WEM 10 WEMBLEY URBAN DISTRICT COUNCIL. ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1919. HARROW: Printed at the "Observer" Printing Works. WEMBLEY URBAN DISTRICT. Annual Report, 1919. To the Chairman and Members of the Wembley Urban District Council. Gentlemen, I have the honour to report upon the natural and social conditions and the sanitary circumstances of the District for the year 1919, being the 26th Annual Report issued since the formation of the Council. The Wembley District, bounded on the North b\ Harrow and Wealdstone, West by Harrow, Greenford and Ealing, South by Ealing and Willesden, East by Kingsbury and Willesden, has an area of 4564 acres—is situated, amidst pleasant undulating- meadow lands, is capable by reason of unusual facilities for access to London (having four railways, eleven stations, and a tramway service) of attracting in the near future a much larger residential population. Under favouring circumstances the potentiality for suchincrease will be more easily realised when it is considered that the District is 1000 acres larger than the borough of Ealing, has twice the area of Harrow, is actually greater in area than Willesdep, and four times the size of Wealdstone. In spite of the fact that the soil is London clay, me salubrity of the climate is well known—the air many times more bracing than London—the difference being very marked on returning- from the Metropolis in the evening. It is an undoubted fact, too, that children thrive to an extraordinary degree in every part of the district—whilst this is a fact, it should be remembered that no one should regard Wembley as a typically suitable resort for those suffering from gout, rheumatism or any form of tuberculosis. Even to these there have been many exceptions—particularly noticeable with those who have been careful to live in dry houses, wear warm clothing and live circumspectly. 4 POPULATION. The figures supplied by the Registrar General for the purpose of this Report are as follow:— 15,635 for the Birth Rate, 15,009 for the Death Rate, the difference being- accounted for by the enforced absence of men on service. BIRTH RATE. The number of Births registered during 1919 was 237, giving a birth rate of 15.15. In 1918 there were 253 births. The illegitimate births were only four. DEATH RATE. There were 129 deaths registered as belonging to the District, giving the quite satisfactory death-rate of 8.5. Among the chief causes of death were:— Malignant Disease 18 Heart Disease 16 Pulmonary Tuberculosis 12 Pneumonia 11 Influenza 10 Of the 129 deaths, only 20 reached the age of 75, six of whom were over 85, six over 80. INFANTILE MORTALITY. Twelve children died under twelve months old in 1919, giving an infantile mortality-rate of 50.6—just under the last six years' average, but too high, of course, for these more enlightened days. The previous year, 1918, the rate was low, 39.5. NOTIFIABLE INFECTIOUS DISEASE. Of the 154 cases notified, 46 were Measles; Diphtheria 18; Pneumonia, 17; Influenzal pneumonia, 12; Malaria, 20; Pulmonary tuberculosis, 15; others forms of Tuberculosis, 5; Scarlatina, 14; Erysipelas, 4; Ophthalmia Neonatorum, 3. Measles were very prevalent but not so marked as in 1918 (46 as against 252), and not of a fatal kind. 5 I twenty of the above infectious cases (diphtheria and scarlet) were removed to Acton Isolation Hospital. We are again very much indebted to this authority for the great care and kindness shown to our patients. The necessity for using our own Isolation Hospital did not occur. CHILD WELFARE CENTRE. The Child Welfare Centre has more than justified your expectation of its proving a useful work in the District. The Committee, were, of course, fortunate in obtaining the efficient services of Dr. Granger Evans to superintend the work, and to her is mainly due the popularity and success of the Clinic. But there have been many ladies who have, from the first, voluntarily assisted and who, in no small degree, have contributed to this early success. With the great increase of work, we shall become anxious for the proper accommodation of the Centre. May I take this