C439(1) NEMBLEY (hate Mun. B) M WEM 16 WEMBLEY URBAN DISTRICT COUNCIL. ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH FOR THE YEAR 1935 CHARLES E. GODDARD, O.B.E., M.D., Medical Officer of Health. Wembley Urban District Council. ANNUAL REPORT FOR THE YEAR 1935 By THE MEDICAL OFFICER OF HEALTH FOR WEMBLEY. Urban District Council of Wembley PUBLIC HEALTH COMMITTEE FOR THE YEAR 1935-36. Chairman—Councillor. H. GAUNTLETT. Cr. C. Barton, Cr. L. Bishop, Cr. A. W. Clarke, Cr. f. Costin, Cr. S. E. Harris, Cr. Miss E. H. Howse, J.P. Cr. E. H. Everett, J.P. (Chairman of the Council). Cr. M. Levy, Cr. Dr. G. H. Plymen, Cr. A. Rowbottom, Cr. H. S. Sirkett, Cr. J. W. G. Snook, Cr. J. Williamson (Vice-Chairman of the Council). MATERNITY AND CHILD WELFARE COMMITTEE FOR THE YEAR 1935-36. Chairman—Councillor Miss E. H. HOWSE, J.P. Cr. C. Barton, Cr. A. W. Clarke, Cr. S. E. Collingbourne, Cr. F. Costin, Cr. H. Gauntlett, Cr. S. E. Harris, Cr. E. H. Everett, J.P. (Chairman of the Council) Cr. M. Levy, Cr. Dr. G. H. Plymen, Cr. A. Rowbottom, Cr. J. W. G. Snook, Cr. H. J. Soar, Cr. J. Williamson (Vice-Chairman of the Council). CO-OPTED MEMBERS. Mrs. Clarke, Mrs. Collison, Mrs. Collyer, Mrs. Empson, Mrs. Farquharson, Mrs. Gauntlett, Mrs. Rowbottom. STAFF OF THE PUBLIC HEALTH DEPARTMENT. (As constituted January, 1936) * 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, M.S.I.A., 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, M.S.I.A., Sanitary Inspector's Cert., Royal San. Inst, and San. Inspector's Examination Joint Board; Meat and Other Foods Inspector's Cert., Royal San. Inst. ; 1st Class Cert. Smithfield Tech. Inst. W. COMBEV, M.S.I.A., Sanitary Inspector's Cert., Royal San. Inst, and San. Inspector's Examination Joint Board ; Meat and Other Foods Inspector's Cert., Royal San. Inst., Smoke Inspector's Cert., Royal San. Inst. * Health Visitors— Miss V. L. DAVIES, Health Visitor's Cert., RoyaJ San. Inst.; Cert, of Central Mid-wives' Board; State Registered Nurse. Miss M. E. MILNER, Health Visitor's Cert., Royal San. Inst. ; Cert, ot Central Midwives' Board; State Registered Nurse, Sanitary Inspector's Cert., Sanitary Inspector's Examination 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. Miss D. C. BINDING, Health Visitor's Cert., Royal San. Inst.; Cert of Central Midwives' Board; State Registered Nurse. (Commenced duty 2/9/35.) Clerical Staff— Chief Clerk: H. N. RYAN. Clerks: G. H. Hughes, W. C. E. Keutenius, T. L. Allison, P. B. D. Bunyan. 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. F. ELIZABETH MILLARD HARVEY, M.B., Ch.B. * 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 Surgeon— CHARLES LAFFERTY, L.D.S. * Contribution made to salary by Ministry of Health or County Council. 4 WEMBLEY URBAN DISTRICT COUNCIL ANNUAL REPORT of the Medical Officer of Health for the year 1935 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 present my 40th (and last) Annual Report on the Sanitary Circumstances of the district for the year 1935, following, as nearly as possible, the order of details from the instructions of the Ministry of Health. 5 SECTION A. Statistics and Social Conditions of the Area. 7 SUMMARY OF GENERAL STATISTICS. Area in acres 6,300 Population (Census) 1931:— Wembley 48,561 Kingsbury 16,636 65,197 Population 1935 (Midsummer), Estimated by Registrar-General 99,120 Number of inhabited houses (December, 1935), according to Rate Books (approx.) 28,503 Rateable Value (December, 1935) £1,093,180 Product of a Penny Rate (estimated) £3,950 POPULATION. (December, 1935.) The number of Parliamentary Electors 70,000 > Estimated Population 105,000 Proportion of population represented as Parliamentary Electors 2/3 Average Number of persons per house 3.684 (approx.) No. of Houses Estimated Population No of Parliamentary Electors (a) (b) Alperton 2,813 10,363 11,360 7,573 Central 2,060 7,589 8,283 5,522 Chalkhill 1,695 6,244 5,841 3,894 Fryent I,477 5,441 5,488 3,659 The Hyde 3,146 11,590 11,889 7,926 Kenton 1,977 7,283 6,051 4,034 Preston 2,581 9,508 8,208 5,472 Roe Green 2,443 9,000 8,957 5,971 Sudbury Court 1,969 7,254 7,129 4,753 Sudbury 3,134 11,546 11,856 7,904 Tokyngton 2,988 1 1,006 11,775 7,850 Wembley Park 2,220 8,176 8,163 5,442 28,503 105,000 105,000 70,000 No census figures of Population for each ward are available. Populations given above are therefore calculated:— (a) Upon the number of persons per house in the whole district multiplied by the number of houses. (b) Upon the proportion of Parliamentary Electors to the population multiplied by the number of Parliamentary Electors in the particular ward. 8 SOCIAL CONDITIONS. There has been no marked change in the social conditions of the area. The greater number of the population of Wembley are engaged outside the district. The chief areas containing factories are Alperton, Wembley Hill Estate (late British Empire Exhibition Grounds) and Kingsbury. None of the industries appear to have a deleterious effect on those engaged therein. UNEMPLOYMENT. The number of men and women over the age of 18 years registered for employment and residing in Wembley is as follows:— Men. Women. 1936 916 284 1,200 1935 531 141 672 These figures are no doubt influenced by the large influx of people into the district from London and the provinces during the past year. Persons under the age of 18 are dealt with by the Education Authority. REGISTER OF RAINFALL DURING THE YEAR 1935 AT SEWAGE FARM, ALPERTON LANE. Month Total Rainfall No. of days on which Rain fell Heaviest Fall ins. ins. January 1.03 13 .24 February 2.61 14 .48 March .49 7 .25 April 3.27 20 .55 May 1.03 12 .22 June 4.03 20 .64 July 1.14 5 .63 August 1.98 8 .65 September 4.00 20 .54 October 2.61 13 .56 November 4.47 20 1.04 December 3.03 23 .39 Totals 29.69 175 9 VITAL STATISTICS. Live Births. Male. Female. Total. Legitimate 807 752 1559 Birth Rate per 1,000 of estimated resident population 16.19 Illegitimate 25 21 46 1605 Still Births. Male. Female. Total. Rate per 1,000 total (live and still births) 30.80 Legitimate 24 23 47 Illegitimate 3 1 4 51 Still Birth Rate per 1,000 estimated population: .50. Deaths. Male. Female. Total. 336 342 678 Death Rate per 1,000 estimated population (Adjusted figure) 8.62 (Crude rate) 6.84 Maternal Mortality. Deaths from Puerperal Sepsis Nil. Other Puerperal causes Nil. Total Nil. Infantile Mortality. Deaths of Infants under 1 year of age:— Male. Female. Total. Legitimate 28 23 51 Illegitimate 2 2 4 55 Death Rate of Infants under 1 year of age:— All infants per 1,000 live births 34.26 Legitimate Infants per 1,000 legitimate live births 32.71 Illegitimate Infants per 1,000 illegitimate live births 86.96 Deaths from Measles (all ages) 1 ,, ,, Whooping Cough (all ages) 4 ,, ,, Diarrhœa (under 2 years) 4 10 INFANTILE MORTALITY. Table Showing Rates, 1931—1935. Year England and Wales Wembley 1931 66 44.84 1932 65 40.89 1933 64 50.66 1934 59 39.90 1935 57 34.26 Average 5 years 62.2 42.11 This figure of 42.11 may be considered satisfactory. INFANTILE MORTALITY DURING THE YEAR 1935. Causes of Death Nett Deaths from stated causes at Various Ages under 1 year of Age Total Deaths underOne 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 — 2 6 Prematurity 10 — 1 — 11 — — — — 11 Congenital defects 8 2 — 1 11 4 — — — 15 Atelectasis — — — — — 1 — — — 1 Measles — — — — — 1 — — — 1 Whooping Cough — — — — — 1 — — 1 2 Erysipelas — — — — — 1 — — — 1 Marasmus — — 1 — 1 — — — — 1 Gastro Enteritis — — — — — 1 1 1 — 3 Haemorrhage 5 1 — 1 7 — — — — 7 Injury at Birth 1 — — — 1 — — — — 1 Inanition — — — — — — 1 — — 1 Bronchitis — — — — — 1 1 — — 2 Congestion of lungs — — 1 — 1 — — — — 1 Inattention at birth 1 — — — 1 — — — — 1 Cerebral congestion — — — — — — — 1 — 1 Totals 25 3 3 2 33 13 14 2 3 55 11 MATERNAL MORTALITY. Table showing Rate per 1,000 total births (live and still), 1931—1935- Year England and Wales Wembley I931 3.95 1.23 1932 4.06 5.98 1933 4.23 5.85 1934 4.41 3.11 1935 3.93 0.00 Average of Rates 4.11 *3.43 * Figure for Wembley based on aggregate figures. for five years = 2.77. It will be noted that there was no maternal death during 1935. BIRTHS. The Birth Rate should be much higher if the middle classes were willing to have larger families. 1 believe that every healthy married pair should be willing to have at least three children—they have no right to use contraceptives, especially when the Government is attempting to give relief in taxation for those raising a family. Birth Control methods are intended on'ly for certain definite cases—not at all for healthy people. These are the people responsible for the limitation of population—race .suicide, etc., not the poor invalid folk who are eligible for treatment at a Birth Control Centre. 12 13 DEATHS. The Death Rate in Wembley has always been low—consistently low for many years—and has shared this low rate with Harrow and Wealdstone, shewing that residence on a clay soil is not a matter of serious moment, if the district is well drained and the dwellings are dry. It is of interest to note that nearly 80 persons died in Wembley in 1935 in their fifth decade, from a variety of causes. They had come to the end of their lives prematurely. This surely must be an admission of failure with the majority of them to be able to reach middle age and yet not to be able to regulate their lives so as to extend it to the seventh or eighth decade. Death in the fifties must often be preventable with due foresight in management. There is no doubt that everyone should be willing to take stock of their physical condition at the age of forty-five, have the heart and vessels carefully tested and be willing to be guided by their medical attendant as to the best course to pursue in their particular circumstances. 16 VITAL STATISTICS OF THE WHOLE DISTRICT DURING 1935, 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 Nett Number Rate of Nonresidents registered in the District of Residents not registered in the District Under 1 year of age At all ages Uncorrected Number Number Rate Number Rate per 1000 nett Births Number Rate 1 2 3 4 5 6 7 8 9 10 11 12 13 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 44 3 7.53 1934 92,160 1,357 1,554 16.91 379 3.88 42 344 62 39.90 681 7.41 1935 99,120 1,918 1,605 16.19 407 4.11 62 333 55 34.26 678 6.84 crude. 8.62 adj'st'd. CAUSES OF DEATH DURING YEAR 1935. CAUSES OF DEATH. M. F. Total. ALL CAUSES 336 342 678 Typhoid and paratyphoid fevers 1 - 1 Measles 1 — 1 Scarlet Fever — — — Whooping Cough 2 2 4 Diphtheria 1 4 5 Influenza 3 7 10 Encephalitis lethargica — 2 2 Gerebro-Spinal fever — — — Tuberculosis of respiratory system 25 20 45 Other tuberculosis 5 6 11 Syphilis 1 1 2 General paralysis of insane, etc. 1 1 2 Cancer 52 44 96 Diabetes 4 1 5 Cerebral haemorrhage 5 20 25 Heart disease 60 88 148 Aneurysm 6 — 6 Other circulatory 10 27 37 Bronchitis 5 3 8 Pneumonia 19 13 32 Other respiratory 4 4 8 Peptic Ulcer 5 4 9 Diarrhœa, etc. (under 2 years) 2 2 4 Appendicitis 2 3 5 Cirrhosis of liver 4 1 5 Other liver diseases — 1 1 Other digestive 11 10 21 Nephritis 13 9 22 Puerperal sepsis — — — Other puerperal — — — Congenital causes, etc. 19 17 36 Senility 4 13 17 Suicide 13 2 15 Other violence 24 13 37 Other defined causes 34 24 58 Causes ill-defined — — — 17 TABLE OF COMPARATIVE VITAL STATISTICS. per 1,000 population per 1.000 Live Births per 1.000 Total Births Birth Rate Still Birth Kate Death Rate Infantile Mortality Maternal Mortality Maternal Mortality Wembley 16.19 .50 8.62 34.26 Nil Nil England and Wales 14.7 .62 11.7 57. 