WEN 12 Wembley Urban District Council. ANNUAL REPORT OF MEDICAL OFFICER OF HEALTH, 1921. PRINTED BY J. W. STEEL, 5. ST. JOHN'S ROAD WEMBLEY. 1 URBAN DISTRICT COUNCIL OF WEMBLEY. PUBLIC HEALTH COMMITTEE. Chairman. Councillor J. W. Comben. Councillor P. Bottoms. Councillor W. Lefley. „ W. J. Busby. „ J. H. Hawley. „ E. Butler. „ A. Hewitt. „ H. H. Crabb. „ A. W. Sheppard. „ G. R. M. Frieake. „ J. W. P. Silvester „ H. T. Treglown. CHILD WELFARE COMMITTEE. Chairman. Councillor J. W. Comben. Councillor P. Bottoms. Councillor A. Hewitt. „ H. H. Crabb. „ A. W. Sheppard. , J. W. P. Silvester Co-opted Members of the Child Welfare Committee. Mrs. Goodman, Miss Watson, and Miss Oliver. PUBLIC HEALTH STAFF. Mrdical Officer of Health {part time). Charles E. Goddard, O.B.E., M.D., L.R.C.P. (Lond.), M.R.C.S. (Eng.), T.D., A.K.C. (Lond.). Sanitary Inspector (whole time). George Hargreave Fearn, Cert.R.S.I. Clerk (whole time). Frank Langmead. Foreman for Removal of House Refuse and Motor Ambulance Driver (whole time). James Mansell. Medical Officer of Child Welfare Centre (part time). Edith C. Hudgell, M.R.C.S., L.R.C.P. (Lond.) Dental Surgeon (part time). Charles Lafferty, L.D.S. Health Visitor (whole time). Maud J. Phillipson, Cert. Gen. Hosp. Training, Queen Victoria's Jubilee Institute, Cert. City of London Disease of Chest Cert. for Tuberculosis. Midivife (whole time). Leila Tubb, C.M.B. Caretaker of Isolation Hospital (whole time). Mrs. Gillians. 2 WEMBLEY URBAN DISTRICT. Annual Report, 1921. To the Chairman and Members of the Wembley Urban District Council. Gentlemen, I have the honour to submit my Report on the general health conditions of the District for the year 1921, being the 28th Annual Report issued since the formation of the Council. Medical Officers are required by Circular 269 of the Ministry of Health to present a Report of a more simple character this year; indeed, to give the usual full and detailed report once only in five years, but to include, nevertheless, as a minimum, certain necessary Darticulars as follow:— AREA. The area of the Wembley District is 4,564 acres. POPULATION. The population of the district in 1921 from figures supplied by the Registrar-General for the purposes of this Report was 16,110. INHABITED HOUSES. The number of houses inhabited in 1921 unknown. The number of families, or separate occupiers for that year unknown. RATEABLE VALUE. The rateable value of the Urban District was £124,930. A penny rate produced the sum of £520. BIRTH RATE. The number of births registered during 1921 was 311, giving a birth-rate of 17.94. In 1920 there were 325 births, giving a birth-rate of 20.8. The number of legitimate births were—male, 143; female, 160—303. The number of illegitimate births wprp—male, 4; female, 4—8. 3 The number of "still-births" during 1921 was 6, the bodies all being sent to Alperton burial ground. DEATH RATE. There were 138 deaths registered as belonging to the district, giving the quite satisfactory death-rate of 8.28. The death rate for England and Wales for 1921 was 12.1. Among the chief causes of death were:— Malignant Disease (Cancer) 17 Heart Disease 9 Tuberculosis (Pulmonary) 11 Pneumonia 12 Cerebral Haemorrhage, &c. Tables of the Vital Statistics will be found at the end of the Report. With reference to the chief causes of death, we ought not to be satisfied with the mere statement that so many died of cancer or malignancy. This dire complaint is acknowledged to be on the increase, and even more active measures should be taken to arrest if possible the incidence of the disease. A Special Commission should be held—international if possible—to co-ordinate the good work already done and to demand from every practitioner full details of all cases attended. The best brains of the country should be sought to formulate schemes to arrive at the knowledge of definite causes and to find a remedy. Until sufficient funds are forthcoming every Public Health Office in the kingdom should have a collecting box in conspicuous places and labelled "For cancer research." No