IC 439 WEM BLEY WEM 14 Wembley Urban District Council ANNUAL REPORT FOR THE YEAR 1933 BY CHARLES E. GODDARD, O.B.E., M.D. MEDICAL OFFICER OF HEALTH FOR WEMBLEY Wembley Urban District Council ANNUAL REPORT FOR THE YEAR 1933 BY CHARLES E. GODDARD, O.B.E., M.D. MEDICAL OFFICER OF HEALTH FOR WEMBLEY 80329 Urban District Council of Wembley. Public Health Committee for the Year 1933-34. Chairman: Councillor H. GAUNTLETT. Councillor E. BUTLER Councillor C. J. LIFE Councillor A. E. DUTTON Councillor A. H. MEEK Councillor A. J. EASTON Councillor H. MILNER Councillor H. W. R. ELSLEY Councillor F. E. THOMPvSON Councillor M. R. HARLEY Councillor M. CAMPBELL (Chairman of the Council). (Vice-Chairman of the Council). Maternity and Child Welfare Committee for the Year 1933-34. Chairman: Councillor A. H. MEEK. Councillor A. E. DUTTON Councillor H. GAUNTLETT Councillor A. J. EASTON Councillor F. E. THOMPSON Councillor H. W. R. ELSLEY Councillor M. CAMPBELL (Vice-Chairman of the Council). Councillor M. R. HARLEY (Chairman of the Council). Co-opted Members: Mrs. COLLISON Mrs. FARQUHARSON Mrs. GAUNTLETT 3 Public Health Staff in 1933. *Medical Officer of Health (part time): CHARLES E. GODDARD, O.B.E., M.D., L.R.C.P., M.R.C.S., A.K.C. *Chief Sanitary Inspector (whole time): GEORGE HARGREAVE FEARN, M.S.I.A. Cert. R.S.I. *Sanitary Inspector (whole time): ROBERT TURNER, M.S.I.A. Cert. R.S.I., Cert. Insp. of Meat and other Foods. Cert. R.S.I., Smoke Insp. Senior Clerk (whole time): HAROLD YOUNG, Cert. R.S.I., Cert. Insp. of Meat and Other Foods. Clerk (whole time): HAROLD N. RYAN. Junior Clerks: WILLIAM C. E. KEUTENIUS THOMAS L. ALLISON *Cons. Gynœccol. and Obst. Surgeon: JOHN WILLIAM BELL, L.P.C.P.I. & L.M., L.R.C.S.I. & L.M. *Medical Officer of Child Welfare Centres (part time): EDITH C. HUDGELL, M.R.C.S., L.R.C.P. (Lond.). * Dental Surgeon (part time): CHARLES LAFFERTY, L.D.S. *Health Visitors (whole time): Miss MAUD J. PHILLIPSON, Cert. Gen. Training, Cert. Queen Victoria's Jubilee Inst.; Cert. of City of London (Tuberculosis). Miss V. L. DAVIES, S.R.N., R.F.N., Cert. C.M.B., H.V.s Cert. R.S.I., Member of C. of N. *Infant Life Protection Visitor: Mrs. DENDLE (resigned March 1933). Miss E. OLIVER (appointed March 1933). Caretaker of Isolation Hospital: Mrs. GILLIANS. Inspector for Removal of House Refuse and Motor Ambulance Driver (Whole time) : JAMES MANSELL. [*Contribution made to salary by Ministry of Health or County Council.] 4 WEMBLEY URBAN DISTRICT COUNCIL ANNUAL REPORT of the Medical Officer of Health tor the year 1933 BY Charles E. Goddard, O.B.E., M.D). To the Chairman ami Members of the Wembley Urban District Council. Mr. Chairman, Madam, and Gentlemen, I have the honour to submit my Annual Report on the Sanitary circumstances of the district for the year 1933, and in doing- so have followed the order of details as far as possible from instructions from the Ministry of Health. Area in acres 4;564 Population 1933 (Midsummer), Estimated by Registrar-General 58,850 Number of inhabited houses, end of 1933, according to rate books 16,000 (Estimated) Rateable Value (1st October, 1933) £623,641 Sum represented by a penny rate (General District) £2,380 SOCIAL CONDITIONS. By far the greater number of the population of Wembley are employed outside the district, which still maintains a " dormitory " character. 5 In the district itself the largest employers of Labour continued to be Atcraft Works; General Electric Co., Universal Furniture Products, Ltd.; Wrigley Products, Ltd.; Wembley Stadium and Empire Sports Arena; and the Glacier Metal Co. The various railway companies are also large employers. There are no local industries which appear to have a deleterious effect on those engaged therein. The Town Planning of Estates which have been developed in the last few years, with its consequent restriction of the number of houses per acre, cannot fail to have a beneficial effect, not only upon our present population, but upon future generations. UNEMPLOYMENT, Wembley has not been so seriously affected by unemployment as many towns of its size, owing to the fact that its industries are varied in character, and that a large number of its inhabitants are in some form of business in London, and are not manual workers. Several separate agencies have greatly assisted in relieving the condition due to unemployment : among them may be mentioned the Guild of Social Service, the Public Assistance Committee, the Rotarians, and also the Maternity and Child Welfare Committee of the Council, in quite a generous distribution of milk to those families with very reduced incomes. VITAL STATISTICS. Live Births. Total Male. Female. Legitimate 795 398 397 Birth Rate per 1,000 of estimated resident population 14.08 Illegitimate 34 17 l7 829 415 414 Average Birth Rate for last 5 years Number 15-95 tered, 1933 608 293 315 Still Births. Rate per 1,000 total (live and still births 29.27 Legitimate 24 12 12 Illegitimate 1 — 1 6 DEATHS. Total. 443 Male. 225 Female 218 Death Rate per 1,000 estimated resident population 7.53 Average Death Rate for last 5 years 8.1 MATERNAL MORTALITY. Deaths. Rate per 1,000 total (live and still births). Deaths from Puerperal Sepsis 1 1.17 Other Puerperal Causes 4 4.68 Total 5 5.85 Average Rate for last 5 years 5.24 INFANTILE MORTALITY. Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 50.66 Legitimate infants per 1,000 legitimate live births 47.79 Illegitimate infants per 1,000 illegitimate live births 117.65 Deaths from Measles (all ages) Nil ,, ,, Whooping Cough (all ages) 2 ,, ,, Diarrhoea (under 2 years) 3 TABLE OF COMPARATIVE VITAL STATISTICS. per 1,000 population per 1,000 Live Births per 1,000 Total Births. Maternal Mortality Birth Rate Still Birth Rate Death Rate Infantile Mortality Maternal Mortality Wembley 14.08 0.42 7.53 50 6.03 5.85 England and Wales 14.4 0.62 12.3 64 4.42 4.23 London 13.2 0.45 12.2 59 118 County Boroughs and Great Towns, including London 14.4 0.67 12.2 67 132 smaller towns— Estimated Resident population 25,000 to 50,000 at Census 1931 14.5 .63 11.0 56 7 Mr. W. R. Hurst, the Registrar of Births and Deaths, has supplied me with the following figures:— Total number of Marriages in the District during 1933 362 Church of England 175 Roman Catholic 17 Non-Conformist 32 Registry Office 138 362 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) LABORATORY FACILITIES. Arrangements are made with the Clinical Research Association for the examination or analysis of clinical material—swabs, etc., water, milk, foodstuffs; and the Royal Institute of Public Health carry out the examination of sputum. The following examinations were made during the year: Examinations of Swabs 432 ,, ,, Blood Specimens 15 ,, ,, Sputum 148 ,, ,, (iraded Milks 146 ,, ,, Water 3 (b) AMBULANCE FACILITIES. (i) Infectious Disease.—The Council has now an arrangement whereby all cases of Infectious Disease occurring in the district are removed to hospital by the ambulance owned by the Acton Borough Council. (ii) Non-Infectious.