4.10 3.93 London 13.3 .52 11.4 58. — — 121 County Boroughs and Great Towns including London 14.8 .68 11.8 62. — — 140 smaller towns— Resident population 25,000 to 50,000 at Census 1931 14.8 .64 11.2 55. — — MARRIAGES. The Superintendent Registrar for the area has kindly supplied me with the following information concerning marriages which took place in the Urban District of Wembley during 1935:— In churches, chapels and synagogues 468 At Registry Office, where one or both parties were resident in the district 241 Total 709 18 SECTION B. General Provision of Health Services for the Area. 19 LIST OF ACTS EITHER IN WHOLE, OR PART,. ADOPTED AND BYE-LAWS AND REGULATIONS IN FORCE IN THE URBAN DISTRICT OF WEMBLEY. Adoptive Acts:— Infectious Disease (Prevention) Act, 1890. . Public Health Acts (Amendment) Act, 1890. Public Health Acts (Amendment) Act, 1907. Baths and Washhouses Acts, 1846 to 1899. Private Street Works Act, 1892. Local Government and Other Officers Superannuation Act, 1922. Public Health Act, 1925. Slaughter of Animals Act, 1933 (application to sheep,, etc.) Byelaws in Force throughout the Urban District of Wembley:— Hoardings and Advertisements 1926 Cleanliness of any premises used for the business of a hairdresser or barber 1935 Byelaws in Force in Area comprising Former Urban District of Wembley:— Houses intended or used for occupation by the working classes and let in lodgings or occupied by members of more than one family 1931 Nuisances (deposits or dumps of filth, dust, ashes or rubbish) 1926 Public Conveniences 1926 New Streets and Buildings 1928 1929 1933 New Streets—Neeld (Wembley) Estate 1913 Smoke Abatement 1930 Byelaws in Force in Area comprising Former Urban District of Kingsbury:— New Streets and Buildings 1926 1931 Smoke Emission I933 20 Byelaws in Force relating to Pleasure Grounds: — Pleasure Grounds (King Edward VII Park) ... 1914 ,, ,, (Sudbury Recreation Ground) 1925 ,, ,, (One Tree Hill) 1927 ,, ,, Church Lane, Welsh Harp Water, Kingsbury Green and Roe Green 1932 Regulations relating to:— Bowling Green. Cricket, Tennis, Football, Hockey and Netball. Fire Brigade. Mortuary. Old Burial Ground. New Burial Ground Putting Green. Swimming Bath. (a) LABORATORY FACILITIES. The Clinical Research Association has continued to carry out the examination of swabs for the detection of Diphtheria, Typhoid, etc; Samples of milk and food are also examined at these laboratories. The Royal Institute of Public Health has carried out examinations of sputum for the detection of tubercle bacilli. The following examinations were made during the year: — Examinations of Swabs 924 ,, ,, Blood Specimens 17 ,, ,, Sputum 191 ,, ,, Graded Milks 122 ,, ,, Water 9 ,, ,, Miscellaneous 4 (b) AMBULANCE FACILITIES. (i) Infectious Disease.—The Council has 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, and this service continues to prove entirely satisfactory. 21 (ii) Non-Infectious.—The ambulance service provided by the Council for accident and illness cases is now under the control of the Fire Brigade. Two ambulances are provided for this service, and no charge is made for their use. The following shows the extent of work carried out during the year:— Accident cases 318 Illness cases 1,261 Total 1,579 Total mileage 16,088 This shows an increase over 1934 of 150 cases, and an increased mileage of 2,185. (c) NURSING IN THE HOME. Wembley District Nursing Association. 9,873 visits were paid during 1935. The Home opened two years ago in Wembley Park has proved a boon to the Association, and the five nurses in residence are well catered for. The Providence Scheme inaugurated just a year ago is making progress. The Inspector from the Queen's Institute has made her usual visits, and has made very favourable reports. Kingsbury District Nursing Association. The Nurses are now accommodated in more central and up-to-date quarters. The number of visits made during the year totalled 4,937. The good work carried out by these Associations is of much value to the residents of the district. 22 23 (d) 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 p.m. Thursday 2.0—4 p.m. Wembley Urban District Council. Tokyngton Hall, Monk's Park, Wembley. Do. Tuesday 2.0—4 p.m. Wesley House, Harrow Road, Sudbury. Do. Monday 2.0—4 p.m. Friday 2.0—4 p.m. Kingsbury Free Church, Slough Lane. Do. Tuesday 2.0—4 p.m. Kingsbury Church Hall, Bacon Lane. Do. Monday 2.0—4 p.m. Wednesday 2.0—4 p.m. Ante-Natal Clinics St. Andrew's Hall. Ealing Road, Wembley. Medical Supervision. 1st, 2nd and 3rd Thursday in each month at 9.30 a.m. Do. Kingsbury Free Church, Slough Lane. Do. 2nd and last Friday in each month at 9.30 a.m. Dental Clinics Alperton Council School, Ealing Road. Dental inspection and treatment of nursing and exnoctant mothers and child- See posters, one of which can be seen at the Public Health Department. Do. Kingsbury Free Church, Slough Lane. ren under 5 years. Do. Do. Day Nurseries Nil. 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. Orthopædic work and Massage. Wembley Hospital. *The Council have an arrangement with the Wembley Hospital, whereby cases referred from the Clinics are treated at the Hospital. THE WEMBLEY HOSPITAL. The Wembley Hospital, with its 63 beds, has been greatly appreciated by the whole district during 1935, administering to more patients than ever before. From its foundation it has been carried on without any debt owing to careful administration. It has a large and important medical and surgical staff. You have sent numerous patients there for massage, sunray, and X-ray treatment. The Board of Management have found now that it will be necessary to double the size of the hospital and to provide a large nurses' home, which together will cost over £100,000. Under the Contributory Scheme 15,010 persons paid 6d. per month, the amount totalling £4,176. For this the subscribers are entitled to free in-patient treatment. THE ISOLATION HOSPITAL. For many years you have been accustomed to send your cases of infectious disease to the Acton Borough Council's Isolation Hospital, and you have had good reason to be satisfied with the care and attention received there. You have recently had the sanction of the Ministry of Health to join with the Borough in forming a Joint Hospital Board, or failing that a Joint Hospital Committee to administer that Hospital. Negotiations are being carried on now with that end in view. SMALLPOX ACCOMMODATION. The Middlesex County Council is responsible for the provision of hospital accommodation for cases of Smallpox occurring in the district. These cases are sent to the Dartford Smallpox Hospital. ACCOMMODATION FOR MATERNITY CASES. There can be no doubt that this matter has been, and is now, in a very unsettled, unsatisfactory condition. When a small district, and before the admission of Kingsbury, you endeavoured to acquire premises for a maternity hostel, but on account of the small size of the proposed hospital, were discouraged to proceed. The need is now very urgent, and you have appealed to the Ministry, in conjunction with the Harrow Urban District Council, for permission to erect a large Maternity Hospital with seventy beds—40 for Harrow, 30 for Wembley. 24 The Middlesex County Council have been quite unable to provide sufficient accommodation for the last two or three years—all their maternity hospitals are quite full, and we have been obliged to send our patients to Queen Charlotte's and the London Hospitals, and to local Nursing Homes in the district. We are often at our wits end to know how to deal with the situation. In some cases we had to telephone to from 10 to 15 different Hospitals before gaining admission. Too often the women apply in the eighth month, having made no provision!—many coming up from Wales and the provinces—on obtaining work in the district. In spite of the fact that the County Council is providing more beds for the accommodation of maternity cases, there is little hope that they will be able to cope with the multitudes flocking into Middlesex at the present time—200 beds would be insufficient—no time should be lost in giving sanction to the proposed local combined scheme—the matter is too urgent for dalliance, seeing that the County Council has failed! and also for the fact that larger numbers are demanding hospital accommodation. HOSPITAL ACCOMMODATION FOR CHILDREN. A children's ward containing six beds is provided at Wembley Hospital. The Hospitals under the control of the Middlesex County Council provide excellent accommodation for children, and cases are also referred to the various London hospitals. LOCAL GOVERNMENT AND OTHER OFFICERS' SUPERANNUATION ACT, 1922. During 1935, 47 examinations were made by the Medical Officer of persons, prior to their inclusion as members of the Staff, for the purpose of the above Act. MATERNITY AND CHILD WELFARE. The National Maternity Service Scheme. The National Maternity Service Scheme for England and Wales, as approved by the British Medical Association, would be a great step in advance if found practical and was universally adopted. The aim is the provision for every pregnant woman of a midwife and a doctor, the latter taking full responsibility for the ante-natal, natal and post-natal attendance in the case, the doctor attending the confinement if desired, or if it was found necessary. It also embraces: — 25 The services of a second practitioner for the anaesthetic, or assistance. The provision of beds in a Maternity Hospital, the doctor still attending his own patient. A supply of sterilised obstetric dressings in every case, and the Provision of ambulance to institutions when required. The scheme is intended to include persons entitled to maternity benefit under the National Health Insurance Acts; persons who, but for unemployment, would have been entitled; persons, in business, of similar economic status; certain grades of government services. If and when the Scheme becomes general, our Maternity and Child Welfare Centres would still carry on for the few, but the main work for them would be mothercraft. In the meantime there is a demand for a longer period of education for midwives, with better status and remuneration. MATERNITY HOMES. The registration of Nursing Homes is under the control of the County Council. The following homes are registered in the district :— Maternity Homes in Wembley, 1935. Misses R. S. Beach and L. Grant, 41 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, 44 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. Mrs. D. Willmot, 139, Stag Lane. LIST OF MIDWIVES. Barber, Phyllis O., Ashley Nursing Home, 3, Kenton Lane, Kingsbury, N.W.9. Bryant, Edith E., 80, The Drive, Wembley. Chapman, Minnie E., 80, Mount Pleasant, Alperton. Clarke, Hilda, 3, Kenton Lane, Kingsbury. Cole, Nellie, 8, Park Chase, Wembley. Collins, Margaret A., 16, Eton Avenue, Wembley. 