money could be ill-spent to fight so grave a menace to the public health. During the year 1921 no case of death occurred in consequence of childbirth, yet throughout the country a certain perentage of these preventable deaths still is found. INFANTILE MORTALITY. Fourteen children died under twelve months old in 1921, giving an infantile mortality of 45 per 1,000 births, which is below the past six years average of 51, but not so low as in 1920, when it was 40. Of the 14 children, 2 were illegitimate. The infantile mortality for England and Wales for 1921 was 83, so that 45 may be considered satisfactory, but is not so low as we hope to reach when the ante-natal work is more firmly established and expectant mothers 4 are taught to realise more fully their responsibilities. The ignorance of the senior schoolgirl and young mother of their anatomy and internal economy is appalling! One is not surprised that the question of the desirability for couples about to marry obtaining a certificate of fitness after a rigid medical examination is again being freely discussed. NOTIFIABLE INFECTIOUS DISEASES. During 1921 there were 134 cases of infectious disease notified as occuring in the district. Of these 55 were Scarlet Fever. 8 were Pneumonia. 43 „ Diphtheria. 5 „ Erysipelas. 15 „ Pulmonary Tuber- 4 „ Tuberculosis (other culosis. than pulmonary). The remainder were sporadic cases of Enteric, Measles, Puerperal Fever, and Encephalitis Lethargica. Diphtheria, which had been very prevalent in 1920, still continued here (and throughout the whole country) during 1921. There were 43 cases; there had been 81 in 1920; 18 only in 1919. Of the 43 cases 3 proved fatal. Doctors now find that larger doses of the anti-toxin may be given with advantage, and wisely do not wait for the result of the swab examination if satisfied clinically that they are dealing with a case of diphtheria. The mortality rate is not large, but might be less or nil if parents could realise the immediate necessity for seeking medical advice in certain forms of sore throat. One has heard that in some instances this apparent neglect may be due to inability to pay a fee, but in Wembley no such excuse can be given, as the dispensary letters are freely given on application to the Clerk to the Council to those of very small means who are not eligible for medical orders from the Relieving Officer. WATER SUPPLY. The Wembley District is served by the Colne Valley Water Co., and the supply is constant, and as a rule good, but for a long time past, especially in the lowlying parts of the district, the water, on first being drawn became milky and appeared full of chalk, depositing a sediment on being allowed to settle. The matter was brought before the Secretary Manager on several occasions, explanations were given, and some improvement took place, but at the end of the year the trouble was still often apparent. Before the war the Colne Valley 5 water was of excellent quality and moderately soft. During the war and since there has been a marked hardness and this chalky deposit, but the water is still good on analysis, and we quite hope soon to return to the pre-war standard. OVERCROWDING. I regret to report that during 1921 there was considerable overcrowding, the accommodation afforded by the Council houses not providing for more than one-third of the need! Your sanitary officers frequently come across urgent cases and, except for assisting by advice in rearranging, are helpless in abating the nuisance. There are several cottages that cannot be put into a reasonably good state of repair, but at the same time cannot be condemned till proper and sufficient housing accommodation is provided. Wembley has always been fortunate in not having many dirty and destructive tenants; however, a few tenants have given trouble and are still under observation. NEW HOUSES. During 1921 93 new private houses and 104 Council houses were completed. With regard to the Council houses, you know how highly I think of their construction, and from the public health