—The Council has two ambulances for the removal of non-infectious and accident cases. No 8 charge is made to residents, and appreciation of the serviceis frequently expressed. During 1933, 927 Wembley cases and 247 Kingsbury cases were removed. (c) NURSING IN THE HOME. The Wembley District Nursing Association continue to provide four district nurses for attendance upon cases of sickness other than those of Infectious Disease. The Association is undoubtedly carrying out an excellent work in a most efficient manner. The Council make a grant each year towards the cost of nursing such diseases as Pneumonia which occur in the district. In suitable cases in which the removal of a person suffering from Infectious Disease is not possible, and those responsible for its treatment have not been able to bear the cost of providing a nurse, such provision is made by the Council. (d) WEMBLEY CLINICS. The Maternity and Child Welfare Clinics, under the charge of Dr. Hudgell, continue to carry out very useful and! efficient work. Two sessions are held weekly at St. Andrew's Hall,, Ealing Road, Wembley ; and one at the Sudbury Centre at the Wesley House, Harrow Road, Sudbury. By arrangement with the Wealdstone Council, mothers and children living in the Kenton area attend a clinic in that district. Details of these attendances are given elsewhere in this Report. Negotiations were commenced for the establishment of a??? Centre at Monks Park, which has since been opened. The Clinics are attended by your Health Visitors and all necessary records are kept on a card index system. In addition a number of ladies act as voluntary helpers and render loyal and valuable service. The Dental Clinic is held at Alperton School, under the charge of Mr. C. Lafferty, who acts as Dental Surgeon, and a considerable number of expectant and nursing mothers and children under five were treated during the year. On alternatesessions the anaesthetic is administered by Dr. Hudgell to any cases requiring this. 9 CLINICS AND TREATMENT CENTRES. (1933 remain the same as for 1932). NAME OF INSTITUTION. SITUATION. SERVICES PROVIDED. BY WHOM PROVIDED. Wembley M. & C.W. Clinic St. Andrew's Hall, Ealing Road. Supervision of mothers and children under 5 (2 sessions a week). Wembley U.D.C. •Sudbury M. & C. W. Clinic Wesley House, Sudbury One „ „ ,, Ante Natal Clinic St. Andrew's Hall, Ealing Road, Medical supervision (2 sessions a month). ,, Dental Clinic Aiperton School, Ealing Road, Dental inspection and treatment of Nursing and expectant mothers and children under 5 (held fortnightly) ,, Day Nurseries Nil Nil Nil School Clinic Wembley Hill School Medical inspection and treatment of school children. Middlesex C.C. Tuberculosis Dispensary Pound Lane, Willesden, and Greenhill Crescent, Harrow Dispensary treatment and supervision. ,, ,, Treatment Centres for V.D Various London Hospitals Examination and treatment. ,, Wembley Hospital Wembley Artificial light treatment.* X-ray installation. Wembley Hospital. *The Council have an arrangement with the Wembley Hospital, whereby cases referred from the clinics are treated at the Hospital. (e) HOSPITALS. The Hospital Services made use of by the inhabitants of Wembley, apart from those for infectious diseases, are provided by the Wembley Hospital, Redhill Hospital, Edgware, and the various General Hospitals of London. THE WEMBLEY HOSPITAL. Supported by voluntary subscriptions and each year showing a good balance on the right side, has, during the past year, proved of great service to the community. The second part of the enlargement has now been completed. There are 53 beds, including 13 in private wards. Each year sees an increase in the amount of work accomplished. During 1933, 881 in-patients were treated, and 562 operations performed. You may feel the establishment of this well-equipped hospital and the assistance you have rendered have been indeed fully justified. Councillors Butler, Life and Thompson represented your interests in this Institution. REDHILL HOSPITAL. This Hospital, established chiefly for Public Assistance cases, is available to others, but unfortunately the hospital is nearly always full. It is understood that extensions are contemplated at an early date. The hospital has been constructed on modern lines, and the care and treatment received there leave nothing to be desired. It is hoped that the enlargement, especially as regards the maternity section, will not be long delayed. ISOLATION HOSPITAL. Cases of infectious disease are treated by arrangement at the Acton Isolation Hospital, and this has been in force since 1913. The County has, on more than one occasion, suggested a scheme for the whole of Middlesex—but the grouping of the Authorities has not been found acceptable. The present arrangement with the Acton Borough Council has not only 11 been most satisfactory in administration, but has proved very economical. It is now suggested that a Joint Hospital Committee shall be formed between Acton and Wembley—formed of representatives from both authorities. This should prove of great service and give direct representation by Wembley in the administrative side. It is not considered that the Ministry of Health would raise objection to such a scheme. However, this proposed scheme has yet to receive the approval of both Councils concerned, and afterwards the Ministry. SMALLPOX ACCOMMODATION. The County Council is responsible for the provision of hospital acccommodation for cases of Smallpox occurring in this district, and cases that occur are sent to the Dartford Smallpox Hospital. I have visited this Hospital and am satisfied that arrangements there are of the best. TUBERCULOSIS. Patients from Wembley are sent to the Sanatoria Accommodation provided by the Middlesex County Council at Harefield and South Mimms; in addition, cases are sent from time to time to the County Tuberculosis Hospital, Isleworth; St. Anthony's Hospital, Cheam; King- Edward VII Hospital, Midhurst; and Brompton Hospital. The Middlesex County Council provide a Tuberculosis Dispensary at Pound Lane, Willesden, and also one at Greenhill Crescent, Harrow. ACCOMMODATION FOR MATERNITY CASES. The Council have arrangements for the admission of maternity cases to the Redhill County Hospital, Edgware, and Queen Charlotte's Hospital, London. Cases are also admitted to the various London hospitals, and to private nursing homes. You have arranged to grant a subsidy in necessitous cases. 12 HOSPITAL ACCOMMODATION FOR CHILDREN. The Wembley Hospital provides a separate ward with six beds solely for the treatment of children. There is a very beautiful, modern, Children's Hospital at Park Royal, under the control of the Middlesex County Council, available for the treatment of the children of the poorer classes, and admission is obtained through the Public Assistance Officer, or, if extremely urgent, directly through the Superintendent. CHILDREN'S CONVALESCENCE. I would remind you of the Middlesex Edward VII Hostel for the reception of necessitous Middlesex children needing change of air. This hospital is at Bexhill-on-Sea. The payment of 35s. provides the return fare and two weeks' maintenance at the Hostel, from May to September, making a Summer holiday. From October to April the Hostel is used as a School of Recovery (certified under the Board of Education for cases of asthemia maramus, chorea, muscular atrophy, etc. The complaints treated include rickets, anaemia, debility, anaemia and general convalescence). Children are admitted from 8 to 14 years for periods of six weeks and longer; girls before Christmas, boys after Christmas. All information may be obtained from the Hon. Secretary, Miss Mary Gardner, of Oakhurst, Harrow-on-the-Hill. THE YARROW CONVALESCENCE HOME. It is not generally known and appreciated that this splendid Children's Convalescent Home at Broadstairs is available only for the middle classes. The terms, which are moderate, can be obtained from the Secretary. ARTIFICIAL SUNLIGHT. This is arranged for at the Wembley Hospital and the fees are paid by the Council in cases recommended by the Clinic doctors for those who are in poor circumstances. 