opportunity of stating that the work undertaken by this Clinic consists in the regulation of the infants' clothing and diet and in weight taking, etc., but if treatment is required the child is referred at once to the respective medical attendant—indeed one's experience is that many cases from this clinic reach the doctors, that would otherwise have no treatment at all, or be too late for efficient help. At this Clinic during 1919, there have been upwards of 4337 attendances. THE DENTAL CLINIC (Mr. Lafferty). The Dental Surgeon reports that this Clinic opened in March, 1919, is doing god work. Atendances are fairly satisfactory, Sudbury and Alperton especially showing appreciation. Dentures were supplied to five cases—109 patients required extractions, 36 filling's. HEALTH VISITOR (Nurse Phillipson). The report of the Health Visitor for the year endingDecember 31, 1919, is most satisfactory and shows a very considerable amount of useful "preventive" work. At the end of this Report you will find her different activities with lists of attendances in tabular form. 6 MIDWIFE (Nurse Tubbs). This new work also has proved successful—the nurse is most efficient, is very acceptable, and is now becoming fully engaged with new cases. THE DISTRICT NURSE (Miss Oliver) continues to be full of work. There is no need to refer to her good services annually but it is well to acknowledge them occasionally, though so well known throughout the district for so many years. On one occasion recently you showed your appreciation of her work at a time of great stress, by a small grant. THE COPLAND VILLAGE HOSPITAL. Miss Lucy Perkin, Hon. Clerk to the Trust, reports that during 1919 56 cases received free medical attendance and medicine. Thirteen patients were sent to Convalescent Homes, 11 patients received complete dentures, 3 patients received spectacles, others surgical appliances; others (carefully selected), received milk for emergences and for short periods. In addition to these services the Trustees' contribution to the District Nurse Fund was increased to £50. Altogether it is considered that no small fund could be more wisely administered, but in spite of all the medical assistance rendered by the foregoing activities there is no question but that the District badly needs a little Hospital of its own for surgical and medical treatment of the inhabitants. Accidents are becoming more numerous and many cases are sent away that could and should be treated in a properly equipped Cottage Hospital. If once the inhabitants could be convinced of this necessity, all classes would unite to found a suitable local Hospital for this increasing district. WATER SUPPLY. The Wembley District is served by the Colne Valley Water Company, at Bushey, Watford, a constant supply. In the past examinations have shown it to have been a good drinking water, comparatively soft, palatable, bright and clean, but during the war, and especially noticeable here in 1919, many users found that the water on first being drawn 7 became milky and appeared full of lime, actually depositing a chalky sediment on being allowed to settle. We are requesting an explanation and hope to have a satisfactory statement that this matter will be remedied at an early date. OVERCROWDING. I regret to report that there has been serious overcrowding for the past two years throughout the whole district. Directly and indirectly the health of the locality must be affected, but it is useless to complain until the housing scheme is completed. At present all we can do is to assist in re-arranging bedroom and apartments. SEWAGE OUTFALL WORKS. It has not, unfortunately, been found possible during the war to carry out the comprehensive scheme of treatment referred to in my Report of 1914—prepared by the Council's Engineer and approved by the L.G.B. Recently, however, the technical staff has returned ana I understand that the scheme is being pressed forward as a matter of urgency—the estimates being brought up to date— with a view to applying to the Ministry for the sanction to borrow the necessary money. The pre-war estimate was £13,000, but this figure