points of view—especially in view of the stress and difficulties of the times—the only question is whether you cannot see your way to continue your efforts and erect as rapidly as possible a number in excess of these already built. OPEN SPACES. Owing to the enterprise and foresight of former Councils, Wembley is at present amply provided with open spaces. They need not be enumerated again on this occasion. SEWAGE OUTFALL WORKS. In my last Report I referred to the new scheme prepared by your Engineer for extension and alterations at the Sewage Works at Alperton, and also to the loan sanctioned by the Ministry of Health. The work has not yet been sufficiently proceeded with to give a detailed report. MATERNITY AND CHILD WELFARE CLINIC. This work is still so much appreciated under the supervision of the Medical Officer, Dr. Hudgell, with the assistance of many voluntary lady workers, that there is a danger of the Clinic being overcrowded. In more 6 prosperous times another centre would certainly have been formed at Sudbury or elsewhere. The list of attendances at the Child Welfare Centre and the Dental Clinic, and the visits paid in connection therewith will be found in tabular form at the end of this report. You have good reason to be satisfied with the excellent work of your several clinics, and with the efficiency of the staff who conducts them. THE DENTAL CLINIC. With Mr. Lafferty, L.D.S., as your Dental Surgeon, is becoming better known and appreciated, and deals with cases not eligible for treatment by the Dental Clinic of the Education Committee. THE ANTE-NATAL CLINIC Was opened in 1921 and conducted by Dr. Hudgell It is becoming better known, and is doing most useful work. Eventually this Clinic should have a marked influence in preventing abortions, miscarriages, premature labours, and in warning mothers to see their doctors when matters are not normal either with themselves or with the foetus. HEALTH VISITOR. You will note the extraordinary amount of good work done by this nurse by the large number of visits shown in the tables at the end of this Report. MATERNITY NURSE. The Maternity Nurse, or Midwife, though most acceptable throughout the whole district, was not, qua midwife, engaged as fully as we anticipated in 1921. Her time was very fully occupied, however, during the whole year as a maternity nurse acting with a doctor, when not dealing with her own cases. THE COPLAND VILLAGE HOSPITAL. The District is fortunate in having this institution, founded by the late Miss Copland and mainly supported by her bequest. In 1921 the Trustees were again in a position to supply over a 100 benefit letters to suitable cases for medical attendance at the patients' homes or at the surgery. Fifteen patients were sent to convalescent homes, or for a holiday, and 6 fresh dental cases were accepted. Surgical aid letters were found, surgical dressings, instruments, and spectacles were provided. In addition to this the sum of £30 was contributed towards the District Nurse Fund. It is hoped that, at no distant date, the funds available from this charity will be used to found a local hospital for the district. 7 SANITARY INSPECTION OF DISTRICT. At the end of this report will be found a tabulated list of the work executed during 1921. It shows an enormous amount of good work, although very little of it comes to your personal knowledge. THE COMMON LODGING HOUSE AND HOUSES LET IN LODGINGS. During 1921 no houses in the District came under either of these categories. OFFENSIVE TRADES. Fish frying is carried on in two premises. Fat melting and extracting also at three premises. All these premises are constantly inspected, and are usually found in a satisfactory condition. BAKEHOUSES, WORKSHOPS AND SLAUGHTERHOUSES Have been frequently and systematically inspected during 1920, and all defects remedied at once. THE COWSHEDS, DAIRIES AND MILKSHOPS. I am glad to report that a much better standard has been attained at the cowsheds. At last the farmers all realise that you will insist upon the clauses of the Milk