26 Coyle, Annie, 22, Valley Gardens, Wembley. Day, Edith L., 77, Boycroft Avenue, Kingsbury. Delahaye, Amy, 12, Lewgar's Avenue, Kingsbury. Dilloway, Lilly G., 98, Sudbury Court Road, Harrow. Flint, Jessie M., 57, Wyld Way, Wembley. James, Alice H., 73, Kenton Road, Kenton. Latimer, Florence T., 77, Boycroft Avenue, Kingsbury. Lewis, Nora E., 3, Kenton Lane, Kingsbury. . Luscombe, Rosina E., 15, Blenheim Gardens, Wembley. McMahon, Margaret, 139, Stag Lane, Kingsbury, N.W.9. Miller, Rose G., 77, Boycroft Avenue, Kingsbury. Monk, Elsie M., 77, Boycroft Avenue, Kingsbury. Norton, Ida E., Nonsuch, 8, Park Chase, Wembley. Pike, Winifred M. (nee MacLennan), 73, Kenton Road, Kenton. Pohl, Ann L., 28, Bovingdon Avenue, Wembley. Poyner, Gwladys M., 5, Vincent Road, Wembley. Rantell, Esther A., 17, Napier Road, Wembley. Sarell, Gertrude E., 15, Holmstall Avenue, Edgware. Smith, Bessie M., 19, Wood Close, Kingsbury. Todd, Clara A., 6, Oakleigh Avenue, Burnt Oak. Whitworth, Christina, 12, Vivian Avenue, Wembley. Willmot, Dorothy, 139, Stag Lane, Kingsbury. Wilson, Elizabeth M., 14, St. James' Gardens, Alperton. BIRTHS NOTIFIED. 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 1539 (b) Still births 37 (c) Total 1576 MILK GRANTS. During 1935 you granted cow's milk daily to mothers and children whose incomes were found to be within your economic scale, to the value of £418 7s. 4½d. In some cases the grant was for Dried Food, such grants amounting to £235 12s. 1d. during the year. The milk question for the multitude appears to be a very complex one. The problem really resolves itself into a question of price. If it could be produced and supplied at half the present cost it would be consumed in immense quantities, with marked benefit to the mass of the people, especially to children and adolescents. The Ministry has recently emphasised the importance of a better milk supply. 27 During 1935 the following Infant Welfare Centres were held :— INFANT WELFARE CLINICS. Centre Day & Time Average Attendance per Session Total Attendances during year Children under I year 1-5 yrs. Mothers Children under 1 year 1-5 yrs Mothers WEMBLEY St. Andrew's Hall, Ealing Road Wednesday 2—4 p.m. Thursday 2—4 p.m. 64 33 87 6,595 3,441 8,943 SUDBURY Wesley House, Harrow Road Monday & Friday 2—4 p.m. 37 21 53 3,330 1,836 4,701 TOKYNGTON Tokyngton Church Hall, Monks Park Tuesday 2—4 p.m. 36 25 56 1.893 1,294 2,93! BACON LANE Church Hall, Bacon Lane Monday 2—4 p.m. Wednesday 2—4 p.m. 63 22 86 6,248 2,178 8,493 SLOUGH LANE Kingsbury Free Church, Slough Lane Tuesday 2—4 p.m. 41 28 67 2,153 1,432 3,470 Total 20,219 10,181 28,538 In addition, by arrangement with the Harrow U.D.C., residents in the Kenton area attended the Clinic held at Elm wood Avenue, Kenton— Children 529 attendances. ANTE-NATAL CLINICS. Centre. Date and Time. Average Attendance per Session. Total Attendances during year. WEMBLEY St. Andrew's Hall, Ealing Road. 1st, 2nd and 3rd Thursday each month at 9.30 a.m. 13 469 SLOUGH LANE Kingsbury Free Church, Slough Lane. 2nd and last Friday in each month at 9.30 a.m. 18 230 Attendances at Harrow Clinic (Kenton) 22 28 DENTAL. Dental Clinics are held at Alperton School, Ealing Road, Wembley, and at The Kingsbury Free Church, Slough Lane, Kingsbury, bi-weekly sessions being held at each centre. Expectant and nursing mothers and children are referred from all the Infant Welfare Centres in the district to these clinics for treatment. The attendances during 1935 are shown on the table. Dentures are supplied to expectant and nursing mothers attending these clinics, and during the year twenty-four applications for full, or partial sets were received and granted. Fifteen sets were supplied free of charge, in eight cases the applicants re-paid a proportion of the cost, and in one case the full cost was re-paid to the Council. DENTAL CLINICS. Centre. Day and Time. Average Attendance per Session Total Attendances during vear. Children Mothers Children Mothers WEMBLEY Alperton Council School, Ealing Road. Fortnightly, Saturdays at 9.30 a.m. 5 7 104 160 SLOUGH LANE Kingsbury Free Church, Slough Lane. Fortnightly, Saturdays at 9.30 a.m. 4 5 94 116 VOLUNTARY HELPERS. The Voluntary Helpers assist the Doctors and Health Visitors in many ways, their work is most useful to the Mothers and Children in arranging teas, the clinic libraries, clothing, cooking and in general welfare work. The Maternity and Child Welfare Committee are very grateful to these ladies for their assistance. INSTITUTIONAL PROVISION FOR UNMARRIED MOTHERS. There is no special provision of this nature available for the district. Any cases requiring such accommodation are referred to County Hospitals.—In any case no patients are neglected. 29 HEALTH VISITORS. In September, 1935, the Council appointed an additional Health Visitor, bringing the total number to six. The following is a summary of visits paid by the Health Visitors during the year. SUMMARY OF VISITS MADE BY THE HEALTH VISITORS. The number of visits paid during the year by the Health Visitors were:— To Expectant Mothers: First Visits 653 Total Visits 1028 To Children under 1 year of age: First Visits 2023 Total Visits 5568 To Children between 1 and 5 years of age: Total Visits 3572 Visits to cases of Ophthalmia Neonatorum 7 Puerperal Fever 1 Puerperal Pyrexia 5 Measles 25 Whooping Cough 139 Diarrhoea 21 General (unclassified) 324 CONVALESCENT HOME TREATMENT. During the year arrangements were made for the convalescence of six children, one mother and baby, and one mother. CONSULTANT. During the year the services of your consultant, Dr. J. W. Bell, for complicated maternity cases, were required by general practitioners in nine cases. MIDWIFERY ASSISTANCE. The Council's Scheme for assisting mothers desirous of having confinements at home, and who are unable to pay a midwife's fee, continued in operation during the year. The fees of midwives in attendance on 5 mothers were paid by the Council during the year. 30 MATERNITY OUTFITS. During the year nine outfits were supplied, one at a reduced price, and eight were supplied free of cost. The cost of these outfits to the Council is 7s. 6d. each. ORTHOPEDIC, MASSAGE and SUNLIGHT TREATMENT. Arrangements exist between the Council and the Wembley Hospital whereby cases referred from the clinics requiring artificial sunlight or massage treatment are dealt with at the hospital. Charges are made to parents according to circumstances. During 1935, 107 cases were referred and 1,169 treatments given. ADMINISTRATION OF PART I. OF THE CHILDREN ACT, 1908, AS AMENDED BY PART V. OF THE CHILDREN AND YOUNG PERSONS ACT, 1932. Infant Life Protection. The work of visiting children placed in the care of fostermothers is carried out by the Health Visitors. Record cards are kept in respect of every child, and a visit paid at least once a month, and notes made of progress and general conditions. The Health Visitors visit all new or prospective foster-mothers in order to ascertain their suitability, and report the recommended maximum number of foster-children they may receive in accordance with the Act. Visits paid during 1935:— To Foster Children 1,132 To Foster Parents 758 At the end of the year there were on the register Foster Children 77 Foster Parents 55 Number of foster children who died during the year 2 On whom inquests were held Nil 31 SECTION C. Sanitary Circumstances of the Area. 33 SANITARY CIRCUMSTANCES OF THE AREA. i. Water. (i) The greater part of the district is supplied with water by the Colne Valley Water Company, but a small area of Sudbury obtains its supply from the Rickmansworth Water Company. The London, Midland and Scottish Railway owns four cottages which obtain their water from the Railway Company's private supply. Samples of these waters were submitted to the Clinical Research Association for. analysis during the year, and the results obtained were satisfactory. Appended is a table showing the results of the chemical and bacteriological examination. In a very few instances a supply tap serves for more than one house. There are no private wells in the district which are used for the supply of water for domestic purposes. 34 CHEMICAL AND BACTERIOLOGICAL WATER REPORTS. Sample of Water— Colne Valley Water Co. (2.7.35) Sample of Water— L.M.S. Railway supply. (22.8.35) Part9 per 100,000 Grains per Gallon Parts per 100,000 Grains per Gallon CHEMICAL. Total solids (dried at 1200C.) 40.30 28.21 19.70 13.79 Combined chlorine 9.50 6.65 1.50 1.05 equivalent to Na CI. 15.68 10.98 2.48 1.74 Nitric Nitrogen (Nitrates) 0.34 0.24 0.48 0.34 Nitrous Nitrogen (Nitrites) Nil Nil Nil Nil Ammoniacal nitrogen 0.0004 0.0003 0.0003 0.0002 Albuminoid nitrogen 0.0044 0.0031 0.0014 0.0014 Oxygen absorbed in 4 hours 270C 0.013 0.009 0.029 0.020 Lead or Copoer Nil Nil Nil Nil Temporary hardness (equivalent to CaCo3) 14.0 9.8 3.0 2.1 Permanent hardness 2.0 1.4 6.0 4.2 Total hardness 16.0 11.2 9.0 6.3 BACTERIOLOGICAL. Average number of organisms producing visible colonies on gelatine plates, incubated at 200—220C. for 3 days = 460 per C.C. 4 per C.C. Average number of organisms producing visible colonies on agar plates, incubated at 37.50C. for 2 days = 19 per C.C. 1 per C.C. B. Coli Not found in 100 c.c. Not found in 100 c.c. Streptococci Not found in 30 c.c. Not found in 30 c.c. B. Welchii (spores) Not found in 100 c.c. Not found in 100 c.c. BACTERIOLOGIST'S REMARKS. These results shew this water to be satisfactory for drinking purposes. From a consideration of the results obtained we are of opinion that this water is quite satisfactory for drinking purposes. 35 The Covering of Cisterns. In October last my attention was drawn to the absence of suitable dustproof covers to the water cisterns of many of the houses in the Sudbury Court Estate. On corresponding with the Colne Valley Water Company the Secretary informed me that this Company could compel the protection and had, and would, insist upon builders providing such covers in all new houses before connecting up the premises with a water supply. It was felt that it was not possible to make the instruction retrospective with 26,000 houses. Householders are urged to clean out their cisterns at regular periods. The Council has not the power to compel a landlord to supply a tap from the main for each set of lodgers, but it is assumed that every house has a draw-off from the main placed in the usual position over the sink on the ground floor. Drainage and Sewerage. (ii) Practically every house in the district is connected with the main drainage system. No extensions to the existing Sewage Disposal Works were carried out during 1935 in view of the early connection to the Middlesex County Council's West Middlesex Trunk Sewer. During the past year there have been constructed 2,900 yards of soil and surface water sewers, representing new sewers and excluding any relaying of existing sewers. 