will now be seriously increased. Meanwhile every care is being exercised in dealing with the sewage with the limited capacity of the tanks and bacteria beds. REMOVAL OF HOUSE REFUSE. This is now being carried out in an efficient manner once in each week. It is a matter of great satisfaction that all vour employees in this and other sanitary work have returned from the war safe and sound. OFFENSIVE TRADES. Fat melting and extracting are carricd on at two premises in the district. Fish frying on one premises. Sanction has been given for fish frying near Alperton at another shop. 8 COWSHEDS, DAIRIES AND MILKSHOPS. We are constantly making inspections of these premises. In 1919, they were found in a fairly satisfactory condition— a few farms gave trouble but cleared up just in time to avoid our recommending- you to take legal proceedings. The Bakehouses, Workshops and Slaughterhouses have been frequently and systematically inspected during 1919— and all defects remedied at once. Food Inspection, in some form, has been undertaken almost daily, and better conditions have been frequently insisted on. Every kind of nuisance has been dealt with and in allcases abatement has followed, by exhibition of firmness and tact without asking you to take legal proceedings during 1919. The School premises have been periodically inspected— and several minor nuisances rectified. At the end of this Report you will find all the tabular lists required by the Ministry. As regards the war and its results on the health of the district, I cannot state that we have suffered to a greater degree than other localities. We have our share of pensioned men, and neurasthenics, but psycho-analysis and better forms of nerve treatment will improve and cure the latter, while time will cure all things ! LIST OF ACTS ADOPTED IN WEMBLEY URBAN DISTRICT. Infectious Disease Prevention Act, 1890. Public Health Acts Amendment Act, 1890. Public Health Acts Amendment Act, 1907. Private Street Works Act, 1892. BYE-LAWS IN FORCE. Common Lodging Houses, Slaughterhouses, Nuisances, Cleansing of Earth Closets, Privies and Ashpits, Houses let in Lodgings, Pleasure Grounds and Open Spaces, Offensive Trades, New Streets and Buildings, Tents, Vans, Sheds and similar structures used for Human Habitation. Regulations made under the Dairies, Cowsheds and Milkshops Order, 1885 9 Before concluding I know you would wish me to express your thanks to the Deputy Medical Officers of Health (Dr. Dyson, Dr. Ambrose Goddard, and Dr. O'Connor), who so efficiently fulfilled their duties during the war—and may I take the opportunity of saying how greatly I have appreciated the courtesy and consideration I have received from every member of the Council—from every member of the staff, and especially from my very able and genial colleague, Mr. G. H. Fearn. Gentlemen, I have the honour to be, Yours faithfully CHARLES E. GODDARD, M.D. Fellow Royal Society Medical Officers of Health „ Royal Sanitary Institute. „ Royal Institute of Public Health. 10 TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1919 AND PREVIOUS YEARS. Year Population estimated to Middle of each year Births Total deaths registered in the District Transferable deaths Nett deaths belonging to the District. Uncorrected Number Nett. Number Hate of Nonresidents registered in the District of Residents not egistered in the District Under 1 year of age At all ages Number Rate Number Rate per 1000 nett Births Number Rate 2 3 4 6 6 7 8 9 10 11 12 3 1914 13,249 324 327 24.7 90 6.8 5 29 15 45.9 114 8.6 1915 14,433 327 335 23.2 103 7 5 34 23 68.6 132 8.15 1916 14,611 346 350 22.01 97 8.55 5 33 19 54.3 125 8.55 1917 16,443 235 237 14.23 127 8.60 6 32 19 77.8 121 8.2 1918 For Birth Rate 16,464. 253 253 15.3 130 8.8 7 36 10 39.5 159 10.8 For Death Rate 14,694. 1919 For Birth Rate 15,635. 237 237 15.15 110 7.32 10 29 12 50.6 129 8.59 For Death Rate 15,009. Area of district in acres (land and inland water), 4,564. Total population at all ages 0,696 Total families or separate occupiers 2,434 At Census 1911. 