Ac 439(1) Wlmbley (hate mum B) M Wemis Wembley Urban District Council ANNUAL REPORT FOR THE YEAR 1934 BY THE MEDICAL OFFICER OF HEALTH FOR WEMBLEY. Wembley Urban District Council ANNUAL REPORT FOR THE YEAR 1934 BY THE MEDICAL OFFICER OF HEALTH FOR WEMBLEY. Urban District Council of Wembley PUBLIC HEALTH COMMITTEE FOR THE YEAR 1934—1935. Chairman— Councillor H. GAUNTLETT. Councillor C. BARTON Councillor Dr. G. H. PLYMEN Councillor A. W. CLARKE Councillor J. W. SNOOK Councillor S. E. HARRIS Councillor F. J. TUCKER Councillor Miss E. HOWSE Councillor F. W. TURNER Councillor J. H. LAMBERT Councillor L. F. WESTERN Councillor M. LEVY Councillor M. CAMPBELL Councillor E. H. EVERETT (Chairman of the Council.) (Vice-Chairman of the Council.) MATERNITY AND CHILD WELFARE COMMITTEE FOR THE YEAR 1934—1935. Chairman— Councillor Dr. G. H. PLYMEN. Councillor C. BARTON Councillor J. H. LAMBERT Councillor A. W. CLARKE Councillor M. LEVY Cr. S. E. COLLINGBOURNE Councillor J. W. SNOOK Councillor H. GAUNTLETT Councillor F. W. TURNER Councillor S. E. HARRIS Councillor L. F. WESTERN Councillor Miss E. HOWSE Councillor M. CAMPBELL Councillor E. H. EVERETT (Chairman of the Council.) (Vice-Chairman of the Council.) Co-opted Members— Mesdames CLARKE, COLLISON, COLLYER, EMPSON, FARQUHARSON, GAUNTLETT, ROWBOTTOM. STAFF OF THE PUBLIC HEALTH DEPARTMENT. (As constituted January, 1935.) * Medical Officer of Health— CHARLES E. GODDARD, O.B.E., T.D., M.D., M.R.C.S., L.R.C.P., A.K.C. * Chief Sanitary Inspector— ROBERT M. TURNER, M.S.I.A., A.R. San. I., Sanitary Inspector's Cert., Royal San. Inst. ; Meat and Other Foods Inspector's Cert., Royal San. Inst., Smoke Inspector's Cert., Royal San. Inst, * Sanitary Inspectors— H. YOUNG, Sanitary Inspector's Cert., Royal San. Inst. and San. Inspector's Examination Joint Board : Meat and Other Foods Inspector's Cert., Royal San. Inst. M. G. CROOK, Sanitary Inspector's Cert., Royal San. Inst. and San. Inspector's Examination Joint Board ; Meat and Other Foods Inspector's Cert., Royal San. Inst. W. COMBEY, Sanitary Inspector's Cert., Royal San. Inst. and San. Inspector's Examination Joint Board ; Meat and Other Foods Inspector's Cert., Royal San. Inst. * Health Visitors— Miss V. L. DAVIES, Health Visitor's Cert., Royal San. Inst.; Cert. of Central Midwives' Board ; State Registered Nurse. Miss M. E. MILNER, Health Visitor's Cert., Royal San. Inst. : Cert. of Central Midwives' Board. Miss G. AINSCOW, Health Visitor's Cert., Royal San. Inst. ; Cert. of Central Midwives' Board; State Registered Nurse. Miss D. S. NEWMAN, Health Visitor's Cert., Royal San. Inst.; Cert. of Central Midwives' Board ; State Registered Nurse. Miss M. H. JONES, Health Visitor's Cert., Royal San. Inst. ; Cert, of Central Midwives' Board; State Registered Nurse. Clerical Staff— Chief Clerk : H. N. RYAN. Clerks : G. H. Hughes, W. C. E. Keutenius, T. L. Almson, P. B. D. Bunyan. Inspector, Removal of House Refuse— JAMES MANSELL. PART TIME OFFICERS. * Medical Officers of Child Welfare Centres— EDITH C. HUDGELL, M.R.C.S. (Eng.), L.R.C.P. (Lond.) MARY KING, M.R.C.S. (Eng.), L.R.C.P. (Lond.), D.P.H. * Consultant Gynaecological and Obstetrical Surgeon— JOHN W. RAIT BELL, L.P.C.P.I. and L.M., L.R.C.S.I. and L.M. * Dental Surge on— CHARLES LAFFERTY, L.D.S. * Contribution made to salary by Ministry of Health or County Council. WEMBLEY URBAN DISTRICT COUNCIL ANNUAL REPORT of the Medical Officer of Health for the year 1934 BY Charles E. Goddard, O.B.E., M.D. To the Chairman and Members of the Wembley Urban District Council. Mr. Chairman, Madam, and Gentlemen, I have the honour to submit my 39th Annual Report on the Sanitary circumstances of the district for the year 1934, and in doing so have followed the order of details as far as possible from instructions from the Ministry of Health. Area in acres 6,299 Population 1934 (Midsummer), Estimated by Registrar-General 92,160 Number of inhabited houses, end of 1934, according to rate books 26,000 Rateable Value (31st December, 1934) £1,006,840 Sum represented by a penny rate £3,700 POPULATION. The Registrar-General has supplied the following memorandum on the change of boundary:— " The statistics of births, deaths and notifiable diseases supplied for the calendar year in respect of the above named area are composite figures combining the records of the former areas of Kingsbury Urban District and Wembley Urban District for the March quarter and 5 the records of the new area of Wembley Urban District for the part of the year subsequent to the date of change. The normal mid-1934 estimate of population for the area as now constituted is 92,160, but, for use with the composite statistics now supplied, a working population figure modified to take account of the fact that the records do not wholly relate to the entire year, has been provided and fixed at 91,925." SOCIAL CONDITIONS. There has been no material change in the social conditions of the district. By far the greater number of the population of Wembley are employed outside the district, which still maintains a " dormitory " character. In the district itself the largest employers of Labour are Atcraft Works; General Electric Co.; Universal Furniture Products, Ltd.; Wrigley Products, Ltd.; Wisemans; Wembley Stadium and Empire Sports Arena; and the Glacier Metal Co. The various railway companies are also large employers, and in the newly acquired area of Kingsbury, General Motors, Ltd.; Daimler, Ltd.; Windovers, Ltd.; Beardmore Motors; De Havilland Aircraft; Desoutter, Ltd.; Frigidaire, Ltd.; Lamson Paragon (Papercrafts); Phoenix Telephones, Ltd. 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. VITAL STATISTICS. Live Births. Male Female Total Legitimate 750 762 1512 Birth Rate per 1,000 of estimated resident population 16.91 Illegitimate 20 22 42 1554 6 Still Births. Male Female Total Legitimate 27 22 49 Rate per 1,000 total (live and still births) 32.98 Illegitimate 3 1 4 53 Still Birth Rate per 1,000 estimated population 51 Deaths. Male Female Total 356 325 681 Death Rate per 1,000 estimated population (Adjusted figure) 9.33 (Crude rate) 7.41 Maternal Mortality. Rate per 1,000 live and still births. Deaths from Puerperal Sepsis 4 2.49 Other Puerperal causes 1 0.62 Total 5 3.11 Infantile Mortality. Deaths of Infants under 1 year of age:— Male Female Total Legitimate 40 21 61 Illegitimate 1 — 1 62 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 39.90 Legitimate Infants per 1,000 legitimate live births 40.34 Illegitimate Infants per 1,000 illegitimate live births 23.81 Deaths from Measles (all ages) 5 ,, ,, Whooping Cough (all ages) 1 ,, ,, Diarrhoea (under 2 years) 2 7 TABLE OF COMPARATIVE VITAL STATISTICS. per 1,000 population per 1.000 Live Births per 1,000 Total Births. Birth Rate Still Birth Rate Death Rate Infantile Mortality Maternal Mortality Maternal Mortality Wembley 16.91 0.58 9.33 39.90 3.22 3.11 England and Wales 14.80 0.62 11.80 59.00 4.60 4.41 London 13 20 0.50 11 90 67.00 118 County Boroughs and Great Towns including London 14.70 0.66 11.80 63.00 135 smaller towns— Estimated Resident population 25,000 to 50,000 at Census 1931 15.00 0.67 11.30 53.00 The Registrars of Births, Deaths and Marriages have supplied me with the following figures:— Total number of Marriages in the district during 1934:— Churches of all denominations 396 Registry Office 196 592 GENERAL PROVISION OF HEALTH SERVICES IN THE AREA. (a) LABORATORY FACILITIES. For many years you have sent to the Clinical Research Association your samples of milk for bacteriological examination, and specimens, and swabs for the detection of Diphtheria, Typhoid, etc.— and to the laboratory of the Royal Institute of Public Health your specimens of sputum for the bacillus of tubercle. We have felt assured and safe at these laboratories. The following examinations were made during the year:- Examinations of Swabs 845 ,, ,, Blood Specimans 9 ,, ,, Sputum 158 ,, ,, Graded Milks 134 ,, Water 7 8 (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 charge is made to residents, and appreciation of the service is frequently expressed. During 1934, 1,429 cases were removed, and the total mileage amounted to 13,903 miles. (c) NURSING IN THE HOME. District Nursing Associations. The Annual Report of the Wembley and District Nursing Association and the Kingsbury Association give excellent accounts of the work done in each part of the district for the year 1934. The Wembley Association with five Queen's Nurses made 11,000 visits, of which 600 were free. The Queen's Institute Inspector made an excellent report of the year's work in the following terms:— "Very good work was seen in all areas. The nurses were efficient, sympethetic and interesting. All patients were in good nursing order and almost appreciative of the nursing service whic is available in Wembley. The home is well and economically managed by the Senior Nurse, and a very high standard of work, and a happy atmosphere maintained. All records and equipment were in good order." The same may be stated of the Kingsbury Nursing Association for their energy and good work and this also must be said about Kingsbury, that all the help possible must be given because of the vastly increased population and the greater difficulty of obtaining funds. Councillor Miss Howse is the representative for the Wembley Association and a representative is about to be appointed for the Kingsbury Association. 