2. Rivers and Streams. The various water courses in the district are kept under frequent observation and any cases of pollution traced to their source. It is gratifying to note the marked improvement in the condition of the rivers and streams since the effluent from the various sewage farms, which originally was discharged into these rivers and streams, has ceased to do so by reason of the sewage being discharged into the Middlesex County Council's West Middlesex Trunk Sewer. When sewage pollution has been evident in the past the Local Authority responsible, and also the Rivers Inspector of the Middlesex County Council, have been promptly notified and the matter has been followed up until there has been a marked improvement. The cleansing of these water courses is carried out periodically by the Middlesex County Council, and in this connection the Chaplin Road Brook was again cleansed 36 during the year; the refuse therefrom being carted away by this Council. A complaint was received of the condition of the expanse of water known as the Welsh Harp which is used to some extent by bathers. This stretch of water is in three districts, namely, Hendon, Willesden and Wembley, and a copy of the complaint was sent to the Medical Officer of Health of each of the other districts concerned. The Welsh Harp belongs to the Grand Union Canal Company and bathing is not permitted by the Company, but owing to the fact that an open space belonging to the Council is quite near to the water it has been the custom for a number of years for people to bathe there. No source of pollution of this water from Wembley could be found, and from ordinary inspection the water appeared to be reasonably clear and was found to contain fish life. Chemical analysis and bacteriological examination, on the other hand, showed that the water was polluted and unfit for bathing purposes. The attention of the Grand Union Canal Company was drawn to the state of affairs which existed, and they have undertaken to erect notices on their land forbidding bathine and drawing attention to the fact that the water is not fit for the purpose. 3. Closet Accommodation. (i) With a few exceptions water closet accommodation is provided in every house in the district. In a number of cases water closet accommodation is shared by two houses, but the properties concerned are already receiving the consideration of the Council under the Housing Acts. In a few instances the houses are provided with pail closets, and in three of these cases demolition orders have been made of the houses concerned. There are no privy middens in the district. Public Cleansing. (ii) The new Public Cleansing Department, with a Special Committee, has been set up to control the collection and disposal of refuse, street cleansing, public conveniences, etc. Previously the collection and disposal of refuse, and supervision of public conveniences, were under the control of this department, whereas street cleansing was under the control of the Surveyor. It can, however, be stated that Wembley has been equipped for several years with modern plant for the collection of refuse. 37 The refuse has continued to be barged from the district,, but this practice will cease upon completion of the new disposal works at Alperton. No refuse is collected from earth closets, privies or cesspools. Tents, Vans and Sheds. A considerable amount of time was taken up during the year in dealing with gipsies, chiefly in the Kingsbury area. These people draw in on any vacant land which suits their purpose without the permission of the owner. No sanitary accommodation is provided and residents in the neighbourhood are requested by the gypsies to supply them with water. The sites used by them are often littered with rubbish, with the result that complaints are received from the local residents. Prompt action is taken by your Public Health Department in such cases, and with the assistance of the landowner and the police the vans are removed from thedistrict. Stables and Piggeries. These premises receive their full quota of attention, and in the case of piggeries the number has fallen considerably during recent years. Wembley can hardly be regarded now as a suitable place for piggeries. The district has become so urbanised that it is difficult to carry on this class of business without causing annoyance to neighbouring householders. 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. 38 (iii) Sanitary Inspection of District. Inspections re Complaints 685 ,, of Slaughter Houses 144 ,, ,, Cowsheds 65 ,, ,, Dairies and Milkshops 148 ,, ,, Butchers' Shops 374 ,, ,, Markets 38 ,, ,, Other Food Premises 769 ,, ,, Bakehouses (Factory) 71 ,, ,, Ditto (Workshop) 10 ,, re Offensive Trades 42 ,, of Factories (not including Bakehouses) 218 ,, ,, Workshops (ditto) 22 ,, ,, Workplaces 56 ,, ,, Outworkers Premises . 41 ,, ,, Schools (Drainage, etc.) 34 ,, ,, Cesspools, etc. 14 ,, ,, Urinals and Latrines 24 ,, ,, Public Conveniences 345 ,, ,, Ditches, Streams, etc. 195 ,, ,, Stables and Manure Pits 127 ,, ,, Piggeries 44 ,, ,, Tents, Vans, Sheds, etc. 68 ,, ,, Yards 2016 ,, ,, Refuse Dumps, Open Spaces, etc. 249 ,, ,, Cinemas, Dance Halls, etc. 38 ,, re Infectious Disease 757 ,, of Houses under Housing Regulations 128 ,, ,, Other Houses 471 ,, ,, Boiler Plant, etc. 36 ,, Miscellaneous 1435 ,, re Supply of Dustbins 43 ,, of Petroleum Installations 61 ,, ,, Verminous Premises 168 ,, ,, Fair Grounds 6 ,, re Overcrowding 21 ,, Re-visits 1553 ,, of Drains 1315 Drain Tests Applied 86 Smoke Observations (half-hour) 179 Ditto (casual) 340 Samples of Water taken 9 Ditto Milk taken 195 Total 12640 Total No. of Informal Notices served 455 ,, ,, Statutory Notices served 44 Nuisances Abated and Defects Remedied. Drains Cleansed from Obstruction 317 New Drains and Inspection Chambers Provided 3 Drains Relaid or Repaired 43 Inspection Chambers Repaired 82 Soil Pipes and Ventilating Shafts Repaired 3 Floors of Dwellings Relaid or Repaired 20 Sub-Floor Ventilation Provided or Improved 5 Oversite Concreted 2 39 Internal Walls and Ceilings Repaired 42 New Lavatory Basins Provided 2 Dampness Remedied 31 New Damp Proof Courses Provided, 2 External Walls and Chimneys Repointed or Repaired 12 Roofs Reconstructed or Repaired 19. Windows Repaired or Additional Windows Provided 114 Spouts and Gutters Repaired or Renewed 40 New Sinks Provided 2 Sinkwaste Pipes Repaired or Renewed 28 Cooking Stoves and Firegrates Repaired or Renewed 31 Wash Coppers Repaired or Renewed 8 Rooms Cleansed and Redecorated 151 Passages and Staircases Cleansed and Redecorated 21 W.C. Walls Cleansed 20 W.C. Structures Repaired or Rebuilt 14 W.C. Cisterns Repaired or Renewed 20 Additional W.C.s Provided 1 Fouled W.C.s and Urinals Cleansed 19 W.C. pedestals Renewed 11 W.C. Flush Pipes Repaired 1 Dustbins Supplied 798 Smoke Nuisances Abated 21 Accumulations Removed 71 Tents and Vans Removed 20 Water Supply Improved 9 Ditches and Streams Cleansed 5 Verminous Premises Disinfested 29 Overcrowding Abated 1 Cesspool Filled-in 1 Nuisance from Animals Abated 3 Latrine Removed 1 Miscellaneous 25 Yards Paved or Repaired 16 Total 2064 ccntraventions remedied:– Slaughterhouses 1 Butchers' Shops 11 Cowsheds 4 Dairies and Milkshops 4 Bakehouses 6 Factories Referred to H.M. Inspector 1 Total 27 40 Factories, Workshops, Workplaces and Outworkers. During 1935, 377 inspections were made of factories, workshops and workplaces, and 41 inspections of outworkers' premises were also carried out. In matters which are the concern of H.M. Inspector of Factories, he is notified by this Department. So far as the provision of sanitary accommodation is concerned the Wembley Council, who are the authority for this matter under Section 22 of the Public Health Act (Amendment Act), 1890, insist on the accommodation complying with the Home Office Order of 1903. Any defects found, or insufficiency of sanitary accommodation, are followed up, and it has been our experience that preliminary notices are complied with without recourse to statutory proceedings. 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) 289 9 — Workshops (Including Workshop Laundries) 32 1 Workplaces (Other than Outworkers premises) 56 Total 377 10 — 41 2.—DEFECTS FOUND IN FACTORIES, WORKSHOPS AND WORKPLACES. Particulars. Number of Defects Number of offences in respect of which prosecutions were instituted Found 1 Remedied 1 Referred to H.M. Inspector Nuisances under the Public Health Acts: Want of Cleanliness 7 7 — — Want of Ventilation 1 — 1 — Overcrowding — — — — Want of drainage of floors — — — — Other Nuisances 3 1 2 — Sanitary accommodation insufficient — — — — unsuitable or defective 13 16† — — 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 Workshop Transfer of Powers) Order. 1921. Total 24 24 3 — *These figures include 71 visits to Factory. Bakehouses and 10 visits to Workshop Bakehouses. OUTWORK IN UNWHOLESOME PREMISES (Sec. 108). No action was taken under this Section. †Three defects remedied in 1935 brought forward from previous year. Shops Act, 1934, Section 10. (iv) Arrangements for Health and Comfort of Shop Workers. During 1935 the Council appointed a full-time Shop Inspector, who has supplied me with the following information concerning work under the above Section of the Act:— No. of Inspection Visits paid 586 42 Section 10 (1) (a)—Ventilation— Number of Shops in which Ventilation was not suitable and sufficient 1 Section 10 (1) (b)—Temperature: Number of Shops in which Temperature was not suitable and sufficient 4 Section 10 (2)—Sanitary Conveniences: Number of Shops in which no Sanitary Conveniences were provided 25. Number of Shops in which Sanitary Conveniences have since been provided 6 Number of Certificates of Exemption granted 19 Section 10 (4)—Washing Facilities: Number of Shops in which no Washing Facilities were provided 12 Number of Shops in which Facilities have since been provided 4 Number of Certificates of Exemption granted 8 Offensive Trades. The only offensive trades carried out in Wembley are those of Fish Frying and Fat Extraction. Many applications are annually received by the Council for the establishment of Fish Frying in different parts of the district, and these applications are granted where it is obvious that they will be appreciated by the residents in the vicinity. Every case is very carefully scrutinised by the Public Health Committe before submission to the Council. Applicants can hardly expect to be successful in good residential parts of the district, or in the main high roads. The Fish Frying plant now supplied is of a very high standard, and can be used without causing a nuisance in the shop or on the pavement if care be taken, but the pungent odour from the chimney is often very noticeable in the street. Smoke Abatement. (v) The various factory chimneys in the district have been kept under frequent observation by your Sanitary Officers. The technical advice offered by your Inspectors has been welcomed by the various factory proprietors and frequently noticeable improvement in conditions has followed. 