out the routine tuberculin testing of entrants in the hope that examination of the contacts of the positive reactors will lead to the detection of those who have exposed the child to the tubercle bacillus. During the year, 816 children were tested. Of these, 12 reacted positively. Six of these had had B.C.G. inoculation; X-ray examinations of the others were clear. No home contacts were in fact discovered in this way. 2. Whenever a pupil or adult worker at a school is found to be suffering from pulmonary tuberculosis, the question of carrying out an investigation at the school is considered. (i) A girl of fifteen was discovered late in 1958 to be suffering from pulmonary tuberculosis. All of the eight teachers who were X-rayed gave negative findings. Of the 65 children tuberculin tested, eight reacted positively. The examination of these led to the recognition that one was suffering from pulmonary tuberculosis; examination of her contacts led to the detection of the infection in her father. (ii) The 25 contacts of a boy of seventeen at a grammar school were tuberculin tested. Six were found to react positively; all were found to be clear on X-ray examination. (iii) A boy at a secondary modern school in August was recognised to be suffering from pulmonary tuberculosis. He and his immediate contacts had all left school at the end of the previous term. All 21 attended the Chest Clinic for examination and were found to be clear. There were three other school children who were admitted to local schools from others outside the district and who had before transfer suffered from tuberculosis, two of them from pulmonary and one from glandular tuberculosis. None was infective at the time of transfer so no investigations were necessary. 3. B.C.G. Inoculation. Another contribution made by the School Health Staff is by B.C.G. inoculation. The groups selected for treatment are children of thirteen years of age. This entails a separate examination as this is not an age group at which a routine medical examination is 91 carried out. As those who have already been exposed to infection do not need the injection, the procedure is first to carry out a tuberculin test. Those who react negatively are given an injection. Those reacting positively are referred to the chest clinic for examination. It has proved possible to carry out these tests on the relevant children at all schools in the course of the year, the pupils at the Secondary Modern schools being dealt with in the Spring term, those at the Grammar schools in the Summer term and those at the Independent schools in the Autumn term. The following is a summary of the work carried out in 1959:— Type of School No. of Pupils Eligible No. of Acceptances Negative Reactors Positive Reactors Secondary Modern 1,189 1,339 1,088 131 Secondary Grammar 879 582 502 54 Special 9 3 3 Independent 972 705 569 59 Total 3,749 2,629 2,162 244 (4,996) (3,139) (2,648) (254) The corresponding figures for 1958 are shown in brackets. Of the negative reactors, 2,107 were given B.C.G. Many were not inoculated at the time of testing mainly because of recent poliomyelitis injections. In this country, inoculation by B.C.G. with a view to protection against tuberculosis was not carried out as a routine practice on any scale until the findings of a field investigation conducted by the Medical Research Council were reported in 1956. This trial showed that the inoculation resulted in a marked reduction in the incidence of tuberculosis amongst the vaccinated as compared with what they might have been expected to have had if they had not been vaccinated. It showed too that the protection conferred by the vaccine was evident soon after it had been given, and was still substantial after two to two and a half years. At the time the report appeared it could only refer to protection for that length of time as up to then only that period had elapsed. It was on this report that the Minister authorised school children of thirteen years of age being given the opportunity of being inoculated with B.C.G. It is under this authority that the County Council arranged for these facilities being made available for children of these ages in the county. The M.R.C. trial which was begun in 1950 is still in progress. A second report has now been issued. The findings are that:— During the five-year period the annual incidence of tuberculosis in the B.C.G. vaccinated group was 0.38 per thousand compared with 2.29 per thousand amongst those in the tuberculin negative unvaccinated group. This represents a reduction attributable to vaccination of 83%'. 92 'The incompleted information beyond five years shows that similar high levels of protection have continued up to at least six and a half years'. 'There is now a suggestion that the lesions in the vaccinated cases were less extensive and less severe than in the negative unvaccinated cases'. This particular age group was selected in the hope of reducing the susceptibility of adolescents who are vulnerable and who are leaving their more sheltered life for one of greater exposure. If the continuation of this trial shows that the protection afforded lasts for an even longer time, it might be possible, while giving the required protection to adolescents, to lower the age at which vaccination is carried out, and so reduce the number of cases occurring amongst those in the years just before thirteen years of age. It is probably unwise to make the change until the trial continued for even a longer time yet, can demonstrate that there is no appreciable falling-off in the effect of the vaccination for a longer time than the five years now being reported. While the efficacy of the preparation has been demonstrated, there is the quite independent question of whether it is needed. This depends on the extent of the infection which the use of this preparation can be expected to reduce. In those countries where there is much tuberculosis any measures such as this will be helpful in any general campaign against this disease. On the other hand, there might be the country or part of the country in which so few adolescents succumb to tuberculosis that the question of the worthwhileness of the scheme has to be gone into. In such a district as this, in which the incidence among tuberculin negative adolescents is already so low, the time might not be too far distant when this problematical saving of infection in a child has to be weighed against the disturbance to the school routine entailed in testing and inoculating some thousands of children each year, and against the lesions suffered by those who have unusual reactions. The County Council's arrangements for B.C.G. inoculation of children of 13 years of age were modified during the year so that vaccination could be offered to those approaching 13 years and could conveniently be treated along with those of that age, children of 14 and students attending establishments of further education. Fifteen persons of ages between 14 and 24 were notified during the year as suffering from pulmonary tuberculosis which presumably they contracted while living in this district. There were no non-pulmonary cases. Of these, 3 (males of 16 and 18 and a female of 15) gave a family history of infection. The ages of the remainder who did not give such a history were: males 18, 21, 23, 24 and 24; females 19, 21, 23, 24 and -4. Of the factors about which the District Council can help, the most important is housing. The Council has all along been very generous in its allocation of houses for those families in which there is a member suffering from pulmonary tuberculosis. In selecting who should be helped, 93 the underlying factor is the determination of the harm done by the family remaining in the then surroundings. An assessment is attempted of the danger of spread from the patients to others. This is determined largely by two factors: one is the infectiousness of the patient, the other is the facility with which the disease could be spread; this is measured by the degree of crowding. Particularly in the earlier stages of the post-war years there were many families so placed that rehousing as a preventive measure was urgently necessary and the Council allocated as many as ten per cent of new housing for these families. The position improved gradually and has now reached a stage when there are really no urgent cases requiring rehousing on these grounds. The occasional case will continue to appear out of the blue on the occurrence of an infective case amongst those living in a crowded house, but in general the situation from this point of view is satisfactory. It has been necessary to adopt this standard of assessment for rehousing as a preventive measure. It has never been possible to consider the other most desirable aspect of rehousing a family in the interests of the patient himself. Arthur Gaunt & Sons (Printers) Ltd. Market Place . Heanor . Derbyshire