9 CLINIC AND TREATMENT CENTRES. DESCRIPTION SITUATION SERVICES RENDERED DATE AND TIME BY WHOM PROVIDED Child Welfare Clinics St. Andrew's Hall, Ealing Road, Wembley. Supervision of mothers and children under 5 years Wednesday 2.0—4.30 p.m. Thursday 2.0—4.30 p.m. Wembley Urban District Council. Tokynpton Hall, Monk's Park, Wembley. Do. Tuesday 2.0—4.30 p.m. Wesley House, Harrow Road, Sudbury. Do. Friday 2.0—4.30 p.m. Kinpsbury Free Church, Slough Lane. Do. Tuesday 2.0—4.30 p.m. Kingsbury Church Hall, Bacon Lane. Do. Monday 2.0—4.30 p.m. Wednesday 2.0—4.30 p.m. Ante-Natal Clinic St. Andrew's Hall. Ealing Road, Wembley. Medical Supervision 1st and 3rd Thursday in each month at 9.30 a.m. Do. Kinpsbury Free Church, Slough Lane. Do. Last Friday in each month at 9.30 a.m. Dental Clinic Alperton Council School, Ealing Road. Kinpsbury Free Church, Slough Lane. Dental inspection and treatment of nursing and expectant mothers and children under 5 years. Do. See posters, one of which can be seen at the Public Health Department. Do. Do. 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. Do. Do. Do. Treatment Centres for V.D. Various London Hospitals. Examination and treatment. Do. Wembley Hospital Wembley. Artificial light treatment.* X-ray installation. Orthopaedic work & Massage. 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. 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. THE WEMBLEY HOSPITAL. The Wembley Hospital, supported entirely by voluntary subscriptions, continues to give very satisfactory results. During 1934 there were 1,091 admissions and 846 operations. The number of beds has been increased to 63, and includes a separate ward for children. This is the eighth year of its existence, and every year shows great strides in useful work, and in equipment. The Electrical and Massage departments have been much used by your Maternity and Child Welfare Clinics during the past year. It is indeed a boon to the district to have such medical and surgical facilities actually on the spot. Your representatives on the Board can report to you, as generous subscribers to the Hospital Fund that the inpatients are always willing to express their gratitude for the care and treatment received there and for the generous diet provided. The cost per occupied bed per week for year 1934 was £2 16s. Id.—quite a satisfactory figure. The management, the medical, surgical and nursing staff, can be congratulated on the continued prosperity of the Hospital, and on the general efficiency of the work, and also on the fact that no debt has been incurred since its foundation. THE ISOLATION HOSPITAL. For more than twenty years we have been exceptionally well served in sending our notifiable infectious disease to Acton. 11 The fees charged for each patient are lower than at any hospital I am acquainted with, and the cost must be certainly considerably less than if we built, equipped and staffed our own hospital. We have reason to be well satisfied with the treatment, diet, etc. I attend personally every week, frequently twice, and interview and know the condition of every one of the patients from this district, usually in number between 20 and 30 at one time. Of course we have many problems to solve with friends and relations, but they are soon surmounted owing to the tact, care and skill of the medical staff and Matron. As you are aware, we have, with Acton, applied to the Ministry for sanction to form a Conjoint Hospital Committee as the most suitable solution of the question of the isolation of our cases in the future. There does not appear to be any good reason for pressing for an early decision in the matter. SMALLPOX ACCOMMODATION. The County Council is responsible for the provision of hospital accommodation for cases of Smallpox occurring in this district, and cases that occur are sent to the Dartford Smallpox Hospital. 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. - During 1934 we had difficulty in finding accommodation for our maternity patients whether bona fide public assistance cases or not, but by sending some to the Redhill Hospital, arrange for the reception of our urgent cases. However, the to Queen Charlottes and other Hospitals, we managed to Maternity and Child Welfare Committee have long felt anxious about the mothers, and have endeavoured to form a scheme with Harrow and perhaps Hendon to establish a joint Hospital Board and build a hospital of from 80 to 100 beds 12 for the huge population of this part of Middlesex. It is greatly to be hoped that such a scheme will materialise in the near future in view of the inability of the County Council to meet the difficulty. 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. Memorial Hostel for the reception of necessitous Middlesex children needing change of air. This home is at Collington Manor, Bexhill-on-Sea. The payment of 35s. provides the return fare and two week's 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 as a Special School for Delicate and Debilitated Children). The complaints treated include anaemia, debility, malnutrition, bronchitis, incipient rheumatism and general convalescence. Children are admitted from 8 to 13 years of age for periods of 6 weeks or 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. It is not generally known and appreciated that The Yarrow Convalescent Home at Broadstairs is available for children of the middle classes only. 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. This service is now being more generally used and the results are reported to be very satisfactory. 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 (April, 1913; March, 1928; January, 1929). Tents, Vans, Sheds and similar structures used for human habitation (1901). Public Conveniences (March, 1926). Mortuary Regulations (February, 1926). Smoke Abatement (May, 1930). Hoardings and Advertisements (December, 1926). In addition the following Bye-laws apply to the Kingsbury area:—Bye-laws Nos. 1, 3, 4, 5, 6, 7, 8, 101, 103, 104, 105, 107, 113, 114, of Bye-laws re.:— New Streets and Buildings (December, 1901). Removal of House Refuse and Cleansing of Earth Closets, etc. (December, 1901). Nuisances (October, 1902). Schedule of Relaxation of Local Acts, Regulations or Bye-laws—Streets (January, 1925). New Streets and Buildings (May, 1926; August, 1931). Smoke Emission (February, 1933). The following Bye-laws apply with respect to the Pleasure Grounds at Church Lane, Welsh Harp Water, Kingsbury Green and Roe Green within the Kingsbury area:— Bye-laws with respect to Pleasure Grounds (April, 1932). 14 MATERNITY HOMES IN WEMBLEY, 1934. Misses R. S. Beach and L. Grant, " Denstone," 34 Elmstead Avenue. Miss W. M. MacLennan, " Mardale," 73 Kenton Road. Mrs. C. Calder, 12 Vivian Avenue. Mrs. E. J. France, " Clovelly," 28-30 Central Road. Misses Martin and Moore, " Elmwood," Elms Lane. Misses H. Clarke, and P. O. Barber, " Ashley," 3 Kenton Lane, N.W.9. Miss A. Gregory, 18 Salmon Street. Mrs. C. A. Todd, 6 Oakleigh Avenue. MIDWIVES. No Midwives are now employed by, or subsidised by, the Local Authority. 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. Archer, A. A., 15, Crummock Gardens, N.W.9. Ashby, D. A. E., 3, Kenton Lane, N.W.9. Cole, N., 8, Park Chase, Wembley Park. Collins, M. A., 16, Eton Avenue, Wembley. Coyle, A., 38, Douglas Avenue, Wembley. Day, E. L., 1, Wood Lane, N.W.9. Dilloway, L. G., 75, Rosebank Avenue, Wembley. Flint, J. M., 57, Wyld Way, Wembley. Gregory, A., Eversley Nursing Home, 18, Salmon Street, N.W.9. King, D., 80, Thirlmere Gardens, Preston Park. Luscombe, R. E., 15, Blenheim Gardens, Wembley. Macdonald, C. A., 233, Oakington Manor Drive, Monks Park. MacLennan, W. M., 73, Kenton Road, Kenton. Mearns, A., 73, Kenton Road, Kenton. Monk, E. M., 1, Wood Lane, N.W.9. Norton, I. E., 8, Park Chase, Wembley Park. Poyner, G. M., 5, Vincent Road, Alperton. Rantell, E. A., 17, Napier Road, Wembley. Raeburn, P.E., 3, Kenton Lane, N.W.9. Rostron, A., 73, Kenton Road, Kenton. Sarell, G. E., 54, Stag Lane, Edgware. Smith, B. M., 19, Wood Close, N.W.9. 15 Todd, C. A., 6, Oakleigh Avenue, Burnt Oak Whitworth, C., 12, Vivian Avenue, Wembley Hill. Willmot, D., 139 Stag Lane, N.W.9. Wilson, E. M., 14, St. James' Gardens, Alperton. MATERNITY AND CHILD WELFARE REPORT. For the Year Ending December 31st, 1934. 