43 During 1935, 340 chimneys were observed and 179 halfhourly observations were taken. On 21 occasions a nuisance was found to exist, but in only one case was the service of a Statutory Notice necessary to obtain the abatement of the nuisance. 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. Public Conveniences. The various Public Conveniences are now controlled by the Public Cleansing Department, and these continue to be maintained in a satisfactory manner. Mortuary. The Council's Mortuary is at the Burial Ground adjoining the Parish Church of St. John, Wembley. The mortuary consists of three cubicles, one being fitted as a chapel, and one fully equipped post-mortem chamber. The Morturary is available free of charge. During 1935 84 bodies were deposited. 51 post-mortem examinations were made. 33 coroner's inquests were held in the schoolroom adjoining. A full-time Mortuary and Burial Ground Attendant is employed by the Council. During the year periodical inspections were made of the Mortuary by your Sanitary Officers. Rag Flock Acts, 1911 and 1928. No samples of Rag Flock were taken by the Council's Sanitary Officers during the year. In two factories rag flock is used for the purpose of upholstery, and the material supplied under guarantee. The Reports of chemical examinations made are open to inspection by the Sanitary Inspectors. 44 4. Schools. Periodical inspections are made of the various elementary and secondary schools in the district. In addition, private schools are inspected, classrooms measured and a tabulated statement is sent to the principal, setting out the maximum number of children who should use such classrooms in accordance with the Board of Education standard. Swimming Bath. Wembley has every reason to be proud of its modern swimming baths. The Council's Bath at Vale Farm, Sudbury, has proved a great boon to all classes, and to old and young by the thousand, and as a health accessory has fully justified the efforts of its promotion. Not the least of the benefits conferred by its use has been the opportunity for sun-ray treatment. Every effort has been made by the Committee to arrange equitably for the times and for the charges to suit all sections of the community. It is understood that a similar bath will be established in the Kingsbury end of the district in the near future. The Empire Pool. The Empire Pool at Wembley Park is undoubtedly a great asset to the district, but serves a much larger public. It is frequented by thousands of people, and is a fine contribution to the health activities of the district—in a measure, together with the numerous open spaces, counterbalancing the less pure atmosphere of the ballrooms and entertainment halls. The chemical and bacteriological examination of the water from these swimming baths gave the following results:— 45 CHEMICAL AND BACTERIOLOGICAL WATER REPORTS. Sample of WaterPublic Swimming Bath (Sudbury). (2.7.1935) Sample of "Water— Swimming Pool (Empire Pool). (19.7.1935) Parte per 100,000 Grains per Gallon Parts per 100,000 Grains per Gallon CHEMICAL. Total solids (dried at 1200C.) 51.90 36.33 — — Solids in solution — — 65.9 46.1 Solids in suspension — — — — Combined chlorine 13.0 9.1 13.6 9.5 equivalent to Na Cl 21.5 15.1 22.4 15.7 Nitric nitrogen (Nitrates) 0.68 0.48 0.44 0.31 Nitrous nitrogen (Nitrites) Nil Nil trace present. Amoniacal nitrogen 0.180 0.126 0.155 0.109 Albuminoid nitrogen 0.040 0.028 0.029 0.020 Oxygen absorbed in 4 hour at 270C 0.065 0.046 0.057 0.040 Lead or Copper — — — — Temporary hardness (equivalent to CaCo3) 3.3 2.3 — — Permanent hardness 14.3 10.0 — — Total hardness 17.6 12.3 — — BACTERIOLOGICAL Average number of organisms producing visible colonies on gelatine plates, incubated at 200—220C. for 3 days= 530 per c.c. 9 per c.c. Average number of organisms producing visible colonies on agar plates, incubated at 37.50C. for 2 days = 4 per c.c. 4 per c.c. B. Coli. Not found in 100 c.c. Not found in 100 c.c. Streptococci. Not found in 30 c.c. Not found in 30 c.c. B. Welchii (spores). Not found in 100 c.c. Not found in 100 c.c. BACTERIOLOGIST'S REMARKS. The chemical analysis shews evidence of contamination, but the bacteriological examination is satisfactory, shewing that the chlorination has been efficient. The water gave a distinct reaction for free chlorine and may be regarded as fit for bathing purposes. Free chlorine was present in the sample on arrival at the laboratory and was found to amount to 0.33 parts per million. These results shew this water to be satisfactory for bathing purposes. 46 SECTION D. Housing. 47 REPORT ON THE PREVENTION AND ABATEMENT OF OVERCROWDING. HOUSING ACT, 1935. In November last I gave you in brief the chief clauses of this Act so far as it relates to overcrowding, setting out the new standard which is to apply to the whole country. The Act imposes on every Local Authority the duty of carrying out an inspection of their district within a period to be fixed by the Ministry (the date fixed was the 1st April, 1936), in order to ascertain what houses are overcrowded and of reporting the result to the Minister with their proposals for supplying new houses or flats where necessary to abate the overcrowding. The overcrowding standard consists of two parts:— 1. Sufficient sleeping accommodation to secure proper sex separation. 2. A standard of capacity irrespective of sex. The number of persons permitted to occupy a house ?s set out in the following Tables:— Table I. Where a house consists of: — The permitted number of persons is:— (a) One room 2 (b) Two rooms 3 (c) Three rooms 5 (d) Four rooms 2 (e) Five rooms or more 10 with an additional 2 in respect of each room in excess of five. (In using this Table, a room of less than 50 square feet is not counted as a room). Table II. Where a room in a house has a floor area of: — (a)11o sq. ft. or more 2 (b) 90 sq.ft. or more,but less than 110 4 (c) 70 sq.ft. or more,but less than 90 1 (d) 50 sq.ft. or more, but less than 70 ½ (e) Under 50 sq.ft. NIL 48 In the application of these Tables, account is only to be taken of rooms which are normally used in the locality either as a living room or as a bedroom. In applying Table II each room of the size mentioned is to be reckoned as capable of accommodating the number set out in the Table, and the aggregate for all the rooms in the house is ascertained in this manner. The "permitted number" for the house is the aggregate number so obtained or the number given by Table I. whichever is the smaller. In considering the application of the standard in relation to particular families it is to be noted:— (1) That in the case of a house part of which is sublet, the rooms occupied by the sub-tenant constitute a separate house; (2) that children between the ages of 1 and 10 years count as half a person and that a child under 1 year of age does not count at all: (3) that apart from the number of persons who may occupy a house there is an over-riding condition that the accommodation available for a particular family must be such that no two persons both of 10 years of age or over of opposite sexes, except persons living together as husband and wife, must sleep in the same room: (4) that only rooms normally used in the locality for slecping or living purposes are counted as rooms, so that bathrooms, sculleries, etc., are not counted as part of the accommodation. The general effect is that overcrowding existing on the appointed day (which has yet to be fixed by the Minister of Health) is not an offence until alternative accommodation has been offered and refused. Where there has been no change of occupier since the appointed day and no addition to the occupants except by births, then notwithstanding that the house is overcrowded no offence is committed by the occupier unless he refuses an offer of suitable alternative accommodation or declines to take reasonable steps to get rid of some person who is not a member of his family, such as a lodger or sub-tenant. Similiar safeguards are provided to cover cases where families become overcrowded in course of time owing to increase in the number or ages of the children or where a 40 house becomes overcrowded solely because a member of the occupier's family who does not normally reside in the house is temporarily residing with him. A landlord renders himself liable for prosecution for an overcrowding offence— (a) Where the landlord or his agent is informed in writing by the local authority that his tenant is committing an overcrowding offence and the landlord does not take steps, including, if necessary, an application to the Court to obtain possession to put an end to the offence, and (b) Where, on the letting of the house, the landlord or person letting on his behalf had reasonable cause to believe that it would be overcrowded, or did not enquire the number, age and sex of the persons who were going to occupy it. The Minister of Health is given the power on the application of a Local Authority and after consultation with the Central Housing Advisory Committee to modify temporarily the overcrowding standard in its application to houses in the district of the particular Local Authority or in any part of that district. The Local Authority is empowered, on the application of an occupier or intending occupier of a dwelling house, to issue a licence allowing that dwelling house to be occupied for a limited period by a number of persons in excess of the permitted number for the house. Such a licence can only be granted when the Local Authority are satisfied that exceptional circumstances exist which make it expedient to do so, and such licences cannot be given for a period exceeding twelve months. Provision is made that as from six months after the appointed day all rent books or similar documents relating to working class houses must contain a summary of those provisions of the Act relating to overcrowding which affect the occupiers, together with a statement showing the permitted number of persons in relation to that house. To enable this information to be given it is the duty of the Local Authority on the application of the landlord or the occupier of a dwelling house to inform him in writing of the permitted number of persons in relation to the house. Powers of entry are given to the Local Authority for the purpose of inspecting and measuring all dwelling houses which come within the scope of this Act, and it is the duty of a landlord 50 or his agent to inform the Local Authority when it comes to his knowledge after the appointed day that his house is overcrowded. It is the duty of the Local Authority to enforce the overcrowding provisions in their area, and the Local Authority are given power to obtain vacant possession of a house which is overcrowded in such circumstances as to constitute an offence if the occupier, after fourteen days notice in writing has not abated the overcrowding. In these circumstances the Local Authority may apply to a Court of Summary Jurisdiction for an order of vacant possession to be given to the landlord and the expenses of their proceedings will be recoverable from the landlord. The definitions appropriate to the overcrowding Sections are as follows:— Dwelling House.