Regulations being complied with in every detail. We cannot yet pretend to have a milk produced at our farms that will compare with Grade A certified milk, hut a great improvement has been effected, and is being maintained throughout the district. We are now troubled with the dirty condition of the milk imported from the Home Counties and mixed with ours, and I have written to the County Medical Officers of Health complaining of this, and giving the names of the farms that send out the milk. In time the farmer himself will see that it pays to send out a clean milk that will, if cooled immediately, keep a week without going sour, instead of being unfit for use a few hours after delivery in hot weather. Last July, at the Conference of the Eoyal Sanitary Institute held at Folkestone I read a paper in which I urged a more vigorous inspection of the cowshed by the sanitary officers, and pointed out in detail every important point that must be observed if a clean milk is to be obtained in the future. Moreover, I insisted on the benefit to the district following a successful prosecution when the cowkeeper declined to relinquish his ancient methods. 8 Bearing on this point it will interest you to know that Certified Grade A milk has recently been obtained at an ordinary farm at Reading by experts using the necessary cleanly methods, showing what a high standard can be attained by vigilant care on the part of the milker and the cowkeeper. We must still peg away and insist upon the public being served with the purest milk obtainable; at the same time I think it fair to point out that Certified Grade A milk cannot be produced under 8d. or 9d. per quart. LISTS OF ACTS ADOPTED IN WEMBLEY URBAN DISTRICT. 1. Infectious Disease Prevention Act, 1890. 2. Public Health Acts, Amendment Act, 1890. 3. Public Health Acts, Amendment Act, 1907. 4. 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. SCAVENGING. Every house must be equipped with a suitably covered portable dustbin. The refuse is removed by the Council once a week. In November last your Engineer and Surveyor presented an able report on the best methods for the disposal of house refuse. The matter is still under consideration. CREMATION. I regret to note that in spite of our continued low death-rate so many of the grave spaces in the new cemetery have been occupied already. It almost seems incredible that the British, pioneers and enthusiasts in all sanitary causes, should have permitted prejudice and sentiment to delay the best-known method of disposal of the dead, viz., Cremation. In conclusion, Gentlemen, it always gives me pleasure to place on record my great appreciation of the courtesy shown by every member of the Council and every member of the staff, and especially do I feel my thanks are due to my loyal and efficient colleague, Mr. G. H. Fearn. 9 HOUSING CONDITIONS. STATISTICS. Year ended 31st December, 1921. 1. GENERAL. 1. Estimated population 16110 2. General death-rate 8.28 3. Death-rate from Tuberculosis 74 4. Infantile mortality 45 5. Number of dwelling houses of all classes approx. 3800 6. Number of working-class dwelling houses 789 7. Number of new working-class houses erected 104 2. UNFIT DWELLING HOUSES. I.—Inspection. 1. Total number of dwelling houses inspected for housing defects (under Public Health or Housing Acts) 378 2. Number of dwelling houses which were inspected and recorded under the Housing (Inspection of District) Regulations, 1910 29 3. Number of dwelling houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 2 4. Number of dwelling houses exclusive of those referred to under the preceding sub-heading found not to be in all respects reasonably fit for human habitation Nil II.—Remedy of Defects without Service of Formal Notices. Number of defective dwelling houses rendered fit in consequence of informal action by Local Authority or their officers 187 III.