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 1423 (b) Still births 34 (c) Total 1457 THE MATERNITY AND CHILD WELFARE SERVICES. During the whole of 1933, whilst the amalgamation of the Wembley Urban District with that of Kingsbury was in contemplation, the question of the future control of the Maternity and Child Welfare Services became at once of much importance. The Middlesex County Council had administered the Kingsbury services for many years and now applied to the Ministry of Health for powers to acquire those of Wembley as well. The Wembley Council at once entered a protest, giving many cogent reasons for the retention of these services, claiming especially that they had been reported on favourably after inspection, and that they had been very efficiently conducted since their establishment in 1916. In the beginning of 1934 the Ministry of Health held an enquiry at the Guildhall, Westminster, on this matter. Each district concerned engaged counsel; every point was fully discussed and many witnesses examined. In the result the Ministry decided that Wembley should administer these Services for the whole of the enlarged district. No time was then lost in taking over the Kingsbury Clinics and the Health Visitors' work, and on the day of the amalgamation the new Medical Officer and her staff at Kingsbury were ready to carry on. I am glad to report that all the Clinic centres are working smoothly. Recently the ladies, who are called Voluntary Helpers, and who assist the doctor and the health visitors on all the Clinic days, formed themselves into an Association, with 16 The number of visits paid during the year by the Health Visitors were:— To Expectant Mothers: First Visits 523 Total Visits 779 To Children under 1 year of age: First Visits 1939 Total Visits 4937 To Children between 1 and 5 years of age Total Visits 3193 Visits to cases of Ophthalmia Neonatorum 2 Puerperal Pyrexia and Fever 21 Measles 115 Whooping Cough 152 Diarrhoea 135 Ringworm 3 Consumption 11 General (unclassified) 210 SUPPLY OF MILK. An economic circumstances scale adopted by the Council governs the supply of milk, and in accordance with the same 183 families received grants of free milk during the year, for expectant mothers, nursing mothers or children under the age of three years, and in certain "Special" cases for children between three and five years. In addition 54 children received Cod Liver Oil, Virol, or Emulsion. MATERNAL MORTALITY Generally—and as Affecting the District. Taking the combined districts now called Wembley, the Maternal Mortality Rate has been and may be stated now to be 3.11 per 1,000 births. This rate shows a decrease on last year which we hope will continue. 17 Chairman and Secretary, and in this way are doing very useful work with the mothers and children in the matter of clothing, cooking and general welfare work. To the lay mind parturition is regarded as a purely normal function, and one that should be performed in almost every case without incident or accident. This is an absolute fallacy. With highly civilised races the perfectly normal case does not occur in more than eight or ten per cent of those delivered. There is nearly always some trouble during the first fortnight. It is quite impossible to predict what will happen in any human affairs, least of all with women at these times. Now there are many factors, fundamental and contributory, that have to be considered in this matter. The whole subject is being approached and discussed as though it were new, or as if, in past years, we had been groping in the dark and were now on a downward course. It is not a new problem, but it is true to say that it is only in recent months that the general public has realised that this mortality is high, and should be reduced, and it is because of this opinion that the Ministry of Health, the Public Health Authorities and the Medical profession are determined to explore every source of trouble likely to throw light upon this serious problem. In every enquiry as to causation you will note that some share of responsibility will be assigned to very different quarters. It may be to Lack of Ante-Natal care; Attempts at Abortion; Malnutrition; Undue Haste and Instrumental Interference; Lack of proper use of Antiseptics, etc; and you will hear various arguments advanced which only state half the case, for instance, certain Maternity Hospitals have only a 7.5 mortality rate per 1,000 live births, therefore the death rate should not be higher elsewhere!! But no mention is made of the fact that only the apparently absolutely normal cases have been admitted to these hospitals, verified of course by Ante-Natal examination and previous history. Again you will hear that it has been proved that the mortality rate is lower in the slums than in Belgravia — but no mention is made to the fact that they may be living more naturally and may be in some respects physically better fitted, if well fed, for Maternity, and it is possible that dwellers in Slum-land often may be immune to their own germs! 18 It is alleged that abortion is greatly on the increase, in this and all districts, and I have reason to believe that it is, but we have no statistics to prove it, or to guage the amount. This evil would and does certainly seriously increase the rate and favours the risks at the end of pregnancy! There is, undoubtedly, an increasing number of neurotic women, who will not produce children without anaesthetics and instruments, who will not wait, and in these demands they are often supported by their husbands. It may be stated very definitely and positively that, for some years, the special duties devolving upon Medical Practitioners at these times have become more onerous and anxious, due partly to the larger proportion of First-births. First-births, especially in Wembley are numerous and are always matters of anxiety due partly no doubt to the ill effects of modern life—so full of excitement with so little rest and peace. With regard to the profession it must be remembered that, in their own interests (to place it on very low ground), general practitioners will and do work hard for a successful issue. They have everything to lose—they know full well that meddlesome Midwifery is bad " and really saves no time, and that, as a rule, it is better to wait and see what nature is capable of, and only intervene when fully justified. It has been found that it is the emergent cases that cause the higher death-rate, admitted without previous acquaintance, no ante-natal care, often illegitimate, after various experimentations with drugs, etc., in general bad condition, that is why some doctors insist upon complete rest before confinement and the modern hospitals all have Ante-Natal beds. You will sometimes hear that statistics prove that the mortality rate is loiver in the practice of Midwives, but you will not hear that all their serious emergent cases are transferred immediately to medical practitioners and that then their responsibility ceases. This of course has an important >earing on our discussion, as the doctors sign the certificates of death!! 1 he question of malnutrition, so often associated with worry, poverty and depression, is an important factor. It is well known now that when the poorer women of the district are well fed, the Maternal Mortality rate is lower. You can 19 be satisfied that, as regards Wembley, no expectant, parturient or nursing mother need be without the generous supply of milk which is sanctioned by the Ministry of Health, according to their circumstances, which grants, I know you are anxious to continue. I have no authority to ask resident medical practitioners and midwives to continue to attend their patients with the same care as they would cases of operation—with special sterilised overalls, india rubber gloves, wearing masks, and in fact carrying out all the necessary details of sterilisation that they know so well, and I feel sure that this has been and will be done in the future. One thing will be necessary in the near future—the better payment of Midwives to enable them to obtain a larger training course and greater efficiency. To a very great extent the Midwifery of the country will be in their hands in the future, with doctors as specialists. The professional status of the Midwife is said to be far lower in this country than on the continent. To sum up this Report I do not anticipate for the whole country any very marked improvement in the Maternal Mortality in the near future—three or even four per 1,000 (live) births cannot be considered excessive under all the circumstances I have mentioned, especially as certification of death is so much more exact now, and as fatal miscarriages and abortions are included. In conclusion I may be allowed to express the hope that this question of Maternal Mortality will not be driven too hard, or it may act as a deterrent to child bearing by the very class who should have more children—the healthy and intelligent, whether they be poor, of moderate means, or rich. 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. 20 CHILDREN'S ACTS. Infant Life Protection. The work of visiting children placed in the care of fostermothers is carried out by the Health Visitors. PARTICULARS RELATING TO THE ADMINISTRATION OF THE CHILDREN'S ACTS DURING THE YEAR 1934. 1. Notification. (a) Number of Foster Parents on Register at end of year 64 (b) Number of Children on the Register:— At the end of the year 89 Who died during the year 1 On whom inquests were held during the year — 2. Visits. (a) To Foster Children 809 (b) To Foster Parents 789 ORTHOPAEDIC AND MASSAGE. All cases from the Clinics requiring treatment for orthopaedic trouble, or recommended for massage, are seen by arrangement at the Wembley Hospital, where the treatment is carried out. SANITARY CIRCUMSTANCES OF THE AREA. WATER. The district is supplied by the Colne Valley Water Co., in the main, but a few houses in Sudbury are supplied by the Rickmansworth Water Co. 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 had these waters analysed, the results of which have been satisfactory. 