—A dwelling house is defined as any premises used as a separate dwelling by persons of the working classes, or of a type suitable for such use. It therefore includes any part of a building which is used or is capable of use as a separate dwelling by persons of the working classes. The part of a house occupied by a sub-tenant is therefore a separate dwelling house for the purpose of the overcrowding provisions. Landlord.—A landlord is defined as the immediate landlord of the occupier, or in the case of a service tenancy the employer of the occupier. Thus the tenant of a whole house is the landlord in relation to the sub-tenant of part of his house. Agent.—An agent is defined as the person who collects the rents of a landlord, or in the case of a service tenancy the person who pays remuneration to the occupier on behalf of the employer. Room.—A room is defined as not including any room of a type not normally used in the locality either as a living room or as a bedroom. Suitable Alternative Accommodation.—Suitable alternative accommodation means, in relation to the occupier of a dwelling house, a dwelling house to which the following conditions are satisfied, that is to say:— (a) The house must be a house in which the occupier and his family can live without causing it to be overcrowded. 51 (b) The local authority must certify the house to besuitable to the needs of the occupier and his family as respects security of tenure and proximity to place of work and otherwise, and to be suitable in relation to his means, and (c) If the house belongs to the local authority they must certify it to be suitable to the needs of the occupier and his family as respect extent of accommodation, having regard to the standard specified in Paragraph (ii) of the Section 37 of the Act of 1930. The Survey in Wembley was carried out on the lines as suggested by the Minister of Health in his Memorandum B The Prevention and Abatement of Overcrowding, and was commenced in December, 1935, and completed by the 31st March, 1936. Two men who had been previously unemployed were engaged to obtain the information on Form A, and in every case where overcrowding was found to exist definitely or was suspected, a visit was paid to the house by one of your Sanitary Inspectors, who then completed Form B. For your information I may say that Form B gives a far greater amount of detail than does Form A and includes the measurements of all the rooms in the house, and also gives the number of persons permitted to occupy the house as set out in Table II in the earlier part of this report. HOUSING. Statistics. Number of new houses erected during the year:— (a) Total, including numbers given separately under (b):— (i) By the Local Authority Nil (ii) By other Local Authorities Nil (iii) By other bodies and persons:— Houses 1924 Flats (108 blocks) 202 Factories 6 Cinemas 2 Shops 69 52 (b) With State Assistance under the Housing Acts:— (i) 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 Nil (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) 1245 (b) No. of inspections made for the purpose 2316 (2) (a) Number of dwelling-houses (included under sub-head (1) above) which were inspected and recorded under the Housing Consolidated Regulations, 1925 128 (b) No. of inspections made for the purpose 261 (3) Number of dwelling-houses found to be in a state so dangerous or injurious to health as to be unfit for human habitation 5 (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 780 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 661 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 8 53 (2) Number of dwelling-houses which were rendered fit after service of formal notices:— (a) By owners *10 (b) By Local Authority in default of owners Nil * Includes compliance in 1935 of 5 notices served in 1934. (b)—Proceedings under Public Health Acts:— (1) Number of dwelling-houses in respect of which notices were served requiring defects to be remedied *36 (2) Number of dwelling-houses in which defects were remedied after service of formal notices:— (a) By owners 13 (&) By Local Authority in default of owners 26 * Includes compliance in 1935 of 3 notices served in 1934. (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 *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 54 SECTION E. Inspection and Supervision of Food. 55 INSPECTION AND SUPERVISION OF FOOD. (a) MILK. Mr. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, has kindly supplied me with the following information. Milk and Dairies (Consolidation) Act, 1915. Tuberculosis Order, 1925. During 1935 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. None of these samples was found to contain tubercle bacilli. 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; 455 inspections of cows were carried out in Wembley, but none of these were found to be suffering from Tuberculosis. Milk (Special Designations) Order, 1923. Licences Issued, 1935:— Designation LICENCE Dealers Supplementary To Bottle To Pasteurise Certified 10 2 — — Grade a. T.T. — 4 3 — Grade A. 1 1 — — Grade A. (Pasteurised) 7 — — — Pasteurised 23 5 — 2 During the year, 122 samples of Graded Milk were taken as follows:— Grade A (T.T.) 57 Grade A Pasteurised 12 Grade A 8 Pasteurised 45 In four cases the bacterial count exceeded the standard prescribed, and in eight bacillus coli was found to be present. The vendors' attention was drawn to this condition, and subsequent samples proved satisfactory. 56 Four samples of milk, two Grade "A" (T.T.) and two Grade "A" Pasteurised, were submitted to examination for the presence of tubercle bacilli, but in no case was this found. COWSHEDS. At one time a very large quantity of milk was produced in Wembley, but at the present time there are now only four farms producing milk for sale, one of which is licensed for the production of Certified milk and one for the production of Grade "A" milk. All of these cowsheds are found to be kept in a satisfactory condition. DAIRIES AND MILK SHOPS. All of these premises are inspected regularly and are generally found to comply with the Milk and Dairies Order, 1926. In the case of all dairies a steam plant is provided for sterilising the utensils and containers used in the trade. During 1935, 148 visits were made to these premises. (b) MEAT AND OTHER FOODS. SLAUGHTERHOUSES. There are 4 slaughterhouses in the district, all of which are licensed annually by the Council. In one instance only is the slaughterhouse used regularly each week. In this case the occupier of the premises is the sole licensee, and slaughtering is carried out only for the purposes of his own retail trade. In one instance the slaughterhouse is used somewhat infrequently by the licensee. In the two remaining cases the slaughterhouses were used once only during the year. These premises are inspected frequently, and the carcases and organs of animals slaughtered are inspected. During 1935, 144 inspections of slaughterhouses were made and the following carcases were examined Beasts and calfs 97 Sheep 52 Pigs 652 INSPECTION OF OTHER FOODS. Special attention is given to premises in which articles used for the food of man are prepared, sold, or stored, in order to see that they comply with the various Acts and Orders relating to such premises. It is generally found that 57 the traders are willing to comply with the provisions of the legal enactments when their attention is drawn to some breach or other, without recourse to statutory proceedings. During 1935, 1,258 inspections were made of Butchers, Markets, Bakehouses and other food premises. UNSOUND FOOD SURRENDERED AND DESTROYED, 1935. In connection with the inspection of meat and other foods the following were found to be diseased or unsound, and were voluntarily surrendered and destroyed:— 4 pigs' carcases and offal Peritonitis & Nephritis 1. Cysticercus Cellulosae 1. Bruised and fevered 2. 2 pigs' lungs Tuberculosis 1. Pleurisy 1. 11 pigs' heads Tuberculosis 11. 6 pigs plucks Cirrhosis 2. Tuberculosis 4. 1 pig's liver Cirrhosis. 8 lbs. pigs' kidneys Unsound. 3 bovine heads & tongues 1 uberculosis 2. Actinomycosis 1. 2 bovine livers Distomatosis 2. 3 bovine lungs Tuberculosis 2. Abscess 1. 2 bovine mesenteries Tuberculosis 2. 1 fowl Tuberculosis. 63 lbs. cod fillets Unsound. 4 long boxes fish roes Unsound. 9 boxes kippers Unsound. 35 handles mushrooms Unsound. 7 lbs. Chinese eggs Unsound. 77 tins cherries Blown. 