13 LIST OF ACTS ADOPTED AND BYE-LAWS MADE BY THE WEMBLEY URBAN DISTRICT COUNCIL. Acts :— Infectious Disease Prevention Act, 1890. Public Health Acts Amendment Act, 1890. Public Health Acts Amendment Act, 1907. Private Street Works Act, 1892. Public Health Act, 1925. Bye-laws Relating to :— Common Lodging- Houses (July, 1898). Slaughterhouses (February, 1923). Nuisances (April, 1912; October, 1919; March, 1926). Cleansing of Earth Closets (January, 1912). Houses Let in Lodgings (June, 1931). Privies and Ashpits (January, 1912). Pleasure Grounds and Open Spaces (July, 1914; October, 1925; March, 1927). Offensive Trades (February, 1914). New Streets and Buildings (March, 1907; April, 1913 ; March, 1928; May, 1933). Tents, Vans, Sheds and similar structures used for human habitation (1901). Public Conveniences (March, 1926). Mortuary Regulations (February, 1926). Smoke Abatement (May, 1930). ON THE SUGGESTED TRANSFER OF THE CONTROL OF THE HEALTH ACTIVITIES TO THE COUNTY. It has been known to you, for more than two years, that the Middlesex County Council would apply to the Ministry to be made the authority for the administration of the Maternity and Child Welfare Services of the Districts of Wembley and Kingsbury—when sanction was given for the union of these districts. This knowledge has been a source of anxiety to all concerned, and, because of the uncertainty, no new work or requisitions of importance could be considered. 14 To speak frankly, it was felt that the Ministry would probably pass over the control of these activities to the County, what really has happened is not part of this report for 1933. The chief reasons given by the Wembley Council for the retention of these activities were as follows :— 1. That so large a district as the new greater Wembley, with a population of 85,000, should certainly control its own health activities. 2. That the work carried on by the Wemblev J Council was quite as efficient as that by the Middlesex County Council. 3. That it was not considered proper that all new officers for the services should be elected by the County. 4. That the " personal touch "—considered of muchimportance at the Maternity and Child Welfare Centres, would undoubtedly be injured by the transfer. 5. That the relative cost of maintenance was less than the County's for the same work. 6. That the new whole time Medical Officer to be appointed, by losing control of the Health Visitors, the Infant Life Protection Work and the personnel of the Clinics, would be deprived of a very important part of his work, and that his post would not attract the best type of officer when re-appointment is made, especially in the absence of the care of tuberculosis, School Clinics, etc. Altogether the suggestion of such transfer was considered by every member of the Wembley Council to be a retrograde movement and one that should be vigorously resisted. MATERNITY HOMES IN WEMBLEY, 1933. Misses R. S. Beach and L. Grant, " Denstone," 34,. Elmstead Avenue. Miss M. M. Betham, " Mardale," 73, Kenton Road. Mrs. Calder, 12, Vivian Avenue. Mrs. France, " Clovelly," 28-30, Central Road. Misses Martin and Moore, " Elmwood," Elms Lane. Miss Middleton, " Parkstone," 87, Castleton Avenue. Mrs. Sharp, " Sunnymede," 57, Preston Road. 15 MIDWIVES. No Midwives are now employed by, or subsidised by, the Local Authority. MIDWIVES. The following is a list of residing midwives who have been registered to practise in the Wembley district. This registration, and their work generally, is under the supervision of the County Council. Betham, M. M., 73, Kenton Road. Collins, M. A., 16, Eton Avenue. Coyle, A., 38, Douglas Avenue. Dilloway, L. G., 75, Rosebank Avenue. Flint, J. M., 57, Wyld Way. Luscombe, R. E., 15, Blenheim Gardens. Macdonald, C. A., 233, Oakington Manor Drive. Monk, E. M., 73, Kenton Road. Norton, I. E., 8, Park Chase. Rantell, E. A., 17, Napier Road. Whitworth, C. M. L., 12, Vivian Avenue. Wilson, E. M., 14, St. James' Gardens. MATERNITY AND CHILD WELFARE REPORT. For the Year Ending December 31st, 1933. Number of births notified in the area during the year under the Notification of Births Act, 1907, as adjusted by transferred notifications :— (a) Live births 766 (b) Still births 14 (c) Total 780 (d) By Midwives 210 (e) By Doctors and parents 570 16 Number of Visits during Year by Health Visitors : (a) To expectant mothers : First visits 324 Total visits 703 (b) To children under 1 year of age : First visits 1090 Total visits 3816 (c) To children between the ages of 1 and 5 years : Total visits 2639 Attendance at Wembley Welfare Centre : (a) No. of New Infants who attended Centre first time : Under 1 year 287 1-5 years 84 (b) No. of attendances of children under 1 year 4937 (c) No. of attendances of children 1-5 years 3117 (d) No. of attendances of mothers 7173 (e) No. of sessions held 98 Attendance at Sudbury Welfare Centre : (a) No. of New Infants who attended Centre first time : Under 1 year 104 1-5 years 32 (b) No. of attendances of children under 1 year 2144 (c) No. of attendances of children 1-5 years 1352 (d) No. of attendances of mothers 2897 (e) No. of sessions held 48 Attendance at Ante-Natal Clinic : (a) No. of expectant mothers who attended the Centre for the first time 144 (b) No. of attendances of expectant mothers ... 242 (c) No. of sessions held 23 17 Attendance at Dental Clinic : (a) No. who attended the Centre for the first time : Children 82 Mothers 99 (b) Total attendances during the year : Children 101 Mothers 153 (c) No. of sessions held 24 Attendance of Wembley Residents at Wealdstone Council Centre, Kenton : (a) No. of New Infants who attended Centre first time : Under 1 year 32 1-5 years 12 (b) No. of attendances of children : Under 1 year 347 1-5 years 32 (c) No. of sessions held 50 Attendance of Wembley Residents at Wealdstone Council Ante-Natal Centre, Kenton : (a) No. of expectant mothers who attended the Centre for the first time 5 (b) No. of attendances of expectant mothers 12 (c) No. of sessions held 12 Visits to Cases of :— Ophthalmia Neonatorum 1 Puerperal Fever 4 Puerperal Pyrexia 6 Measles 32 Whooping Cough 287 Epidemic Diarrhoea 3 Ringworm 33 Consumption 52 Total No. of children who were in attendance at Centres at end of year (excluding Kenton) : (i) Children under 1 year of age 401 (it) Children between the ages of 1 and 5 years 524 18 MATERNAL MORTALITY. The investigation of maternal deaths occurring in this district is carried out by the Middlesex County Council. Arrangements are made for cases of Puerperal Pyrexia and Puerperal Fever to be admitted either to one of the London County Council's Hospitals or to Queen Charlotte's Isolation Hospital. With a view to tracing the source of infection in certain cases I have arranged for the Medical Practitioner in attendance on such case to take a swab of their throat and nose, and from that of all other attendants and for them to be sent to Queen Charlotte's Hospital for typing. It is regrettable to record that during the year there were five maternal deaths—one from puerperal sepsis and four from other puerperal causes. Dr. j. Bell acts as a consultant in cases of Puerperal Fever or Puerperal Pyrexia, and was called upon in this capacity on two occasions. Arrangements are also made with certain nursing associations for the supply of nurses when required. Dr. J. Bell also acts as consultant in complicated maternity cases, and during 1933 he was called in on three occasions. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS. No special institution exists in the District for the care of unmarried mothers. When applications occur they are referred to the Public Assistance Officer, and accommodation is found in the new Maternity wards of the Redhill Hospital. HEALTH VISITING. The Health Visitors visit all houses where a birth has occurred, for the purpose of giving advice on the feeding and all matters relating to the care of the child, where possible on the nth day, and unless requested otherwise every three months to one year; at 18 months; 2, 3, 4, and just prior to 5 years, Where requested, expectant mothers are also visited. Enquiries are made into all cases where notice is received from the Middlesex County Council that a midwife has called 19 in medical help due to inflammation or discharge from infants' eyes, in cases of Ophthalmia Neonatorum, and in such other cases as I direct. The Health Visitors have an office in a house near the Public Health Department. Every detail of their work is recorded on the card index system. In addition to their work in the District, the Health Visitors attend the Child Welfare Clinics and the Ante-natal and Dental Clinics. Taking into consideration the fact that the district consists for the greater part of detached and semi-detached residences of modern type and that we have no slums the services provided are sufficient at the present time. CHILDREN'S ACTS. Infant Life Protection. During 1933 Mrs. Dendle continued the carrying out of her duties as Infant Life Protection Visitor in a most efficient manner, and details of her visits and circumstances were carefully recorded. She resigned in March, 1933, and her duties were taken over by a former District Nurse, Miss Oliver, who also discharged the duties most efficiently. PARTICULARS RELATING TO THE ADMINISTRATION OF THE CHILDREN'S ACTS DURING THE YEAR 1933. 1. Notification. (a) Number of Foster Parents on Register at beginning of the year 25 (b) Number of Foster Parents on Register at end of year 28 (c) Number of Children on the Register :— (i) At the beginning of the year 39 (ii) At the end of the year 40 (iii) Who died during the year Nil (iv) On whom inquests were held during the year Nil 20 ORTHOPÆDIC AND MASSAGE. All cases from the Clinics requiring treatment for orthopædic trouble, or recommended for massage, are seen by arrangement at the Wembley Hospital, where the treatment is carried out, the charge for same is met by the Council. SANITARY CIRCUMSTANCES OF THE AREA. WATER. The district is supplied by the Colne Valley Water Co., a few houses in Sudbury by the Rickmansworth Water Co. As regards the Colne Valley Water it may be said to be satisfactory in quantity and quality. We had a few complaints about its hardness, but on comparing this water with that of the neighbouring companies we found it was several degrees softer. However, I am assured by the Secretary of the Company that special plant had been put down to render the water still softer. We have had no complaints of the quality of the Rickmansworth water—but for a time there was a short supply. However, this was rectified as soon as the Company had finished the supply of new pipes. Four cottages belonging to the London Midland and Scottish Railway Company are supplied with water from the private supply belonging to that company. Periodically we have all these waters analysed. DRAINAGE AND SEWERAGE. A very important improvement has been effected in regard to the drainage system of the district by the extension of the Western outfall and Intercepting Sewer, which is now in commission after being laid for three years without use, due to circumstances arising out of the Middlesex County Council's Regional Sewage Scheme. The sewer relieves certain older sewers which were surcharged, and thus obviates flooding. The Outfall Works have been extended to enable them to deal with the estimated flow of sewage up to the end of 21 1935 by which date it is anticipated that the Regional Scheme will be in operation and the Council's Works no longer required. Certain portions of the Park Royal area of the Borough of Ealing have by agreement with the Ealing Council been drained into the Wembley sewers. RIVERS AND STREAMS. The various rivers and streams in the District were kept under frequent observation during the year, and I am pleased to report that there were no complaints received during the year as a result of any nuisance caused by pollution of the stream at Kenton from the Hendon R.D. Council's sewage farm. It was not necessary to take action in respect of any stream. The Chaplin Road Brook was again cleansed by the County Council, and the refuse therefrom was carted awav by this Council. CLOSET ACCOMMODATION. Practically every house in the District is provided with water closet accommodation. At the end of the year, seven houses remained which are provided with earth closets. There are four cesspools in the District, this provision being due to the fact that the premises are isolated and are a considerable distance from any sewer. PUBLIC CLEANSING. The removal of house refuse is carried out each week under the supervision of the Chief Sanitary Inspector, by means of 6 low loading line S.D. Freighters, and 4 horsedrawn vans. The work is carried out in an efficient manner, the number of complaints received is small, and the cost is satisfactory. The refuse is deposited in barges and moved from the District. The Chief Sanitary Inspector regularly inspects in company with the Sanitary Inspector to the Local Authority the tip at West Drayton, where the refuse is taken, to see that the terms of the contract embodying the conditions laid down in the Local Bye-laws are carried out. No refuse is collected in this District from earth closets, privies or cesspools. 22 SANITARY INSPECTION OF DISTRICT. No. of Complaints investigated 269 ,, ,, Drains inspected 644 ,, ,, Drains tested 10 ,, ,, Smoke half-hourly observations taken 19 ,, ,, Chimneys observed for smoke 415 ,, ,, Visits to Slaughterhouses 87 yy yy y y yy Cowsheds 16 " " " " Dairies and Milkshops 155 " " " " Premises where food is prepared, sold or stored 425 yy yy yy yy Bakehouse 72 " " " " Offensive trades 24 ,, ,, ,, ,, Factories, workshops and work- places 126 " " ' " School 64 " " " " Cesspools I ,, ,, ,, ,, Urinals and Latrines 21 " " " " Ditches and Streams 124 yy yy yy yy StableS I 67 " " ' " Piggeries 18 ,, ,, ,, ,, Public conveniences 1148 ,, ,, ,, ,, Cinemas, dance halls, etc 28 ,, ,, ,, ,, yards 678 ,, ,, ,, ,, Refuse tips 90 ,, ,, Visits in connection with Infectious Disease 293 ,, ,, Visits to Mortuary 5 ,, ,, Water samples taken 3 ,, ,, Samples of Chocolate taken 4 ,, ,, Samples of Milk taken 146 ,, ,, Houses inspected under Housing Regs., 1925 61 ,, ,, Other house inspections 191 ,, ,, Re-visits 1115 ,, ,, Miscellaneous visits and inspections 372 6791 Total number of informal notices served 396 Total number of statutory notices served 64 23 SANITARY WORK EXECUTED DURING 1933. Drains cleansed from obstruction 370 New drains and inspection chambers provided 56 Soil pipes and ventilating shafts repaired 1 Yards paved and repaired 1 Floors of dwellings relaid or repaired 24 Walls and ceilings repaired 86 Dampness remedied 31 Roofs repaired 23 Water supply improved 18 Additional windows provided and existing windows repaired or made to open 75 Defective spouting and eaves gutters repaired 29 New sink.s provided 2 New waste pipes provided and others repaired 4 Rooms cleansed, re-papered or distempered 85 Coppers and cooking stoves replaced or repaired 16 Additional W.C.'s provided 3 W.C.'s reconstructed 7 Foul W.C.'s or Urinals cleansed 35 Water Closets repaired and walls cleansed 15 Defective W.C. cisterns repaired 15 Dangerous stairs repaired 6 Dustbins supplied 686 Nuisances from animals abated 4 Offensive accumulations removed 31 Ditches and streams cleaned 7 Chimneys repaired 22 Walls repointed 3 Bakehouse contraventions remedied 2 Dairies, cowsheds and milkshops, contraventions remedied 2 Slaughterhouse contraventions remedied 1 Premises where food is prepared, sold or stored, contraventions remedied 13 Factories and workshops, contraventions remedied 27 Cinemas, dance halls, etc., contraventions remedied 2 Manure pits provided or repaired 1 Stagnant pools filled in 1 Baths provided 2 24 SMOKE ABATEMENT. Chimneys of the various factories in the district are kept under constant observation, and when necessity arises formal observations are taken. I have found that where, as a result of investigation, faulty stoking