21 DRAINAGE AND SEWERAGE. No important works under this heading were carried out during the year as development is fully provided for in this respect by the Council's existing systems pending the Middlesex County Council's West Middlesex Sewage Scheme coming into operation. RIVERS AND STREAMS. The Chaplin Road Brook was again cleansed by the County Council, and the refuse therefrom was carted away by this Council. CLOSET ACCOMMODATION. Practically every house in the District is provided with water closet accommodation, and all new houses are connected to the main sewerage system. 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. In the case of the added district of Kingsbury the work is carried out by a firm of contractors. 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. SANITARY INSPECTION OF DISTRICT. Inspections. No. of Complaints investigated 538 Slaughter Houses 87 ,, Cowsheds 36 ,, Dairies and Milkshops 166 ,, Butchers' Shops 252 22 ,, Markets 32 ,, Other Food Premises 723 Bakehouses (Factory) 38 ,, ,, (Workshop) 19 ,, Offensive Trades 44 Factories (not including Bakehouses) 109 ,, Workshops (not including Bakehouses) 28 ,, Workplaces 30 ,, Outworkers Premises 3i ,, Schools (Drainage, etc.) 29 ,, Cesspools, etc. 7 Urinals and Latrines 212 ,, Public Conveniences 552 ,, Ditches, Streams, etc. 245 ,, Stables and Manure Pits 183 Piggeries 26 ,, Tents, Vans, Sheds, etc. 120 ,, Yards 1307 ,, Refuse Dumps, Open Spaces, etc. 187 Cinemas, Dance Halls, etc 23 ,, Visits re Infectious Disease 439 ,, Houses Inspected and Recorded under Housing Regulations 4i ,, Other House Inspections 272 ,, Boiler Plant, etc., Inspected 26 ,, Miscellaneous Inspections 1097 ,, Visits re supply of dustbins 76 ,, ,, to Petroleum Installations 40 ,, ,, Verminous Premises 33 ,, ,, Swimming Pools 6 ,, ,, Mortuary 4 ,, ,, re Overcrowding 9 ,, Revisits 839 ,, Drain Inspections 1246 ,, Drain Tests Applied 46 ,, Drains opened up 1 ,, Smoke Observations (J hour) 3b .» »» ,, (Casual) 420 Samples of Water Taken 16 ,, Milk Taken 135 Total 9806 Total No. of Informal Notices served 479 ,, ,, Statutory Notices served 26 2.3 NUISANCES ABATED AND DEFECTS REMEDIED. Drains Cleansed from Obstruction 382 New Drains and Inspection Chambers provided 18 Drains Relaid or Repaired 42 Inspection Chambers Repaired 20 Soil Pipes and Ventilating Shafts Repaired 2 Floors of Dwellings Relaid or Repaired 5 Sub-Floor Ventilation Provided or Improved 1 Internal Walls and Ceilings repaired 24 New Lavatory Basins Provided 5 Dampness Remedied 19 External Walls and Chimneys Repointed or Repaired 21 Roofs Reconstructed or Repaired 25 Staircases Repaired 1 Windows Repaired or Additional Windows Provided 55 Spouts and Gutters Repaired or Renewed 16 New Sinks Provided 6 Sinkwaste Pipes Repaired or Renewed 14 Cooking Stoves and Firegrates Repaired or Renewed 20 Wash Coppers Repaired or Renewed 6 Food Stores Cleansed 1 Rooms Cleansed and Redecorated 77 Passages and Staircases Cleansed and Redecorated ... 17 W.C. Walls Cleansed 20 W.C. Structures Repaired or Rebuilt 13 W.C. Cisterns Repaired or Renewed 40 Additional W.C.s Provided 10 Fouled W.C.s and Urinals Cleansed 39 W.C. Lighting and Ventilation Improved 1 W.C. Pans Repaired 3 Dustbins Supplied 903 Smoke Nuisances Abated 1 Accumulations Removed 45 Tents and Vans Removed 40 Water Supply Improved 8 Ditches and Streams Cleansed 8 Verminous Premises Disinfested 13 Flooded Cellars Pumped Dry 1 Drains Disconnected and Sealed Off 4 Overcrowding Abated 7 Earth Closet Filled in 1 Water Cisterns Cleansed 1 Street Gullies Sealed 1 Nuisance from Public House Yard Abated 1 24 Manure Pits Provided 1 Miscellaneous 25 Total 1863 Contraventions Remedied. Slaughter Houses 3 Butchers' Shops 7 Cowsheds 2 Dairies and Milkshops 4 Bakehouses 3 Outworkers Premises 1 Total 20 SMOKE ABATEMENT. Chimneys of the various factories in the district are kept under frequent 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. It was not necessary to institute any legal proceedings during the year. PUBLIC CONVENIENCES. The various Public Conveniences are controlled by your Public Health Department and are kept in a satisfactory manner. During the year a new Public Convenience was erected in Lancelot Road, thereby providing for the needs of central Wembley. MORTUARY. The Council, during 1934, appointed a Mortuary Keeper and Handyman, whose time is devoted to the work at the Mortuary and the Old Wembley Burial Ground. Periodical inspection of the Mortuary is carried out by the Sanitary Officers. During 1934, 121 bodies were deposited, 41 post-mortem examinations were made, and 31 Coroner's inquests were held in the school-room adjoining. 25 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 Rag Flock 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. SCHOOLS. The sixteen Elementary and the two Secondary Schools provided by the Education Authority are inspected periodically, 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. Statistics. Number of new houses erected during the year:— (1a) Total, including numbers given separately under (b):— (i) By the Local Authority 150 (ii) By other Local Authorities Nil (Hi) By other bodies and persons 2580 The latter number is in respect of the present Urban District of Wembley and includes 191 houses which were erected in the former Kingsbury Area between 1st January, 1934, and the 31st March, 1934. The number also includes 140 flats. 26 (b) With State Assistance under the Housing Acts:— (/) By the Local Authority (a) For the purpose of Part II. of the Act of 1925 Nil (b) For the purpose of Part III. of the Act of 1925 Nil (c) For other purposes 48 (ii) By other bodies or persons Nil 1. Inspection of Dwelling-Houses during the Year:— (1) (a) Total number of dwelling-houses ted for housing defects (under Public Health or Housing Acts 1096 (b) No. of inspections made for the purpose 1944 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 41 (b) No. of inspections made for the purpose 332 (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-head) found not to be in all respects reasonably fit for human habitation 537 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 431 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 6 27 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners 4 (b) By Local Authority in default of owners Nil (6) - Proceedings under Public Health Acts :— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied 20 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners * 18 (b) By Local Authority in default of owners Nil * Includes compliance in 1934 of 1 notice served in 1933. (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 Nil (2) Number of dwelling-houses demolished in pursuance of Demolition Orders * 2 * Orders made in 1933. (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 4. Clearance Order. Under Part 1 of the Housing Act 1930 :— (1) Number of dwelling-houses demolished 4 (2) Number of persons displaced 10 28 INSPECTION AND SUPERVISION OF FOOD. (a) Milk. 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 the year 1934, fifteen samples of Milk were taken from retailers in the district. The samples were submitted to the Lister Institute for animal inoculation tests for the presence of tubercle bacilli. One sample was found to contain living tubercle bacilli, and was traced to a farm in Buckinghamshire. The County Medical Officer of Buckinghamshire subsequently reported that after examination of the herd at this farm two cows were slaughtered under the Tuberculosis Order, 1925. Routine examination of milch cattle was carried out during the year by Mr. Reginald Wooff, M.R.C.V.S., the County Council's whole-time veterinary inspector; 375 inspections of cows were carried out in Wembley, and 197 inspections in Kingsbury, but none of these cows was found to be suffering from tuberculosis. Milk (Special Designations) Order, 1923. Licences Issued, 1934:— Designation licence Dealers Supplementary To Bottle To Pasteurise Certified 9 1 — — Grade A T.T. 10 2 3 — Grade A 1 — — — Pasteurised 17 3 — 2 During the year, 135 samples of Graded Milk were taken as follows:— Certified 1 Grade A (T.T.) 65 Grade A Pasteurised 16 Grade A 4 Pasteurised 49 29 (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 103 Pigs 379 Sheep 640 Calves 74 UNSOUND FOOD SURRENDERED AND DESTROYED, 1934. Ox head and tongues 3 Pigs mesenteries and spleens 22 Pigs carcases and organs Z Pigs heads 14 Pigs lungs 21 Pigs forequarter and loin 1 Pigs hands 2 Pigs legs 2 Pigs livers 10 Rabbit 1 Cod 10 stone Cod roes 9 lbs. Veal 36 lbs. 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 FOODS 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. 30 Article No. Taken Adulteration Milk 140 1 Milk, sterilized 1 — Butter 1 — Cherries 1 — Cream Pastry 3 1 Gin 1 — Hake 6 5 Lemon Sole . 