—Action under Statutory Powers. (A) Proceedings under Section 28 of the Housing and Town Planning, &c., Act, 1919 Nil 1. Number of dwelling houses in respect of which notices were served requiring repairs 1 2. Number of dwelling houses which were rendered fit:— (a) By Owners 1 (b) By Local Authority in default of Owners Nil 10 3. Number of dwelling houses in respect of which Closing Orders became operative in pursuance of declarations by Owners of intention to close Nil (B) Proceedings under Public Health Acts. 1. Number of dwelling houses in respect of which notices were served requiring defects to be remedied 201 2. Number of dwelling houses in which defects were remedied 187 (a) By Owners 187 (b) By Local Authority in default of Owners Nil (C) Proceedings under Section 17 and 18 of the Housing, Town Planning, &c., Act, 1909. 1. Number of representations made with a view to the making of Closing Orders 2 2. Number of dwelling houses in respect of which Closing Orders were made 2 3. Number of dwelling houses in respect of which Closing Orders were determined the dwelling houses have been rendered fit Nil 4. Number of dwelling houses in respect of which demolition orders were made Nil 5. Number of dwelling houses demolished in pursuance of demolition orders Nil 3. UNHEALTHY AREAS. Areas represented to the Local Authority with a view to Improvement Schemes under (a), part 1, or (b) Part 2, of the Act of 1890:— 1. Name of area Nil 2. Acreage Nil 3. Number of working-class houses in the area Nil 4. Number of working-class persons to be displaced Nil 4. Number of houses not complying with the ing bye-laws erected with the consent of the Local Authority under Section 25 of the Housing, Town Planning, &c., Act, 1919 70 5. Staff engaged on housing work with, briefly, the duties of each officer Sanitary Inspector only. 11 SANITARY INSPECTION OF DISTRICT. Visits to Dairies 78 „ „ Cowsheds 43 „ „ Foodshops 276 „ „ Slaughterhouses 72 „ „ Bakehouses 23 .. Piggeries 46 „ „ Laundries 3 „ Factories and Workshops 42 „ „ Urinals 48 „ „ Ditches 27 „ „ Occupied Vans 3 „ „ House Refuse Shoots 13 „ „ Schools 28 Inspection under Housing and T.P. Acts 30 Re-inspections under Housing and T.P. Acts 38 House drains inspected 599 Other inspections 878 Inspections on complaint 60 Visits to cases of infectious disease 196 2503 SANITARY WORK EXECUTED. Eaves gutters, repaired or renewed 26 Dampness remedied 20 Damp-proof course inserted 5 Yards paved 12 Ventilation provided under floors 12 Walls and ceilings cleansed and limewashed 39 Windows made to open 3 Sash cords renewed 12 W.C.'s repaired or regulated 56 Water laid on to W.C. cisterns 5 Drains inspected 599 Drains tested 37 Drains relaid or repaired 24 Drains unstopped or cleansed 48 Vent pipes repaired or renewed 9 Manhole covers repaired or renewed 13 Cesspools cleansed 8 Dirty houses cleansed 29 Accumulations of refuse removed 21 Dustbins supplied 144 12 UNSOUND FOOD DESTROYED. Bacon 24¼1bs. Tomatoes 2 lbs. Beef 12 lbs. 79 Oranges 18 Tins of Sardines 3 Tins of Grapes MATERNITY AND CHILD WELFARE. Year's attendance at Welfare Centre 4255 Infants under I year 1776 Children under 5 years 532 Average weekly attendance 85 Actual infants attending 590 Actual children 107 New infants 125 Home visits paid to all children 6875 Number of visits to infants 4995 Number of visits to children 1880 Number of infants visited 1040 Number of children visited 429 Dental Clinic 582 Under 5 years 38 Children 126 Adults 42 Actual number of attendances 266 Whooping Cough 95 Consumptives 33 Ringworm 7 Pregnant mothers 128 Summer diarrhœa 186 Milk supplied pints 122 Number on books 1469 Number on centre list 650 Number of children left for school 150 13 TABLE I. VITAL STATISTICS OF WHOLE DISTRICT DURING 1921 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. of Nonresidents registered in the District. of residents not registered in the District Under 1 year of age. At all ages. Number Rate Number Rate Number Rate per 1000 nett Number Rate I 2 3 4 5 6 7 8 9 10 11 12 13 1916 14,611 346 350 20.01 97 855 5 33 19 54.3 125 8.55 1917 16,433 1918 For Birth Rate 16,464 235 237 14.23 127 8.6 6 32 19 77.8 121 8.2 For Death Rate 14,694 253 253 15.3 130 8.8 7 36 10 39.5 159 10.8 1919 For Birth Rate 15,635 237 237 15.15 110 7.32 10 29 12 50.6 129 8.59 For Death Rate 15.009 325 325 20.82 95 6.08 5 35 13 40 130 8.33 1920 15,607 1921 16,110 289 311 19.31 104 6.45 5 39 14 45.01 138 8.28 Area of district in acres (land and inland water), 4.564 Total population at all ages 16,191 At Census 1921. 