has been the cause the advice of a technical officer is welcomed by factory proprietors and that a marked improvement usually follows,. PUBLIC CONVENIENCES. The various Public Conveniences are controlled by your Public Health Department and are kept in a satisfactory manner. It is satisfactory to report that the Council has been able to secure the necessary land for the erection of a Public Convenience in Lancelot Road which should meet the needs of Central Wembley. MORTUARY. The Mortuary is periodically inspected by your Sanitary Officers. During 1933, 114 bodies were deposited, 30 postmortem examinations were made, and 22 Coroner's inquests were held in the school-room adjoining. The deaths had been due to accident, suicide, apoplexy, arterio-sclerosis, pneumonia, tuberculosis in some form, syncope, cancer, etc. The Council make no charge for the use of the Mortuary. In this Mortuary one of the three cubicles is fitted up like a miniature chapel. I should be glad if residents would remember to use this chamber for their deceased friends, especially in the Summer, and whenever their home accommodation is limited. RAG FLOCK ACTS, 1911 and 1928. There are no premises in the District in which RagFlock is manufactured. In two factories in the District Rag Flock is used for the purposes of upholstery. In each instance it is supplied under guarantee and samples are frequently chemically examined and the reports are open to inspection by the Sanitary Officers. No samples were taken by the Council's Sanitary Officers. 25 SCHOOLS. I he eleven Elementary and the one Secondary Schools provided by the Education Authority are inspected every three months, and, in addition, visits are paid from time to time to the various private schools. They have been found to be in good sanitary condition, furnished with a supply of water direct from the main, and the sanitary accommodation is usually kept in a satisfactory manner. In cases of infectious disease, necessary steps are taken to exclude patients and contacts. No schools were closed during the year on account of infectious disease. HOUSING. (a) Statistics. Number of new houses erected during the year :— (a) Total, including number given separately under (b) 1130 (i) By the Local Authority 54 (ii) By other Local Authorities Nil (iii) By other bodies and persons 1076 (b) With State assistance under the Housing Acts :— (i) By the Local Authority (1930 Act) 54 (if) By other bodies or persons Nil 1. Inspection of Dwelling-Houses during the Year:— (1) (a) Total number of dwelling-houses inspected for housing defects (under Public Health or Housing Acts) 914 (b) No. of inspections made for the purpose 1745 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations 1925 61 (b) No. of inspections made for the purpose 304 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 8 (4) Number of dwelling-houses (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 607 26 2. Remedy of Defects during the Year Without Service of Formal Notices :— Number of defective dwelling-houses rendered fit in consequence of informal action by the Local Authority or their officers 531 3. Action under Statutory Powers during the Year :— (a)—Proceedings under Sections 17, 18, and 23 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which notices were served requiring repairs 4 (2) Number of dwelling-houses which were rendered fit after service of formal notices :— (a) By owners 1 (b) By Local Authority in default of owners Nil (b)—Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 52 (2) Number of dwelling-houses in which defects were remedied after service of formal notices :— (a) By owners *19 (b) By Local Authority in default of owners 35 * Includes compliance in 1933 of 2 notices served in 1932. (c)—Proceedings under Sections 19 and 21 of the Housing Act, 1930 :— (1) Number of dwelling-houses in respect of which Demolition Orders were made 4 (2) Number of dwelling-houses demolished in pursuance of Demolition Orders Nil (d)—Proceedings under Section 20 of the Housing Act, 1930 (1) Number of separate tenements or underground rooms in respect of which Closing Orders were made Nil (2) Number of separate tenements or underground rooms in respect of which Closing Orders were determined the tenement or room having been rendered fit Nil 27 INSPECTION AND SUPERVISION OF FOOD. (a) Milk. The veterinary examination of milch cows is carried out by the Middlesex County Council, whilst your sanitary officers pay frequent visits to cowsheds at the time of milking-, with a view to seeing that the necessary steps are taken for the production of clean milk, and also to Dairies and Milkshops. I am indebted to Mr. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council for the following particulars of the action taken under the Milk and Dairies (Consolidation) Act, 1915. "During 1933 seventeen samples of milk were taken from retailers in the district, and submitted to animal innoculation at the Lister Institute. In none of these samples were living tubercle bacilli demonstrated." Milk (Special Designations) Order, 1923. Licences Issued : Certified : 9 Dealers' Licences. Grade A (T.T.) : 14 Dealers' Licences and 1 Supplementary Licence (including 4 licences to bottle). Pasteurised : 16 Dealers' Licences, 2 Licences to Pasteurise, and 2 Supplementary Licences. During the year 146 samples of Graded Milk were taken as follows :— Average Bacterial No. of Samples, count per 1 c.c. Certified 1 1,496 Grade A (T.T.) 66 104,373 Grade A, Pasteurised 25 11,276 Pasteurised 54 22,185 It will therefore be seen that the above figures are well within the standard allowed under the Milk (Special Designations) Order, 1923. 28 (b) INSPECTION OF MEAT AND OTHER FOODS. Visits have been paid to the various slaughterhouses on practically every occasion on which slaughtering of beasts or pigs has taken place. During the year there were slaughtered— Beasts 93 Pigs 229 Sheep 583 Calves 29 UNSOUND FOOD SURRENDERED & DESTROYED, 1933. Ox Heads and Tongues 4 Ox Liver 181 ibs Ox Liver 3 sets Ox Mesenteries 1 Pig's Mesenteries 3 Boar, entire carcase and organs 1 Devon pasties 2 Pork pies 4 Rice i84lbs. INSPECTION OF OTHER FOODS. The various premises in Wembley in which food is manufactured, prepared, stored or exposed for sale, have been frequently inspected during the year and the conditions existing have usually been satisfactory. The bakehouses are inspected at frequent intervals and usually kept in a clean condition. (c) SALE OF FOOD AND DRUGS (ADULTERATION) ACT. I am indebted to Mr. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, for the following facts relating to samples taken during the year in this district, 29 Article No. Taken Adulteration Milk 98 - Milk, sterilized 1 — Bread and butter 1 1 Butter 1 — Hake 7 2 Lemon Soles 6 2 Totals 114 5 (d) CHEMICAL AND BACTERIOLOGICAL EXAMINATION OF FOOD. Any chemical and bacteriological work which is required in connection with food is carried out by the Clinical Research Association. FOOD HANDLING AND FOOD EXPOSURE. I cannot report that the unnecessary handling of food has ceased. I hear, and occasionally see, evidence of it, especially at confectioners. Bread continues to be ill-used, dropped in the road, left on door steps, and will still be polluted until the public demand that it must be delivered in a paper bag, or covering of some kind. NUTRITION. The question of nutrition, of food allowances necessary to maintain health and working capacity, is perhaps not of so great importance in this district as in so many that have large institutions to administer, but is certainly of interest to families and Individuals, especially in these days of unemployment. Recently two Committees have been making careful scientific investigations of this matter on quite different lines, viz. : the Permanent Advisory Committee of the Ministry of Health and the ad hoc Committee of the British Medical Association. These Committees have now agreed as to the minimum allowance required by men, women, boys, girls and children —in heavy, moderate, or light work—only as an average, as no definite well defined scale can be arranged for in human affairs. 