3 — Minced Beef 9 — Rum 1 1 Sausages 3 — Whisky 12 2 Totals 181 10 (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. We have no power to compel the protection. At my request several of the large emporiums have covered their confections with glass. PREVALENCE OF, AND CONTROL OVER, INFECTIOUS AND OTHER DISEASES. Supply of Anti-toxin. General. The Council supply free of charge to any practitioner for the use in this district, Diphtheria Anti-toxin, Tetanus Antitoxin, Anti-Streptoccoccus Serum, Sputum containers, Swabs, Widal Outfits, Specimen containers, etc. 31 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 to the removal of cases, infectious and otherwise, is communicated by me to Medical Practitioners in the following form:— WEMBLEY URBAN DISTRICT COUNCIL. Public Health Department. For Removal of Cases of Infectious Disease. During Office hours, 9 a.m. ) Telephone: to 5 p.m. Saturday, 9 a.m. to 12 noon.) WEMbley 3443. After Office hours ) Communicate with Acton or during week- Isolation Hospital: ACOrn ends 1 4231. Disinfectors: Mr. F. Roberts, Isolation Hospital, Alperton. PERivale 3122. Mr. C. W. Jeffs, 18 Valley Gardens, Wembley. WEMbley 4107. 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, where these can be obtained at any hour. 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 five deaths from Diphtheria. 32 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 should be ashamed of a death from diphtheria if I did not know that the medical practitioners act at once, regarding all cases as urgent and dangerous. NOTIFIABLE INFECTIOUS DISEASE. It would be difficult to estimate the exact value of any comparative statistics relating to the districts of Wembley and Kingsbury, now combined—they are so different in area, and size of population, but the following statement with regard to the incidence of infectious disease is of interest:— From January to December, 1934: Wembley proper, had 116 cases of Scarlet Fever admitted to hospital. They stayed in the hospital on the average 44.8 days, and the average cost per patient was £14 6s. od« From April to December, 1934: Kingsbury had 113 cases admitted to hospital. They stayed in the hospital 33.4 days on the average and cost £10 9s. od. The combined new district had, therefore, 229 cases in hospital, average length of stay was 39.2 days, and the average cost per patient £12 8s. od. With regard to Diphtheria:— From January to December, 1934: Wembley had 34 cases of the disease staying in 28.5 days and costing £11 9s. od., whilst Kingsbury for the period from April to December had 33 cases staying in 24 days each, and costing £10 4s. od. each. You will note in the table subjoined some comparative figures of infectious disease, but they are not really of great value with a shifting population and for short periods of time. 33 INOCULATION AGAINST DIPHTHERIA. This question of immunisation is a very complex one— far more so than the general public have any conception of. If the whole community were inoculated, especially children under five years of age, you might certainly expect that diphtheria, as a disease, would be banished from the country, but nothing of the kind is likely to occur, there will be no general desire for immunisation, and no law to compel it. Official reports tells us that " The incomplete artificial immunisation of a group may have no inhibiting effect on the incidence of diphtheria " and may even increase the risk of attack in the unprotected section of the community, by increasing the carrier rate. Diphtheria is spread in two ways—by those actually suffering from the disease, and much more by carriers, that is by persons who are found to have the active bacillus of diphtheria (Klebs Loeffler) in their throats without any symptoms of the disease. By all means let us have large families and groups of children swabbed to ascertain the presence of this noxious germ and have active treatment to eliminate it, and immunise the others with or without a previous Schick Test. It is not known how long protection lasts after the inoculation, it may be as long as ten years, in a few cases it does not prevent an attack, though considerably modifying it. We are all less susceptible to diphtheria as we grow older. In recent years the incidence of diphtheria has shown a tendency to decrease, and one cannot be certain that the alleged improvement in the mortality rate is really due to the immunisation, especially as the large towns, where nothing has been attempted, show a precisely similar drop in the number of deaths! In plain English I do not believe we can eradicate diphtheria from our district, because we cannot carry out a campaign of wholesale immunisation among the young people, still less of the whole country. At the moment therefore, whilst acknowledging that the inoculation has an important place in " preventive " medicine, I can only recommend that you provide the resident medical practitioners with the toxoid anti-toxoid required for the one dose and that you pay the fee agreed upon for those people whose incomes come within the approved scale. 34 I would remind you what great care is taken the moment a case is notified by a doctor to visit and inspect the premises, to remove the patient, have every " contact " swabbed, and the place thoroughly disinfected. Encephalitis Lethargica. Two deaths occurred from Encephalitis Lethargica during the year. Hospital Accomodation for cases of Infections Disease. This has been dealt with elsewhere in my Report, 361 cases of Scarlet Fever were notified* during the year, 281 of which were admitted to Hospital. 84 cases of Diphtheria were notified, 75 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. The incidence of these diseases did not increase as a result of the isolation being carried out at home. Puerperal Fever and Puerperal Pyrexia. Eleven cases of Puerperal Fever and 38 cases of Puerperal Pyrexia were notified during the year. There was no observed relation between these cases and Scarlet Fever. Of these two cases of Puerperal Fever and 26 cases of Puerperal Pyrexia occurred in a Maternity Hospital situated in this district and belonging to a neighbouring authority. TENTS, VANS AND SHEDS. Gipsies made their appearance again during the year, chiefly on vacant pieces of land in Kingsbury and a number of complaints from residents in the district were received as to nuisance caused by these nomads. Prompt action was taken in each case with the result that the vans were removed from the district. 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. 35 OFFENSIVE TRADES. The only Offensive Trades carried out in the Wembley district are those of Fish Frying and Fat Extraction. The premises are frequently inspected and are well conducted. Every application for permission to establish a Fish Fiying business is very carefully scrutinized by the Council, consideration being given to the special need and to the exact locality. Legal proceedings were taken against an offender for establishing and carrying on the offensive trade of Fish Frying without the consent of the Council, and a conviction was obtained in respect of each offence, a fine of £5 with £5 5s. costs being imposed. No complaints were received in the case of the business of Fat Extraction during the year. LENDING LIBRARIES AND INFECTIOUS DISEASE. Recently I have drawn the Council's attention to the fact that books from Lending Libraries are brought into contact with notifiable infectious disease, such as scarlet fever, pulmonary tuberculosis (consumption) and diphtheria. The matter is serious as it may mean the propagation of disease and usually the loss of the books. Often it implies want of care on the part of the patient, and also of the librarian. I was instructed to draw the County Librarian's attention to the matter, and request the managers of the local lending libraries to exhibit a warning notice that books are, on no account, tc come in contact with any person suffering from an infectious disease. 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. 36 DISINFECTION OF PREMISES AND ARTICLES. During the year 610 disinfections were carried out after:— Notifiable Infectious Diseases 515 Cancer 21 Miscellaneous 54 Vermin 20 Number of Articles Disinfected or Destroyed. Disinfected. Destroyed. Beds 213 17 Bolsters 297 7 Blankets 1259 11 Counterpanes 604 4 Covers 77 1 Curtains 6 4 Cushions 151 4 Mattresses 550 25 Palliasses — 4 Pillows 1143 16 Rugs and Mats 34 2 Sheets 781 12 Wearing Apparel 443 44 Sundries 191 35 Total 5749 186 CANCER. Last year, 1934, there were 91 deaths from this disease in the district, 54 men, 37 women. In 1933—90 in the combined districts—73 in 1932—66 in 1931. Taking the average for the last four years, the percentage rate per 1,000 of population is 1.01, a figure which is considerably lower that that for England and Wales, which is 1.50. I am sure that this number can be lessened by the determination of sufferers to seek advice at an earlier stage. The presence of a small, new growth anywhere about the body should be at once a matter of concern, and its true nature ascertained. The presence of any unusual discharge, especially of an offensive character, should be immediately rectified. No one should be satisfied with anything less, and if necessary should see a doctor many times and be absolutely assured of their position. All superficial cancers are curable 37 in the early stages, and many in deeper structures. The folly of attending at a chemist for a year (as in a recent case) in fact, till the case was inoperable, need only be mentioned to be condemned. To waste time, as occurs so frequently, by using quack nostrums is certainly suicidal. The time has long gone by when the mention of the subject of Cancer was taboo, we must look facts in the face in these matters and banish