36 ,, pears ,, 19 ,, pine slices ,, 5 ,, pine cubes ,, 13 ,, grape fruit ,, 1 ,, loganberries ,, 8 ,, oranges ,, 5 ,, apricots ,, 2 ,, asparagus ,, 3 ,, tomatoes ,, 1 ,, quince jam ,, 58 FOOD HANDLING AND FOOD EXPOSURE. I am still unable to report that the unnecessary handling of food has ceased. Bread continues to be ill-used, delivered unwrapped, and left on door-steps, and until the public demand that it shall be delivered in a paper bag, or some satisfactory covering, contamination and pollution will continue. Health Authorities are in need of legislation to control this matter in a very definite way. (c) SALE OF FOODS AND DRUGS (ADULTERATION) ACT. By the courtesy of Mr. Robinson, Chief Officer of the Public Control Department of the Middlesex County Council, I am able to set forth the following facts relating to samples taken in the district during 1935: — Article. No. taken. Adulteration. Milk 149 9 Brandy Essence 1 — Cream 1 — Cream Pastry 2 2 Gin 2 — Iodine 1 — Jelly 1 — Minced Beef 5 — Rice, ground 1 — Sausages 4 — Whisky 1 — Totals 168 11 (d) CHEMICAL AND BACTERIOLOGICAL TION OF FOOD. Any chemical and bacteriological work which is required in connection with food is carried out by the Clinical Research Association. (e) NUTRITION. " THE RELATION OF FOOD TO HEALTH." The Relation of Food to Health should undoubtedly be one of the most important considerations of modern life. Scientifically we like to express the different food values in terms of calories. Now a calorie is a heat standard, and it 59 represents the amount of heat required to raise one litre of water one degree of temperature (Centigrade) and we use it to express energy value, just as in the same way we mention a foot or a mile as a standard or unit of measure, or an ounce or a pound as a unit or standard of weight. In rough estimation of the needs of a man, as regards diet, we say he needs about 3,400 calories to keep him in health and vigour even for laborious work. We should not dare to say this was sufficient for a growing boy or girl of 15 to 18 years of age, or for an expectant mother—they need as much as from 4,000 to 5,000 calories in order to obtain all that is needed for their extra growth and requirement, but taking the average work that a man undertakes it will be found that about 3,000 calories daily will suffice. This means that 80 to 100 grammes of protein food will be required (from 2½ to 4 ozs.) (meat, cheese, eggs or fish). This cannot with exactitude be stated for any individual as so much depends on the physique, the occupation, habits, etc. The rest of diet is made up of carbohydrates (starches) and hydrocarbons (fats, etc.) and water. The promoters of the "Keep Fit Movement" are well aware of the amount of food necessary to keep one in perfect health, that is, a well-balanced diet, and this is especially the case with trainers of athletes. I have no faith in the dictum of a fat man who states that he is a small eater, because I have watched him at meals and I note that he consumes far too much starchy food—bread, potatoes, cakes, etc. Fats (cream, butter, oil, etc.) do not make people fat to the same extent as starchy food, but are necessary for digestion. To sit in an office, in a car, or take too little exercise will certainly assist in the accumulation of fat over the abdomen and elsewhere. Every healthy man or woman should take the equivalent of a 4-mile walk daily. Young people always do in some form (dancing, games, football, badminton, tennis, golf, etc.). The worst mistake at the table is rapid eating as it always implies the ingestion of several more tablespoonsful of food than are required, and generally more than can be easily digested. The criterion of a well-balanced diet is to keep well, that is to be cheerful and full of energy, to keep the same weight, and to function with regularity. 60 SECTION F. Prevalence of, and Control Over, Infectious and Other Diseases. 61 62 CASES OF INFECTIOUS DISEASE (OTHER THAN TUBERCULOSIS) NOTIFIED DURING THE YEAR 1935. 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 292 1 5 13 20 16 150 45 7 20 11 4 - 218 Nil Diphtheria 95 1 2 2 10 4 28 15 5 19 8 1 — 90 5 Enteric Fever (including Paratyphoid) 7 - — 2 - — - - 1 1 2 1 - - 1 Puerperal Fever 1 - - - - - - - - 1 - - - - - Puerperal Pyrexia 19 - - - - - - - 1 13 5 — — 17 — Pneumonia 66 4 1 2 — 2 15 — 7 8 3 18 6 - 32 Erysipelas 29 1 1 — — — 1 — 1 4 11 9 1 — — Ophthalmia Neonatorum 8 8 - - — — — — — — — — — 3 — Acute Anterior Poliomyelitis 2 - - - 1 - - - - 1 - - - - - Encephalitis Lethargica 1 — — — — — — 1 — — — — — — 2 Polio-Encephalitis 1 — 1 - - - - - - - 1 - - - - TABLE SHOWING NOTIFICATIONS OF INFECTIOUS DISEASE OCCURRING IN 1935 IN ELECTORAL WARDS. DISEASE. Total Electoral Wards. Alperton. Central. Chalkhill. Fryent. The Hyde. Kenton. Preston. Roe Green. Sudbury Court. Sudbury. Tokyngton Wembley Pk. Unclassified. Scarlet Fever 292 28 22 41 26 19 24 11 40 13 25 25 20 3 Diphtheria 95 7 1 5 — 9 7 9 32 - 11 8 6 — Enteric Fever 7 2 — - — 1 2 1 — — — — 1 — Puerperal Fever 1 — 1 — - - - - - - - - - - Puerperal Pyrexia 19 2 1 — — 3 — - 1 — — — — 12 Pneumonia 66 5 5 5 5 3 5 2 7 3 13 8 5 — Erysipelas 29 4 1 1 3 4 2 2 — 2 5 5 — — Ophthalmia Neonatorum 8 - — — - 2 — — — — 4 — 1 1 Encephalitis Lelhargica 1 - - - - - - - - - - - 1 — Polioencephalitis 1 - - - - - - - - - - - - - Acute Anterior Poliomyelitis 2 — — — — — — — 1 — — — 1 — 63 NOTES ON INFECTIOUS DISEASE. Whilst in recent years the incidence of smallpox and enteric (typhoid) has been reduced almost to a minimum, and that of Tuberculosis is lessening—diphtheria and scarlet fever are as prevalent as ever, the former often virulent in type, the latter usually mild, and we as Sanitarians have to acknowledge that our efforts have failed in spite of careful isolation and disinfection of the patient and his surroundings. It is true that time is often lost before a case of infectious disease is recognised by the friends and seen by a doctor. The premises and relatives becoming infected before isolation is ordered. It is now generally believed that ordinary disinfection as usually carried out is of no great value; it may, indeed, be worse than useless if it is so much relied on that no cleansing or spring cleaning is thought necessary. At the same time I am not one of those who would regard our present method of disinfection as unnecessary or pure "eyewash" if properly supported by other measures. It is wiser, no doubt, to repaint and repaper a room after use by a consumptive, diphtheritic or a scarlatinal patient, but we cannot insist upon it. Thorough cleansing of every part of a room and furniture, and an exposure to sunlight would be very effectual domestic disinfection. Then it must be remembered as regards scarlet fever that it is often most difficult to diagnose and is often missed by parents altogether. There may be sore throat and little else (Scarlatina sine eruptione) or only a slight peeling subsequently (Scarlatina latens). The disease as we see it now (Scarlatina simplex) is gradually through generations becoming attenuated, and usually is not serious, but I remember in the 70's, 80's and 90's when whole families of children would be wiped out with (Scarlatina maligna) a horribly septic form, obvious on the 3rd day and fatal in the 5th, 6th or 7th, the little patients becoming dried up with toxœmia. We need to be much more active to the necessity for prophylactic measures, as soon as infectious disease is suspected, cover the patient with eucalyptus Vaseline (1 in 8), take swabbing of the throat; and isolate at once, avoiding personal contact. I imagine it will take quite three more generations before scarlet fever will be regarded as unimportant. What is serious at the moment is the increased number of mastoid abcesses due to the streptococcus germ in the discharging ears penetrating 64 the bone at the back of the ear, requiring operation by skilled aural surgeons. Unfortunately, hardly known before, mastoid inflammation is occurring frequently with measles now. With regard to diphtheria we have not had many cases during 1935 in epidemic form to cause anxiety. There were 5 fatal cases. We may hope to have fewer in the future as you have sanctioned immunisation—providing the injection and paying the doctor's fees for those who are eligible. All I would stress here is that wise parents will call in doctors and have a swab taken of the pharynx on the 1st or 2nd day at latest of any acute sore throat—be on the safe side, and have the injection in the early stage of the disease. DIPHTHERIA IMMUNISATION. Last year you inaugurated a scheme for the immunisation against Diphtheria which is being widely accepted. It was arranged with the approval of the local branch of the British Medical Association, and assured to the doctor his fee for attendance and the toxoid ; the service being free of charge to the patient. It is hoped that gradually large numbers of the children of the district will be rendered immune to diphtheria . The beneficiaries, it is understood, should be within the National Health Insurance Scale. TABLE SHOWING MONTHLY INCIDENCE OF SCARLET FEVER AND DIPHTHERIA DUING THE YEAR 1935. Scarlet Fever Diphtheria January 37 14 February 24 13 March 34 10 April 17 5 May 27 15 June 25 7 July 16 6 August 11 4 September 16 5 October 19 7 November 37 1 December 29 8 Total 292 95 65 GENERAL. Supply of Anti-toxin. The Council supply free of charge to any practitioner for the use in this district, Diphtheria Anti-toxin, Tetanus Anti-toxin, Anti-Streptococcus 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 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 4466. After Office hours Communicate with Acton or during week- Isolation Hospital: ACOrn ends 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 4472. 66 DISINFECTION OF PREMISES AND ARTICLES. During the year 611 disinfections were carried out after:— Notifiable Infectious Diseases 534 Cancer 24 Miscellaneous 44 Vermin 9 Number ok Articles Disinfected or Destroyed. Disinfected. Destroyed. Beds 121 9 Bolsters 317 6 Blankets 1221 9 Counterpanes 278 9 Covers 5 — Cushions 50 6 Mattresses 590 27 Palliasses 1 2 Pillows 1159 20 Rugs and Mats 23 — Sheets 663 14 Wearing Apparel 220 7 Carpets 3 — Sundries 84 8 Total 4735 117 CANCER. Last year, 1935, there were 96 deaths from this disease in the district, 52 men, 44 women. In 1934 there were 91 deaths, 54 men, 37 women. Taking the average for the last five years the rate per 1,000 of population is 1.01, a figure which compares favourably with that for England and Wales. One may be 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 a matter of concern and its true nature ascertained at once. The presence of an unusual discharge, especially of an offensive nature, should be rectified. No one should be satisfied with anything less, and if necessary should see a doctor many times to be assured of their 67 tion. It may be stated with assurance that all superficial cancers are curable in the early stages, and many, in deeper structures. The folly of trifling with nostrums and quacks until the case is inoperable need only to be mentioned to be condemned. At the invitation of the British Empire Cancer Campaign I have given numerous short addresses to Women's Institutes and Co-operative Societies round this part of Middlesex, and have been astonished at the keenness and desire for further knowledge displayed by the members of those Societies. There is no doubt of the value of the research work of the British Empire Cancer Campaign in co-ordinating the details of the fight against cancer all over the world— preventing 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. We are all impatient to hear of success with human cases—it may be near or still a few years distant. In the meantime every encouragement should be given to those devoting their lives to this beneficent work. It is known now, from the investigations of the Ministry of Health, that cancer is not in the ordinary sense infectious or contagious, is not necessarily incidental to middle life, is not produced by diet per se—but can be induced by all forms of chronic irritation, such as septic jagged teeth, hot clay pipe, chronic sores, warts, discharges, constipation, etc. It is not believed that one county or locality is more affected than another. OPHTHALMIA NEONATORUM. Eight cases of Ophthalmia Neonatorum were notified during the year. A summary of cases, with the result of treatment, is given in the following table:— No. of cases notified No. Treated Vision unimpaired Vision impaired Under Treatment end of year Removed from District at Home in Hospital 8 5 3 6 — 1 1 68 69 TUBERCULOSIS. New Cases and Mortality during 1935. Age Periods. New Cases. Deaths. Pulmonary. N on- Pulmonary. Pulmonary. Non-Pulmonary. M. F. M. F. M. F. M. F. Under 1 year — — — - — — - - 1 to 5 years — — 1 - 1 — 2 - 5 to 15 years 4 1 4 2 — - - 1 15 to 25 years 8 18 3 - 5 4 2 - 25 to 35 Years 17 15 — 1 7 8 - 2 35 to 45 years 10 10 1 1 7 3 - 1 15 to 55 years 7 4 1 1 5 3 1 - 55 to 65 years 3 1 — - - 1 - 1 55 years and over - - — - — 1 - 1 Totals 49 49 10 5 25 20 5 6 56 deaths from Tuberculosis were registered during the year. 14 cases were not notified as suffering from Tuberculosis during life (25 per cent.). The Death Rate from Tuberculosis for the year 1935 was .56 per 1,000 population. 