30 The different food values are expressed as calories. You remember that a calorie is a heat standard and is the amount of heat required to raise one litre of water one degree Centigrade, and is always used to express the energy value of food, just as a foot rule is used to measure length or an ounce in calculating weight. Having no slums or a very serious amount of unemployment, it cannot be said that there has been any marked degree of lack of food—not covered by insurance—public assistance or milk grants. No doubt many were on the borderland of the minimum laid down by the Ministry, but on the whole, the amount of food received has been adequate. POISONING BY ANTIMONY. The Memorandum 171 of the Ministry of Health draws attention to the danger of storing acid drinks and food in cheap enamel-ware. Tartaric and citric acid, for example, coming into contact with modern enamel have been found to form compounds of antimony which have given rise to outbreaks of poisoning by antimony. NOTES ON CURRENT SUBJECTS, One cannot be easily convinced that the benefits which ultimately accrue from the efforts of Authorities in favour of the scores of Public Health activities are in any sense commensurate with the enormous annual expenditure of money. Whilst no one can doubt the obvious and immediate success of Infant Welfare work throughout the country in assisting the young child to make a fair start in life with the best physical equipment, one sees how soon the good derived may be neutralised by preventable causes. Many factors contribute to this end. We cannot attribute ill-health to the noxious environment of slum life, for slums here are practically non-existent, but the indulgence of parents who make little attempt to control the boy and girl is often very marked, especially during the daylight saving period. On visiting the schools you can almost pick out the children who are permitted to remain up until 9, 10, and 31 even 11 o'clock every evening, although it is well known that the growing child requires from 10 to 12 hours in bed every night. I should like to be able to report that young children would only be admitted to entertainment halls in the daytime, and that a very thorough system of ventilation was always insisted on by the County. The lack of parental control is evident later, when you see youths smoking all day, even at work, and as a consequence looking pale, coughing incessantly and becoming catarrhal. Every year we have to record an average which is far too high for Pulmonary Tuberculosis (consumption) in youths of both sexes who would never become susceptible if they kept fit. The majority of those who reach middle age die in the fifties and sixties instead of reaching the seventh and eighth decade. The tendency to keep late hours, to take cocktails, irregular and improper diet, is not the correct antidote to the increasing stress of life spent in town or even at home. There is no doubt that a large number of people are still living dangerously and are acquiring a condition of very low resistance. Hence the susceptibility to colds, to influenza, phthisis, pneumonia—later to cancer and scores of other ills that are constantly awaiting us. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Supply of Anti-toxin. General. The Council supply free of charge to any practitioner for use in this district, Diphtheria Anti-toxin, Tetanus Anti-toxin, Anti-Streptoccoccus Serum, Sputum containers, Swabs, Widal Outfits, Specimen containers, etc. During office hours these can be obtained from the Public Health Department and at all other times from the Ambulance House adjoining the Fire Station. Information as to this and also as to the removal of cases, infectious and otherwise, is communicated by me to Medical Practitioners in the following form :— 32 WEMBLEY URBAN DISTRICT COUNCIL Public Health Department. For Removal of Cases of Infectious Disease During Office hours, 9 a.m. to 5 p.m. Saturday, 9 a.m. to 12 noon Telephone: WEMbley 3443. After Office hours or during weekends Communicate direct with Isolation Hospital: ACOrn 4231. For Removal of Accident or Non-Infectious Cases. Telephone: Wembley Fire Station, WEMbley 0100. For Supply of Swabs, Diphtheria Anti-toxin, Sputum Containers, Etc. After Office hours, apply to Ambulance House, adjoining Fire Station. To Consult the Medical Officer of Health. After Office hours, telephone BYRon 2424. In the absence of the Medical Officer, telephone the Chief Sanitary Inspector, WEMbley 3443. During the past year there have been no deaths from diphtheria. But I regret to say that too often in past years it has happened that parents have not realised the necessity of obtaining medical advice early enough to be effective; have delayed, in fact, four or five days till the patient has become toxic, and has been unable to respond to any treatment. It should be understood that any septic throat should be seen by a doctor at once. In some instances neglect is culpable, and in all must be regretted and deplored. As a medical officer I am often ashamed of a death from diphtheria, and I know the medical practitioners act at once, regarding all cases as urgent and dangerous. 33 Encephalitis Lethargica. No deaths occurred from Encephalitis Lethargical during the year. Return Cases of Scarlet Fever. There were no return cases during the year. Public Health (Infectious Disease) Regulations, 1927. One case of Malaria was notified during the year. So far as the other diseases are concerned, there were notified 57 cases of Pneumonia, of which 27 proved fatal. Hospital Accommodation for Cases of Infectious Disease. This has been dealt with elsewhere in my Report, 152 cases of Scarlet Fever were notified during the year, 114 of which were admitted to Hospital. 34 cases of Diphtheria were notified, 30 of which were admitted to the Infectious Diseases Hospital. Where the home conditions are suitable and medical supervision is carried out by the Medical Practitioner in charge of the case, patients suffering from Scarlet Fever and Diphtheria are nursed at home. Suitable disinfectants are supplied free of charge. 38 cases of Scarlet Fever and 4 cases of Diphtheria were nursed at home during the year, At the termination of the cases, disinfection of the premises and bedding is carried out. The incidence of these diseases did not increase as a result of the isolation being carried out at home. Puerperal Fever and Puerperal Pyrexia. Four cases of Puerperal Fever and 6 cases of Puerperal Pyrexia were notified during the year. There was no observed relation between these cases and Scarlet Fever. EXAMINATION OF BACTERIOLOGICAL AND PATHOLOGICAL SPECIMENS. The Council make provision for the examination of specimens by the Clinical Research Association and the Royal Institute of Public Health, and full advantage of this 34 service is taken by the resident Medical Practitioners. In J • any instance in which Diphthera has occurred in families and in which it has been considered necessary so to do, swabs have been taken from the whole of the inmates of the house and forwarded for examination. It is my custom to arrange for the attendance at this office of the children of the less well-to-do families, with a view to saving the expense, which would otherwise be incurred, and in this respect 45 swabs were taken during the year. Very little use has so far been made of the tests known as the Schick and Dick