ignorant prejudice. At the invitation of the British Empire Cancer Campaign I gave a number of short addresses to Women's Institutes and Co-operative Societies last year all round this part of Middlesex and have been astonished at the keenness and the desire for further knowledge displayed by the members of these societies. There is no doubt of the value of the good research work of the British Empire Cancer Campaign. They are co-ordinating the details of the fight against cancer all over the world, to prevent overlapping. In one laboratory in England cancer has been produced in rats and mice and they have been cured and rendered immune by a new special serum. It is alleged that experiments are now sanctioned on hopeless human cases, but, so far, the results, though encouraging, are not final. We may be within sight of a cure for cancer, or it may still be a few years distant. In the meantime every encouragement should be given to those engaged in this beneficient work, especially as all research investigations are very costly. It is known now, from investigations by the Ministry of Health, that cancer is not in the ordinary sense infectious or contagious; is not necessarily incidental to middle life— in fact is more prevalent later on; is not produced by any form of food or diet per se, but can be induced by all forms of chronic irritation such as septic, jagged teeth, clay pipe, chronic sores and wounds, warts, discharges, constipation, etc. It is not believed that one county or one locality is more affected than another. DESTRUCTION OF RATS. The Middlesex County Council are the Authority under the Rats and Mice Destruction Act, 1919, and all complaints received in this connection are referred to that authority. 38 PREVENTION OF BLINDNESS. No action was taken under Section 66 of the Public Health Act, 1935, for the prevention of blindness or the treatment of persons suffering from any disease or injury to the eyes. OPHTHALMIA NEONATORUM. Nine cases were notified during the year, seven of which occurred in the Maternity Hospital owned by a neighbouring authority and situated in this district. The vision was unimpaired in eight of the cases and one case left the district. 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. EUGENICS—or the Science of Good Living—has been prominently before the public for some years, but is still little understood and appreciated. It implies, not only a duty to ourselves and neighbours, but to posterity! We are most careful about the breed of our horses and dogs, and even of our poultry, but appear to be very little concerned about the human race, which should have paramount attention. There is, for instance, no concerted action or attempt to eliminate definitely defective types. We prefer to provide hospitals—general and mental, filling the latter, at enormous expense, with hereditary disease, and the former with the halt, the blind, the chronic invalid, and hosts of people so damaged as to be unfit for any occupation and only able to fill the ranks of the unemployable and be dependent on others! During the past few years I have noticed that even many of our young people ask for trouble—especially the girls— working all day in London offices, taking insufficient food, and spending their nights in the ballroom, with the result that they easily contract pulmonary tuberculosis (consumption) after exhausting all their power of resistance. 39 At the present moment we have resident in our district 388 persons, all suffering from this disease. Here, indeed, is an admission of failure from a Eugenic point of view, and a serious reproach to their mode of life in this very salubrious district. NUMBER OF MEDICAL PRACTITIONERS. It will interest you to know that we have a list of fiftyfour medical practitioners resident and practising in the Urban District of Wembley and another list of 35 of those outside Wembley who practise in the district. In this class of medical practice it is usual to allow an average of about two thousand persons to each resident practitioner, so that, with the advent of more doctors to the district (resident or otherwise) the present staff may fail to obtain their fair share of work and experience. WEMBLEY AS A RESIDENTIAL DISTRICT. Frequently I receive letters from people in different parts of the country who propose to buy a house and take up residence in Wembley, but who first desire to ascertain if they would be wise in so doing. They generally add: "Is Wemley, being on a clay soil, a suitable, or desirable spot for residence when considering a tendency to rheumatism, asthma, or any chest affection?" My reply, based on long experience, is to the effect that, provided the house is dry, the road made up, and suitable clothing is worn, Wembley, for the ordinary healthy person, is undoubtedly one of the most bracing, salubrious districts anywhere near London, and especially beneficial to children. The purity of the atmosphere is always immediately apparent on arriving from London by train—the drainage is excellent —the well-made roads dry in half an hour after heavy rain— the amount of available sunshine is double that of the city and East End—hardly any pollution of the atmosphere occurs from the Alperton and Exhibition factories—the water supply (frequently tested) is of the best, and though hard, is definitely softer than that of all the other neighbouring companies—added to this our death-rate is, and always had been, one of the lowest in the County—the undulating charcter of the district, especially of the Kingsbury area, and the many parks, recreation grounds, open spaces and other amenities, greatly add to the charm of Wembley as a residential district. 40 Now, on the question of rheumatism, whether the acute form, the sub-acute, chronic rheumatoid arthritis, fibrositis, etc., one must speak with more reserve. Few doctors would, I suppose, send their rheumatic patients to Wembley for a cure, but they might do worse very easily. I have known many patients with chronic rheumatism, and arthritis, who have resided for years on gravel near the Thames, improve in a marked degree after a few months residence in Wembley. Still one would be guarded in giving any positive statement, and this would apply to all forms of chest disease too. Other factors may intervene—lack of means—insufficient nourishment, and every kind of depressing circumstance will necessarily militate against the well known advantages of the district. NUTRITION OF THE UNEMPLOYED AND THE MILK SUPPLY. Fortunately it cannot be said that, as a district, we have a large percentage of unemployed. One is sometimes asked about their physical condition and it may be stated that we have received no information of cases of serious malnutrition. Actual starvation is extremely rare in England, and is not known in Wembley by your Social workers—but it is evident that many suffer from inability to obtain certain constituents of an efficient and wholesome diet. They do not receive the best protein (Albuminous food), calcium—iron and the essential vitamins A and D, and as a result one sees anaemia —dental decay—lassitude and loss of weight, etc. The lower the family income the higher must be the percentage income spent on food. The cheap foods—sugar, bread and margarine, etc., may satisfy hunger, but do not adequately maintain the best health. It is true, unfortunately, that not every housekeeper has been taught, or has acquired the art of good management; and there must be many who, at times, are quite short of food when all the other necessaries of life have been provided for—(there is a strange anomoly with regard to the present system of relief. The single man, however deserving, however destitute, has only the option of "the House "—he can receive no relief). As regards diet, you are about to issue to your Clinics, as soon as published, tables of diet, preparations of best food that can be bought with very little money, and which for taste—calories—vitamin content compare favourably with 41 the more expensive foods now used by our poorer neighbours. We acknowledge freely that this new knowledge of dietetics has been derived partly from recent circulars of the Ministry of Health and particulars from the researches on the subject carried on at the Maternity and Child Welfare Department at Hounslow. The milk supplied to the mothers and children attending your Clinics is a real boon. No less than 16,638 pints of the best milk were supplied during the past year to those who were found on investigation to be in receipt of an income within your economic scale. Even with the School supply I still think that children do not receive a sufficient daily quantity of milk. We have no doubt now that milk efficiently pasteurised is even safer and better than the graded milks for all classes. I am hoping that none of the institutions to which ou. children are sent provide margarine instead of butter, or any milk that has not been efficiently pasteurised. ON DYING PREMATURELY. In the returns of deaths received at this office every week it is noticed how often men (especially) fail to reach their fifth and sixth decade, instead of the seventh or eighth in sound health. This failure often arises, not so much from wilful carelessness and neglect, as from complete ignorance of their physical state. They drift on with many unsuspected disabilities. If they were wiser, in spite of apparent fair health, they would consult their doctor at 40, 45 and 50, have their weight taken, their heart and blood tension tested, their urine examined—such symptoms as dyspepsia, constipation, uric acid troubles, insomnia, etc., corrected before they become chronic. There is no doubt that the majority of middle aged men, almost unconsciously, eat and drink more than is required, and take far too little exercise. The man who knows that his parents and grandparents died in middle age can, and should, reverse the hereditary tendency by a very careful regime— in fact take as much care of his own health as he does of the other members of the family. There is no excuse for anyone dying prematurely, except from accident, whose parents lived to eighty or ninety. 