14 TABLE II. CASES OF INFECTIOUS DISEASE NOTIFIED DURING THE YEAR 1921. Notifiable Disease Cases notified in the whole District. Total cases remov'd to Hospital. Total Deaths from I D. in District At all Ages. At all Ages—Years. Under 1 I to 5 5 to 5 15 to 25 25 to 45 45 to 65 65 and upw'ds Scarlet Fever 55 1 5 45 4 37 Diphtheria 43 1 4 22 12 4 30 3 Pulmonary Tuberculosis 15 3 3 7 2 11 Pneumonia 8 1 2 1 4 12 Erysipelas 5 2 3 Tuberculosis (other than Pul) 4 2 2 1 Encephalitis L. 1 1 1 Measles 1 1 Enteric Fever 1 1 Puerperal Fever 1 1 1 Totals 134 2 11 74 20 22 5 67 29 15 TABLE III CAUSES OF AND AGES AT DEATH DURING YEAR 1921. Causes of Death Deaths at the subjoined Ages of "Residents whether occuring within or without the District. Total deaths whether of ''Residents" or Non-Resident" in institutions in the District. All Ages Under 1 year and under 2 2 and under 5 5 and under 15 15 and under 25 25 and under 45 45 and under 65 65 and upwards All Causes 1 Certified 138 14 2 8 7 33 27 47 1 Uncertified Whooping Cough 1 1 Diphtheria 3 1 1 1 Influenza 2 1 1 Pul. Tuberculosis 11 2 8 1 forms of other Tuberculosis 1 1 Cancer 17 2 5 10 Heart Disease 9 2 3 4 Bronchittis 6 1 1 4 Pneumonia (all forms) 12 1 5 2 4 Other Respiratory Diseases 1 1 Diarrhoea 2 2 Nephritis 2 1 1 Puerperal Fever 1 1 Arterio-sclerosis 5 5 Cerebral Haemorrhage 11 1 10 Diabetes 4 1 1 2 Appendicitis 3 1 1 1 Ulcer of Stomach 4 2 2 Encephalitis Lethargica 1 1 Violence 3 2 1 Suicide 2 Congenital Debility 6 6 2 Other Defined Diseases 31 5 4 1 3 4 14 Totals 138 14 2 8 7 33 27 47 16 TABLE IV. INFANTILE MORTALITY DURING THE YEAR 1921. Cause of Death Nett Deaths from stated Causes at. Various Ages under One Year of Age. Total Deaths under One Year Under 1 Week 1-2 Weeks 2-3 Weeks 3-4 Weeks Total under 1 month 1-3 Months 3-6 Month8 6-9 Months 9-12 Months All Cases Certified 5 1 6 2 3 3 14 Uncertified Congenital Debility 4 4 1 1 6 Other defined Diseases 1 1 2 1 1 1 5 Diarrhoea 2 2 Whooping Cough 1 1 Totals 5 1 6 2 4 2 14 17 FACTORIES, WORKSHOPS, WORKPLACES AND HOMEWORK, I.—INSPECTION Including Inspections made by Sanitary Inspectors or Inspectors of Nuisances. Premises. Number of Inspections. Written Notices Prosecutions. Factories (Including Factory Laundries) 23 Workshops (Including Workshop Laundries 19 1 Workplaces Total ... 42 1 2.— DEFECTS FOUND. Premises. Number Number of Prosecutions Found 1 Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts:- Want of Cleanliness 4 4 Want of Ventilation Overcrowding Want of drainage of floors Other nuisances Sanitary accomodation insufficient unsuitable or defective 1 1 not separate for sexes Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouse (S. 101) Breach of special sanitary requirements for bakehouses ss. 97 to 100) Other offences Totals 5 5 18 4.-REGISTERED WORKSHOPS. Workshops on the Register (S. 131) at the end of the year. Number. Important classes of workshops, such as workshop bakehouses may be enumerated here. Carpentering, Cabinet Making, etc. 3 Printing 1 Cycle and Motor Works 8 Dentists 1 Harness Making 1 Blacksmiths, Wheelwrights, etc. 3 Boot Making 3 Laundries 2 Tramway Depot 1 Bakehouses 8 Milliners 1 Watchmakers 1 Tailors 2 Plumbers 1 Other Trades 5 Total number of Workshops on Register 41 5.—OTHER MATTERS Class Number. Matters notified to H.M. Inspector of Factories:— Failure to affix Abstract of the Factory & Workshop (Act S. 133) Nil Action taken in matters referred by H.M. Inspectors as remediable under the Public Health Acts but not under the Factory and Workshop Acts (s. 5. 1901.) Notified by h.M. Inspector Reports(of action taken) sent to H.M. Inspector. Nil Other Underground Bakehouses (s. 101) in use at the end of the year 1