tests in Diphtheria and Scarlet Fever respectively. PREMISES AND OCCUPATIONS SUBJECT TO CONTROL BY THE LOCAL AUTHORITY. HOUSES LET IN LODGINGS, AND COMMON LODGING-HOUSES. There are no premises in the District which come within either of these classifications. TENTS, VANS, AND SHEDS. The development of the District, with its consequent removal of their accustomed haunts, has compelled the tribes or wandering nomads, from whom this District has suffered so much in days gone by, to seek fresh fields and pastures new. OFFENSIVE TRADES. The only Offensive Trades carried out in the Wembley district are those of Fish- Frying and Fat Extraction. There were during the year six shops registered for the purpose of fish frying in the district. They are frequently inspected and are well conducted, Every application for permission to establish a Fish Frying business is very carefully scrutinized by the Council, consideration being given to the special need and to the exact locality. We seldom receive any complaints now. No complaints were received in the case of the business of Fat Extraction during the year. 35 SMALLPOX. On several occasions I have been asked to meet resident practitioners to assist in the diagnosis of smallpox. NON-NOTIFIABLE INFECTIOUS DISEASES. The practice which has been in force with regard to the exclusion notices received from the various schools still continues and in any case where it is necessary that further enquiries should be made a visit is paid to the home by one of your Public Health Staff, and in cases of doubt parents are persuaded to arrange for a child to be seen by a medical practitioner. Where a number of cases of infectious disease have occurred in schools it has always been my custom to ascertain the names of those absent and to investigate the cause of such absence. DISINFECTION OF PREMISES AND ARTICLES. During the year 357 disinfections were carried out after :— Notifiable Infectious Diseases ... 309 Cancer ... ... ... ... 24 Miscellaneous ... ... ... 24 Number of Articles Disinfected or Destroyed. Disinfected. Destroyed Beds 192 9 Bolsters 294 2 Blankets 9°3 — Counterpanes 502 2 Covers 98 1 Curtains 2 — Cushions 204 4 Mattresses 364 21 Palliasses 3 — Pillows 716 6 Rugs and Mats ... 99 3 Sheets 546 4 Wearing Apparel 655 69 Sundries 260 68 Total 4838 189 36 PLAIN WORDS ON CANCER. In spite of much new knowledge with regard to Cancer, the mortality rate is very high. Every year our district loses over 50 persons from this disease. It is well known that, to a considerable extent, this high rate is preventable. What happens so often is that, the early stages being comparatively painless, the new growth is not recognised at first as abnormal; or from false modesty or disinclination, its consideration is neglected.. Too often so-called friends advise that on no account should an operation be undertaken—or they know a special home where patients are cured without operation ! These friends accept a grave responsibility, and so do the institutions that receive these deluded patients, and so frequently treat them without even medical attendance. The continued permisssion of this general nullity of treatment is one of the strange anomalies of the 20th centurv administration—so inimical to the best public health methods ! No cases are so sad as those who arrive too late for 'treatment—a tragedy to the patient—depressing to the doctor, and a serious loss to the community. On the other hand scores of lives are saved annually by early surgical treatment, especially by certain new surgical details of technique, and a more exact dosage of radium, often avoiding operation. The Ministry of Health has appointed special Committees to make full investigation, and can now state that no single article of diet favours the growth of cancer—that cancer is not in the ordinary sense inherited, is not contagious—(no doubt similar constitutions and similar tissues under unfavourable and unnatural conditions, such as may arise from chronic irritation or chronic constipation, may acquire the complaint, and especially may this be the case where the tissues are old and worn out). Nor is there good evidence that cancer attaches to particular houses or districts. We are all urged by the Ministry of Health, whenever there arc signs or symptoms that are not understood, to see a doctor at once, and be cured whilst the opportunity occurs. 37 DESTRUCTION OF RATS AND OTHER PESTS. We frequently have complaints that premises are infested with rats and we lose no time in notifying the County Council Official whose duty it is to investigate each case, to give full instructions and when possible to suggest remedies. PREVENTION OF BLINDNESS. No action was taken under Section 66 of the Public Health Act, 1925, for the prevention of blindness or the treatment of persons suffering from any disease or injury to the eyes. OPHTHALMIA NEONATORUM. One case was notified during the year. The vision was unimpaired. PREVENTION OF DEAFNESS. It has always been obvious that while much has been, and is being, done for the blind, and rightly so, very little is undertaken municipally for the deaf. In May last the Ministry of Health issued a Circular (No. 1337a) drawing the attention of Maternity and Child Welfare Authorities and others to the need of early and effective treatment of ear diseases and discharges, resulting from infectious disease such as measles, scarlatina, diphtheria, and meningitis and the particular observation and treatment of nasal and throat defects. The resident medical practitioners and the clinic doctors have been furnished with the Circular. TUBERCULOSIS. Public Health (Prevention of Tuberculosis) Regulations, 1925. No action was taken under these regulations during the year regarding tuberculous employees in the milk trade. Public Health Act, 1925—Section 62. No action was taken under this section during 1933. Tables relating to Tuberculosis appear at the end of the Report. 38 THE "NOVOX" APPARATUS FOR ALL CONDITIONS OF BREATHLESSNESS. You have provided at the Fire Station an apparatus containing Oxygen and Carbon Di-oxide for the resuscitation of those, who, from whatever cause, are not breathing or who have difficulty in obtaining breath. It has proved to be extraordinarily useful in numerous cases of emergency. BIRTH CONTROL. The subject of Contraception has been freely and exhaustively discussed for some years by all classes and creeds, and, whatever the objections may be—and they are many—it must now be conceded that the practice has a definite position for certain well marked and recognised instances of abnormal conditions, for example:—for those suffering from hereditary disease, mental troubles, syphilis, chronic epilepsy, alcoholism, active tuberculosis, advanced heart or kidney trouble; for those who, having already four or five children, are becoming exhausted and unfit—for those wh ohave rickety contracted pelves, and perhaps have already had Caesarian section—and for other causes to be determined by the medical attendant. It is certainly not desirable that the strong and healthy should practise birth control methods; by so doing they accept, from a eugenic point of view, a grave responsibility. Birth Control is, in any case, preferable to the sudden and unnatural termination of pregnancy (abortion), which is said to be greatly on the increase. There is no doubt that poorer women, who are eligible, should be able to obtain advice as to the best modern methods of contraception—not at a Maternity and Child Welfare Clinic, but at what is known as a Gynaecological Clinic, held say once a month, a Clinic which deals only with illnesses peculiar to women. CREMATION. We constantly hear of land being surveyed and acquired still for burial grounds in Middlesex, and around London, but not a suggestion for a Columbarium or Garden of Sleep. In many continental towns nearly all Protestants, on dying, are cremated now—they realise the danger and the folly of using valuable land for purposes of burial. 