42 OXYGEN THERAPY AND THE OXYGEN TENT. I am glad to note that the " Novox " apparatus has been frequently used for the immediate treatment of asphyxia during the past year. In a large population there must be a considerable number of people annually who would be immediately benefited, indeed whose lives might be prolonged or saved by its use. The apparatus consists of cylinders of oxygen and carbonic acid gas—the latter, in certain proportions of the mixture, being a powerful stimulus to breathing. The apparatus is kept at the Fire Station and also in the Ambulance. When it is desired to give oxygen alone, of many methods tried, there are only two really good and efficient. One by the nasal catheter, and the other the oxygen tent, and these might be used e.g. in cases of acute bronchitis, asthma, pneumonia, cyanosed conditions, etc. But the best method of giving oxygen is by the oxygen tent. The first tent was devised by Sir Leonard Hill in 1921. It has been developed in America and further improved at Guy's Hospital. Unfortunately the technique required is somewhat elaborate, and implies the employment of a technical assistant as there are so many points to be remembered in using the tent. Of its efficacy there can be no doubt; it is alleged that recently out of 28 grave cases of pneumonia, with a bad prognosis, 20 have lived, and the rest were relieved. I only draw attention to the matter to advocate the support of the establishment of an oxygen service in town, available to all, on payment, it is suggested, of about £3 a day, and less on subsequent days. The Council is concerned that such service shall be available for the poorer patient at cost, or at less than cost price. All enquiries on this matter should be made to the Medical Section, British Industries House, Marble Arch, W.I. BIRTH CONTROL. Birth control is not really a good term. It would be better styled Control of Conception. Contraception does not destroy new life, because you cannot destroy that which has never existed. Abortion is quite another story— is practised, to a very serious extent by all classes, and especially by those women who are ignorant of the safe and simple methods of contraception. It must be obvious to all that 43 contraception is far safer, healthier and more natural than emptying the uterus, even if this could be done by skilled surgeons on medical grounds, instead of by ignorant charlatans and low class women—we must be careful not to confuse the issues. On public platforms you will hear the statement "We want self control, not Birth Control" but think a moment what this means. It implies one of three courses of behaviour:— 1. Permanent abstinence. 2. Restricting intercourse to the so-called "safe periods " or, 3. Coitus reservatus or coitus interruptus. Take No. 1:— Permanent abstinence among the happily married is not possible, and need not be discussed. No. 2:— So called safe period is by no means safe and often fails. No. 3:— Are certainly evils—physiologically and psychologically —are heartily condemned by the medical profession and are considered to be the prime cause of wide spread anxiety—neuroses and unhappy marriages. Those who oppose contraception should think of the existence of nearly half a million lunatics, idiots, imbeciles, mental defects and queer people in England and Wales alone. Yet no official enquiry is made into the family history before marriage, although this could be effected at no great cost and in strict confidence. Fortunately the Women's Societies of the nation are becoming anxious about the condition of affairs and will presently insist upon some definite action by the State. In the meantime contraception is necessary. Your health Visitors have produced lists of women who should be advised. Take for example the tuberculous. I suppose no class of woman conceives more easily that a consumptive and whilst pregnant her symptoms seem to be in abeyance. No classes of cases give the doctor more anxiety than those suffering from heart disease, Brights, epilepsy, dropsy, the hemorrhagic diathesis—why deprive them? Surely some women need protection from a diseased or alcoholic husband! 44 it is far better to have a race of self-supporting, virile citizens than a multitude of weaklings! There should not be need for half the Hospital accommodation now demanded with the legitimate use of contraception, especially with the unemployed, semi-starved people in the North. On the other hand one can deplore the fact that many strong, healthy couples prefer a motor car to even only two children—they may be full of regret in later years—having no family. One great advantage of contraception is that women who are not strong and desire four or five children can "space" them every two or three years. There is not a word of truth that the use of contraceptives is harmful. There are four well known methods in use—fairly sure and safe, but not absolutely foolproof, but this is not the place to discuss them. You will be asked to consider the establishment of a Clinic, but whether you decide on this or on the joint action with those already established by neighbouring Councils, remains to be seen. I shall be reporting to the Special SubCommittee on the matter again in the near future. ABORTION. It would be very difficult to estimate The Prevalence of Abortion in the district, because very little information is forthcoming, no official notification is made, no register kept, and therefore no statistics can be given. There is good reason, however, to believe that abortion very trequently occurs, and that the results are often seen by the resident medical practitioners. Besides this it is often frankly acknowledged. By some, abortion is regarded as a comparatively light and trivial matter, by others as most serious and immoral, and it is certainly disappointing to those who desire a family. It will be seen, therefore, that abortion may be voluntary, that is, induced, or accidental and involuntary. In the former case it will be sought by drugs, by violent exercise, by instrumentation, or by legitimate medical advice and assistance. If involuntary it will occur by accident, by certain physical incompatibilities, or by inherited or acquired diseases, such as syphilis, alcoholism, chronic kidney trouble, etc. 45 There is no doubt that the majority of abortion cases are induced wilfully and knowingly by those, perhaps who believe they are physically unfit to bear children—more often because, economically, they feel they have insufficient income to support a family. Of course there are many other reasons, and they seek these means of disposal of the foetus because they are ignorant of the safe and easy methods of contraception. Unfortunately, unnatural interference with pregnancy at any stage, and especially later, producing abortion, or later still, miscarriage, often causes pyrexia of fever, usually of a septic character, e.g. septicaemia, puerperal fever, hence the frequent fatal results which may and do certainly assist in raising the mortality attributed to maternity. CREMATION AND EMBALMING. In nearly all my Annual Reports I have urged the desirability of providing suitable space in our burial grounds for the accommodation of urns, and for the distribution of ashes (columbarium and Garden of Sleep). A larger body of the public than formerly are desiring this accommodation and on sanitary grounds this must be the correct view of the best method for the disposal of the dead in these days. It is to be deplored that one constantly notices the purchase of ground in the overcrowded county of Middlesex for the purpose of cemeteries without this special provision for the cremated. There is, of course, a satisfactory alternative—embalming. It should be realised that the science of embalming makes a dead body safe from a health point of view, and at the same time produces an effect in appearance which brings comfort to the relatives. Embalming has now been brought to a fine state of perfection. Every part of the body is sterilised and a lifelike appearance is produced. This method of disposal has certainly some advantages and moreover is not expensive. It may be added that embalming has now found considerable favour in Canada and the United States. Those who seek to know more should apply to The British Institute of Embalmers, 181, Ladbroke Grove, London, W.I0. NOISE. I suppose there is no doubt that the nuisance of noise is detrimental