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 1935. At the end of 1935 there were 348 cases of tuberculosis on the register. Of these 302 were pulmonary and 46 nonpulmonary. There were 113 new cases notified as occurring in the district in 1935, and in addition 67 transfers from other districts, 2 cases were restored to the register, making 182 new cases in 1935. 78 Patients died. 86 were alleged to have recovered. 109 were admitted to sanatoria or hospitals. 84 were discharged from sanatoria or hospitals. In some cases the patients were not sleeping in a separate bed and not in a separate room. In 13 cases it was found that a past history of tuberculosis existed in the family. Tuberculosis, in an acute or chronic form, is said to be gradually lessening in frequency. The procedure at the moment is that the medical practitioner, whether resident or non-resident, notifies the case as suffering from tuberculosis in some form and at varying stages of the complaint. This notification is at once sent to the Tuberculosis Officer. The patient is examined and advised, and in due course sent to a sanatorium if such treatment is considered desirable. We, as a Council primarily concerned, receive what is called an environmental form a few days after the notification, and we learn the conditions of the home, etc. If the patient is not occupying a separate room or bed we call to know the reason, and advise. We supply sanitary handkerchiefs, sputum pots, advise as to shelters, etc. The Middlesex County Council reports show that regular inspections of cowsheds are made as often as four times a year—that last year no cows in the Wembley area were found to be tuberculous, and we know that a very careful and regular testing of the milk of the district is undertaken. We ourselves being responsible for the examination of the graded milks. 70 We should be glad to have more regular and definite information of patients from this district entering sanatoria —how long they have to wait for admission—whether the provision of accommodation is keeping pace with the enormous increase in population. NON-NOTIFIABLE INFECTIOUS DISEASE. Measles, Whooping Cough, and Chicken-pox are always very prevalent in the schools of the district in the springtime. We do not pretend to have much control. The Head Teachers send us lists of those children suffering from these complaints, every week, and exclude from the schools those of the family who have so far not suffered from them. 71 SECTION G. General. 73 EUGENICS. For many years I sat on the Council of the Eugenics Society and have always advocated eugenic measures— indeed these may be regarded as the motive power of my actions in the cause of public health. In these I may claim to have had the full support of my Councillors in keeping abreast with modern methods and improvements. Eugenics, the science of well-being, of good living, has been prominently before the public for many years, yet it cannot be said to be well understood and practised. When one notes the care men take in their breeding of cattle, horses, dogs, poultry, one is amazed how neglectful they are of the human race! The time is overdue when, instead of wasting huge sums on educating people who are incapable of assimilating the higher grades of instruction, we should spend far more on physical culture. Every encouragement should be given by prizes, patronage and subsidy to scientific training, and to keep in close touch with youth till the age of 25. The exercise in sports, however good in their way, does not necessarily develop special groups of muscles to enable competitors to hold their own among the nations. Parallel with this is the consideration that there is a very serious loss to the services of the nation by the exclusion of able, well-conducted youths of splendid physique who, by no means ignorant of affairs, could never sit for, or pass any examination test of the matriculation standard. This is a plea for the recognition of marked intelligence combined with physical fitness. So many youths are late developers mentally. NUMBER OF MEDICAL PRACTITIONERS. There are now 56 qualified resident medical practitioners in the district, and about 30 from other districts who treat patients. BIRTH CONTROL. In my last Annual Report I foreshadowed the establishment of a Birth Control Clinic. By the time this report is issued this Clinic will be in being. It will be established because it is realised that many residents need this assistance and advice. Only last week two typical cases came to our notice among probably a score of others in the district. These had already eight or more children—husband out of work—none robust. The advice is needed for those who have already borne children of low mentality, who are con- 74 sumptive or suffer from chronic heart or kidney disease. It is needed by those who are married to diseased, alcoholic husbands, etc. This Clinic will not sanction advice to the strong and healthy; will certainly discourage contraceptive methods for those who should bear healthy children. One of the chief advantages is that mothers can "space" their families. I believe that every strong, sound couple should be willing to have three or four children. We have been fortunate in obtaining the services of Dr. Evelyn Fisher, the Chief Medical Officer to Dr. Marie Stopes' Centre, to conduct this Clinic. The session will be held every fortnight on premises close to Wembley Park Station. GYNÆCOLOGICAL CLINIC. This Clinic will be held also once a fortnight and is intended to benefit especially neglected poor, middle-aged women who cannot afford to see a doctor. It is hoped, at this Clinic, to discover the early stages of cancer, and to treat or advise for numerous complaints peculiar to women; also to avoid the necessity for poor women to toil up to the London hospitals. Patients who are not poor will, after examination, be referred to their own doctors. When once known, this Centre will be much appreciated. Dr. Elizabeth Harvey, who is very experienced in this branch of the work, will conduct the Clinic as Medical Officer. CONCLUSION. In June I shall have completed forty-one years' service as the Medical Officer to the Wembley Urban District Council, and this is my last report. I had hoped to have remained on till the district became a borough, and we had entered the new Town Hall, but I realised recently that, with the increased population and work, it was my duty to retire. After the happy relationship with the members of the Council for so many years I take leave with profound regret ! I must, however, take this opportunity of expressing my gratitude to my own very efficient and energetic staff, coupled with the names of the Chief Sanitary Inspector, Mr. Robert Turner, and the Chief Clerk, Mr. Harold Ryan. I am, Mr. Chairman, Miss Howse, and Gentlemen, Your obedient Servant, CHARLES E. GODDARD. Medical Officer of Health. 75 INDEX. Abatement of Overcrowding 48, 49, 50, 51, 52 Acts—adoptive in force 20, 21 Ambulance Facilities 21, 22 Ante-Natal Clinics 23, 28 Anti-toxin 66 Area 8 Articles disinfected 67 Birth Control 74, Births 10, 12, 13, 27 Byelaws in force 20, 21 Cancer 67, 68 Causes of Death 17 Children Acts, 1908-1932 31 Children—hospital accommodation for 25 Cisterns—covering of 36 Clinic and Treatment Centres 23 Closet Accommodation 37 Common Lodging Houses 38 Comparative Vital Statistics 18 Conclusion 75 Consultant 30 Contraventions Remedied 40 Convalescent Home Treatment 30 Cowsheds 57 Dairies and Milk Shops 57 Deaths 10, 14,15, 17 Defects remedied 39, 40 Dental Clinics 23, 29 Dentures 29 Diphtheria Immunisation 65 Disinfection of Premises and Articles 67 Drainage and Sewerage 36 Dwelling Houses Inspected 53 Empire Pool 45 Eugenics 74 Factories 41, 42 Fat Extraction 43 Fish Frying 43 Food Adulteration 59 Food Examination 59 Food Exposure 59 Food Handling 59 Food, Relation of, to Health 59, 60 Foster Children 31 Foster Parents 31 76 Gynæcological Clinic 75 Gypsies 38 Health Visitors 4, 30 Houses let in Lodgings 38 Houses—No. of inhabited 8 Housing Defects remedied 53 Housing Statistics 52 Immunisation against Diphtheria 65 Infant Life Protection 31 Infant Welfare Clinics 23, 28 Infantile Mortality 10, 11 Infectious Disease—table of incidence 62 Infections Disease—table showing ward incidence 63 Infectious Disease—Notes on 64 Inspection of Dwelling Houses 53 Inspection of other Foods 57 Institutional provision for Unmarried Mothers 29 Isolation Hospital 23, 24 Laboratory Facilities 21 Local Government and Other Officers' Superannuation Act 25 Marriages 18 Massage Treatment 23, 31 Maternal Mortality 10, 12 Maternity Accommodation 24 Maternity Homes 26 Maternity Outfits 31 Meat and Other Foods 57 Medical Practitioners 74 Midwifery Assistance 30 Widwives—List of 26, 27 Milk 56 Milk Grants 27 Milk Licences 56 Milkshops 57 Mortuary 44 National Maternity Service Scheme 25 Non-notifiable Infectious Disease 71 Nuisances abated 39, 40 Nursing in the Home 22 Offensive Trades 43 Ophthalmia Neonatorum 68 Orthopaedic Treatment 23, 31 Outworkers 41, 42 Piggeries 38 Population 8 77 Premises and Occupations subject to control by the Local Authority 38 Prevention of Overcrowding 48, 49, 50, 51, 52 Public Cleansing 37 Public Conveniences 44 Rag Flock 44 Rainfall 9 Rateable Value 8 Rats—destruction of 44 Regulations in force 20, 21 Rivers and Streams 36 Sanitary Circumstances of the Area 33 Sanitary Inspection of the District 38, 39 Schools 45 Sewerage and Drainage 36 Shops Act, 1934 42, 43 Slaughterhouses 57 Smallpox 24 Smoke Abatement 43, 44 Social Conditions 9 Stables and Piggeries 36 Staff 4 Statistics—General 8 Statistics—Vital 10 Still Births 10 Streams 36 Sunlight Treatment 23, 31 Swimming Baths 45 Tents, Vans and Sheds 38 Treatment Centres 23 Tuberculosis 23, 70, 71 Tuberculosis—new cases and mortality 69 Unemployment 9 Unmarried Mothers—Institutional provision for 20 Unsound Food surrendered 58 Vale Farm Swimming Bath 45 Visits made by Health Visitors 30 Vital Statistics 10, 16, 18 Voluntary Helpers 29 Water 34 Wembley Hospital 23, 24 Workplaces 41, 42 Workshops 41, 42 78