11 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1919. Notifiable Disease Cases notified in the whole District. Total cases removed to Hospital At all Ages At Ages—Tears. Under 1. 1 to 5 to 15 15 to 25 25 to 45 45 to 65. 65 and upwards Measles 46 1 12 24 6 3 Diphtheria (including (Membranous croup) 18 5 8 5 14 Erysipelas 4 1 3 Scarlet fever 14 1 11 2 6 Pneumonia 17 1 3 5 3 4 1 Influenzal Pneumonia 12 1 2 4 3 2 Ophthalmia Neonatorum 3 3 Pulmonary Tuberculosis 15 1 5 8 1 Other forms of Tuberculosis 5 1 1 2 1 Malaria 20 4 15 1 Totals 154 6 21 53 31 35 9 — 20 12 TABLE III. CAUSES OF AND AGES AT DEATH DURING YEAR 1919. Causes of Death Deaths at the subjoined Ages of ' Residents ' whether occurring within or without the District Total deaths whether of "Residents or "Non" Residents" in Institutions in the District All Ages Under 1 year 1 and under 2. 2 and under 5 5 and under 15 15 and under 25 25 and under 15 45 and under 65 65 and upwards All Causes Certified 1.29 12 1 5 5 6 18 34 48 Uncertified Diphtheria and Croup 1 1 Influenza 10 2 1 2 3 1 1 Phthisis (Pulmonary Tuberculosis) 12 1 8 3 Other Tuberculous Diseases 1 1 Cancer, malignant disease 18 1 8 9 Organic Heart Disease 16 1 1 6 8 Bronchitis 3 1 4 Pneumonia (all forms) 11 1 1 1 1 4 3 Other diseases of Respiratory organs 3 1 2 Cirrhosis of Liver 2 1 1 Nephritis and Bright's Disease 1 1 Congenital Debility and Malformation, includPremature birth 8 8 Violent Deaths, excluding Suicide 5 2 1 1 1 Suicide 1 1 Other defined diseases 35 1 1 2 1 2 8 20 Totals 129 13 1 5 5 6 18 34 48 Cerebro Spinal Meningitis, 1, (included in above figures). 13 TABLE IV. INFANT MORTALITY DURING THE YEAR 1919. Cause of Death Under 1 Week 1-2 Weeks 3 Weeks 3-4 Weeks Total under 1 Month. 1-3 Months 3-6 Months 6-0 Months 9-12 Months Total Deaths under One Year All Causes Certified 7 3 1 1 12 Uncertified Pneumonia (all forms) 1 1 Atelectasis 1 1 Congenital Malformations 4 4 1 1 5 Premature Birth 2 2 2 Atrophy. Debility and Marasmus 1 1 Influenza 1 1 2 1 Totals 7 3 1 1 12 Nett Births in the year: legitimate 233; illegitimate 12. Nett Deaths in the year: legitimate 4; illegitimate 0. 14 MATERNITY AND CHILD WELFARE. Year's attendance at Welfare Centre 4337 Infants under one year 1728 Children under five years 932 Average weekly attendance 60-70 Actual Infants attending 300 Actual Children 69 New Infants 109 Home visits paid to all children 6207 Number of visits to Infants 3904 Number of visits to Children 2303 No. of Infants Visited 615 No. of Children Visited 171 Dental Clinic 129 Under 5 years 4 Children 110 Adults 15 Measles 25 Whooping Cough 47 Consumptives 36 Ringworms 36 Pregnant Mothers 32 Summer Diarrhœa 24 Milk Tickets 994 Number on Books 886 Number on Centre List 369 SANITARY INSPECTION OF DISTRICT. Visits to Dairies 94 „ „ Cowsheds 84 „ „ Foodshop 418 „ „ Slaughterhouses 91 „ „ Bakehouses 25 „ „ Piggeries 70 „ „ Laundries 8 „ „ Factories and Workshops 20 „ „ Urinals 34 „ „ Ditches 42 „ „ Occupied Vans 3 „ „ House Refuse Shoots 36 „ „ Schools 38 Inspection under H. and T.P. Acts 222 Re-Inspections under H. and T.P. Acts 521 Other Inspections of Houses 311 Visits on Complaint 76 „ to cases of Infectious Disease 53 2,146 15 SANITARY WORK EXECUTED Roofs Repaired 45 Eaves guttering repaired or renewed 42 Eaves guttering cleansed 22 Stack pipes repaired 6 Stack pipes renewed 7 Dampness remedied 59 Yards paved 17 Floors repaired or relaid 49 Ventilation provided under floors 9 Oversite provided 6 Baluster rails fixed 4 Walls and ceilings cleansed and limewashed 122 Windows repaired 14 Windows made to open 13 Sash cords renewed 33 W.C.'s repaired 38 W.C. cistern regulated 18 Water laid on to W.C. cistern 3 Sinks provided or repaired 12 Sink waste trapped 5 Sink gulley dished 7 Drains relaid 14 Drains unstopped and cleansed 45 Vent pipe repaired or renewed 4 Manhole cover repaired or renewed 14 Cesspools cleansed 7 Urinals cleansed 12 Dirty Houses Cleansed 6 Accumulations of Refuse Removed 20 Dustbins supplied 66 16 UNSOUND FOOD DESTROYED. Gammon 13lbs. Collar 11 „ Fore-ends 69 „ Fore-hock 7¼ „ Sides of Bacon 90 „ Other Bacon 204¾ „ Beef 120 „ Cheese 36 „ Dates 56 „ Apples 40 „ Tomatoes 2 „ Rabbits 22 „ Oxtails 4 „ Condensed Milk 8 tins