to health—is positively harmful to the sensi- 46 tive and nervous invalid. We know that the Anti-Noise League has a Committee sitting which is dealing with the social and scientific aspect of noise, with a view to early legislation. We shall all be anxious to see their final report. The unnecessary noises we are all suffering from are legion. Among them may be mentioned those due to inefficient silencers on sports cars and motor cycles—over these the police have some control, but only seldom exert it. The din outside offices produced by roller skating should certainly be prevented. The shrill screaming whistles of the fast trains passing through Wembley night and day cannot be so frequently necessary. The noise made by old, worn out lorries materially adds to the nuisance. Even the quiet of Sunday is seriously disturbed by the fearful noise overhead due almost entirely to civil aviation. It is quite time this received attention. We know how useful, perhaps necessary, is the pneumatic drill, but the noise produced is appalling! Some attempt should be made to mask or mitigate this, by boxing in or casing the immediate part operated with asbestos or rubber. Fortunately this nuisance only stays in one spot a short time. CONCLUSION. On behalf of the Public Health staff I desire to express our great appreciation of the courtesy and consideration shown during the past year by every member of this Council. At the same time I should like to take this opportunity of thanking my able colleagues, the Chief Sanitary Inspector and other members of the staff for their continued, loyal assistance in the work of the department. I am, Your obedient servant, CHARLES E. GODDARD. 47 VITAL STATISTICS OF THE WHOLE DISTRICT DURING 1934, 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 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 4.8 0 27 186 42 50.66 443 7.53 1934 92,160 1357 1554 16.91 379 3.88 42 344 62 39.90 681 7.41 49 CASES OF INFECTIOUS DISEASE (OTHER THAN TUBERCULOSIS) NOTIFIED DURING THE YEAR 1934. 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 361 3 2 11 17 21 159 80 16 43 9 — — 281 1 Diphtheria 84 — 2 3 8 6 23 11 5 21 5 — 75 5 Enteric Fever 1 — — — — — — — — — — 1 — — — (including Paratyphoid) Puerperal Fever 11 — — — — — — — — 11 — — — 10 4 Puerperel Pyexia 38 — — — — — — — 1 32 5 — — — l Pneumonia 86 1 6 1 6 4 9 4 3 21 5 21 5 — 36 Erysipelas 40 — — 1 — 1 — 2 l 11 8 12 4 16 — Ophthalmia Neonatorum 12 12 — — — — — — 11 — — — — — — Acute Anterior Poliomyelitis. 1 — — — — — — — — — — — — — — Smallpox 1 — — — — — — — — — — 1 — 1 — Cerebro-Spinal Fever 2 — — — 1 — 1 — — — — — — 2 1 50 TUBERCULOSIS. New Cases and Mortality during 1934. Age Periods New Cases Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M. F M. F. M. F. M. F. Under 1 year — — — 1 — — — 1 1 to 5 years — — 3 — — — 1 — 5 to 15 years 2 — 4 4 — — — 1 15 to 25 years 15 22 3 5 6 7 1 1 25 to 35 years 22 18 2 1 7 3 1 — 35 10 45 years 14 11 — 1 3 3 1 — 45 to 55 years 14 6 — — 5 2 — — 55 to 65 years 7 1 — 1 4 — — — 35 years and over 2 1 — — — 1 — — Totals 76 59 12 13 25 16 4 3 48 deaths from Tuberculosis were registered during the year. 10 cases were not notified as suffering from Tuberculosis during life (20.83 per cent). The Death Rate from Tuberculosis for the year 1934 was .52 per 1.000 population. 51 CAUSES OF DEATH DURING YEAR 1934 CAUSES OF DEATH M. F. Total ALL CAUSES 356 325 681 Typhoid and paratyphoid fevers — — — Measles 3 2 5 Scarlet Fever — 1 1 Whooping Cough 1 — 1 Diphtheria 2 3 5 Influenza 5 2 7 Encephalitis lethargica — 2 2 Cerebro-Spinal fever 1 — 1 Tuberculosis of respiratory system 25 16 41 Other tuberculous diseases 4 3 7 Syphilis 2 — 2 General paralysis of the insane, tabes dorsalis 3 — 3 Cancer, malignant disease 54 37 91 Diabetes 3 4 7 Cerebral haemorrhage, etc. 9 11 20 Heart disease 53 75 128 Aneurysm 1 1 2 Other circulatory diseases 16 28 44 Bronchitis 7 6 13 Pneumonia (all forms) 23 13 36 Other respiratory diseases 5 2 7 Peptic Ulcer 11 1 12 Diarrhoea, etc. (under 2 years) 2 — 2 Appendicitis 7 4 11 Cirrhosis of liver 2 2 4 Other diseases of liver, etc. — 4 4 Other digestive diseases 14 10 24 Acute and chronic nephritis 9 14 23 Puerperal sepsis — 4 4 Other puerperal causes — 1 1 Congenital debility, premature birth, malformations, etc. 24 17 41 Senility 5 15 20 Suicide 8 6 14 Other violence 23 9 32 Other defined diseases 34 31 65 Causes ill-defined or unknown — 1 1 52 During 1934 the following Infant Welfare Centres were held:— INFANT WELFARE CLINICS. Centre Day & Time Average Attendance per Session Total Attendances during year Children under 1 year 1-5 yrs Mothers Children under 1 year 1-5 yrs. Mothers WEMBLEY St. Andrews Hall, Ealing Road Wednesday 2-4.30 p.m. Thursday 2-4.30 p.m. 52 28 74 5372 2895 7598 SUDBURY Wesley House, Harrow Road Friday 2-4.30 p.m. 55 31 74 2795 1573 3779 † TOKYNGTON Tokvngton Church Hall, Monks Park Tuesday 2-4.30 p.m. 34 17 46 1473 711 1962 * BACON LANE Church Hall, Bacon Lane Monday 2-4.30 p.m. Wednesday 2 4.30 p.m. 49 21 70 3627 1554 5153 * SLOUGH LANE Tuesday 2-4.30 p m Kingsbury Free Church, Slough Lane 39 21 58 1431 791 2163 * 9 months, April to December, 1934, Total at all Centres— t New Centre opened 29th February, 1934. 14698, 7524, 20655 In addition, by arrangement with the Harrow U.D C residents in the Kenton area attended the Clinic held at Elmwocd Avenue, Kenton — Children under 1 year of age 189. Children 1-5 years of age - 169 53 INFANTILE MORTALITY DURING THE YEAR 1934. 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 Pneumonia 1 — — — 1 1 4 1 2 9 Prematurity 23 — — — 23 — — — — 23 Congenital defects 5 1 — — 6 1 3 — — 10 Atelectasis 1 1 — — 2 — — — — 2 Asphyxia 2 — — — 2 — 1 — -— 3 Melaena Neonatorum 1 — — — 1 — — — — 1 Convulsions — — — — — 1 — — — 1 Meningitis — — — — — — 1 — — 1 Marasmus — — — — — 1 — 1 — 2 Gastro Enteritis — — — — — 2 1 — — 3 Cerebral Haen orrhage 1 1 — — 2 — — — — 2 Injury at Birth 2 — — — 2 — — — — 2 Inanition — — — — — — 1 — — 1 Toxæmia — — — — — — 1 — — 1 Mastoiditis — — — — — — 1 — — 1 Totals 37 2 — — 39 6 13 2 2 62 54 ANTE NATAL CLINIC Centre Date and Time Average Attendance per Session Total Attendances during year WEMBLEY St. Andrews Hall, Ealing Road 1st and 3rd Thursday each month at 9.30 a.m. 12 295 * SLOUGH LANE Kingsbury Free Church, Slough Lane Last Friday in each month at 9.30 a.m. 15 133 * April to December, 1934 DENTAL CLINICS Centre Day and Time Average At endance per Session Child- Mothren ers Total Attendances during year Child- Mothren ers WEMBLEY Alperton Council School, Ealing Road Fortnightly, Saturdays at 9.30 a.m. 4 5 91 133 SLOUGH LANE Kingsbury Free Church Slough Lane Fortnightly, Saturdays at 9.30 a.m, 4 5 57 72 * May to December, 1934 55 1.— INSPECTION OF FACTORIES, WORKSHOPS AND WORKPLACES. Including Inspections made by Sanitary Inspectors. Premises Number of Inspections Written Notices Occupiers Prosecuted *Factories 147 6 - (Including Factory Laundries) Workshops 47 - - (Including Workshop Laundries) Workplaces 30 - - (Other than Outworkers premises) Total 224 6 - 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 wider the Public Health Acts: Want of Cleanliness 23 18 — — Want of Ventilation 1 — — — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 10 9 — — Sanitary accommodation insufficient — — — — unsuitable or defective 7 7 — — 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 41 34 — — * These figures include 38 visits to Factory Bakehouses and 19 visits to Workshop Bakehouses. OUTWORK IN UNWHOLESOME PREMISES (Sec. 108). No action was taken under this Section. INDEX. page Abortion 45 Acts, adoptive in force 14 Ambulance facilities 9 Area 5 Bakehouses 30 Births 6 Birth Control 43 Blindness—Prevention 39 Bye-laws, in force 14 Cancer 37 Children's Acts 21 Clinics 10, 53, 55 Closet Accommodation 22 Committees 3 Common Lodging Houses 35 Conclusion 47 Cremation 46 Deaths 7, 42, 52 Diphtheria 34 Disinfection 37 Drainage and Sewerage 22 Encephalitis Lethargica 35 Enteric Fever 50 Erysipelas 50 Eugenics 39 Factories and Workshops 56 Fish Frying (see offensive trades) 36 Food—adulteration 30 Food—examination 31 Food—inspection 29, 30 Food—unsound 30 Health Services 8 Hospitals 11 Houses let in Lodgings 35 Houses—number inhabited 5 Housing 26 Infantile Mortality 7, 54 Infectious Diseases 31, 50 Inquests 25 Isolation Hospital 11 Laboratory Facilities 8 57 PAGE Lending Libraries (and Infectious Disease) 36 Maternal Mortality 7, 17 Maternity Cases—accommodation for 12 Maternity and Child Welfare 16 Maternity Homes 12, 15 Midwives 15 Milk—Samples 29 Milk—Supply (Nutrition of Unemployed) 41 Mortuary 25 Noise 46 Nursing. 9 Offensive Trades 36 Ophthalmia Neonatorum 39 Oxygen Therapy 43 Pneumonia 50 Population 5 Public Conveniences 25 Puerperal Fever and Pyrexia 35 Rag Flock Acts 26 Rateable Value. 5 Rats—destruction of 38 Rivers and Streams 22 Sanatoria 12 Sanitary—circumstances 21 Sanitary—inspection 22 Nuisances Abated and Defects Remedied 24 Scarlet Fever 35 Schools 26 Slaughterhouses 30 Slaughtering 30 Smallpox 12 Smoke Abatement 25 Social Conditions of Area 6 Staff 4 Still Births 7 Swabs 31 Tents, Vans and Sheds 35 Tuberculosis 12, 39, 51 Vital Statistics 6, 49 Vital Statistics (comparative) 8 Water Supply 21 Welfare Report 16 Wembley as a Residential District 40 58