39 CONCLUSION. It is always a real pleasure to refer to the consideration and assistance received from the Chairman and Members of the Public Health and the Maternity and Child Welfare Committees, indeed from all the Councillors, because this harmony and goodwill is obviously reflected in the work of the Department, and especially do I wish to refer to our Chief Sanitary Inspector, Mr. G. H. Fearn, whose talent for this work, for so many years, has been outstanding. His departure would really be irreparable if it were not for the fact that your choice of a successor, and other members of the staff, will, in a measure, compensate for his loss, and materially assist in maintaining the usual satisfactory standard of efficiency. I have the honour to be, Your obedient Servant, CHARLES E. GODDARD, Fellow of the Society of Medical Officers of Health. Fellow, Royal Sanitary Institute. Fellow, Royal Institute of Public Health. 40 41 VITAL STATISTICS OF THE WHOLE DISTRICT DURING 1933, 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 Rate of Nonresidents regist'r'd in the District of Residents not regist'r'd in the District Under 1 year of age At all ages Number Rate Number Rate per 1000 nett Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 1929 35,530 482 607 17.08 244 6.87 20 126 33 54.36 350 9.85 1930 40,094 585 700 17.45 211 5.13 16 120 28 40.00 315 7.85 1931 48,590 663 780 16.05 272 5.59 14 129 35 44.84 387 7.96 1932 53,420 671 807 15.10 264 4.94 19 146 33 40.89 391 7.31 1933 58,850 621 854 14.08 284 4.80 27 186 42 50.66 443 7.53 42 CASES OF INFECTIOUS DISEASE (OTHER THAN TUBERCULOSIS) NOTIFIED DURING THE YEAR 1933. NOTIFIABLE DISEASE Total Cases Notified at all Ages Cases Notified in the Whole District Total removed to Hospital Total Deaths At all Ages—Years Under 1 1-2 2-3 3-4 4-5 5-10 10-15 15-20 20-35 35-45 45-65 65 & over Scarlet Fever 152 — 3 5 10 9 64 35 11 12 2 1 — 114 2 Diphtheria 34 — 1 1 — 5 10 5 1 6 3 2 — 30 — Enteric Fever (including Paratyphoid) 3 — — — — — — 1 1 — — 1 — 2 — Puerperal Fever 4 — — — — — — — — 3 1 — — 2 1 Puerperal Pyrexia 6 — — — — — — — — 5 1 — — 1 — Pneumonia 57 2 1 2 — — 3 2 3 16 10 13 5 — 27 Erysipelas 22 — — — 1 — 1 1 1 5 — 11 2 4 — Ophthalmia Neonatorum 1 1 — — — — — — — — — — — — Acute Anterior Poliomyelitis 3 — — 1 — — 1 1 — — — — — — — Malaria 1 — — — — — — — — 1 — — — — — 43 TUBERCULOSIS. New Cases and Mortality during 1933. New Cases Deaths Age Periods Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F. M. F. M. F. M. F. Under 1 year — — 1 — 1 1 1 — 1 to 5 years 1 — 2 — — — 2 — 5 to 15 years — 1 4 1 — — 1 — 15 to 25 years 9 2 — 1 6 1 1 — 25 to 35 years 8 7 1 3 3 6 — — 35 to 45 years 13 1 1 1 3 — 1 1 45 to 55 years 10 3 — — 5 — 1 — 55 to 65 years 1 — — — — — — — 65 years and over 1 — 1 — — — — — Totals 43 14 10 6 18 8 7 1 34 deaths from Tuberculosis were registered during the year. 5 cases were not notified as suffering from Tuberculosis during life (14.7 per cent.). The Death Rate from Tuberculosis for the year 1933 was .58 per 1,000 population. CAUSES OF DEATH DURING YEAR 1933. CAUSES OF DEATH M. F. Total ALL CAUSES 225 218 443 Typhoid and paratyphoid fevers — — — Measles — — — Scarlet fever 1 1 2 Whooping Cough 1 1 2 Diphtheria — — — Influenza 5 11 16 Encephalitis lethargica — — — Cerebro-Spinal fever — — — Tuberculosis of respiratory system 18 8 26 Other tuberculous diseases 7 1 8 Syphilis — — — General paralysis of the insane, tabes dorsalis 1 1 2 Cancer, malignant disease 27 37 64 Diabetes 3 5 8 Cerebral haemorrhage, etc. 11 12 23 Heart disease 32 47 79 Aneurysm 2 — 2 Other circulatory diseases 18 14 32 Bronchitis 7 3 10 Pneumonia (all forms) 12 15 27 Other respiratory diseases — 1 1 Peptic Ulcer 5 2 7 Diarrhoea, etc. (under 2 years) 3 — 3 Appendicitis 1 1 2 Cirrhosis of liver 1 1 2 Other diseases of liver, etc. 1 1 2 Other digestive diseases 5 2 7 Acute and chronic nephritis 8 11 19 Puerperal sepsis — 1 1 Other puerperal causes — 4 4 Congenital debility, premature birth, malformations, etc. 17 11 28 Senility — 5 5 Suicide 4 2 6 Other violence 12 7 19 Other defined diseases 23 12 35 Causes ill-defined or unknown — 1 1 44 INFANTILE MORTALITY DURING THE YEAR 1933. Causes of Death Nett Deaths from stated causes at Various Ages under 1 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 Months 6-9 Months 9-12 Months Cerebro Spinal Meningitis — — — — — — 1 — — 1 Prematurity 8 2 1 — 11 3 — — — 14 Enteritis — — — — — 1 1 1 — 3 Marasmus — — — 1 1 1 — — — 2 Congenital defects 3 — — — 3 — 3 — — 6 Asphyxia Neonatorum 1 — — — 1 — — — — 1 Atelectasis 2 — — 2 — — — — 2 Wilful Murder — — — 1 — — — 1 Whooping Cough — 1 — — 1 Pneumonia — 1 — 1 2 2 — 1 1 6 Acute Tuberculosis — — — — — 1 — — — 1 Tuberculous Meningitis — — — — — — — 1 — 1 Cæsarean Section 1 — — — 1 — — — — 1 Umbilical Hernia 1 — — — 1 — — — — 1 Injury at Birth 1 — — — 1 — — — — 1 Total 17 3 1 2 23 9 6 3 1 42 45 1.—INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted Factories (Including Factory Laundries) 175 10 — Workshops (Including Workshop Launddries) 22 9 — Workplaces (Other than Outworkers premises) 1 — — Total 198 19 — 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars Number of Defects Number of offences in respect of which prosecutions were instituted. Found Remedied Referred to H.M. Inspector Nuisances under the Public Health Acts: Want of Cleanliness 17 12 2 — Want of Ventilation 1 1 — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 6 3 — — Sanitary accommodation insufficient 2 2 — — unsuitable or defective 12 9 — — not separate for sexes — — — — Offences under the Factory and Workshop Acts:— Illegal occupation of underground bakehouses (S.101) — — — — Other offences — — — — Excluding offences relating to outwork and offences under the Sections mentioned in the Schedule to the Ministry of Health (Factories and Workshops Transfer of Powers) Order, 1921. Total 38 27 2 — *These figures include 56 visits to Factory Bakehouses and 16 visits to Workshop Bakehouses. OUTWORK IN UNWHOLESOME PREMISES (Sec. 108). No action was taken under this Section. INDEX. PAGE Acts, adoptive in force 14 Ambulance Facilities 8 Area 5 Bakehouses 29 Births 6 Birth Control 39 Blindness—Prevention 38 Bye-laws, in force 14 Cancer 37 Children's Acts 20 Clinics 9, 17 Closet Accommodation 22 Committees 3 Common Lodging Houses 35 Conclusion 40 Cowsheds 28 Deaths 7, 44 Diphtheria 33 Disinfection 36 Drainage and Sewerage 21 Encephalitis Lethargica 34 Enteric Fever 42 Erysipelas 42 Factories and Workshops 46 Fish Frying (see offensive trades) 35 Food—adulteration 29 Food—examination 30 Food—inspection 28 Food—unsound 29 Health Services 8 Health Visiting 19 Hospitals 11 Houses let in Lodgings 35 Houses—number inhabited 5 Housing 26 Infantile Mortality 7, 45 Infectious Diseases 32, 42 Inquests 25 47 PAGE Isolation Hospital 11 Malaria 34 Maternal Mortality 7,9 Maternity Cases—accommodation for 12 Maternity and Child Welfare 16 Maternity Homes 12, 15 Midwives 16 Milk—Samples 28 Mortuary 25 Nursing 9 Offensive Trades 35 Ophthalmia Neonatorum 38 Pneumonia 42 Population 5 Public Conveniences 25 Puerperal Fever and Pyrexia 18, 34 Rag Flock Acts 25 Rateable Value 5 Rats and Other Pests—destruction of 38 River and Streams 22 Sanatoria 13 Sanitary—circumstances 21 Sanitary—inspection 23 Sanitary—work executed 24 Scarlet Fever 34 Schools 26 Slaughterhouses 29 Slaughtering 29 Smallpox 12, 36 Smoke Abatement 25 Social Conditions of Area 5 Staff 4 Still Births 14 Swabs—examination of 34 Tents, Vans and Sheds 35 Tuberculosis 12, 38, 43 Vital Statistics 6, 41 Water Supply 21 Welfare Report 16 48